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Objectives Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder ( BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder. Methods The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression. Results BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD. Conclusions Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder. [ABSTRACT FROM AUTHOR]

Oppositional defiant disorder ( ODD) or conduct disorder ( CD) occurs when children's disruptive and antisocial behaviours start to interfere with their academic, emotional and/or social development. Recently, there has been a considerable investment to implement national school-based early intervention programs to help prevent the onset of ODD/ CD. Aim: This paper describes the delivery of the Royal Children's Hospital, Child and Adolescent Mental Health Service and Schools Early Action Program: a whole school, multi-level, multidisciplinary approach to address emerging ODD/ CD and pre- versus post-delivery assessment in 40 schools over a 4-year period (2007-2010). Methods: All children from preparatory to grade 3 (ages 4-10 years) were screened for conduct problems ( n = 8546) using the Strengths and Difficulties Questionnaire. Universal, targeted and indicated interventions were delivered in school settings. In total, 304 children participated in the targeted group program where the Child Behaviour Checklist was used as a pre- and post-intervention measure. Cohen's d effect sizes and a reliability change index were calculated to determine clinical significance. Results: Significant reductions in both parent- and teacher-reported internalizing and externalizing symptoms were noted. Parent, teacher and child feedback were very positive. Conclusions: A future randomized controlled trial of the program would address potential placebo and selection bias effects. [ABSTRACT FROM AUTHOR]

This paper briefly describes narrative and open dialogue approaches before exploring their shared values, ways of working, their differences and the possibilities for integration. Both authors have extensive experience in using a narrative therapy approach, while Val Jackson, a family and systemic psychotherapist, also uses an open dialogue approach in her work in an early intervention in psychosis service in Yorkshire, UK. [ABSTRACT FROM AUTHOR]

A central issue when designing multidimensional biological and psychosocial interventions for children who are exposed to multiple developmental risks is identification of the age period(s) in which such interventions will have the strongest and longest lasting effects (sensitive periods). In this paper, we review nutritional, neuroscientific, and psychological evidence on this issue. Nutritional evidence is used to identify nutrient-sensitive periods of age-linked dimensions of brain development, with specific reference to iron deficiency. Neuroscience evidence is used to assess the importance of timing of exposures to environmental stressors for maintaining neural, neuroendocrine, and immune systems integrity. Psychological evidence illustrates the sensitivity of cognitive and social-emotional development to contextual risk and protective influences encountered at different ages. Evidence reviewed documents that the early years of life are a sensitive period when biological or psychosocial interventions or exposure to risk or protective contextual influences can produce unique long-term influences upon human brain, neuroendocrine, and cognitive or psychosocial development. However, the evidence does not identify the early years as the sole sensitive time period within which to have a significant influence upon development. Choice of age(s) to initiate interventions should be based on what outcomes are targeted and what interventions are used. [ABSTRACT FROM AUTHOR]

Part of the Dutch Dyslexia Programme has been dedicated to early intervention. The question of whether the genetically affected learning mechanism of children who are at familial risk (FR) of developing dyslexia could be influenced by training phoneme awareness and letter-sound associations in the prereading phase was investigated. The rationale was that intervention studies reveal insights about the weaknesses of the learning mechanisms of FR children. In addition, the studies aimed to gather practical insights to be used in the development of a system of early diagnosis and prevention. Focused on the last period of kindergarten before formal reading instruction starts in Grade 1, intervention methods with comparable samples and designs but differences in delivery mode (use of computer or manual), tutor (semi-professional or parent), location (at school or at home), and additional practices (serial rapid naming or simple word reading) have been executed to test the hypothesis that the incidence and degree of dyslexia can be reduced. The present position paper summarizes the Dutch Dyslexia Programme findings and relates them to findings of other studies. It is discussed that the Dutch studies provide evidence on why prevention of dyslexia is hard to accomplish. It is argued that effective intervention should not only start early but also be adapted to the individual and often long-lasting educational needs of children at risk of reading failure. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim In a survey conducted in the Lausanne catchment area in 2000, we could estimate on the basis of file assessment that first-episode psychosis ( FEP) patients had psychotic symptoms for more than 2 years before treatment and that 50% did not attend any outpatient appointment after discharge from hospital. In this paper, we describe the implementation of a specialized programme aimed at improving engagement and quality of treatment for early psychosis patients in the Lausanne catchment area in Switzerland. Method The Treatment and Early Intervention in Psychosis Program- Lausanne is a comprehensive 3-year programme composed of (i) an outpatient clinic based on assertive case management; (ii) a specialized inpatient unit; and (iii) an intensive mobile team, connected for research to the Center for Psychiatric Neuroscience. Results Eight years after implementation, the programme has included 350 patients with a disengagement rate of 9% over 3 years of treatment. All patients have been assessed prospectively and 90 participated in neurobiological research. Based on this experience, the Health Department funded the implementation of similar programmes in other parts of the state, covering a total population of 540 000 people. Conclusion Programmes for early intervention in psychosis have a major impact on patients' engagement into treatment. While development of mobile teams and assertive case management with specific training are crucial, they do not necessitate massive financial support to be started. Inclusion of a research component is important as well, in terms of service planning and improvement of both quality of care and impact of early intervention strategies. [ABSTRACT FROM AUTHOR]

