Why Early Intervention
T. Berry Brazelton, M.D.
We need more sophisticated methods for assessing neonates and for predicting their contribution to the likelihood of failure in the environment-infant interaction. The possibilities for synergism toward a failure in interaction between an infant who is not rewarding and an already stressed environment seem obvious. We also must be able to assess at-risk environments, for the impracticality of spreading resources too thinly points to the necessity of selecting target populations for our efforts at early intervention. With better techniques for assessing strengths and weakness in infants and the environment to which they will be exposed, we might come to understand better the mechanisms for failures in development. Even when desperate socioeconomic conditions produce comparable stresses, in many families children do not have to be salvaged from the clinical syndrome of child abuse, failure to thrive, and Kwashiorkor syndrome. Minimally brain-damaged babies do make remarkable compensatory recoveries in a fostering environment. Understanding the infant and the problems he will present to his parents may enhance our value as supportive figures for them as they adjust to a difficult child.
In other words, there appear to be at least two sources of vulnerability that contribute to the risk of failure in developmental outcome, the baby's own organizational system and capacity for growth—central nervous system and autonomic as well as physical—and the capacity of the environment (usually represented by the parents) to adjust to and nurture the at-risk infant in ways that are appropriate to individual needs. If the interaction between these two is positive, the opportunities are significantly increased for fueling feedback cycles necessary to the baby for developing energy for developmental progress.
An understanding of the forces that work toward a child's development is critical to an understanding of the child's failure and toward any effort to prevent such failure. At least three forces are constantly at work (see figure 28-1.).
AUTONOMIC NERVOUS SYSTEMS
Maturation of the central and the autonomic nervous systems, which regulate the baby's capacity to control reactions to incoming stimuli,____________________
The work reported here was done in close collaboration with Heideliese Als, Ph.D., Barry M. Lester, Ph.D, and Edward Tronick, Ph.D.