Early intervention for developmental delay in young children: what the evidence shows

Early intervention programs aim to support young children who may be at risk for developmental delays. These programs often focus on improving motor skills, cognitive abilities, and overall functional outcomes. Research helps us understand how effective these interventions can be, especially for children born prematurely or those at high risk for conditions like cerebral palsy.

It is important to remember that research on high-risk infants does not apply to every child who might be a late walker or talker. Each child develops at their own pace, and a licensed healthcare professional can assess your child's specific situation.

Early Intervention for Preterm Infants

Infants born prematurely (before 37 weeks of pregnancy) face a higher risk of developing difficulties with thinking skills (cognitive impairment) and movement (motor impairment) compared to infants born at full term [1]. Early developmental interventions are sometimes offered after these infants leave the hospital to help improve their overall function [1].

A large review of studies, known as a Cochrane review, examined how effective these early developmental intervention programs are for preterm infants [1]. The review included 25 studies with a total of 3615 participants [1]. The studies looked at interventions that started within the first 12 months of life and included a component after hospital discharge [1].

Study Design and Limitations

The Cochrane review aimed to compare early developmental intervention programs to standard medical follow-up for preterm infants [1]. Researchers looked at outcomes at different ages: infancy (under three years), preschool age (three to under five years), school age (five to under 18 years), and adulthood (18 years and older) [1]. They also explored how factors like gestational age, birth weight, and brain injury might affect outcomes [1].

The studies included in the review varied in their focus, intensity, characteristics of the participants, and how long they followed the children [1]. Only 12 of the 25 studies were randomized controlled trials with appropriate methods to hide how participants were assigned to groups [1]. This variability made it challenging to compare different intervention programs directly [1].

Cognitive Outcomes

The review found that early developmental interventions had a positive effect on cognitive outcomes for preterm infants at certain ages [1].

• Infancy (zero to under three years): Interventions improved cognitive outcomes during infancy [1]. A meta-analysis of 16 studies with 2372 participants showed an improvement in developmental quotient (DQ) [1]. This improvement was a standardized mean difference (SMD) of 0.32 standard deviations (SDs) [1].
• Preschool age (three to under five years): Cognitive benefits continued into preschool age [1]. A meta-analysis of eight studies with 1436 participants found an improvement in intelligence quotient (IQ) [1]. This improvement was an SMD of 0.43 SDs [1].
• School age (five to under 18 years): The positive effect on cognitive outcomes did not continue into school age [1]. For school-aged children, five studies with 1372 participants showed that the effect on IQ was not sustained [1]. The authors noted significant differences between studies for cognitive outcomes at both infancy and school age [1].

Motor Outcomes

For motor outcomes, the review found a small, significant effect in favour of early developmental interventions during infancy only [1].

• Infancy (zero to under three years): A meta-analysis of 12 studies with 1895 participants showed a small improvement in motor scale DQ [1]. This effect was an SMD of 0.10 SDs [1].
• Preschool and School age: There was little evidence of a positive effect on motor outcomes in the long term [1]. Only five studies reported motor outcomes at preschool age (three studies) or school age (two studies) [1].
• Cerebral Palsy Rate: The review found no effect of early developmental interventions on the rate of cerebral palsy among survivors [1]. Seven studies with 985 participants showed a risk ratio of 0.82, indicating no significant difference [1].

Authors' Conclusions on Preterm Interventions

The authors of the Cochrane review concluded that early intervention programs for preterm infants can positively influence cognitive and motor outcomes during infancy [1]. The cognitive benefits were found to last into preschool age [1]. However, the wide variety of intervention programs and gestational ages of the infants in the studies led to significant differences between studies [1]. More research is needed to determine which early developmental interventions are most effective and to understand their longer-term effects [1].

Early Intervention for Cerebral Palsy

Cerebral palsy (CP) is the most common physical disability in childhood [2, 3]. It affects about 1 in 500 live births [3]. Early intervention for children under two years old who have CP or are at high risk for it is very important [2].

Early and Accurate Diagnosis of Cerebral Palsy

Historically, a diagnosis of cerebral palsy was often made between 12 and 24 months of age [3]. However, current evidence shows that a diagnosis can be made before 6 months of corrected age [3]. Early diagnosis is crucial because it allows for prompt referral to specific early interventions [3]. These interventions can help optimize a baby's brain and motor development, prevent secondary complications, and support caregivers [3].

