To understand the role of early attention We must understand the role we must take into account that the development of children is a complex process of biological, psychological and social evolution, the result of the interaction between genetic and environmental factors. During this stage many skills related to the perceptive, motor, cognitive, linguistic and affective-social aspects of the child are formed.
This is a critical period during which the nervous system Has a high plasticity, that is, it can be altered by some external or internal cause. The risks that children may have of presenting a future developmental disorder may be biological or social.
It is considered biological risk those children who have been subjected to situations such as being premature, have low weight or present Anoxia at birth. On the other hand, psycho-social risk refers to the social conditions surrounding the child, such as lack of care or intra-family interactions, abuse, neglect, abuse...
In turn, plasticity is related to the capacity for organic and functional recovery and reorganization. But OJO!, this capacity decreases later and will be fundamental the early detection, the beginning of the interventions and of course the family involvement.
This is where early attention is of interest. It is a set of interventions whose purpose is to respond to the transient or permanent needs of these children, as soon as possible, optimizing and compensating for the deficits.
The objective is that they can reach an adequate maturity in all areas, as well as a high level of personal and social development. It is necessary to take into account the child in its entirety and the participation of an interdisciplinary team (professionals share information) and transdisciplinar (professionals acquire knowledge of other disciplines).
Historical aspects
The TA began in Spain in the 1970s by numerous parents' associations with children with difficulties. Beginning in the 1980s, the State began to create early care centers, formerly known as early stimulation.
In 2000, the Early Warning Group (G.A.T.) was set up with the objective of elaborating the White Paper on Early Care and to overcome the possible lack of coordination that could occur among different professionals, associations, families and resources. It sought to ensure fundamental aspects in this area such as interdisciplinarity, globality, coordination and quality.
The ODAT, or diagnostic organization for early care, based on the AT White Paper, integrates existing classifications, organizing them according to reality and needs. It takes into account the bio-psycho-social approach, the 1st, 2nd and 3rd prevention (detection, diagnosis and treatment) and the common language among the professionals who work. It attends to the peculiarities and peculiarities of the children population from 0 to 6 years susceptible of AT. The Junta de Andalucía was the first organization to try to unite ODAT and ICD-9.
Objectives of Early Care
The following key objectives have been proposed to work towards:
-The adoption of measures for PREVENTION, both primary, secondary and tertiary.
-The EARLY DETECTION of the risks of deficiencies. Detect if the child behaves, reacts and relates as expected to his age, analyzing and describing the strengths and weaknesses of him and his environment.
- SWOT ANALYSIS:
- D: Weaknesses
- A: Threats
- F: Strengths
- O: Opportunities
- INTERVENTION as a process aimed at achieving maximum physical, mental and social development. For example:
- Reducing the effects of deficits and optimizing the overall course of child development.
- Using mechanisms of compensation, elimination of barriers and adaptation to specific needs.
- Avoiding or reducing the side effects caused by a disorder or risk situation.
- Take into account the family and in the child's environment, considering the child as an active subject of the intervention.
How to evaluate in early care?
To begin with, it is necessary to evaluate the child and his environment, both family and school. The more information we have at our disposal, the more we can evaluate it. The evaluation will begin as soon as possible and will be done at the beginning, to confirm what the parents say and in the middle, to see how the child is evolving.
Areas to evaluate
As for the Aspects to be evaluated in the child The cognitive area, the motor area (gross and fine motor), the area of language (comprehension and expression), the socio-emotional area and the adaptive or self-care area must be taken into account.
The last two are usually evaluated through questionnaires filled out by parents. In this way we will obtain information about the child's behavior (anxiety, mood, somatic complaints) and personality (internal and external conflicts, temperament, relationship with father and mother, place in the family...).
It is also important to evaluate additional aspects in the child, through observation. These are: self-regulation Which modulates attention and control of impulses; Persistence or repeated attempt to perform any action; The anticipation of failure, that is to say when the child has to face a task that he knows he will not get; Tolerance to frustration, or how the child continues despite accumulating successive experiences of failure; Flexibility or the extent to which alternatives are sought for solving problems; Motivation or degree of enthusiasm and excitement about new games and the interactivity or degree of relationship of the child with both the evaluator and his / her family.
An interesting aspect is the corrected age. This refers to the age the child would have if he had been born at term, that is at 40 weeks of gestation. This is important to take into account to evaluate not only growth but also the development of mental, motor, behavior and language. An illustrative example is if your child was born at week 28, was 12 weeks (3 months) premature. If you are now 6 months old (24 weeks from birth), your corrected age is 24 weeks - 12 weeks = 12 weeks (3 months).
With respect to Evaluation within the family environment , It is important to attend to the current emotional state. That is to say, it is a family that is going to have a baby, for 9 months they have fantasized about what their son will look like, but after birth a child is born that is not what they expected. The family passes a duel, and alomejor the father and the mother go to different rhythms of recovery, that has to be taken into account.
