8th World Congress
Amsterdam, The Netherlands
Short Abstracts - Day 1, Tuesday#13
DC: 0-3: CROSS-CULTURAL CHALLENGES IN RELIABLE DIAGNOSIS.
Thomas, J., Risholm Mothander, P., Grette Moe, R., Clark, R., Department of Psychiatry, Children’s National Medical Center, 111 Michigan Ave., N. W., Washington, D.C., USA jmthomas@cnmc.org
This workshop highlights ongoing WAIMH and worldwide work with the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Zero to Three, 1994) (DC: 0-3). The workshop will facilitate cross-cultural focus on challenging diagnostic and reliability issues for experienced clinicians using the DC: 0-3. Workshop presenters and participants will share approaches to challenges in reliable diagnostic decision-making in the clinical setting. These challenges include: 1) systematic protocol requirements; 2) organization of observations to elucidate developmental difficulties and the adaptiveness of caregiver-child relationships; and 3) systematic data collection, given the clinician’s responsibility to be flexible to family perspectives and style and to intervene optimally. Presenters, experienced cross-cultural collaborators, will facilitate this exchange through analysis of two complex cases, one from Scandinavia and one from the United States.
#15
EVALUATING PARENT – INFANT PSYCHOTHERAPY EFFICACY BY MEANS OF DC: 0-3.
Martelli M., Collini M., Gentili C., Knauer D. Clinique de Psichiatrie de l’Enfant e de l’Adolescent, Ch. Des Crêts-de-Champel 41, CH-1206 Genève Switzerland
The present paper intends to illustrate the outcome of brief parent – infant psychotherapy in a sample of children who were referred to the “Centro per la Prima Infanzia” in Bologna (Italy) with different primary concerns. The clinical activity of the Center concerns with mental health during early childhood and focuses on the assessment and treatment of parent/s - infant relational disorders. The clinical data concerning 58 children who attended the Center and were treated with brief parent/s -infant psychotherapy is presented. Of these, 37 cases went through a brief mother-infant psychotherapy, according to the Geneva model (PTBMB) and 21 were treated with other guide relational therapies. The protocol provided the use of the pre and post-therapy DC:0-3 clinical record, and for a sub-group of children, a follow- up evaluation. Preliminary data on a group of children with regulatory disorders according to the DC:0-3 criteria and treated with brief parent-infant psychotherapy are also presented. The results confirm that the DC: 0-3’s axis I and II are strongly related and suggest that the parent – child relationships provide one of the most powerful protective factors.
#16
INFANTPSYCHIATRY IN ANTWERP: A DESCRIPTION OF THE PROTOCOL, CLINICAL POPULATION AND AN EVALUATION OF THE 0 - 3 CLASSIFICATION.
Van hee, Magda; Dr. Van Wetswinkel, Ulla; Naessens, Birgitt; Vits, Gert & Prof. Dr. D. Deboutte (Van hee, Magda: Tamara.Buyens OCMW.Antwerpen.be)
Since october 1999, the infantpsychiatric unit of the Center for Child and Adolescent Psychiatry of the University of Antwerp (U.C.K.J.A.) started. Since then about 400 children with a variety of psychiatric disorders or social/emotional problems came to consult with their parents. In our presentation an overview of this population will be shown.
We will share our diagnostic protocol, which includes an intake, the collection of anamnestic information, several observations of the child in its interactions with parents and therapists, and, when indicated, the evaluation of language and cognitive development.
For diagnoses, we use the “zero to three classification”. In doing so, we became convinced of its value but nevertheless came across some difficulties. These will be discussed.
When possible, we will highlight our general therapeutic approach as well as our approach of specific topics (feeding and sleeping disorders, home-training).
#17
DC 0-3 CLASSIFICATION OF CHILDREN 18 MONTHS OF AGE IN A POPULATION BASED EPIDEMIOLOGICAL STUDY.
Houmann T*, Skovgaard A.M, Christiansen E, Landorph S, Heering K, Nielsen S.K, Jørgensen T.*Child and adolescent Psychiatric Department, University Hospital of Copenhagen, Glostrup, Denmark E-mail: thou@glostruphosp.kbhamt.DK
Objective: To study the prevalence of developmental disorders and mental health problems in children 18 months of age, and the distribution of DC 0-3 and ICD-10 diagnostic categories in a general population sample.
