New Hampshire Council on Autism Spectrum Disorders
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Concord, NH  03301
info@nhcouncilonasd.org

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Twelve Things to Know 
About NH's Family Centered 
ESS Program

1.  There is NO cost to families for participating in Early
      Supports and Services (ESS).

2.  Anyone, including a parent, can make a referral.

3.  Intake coordinators welcome referrals and see  
     assessment as an opportunity to teach about child
     development.  If a child is not found to need FSESS,              this does not mean that the family has "wasted their
     time."

4. There are 10 regional agencies that coordinate ESS
     assessment and services in surrounding towns --
     these issure to be one within reasonable driving
     distance.

5.  FCESS has 45 days from the initial referral to
     evaluate the child and make an eligibility
     determination.

6.  Assessment and services take place where the child
     spends time -- typically at home or a child care
     setting.

7.  A child does not have to have a specific diagnosis t  
     be found eligible for ESS.  In fact, most do not.

8.  It is not unusual for a child to have a developmental 
     delay in one or two areas (also called developmental 
     "domains") and at the same time, demonstrate 
     considerable strengths in other areas. This does not 
     effect their eligibility.

9.  Services are guided by an individualized plan that the
     parents or other family caregivers develop with the
     help of an FSESS professional.  Family caregivers    
     decide what goals yo focus on in ESS services.

10.Family caregivers can expect to receive training from
     their FSESS provider so that they can continue to
     support their child's development throughout the day.

11.If a child has a formal diagnosis of an autism spectrum
     disorder, there are additional funds (up to $4500/
     months) for therapeutic services.

12.ESS providers will help transition the child out of   
     services or into preschool special education, which  
     happens at the third birthday.

Family Centered 
Early Supports and Services

Developmental milestones come fast and furious in early childhood. When we describe a toddler as “busy,” we may not appreciate even half the hard work that she undertakes every day. In fact, at no time in life is the brain more active. Thanks in part to recent improvements in neuroimaging (a technology that takes pictures of the brain), we have an increasingly detailed model of how the structures supporting social, emotional, and mental development are built during the first five years of life. Here are some key concepts:

  • Brain architecture is built over time. Through a complex interaction of genetics and the environment, the brain becomes increasingly organized and specialized. By reaching out and exploring the world around him, the child facilitates this process insuring exposure to a wide range of experiences each day.
  • The brain operates on a “use it or lose it” principle. In the first few years of life, 700 new neural connec-tions are formed every second. After this period of rapid proliferation, connections are reduced through a process called “pruning,” as individual neurons shed the treelike extensions, called “dendrites,” that connect one nerve cell to another
  • The brain is built from the bottom up. Sensory pathways like those for basic vision and hearing are the first to develop, followed by early language skills, and higher cognitive functions like problem solving. Connections proliferate and prune in a prescribed order, with later, more complex brain circuits built upon earlier, simpler circuits.
  • Social interactions are critical to building the brain’s architecture. An important ingredi¬ent in this developmental process is the “serve and return” relationship be¬tween children and their parents or other caregiv¬ers in the family or community. Young children naturally reach out for interaction through babbling, facial expressions, and gestures and adults respond with the same kind of vocalizing and gesturing back at them. 
  • The brain’s capacity for change decreases with age. The brain is most flex¬ible, or “plastic,” early in life in order to accommodate a wide range of environments and interac¬tions. As the maturing brain becomes more specialized and assumes more com¬plex functions, it is less capable of reorganizing and adapting to new or unexpected challenges.
  • Early development sets the stage for later life. Not only is the brain harder to change as we age, the foundation built in the first few years of life determines, in part, how one thinks, behaves, and experiences emotions later.  

With this background in mind, it is easier to appreciate why it is so important to intervene as early as possible when a child shows evidence of a disruption in this developmental process. Early childhood is a window of opportunity, when parents, caregivers, and educators can have a lasting impact on later life. Not only is the brain’s architecture more readily shaped, the risk of creating a weak foundation -- one that lacks the rich and complex connections associated with healthy brain development --is very high whenever we observe a delay in achieving basic skills or milestones.

If a child has ASD, does this mean their brain is not developing?


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Certainly young children that have an ASD are developing new skills all the time. However, they may be developing these skills in an unusual order or in an uneven pattern. Because the brain is so complex, a relative weakness in one area -- say social awareness -- can ultimately undermine other higher order skills like sequencing events. One well regarded theory about the underlying neurology of ASD holds that the brain develops quite rapidly in infancy, creating more neural connections that typically expected. This may explain why many children with ASD have an above average head circumference during the first 12 to 18 months of life. For reasons not well understood, this is followed by a period of “over pruning,” when the brain sheds neural connections at an accelerated rate. This leads to a brain architecture that is more highly specialized: Capacities that require the interaction of many brain regions, for example social interactions, are not well supported in the brain; but other capacities such as long term memory can be unusually well developed.

How does early intervention help a child with ASD?

NH Family Centered Early Supports and Services Program (FSESS) helps more than 1880 children a year to achieve developmental milestones that appear to be delayed. Because many children with ASD are not diagnosed before age three, it is not known how many of these are on the autism spectrum.  

  • FSESS providers will conduct a multidisciplinary assessment by two early childhood professionals for any child referred to them within 45 days.
  • If a child is found to qualify, then the provider will work the family to create an Individual Family
  • Support Plan (IFSP) which identifies the needs and strengths of the child and concerns of the family. The IFSP is designed to maximize the use of the therapist’s intervention to help the family support the development of their child.
  • Providers also teach parents and other caregivers to play with their child in ways that may accelerate development or that target specific areas where the child is struggling.  

Assessment and services take place in the child’s home or sometimes a daycare setting. They are designed to meet the expressed needs of the family -- for example, if the family’s primary concern is toilet training, then the provider and the parent work together on this skill. It is important to appreciate that whatever the specific skill, many other developmental concerns can be addressed. For example, the provider may introduce the family to the use of a picture exchange system (PECS) that allows a child with a language delay to use a picture card to communicate his need and desire to use the bathroom.In the case of a child who has, or may eventually have, a formal diagnosis of ASD, services are likely to focus on communication and social interaction. In point of fact, any child and family would benefit from the assessment, coaching, and attention of an early childhood specialist. 

How is a child referred to FCESS and how to I find a provider?

Anyone who has a concern about a young child’s development can make a referral, including physician who has had a child screen positively for ASD or a parent who has concerns about their child. FCESS is delivered regionally through ten area agencies throughout the state. Your regional agency can be found here. Specific information about referral is also available at: www.dhhs.nh.gov/dcbcs/bds/earlysupport/index.htm

What are the eligibility criteria?

There are four ways in which a child may qualify for Family Centered Early Supports and Services.  This is a brief summary, and to see more detailed information, link here.

  • The child has a diagnosed established condition that has a high probability of resulting in a developmental delay.
  • The child demonstrates atypical development.
  • The child is experiencing delays of 33% in one or more area of development.
  • The child is at risk for substantial delay.