Early Childhood Intervention for Children With Disabilities

Introduction: The Case for Early Intervention

Children with special needs include those who have disabilities, developmental delays, are gifted or talented, and are at risk of future developmental problems. Early intervention consists of the provision of services for such children and their families for the purpose of lessening the effects of their condition. Early intervention may focus on the child alone or on the child and the family together. Early intervention programs may be center-based, home-based, hospital-based, or a combination. Early intervention may begin at any time between birth and school age; however, there are many reasons for it to begin as early as possible. Early intervention is the key to achieving the most positive outcome in aiding the disabled child to develop as normally as possible.

There are three primary reasons for intervening early with an exceptional child: to enhance the child's development, to provide support and assistance to the family, and to maximize the child's and family's benefit to society. Child development research has established that the rate of human learning and development is most rapid in the preschool years. Timing of intervention becomes particularly important when a child runs the risk of missing an opportunity to learn during a state of maximum readiness. A child may have difficulty learning a particular skill at a later time if the most teachable moments or stages of greatest readiness are not taken advantage of.

Early intervention services have a significant impact on the parents and siblings of an exceptional infant or young child. The family of a young exceptional child often feels disappointment, social isolation, added stress, frustration, and helplessness. The stress caused by the presence of an exceptional child may affect the family's well-being and interfere with the child's development. Families of children with disabilities are found to experience increased instances of divorce and suicide, and the child with a disability is more likely to be abused than a child without one.

A third reason for intervening early is that society will reap maximum benefits. The child's increased developmental and educational gains and decreased dependence upon social institutions, the family's increased ability to cope with the presence of an exceptional child, and perhaps the child's increased eligibility for employment all provide economic as well as social benefits.

The reasons for early intervention are clear. However, many early intervention programs fall short in providing the child a well-rounded development. An effective Early Childhood Intervention Program must not only address the academic aspects of the disabled child's development, but must also address the physical, psychological, social, and spiritual development in the context of family, relationships, and culture. This paper addresses the current situation and evaluates current programs for their effectiveness in achieving a well-rounded program for preschool children with disabilities. It also examines the elements needed for a program to be successful.

After nearly 50 years of research, there is evidence that early intervention increases the developmental and educational gains for the child, improves the functioning of the family, and reaps long-term benefits for society. Early intervention has been shown to result in the child needing fewer special education and other habilitative services later in life, being retained in grade less often, and in some cases being indistinguishable from non-disabled classmates years after intervention.

Is Early Intervention Really Effective?

A top-down perspective on quality takes into account program and setting characteristics such as the ratio of adults to children, the qualifications and stability of the staff, characteristics of adult-child relationships, the quality and quantity of equipment and materials, the quality and quantity of space per child, the number of toilets, fire safety provisions, health and hygiene procedures and standards, and aspects of working conditions for staff. There is substantial evidence to suggest that these program and setting characteristics do predict some effects of an early childhood program (Howes et al., 1992). However, an appropriate physical setting does not always indicate the most effective program.

It is reasonable to assume that the important ultimate effects of a program depend primarily on how it is viewed from another angle. If the child's experience of a program is the true determinant of its effects, then assessment of program quality requires an answer to the central question: What does it feel like to be a child in this environment?

The older the children served by a program, the longer the time period required for reliable assessment of the quality of daily life as seen from the bottom up. In other words, a good-quality program is one in which, from the child's perspective, experiences are intellectually and socially engaging and satisfying on most days. Such a program is not dependent on occasional exciting special events. Isolated events experienced in early childhood programs are unlikely to affect long-term development. However, experiences that may be inconsequential when rare, but harmful or beneficial when frequent or repeated, must be addressed in assessments of program quality (Katz, 1991).

This approach to the assessment of quality raises complex issues that suggest the early childhood profession is obliged to develop a set of standards of professional practice. Each perspective contributes in a different way to an overall assessment of program quality. The profession must continue to work on developing an accepted set of professional standards to which practitioners can fairly be held accountable. Any approach to the assessment of quality requires not only a set of criteria to apply to each program, but some consensus on the minimum standards for each criterion.