Methods: As a part of The Copenhagen County Cohort DK 2000 (n= 5560 children born in 2000) 400 children are sampled for a standardized clinical psychiatric assessment at the age of 18 months. The cases are 200 children screened by the public health nurses as having developmental problems, or problems in the mother-infant relation. The controls are a random sample of 200 children screened without problems. The clinical assessment consists of: Clinical observation and videotape recordings. The Bayley Scales of Infant Development, The Parent-Child Early Relational Assessment (ERA) a standardised parent interview including ASEBA (CBCL) 18 months-5 years, Infant-Toddler Symptom Checklist, CHAT, temperament, general health and sociodemographic items. Infant mental health disorders are classified according to DC 0-3 and ICD-10.
Results: The study runs from juli 2001–juli 2002. Among the children examined until September 01 a fourth fullfilled the criteria for the following DC 0-3 diagnoses: Traumatic Stress Disorder, Regulatory Disorder, Adjustment Disorder, Multisystem Developmental Disorder-type C, Sleep Behavior Disorder, Anxiety Disorder, Retardatio Psychomotorica. The participation has been 63 %, and preliminary analyses shows that cases are represented with …% and controls with …%.
The prevalence of infant psychiatric disorders in the study population, and the diagnostic distribution of DC0-0-3 and ICD-10 diagnoses will be presented at the conference July 2002.
#18
WHEN DOING IS SAYING: BIRTH RITUALS AND MENTAL REPRESENTATIONS OF INFANTS AMONG IMMIGRANT MOTHERS.
Coyer G. Laboratoire d'Anthropologie Sociale, CNRS, EHESS, Collège de France, Paris, France. gilbert.coyer@wanadoo.fr
In all cultures, birth rituals serve as a support for mental representations of conception, pregnancy and the newborn. An observation of African primiparæ, patients of the French prenatal and pediatric public health facility (PMI), shows how difficult it is for these immigrant mothers to adapt to the western mode of giving birth. A longitudinal observation of some of these immigrant families, who receive preventive or psychiatric care after birth, indicates a strong correlation between the traumatic first birth in France and the mother's difficulty in mentally representing their infants in the future. Alluding to the non-respect of birth rituals (name, giving, placenta burying, etc) provokes mental representations related to the pregnancy as well as maternal depression, and also improves the quality of mother-child interactions.
#19
A VARIATION OF: - “THE DEAD MOTHER - A CASE STUDY OF A PSYCHOANALYSIS AND THE BIRTH OF TRIPLETS”.
Tuters, Elizabeth. 72 Woodlawn Avenue West, Toronto, Ontario Canada M4V 1G7. Email: etuters@sympatico.ca.
The paper will describe the many layers that have had to be understood in the psychoanalysis of a female patient suffering from the psychological loss of her mother early in life -- the mother was alive but emotionally unavailable to her as a child, owing to sudden depression caused by severe loss. The patient herself felt depressed throughout her childhood, adolescence and young adulthood. She was unaware of her unconscious identification with the depressed mother, her only way of keeping her alive. The analysis revealed a deep-seated longing for an idealized mother and father, which led to a marriage and a pregnancy with multiples, and the birth and rearing of three nonidentical infant girls, with different developmental needs. The focus will be on the relationship of the analyst with all four -- the mother and each infant.
#20
SEEING IS BELIEVING: USING VIDEOTAPING AND GUIDED SELF-OBSERVATION TO PROMOTE PARENTAL SENSITIVITY.
Erickson, M.F., Rose, T., Kowalenko, N. Children, Youth & Family Consortium Univ. of Minnesota, Minneapolis, MN 55455, USA. mferick@umn.edu
An infant’s optimal mental health is nurtured in relationships with sensitive, responsive caregivers. “Seeing Is Believing” is a strategy to help parents identify their baby’s cues and recognize their own strengths in responding sensitively to those cues. The worker videotapes parent-infant interaction then watches the tape with the parent, asking questions to help the parent discover the meaning of behavior and see through the baby’s eyes. Originally developed as part of the STEEP™ program, a preventive intervention combining home visits and support groups, “Seeing Is Believing” now is used by nurses, educators, and mental health professionals in North America, Australia and Europe. The strategy has been used with indigenous families in an urban neighborhood, women identified as substance abusing during pregnancy, families identified as abusive or neglectful, and families of pre-term infants. “Seeing Is Believing” also is the centerpiece of a cross-disciplinary model of training and reflective consultation for professionals, a partnership between the University of Minnesota and state agencies that oversee services for infants and families.
