What are early interventions? Why is research on them so important?
Just like our babies, the field of developmental research is growing quickly. We are constantly finding new methods and theories to explain processes, many of which you will have read about on this blog. Our understanding of child development has reached the point where we can do more than identify potential developmental issues. We can look out for developmental signs early in infancy and take action to minimise the risks for our children. For example, if a mother notices that her baby still hasn’t said their first word by the time other babies are babbling away, she need not panic! This is what early interventions are designed for and where they can really help out.
Early interventions are designed to identify children who may be at risk for developmental or learning difficulties (e.g., if their parents or older siblings have/had the same difficulties), and help them learn the necessary skills as early as possible (usually before the age of three). This can take the form of therapy, counseling, special education, and other forms of specialised support or training. The idea is that in infancy, neural plasticity is greater. Neural plasticity is the notion that neural connections in the brain aren’t “set in stone.” New habits, behaviours and knowledge can be learned, old ones can be forgotten, useful ones can be practiced and maintained. Think of a girl sledding outside on a snowy day. If she sleds down the same tracks again and again, eventually those tracks will become ingrained into the snow, making them faster and easier to sled on. The girl then goes inside for a break, comes back outside, and the tracks have been covered by the snow - gone! She looks for a new way to come down the hill. That's how she notices an even better, more fun slope, so she goes and forms new, better tracks somewhere else. Babies have it easy: the “snow” they’re sledding on is so much softer than adult’s snow. There are far fewer hard, consolidated tracks, so they can create new pathways with ease. This is why baby brains are more responsive to learning and can easily pick up habits that are useful in new situations.
To make the most of this wonderful flexibility, it is vital that parents provide a supportive environment where their baby can grow and learn to their full potential. Therefore, an ideal early intervention is one that enables the baby to grow while empowering their parents along the way. It is important to involve parents in the sessions, consulting them about how their child learns best and giving tips on what can be done outside session hours to encourage further learning and good habits. (Take a look at these Babybrains workshops which can help you learn more about your baby and understand how to build a quality parent-child relationship with both typically and atypically developing children).
As you can guess, a lot of research and testing must go into developing interventions so that they can be appropriately specialised, compelling and effective. A high quality early intervention should be backed up by scientific research, developed especially for the disorder, and be regular, supportive and structured. While early interventions are already available for a wide range of additional needs, not much has been done with attention deficit hyperactivity disorder (ADHD). I currently have the honour of being a voluntary research assistant on the Babylab's Inter-STAARS study, which looks at the effect of a computerised eye-tracking intervention for babies at a genetic risk of ADHD (meaning they already have a parent or sibling who has been diagnosed with it). This is a very new idea, and we don't yet know if it works, but read on to see how we can find out.
Day to day, we visit families’ homes, set up our portable eye tracker, and show the baby a series of fun, colourful videos that respond to how the baby is looking at them. The baby focuses on a certain box on the screen, and a bright character with cheery music might appear. The baby looks away and a cute animal on the screen disappears. These are just some examples of the exciting videos that have been put together by Dr Sam Wass at Cambridge to see whether we can train babies' attention, focus and memory. By providing babies with fun, engaging videos, they are easily encouraged to participate and interact with the intervention. In practice, we can take advantage of the brain's plasticity to improve the function of the parts of the brain that we believe are responsible for mediating ADHD behaviours.
“Can Inter-STAARS diagnose my baby with ADHD?"
This is one of the most common questions we get while recruiting for our study. It is also one of the biggest misconceptions. Our answer is no, we can't. Early interventions are designed to minimize the effects of a developmental issue, not diagnose it. Many symptoms of ADHD, such as restlessness and trouble focusing, are also perfectly normal behaviours for babies who are still discovering the world around them. They don't have much patience for boring sit-down tasks. In rare cases, symptoms of ADHD can be seen in toddlers as young as three; however, most aren't diagnosed until age seven. Some only realize in adolescence or adulthood that they might have the disorder. When we run the intervention study, we don't know whether the infants have ADHD or will go on to have it. All we know is that ADHD can be inherited and so children who have parents with ADHD are more likely to develop ADHD themselves. We want to intervene to train at-risk infants on aspects of their attentional control so that they can build up a resilience to any ADHD symptoms that would have emerged later in childhood. Regardless of how our participants go on to develop, those who complete the training study would have the chance to benefit from additional attention control skills while having had a little extra fun with us, helping the progress of science.
"Why do you have to come to my home? Why isn't this done in a lab?"
Two suitcases, one pop-up tent, a monitor, portable eye-tracker, speaker, stand, webcam, laptop, and apple rice cakes. We don't carry all this equipment across London just because we get bored in our office. It is important that early interventions are carried out in a natural setting where both the parent and baby feel comfortable and relaxed. In addition, by training in a familiar environment, babies can more easily apply any learned skills to their everyday activities. Babies learn best when they are around familiar people, and sitting on their parents' lap during the intervention allows them to have access to comfort and reassurance at all times. Throughout the sessions, parents and babies can take breaks, have snacks, interact with the researchers. Some babies are so relaxed that they may decide to take a nap halfway through a session! Not much data there, but babies have a mind of their own. We never ask them to sit through a whole session if they are tired or restless. Effective learning of skills happens when an activity is consistently regular and in line with schedules and family life. We will always tailor our visits around what suits the family as a whole, working around job, school, nursery and nap times. This is why Inter-STAARS, and early interventions in general, are best suited for the home environment as opposed to the lab.
“I don’t want my baby watching TV. Is this study right for them?”
As developmental researchers, we are aware that parents might have this concern. It’s for this reason that we have gone to great lengths to ensure that our study is engaging, stimulating, and ethically approved by the NHS. Of course, it is still up to you as a parent to decide how much screen time you want your baby to have. Our intervention study consists of 12 short weekly visits, which is around 2 hours’ screen time a month. This is about the length of the new Incredibles movie, and far below the average amount of time that a child under 2 years spends watching TV. Add to that an atmosphere where the baby gets to interact with our friendly researchers, spend quality time with their caregivers, and potentially train their attention and memory, and the study becomes less about screen time and more about providing the baby with a wholesome, interactive experience.
"Does the intervention work?"
This is exactly what the study is trying to find out. A previous study has found that this intervention improves certain aspects of attentional control in infants who are not at risk of any developmental problems. We are hoping it has the same positive effect for babies who are at a genetic risk for ADHD. We will only find out by comparing the performance of the babies that receive the attention training to the babies that receive the "placebo" training (an alternative set of videos which have not shown any effect on attention skills). If shown to have an effect, the training could be implemented on a larger scale for babies who may show lower attentional control in infancy or babies who are at risk of other developmental disorders affecting attention, including autism spectrum disorder. Having the opportunity to work on these important cognitive skills while the brain is still developing could mean that babies would go on to build more meaningful emotional connections. They may also be more equipped to carry out numerous tasks and activities that require just that little bit of extra memory, focus and attention. From here on, the potential benefits for their mental and emotional wellbeing would be countless.
Inter-STAARS is due to carry on until December 2018. If you have a baby under 14 months with a parent or sibling with ADHD, and would like to know more or participate in the study, feel free to contact Amy at the Babylab on 0207 079 0761 or firstname.lastname@example.org.