Early intervention 早期培育 Chow Chun Bong 周鎮邦

Children, Youth and Violence: Searching for Solutions "Early life experiences have disproportionate importance in organizing the mature brain and are directly connected to children's optimal development." B.D. Perry, M.D. from: Incubated in Terror: Neurodevelopmental Factors in the ‘Cycle of Violence’," Children, Youth and Violence: Searching for Solutions The quality of caring a child receives in the first three years of life is the single most important factor other than genetics influencing that child's development. Paul. D. Steinhauer, M.D, Chair, Voices for Children from: Kaleidoscope Magazine, Hospital for Sick Children "The interest in ‘early education as prevention' is coming from those in industry who are concerned about the quality of the future work force, from families searching for adequate child care, and from private citizens who are concerned about the quality of life." D.P. Weikart, from: Early Childhood Education and Primary Prevention, Prevention in Human Services

Summary 簡介 Early child development – From neuron to neighbourhoods兒童的早期發展 Early intervention 早期干預的成效 Examples 例子 Down syndrome 唐氏綜合症 VLBW 早產兒

父母對兒童發展的誤解 兒童對周遭環境的認知和感應 最有益的遊戲 對兒童的期望 管教和溺愛 不了解何時開始有感應 不清楚她們何時受到父母情緒的影響 不相信6月大的嬰兒有長遠記憶- 早期目睹的家庭暴力對她們會有長遠影響 不知到嬰兒也會抑鬱 最有益的遊戲 對兒童的期望 相信不少幼兒行為是出於報復 管教和溺愛 不理解體罰和責罵對小孩的影響

From Neurons to Neighborhoods: The Science of Early Childhood Development 由腦細胞到鄰舍 – 兒童早期發展的科學 Committee on Integrating the Science of Early Childhood Development Board on Children, Youth, and Families Institute of Medicine National Research Council October, 2000

Putting the Study in Context 近年在腦神經科，行為及社會研究方面得到重大發展 如果不能好好應用此等成果，兒童的未來將會受到影響 Explosion of knowledge in neurobiology and the behavioral and social sciences Marked variations in the social and economic circumstances under which families are raising young children throughout the world At a time when scientific advances could be used to strengthen early childhood policies and practices, if knowledge is dismissed or ignored children suffer the consequences

CONCLUSIONS 結論

兒童腦部發展在早期非常快速 經驗會決定甚麼連接會持續及發展， 常用的連接會增強，較弱的神經線連接會被取締． 這樣我們的腦神經會適應周圍環境． 新生: 每一腦細胞有2,500神經線連接 2-3 歲時:每一腦細胞有15,000神經線連接 成年後:每一腦細胞有8,000神經線連接 經驗會決定甚麼連接會持續及發展，　常用的連接會增強，較弱的神經線連接會被取締．　這樣我們的腦神經會適應周圍環境．

Core Concepts of Development Human development is shaped by a dynamic and continuous interaction between biology and experience. 人類發展是通過生理和經驗不斷互動、互相影響下成長的。 Culture influences every aspect of human development and is reflected in childrearing beliefs and practices designed to promote healthy adaptation. 育兒文化和信念對各方面的成長都有重要的影響． The growth of self-regulation is a cornerstone of early childhood development that cuts across all domains of behavior. 自我調適的成長是兒童成長的碁石　 Children are active participants in their own development, reflecting the intrinsic human drive to explore and master one‘s environment.　兒童本身是自己發展的積極參與及推動者． Human relationship‘s and the effect of relationships on relationships, are the building blocks of healthy human development. 人與人之間的相互關係是健康成長的基礎．　

The broad range of individual differences among children often makes it difficult to distinguish typical variations and maturational delays from transient disorders and persistent impairments. The development of young children unfolds along individual development pathways whose trajectories are characterized by continuities and discontinuities, as well as by a series of significant transitions. The development of young children is shaped by the ongoing interplay among sources of vulnerability and sources of resilience. The timing of early experiences can matter, but, more often than not, the developing child remains vulnerable to risks and open to protective influences throughout the early years of life and into adulthood. The course of development can be altered in early childhood effective interventions that change the balance between risk and protection, thereby shifting the odds in favor of more adaptive outcomes.

Panel Conclusions 結論 傳統的先天對後天的理論己不合時宜。 後天環境明顯影晌腦部展 – 早在胎兒時期開始直致成年。 The traditional nature versus nurture debate is simplistic and scientifically obsolete Environmental influences clearly affect brain development, beginning well before birth and continuing long into adulthood Early intervention programs can improve the odds for vulnerable children, but those that work are rarely simple, inexpensive, or easy to implement 傳統的先天對後天的理論己不合時宜。 後天環境明顯影晌腦部展 – 早在胎兒時期開始直致成年。 早期訓練可以改善高危兒童的機會，但通常都是複雜，昂貴和不易實施的。

Panel Conclusions 結論 幼兒的感覺和思考同樣重要 健康的早期發展依賴培育和穩定可靠的關係 How young children feel is as important as how they think, particularly with regard to their readiness for school Healthy early development depends on nurturing and dependable relationships Culture influences all aspects of early development through child-rearing beliefs and practices 幼兒的感覺和思考同樣重要 健康的早期發展依賴培育和穩定可靠的關係 文化會透過育兒信念和行動影響兒童各方面的發展

Panel Conclusions 結論 全無證據顯示”特殊刺激”活動可促進腦部發展 There is little scientific evidence that special “stimulation” activities, above and beyond normal growth-promoting experiences, lead to “advanced” brain development in early childhood Substantial scientific evidence indicates that poor nutrition, specific infections, environmental neurotoxins, drug exposures, and chronic stress can harm the developing brain Significant parent mental health problems, substance abuse, and family violence impose heavy developmental burdens on young children 全無證據顯示”特殊刺激”活動可促進腦部發展 很多證據顯示營養不良，特別感染，藥物和長期受壓可以傷害腦部發展 父/母患有精神病，濫用藥物和家庭暴力對兒童發展有嚴重傷害

A CRITICAL PERSPECTIVE ON THE SCIENCE OF EARLY CHILDHOOD INTERVENTION

Essential Features of Effective Interventions 有效干預的特質 Individualization of service delivery Quality of program implementation Provider knowledge, skills, and relationship with the family Family-centered, community-based, coordinated orientation Timing, intensity, and duration of intervention 個人的 優質的 員工的知識，技巧和與家庭的關係 以家庭為中心，基於社區和協調的 時刻，密度和時間

Persistent Challenges Facing The Field of Early Childhood Intervention 早期培育的挑戰 Increasing access and participation Ensuring greater quality control Defining and achieving cultural competence Identifying and responding to the special needs of distinctive subgroups Influencing and assessing the impacts of post-intervention environments Reducing fragmentation and strengthening the service infrastructure Assessing costs and making choices among early childhood investments 更多的參與 文化的保育 適當回應特殊需要 質素的保持 改善干預後家庭周遭環境 減少服務分割和加強服務的機能 效益評估及多樣化

How do children develop? 兒童如何發展 體能發展 – 大肌肉 : 跑 ,跳. 小肌肉 : 剪 , 貼 智能發展 – 學習思考和如何解決問題. 情緒發展 -學習 , 體驗,認知 , 表達和控制感覺 社交發展 -學習如何與人相處. To encourage children’s best development, we need to understand the various ways they grow. Children‘s physical development includes learning large muscle skills like jumping and running, and small muscle skills like cutting and pasting. Intellectual development involves children‘s increasing ability to think and solve problems Emotional development is about learning to experience, identify, express and control feelings. Social development means learning how to relate to others

