http://people.uncw.edu/caropresoe/EDN500/500Fall06/EarlyChildoodDevelopPrg_LR.pdf

The effectiveness of early childhood development programs. A systematic review.

Background Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant’s environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants. Methods MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies. Results Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress ( Z = 0.40, p = 0.69) and sensitivity/responsiveness ( Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety ( Z = 2.54, p = 0.01), depressive symptoms ( Z = 4.04, p Z = 2.05, p = 0.04). Conclusions Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. Implications of key findings Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.

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Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis

It Takes a Village, and Other Lessons Children Teach Us

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother-infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother-infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n=26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months' corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother-infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers' posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother-infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother-infant interactions.

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: the case of preterm birth.

In this article, the author presents a framework for establishing an agenda to design or strengthen early intervention systems from an international perspective. Given the extraordinary diversity of potential factors that can influence early intervention around the world, a set of early intervention principles is put forward that appears to have achieved international consensus. The framework utilizes these generally accepted principles to derive agenda items and therefore forms the basis for establishing common ground across international communities. Examples of specific agenda items and possible barriers are discussed for each of the principles.

International Perspectives on Early Intervention: A Search for Common Ground.

Recognition of the importance of brain development in the early years of life has led to expanded early intervention programs for very young children with or at risk for developmental disabilities throughout the world. Recent developmental brain research suggests a plausible biological basis for early intervention. However, specific intervention practices must be judged on their efficacy, effectiveness, and cost justification. Early intervention has made important shifts in emphasizing social competence in the child and the essential role of the family and community.

James A. Blackman

Papers

Early Intervention: A Global Perspective.