Minimum intervention dentistry (MID) is the modern medical approach to the management of caries, utilizing caries risk assessment, and focusing on the early prevention and interception of disease. Moving the focus away from the restoration of teeth allows the dentist to achieve maximum intervention, with minimal invasive treatments. The four core principles of MID can be considered to be: (1) Recognition - early identification and assessment of potential caries risk factors through lifestyle analysis, saliva testing and using plaque diagnostic tests; (2) Reduction - to eliminate or minimize caries risk factors by altering diet and lifestyle habits and increasing the pH of the oral environment; (3) Regeneration - to arrest and reverse incipient lesions, using appropriate topical agents including fluorides and casein phosphopeptides-amorphous calcium phosphates (CPP-ACP); (4) Repair - when cavitation is present and surgical intervention is required, conservative caries removal is carried out to maximize the repair potential of the tooth and retain tooth structure. Bioactive materials are used to restore the tooth and promote internal healing of the dentine. Effective implementation of MID involves integrating each of these four elements into patient assessment and treatment planning. This review paper discusses the key principles of MID as a philosophy of patient care, and the practical objectives which flow into individual patient care. [ABSTRACT FROM AUTHOR]

This paper will describe the rationale for, and importance of, psychological interventions for young people early in the course of bipolar disorder. Emerging literature in this field will be discussed in addition to describing specific clinical challenges and opportunities with this population. In order to be more developmentally appropriate for young people with bipolar disorder, eight aspects of clinical work which may require modification were identified. The evidence base for the effectiveness of psychological interventions for people diagnosed with bipolar disorder is growing. However, some aspects relating to working with adults with bipolar disorder require modification to be effective in working with young people early in the course of the disorder. [ABSTRACT FROM AUTHOR]

There is a scarcity of empirically validated treatments for infants and toddlers under age 3 years with autism spectrum disorders (ASD), as well as a scarcity of empirical investigation into successful intervention characteristics for this population. Yet early screening efforts are focused on identifying autism risk in children under age 3 years. In order to build ASD interventions for infants and toddlers upon a foundation of evidence-based characteristics, the current paper presents the results of a systematic literature search and effect size analysis of efficacious interventions for infants and toddlers with other developmental disorders: those who were born prematurely, have developmental impairments, or are at high risk for developmental impairments due to the presence of a biological or familial condition associated with developmental impairments. A review of 32 controlled, high-quality experimental studies revealed that the most efficacious interventions routinely used a combination of four specific intervention procedures, including (1) parent involvement in intervention, including ongoing parent coaching that focused both on parental responsivity and sensitivity to child cues and on teaching families to provide the infant interventions, (2) individualization to each infant's developmental profile, (3) focusing on a broad rather than a narrow range of learning targets, and (4) temporal characteristics involving beginning as early as the risk is detected and providing greater intensity and duration of the intervention. These four characteristics of efficacious interventions for infants and toddlers with other developmental challenges likely represent a solid foundation from which researchers and clinicians can build efficacious interventions for infants and toddlers at risk for or affected by ASD. [ABSTRACT FROM AUTHOR]

If early intervention in dementia care is to be enhanced, it is important to have a critical debate over how this should be realized. In this paper, we offer a synthesis of two approaches to care: mental health recovery and person-centred care, and apply them to early-stage dementia care. 'Person-centred care' has become a catchphrase for good dementia care. However, many people have not experienced improvements in care, and other lynch pin concepts, such as 'mental health recovery', might have utility in driving reform. The similarities and differences between the two approaches are drawn out, and the difficulties of using the word 'recovery' when discussing a degenerative disease are highlighted. The implications of this discussion for early intervention are discussed. It could be seen that the two bodies of knowledge have much to offer each other, despite initial dissonance with the label of recovery in dementia care. [ABSTRACT FROM AUTHOR]

A number of studies have demonstrated that Early Intervention in Psychosis (EIP) services can produce improved outcomes for service users. However, the essential elements that produce these results remain elusive. This paper considers a number of hypotheses, with a particular focus on one service in the UK, which was designed according to policy guidance. It concludes that the structure of EIP services allows for the effective implementation of evidence based psychosocial interventions, which often fail to be implemented successfully within standard mental health services. [ABSTRACT FROM AUTHOR]

