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Early intervention and relationships

PART 1: Questioning the effectiveness of our approaches…

Early intervention is defined as therapeutic services provided to children with developmental difficulties from birth to six years of age (Law et al., 2011). Within this, it is considered common practice for allied health practitioners to conduct activities directly with the child themselves to support both child development and participation in everyday activities (Case-Smith, Frolek, & Schlabach, 2013; Law et al., 2011). The effectiveness of these developmentally-orientated early interventions has been questioned in the literature (Atkins-Burnett & Allen-Meares, 2000; Case-Smith et al., 2013; Karaasalan, Diken, & Mahoney, 2011; Innocenti, Roggman, & Cook, 2013). It has been suggested that the effectiveness of early intervention for children with developmental delays is not related to the amount or intensity of services received but to the ability of the parents to read their child’s cues and respond sensitively (Innocenti et al., 2013; Mahoney & Nam, 2009). Furthermore, there have been a number of calls for practitioners to include a relational-focus as a core component of the interventions provided (Atkins-Burnett & Allen-Meares, 2000; Karaasalan et al., 2011; Innocenti et al., 2013).

It is widely understood that parents are the most important people in a young child’s life (Guralnick, 2011; Hadders-Algra, 2011; Mares, Newman, & Warren, 2009), with recognition that parenting has a significant impact on child developmental outcomes (Innocenti et al., 2013; Parkes et al., 2011; 2013; van Zeijl et al., 2006; Zeanah & Zeanah; 2009). Infant brain research has demonstrated that child development is underpinned by gene-environment interactions (Center on the Developing Child at Harvard University; 2007; Fonagy, 2002). Alongside gene expression, the child’s early relationship-based interactions are integral to the development of optimal brain architecture. In particular, parenting behaviours that include warmth, positive affect and tone, attentiveness to the child’s cues and interests, and extending the child’s skills are linked with more positive developmental outcomes (Spiker, Boyce, & Boyce, 2002).

Consistent with this, the national guidelines for best practice in Australia (Early Childhood Intervention Australia, 2016) has recommended early intervention practitioners focus on parent responsiveness and strengthening parent-child relationships. Furthermore, a recent Australian study indicated that early intervention practitioners perceived the parent-child relationship as being an essential consideration in their work (Alexander et al., 2018). However, less than half of the participants felt comfortable targeting parent-child interactions in their interventions. The authors of this study concluded that supporting parent-child relationships needs to be a part of early childhood interventions; however, they noted that there is a need to support allied health practitioners to build their knowledge, skills, and confidence in this area.

Taken from: Jacqui Barfoot, PhD Thesis “Early childhood interventions for children with developmental delays, including cerebral palsy: Adopting a relationship focus.” Submitted 2019.