#21
PARENT-INFANT RELATIONAL INTERVENTION WITH THE CLINICAL NEONATAL BEHAVIORAL ASSESSMENT SCALE (CLNBAS).
Nugent, J.K., Keefer, C.H., O’Hare, C., O’Brien, S., Johnson, L. Brazelton Institute, Children’s Hospital, 1295 Boylston St., Boston, MA. 02215. USA kevin.nugent@tch.harvard.edu. Clinical Neonatal Behavioral Assessment Scale (CLNBAS) was developed as an interactive observation to create a profile of a baby's physiological, motor, state, and social behavior for parents. By helping parents read their baby's unique and universal communication cues, the CLNBAS is used to provide anticipatory guidance for parents to make informed care giving choices for their baby. This clinical Scale is a relationship-building tool, promoting positive and realistic parent-infant relationship, as well as clinician-parent relationship. In this Teach-in, we will present detailed analyses of 3 cases showing the use and effectiveness of the CLNBAS with normative, but challenging, newborn-parent relational issues: adopting mother and infant, parents of a newborn who had experienced the death of a previous child, and the third case of a newborn with micropthalmia. Since the period from birth to the beginning of the third month of life is not only a major stage in the infant's behavioral adaptation to the new environment but also marks a unique transition stage for parents, the aim of this CLNBAS-based intervention is to facilitate the development of a positive parent-infant relationship at this critical juncture.
#22
AN INSIDE OUT BABY.
Re,J. and Chapman, C.D., The Gatehouse Centre, Royal Children’s Hospital,Parkville. 3054 Victoria Australia. Jenre@ozemail.com.au
This paper will explore the psychological and developmental impact of hospitalisation during the first year of life for Codey, a baby born with gastro schisis resulting in the bowel and intestines being placed on the outside of his body. The neo-natal period was stormy and complicated with numerous surgical procedures and at six weeks a life threatening illness occurred. During his entire hospitalisation, contact with his parents was inconsistent, of short duration and he was eventually discharged into foster care at twelve months of age. The authors are particularly interested in exploring how Codey organised his early experience, how self-regulation was established and by what mechanisms his mental and emotional development proceeded in such adverse conditions. Psychoanalytic theory, especially Esther Bick’s notion of the second skin and Winnicott’s false self, self regulation theory, and attachment theory are all seen to contribute to an understanding of the complexity of Codey’s early experience while also raising many questions.
#23
REPARATION STRATEGIES ON THE PART OF THE INFANT IN A CONFLICTUAL MOTHER-INFANT RELATIONSHIP.
Rabain D., Downing G., Mazet Ph. Unite Petite Enfance Vivaldi -28 allee Vivaldi 75012 Paris, France unite0-3ans.vivaldi@psl.ap-hop-paris.fr
Researchers such as Colin Trevarthen and Daniel Stern have emphasized the interactional capacities of infants. Less studied are how in conflictual interactions some infants manage to search for a reparative solution. This can be well discerned by means of microanalysis of videotapes. Faced with a parent who little recognizes and poorly interprets the point of view of the infant, what options does the infant choose? How does he organize and regulate himself? How does he respond to intrusion, lack of rhythmic attunement, and/or the parent's ignoring his signals? Does he find a way to modify the parent's behavior? If not, how does he otherwise adapt? To illustrate this problematic, we have chosen to present some brief sequences from videotapes of a mother and her infant. Diego and his mother have been followed therapeutically from birth to two years at the Unite Petite Enfance Vivaldi, an infant psychiatric unit at Salpetriere Hospital, Paris. We see how at several different age periods the mother has continual difficulties in the interaction. She overly excites and solicits. She blocks Diego's attempts to regulate himself. She fails to respect his limits and mistakenly interprets his needs. We see as well how Diego progressively finds ways to cope with this situation. He experiments with nuanced protest, changes of rhythm, strategic withdrawals and creative alternatives for contact. On her side the mother proves eventually capable of new responses to Diego's actions. This video material is stimulating for theoretical reflections about both the nature of intersubjectivity and the effectiveness of therapeutic intervention.
