Early intervention strategies with babies and toddlers born prenatally cocaine exposed: areas of focus and hope

1
Early intervention strategies with babies and
toddlers born prenatally cocaine exposed areas
of focus and hope

• Substance Exposed Newborns Collaborative
  Approaches to a Complex Issue
• June 23-24, 2010
• Lynne Katz, EDD
• University of Miami, Department of Psychology

2
Background

• Children who are prenatally exposed to cocaine
  are at-risk for cognitive, language, and
  behavioral delays (Lester, et al., 2000)
• Regardless of etiology, children who are
  prenatally exposed to cocaine are an at-risk
  population who are likely to benefit from early
  intervention services.

3
Background

• Most of the intervention research for
  substance-exposed children has focused on the
  impact of home-based programs (Black, et al.,
  1994)
• The University of Miamis Linda Ray Intervention
  Program was designed to examine the impact of
  three levels of intervention on developmental
  outcomes for children who are prenatally exposed
  to cocaine. Multiple cohorts of babies and
  toddlers have participated since 1991
• There is an 80 overlap between these children
  and the child welfare system

4
Developmental screenings are mandated for child
welfare linked children

• Child Abuse Prevention and Treatment Act (P.L.
  93-247)
• Families are at the table when the Individual
  Family Support Plan (0-3) and the Individual
  Education Plan (36 months ) are developed as
  part of the IDEA Part C and Part B entitlements
• Opportunities to discuss the childs special
  needs and to what degree the family embraces the
  concept of special needs and services are the
  first steps

5
Focus of interventions What families and the
Court can expect

• The literature tells us the prevailing areas of
  developmental delay continue to be related to
  speech and language and social-emotional
  development
• We will be using science to inform our
  interventions
• Families will be engaged in the process of
  intervention development from the start and
  knowledge transfer will be ongoing

6
Ages Stages Developmental Screenings in
Miami-Dade FL Children of Substance Abusing
Parents enrolled in Dependency Drug Court

• 200 screenings completed in 2007
• Children range from 04 months- 48 months
• 72-78 children showed delays as compared to the
  10-30 expected w/in general population

7
Comparison

• How did these children compare to a larger but
  similar sample?
• Linda Ray Intervention Center screened 200
  infants toddlers to compare with the DDC Court
  sample
• Areas of delay in both groups primarily
  social-emotional language development
• Delays become more evident approaching 24 months
  as impact of risk heightens during the expected
  burst of language

8
Cognitive Development Bailey MDI Scores
Linda Ray Infant Center Data as of 12-2-99, N329
9
Impact on the child, the family and multiple
systems Getting the buy-in

• Research informed intervention offers best chance
  for narrowing or ameliorating developmental
  delays prior to child entering kindergarten
• Opportunities to reduce the stressors related to
  parenting a child with special needs when
  intervention and parenting strategies are
  available to families in one-stop shopping format
  
• Increases chances that child will be ready for
  school
• Makes economic sense across systems of care

10
Target specific areas for intervention within the
domains

• Joint attention
• Gestures and early vocalizations
• Receptive and expressive language
• Early literacy exposure

11
Families learn their role in creating language
outcomes and the role of the interventionist

• Research suggests that caregivers that use more
  complex syntax, a richer vocabulary, and are
  responsive and sensitive to their childrens
  signals encourage the development of linguistic
  capabilities.
• These factors may be particularly influential for
  children at-risk for developmental delays where
  developmentally informed input at home may be
  lacking.

12
TechniquesEnhanced Milieu Training (EMT)

• EMT is intended for toddlers with a vocabulary of
  greater than 10 words.
• Relies on environmental arrangement, responsive
  interaction, and milieu teaching procedures to
  promote new language forms.
• Verbal prompts, expansions of utterances, and
  social consequences are used to increase language
  use.

13
EMT Intervention

• Intervention procedure
• Establishing a turn-taking routine with the
  child.
• Interrupting the routine so requesting behavior
  is a solution.
• Resuming routine when requesting behavior is used
  and verbally acknowledging/modeling the
  appropriate form of the communicative behavior.
• Behaviors and vocalizations become more complex
  throughout the intervention sessions.

14
Participants

• EMT study included
• children were identified as having the same
  primary caregiver from 18 to 36 months (both in
  home and at the Center)
• this primary caregiver was the same caregiver who
  participated in the 24-month interaction
• N 89 caregiver-child dyads
• Data collected at 36 months using the Reynell
  Developmental Language Scales

15
Method (continued)

• At 24 months, the dyads participated in a
  six-minute play interaction.
• Interactions were coded for variables examining
  caregiver speech, responsivity, and directiveness.

16
Results

• Lexical richness and adult responsivity were
  significantly associated with language outcome at
  36 months.
• Number of words and directiveness were not
  significantly associated with language
• Informs both discussions for the parenting
  programs and the work of the interventionist

17
Discussion

• Milieu training appears to be valuable to
  enhancing the pre-linguistic and linguistic
  abilities of substance-exposed children.
• This intervention allows the interventionist to
  work closely with the childs individual needs.
• Children are enthusiastic about the naturalistic
  interaction.

18
Results (continued)

• Findings indicated that only lexical richness,
  not directiveness, independently accounted for a
  significant amount of the variance in language
  outcome.

19
Conclusions

• These results have critical implications for both
  the understanding of language development in a
  high-risk population, as well as the development
  and implementation of interventions designed to
  impact the language outcome of young at-risk
  children.

20
Priming to enhance language

• Priming is an acoustic intervention that
  stimulates and exercises middle ear muscles when
  the individual is in a calm state with the goal
  of improving social engagement behaviors (e.g.,
  listening and eye contact).
• Previous research with the priming stimuli
  demonstrated improved communication in children
  with autism (S. Porges, University of Illinois at
  Chicago).

21

• Linda Ray Children participate in the listening
  intervention for 40 minutes daily for 1 week.
• Children listen to adapted Disney music via Mp3
  players and headphones created for young
  children.
• After the initial 1 week intervention, children
  listen to music for 10 minute boosters every day
  for 15 weeks.
• Embedded into practice when child turns 18 months
  (pre-empting the 24 months dip)

22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
Overall, our studies have shown that Priming is
effective in increasing the language and
cognitive ability of cocaine exposed children.

26
Curriculum components

• Language development curriculums and
  interventions i.e.Hanen Program Learning
  Language and Loving It
• Dependency System Process understanding

• Conscious Discipline (Bailey, 2005)
• Sensory Integration
• Attachment
• Parent-Child Relationship building

27
Food for thought

• What does early intervention in your state
  provide for the target group of babies and
  toddlers born prenatally exposed?
• For those children served, what does outcome data
  on children leaving Part C look like?
• What specific training components are offered to
  early interventionists about SEN population?
• Opportunities for cross-state collaborations
  exist