Programs to develop speech and cognitive skills in preschool children with Down's syndrome, cerebral palsy, fetal alcohol syndrome and other problems have flourished in recent years, partly because of increased federal funding.
Experts have long maintained that such children needed treatment in the first year of life to achieve the best speech, physical and cognitive development. But, until recently, little research had been done to confirm their observations about early speech development.
But now, researchers at Cal State Northridge have released a study that shows that developmentally disabled children as young as 3 months old can greatly benefit from early intervention programs in speech.
The research project was headed by Stephen Sinclair, acting director of CSUN's communicative disorders department. Graduate students Janice Woolsey and Michelle Hamilton, as well as CSUN speech pathologist Ruth Harris, who assisted with the research, studied files of 200 children who have graduated from the university's early intervention program, directed by Harris.
Woolsey said the study concentrated on program graduates, comparing their growth patterns before and after entry into the program. The findings showed that development in the areas of speech and cognitive skills is "delayed if entry into early intervention therapy is delayed."
The study shows that these children "need a warm-up period" to give them a boost in language and cognitive skills, Woolsey said. "The danger comes when the opportunity for that warm-up period has passed. By then, it's too late to lay solid foundations for future skills."
"Language acquisition begins much earlier than most people suspect," Harris said. From the moment of birth, babies begin noticing sounds around them, learning the foundations of speech.
"Children learn more in their first years of life than in all subsequent years," she said. "The most critical learning period is between 0 and 4. A child learns more during those first few years than during all his other years put together. If nothing is done to enhance those first years, especially with special-needs children, then you've lost miles of ground, some of which can never be recovered."
While some studies of early intervention programs have been conducted by the University of Vermont, Columbia University in New York and Vanderbilt University in Tennessee, few have focused solely on early language development in special-needs children, Woolsey said.
"Studies like CSUN's are important for the ongoing growth of intervention programs," said Sherry Beamer, an administrator with the state-funded North Los Angeles County Regional Center, one of 21 such agencies in California. These agencies, formed in the 1960s, coordinate services and funding for programs that serve developmentally delayed children.
"CSUN's early intervention program is one of the more solid programs because it's based within a university. They get support from other university departments, like physical therapy and child development, that aren't generally available to other programs."
The CSUN program, housed in the university's department of communicative disorders, was funded initially in 1983 by a $60,000 U. S. Department of Education grant to serve the language needs of developmentally delayed children under 5. In 1987, the program began serving children younger than 3 and added a physical therapist and early childhood educator. A staff of six, plus 12 student interns from CSUN's physical therapy, communicative disorders and child development departments, now serves 30 children ages 3 months to 3 years who attend half-day sessions every Monday and Friday.
The recently released study, Harris said, provides backup data for intervention specialists who must persuade pediatricians to refer children with delays in development to intervention programs at an early age.
Many parents, such as Michele Pietrantonio of Sun Valley, who brought her 2 1/2-year-old son, Nick, to the CSUN program in December, are told by pediatricians to wait before visiting an early intervention center.
"We asked our pediatrician several times about Nick, who wasn't holding his head up and was kind of floppy--like a little cloth doll," Pietrantonio said. "She suggested to wait to see what happened until 6 months. Nothing happened at 6 months--he wasn't crawling, babbling or cooing and he just lay there. We were then told to wait until he was 9 months old. We finally took him to a Childrens Hospital doctor who said Nick was delayed about six months."
Pietrantonio, 32, said her son--who has a syndrome possibly related to cerebral giantism since his head was abnormally large at birth and he is tall for his age--"was a little terror when he first came through those doors. He didn't talk much, but he now talks up a storm and he has calmed down quite a bit. He can focus on tasks now, like emptying the trash or washing his hands, and he's more aware of his surroundings."
On a recent morning at the CSUN program, parents and their children formed a circle and sang a song, passing a mirror around as each child was acknowledged by name. The mirror encourages self-identification.
Later, the children gathered at a sandbox for the week's nature lesson, which helped stimulate their senses. The youngsters dug their hands and feet into the sand or scooped it into pails. The rest of the morning was devoted to 20-minute private and small group sessions with speech, physical or childhood development specialists.
"A child learns by playing," Harris said. "We engage children in play, then seek to make that play a part of how they learn new skills."
Harris said it is important to treat not only individual children, but the entire family as well.
"We regard the parent as part of our team," she said. "We model activities for the parent because it's the parent who eventually becomes the primary intervenor, not the therapist. That's how real, long-term change takes place."
Long-term change for parent Doreen Stoutland has meant that her daughter Kasey, 2, who has Down's syndrome, can now walk and "has really taken off with signing," said the mother, who lives in Northridge. "We took her to CSUN at 3 months and it's made all the difference. If I hadn't learned to sign, Kasey wouldn't be able to communicate with us now."
Harris said, "We often have strained, frustrated parents who come in here lacking the skills to work with their delayed children. Our job is to empower them by providing knowledge and skills, and by improving communication with their children."
Chirlain Covington knows that frustration firsthand. She said she thought that she had the "sweetest little baby that had ever lived" until she suspected that her child's gentle disposition could be a sign of underdevelopment.
Covington's daughter, Brittany, was diagnosed four years ago with a seizure disorder and microcephaly, characterized by a small head or brain size. The child was enrolled in the CSUN program at 8 months and soon learned to sit up, crawl and sign to compensate for her impaired language skills. Brittany, now 5 1/2, attends special sessions at Lowman Elementary School in North Hollywood and has a vocabulary of about 20 words and eight signed words.
"I don't think she would be as far along as she is today without the CSUN program," said Covington, 40, of Lake View Terrace. "The program has helped me too. I can talk to her now and encourage her growth in a way that puts her needs first."
Programs offering services for delayed or "high-risk" children under 3 received little funding until 1986, when the federal Individuals With Disabilities Act was amended. The act, which mandated that services be made available for those ages 3 to 21 when it became law in 1975--was amended in 1986 to include children from birth to 3.
Since the amendment, funding has increased for the six San Fernando Valley-based early intervention programs that serve a burgeoning population in the San Fernando, Santa Clarita, Antelope and Simi valleys.
"There's just more people in general now, especially young families and women of child-bearing age," said Valentina Knox, prevention unit supervisor with the North Los Angeles County Regional Center. The Sepulveda-based program has a caseload of about 800 families, whom they refer to area intervention programs. Knox said her center receives 30 new cases a month; four years ago, the center had a caseload of 100 families with five new referrals each month.
"All programs have a different approach," Knox said. "Some focus on physical or speech development, but CSUN's is comprehensive. They approach early development from all angles."
Knox said that while the amended disabilities act has improved awareness of services, the field is having to handle far more youngsters than ever. Advances in medical technology make it possible to save more premature infants than was possible five years ago.
The Child Development Center at Simi Valley Hospital, begun in 1979, serves 180 children, a figure that has doubled in the past five years, according to its director, Fran Chasen. "But our emphasis has changed," she said. "We now see kids who are more medically fragile, like those with fetal alcohol syndrome."
Harris said she hopes that future early intervention studies will take a broader look at a child's development. "In all past studies, there's been an assumption that it's the child who makes all the progress," Harris said. "No one has looked at the modification in parents' behavior that's essential in order to change a child's behavior.
"The earlier we can begin training parents to help their children, the better off the whole family unit will by 5, 10, 15 years down the road."