#24
THE DENIAL OF INTERSUBJECTIVITY AS A PARADIGM OF EARLY INFANT ABUSE AND NEGLECT: A CASE STUDY FROM PREGNANCY TO LATE INFANCY.
Wendland, J., Rabain, D. & Mazet, Ph. Unité Petite Enfance - Pitié-Salpetrriere Hospital (28, Allée Vivaldi, 75021- Paris, France) Unite 0-3ans. Vivaldi@psl.ap-hop-paris.fr.
From birth infants seek contact and dialogue with the adult and are sensitive to lack of response and non-contingent or inadequate behavior. Even in the absence of overtly violent behavior, the infant can be confronted with non respect of his physiological and emotional needs and even with denial of their subjectivity by others. In the present work, we explore the hypothesis that the denial of the inter-subjectivity by others in early interactions may be the main mechanism in infant abuse and neglect. To illustrate this idea we will present video tape sequences and a detailed treatment of a borderline mother and her baby girl seen at the Unité Petite-Enfance Vivaldi, an 0-3 infant psychiatric unit at Salpétrière Hospital, Paris (interviews during pre- and post partum periods, infant parent group therapy sessions and mother –infant therapy sessions).
#25
ATTACHMENT THERAPY: DIAGNOSIS AND TREATMENT OF ATTACHMENT DISORDERS.
Brisch, K. H., Dept. of Psychosomatic Medicine and Psychotherapy, Children’s Hospital, Ludwig-Maximilians University, Pettenkoferstr. 8 a, D-80336 Munich, Germany, Karl-Heinz.Brisch@kk-i.med.uni-muenchen.de
Based on attachment theory a diagnostic classification system of attachment disorders is presented. The presentation of clinical case studies (with video) demonstrates the differential use of the classification system of attachment disorders in infants and childhood. This attachment-oriented diagnostic approach is compared with classification systems of other diagnostic manuals (ICD and ZTTDC:0-3) and advantages and disadvantages are discussed. The general and special guidelines of attachment therapy are presented. The special treatment approach and the process of psychotherapy with various attachment disorders is demonstrated with audio-visual material.
Ref: Brisch, K.H. (2002) Attachment Disorders. From Attachment Theory to Therapy. Guilford Press, New York.
#26
PSYCHOSOMATIC KNOWLEDGE IN A PEDIATRIC HOSPITAL.
Scheer, P.J. & Kurz, R. Hospital for Children and Adolescence, LKH-Graz-Univ.-Klinikum, Auenbruggerplatz 30, A-8036 Graz, Austria Peter.Scheer@klinikum-graz.at
The aim of this workshop is to share knowledge gathered in a twenty-year period. The psychosomatic team consisting of pediatricians with additional psychotherapeutic training, physiotherapists, speech therapists, pediatric nurses and various other hospital–based services has developed expertise and is now able to manage treatment for infants in life threatening situations. When we started more than half of our patients came from broken home situations. As a first intervention of change we decided to concentrate on eating, elimination and somatoform disorders. Thus, the kind of clients shifted, more and more seriously ill patients were admitted. Since approximately 10 years we have developed special skills for infants after complicated delivery with congenital malformations, intracerebral hemorrhages and genetic problems, resulting in long-term tube feeding. Today babies come from all German-speaking countries especially for our special tube-weaning program. The development of our institution, containing a 14 bed ward and 200 m2 out-patient clinic are described and demonstrated by video hopefully as a challenging example for other colleagues.
#27
THE BEHAVIORAL CORRELATES OF ANAL PHASE DEVELOPMENT.
Sherkow, S., Weinstein, L., Hoffman, L., Williams, C., Christian, C., & Gottdiener, W. H. The Parent Child Center, The New York Psychoanalytic Institute & Society, New York, NY 10028. USA spsherkow@aol.com.
The objective of this study was (a) to describe the changes in cognitions, affects, behaviors, and interpersonal relations that occur in the anal phase; (b) to develop measures of behavioral correlates of anality; (c) to describe the changes that occur in the mother-child dyad during the anal phase, and (d) to discuss the implications of these changes for normal and pathological development, and for treatment. Sample: mother-child dyads beginning at birth and followed for three years. Children’s and mothers behaviors: sampled using ad libitum sampling and continuous recording employing videotaping, checksheets, and monthly interviews with mothers. Preliminary findings: Children display (a) increased awareness of their orifices, and urinary and bowel functions; (b) increase in the quantity of and a change in the type of aggressive behavior, and (c) mothers change reactions to children’s aggression. Implications of the results will be discussed.
