Early Interventions for Infants with, or at Risk of, Neurodevelopmental Disorders : A Systematic Review
Over the past few years, support for very early intervention of infants at risk for neurodevelopmental disorders (NDD) has begun to emerge in the literature as an attempt to positively modify the natural history of these disorders. Indeed, very early intervention seeks to modify environment and experience that can shape brain development and outcomes across the lifespan. Growing prevalence of NDD and greater awareness of their impact effects have led to the development of early intervention programs with the aim of taking action as early as possible to tackle these conditions.
The review seeks to establish, through the available literature, available intervention programs for infants 0-3 years recently diagnosed with a NDD, those at risk, and their families.
We conducted a systematic review of the published work according to the PRISMA statement. Relevant studies were identified by searching the following data sources: PsycINFO, Embase, Medline via Ovid, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Database of Systematic Reviews, from 2000 to Jan 2018. Search terms were arranged relating to disorders, population, and interventions. Reference lists from identified trials and review articles were manually scanned to identify other relevant studies.
The review includes 122 studies with controlled trial design from 15 countries. A quantitative analysis (e.g. meta-analysis) of the results could not be performed due to differences in the design, duration and intensity of interventions, as well as the heterogeneity in outcome measurement tools used. Findings from the studies were reported narratively. Nearly half of the intervention programs identified were parent-mediated. Among other delivery characteristics, we examined the implementation settings such as session formats and implementers’ qualifications: 81% of the studies implied individual training sessions, 9% as a group, and 10% both types, and most of the interventions were implemented by a professional. High risk was evident in the studies in relation to reporting, attrition biases, and blinding of participants. Overall, we found gains in language development, social communication and play skills as well as adaptive functioning for some programs, with findings largely inconsistent across studies and time points.
The review finds some evidence for the effectiveness of early interventions programs in promoting behavioral, social and play skills in infants at risk for a NDD and their families. Our results highlight the importance to develop and implement such programs with the aim of taking action as early as possible to tackle these conditions.