Intervention

1. Intervention Daniel Messinger Messinger

2. Intervention questions • Describe the results of the Linda Ray intervention. Describe the IHDP project and its major results at 3, 5, and 8 years. What is the animal model for early intervention? Describe the major results of the Abecedarian project. How do these results relate to those of the rat study? Argue for whether you think early intervention works, how long it works, and for whom it works? Should society devote resources to early intervention or later intervention? What did Yoder and Stone find? Explain how this is a moderated effect. What other autism intervention shows a moderated effect? Messinger

3. Early Head Start Effects Messinger

4. The Effects of Universal Pre-K on Cognitive Development Gormley Jr., Gayer, Phillips,& Dawson Developmental Psychology 2005, Vol. 41, No. 6, 872–884 Messinger

5. Linda Ray Intervention Center: 3 levels of intervention • Claussen, A. H., Scott, K. G., Mundy, P. C., & Lynne F. Katz. (2004). Effects of three levels of early intervention services on children prenatally exposed to cocaine. Journal of Early Intervention, 26(3), 204-220. Messinger

6. Moderate to large intervention effects Center Advantage Messinger

7. Where should intervention take place? Center vs. Home Center vs. Primary Home vs. Primary Bayley MDI .28 .73 .42 Expressive .82 .92 .06 Receptive .53 .62 .13 Fine Motor .12 .09 .04 Gross Motor .23 .82 .51 Effect Sizes • Cognition, receptive and expressive language, gross motor development • some small effects for behavior problems. Messinger

8. It’s an ongoing problem • 1.5 million children in Central and Eastern Europe live in public care. • Children who have been abandoned, parents have died, live in hospitals because of a chronic illness • Quality of care can be poor in these institutions • Exceed 15:1 ration • Poorly trained caregivers who are uncommitted to the child’s welfare (insensitive, unresponsive) • Exposure to mature language is lacking. • Basic sensory deprivation lacking (not held or or touched) • Strict adherence to conformity Romero

9. Effects on Development • Adopted children did better across domains than institutionalized children. • Children who spent more than 8 months in Romanian institutions had more behavior problems, disturbances of attachment, and lower IQs. • Bucharest Early Intervention Project (BEIP): -3 cohorts -Findings: -Institutional care has negative effect on physical growth, language, cognitive, social-emotional development, and brain development. -Children placed in foster care improved in many of the domains . Romero

10. Effects on Brain Development • Adopted children from institutions suffered from mild neurocognitive impairments, impulsivity, attention, and social deficits. • Institutionalized children had fewer white matter connectivity leading to less connectivity between brain regions. • Normal range of IQ (although verbal IQ was lower than performance IQ) in institutionalized children. • Less cortical brain activity in institutionalized children compared to never institutionalized children. • Institutions are low on environment-expectant environment which is necessary for brain development. Romero

11. Valid conclusion? • “It is in contrast to severe deprivation that enrichment shows its statistically significant effects.” • Gottlieb & Blair, 2004 Messinger

12. Gottlieb & Blair 2004 • Rodent research indicates that enriched early experiences avert the deterioration of learning ability seen when rodents are reared in impoverished conditions • It is only in comparison to impoverished conditions that enrichment shows an influence • Exposure to enriched conditions after exposure to impoverished conditions does not matter Bell

13. Early visual experience & exploration! • From about 27 days of age to 100 days of age: • a stovepipe cage (little motor or visual experience), • an enclosed running wheel (motor activity but little variation in visual experience), • a mesh cage that restricted motor activity but considerable variation in visual experience as it was moved daily to different locations in the laboratory. • (4) large free environment box – socially and physically stimulating Messinger

14. Its early experience that’s important Table 2. Mean Errors in Hebb-Williams Maze of Rats With Different Early and Late Environmental Experiences Note. Data from Hymovitch (1952). The Stovepipe/Free Environment and Normal Cage groups made significant more errors than the other two groups (p <.001). Bell

15. Abecedarian project:2 intervention components • Birth – 5 years: “comprehensive educational daycare intervention” • “utilized developmentally appropriate curricula designed to facilitate children’s language, motor, social, and cognitive growth. • Full-day care, 50-weeks per year, 93% enrolled by 3 months • 5 – 8: “school age intervention delivered through home visitors, liaisons between home and school. • designed to increase parent involvement in the educational process Messinger

16. Yield 4 intervention conditions • Early daycare intervention (birth – 5) with follow through services to 8 years • Only the educational daycare intervention • Only the school age follow through • An untreated control group. Messinger

17. Early intervention counts! Messinger

18. Messinger

19. Real life: % retained in grade Messinger

20. IHDP • 3-year intervention: • home visits, child development center services, parent group meetings. • Randomized controlled trial of premature infants • (< or = 37 weeks' gestation): 2 LBW groups (lighter [< or = 2000 g] and heavier [2001-2500 g]) • intervention (n=377) and follow-up only (n=608). • McCarton, C. M., Brooks-Gunn, J., et al. (1997). Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program. JAMA, 277(2), 126-232. Messinger

21. 3 Year effects Messinger

22. Age 3 effects visible only in heavier group at age 8 • At 8 years, in the entire cohort and in the lighter LBW, groups were similar on all outcome measures. • Differences favoring the intervention group were found within the heavier LBW group: • full-scale IQ score (4.4 points, P=.007), verbal IQ score (4.2 points, P=.01), performance IQ score (3.9 points, P=.02), mathematics achievement score (4.8 points, P=.04), and receptive vocabulary score (6.7 points, P=.001). • But ‘attenuation of the large favorable effects seen at 3 years was observed in both the heavier and lighter LBW groups.’ Messinger

23. Dose-response effects • At age 8, effects on the Wechsler Intelligence Scale for Children Full and Verbal scales for children who attended > 400 days ranged from 7 to 10 points. • Heavier LBW infants (2,001–2,500 g), 14 points • lighter LBW infants (< 2,000 g), 8 points. • These effects were all substantially higher than corresponding Intent-to-Treat effects. • Similar, smaller effects for children attending 350 days. • Hill, J. L., Brooks-Gunn, J., & Waldfogel, J. (2003). Sustained Effects of High Participation in an Early Intervention for Low-Birth-Weight Premature Infants. Developmental Psychology, 39(4), 730–744. Messinger

24. Days of Treatment Messinger Hill, J. L., Brooks-Gunn, J., & Waldfogel, J. (2003). Sustained Effects of High Participation in an Early Intervention for Low-Birth-Weight Premature Infants. Developmental Psychology, 39(4), 730–744.

25. 18 Year effects! • INTERVENTIONgroup effects on math (Woodcock-Johnson Tests of Achievement5.1 points), risky behaviors (YRBSS, –0.7 points), and vocabulary (PPVT-III, 3.8 points) in the HLBW youth. • Results adjusted for cohort attrition. Assessed 636 youths at 18 years (64.6% of the 985,72% of whom had not died or refused at prior assessments). • Why no observable benefit in the LLBW group? • McCormick, Marie C., Brooks-Gunn, Jeanne, Buka, Stephen L., Goldman, Julie, Yu, Jennifer, Salganik, Mikhail, Scott, David T., Bennett, Forrest C., Kay, Libby L., Bernbaum, Judy C., Bauer, Charles R., Martin, Camilia, Woods, Elizabeth R., Martin, Anne, Casey, Patrick H. Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development ProgramPediatrics 2006 117: 771-780 (doi:10.1542/peds.2005-1316) Messinger

26. Argument • IHDP failed to produce any enduring and meaningful effect on cognitive development? • 2 primary reasons for this unsuccessful outcome are failures to consider genetic influences and to individualize intervention • Early generic educational intervention has no enduring effect on intelligence and does not prevent mental retardation: IHDP. Baumeister & Bacharach (2000). Intelligence, 28(3), 161-192. • What is the take home message? Messinger