Although the use of differential reinforcement has been recommended in previous investigations and in early intervention curriculum manuals, few studies have evaluated the best method for providing differential reinforcement to maximize independent responding. This paper reviews previous research on the effectiveness of differential reinforcement as treatment and describes important areas of future research. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to provide clarification with regard to the nature of mediator and moderator variables and the statistical methods used to test for the existence of these variables. Particular attention will be devoted to discussing the ways in which the identification of mediator and moderator variables may help to advance the field of early intervention in psychiatry. Methods: We completed a literature review of the methodological strategies used to test for mediator and moderator variables. Results: Although several tests for mediator variables are currently available, recent evaluations suggest that tests which directly evaluate the indirect effect are superior. With regard to moderator variables, two approaches (‘pick-a-point’ and regions of significance) are available, and we provide guidelines with regard to how researchers can determine which approach may be most appropriate to use for their specific study. Finally, we discuss how to evaluate the clinical importance of mediator and moderator relationships as well as the methodology to calculate statistical power for tests of mediation and moderation. Conclusion: Further exploration of mediator and moderator variables may provide valuable information with regard to interventions provided early in the course of a psychiatric illness. [ABSTRACT FROM AUTHOR]

Early intervention approaches have rarely been implemented for the prevention of attention deficit/hyperactivity disorder (ADHD). In this paper we explore whether such an approach may represent an important new direction for therapeutic innovation. We propose that such an approach is most likely to be of value when grounded in and informed by developmental models of the dynamic, complex and heterogeneous nature of the condition. First, we set out a rationale for early intervention grounded in the science of ADHD viewed through developmental models. Second, we re-examine the concept of disorder-onset from the perspective of developmental trajectories and phenotypes. Third, we examine potential causal pathways to ADHD with regard to originating risk, pathophysiological mediators, environmental moderators and developmental continuities. Finally, we explore the potential value of strategies for identifying young children at risk for ADHD, and implementing interventions in ways that can target these underlying pathogenic processes. The utility of such an approach represents an important area for future research but still requires ‘proof of concept’. Therefore prior to widespread clinical implementation, far greater knowledge is required of (i) developmental pathways into ADHD, (ii) the value of identifying neuropsychological mediators of these pathways, and (iii) the extent to which targeting mediating mechanisms will improve treatment outcomes for children with ADHD. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe a service operating in Milan, Italy, that provides early intervention for young people aged 17–30 years at the onset and at high risk of psychosis. Method: Following 2 years of preliminary study and organization, Programma2000 was launched in Milan in 1999. This programme was targeted at early detection and intervention in subjects at the onset of, at risk of, or showing ‘prodromal’ signs of psychosis. This paper contains data on the organization and activities of Programma2000. Results: The service has been active since its launch and has received 378 referrals as of March 2009, 342 of which were thoroughly evaluated. At entry, patients undergo a detailed evaluation of their psychopathology, personal and social role functioning, and cognitive status, with repeated testing over time in order to multidimensionally assess outcome. Treatment involves cognitive–behavioural psychotherapy, structured and unstructured psychosocial interventions, and pharmacotherapy when deemed necessary. Treatment appears effective in reducing morbidity and improving social functioning. Conclusion: A team dedicated to the early identification and treatment of young people with early psychosis is a feasible and sustainable extension of the traditional methods of care for people with mental disorders in Italy. [ABSTRACT FROM AUTHOR]

Aims: This paper assesses the impact of different models of early intervention (EI) service provision on functional recovery and inpatient hospital admission. The study compares the outcome of a comprehensive EI team with a partial model (community mental health team (CMHT) plus specialist support) and traditional care (generic CMHT) over a 10-year period. Methods: The design is in comparison with historical control. The study compares the functional recovery outcomes of three cohorts from the same geographical area over the period 1998–2007. The primary outcomes were partial and full functional recovery defined with respect to readily identifiable UK benefit system thresholds and psychiatric inpatient admission days at 1 and 2 years post-referral. Results: Only 15% of individuals made a full or partial functional recovery at 2 years under the care of a traditional generic CMHT in 1998. In 2007, 52% of the cases were making a full or partial functional recovery under the care of the comprehensive EI team. A large reduction in inpatient admissions was associated with the EI strategy. Conclusions: The implementation of comprehensive EI teams can have a major impact in improving functional recovery outcomes in psychosis and reducing inpatient admissions. Partial implementation using limited funding of specialist workers in collaboration with traditional care appeared to have a more limited effect on these recovery dimensions. The implementation of targeted EI in psychosis strategies can result in substantive functional benefits. [ABSTRACT FROM AUTHOR]