We must also take into account the needs and resources of families, for example, if they live in a city or town; If they have extra stress such as having someone unemployed in the family, having other children...; If they have sources of support such as a grandmother who can be commissioned during the child's working hours...
Finally, the parent-child bonding and the existing attachment is fundamental, it will be evaluated if it is safe, insecure, ambivalent. In addition, the feeling experienced by the evaluator by the projection of the family and the child will be fundamental and can serve as a guiding guide.
At school environment Will it be important to evaluate the willingness to collaborate and / or share information, as well as the resources they have, does the child have a teacher of therapeutic pedagogy and a psychologist? Is the tutor available when needed? Curricular adaptation in class? It must be taken into account that parents often refuse to let the school know anything about the fear of being labeled with their child.
Difficulties associated with evaluation
In view of the possible difficulties that the child may present during the performance of the task, it is advisable to leave the task even if it has not fulfilled the time required by it and is not going to be scored. It is necessary to establish the ceiling of the test, and for this you will have to face tasks that the subject is not able to solve.
It is also important to observe how the child reacts to the accumulation of failures. In addition, it must be taken into account that the development of a child is staggered, and during it combine advances with stops and even setbacks. Sometimes these are produced to strengthen previous advances or even recover from hospitalization.
Evaluation techniques and instruments used
Different instruments are available that can be used to confirm the initial hypotheses based on the child's history, and to evaluate both the deficits and the child's abilities and abilities.
- Observation of spontaneous and reactive behavior in situations and stimuli presented, as well as the relationship with parents and the professional that evaluates. And observation at home.
-Evaluation in school context: relationship with peers and teacher.
- Physical examination and neurological and functional assessment of the child.
- Standardized tests, which I will comment on below.
-Additional tests.
In addition, in the beginning an in-depth interview with the family of the child's medical history will be carried out, where questions will be asked as risk factors in pregnancy, delivery, postpartum, diagnostic tests and diagnostic impression.
Information about evolutionary data will also be collected as a head support (basic ability to raise the head, to explore, to know the world around him and then to walk), social smile, voluntary grasping, voluntarily sitting, crawling or crawling, , Chewing, first steps, first words, first sentence and other evolutionary milestones.
I will now go on to discuss the instruments most used in early care, to evaluate neonates, development, behaviors and personality.
To assess the behavior, attention will be paid to the behavior of the subject during the evaluation, as well as questionnaires completed by parents and teachers.
Examples include the Child Behavior Check List or CBCL, which is a list of children's behaviors that evaluate both internalizing behavior, where children direct their emotions and feelings inwardly. That is, we could talk about problems of anxiety and depression, somatic problems and withdrawn behavior.
Outward-directed behavior directed towards the outside as aggressive or delinquent behavior. And finally social problems, attention and thought, which may be present in these children. BASC, which is a behavioral assessment system for children and adolescents, can be used to measure numerous aspects of behavior and personality, including both positive (adaptive) and negative (clinical) dimensions.
Regarding the personality evaluation, projective tests can be used from the age of 3 years onwards. But... what are the projective tests?
These are instruments that stimulate the subject's imagination, where there are no right or wrong answers, and reveal unconscious aspects of behavior. There are different subtypes. Some of the most used in early childhood care to evaluate these children are as follows. For example, thematic, where the goal is to tell a story from the visual presentation of sheets. Within this subtype we find the black paw test.
On the other hand, expressive or graphics, where children must write or draw. For example: the drawing of Corman's family; The Buck House-Tree-Person Test (HTP) or the Winnicott Scribble Game, which allows us to see if the child perseveres in the same or if he is creative.
Finally, the associative ones, where the objective is to emit answers that are associated with the stimulus, for example the fables of Düss.
Final reflection
Throughout this article I have tried to offer a vision of the difficulty of working with children with developmental difficulties and the difficulty of evaluating them in early care.
In addition, society's commitment to the protection of these children is very important, and in this way, and with the collaboration of all, they will be able to attend to the inequalities that they present and the right to achieve an evolutionary development can be guaranteed. As standardized as possible and a full and independent life.
Bibliography
- State Federation of Associations of Early Care Professionals (GAT), (2005), Early Care White Paper . Madrid Spain. Real Board of Disability.
- State Federation of Early Care Professionals Associations (GAT), (2008), Descriptive manual Odat. Update 2008. Madrid Spain. Real Board of Disability.
- Fernández-Ballesteros, R., (2011). Psychological evaluation: concepts, methods and case studies. (2nd ed.). Madrid Spain. Pyramid.
- Moreno Rosset, C., 2005). Psychological evaluation: theories and practices. (2nd ed.). Madrid Spain. Sanz and Torres.