What do children need for healthy development? 健康成長的原素 To thrive, children need a healthy physical start, enough to eat, and warmth and affection. 。 To help their intellectual development they need a safe and stimulating environment where they can play, learn and explore. They need encouragement and guidance from adults. 健康的開始 – 食物，溫暖和愛護 安全，多采多姿的環境去學習，遊玩，探索。 鼓勵，輔導。

Why are the early years so important? 早年經驗的重要性 The earlier children experience good care, the longer their developmental gains last. Early childhood experiences have powerful effects on the development of children‘s physical and emotional abilities and influence their abilities in math, logic, language and music. New research indicates that infant brain development during the first years of life depends on that infant’s environmental experience. The brain develops according to the quantity and quality of the stimuli it receives Daily exercise increases nerve connections in the brain. This makes it easier for children to learn. 早期培育對長期發展非常重要 早期經驗對兒童的各種能力發展有重要影響 兒童腦部的發展和他們的早年經驗有重要關係 腦部發展依賴早年經歷的質量和質素 每天運動增加腦部聯系，增強學習能力

早年經驗的重要性 學習臨界 增加小孩的詞彙 從小教導數學理念可增加長大後的數學技巧 音樂培訓可爭強小孩思考和做決定的能力 development when it is especially open to certain kinds of learning. The more words a child hears by age two, the larger his/her vocabulary will grow. Research indicates that toddlers taught simple math ideas, like bigger or smaller, and more or less, do better in math when they are older. Early music lessons help develop skills which later improve a child’s ability to think things through and make decisions. The brain continues to develop and mature in many areas, but patterns of behaviour and emotional response set in the early years are very difficult to change or make up for in other ways. 學習臨界 增加小孩的詞彙 從小教導數學理念可增加長大後的數學技巧 音樂培訓可爭強小孩思考和做決定的能力 早年形成的行為模式將持久很難改變

對幼兒的成長最重要不是玩具或音樂， 最重要的是關切和愛護的親子養育 Sensitive parenting—not educational toys or Mozart CDs— provides the essential catalysts for early intellectual growth. Language enables children to put their developing ideas and concepts into words they can share with others, and language revolutionizes thought by giving children access to the concepts, ideas, and values of other people. Nothing focuses a young child’s attention on what other people are thinking or feeling more than the realization that a conflict must be resolved The irreducible core of the environment during early development is people 對幼兒的成長最重要不是玩具或音樂，　最重要的是關切和愛護的親子養育 語言可幫助孩子把思考和理念表達出來。語言亦可幫助孩子理解他人的理念。 糾紛對孩子有嚴重影響。要適當解決糾紛。 家庭成員是兒童成長的核心。

早期培育計劃必須平衡思考、讀算技巧和情緒、社交發展的培訓，這對有特殊需要者尤為重要 Need for Comparable Attention to Cognitive, Emotional and Social Developmental Needs 同樣重視思維，情緒和社交發展 早期培育計劃必須平衡思考、讀算技巧和情緒、社交發展的培訓，這對有特殊需要者尤為重要 必須重視有嚴重傷殘幼兒的問題(尤其患有行為/精神問題) – 使得基本醫療、早期教育和早期教育服務有緊密聯系。 Early childhood programs must balance the focus on cognition and literacy skills with comparable attention to the emotional and social development of all children, including those with special needs Greater commitments must be made to address significant developmental disabilities, including serious mental health problems, in young children by establishing clear linkages among primary health care, early education programs, and early childhood intervention services

What are the effects of high quality child care? 高質素幼兒培育的好處 High quality child care and early childhood education can improve children’s chances for success in later life. The care that children receive in the early years influences whether or not they will succeed when they begin school. Children who do not get good care when their parents are not available have decreased language and social skills. Readiness to learn in kindergarten is the best indicator that children will do well in school. The care that children receive helps them to: understand and use language 明白和應用語言 control aggression 控制情緒 play and work with other children 交朋結友 accept adult direction 接受意見 focus attention and do things independently. 集中精神，獨立做事