This paper outlines the presentation, aetiology and treatment of attention deficit hyperactivity disorder (ADHD) in pre-school children. A review of current parenting training interventions demonstrates that there is good evidence for their efficacy in reducing symptoms of ADHD in pre-school children, and three interventions are evaluated: The new forest parent training programme (NFPP); the triple P--positive parenting programme and the incredible years parent training programme (IY). The evaluation of the NFPP provides strong evidence demonstrating its effectiveness for pre-school children with ADHD, while the efficacy of the Triple--P and the IY programme have, to date, only been demonstrated on children with conduct problems and co-morbid ADHD. It is suggested that parent training should be the first choice treatment for pre-school children presenting signs of ADHD, and medication introduced only for those children where parent training is not effective. Few moderators of outcome have been identified for these interventions, with the exception of parental ADHD. Barriers to intervention and implementation fidelity will need to be addressed to achieve high levels of attendance, completion and efficacy. The IY programme is a good model for addressing fidelity issues and for overcoming barriers to intervention. The future directions for parent training are also discussed. [ABSTRACT FROM AUTHOR]

This paper discusses aspects of the implementation of the Common Assessment Framework (CAF) in the UK, introduced under the Change for Children Programme and designed to facilitate early intervention and improve multi-agency working. The study area was rural in character and findings are compared with evaluation of early CAF implementation which focused primarily on urban areas. The study provided lessons for practice, many of which resonate particularly with rural problems identified in the international literature. There may be advantages in rural areas in ease of involvement of families in processes, in early awareness of practitioners of difficulties in families and in depth of relationships with families. These in turn may support early intervention. Disadvantages centre around resource issues, those of skills and confidence and lack of contact with and therefore distrust of other agencies. [ABSTRACT FROM AUTHOR]

Aim: To consider how early intervention in psychosis can support a recovery paradigm. Methods: Significant numbers of those developing a first episode of psychosis are on a path to a persisting and potentially life long condition. Constituting the schizophrenia spectrum disorders, such conditions demand the particular qualities and attitudes inherent within recovery-based practice. This paper explores some of these qualities and attitudes by examining the tension between a traditional ‘clinical’ narrative used by many health providers and a ‘human’ narrative of users of services and their families. Results: We draw out key features and constructs of recovery practice as they relate to the EI paradigm. These include: woodshedding, turning points, discontinuous improvement models, therapeutic optimism, gradualism and narratives of story telling. We also highlight the role of family members and other close supporters and believe their potential contribution requires greater consideration. Conclusions: The early intervention (EI) paradigm can resonate and indeed offer a stronghold for recovery-based practice where traditional mental health services have sometimes struggled. Conversely, failure of caregivers to provide such an approach in the early phase of illness can cause unnecessary and sometimes disastrous consequences. [ABSTRACT FROM AUTHOR]

Background This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia. Method A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services. Findings The new services would cost around £220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around £120 million in public expenditure (social care) and £125 million in private expenditure (service users and their families), a total of £245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable. Interpretation These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: Early medical or behavioural intervention to slow cognitive decline might be a viable strategy for reducing disability and rates of institutional care in older persons. This paper details the published work supporting cross-sectional and longitudinal associations between vascular risk factors, depressive symptoms and progressive cognitive decline. Evidence for the beneficial effects of providing relevant interventions is assessed. Methods: Relevant published work from the areas of dementia research, ‘vascular depression’ and the cognitive benefits that might result from treating vascular risk factors, managing depression or promoting nutrition, cognitive or physical exercise was ascertained from electronic database searches and recent reviews of key areas. Results: The existing published work does not provide many examples of early intervention strategies that target vascular strategies or active treatment of depression to reduce the rate of cognitive decline. Most studies have major limitations including the evaluation of only single-risk-factor interventions, the observational designs and the inadequate measurement of cognition. An optimal early intervention strategy might be to target multiple risk factors within relevant experimental or health service frameworks. Conclusions: Early identification and multifaceted reduction of vascular risk factors, active management of depression, engagement in cognitive activity and physical exercise and promotion of better nutrition might together help to slow some forms of cognitive decline or progression to dementia. This health services approach now requires systematic evaluation. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this review is to report on existing literature regarding children and adolescents younger than 16 years of age experiencing a first-episode psychiatric disturbance. Rather than providing a comprehensive list of service implications, this paper identifies some of the gaps in knowledge and practice to encourage ongoing analysis regarding better practices for early intervention for children and adolescents experiencing a first-episode psychiatric disturbance. Methods: A search was conducted to identify key evidence-based literature published from 1985 to 2007 discussing various aspects of child and youth mental health in Canada, the USA, the UK, Australia and New Zealand. The review also included ‘grey’ literature. Categories of information include diagnoses, pharmacological and non-pharmacological treatment, prevalence, environmental and other risk factors, and demographic variables. Results: Understanding first-episode psychiatric disturbance for patients under the age of 16 years is limited because of a scarcity of controlled studies focusing on this population. Programme evaluations are sparse, perhaps because of the small number of specialized units servicing this population. It may be helpful to enlist early intervention psychosis programmes that have been successful in assisting young people aged 16–24 in the development of better practices and care outcomes for younger age groups. Conclusions: The authors highlight information that has the potential to assist in optimizing care for those youth younger than 16 years experiencing or exhibiting signs of a first-episode psychiatric disturbance. [ABSTRACT FROM AUTHOR]

The concept of prevention is not new to psychiatry and has long been recognized in general medicine. Recent evidence has highlighted that early pharmacological and psychosocial treatment dramatically ameliorates poor prognosis and outcome for individuals with psychotic disorders, reducing conversion rates to full-blown illness and decreasing symptom severity. Nevertheless, despite the many recent advances in our thinking about early intervention, the need for early intervention in bipolar disorder (BPD) is an area that has been relatively neglected. This review attempts to synthesize what is currently known about early intervention in BPD. We discuss methodological issues pertaining to this topic, review clinical studies that focus on high-risk subjects as well as first-episode patients and review findings from brain imaging studies in the offspring of individuals with BPD as well as in first-episode patients. A companion paper discusses the cellular and molecular mechanisms of action of agents with neurotrophic and neuroplastic properties, with a particular emphasis on lithium and valproate. [ABSTRACT FROM AUTHOR]

Objective: Affective psychoses and bipolar disorders have been neglected in the development of early intervention strategies. This paper aims to gather current knowledge on the early phase of bipolar disorders in order to define new targets for early intervention. Methods: Literature review based on the main computerized databases (MEDLINE, PUBMED and PSYCHLIT) and hand search of relevant literature. Results: Based on current knowledge, it is likely that an approach aiming at the identification of impending first-episode mania is the most realistic and manageable strategy to promote earlier treatment. During the period preceding the onset of the first manic episode, patients go through a prodromal phase marked by the presence of mood fluctuation, sleep disturbance, and other symptoms such as irritability, anger, or functional impairment. Additionally, various risk factors and markers of vulnerability to bipolar disorders have been identified. Conclusions: In the few months preceding first-episode mania, patients go through a prodrome phase (proximal prodrome) that could become an important target for early intervention. However, considering the low specificity of the symptoms observed during this phase, criteria defining high-risk profiles to first-episode mania should also include certain risk factors or markers of vulnerability. While more research is needed in high-risk groups (e.g., bipolar offspring), retrospective studies conducted in first-episode mania cohorts could provide valuable information about this critical phase of the illness. [ABSTRACT FROM AUTHOR]

Background Portage provides home-based, early intervention and support to families who have a young child with additional needs. Working in the context of the Every Child Matters agenda, the National Portage Association (NPA) aims to develop inclusive, high-quality provision. This paper reviews their recent work, presents a summary of the findings of a national survey of Portage and discusses their implications. Methods All Portage services known to the NPA and local authorities in England were asked to complete a questionnaire and forward another to families using early years' services to evaluate the support they receive. Results The survey identified the extent and gaps in Portage provision and the level of unmet need. Families who contributed said they valued Portage because it helped their child and provided support for the whole family. Discussion of findings The survey identified 31 local authorities in England, where Portage is not available. Geographical gaps were most notable in the North East and West Midlands regions. Despite a small increase in the extent of Portage provision, it is estimated that services only meet the needs of a small proportion of families that are eligible. Current work may help overcome geographical gaps through supporting the development of high-quality Portage services but, in endeavouring to meet the needs of families waiting for Portage, it is important not to diminish the quality of support already provided. Portage aims to provide flexible support for families to respond to their individual needs. Evaluating its effectiveness is problematic because of its complex nature but this survey provided an opportunity for families to share their views at a national level. Conclusions Continued development work can help Portage provision become more accessible and one of the options routinely available to families who have a young child with additional needs. [ABSTRACT FROM AUTHOR]

Background Congenital visual impairment has serious consequences for early development, particularly in those with the most profound impairment. Although there is individual variation, developmental delays and risks, including ‘developmental setback’, are widespread. There is no scientifically robust developmental framework grounded in contemporary theory and scientific knowledge to guide early intervention which may prevent or minimize the risk factors and developmental difficulties. The UK governmental initiative, Early Support, gave the impetus for developing a new developmental framework for babies and young children with visual impairment. Methods This paper reports on the scientific literature that underpins the new framework and the limitations of existing intervention materials. The case for focusing on particular vulnerable areas and developing a new developmental framework, the Early Support Developmental Journal for babies and children with severe visual impairment, is presented. Conclusions The future direction for service delivery and evaluation is briefly described. [ABSTRACT FROM AUTHOR]

