“Early Intervention” — A Clinical Term Parenting Books Don’t Cover
A little bit of support early on can have meaningful impacts later on.
(4 min read)
Early intervention is the clinical term for setting a child up for success by addressing lagging skills during critical developmental windows in early childhood. Before age six, neurological connections related to speech, fine and gross motor development, behavior, and socialization are considered more malleable and, therefore, more easily influenced and responsive to intervention(s). Also, children between the ages of two and six often receive less support, as regular check-ups and milestone screenings wane until elementary school.
The Need for Developmental Scaffolding
Skills that develop naturally for most children may require targeted support to develop in others. Suppose a child is struggling with a developmental skill. The child may opt out of certain activities, have a low tolerance or interest in participating, or demonstrate a stronger preference for different types of play. Targeted services, or early interventions, are available to help young children with specific developmental delays or conditions catch up and close the gap. These interventions increase their chances for success in school and life, giving them better coping skills and helping preserve self-esteem and confidence. A small intervention (or scaffolding) early on can significantly impact a child's outcomes later on.
Let’s consider the example of a child who has trouble initiating or maintaining eye contact, which could result from sensory challenges, motor coordination, or processing issues. With early intervention, this skill can be improved upon. Without it, the child’s lack of sustained eye contact may have a compounding effect, as the child misses out on opportunities to develop critical social-emotional skills that come with paying visual attention to their environment and subtle social or physical/facial cues. In another case, a child who struggles to hold their pencil with an efficient grasp can learn and adapt much easier between ages four and six. Afterward, it is a lot harder for the child to adjust, and being unable to hold their pencil efficiently may frustrate them at school as their hand cramps or fatigues when trying to keep up with writing assignments. These are oversimplified examples, but they get the idea across.
Behavior As Communication
The need for early intervention often starts with unusual or unwanted behaviors. Your child’s behavior is a form of communication. A child cannot rely on maturity, insight, or vocabulary to adequately express themselves, but their behavior can provide powerful insights into their needs. It takes training and insight to observe a child and accurately identify what drives their behavior and what it communicates about their needs. Parents and those who work closely with young children should assume that children will do well if they can and prefer to do well if it is within their capability. Accepting your child for who they are and identifying their strengths alongside needs can help set them up for success. Understanding what is behind your child’s unwanted behaviors allows you to update your parenting toolbox and adapt as your child goes through different stages and phases.
If a young child is exhibiting unwanted behavioral patterns, it may indicate one of the following: a skill deficit or lag, a mismatch with their environment, or that internal or external expectations are either misplaced or inappropriate.
Addressing Lagging Skills
Early intervention primarily focuses on lagging skills in young children. Areas of developmental concern often include:
Motor skills, or fine and gross motor coordination, includes reaching, crawling, walking, climbing, jumping, drawing, and building, as well as oral (e.g., chewing and swallowing) and ocular motor issues (e.g., eye tracking and visual processing). Specific sensory systems can neurologically impact core strength, and weak core muscles can lead to difficulties with handwriting, fine motor skills, sitting still, or keeping good posture (e.g., at circle times).
Cognitive and executive functioning skills include thinking, learning, organizing, regulating, managing transitions, attending, and problem-solving skills. Executive functioning begins in infancy with self-soothing and develops into higher-order skills for mental flexibility, self-control, and working memory as children mature.
Communication skills such as talking, listening, and understanding develop from a child’s ability to speak, detect and process auditory information, and communicate preferences and needs. Many issues can get in the way of a child’s effective communication, ranging from obstructive physical problems (e.g., tongue ties, oral motor challenges, and oversized tonsils and adenoids) to complex cognitive processes (e.g., auditory processing). Identifying where the lag lies is critical.
Self-help or adaptive skills relate to a child’s ability to program eating, dressing, and other organizational skills. A child can make significant gains when motor planning for self-help is supported.
Sensory processing is how the body detects and interprets external and internal sensory stimuli, organizes and analyzes sensory signals, and responds accordingly. This is a complex area of specialization, and I’ve dedicated several other posts to it.
Social-emotional skills and regulation come from integrating the above skills so a child develops empathy, interpersonal skills, and the ability to comfortably engage in social interactions. To develop age-appropriate social-emotional skills, a child must be able to track their environment and that of peers with a certain level of attention, consideration, and self-control. An unbalanced sensory system or immature executive functioning can challenge a child’s ability to regulate emotions and attend to others. This can be a barrier to picking up critical social-emotional cues and successfully engaging in social interactions or playing with peers. These children may struggle to keep an even temperament, fluctuating quickly among extremes of excited, fixated, or apathetic.
Specialists most commonly involved in early intervention include:
Specialized clinicians, such as Developmental-Behavioral Pediatricians (DBPs) and Pediatric Neuropsychologists (Neuropsychs)
Behavioral Specialists, including Board Certified Behavioral Analysts (BCBAs) and Licensed Marriage and Family Therapists (LMFTs)
Pediatric Occupational Therapists (OTR/Ls) and Pediatric Physical Therapists (PTs)
Speech and Language Pathologists (SLPs) and specialized myofunctional or oro-facial SLPs
Registered Play Therapists (RPTs)
Audiologists
Developmental/Functional Optometrists or Certified Optometric Vision Therapists (COVT)
If you suspect your child may benefit from early intervention, you can seek a referral from your pediatrician. Assessments often begin with a DBP or Neuropsych. Alternatively, you can contact your Regional Center, which can coordinate special assessments, determine eligibility for services, and provide case management.
Early Intervention Services Under Federal Law
Early Intervention Services are available nationally under the Individuals with Disabilities Education Act (IDEA). Part C of IDEA offers services for qualifying at-risk infants and toddlers from birth to 36 months, while part B applies to services for school-aged children (preschool through high school or ages three through 21). Eligibility is coordinated through Child Find services that are federally mandated but state-based. Through a coordinated evaluation, eligibility determines access to “appropriate” services. What is “appropriate” is a gray area. “Appropriate” is defined loosely in the law as beneficial (not best). The focus of the law is providing access rather than optimizing potential. What the state or local school districts define as beneficial and “appropriate” support will undoubtedly be helpful but not necessarily ideal or optimal for every situation. Additional or private support may be needed if eligibility is denied or what is deemed “appropriate” does not maximize the benefit to the child’s potential.
To read more about addressing unwanted behavioral patterns, the following books from Dr. Ross Greene are a good starting point:
