From early activity to early interactivity: towards a new culture of very early intervention in infants at high neurodevelopmental risk

Extensive studies in humans and non-human models suggest how early intersubjectivity is the foundation for emotional and cognitive development, not only in typical but also in atypical development. Mother’s as well as infant's wellbeing are both necessary for a healthy development of early interactions and, in turn, for infant later outcome. For example, post-natal depression in the mother is known to have negative impact on both mother-infant interaction and later neurodevelopment of the baby. Similarly, adverse conditions in the baby, e.g. cleft lip and palate, affect early intersubjectivity and infant later emotional and cognitive outcome. In babies with congenital brain damage it is unquestionable how early development of intersubjectivity is at very high risk. The ability to generate (transmit) and to recognize (receive) social stimuli is potentially disrupted in both components of the dyadic relationship, due to the physical wound in the baby and the psychological one in the parent. One of the main sensory channels, vision, that is active in newborns from the first hours and critical to connect with the physical and social environment, is generally affected, and holds the baby off from critical social cues. Profound pain and sense of discomfort during spontaneous, and therefore unavoidable, behaviours are further barriers to the accessibility of the baby to early interaction. For these and other reasons, congenital brain damage should be considered as a paradigmatic model of disruption of early interaction, and possible opportunities for focused intervention should be investigated. Within this framework, we will review recent scientific findings on brain mechanisms supporting the interactive, motor and social processes of infant development. By focusing on the effects of specific sensorimotor and social experiences, we will evaluate the limits and potentials of intervention strategies centred on the promotion of early intersubjectivity to overcome the adverse effects of neonatal brain lesions.