In research and evaluation, a sample of subjects typically receives some form of programmatic treatment, and outcome scores for these subjects are then compared with those of a control or comparison group. The traditional control-group, comparison-group design adopts the viewpoint that the frequency and nature of observable cognitive activities increase at a steady rate as a result of growth. This model assumes that growth among infants is linear and that all infants have the same capacity to learn. These assumptions would result in a uniform program for all, with all benefiting equally.

Another viewpoint is that infants and toddlers are going through a period of rapid, non-linear growth and change along many interwoven lines of development (Horner, 1980). Accordingly, different individuals would present different levels and kinds of cognitive development during different stages. Short-term consistency of individual traits would be low, traits measured during infancy would have low correlation with later skills, and broad programmatic treatment effects would be small — indicating that a different research and evaluation model is needed.

Test-retest reliability tends to be quite low when scales are administered to infants. As the child gets older, test-retest reliabilities tend to improve. Werner and Bayley (1966) summarized studies examining the test-retest reliability of various infant measures and noted wide variations in scale scores. One study, for example, found one-day test-retest reliabilities on the Buher Baby tests to range from .40 to .96 depending on the age of the infants. Another study found two-day test-retest reliabilities on the Linfert-Hierholzer scales for one-, two-, and three-month-olds to be -.24, .44, and .69 respectively. Horner (1980) found four-to-ten-day test-retest reliabilities on the Bayley for nine-month-old females, nine-month-old males, fifteen-month-old females, and fifteen-month-old males to be .42, .67, .96, and .76 respectively. Werner and Bayley (1966) found the percentage of agreement across two administrations of the Bayley to eight-month-olds varied from 41% to 95% with a mean of 76%. With nine- and sixteen-month-olds, Horner (1980) found slightly higher consistencies on the same items, with means of 85% for both age groups.

Thus, test-retest reliability is extremely low for infants and increases moderately for toddlers. The lack of test-retest reliability is consistent with the view of the child as going through non-linear growth, and is inconsistent with the notion that cognitive activity in infants increases at a steady rate as a result of growth.

Classic studies of mental growth in normal infants and toddlers show inconsistent and unpredictable growth rates of observable skills and traits. Bayley, for example, reported correlations between -.04 and .09 between scores during the first three months of life and scores at 18 to 36 months. Looking at race and gender with a sizeable sample, Goffeney, Henderson, and Butler (1971) found virtually no correlation between eight-month and seven-year measures. Escalona and Moriarty (1961) found virtually no correlation between 20-month and six-to-nine-year scores.

"The findings of these early studies of mental growth of infants has been repeated sufficiently often so that it is now well established that test scores earned in the first year or two have relatively little predictive validity" (Bayley, 1970). Comprehensive reviews of the literature by Thomas (1970) fully support Bayley's view and draw the same conclusion. There are exceptions, however: many developmental inventories are excellent screening devices capable of identifying children with permanent cognitive disabilities.

Through factor analysis, Bayley (1955) identified three distinct kinds of intellectual behaviors: sensorimotor, which is dominant during the first year; persistence, which tends to be dominant during the second and third years; and a general intelligence factor, which is dominant at age four and the only operating factor after age six. This third factor appears to be a stable intelligence factor.

The important consideration for research and evaluation is that there is no continuity across these three developmental stages. Rather, infants and toddlers develop a composite of skills that are not interdependent. Scores obtained when a child is in one stage of development will be uncorrelated with scores obtained when the child is at a different stage.

Lewis and McGurk (1972) argued in their classic Science article that infant development scales "are unsuitable instruments for assessing the effects of specific intervention programs" (p. 1176) and that "the success of specific intervention programs must be assessed according to specific criteria related to the content of the program" (p. 1177).