#28
TREATING DISORDERS OF RELATING AND COMMUNICATING THROUGH DEVELOPMENTAL GROUP THERAPY: FROM SENSORI-MOTOR INTERACTION TO VERBAL COMMUNICATION.
Jacoby, R., Pinte, I., Vervier, J-F. Service de pédopsychiatrie, CHL, Luxembourg
In this group experience we used dance/movement therapy to treat young children with a disorder of relating and communicating in order to foster self-regulation, interaction, communication and socialization. Starting from an analysis of the three components of this model (the dance/movement modality, the group of children and the adult therapist), we will try to understand what are the therapeutic factors in the processes observed. The main feature of this approach lies in working with the non-verbal dimensions of space, time and intensity. Particular emphasis will be placed on how regulatory processes are supported through each component of the treatment modality. These non-verbal dimensions form the underpinnings of social interaction out of which communication progressively emerges and develops. We will discuss the multifaceted role of the developmental group therapist in these processes. The development of communication and socialization of a four-year-old girl with a MSDD will be illustrated using video taped examples from the sessions.
#29
NARCISSISTIC AND BORDERLINE MATERNAL PERSONALITY DISORDER: PRENATAL MANAGEMENT AND POSTNATAL THERAPEUTIC CONSIDERATIONS.
Danon, G., Le Nestour, A., Bydlowski, M., Rosenblum, O., Squires, C., Heroux, C. & Patouillot, L. , Laboratoire de Psychopathologie Périnatale, 89 rue d'Assas, 75006 Paris, France. L'Aubier, Centre du Tout Petit, Erasme Hospital. gisdanap@aol.com.
Post-partum depression, when occurring in Personality disorders, mothers is also an incentive for accepting and following treatment. Depression could be another way to access these mothers. Depressive symptoms in BLDP mothers and their specificities in this population will be analyzed in reference to study on borderline personality disorder mothers and their infants (as opposed to non BLDP mothers) presented in Montreal.
Video presentation will be shown illustrating specific characteristics of BLDP mother-infant interaction. Follow-up of prenatal and postnatal management of BLDP mothers and infants questioning specificity of setting and treatment for this population will be discussed.
#30
SLEEPING PROBLEMS – WHY DO SOME MOTHERS RESPOND NEGATIVELY TO SUCCESSFUL INTERVENTION?
Barth, R. Beratungsstelle MenschensKind für Eltern mit Säuglingen und Kleinkindern, Elsässer Str. 27a, 22049 Hamburg, Germany diplpsychrenatebarth@t-online.de
Infant sleeping problems are a common parental concern. Psychodynamically it can be conceptualized as an issue of separation and autonomy, that has not been resolved. Within a therapeutic context, parents generally find a solution within a few sessions. However, there is a small subgroup of patients, for whom signs of improvement are threatening. Typically they terminate treatment after only a few sessions. The mothers in question display a symbiotic bond with their children, that appears extreme. The fathers are physically or emotionally absent. These mothers react in an aggressive way towards the therapist, and produce a strong aggressive countertranference, that is difficult to contain. Facilitated by case material, it is the goal of this presentation to come to a better understanding of the underlying psychodynamic of this phenomenon, and to discuss implications for treatment.
#31
HELPING BABIES IN DIFFICULTY THROUGH HUMANISING EVERYDAY CARE.
Tardos, A., Vámos, J. Pikler Institute, 1022 Budapest, Lóczy Lajos utca 3. Hungary. pikler @matavnet.hu.
The experiences of the Pikler Institute show that if the caretaking situations such as feeding, bathing, dressing are not regarded as routine but rather treated as important meetings each time, then these everyday situations help both the physical and psychological development of the infant. The approach based on the importance of the self-initiated free movement of the infant and cooperation with him from the very beginning was what the Hungarian pediatrician, Emmi Pikler (1902-1984) expected from the families she worked with and later in the institute she founded. The method has proved to have a therapeutic effect for emotionally disturbed infants. We would like to describe this unusual approach to caretaking from the point of view of the child and also of the adult. With the help of video recordings made of their development including also caretaking situations we would like to analyze what effect this method of caretaking had for two infants who arrived to the institute in very bad condition. We will show how their stiff, alarmingly defensive behavior disappeared, and how they developed trust toward themselves and toward the environment, how they enjoyed the possibility of free movement, the time spent together with the caregivers, how they could use this in the development of their personality, and how they discovered the joy of life. We will point out the moments during caretaking when the self-defensive position changed into a more open attitude.