This paper explores issues and implications for diagnosis and treatment, stemming from the growing number of children identified with autism spectrum disorders (ASDs). Recent developments and innovations in special education and Medicaid programs are emphasized. Eligibility determination policies, innovations in diagnostic practices, the cost and financing of assessment, variability among programs in diagnostic criteria, and racial/ethnic disparities in the timing of diagnosis all influence the capacity of service systems to provide diagnoses in a timely, coordinated, accurate, economical, and equitable manner. There are several barriers to the more widespread provision of intensive intervention for children with ASDs, including lack of strong evidence of effectiveness in scaled-up public programs, uncertainty about the extent of obligations to provide services under the Individuals with Disabilities Education Act, high cost of intervention, and variability among states in their willingness to fund intensive intervention via Medicaid. Innovative policy experiments with respect to financing intensive intervention through schools and Medicaid are being conducted in a number of states. © 2007 Wiley-Liss, Inc. MRDD Research Reviews 2007;13:129–135. [ABSTRACT FROM AUTHOR]

Autism is a neurodevelopmental disorder defined by impairments in social and communication development, accompanied by stereotyped patterns of behavior and interest. The focus of this paper is on the early development of communication in autism, and early intervention for impairments in communication associated with this disorder. An overview of components of communication is provided. Communication characteristics that are diagnostic of autism are summarized, with consideration of the overlap between social and communication impairment, particularly for children with autism functioning at the prelinguistic level. Early communication development and predictors of communication functioning in autism are examined, based on a review of prospective and retrospective studies. The focus of the discussion then turns to intervention. Consideration is given to the rationale for beginning intervention as early in life as possible for children with autism. Implications of motor, imitation, and play deficits for communication-based intervention are examined. Finally, issues related to the design and delivery of intervention for young children with autism are presented, along with a review of the major early intervention approaches for autism. © 2007 Wiley-Liss, Inc. MRDD Research Reviews 2007;13:16–25. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a survey, which examined how people with psychosis and their carers had experienced local mental health services. The research was conducted prior to the establishment of an early intervention service and other service improvements in the region. The results suggest that the mental health service is improving overall for individuals with psychosis and their carers. The experiences of recent service users and carers seem more positive than those whose first contact with the services occurred during the 1970s and 1980s. Both service users and their carers report feeling largely supported by mental health professionals and voluntary support agencies, and feel included in the treatment approach. However, a number of important issues were highlighted. These include (i) the need for public education (which may help to reduce the delay which currently occurs between people seeking support and receiving treatment); (ii) improved access to alternative treatments, such as psychosocial therapies (in conjunction with pharmacological treatment); the provision of appropriate psychiatric facilities; and (iii) the inclusion of an early intervention treatment approach. The survey provides descriptive information from one NHS trust, which shows support for larger scale research findings and government recommendations. [ABSTRACT FROM AUTHOR]

Behaviour problems make up approximately 30–50% of all referrals to child and adolescent mental health services. Behavioural parent training is one of the most effective interventions for young children. However, those families most at risk of difficulties fail to access services. This paper outlines the Children And Parents Service (CAPS), a citywide multi-agency, early intervention service to young children and their families. The intervention includes parent training groups, multi-agency training and liaison in community settings. The model of service delivery is outlined and the obstacles to service implementation and the strategies used to overcome them are discussed. The service has adopted a well validated evidence-based model of parent training, monitoring of outcomes and user involvement, and is delivered in the wider context of multi-agency systems. A thorough evaluation of service delivery models, including CAPS, would be beneficial. Whilst research trials examine the efficacy of treatments, the effective delivery of treatments within clinical services requires clarity about the place of the intervention within wider systems. The CAPS model proposes a framework for delivering interventions within these systems. [ABSTRACT FROM AUTHOR]

This paper explores the experiences of early intervention for three families in England. The case study research considers parental perspectives and children's experiences of early intervention: what do parents want and what are children's experiences? In particular the ways in which parents and children participate in early intervention programmes in order to support learning will be explained. Case study data includes interviews with four parents. The early intervention experiences of three children with Down Syndrome aged 3–4 years old will be described and placed within the context of early years and inclusive education policy and practice in England ( DfES, 2001, 2003a,b; 2004a; TSO, 2003; QCA, 2000 ). Recent recognition within Government policy towards increased parental involvement in the learning of young children will be considered within the context of inclusive education and early years policy and practice. The ways in which parents are encouraged to be involved in developing the learning of their children and their support from professional services will be considered. The parents’ views and experiences enable a conceptualisation of the implementation of policy and practice, in relation to the opportunities provided and the difficulties encountered. The tensions identified raise questions about whether parents are receiving the kinds of support they need and expect, and in particular whether suitable consideration has been given to the pedagogic models being applied through early intervention programmes. [ABSTRACT FROM AUTHOR]