Few early childhood programs seek to improve overall intelligence or to hasten the general cognitive development of infants and toddlers. Rather, most programs seek to provide interventions for specific identified needs, for the family or child or both. The typical early childhood program can be accurately viewed as a collection of individually tailored programs. Thus, individual intended outcomes should be identified and the program's success gauged against whether those outcomes were worthwhile and whether they were attained.

Due to the inaccuracies of control-comparison group hypothesis testing in this setting, the use of case studies, the computation of effect sizes, and the examination of growth curves can provide rich data to help policymakers and researchers understand interventions. Effect sizes help gauge the relative contributions of the intervention, while growth curves can help identify trends and control for some error.

It is clear that there are two approaches to evaluating an Early Childhood Intervention Program; however, neither is adequate on its own. To look only at external factors such as facility quality, staff qualifications, and the number of smoke detectors does not give an accurate picture of the most important factor: do children benefit from the program? Because of the age group involved and the differences in individual rates of development, it is also ineffective to use standard infant and early childhood development scales to assess the program.

How, then, do we assess the effectiveness of an Early Childhood Intervention Program? Research has shown that certain factors in early childhood significantly affect the achievement of positive outcomes for young children. It would stand to reason, therefore, that an effective program would incorporate as many of these factors as possible. It may be possible to develop a scale based on the effective inclusion of these factors as a measure of program effectiveness.

Are There Critical Features to Include in Early Intervention?

While there have been too few attempts to determine the critical features of effective early intervention programs, a few factors are present in most studies that report the greatest effectiveness. These program features include: the age of the child at the time of intervention; the level of parent involvement; and the intensity and/or the degree of structure of the program.

Many studies report that the earlier the intervention, the more effective it is. With intervention at birth or soon after the diagnosis of a disability or high-risk factors, developmental gains are greater and the likelihood of developing additional problems is reduced (Cooper, 1981; Garland, Stone, Swanson, & Woodruff, 1981; Maisto & German, 1979; Strain, Young, & Horowitz, 1981).

One hallmark of any successful early childhood program is the degree to which it involves parents. Such involvement should not stop when children reach the schoolhouse door. Ongoing communication between parents and teachers has become increasingly important. Parents can be involved as decision-makers, volunteers, and staff. They can participate in parent education and support groups, be encouraged to observe the classroom, and, in general, take a more active role in their child's education both at school and at home (Lombardi, 1992).

An important yet often overlooked strategy in the effort to increase parent involvement is involving fathers or other significant male role figures. In a recent study of a pre-kindergarten at-risk program, McBride and Lin (in press) found that a majority of mothers surveyed reported their children had regular and consistent interaction with a father or other male role figure despite the high proportion of single-parent families being served. In a nationwide survey of Head Start programs serving low-income families, Levine (1993) found that a man — whether the father, the mother's partner, or another male relative — is present in approximately 60 percent of Head Start families.

The lack of initiatives designed to encourage male involvement in pre-kindergarten programs for children at risk for later school failure fails to build upon the strengths that many of these men can bring to the parenting situation — strengths that can be utilized in the development of effective home-school partnerships. When men become actively involved, they can have positive impacts on many aspects of children's development.

Given the support for increased involvement of parents in their children's schooling and the positive contributions men can make to their children's development, it is important to reach out specifically to fathers or other significant males in parent involvement efforts for pre-kindergarten and early childhood programs. In doing so, however, several barriers must be overcome. Levine (1993) has outlined four factors that constrain Head Start and state-funded pre-kindergarten programs from encouraging father involvement: (1) fathers' fears of exposing inadequacies; (2) ambivalence of program staff members about father involvement; (3) gatekeeping by mothers; and (4) inappropriate program design and delivery. Each of these barriers must be addressed as programs attempt to encourage and facilitate increased involvement of fathers.

