A Developmental Systems Framework for Early Intervention

What is a developmental systems perspective?

"The building of brains, bodies, and flexibility involves a cascading developmental process in which genes and their products interact within their local environment to create the substrates for further development.” (Spencer et al 2009)

A developmental systems approach to understanding infant development asserts that development is a process of self-organization, among multiple factors, within the organism and without, driven by interactions and experiences. (Ulrich 2011)

Ulrich (2010) lists the following principles that govern change in  developmental systems:

  1. Behavior patterns and changes in patterns emerge via self-organized interactions among many subsystems, intrinsic and extrinsic to the organism, within a context, and the performer's goals.
  2. Behavior is dynamic and adaptive, changing in response to repeated cycles of perceiving and acting and to variations in the contextual demands or intrinsic capacities of the system.
  3. There are multiple, redundant pathways to achieving the same functional goal.
  4. History matters; factors that may not have obvious relevance to a particular outcome may have a profound, cascading impact.
  5. Organization and change at the level of the nervous system are significantly affected by repeated cycles of perceiving and acting.

A developmental systems framework for early intervention

A developmental systems framework for early intervention takes into account the complex interactional nature of  all the factors that influence infant development, behavior and learning. 

The  DS Framework for early intervention has two components:

1 A  set of principles to guide the overall structure of the intervention (the what, where, when and how of implementation) based on the best available evidence. 

The GAME  and Small Step  intervention protocols provide such evidence based set of principles for implementing an early intervention program for infants. 

2 A set of principles to guide assessment and training based on the best available information about perceptual-motor development and learning, and the interaction between the infant, the task and the environment (T-I-E). 

Task Oriented Motor Training provides a guide to assessment and developmental task training for children with developmental delay. 

The what, where, when and how of a DS framework for EI

Building on the GAME and Small Step intervention approaches, the Developmental Systems EI Framework (DSEIF) is based on a set of principles to guide the implementation of EI for infants at risk for developmental delay, and guide therapists'  interaction with, and clinical reasoning for, the individual child and family . 

1  Family centered care and the centrality of parents (caregivers) 

2  A solution focused and couching approach to therapy

3  Therapy always starts with the infant's abilities - the cascade nature of development 

4  An emphasis on training intensity, repetition and many daily opportunities 

5  Experience drives the acquisition of new skills and abilities - and repetition is needed 

6  The importance of self-initiated action for motor learning - promoting motivation to move and autonomy 

The role of exploration, curiosity, and the drive to interact with people and things 

7  Promoting enjoyable and meaningful social interaction and communication is central to intervention

8  Promoting use of the hands and feet to explore and interact with and on the environment

9  Attention to feeding, sleep and other aspects of the infant's wellbeing, life and experience 

Task oriented movement training (TOMT)

Task Oriented Movement Training, in keeping with other task oriented, function focused approaches to early intervention (EI), starts with the assumption that infants and toddlers only learn new skills when they actively engage in exploring their environment and try out different options for achieving their goals.  

Advances in our understanding of motor development, control and learning from the latest neuroscience research  literature provides a host of  new insights into the many factors that contribute to task performance – and how the specifics of motor control are tightly linked to the task and context.  In other words, you cannot separate perceptual motor control from the context and task demands.  Read more

Factors within the child, the task or the environment can either constrain or promote the infant or child's ability to successfully complete a task.

Task oriented movement training within a developmental systems framework takes as a starting point the idea that behavior is always influenced by the complex interaction between the infant, the demands of developmental task, and the environment.  

This means that an infant's ability to perform a particular task is determined by factors within the infant (strength, flexibility, coordination, motivation, interest, level of alertness, attention abilities), the task demands (biomechanical, timing and sequencing of movements, stability and balance requirements) and the social and physical environment.  

TOMT to improve tasks that relate to parent identified goals starts by assessment of the infant's present abilities, identifying the factors that  constrain/limit task performance and adapting the task or environment to allow the infant to succeed, 

General guidelines for assessment  

1  Start with the parent identified goals.  

  •    Sit on the floor, reach for, get hold of, and play with a toy without falling over. 
  •    Sit up from lying by herself 

2  Identify the developmental tasks that the infant needs master in order to achieve the goal. 

  • Sit without support and maintain balance when reaching to toys within easy reaching distance. 
  • Roll from supine to prone, transition to prone kneeling, transition to sitting. 
    Roll from supine to side lying, push up on arms to transition to sitting

Observe the infant's ability to perform the task.