Objective: The paper presents a comprehensive overview of prospective studies monitoring or intervening in the pre-onset phase of first episode psychosis. Method: A systematic literature search was conducted and supplemented by a manual search. All relevant studies were ordered and intensively reviewed according to specified criteria. Methodological and conceptual issues are discussed. Results: Reports of 23 prospective studies were found, some describing subsamples of larger samples. Major methodological and conceptual divergences exist. Conclusion: Applied criteria detect individuals with a significantly increased risk of psychosis within the schizophrenia spectrum, but these criteria are only validated on clinical populations. The significance of differences in sample-characteristics is unclear. Most study samples are small. Results are preliminary and in need of further research before they constitute a realistic knowledge base. Methodological and conceptual issues should not be underestimated. [ABSTRACT FROM AUTHOR]

Objective: Whereas early detection and therapy of schizophrenic psychoses until some time ago concentrated on frank schizophrenia, during the last years some centres have also started to treat patients even before a clear diagnosis could be established. This paper attempts to discuss if and when this is justified in the light of recent research. Method: Mini review of literature. Results: The rationale for early detection and treatment of schizophrenia is based on several observations: diagnosis and treatment of schizophrenia are often seriously delayed. Consequences of the disease are severe already in the early undiagnosed phase of the disorder and early treatment seems to improve the course of the disease. It can therefore be stated quite safely that patients should be treated as early as possible. However, the question of how early has not been sufficiently answered up to now. Conclusion: We are at the moment in an ethical dilemma between either diagnosing and treating this disorder too late or too early. The only way and prerequisite for solving this dilemma is a more reliable identification of individuals at risk and the beginning disease process. [ABSTRACT FROM AUTHOR]

This article summarizes a symposium held at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, British Columbia, Canada. It was prepared by the conference co-organizers/co-chairs with substantial input from each of the symposium participants. Increasingly, alcohol abuse interventions focus on preventing alcohol problems or intervening early before risky drinking behavior becomes ingrained. Universal prevention programs have produced no or only modest effects on the drinking behavior of youths. Although some existing targeted prevention programs have proved effective, they have not tapped the full range of potential intervention targets, such as the underlying motivations for alcohol misuse in youths who are at greatest risk. The set of papers presented in this symposium outline exciting new developments in the field of targeted prevention and early intervention programs for adolescent drinking problems, presented by an international panel of researchers. These developments include attention to making interventions relevant to adolescents' lives, focus on personality and motivational factors underlying alcohol misuse, and combining existing cognitive behavioral programs with expectancy challenge and motivational interviewing techniques. [ABSTRACT FROM AUTHOR]

Recent legal and policy changes, including the introduction of the Human Rights Act, provide the context for the new child welfare and protection policies proposed for England. These proposals are discussed from a legal perspective in relation to early and coordinated intervention, sharing information between agencies and with children and families, partnership with children, information management, and structural and legal change. Consideration is also given to issues overlooked by the Green Paper, such as immigration and asylum, youth justice and the whole family justice system. The discussion concludes by arguing for the need for integrating cultural and structural change and for leadership (and investment of resources) across government to achieve such goals. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To identify and discuss methodological pitfalls that may help explain why many questions around early detection (ED) and duration of untreated psychosis (DUP) are still unsolved. Method: This paper concentrates on pitfalls in the following areas: sampling, measurement and data analyses. Results: The main problems seem to be: Sampling: Referral bias, exclusion of patients, patient refusal, and patients lost to follow-up. Measurement: Reliability, which is particularly cogent for multisite investigations, and validity, which includes: Start of illness, start of psychosis, diagnoses, start of treatment, the relationship between ED and DUP and choice of outcome measures. Data analyses: Overlooking threshold effects of DUP, improper control for baseline scores, and lack of control for confounders. Conclusion: Methodological pitfalls may bias ED studies. Several pitfalls are unavoidable, but proper design and quality assurance can reduce their impact. Researchers ought to identify the pitfalls, and to estimate and discuss their influence. [ABSTRACT FROM AUTHOR]

Objective: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). Results: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. Conclusion: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic. [ABSTRACT FROM AUTHOR]

Abstract Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers’ attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child’s sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed. [ABSTRACT FROM AUTHOR]