Clinical signs and symptoms of cerebral palsy develop and change before a child turns two years old [3]. Because of this, healthcare professionals should use a combination of standardized tools along with a child's medical history to predict risk [3].

Specific tools can help detect the risk of cerebral palsy at different ages:

• Before 5 months' corrected age:
  • Term-age magnetic resonance imaging (MRI): This imaging technique has a sensitivity of 86% to 89% for detecting risk [3].
  • Prechtl Qualitative Assessment of General Movements: This assessment has a high sensitivity of 98% [3].
  • Hammersmith Infant Neurological Examination: This examination has a sensitivity of 90% [3].
• After 5 months' corrected age:
  • Magnetic resonance imaging (MRI): If safe and possible, MRI still has a sensitivity of 86% to 89% [3].
  • Hammersmith Infant Neurological Examination: This examination continues to be predictive with a sensitivity of 90% [3].
  • Developmental Assessment of Young Children: This assessment has an 83% C index for detecting risk [3].

While these tools are good at predicting risk, determining the specific type and severity of cerebral palsy can be more challenging in infancy [3]. MRI and the Hammersmith Infant Neurological Examination can help with these clinical decisions [3].

In high-income countries, statistics show that about 2 out of 3 individuals with cerebral palsy will learn to walk, 3 out of 4 will learn to talk, and 1 out of 2 will have typical intelligence [3].

Early Intervention Guidelines for Children at High Risk of Cerebral Palsy

An international clinical practice guideline provides recommendations for early intervention for children aged 0 to 2 years who are at high risk of cerebral palsy or have a diagnosis of CP [2]. The guideline was developed through a systematic review of 16 systematic reviews and 27 randomized clinical trials [2].

The guideline emphasizes that when a child meets the criteria for high risk of CP, intervention should begin as soon as possible [2]. Parents often want an early diagnosis and treatment, and they support starting interventions quickly [2]. Early intervention is important because it takes advantage of a critical time for the brain's ability to change and adapt (plasticity) in developing systems [2].

The guideline supports three best-practice principles: 1. Immediate referral for intervention after a diagnosis of high risk of CP [2]. 2. Building parental capacity for attachment [2]. 3. Parental goal-setting at the start of the intervention [2].

The guideline offers 28 specific recommendations (24 for and 4 against) across nine different areas of development and support: * Motor function: 4 recommendations [2]. * Cognitive skills: 2 recommendations [2]. * Communication: 7 recommendations [2]. * Eating and drinking: 2 recommendations [2]. * Vision: 4 recommendations [2]. * Sleep: 7 recommendations [2]. * Managing muscle tone: 1 recommendation [2]. * Musculoskeletal health: 2 recommendations [2]. * Parental support: 5 recommendations [2].

Referrals for intervention across these nine areas should be specific, following the recommendations in this guideline [2].

What this means for you

If you have concerns about your child's development, speaking with a healthcare professional is a good first step. They can help determine if your child might benefit from an assessment or early intervention.

For children born prematurely or those at high risk for conditions like cerebral palsy, early intervention programs may offer support for cognitive and motor development, especially during infancy and preschool years [1, 2]. While the benefits for cognitive skills may extend into preschool age, the long-term effects, particularly into school age, are less clear [1].

If a child is identified as being at high risk for cerebral palsy, an early and accurate diagnosis can help ensure they receive timely interventions [3]. Interventions for children aged 0 to 2 years who are at high risk of CP should start as soon as possible [2]. These interventions often involve a range of supports across different developmental areas, including motor function, cognitive skills, communication, and parental support [2].

A licensed occupational therapist can assess your child's motor skills, cognitive abilities, and daily living activities. They can also provide strategies and interventions to support your child's development. You can find more information about children's occupational therapy in the Greater Toronto Area or search for occupational therapy clinics in Calgary.

In Alberta, the Family Support for Children with Disabilities (FSCD) program works with eligible families to provide support and services based on each child and family’s needs [6]. This program aims to help parents support their child's healthy development, encourage participation in home and community activities, and assist with some of the extraordinary costs related to a child's disability [6]. You can learn more about eligibility and how to apply for the FSCD program on the Government of Alberta website [6].

Occupational therapists are registered by a provincial regulatory college, and that college is where a registration check belongs. In Alberta, that is the Alberta College of Occupational Therapists (ACOT) [4]; other provinces have their own. The Canadian Association of Occupational Therapists is a national professional organization rather than a regulator — it does not register occupational therapists, but it is a useful place to read about what the profession does [5].