Sitting without support 

  • Sits without support  but balance is precarious and she topples over when she turns head to look to side, or lifts hand to reach for a toy. Bangs her head on play mat she falls backwards.  

Transition from supine to sitting 

  • When lying supine, the infant happy to stay in position. Not initiating rollin to side lying or prone. 
    Dislikes prone lying, rolls onto her back, does not attempt to push up into prone kneeling. 

Adapt the task and the environment to allow the infant to successfully perform the adapted task. 

This stage is important because it provides a picture of the infant's abilities - and this is the starting point for training. 

Sitting and reaching 

  • Provide hip level support using a 10 cm high step/box on either side, and a 20 cm box at her back to stop falling backwards. Place toys on either side on top of step, and within easy reach.  

Transition from supine to sitting 

  • Practice moving from sitting to supine 
  • Practice sitting up from lying on cushion, with chest raised to 45 degrees. 
  • Practice moving from sitting to prone kneeling at a step

General guidelines for training 

1   Start by providing the infant with many opportunities to practice new tasks that are adapted to allow the infant to succeed. 

2   Adjust the task and the environment to make the task progressively more difficult and challenging while allowing the infant to succeed most of the time. 

  • Share with the parent your thoughts and ideas about how to increase the difficultly of the task.
  • Encourage the parent to suggest and try out ideas - ways to modify the task, adapt it to suite family routines, or family circumstances.  
  • Explore ways motivate the infant to actively  engage with task.  

3  Work with parent to create a home practice routine/schedule

  • With the parent identify opportunities within the day to practice the task. 
  • With the parent consider short time periods for dedicated practice. 


References 

Ulrich B. D. (2010). Opportunities for early intervention based on theory, basic neuroscience, and clinical science. Physical therapy, 90(12), 1868–1880. doi:10.2522/ptj.20100040

Spencer, J. P., Samuelson, L. K., Blumberg, M. S., McMurray, B., Robinson, S. R., & Tomblin, J. B. (2009). Seeing the world through a third eye: Developmental systems theory looks beyond the nativist-empiricist debate. Child development perspectives, 3(2), 103–105.   Article 

Bibliography

Adolph, K. E., Robinson, S. R., Young, J. W., & Gill-Alvarez, F. (2008). What is the shape of developmental change?. Psychological review, 115(3), 527–543. doi:10.1037/0033-295X.115.3.527

A remaining possibility is that variable acquisition periods reflect a biological reality: As infants acquire new motor skills, they perform close to the limits of their abilities, much like athletes struggling to meet their personal best during competition. In early periods of skill acquisition, infants’ peak skill level is far below the criterion level, and on a binary scale, the skill is considered absent. At later periods, as infants’ abilities hover around the criterion threshold, their top level of performance exceeds criterion on some days, but not others, resulting in variable trajectories. Eventually, infants’ peak skill level comfortably surpasses threshold, and skills are expressed on a consistent, daily basis. To achieve a more stringent criterion for the same skill (e.g., walks > 3 m versus walks < 3 m), infants must acquire a still higher level of peak performance.

This “peak performance” interpretation implies that at least for gross motor skills, over the first year and a half of life, infants continually push the envelope of possibility by attempting actions that they haven’t quite mastered. Like Vygotsky’s (1978) concept of a “zone of proximal development,” day-to-day variability in motor skill performance may reflect periods of development when infants are operating close to their limits; they are most disrupted by perturbations, and can benefit most from external support. This account also accords with previous proposals that motor skills are more unstable and sensitive to context when they first appear in infants’ repertoires (Thelen, Fisher, & Ridley-Johnson, 1984; Robinson & Smotherman, 1992; Garciaguirre, Adolph, & Shrout, 2007). As infants’ peak abilities expand, performance improves, and skills are expressed for longer durations and under more variable and challenging circumstances.