Messinger

Intervention

Daniel Messinger

Messinger

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

Early Head Start Effects

Messinger

The Effects of Universal Pre-K on Cognitive Development

Gormley Jr., Gayer, Phillips, & DawsonDevelopmental Psychology 2005, Vol. 41, No. 6, 872–884

Messinger

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

Moderate to large intervention effects Center Advantage

Messinger

Effect Sizes 

Receptive .53 .62 .13

Gross Motor .23 .82 .51

Center vs. Home

Center vs. Primary

Home vs. Primary

Bayley MDI .28 .73 .42

Expressive .82 .92 .06

Fine Motor .12 .09 .04

Where should intervention take place?

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

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

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

Messinger

Valid conclusion? “It is in contrast to severe

deprivation that enrichment shows its statistically significant effects.”

Gottlieb & Blair, 2004

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

Messinger

Early visual experience & exploration!

From about 27 days of age to 100 days of age:(1)a stovepipe cage (little motor or visual experience), (2)an enclosed running wheel (motor activity but little variation in visual experience), (3)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

Its early experience that’s important

Free environment/Stovepipe

Stovepipe/Free environment

Free environment/ Free environment

Normal Cage/ Normal Cage

161 248 152 221

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

Messinger

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

Yield 4 intervention conditions

1. Early daycare intervention (birth – 5) with follow through services to 8 years

2. Only the educational daycare intervention

3. Only the school age follow through 4. An untreated control group.

Messinger

Early intervention counts!

Messinger

Messinger

Real life: % retained in grade

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

Messinger

3 Year effects

Behavioral Competence  

Control Group(n = 547)

Mean (SD)

Intervention Group(n = 338)

Mean (SD)

Effect Size(P)

Child behaviorchecklist(age 2-3 y)

47.2 (20.5) 43.7 (19.1)    18 (.006)

Messinger

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

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

Days of Treatment

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

18 Year effects!

INTERVENTION group effects on math (Woodcock-Johnson Tests of Achievement

5.1 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

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

Does intervention work?

Did IHDP work? Does inoculation model work? What kind of intervention works?

Messinger

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

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

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

Messinger

Overall Change in Frequency of Intentional Communication Acts

Messinger

Pretreatment x Type of treatment

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 Inten

sive Intervention for Autism Spectrum Disorders

Messinger

Child Effects Randomized,

Controlled Trial of an

Intervention for Toddlers With Autism:

The Early Start Denver Model.

Dawson, Rogers, et al.,

2009www.psy.miami.edu/faculty/

dmessinger

Rogers JACAAP No child effects

for ESDM with parent as interventionist

Messinger

A RandomizedA RandomizedClinical Trial ofClinical Trial of

Hanen’s More Than WordsHanen’s More Than Words

Alice S. CarterUniversity of Massachusetts Boston

Wendy Stone & Paul YoderVanderbilt University

Daniel MessingerUniversity of Miami

Intervention effects for low functioning children with ASD

www.psy.miami.edu/faculty/dmessinger

-2

-1.5

-1

-0.5

0

0.5

1

1.5

2

1.00 8.00

Res

idua

lized

Gai

n Sc

ores

of

Init

iati

ng J

oint

Att

enti

on

DPA Number of Toys at T1

Control Group

Treatment Group

3.15 5.51Lower RoS Higher RoS

Min Max

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1.00 8.00

Res

idua

lized

Gai

n Sc

ores

of

Init

iati

ng B

ehav

iora

l Req

uest

s

DPA Number of Toys at T1

Control Group

Treatment Group

2.85 5.10Lower RoS Higher RoS

Min Max

-6

-4

-2

0

2

4

6

8

1.00 8.00

Res

idua

lized

Gai

n Sc

ores

of

PC

FP

Wei

ghte

d F

requ

ency

of

Inte

ntio

nal C

omm

unic

atio

n

DPA Number of Toys at T1

Control Group

Treatment Group

2.50 4.64Lower RoS Higher RoS

Min Max

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1.00 8.00

Res

idua

lized

Gai

n Sc

ores

of

PIA

CV

Non

verb

al C

omm

unic

atio

n

DPA Number of Toys at T1

Control Group

Treatment Group

5.51Higher RoS

Min Max

Child effects moderated by low level Time 1 object interest

dmessinger@miami.edu

Parenting Effects?

Messinger

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.