Why should we care that all children get the best care? The social and learning skills children need for success in school and work begin to develop in early childhood Several studies show that good pre-school programs can improve how children do in school, especially children who face such disadvantages as poverty, poor housing and food, parents with mental illness or other problems. Good early child care can reduce later anti-social behaviour, delinquency and crime. Recent research links trouble-making behaviour in young boys with later anti-social behaviour. It has found that good early education programs have a strong, long-term impact on decreasing anti-social behaviour in teenage boys. 很多社交，學習技巧在兒童早年時期已經開始發展 優質的學前教育可促進學習能力 良好的早年培育可減少青少年期的反叛和犯罪行為

Why is high quality child care a good investment? The benefits from early childhood care and education programs far exceed their cost. A four year Swedish study found that children entering daycare at an early age did a number of important learning and social tasks significantly better than children who were older when they started daycare. Money spent on Head Start early education programs in the United States has decreased the need for spending on special education, welfare, teen pregnancy, delinquency and crime. 早期培育的成效遠超過它的成本 一瑞典研究證明幼兒教育可增強學習能力 美國研究也顯示幼兒教育可減少特殊教育及其他的經費

Conclusion 總結 早期經驗對小孩成長的重要性 情緒和社交的發展的重要性 優質的早期教育的重要性 親子培育的重要性 促進健康和預防傷害的重要性

早期訓練服務 目標：－ 為患有殘疾的孩童計劃和發展一全面的、 協調的、多元化的、並以家庭為中心的早期訓練服務。 需要整合醫療，健康教育和社會的服務。

誰提供服務 ？ 聽覺治療師 特殊教師； 家庭治療師； 治療師； 護士； 心理學治療師； 營養師； 社會工作者； 兒科醫生和其他的醫師 職業治療師； 語言治療師。 最重要的是父母

結果- 唐氏兒童 身體健康 * 加入計劃的年齡與住院治療頻率有關 (p＝0.03） * 早期訓練有較好的生長 - 高度和重量 * 加入計劃的年齡與住院治療頻率有關 (p＝0.03） * 早期訓練有較好的生長 - 高度和重量 （p＝0.009 r＝0.67) 社會健康 -家人接受程度 * 參加計劃後明顯地促進家人的接受程度 （p＝0.005） * 出席率和家人接受程度有聯系 （p＝0.001 r＝0.8） 家人接受程度和身體健康和發展程況 * 較好的接受程度有較好的生長 （p＝0.018 r＝0.62） * 參加計劃的孩子明顯地有較佳的發展

早產兒在醫院的早期訓練計劃 主旨 1. 小心、耐心照顧 2. 各種觀感刺激 - 減少不必要打擾 新生兒早期訓練計劃結果 –袋鼠Kangaroo care , 按摩 , 代乳 短時期 （6-12 個月） 在生長及發展上的 （氧需求， 住院治療期間） 均獲益。 但是過度刺激能引致神經緊張和生理系統不安定(hypoxia，apnoea 和 bradycardia)。

新生兒早期訓練計劃 1. 個別化，功能化﹐及注意嬰兒的個別狀況。 2. 看護人員和父母能認識嬰兒在各種情況的表徵 3. 提高父母-嬰兒的親子關係 4. 減少過度的打擾 5. 促進父母親的參與 6. 週期性的健康和發展上的追蹤 新生儿早期訓練計劃成功的因素 ＝ 幫助父母學到怎樣照顧他們的嬰兒 1. 家庭得到廣泛的支持 2. 父母積極參與新生儿早期訓練計劃

Programme design 成功的設計 積極專業; 早期開始; 高質素 – 幼兒對老師比例,課程; 父母的參與; 以兒童為中心 Intensity of service Onset and duration Quality - program quality depends on small group sizes, high ratios of staff to children, trained and well-supervised teachers, and developmentally appropriate curricula. Child focused and involving parents