Patterns of Developmental and Behavioral Progress for Young Brain-Injured Children During Interdisciplinary Intervention

Pediatric hospital rehabilitation teams and community-based early intervention programs confront the increasing demand to treat infants and preschoolers suffering both acquired and congenital brain injuries. However, few outcome studies are available to provide clear and practical guidance to their efforts. Specialists require more complete knowledge of the problems and the possibilities for these young handicapped children. Needed research can establish norms for progress and recovery, which can be used to evaluate individual gains, to provide prognoses, and to monitor interdisciplinary treatment impact. Our preliminary research traced comparative patterns of developmental and behavioral progress during intervention for infants and preschoolers suffering acquired and congenital brain injuries. In addition, this study documented treatment impact for both brain injury groups. Results demonstrated the existence of very similar overall progress and recovery patterns within both groups. An intensive interdisiplinary treatment approach proved to be responsible for facilitating developmental and behavioral gains beyond levels expected due to maturation. Practical implications of these results for early intervention teams are detailed. Well-designed empirical research is needed to document the recovery rates and developmental/behavioral progress patterns of infants and preschoolers suffering both acquired and congenital brain injuries. Furthermore, studies must demonstrate the efficacy of early intervention approaches designed to promote progress for such young handicapped children. In response to these needs, our prospective research defined the patterns of developmental and behavioral progress for young brain-injured children. Cognitive developmental patterns revealed the strongest and most dramatic rates of gain whereas neuromotor patterns showed the least. Similarly, various neurophysiological and self-regulatory behavior processes in both brain-injury groups showed enduring deficits and were least affected by intervention. These results also demonstrate that an intensive, interdisciplinary, early intervention treatment program significantly enhanced the developmental and behavioral functioning of young children with both acquired and congenital brain injuries. These research outcomes suggest guidelines for future clinical research and practice in early intervention. Multidimensional diagnostic batteries composed of both child performance and clinical judgment scales can substantially improve the sensitivity and comprehensiveness of team assessments for young brain-injured children. In particular, curriculum-based scales accurately detected changes across several developmental areas and clinical judgment ratings offered an invaluable method for describing subtle changes in complex behavioral dimensions. Next, rehabilitation programs must expand their treatment focus to promote cognitive and social skill development along with neuromotor skill development for young brain-injured children. Finally, longitudinal research is needed to monitor these children and to determine the extent to which their accelerated developmental progress patterns during intensive treatment are maintained. Comparisons of developmental progress among these children now attending various community-based early intervention programs that vary in structure and intensity are planned. Also, comparisons with similar groups of children never treated on an inpatient basis will be conducted.