Maternal directiveness is portrayed as a negative interactional phenomenon in the mental retardation literature. Based on the speculation that a directive interactional style is causally related to poor developmental outcomes, the reduction of maternal directive behaviour is becoming a major thrust in early intervention work. This paper questions the characterization of directiveness as an inherently negative interactional phenomenon and highlights limitations in our current understanding of directiveness. Critical issues requiring attention in future research are identified and early interventionists cautioned that management of maternal directive behaviour must be founded on sound, empirically validated principles. [ABSTRACT FROM AUTHOR]

Research on methods to enhance and remediate the communication and language development of children with mental retardation and developmental disabilities has been ongoing since the early 1960s. Scores of studies have been conducted over this time period, the vast majority aimed at testing various procedures or intervention “packages” with relatively small numbers of children for very limited periods of time. This “technology building” period is gradually receding and the framework of a developmental model of early communication and language intervention is emerging. This model supports the use of different intervention approaches at different points in a child's development. The purpose of this paper is to describe the basic framework of this emerging model, to provide an overview of the research findings that support it, and to identify high priority areas for further investigation. MRDD Research Reviews 1997;3:358–362. © 1997 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Developmental therapies in children with cerebral palsy have been a traditional mainstay of treatment. Their use is part of mandated intervention programs in every state. Until recently, however, research into the effects of these interventions has been limited both in scope and quality. This paper reviews the status of research into the effects of developmental therapies, using physical therapy in cerebral palsy as the model. Recent studies have not demonstrated consistent treatment effects in cerebral palsy, but the quantity and scope of the research is insufficient to make global statements about treatment effect. Directions for future research should include multi-center clinical trials incorporating no-treatment control groups as well as single-subject studies to generate hypotheses for larger studies. A wide variety of parameters of the subject–treatment interaction may affect treatment outcome and should be investigated. These include treatment timing, intensity, parent involvement, treatment combinations, and the profile of the child's associated disabilities. Study cohorts at extreme risk for cerebral palsy can be identified through neuroimaging and may allow evaluation of very early treatment effects. Studies evaluating a wide range of measures, including functional and economic outcomes, are necessary if decisions about program support are to based on treatment effectiveness as well as cost. MRDD Research Reviews 3:145-152, 1997. © 1997 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

For many children and families, a multidisciplinary team evaluation is their introduction to special education systems. Increasingly, federal guidelines man-dating parent involvement in all aspects of service provision have meant that parents are being asked to participate as part of the evaluation team. If families and professionals are to serve as partners in the evaluation process, mutual respect and understanding of one anothers' perspectives will be crucial. This paper uses survey data from 39 parents and 81 professionals to examine the various expectations and perceptions brought by participants to the assessment process. Results indicated that there is substantial variability of perceptions among parents and professionals about the nature of child assessment and their respective roles in it, implications for research and practice are discussed, along with techniques for involving families in the assessment process in more meaningful ways. [ABSTRACT FROM AUTHOR]

Aim Mental health is a major concern among adolescents. Most mental illnesses have their onset during this period, and around 14% of all young people aged 12 to 17 years experience a mental illness in a 12-month period. However, only 65% of these adolescents access health services to address their mental health problems. Approximately 70% of all Australian adolescents participate in sport, and this presents an opportunity for mental health promotion. Methods This paper reviewed current approaches by sporting organizations to mental health promotion, prevention and early intervention by searching peak body websites, as well as the wider Internet. Results Findings revealed many of the sport organizations reviewed acknowledged the importance of mental components of their sport to increase competitiveness, but few explicitly noted mental health problems or the potential of their sport to promote good mental health. Although some had participated in mental health promotion campaigns, there was no evaluation or reference to the evidence base for these campaigns. Conclusions We describe a framework for integrating mental health promotion into sports organizations based on the MindMatters programme for schools. [ABSTRACT FROM AUTHOR]

Objective The purpose of this paper is to explore the relationship between binge eating disorder (BED) and obesity. Methods Recent literature relating to the etiology, risk factors, pathophysiology, and treatment of binge eating disorder was reviewed. Results The data suggest that binge eating may be a contributor to the development of obesity in susceptible individuals. Although eating disorders treatment in the absence of obesity treatment does not result in large weight losses, amelioration of binge eating does result in small weight losses and decreased weight regain over time. Discussion Our challenge in the future is to understand better the ways in which BED and obesity co-exist, and to find treatment strategies that will relieve the distress and dysfunction due to this disordered eating while enhancing appropriate weight loss or preventing further weight gain. Published 2003 by Wiley Periodicals, Inc.[sup †] Int J Eat Disord 34: S117–S120, 2003. [ABSTRACT FROM AUTHOR]