#32
WORKING WITH PREGNANT IMMIGRANT WOMEN: A CLINICAL AND CULTURAL APPROACH.
Moro M.R. (France), Maldonado M. (USA), Barriguete A. (Mexique), Paris 13-University, Avicenne Hospital, Service de psychopathologie de l’enfant, 125, rue de stalingrad 93009 Bobigny cedex, France Email : marie-rose.moro@avc.ap-hop-paris.fr
The task of understanding and helping pregnant women from a different cultural background who are experiencing intense psychological distress is presented. We focus on women and families living in France, who come from other cultural groups, like from Maghrib, Black Africa and Asia. The immigrant woman may abandon her traditions, or be unable to implement them. In conditions of isolation and cut-off from her cultural group, she may experience depression and intense anxiety. These are expressed in ways that are also influenced by her culture. Alternatively, traditional practices may lose their meaning in the new country. Our clinical intervention group attempts to provide clinical services to women from those areas, by having a translator, a clinician versed in that cultures norms, codes, forms of expressing distress and acceptable ways to accept help. A group format is often used in consultation and therapy, as this is perceived as safer by many patients. Understanding the womans own way of perceiving her situation, of thinking about her suffering and what should be done to alleviate it, are key to providing sensitive clinical care.
#33
MIRRORS: THEIR SIGNIFICANCE IN CLINICAL PRACTICE.
Kernberg, PF., Normandin , L., Wortman, A. Westchester Division, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605, USA pkernber@med.cornell.edu.
The clinical teach-in will include the description of a clinical research that examines and correlates mirror behaviors of children between 24 to 36 months of age with the quality of the mother-child interaction, in normality and pathology. Moreover, specific behaviors in front of the mirror described here for the first time, indicated three clusters, positive relatedness to self and other, negative relatedness to self and other, and confused relatedness to self and other. Quality of affects in front of the mirror covaries with attachment type and mirror behavior clusters. Videotaped material will illustrate these different configurations and the application of the mirror instrument to prevention, diagnosis and treatment assessment.
#34
Abstract not available
#35
FROM THE PRENATAL MATERNAL PSYCHIC TRANSPARENCE TO THE WINNICOTTIAN PRIMARY MATERNAL CONCERN : A MODEL FOR THINKING THE EMERGENCE OF MENTAL OBJECT.
Golse B. & Bydlowski M. Hôpital Necker-Enfants Malades, Service de Pédopsychiatrie, 149 rue de Sèvres, 75015 Paris, FRANCE , monique.bydIowski@mageos.com.
The first objective of this study is to propose to consider there is a dynamic continuum between the maternal prenatal psychic transparence (type of mother's functioning described by M. Bydlowski during the second part of the pregnancy) and the winnicottian concept of primary maternal concern (described, a long time ago, by D.W. Winnicott).
The second objective is to show how the transition from one to the other can be dissected in four steps which provide a useful model of the internal and external objects’ progressive institution.
#36
Abstract not available
#37
UNEXPLORED POTENTIAL: PSYCHO-EDUCATIONAL INTERVENTION FOR UNDER THREES WITH DEVELOPMENTAL DIFFICULTIES.
Bruria Koblenz, Morag Hunter-Carsch, Marianne Coleman , University of Leicester School of Education , UK koblenz_b@bezeqint.net
The three researchers bring together their specialist professional experience in the fields of educational psychology and educational management in order to address the question, 'with reference to the population of under 3 year olds with developmental difficulties, to what extent can their learning potential be improved by early intervention that is essentially multidiscipline yet psycho-educationally mediated?' This issue is increasingly important in the context of the 'inclusive education' movement for school age and preschool children. It prompts concern about intervention at progressively earlier stages in the development of children who may later be amongst those described as having 'special educational needs'. The paper draws upon a single case-study of a 2 year old over 2 years in a new developmental center in Israel in to order to illustrate some vital issues and questions which have contributed to the development of a new approach to integrating therapeutic and educational perspectives for under three year olds and their families, one which is based on dynamic diagnostic assessment over time.
#38
Abstract not available