27. Does intervention work? • Did IHDP work? • Does inoculation model work? • What kind of intervention works? Messinger

28. Effects for some • Change in cognitive function over time in very low-birth-weight infants • Early intervention led to greater increases over time in PPVT-R scores among children whose mothers had less than a high school education compared with those with a high school education level or greater (interaction). • WHY? • (Ment et al, 2003, JAMA, 289, 705-711) Messinger

29. Randomized Comparison of Two Communication Interventions forPreschoolers With Autism Spectrum Disorders Responsive Education and Prelinguistic Milieu Teaching [RPMT] VS. Picture Exchange Communication System [PECS] • Each: 3 times per week, in 20-min sessions, for 6 months. • 36 preschoolers with autism spectrum disorders. • RPMT facilitated the frequency of generalized turn taking and generalized initiating joint attention more than did the PECS. • But only for children who began treatment with some initiating joint attention. • PECS facilitated generalized requests more than the RPMT in children with very little initiating joint attention prior to treatment. • Effect sizes were large. • Paul Yoder and Wendy L. Stone. Journal of Consulting and Clinical Psychology 2006, Vol. 74, No. 3, 426–435 Messinger

30. Results • Initiating joint attention grew in both treatements  • RPMT superior to PECS  • PECS superior to the RPMT • Interactions   Strengths •  Random assignment • High fidelity  • Ecologically valid measures Fernanandez

31. Overall Change in Frequency of Intentional Communication Acts Messinger

32. Pretreatment x Type of treatment Messinger

33. ASD Interventions • Landa et al. • http://www.webmd.com/brain/autism/news/20101207/early-intervention-improves-autism-symptoms\ • Denver Early Start • Carter et. al • A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders Messinger

34. Child Effects Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Dawson, Rogers, et al., 2009 www.psy.miami.edu/faculty/dmessinger

35. Rogers • JACAAP • No child effects for ESDM with parent as interventionist Messinger

36. A RandomizedClinical Trial ofHanen’s More Than Words Alice S. Carter University of Massachusetts Boston Wendy Stone & Paul Yoder Vanderbilt University Daniel Messinger University of Miami

37. Intervention effects for low functioning children with ASD www.psy.miami.edu/faculty/dmessinger Child effects moderated by low level Time 1 object interest

38. Parenting Effects? dmessinger@miami.edu

39. Additional readings • Messinger, D., Dolcourt, J., King, J., Bodnar, A., & Beck, D. (1996). The survival and developmental outcome of extremely low birthweight infants. Infant Mental Health Journal, 17(4), 375-385. • Hollomon, H.A. Dobbins, D. R., & Skott, K.G. (1998). The effects of biological and social risk factors on special education placement: Birth weight and maternal education as an example. Research in Developmental Disabilities, 19(3), 281-294. • Infant Health and Development Project (1990). Enhancing the outcomes of low-birth-weight, premature infants: A multisite, randomized trial. Journal of the American Medical Association, 263(22), 3035-3042. • Brooks-Gunn, J., McCarton, C., McCormick, M. C., & Klebanov, P. K. (1998). The contribution of neighborhood and family income to developmental test scores over the first three years of life. Child Development, 69(5), 1420-1436. • Vohr, B. R., Wright, L. L., Dusick, A. M., Mele, L., Verter, J., Steichen, J. J., Simon, N. P., Wilson, D. C., Broyles, S., Bauer, C. R., Delaney-Black, V., Yolton, K. A., Fleisher, B. E., Papile, L.-A., & Kaplan, M. D. (2000). Neurodevelopmental and Functional Outcomes of Extremely Low Birth Weight Infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics, 105(6), 1216-1226. • Susan Landry, Developmental Psychology. • Zeanah, C. on developmental risk. J am acad child and adol psychiatry '97 362. Messinger