McBride and colleagues (McBride, Obuchowski, & Rane, 1996) have identified several key issues that need to be explored as early childhood programs struggle to build stronger home-school partnerships through parent involvement initiatives targeted at men. Early childhood educators need to be specific in their reasons for developing such initiatives. Prior to developing them, educators must ask themselves why they think such efforts are important and how they can enhance services provided to children and families. Focusing on male involvement simply because it is a current social issue increases the likelihood that such efforts will wane when the next issue emerges.

Not everyone will be committed to the concept of parent involvement initiatives targeted at fathers or other significant males. The lack of male involvement and responsible fathering behaviors is often cited as a major reason for children's later school failure, and many will question why resources should be targeted at these men. This resistance may come from mothers, teachers, school administrators, and community leaders. Since support from these groups is critical to success, educators will need to build a strong and clearly articulated rationale for such initiatives.

Educators will also need to be specific about whom to target. Research has indicated that children growing up in low-income and single-parent homes often have regular and consistent interactions with a father figure, although not necessarily their biological father. Focusing efforts exclusively on biological fathers will exclude a large proportion of men who play significant roles in the lives of these children.

Most early childhood educators have received little, if any, formalized education and training in the area of parent involvement, and this is especially true regarding male involvement. If such efforts are to be successful, teachers will need staff development and in-service training experiences that allow them to develop a knowledge base from which to design and implement male involvement initiatives. Although having male staff members provide leadership for these initiatives would be desirable, such expectations are not always realistic given that the majority of professionals in this field are female. Women can be successful in these efforts, but they must acknowledge and build upon the unique strengths that men bring to parenting and be sensitive to differences in the ways men and women interact with young children.

Research has indicated that mothers tend to be the "gatekeepers" to their children for fathers or other significant male role figures. As educators develop initiatives to encourage male involvement, they must not do so at the expense of efforts targeted at mothers. Mothers need to be involved in the development of these efforts from the beginning and made aware of why resources are being put into developing these activities and how they and their children will benefit.

As with any other initiative, early childhood educators must proceed slowly in building a male-friendly environment that encourages male involvement in the program. Building such a culture is a long-term process, and educators should not expect too much too soon. They should start slowly and build upon their successes. When developing initiatives for male involvement, educators should first evaluate the parent involvement components already in place and explore how they may be adapted to reach out to men. Schools also need to respond to the diversity among families. Parent activities need to be responsive to the language and culture of the family and be tailored to meet the specific needs of teen parents, single parents, working parents, blended families, and families with special service needs (Lombardi, 1992).

The program must be developmentally appropriate. Continuity across early childhood services is achieved by the degree to which all programs are developmentally appropriate. As children progress from preschool to kindergarten and on to the primary grades, they show increased motor and language skills, they can pay attention longer, they can play more cooperatively, and they are more able to develop interests that go beyond their immediate surroundings. Throughout the preschool and early elementary years, children learn best through active exploration of their environment and through interactions with adults, other children, and concrete materials that build on earlier experiences (Lombardi, 1992).

Programs for young children should not be seen as either play-oriented or academic. Rather, developmentally appropriate practice, whether in a preschool or a primary classroom, should respond to the natural curiosity of young children, reaffirm a sense of self, promote positive dispositions toward learning, and help build increasingly complex skills in the use of language, problem solving, and cooperation (Lombardi, 1992).

In the area of cognitive development, the focus falls on creativity, language development, children's perceptions of their own cognitive competence, and traditional measures of achievement. Classrooms characterized by child initiation appear to facilitate children's creative development. Several research teams found that children in child-initiated classrooms scored higher on measures of creativity, or divergent thinking, than children in academically oriented classrooms (Hirsh-Pasek, Hyson, & Rescorla, 1990; Hyson, Hirsh-Pasek, & Rescorla, 1990).

In studies on language development, the developmentally appropriate, or child-initiated, programs were associated with better language outcomes. Progress reports from public and preschool programs indicated that children in child-initiated classrooms had better verbal skills than children in academically oriented programs (Marcon, 1992). Children's receptive language was better in programs with higher quality literacy environments and when developmentally appropriate activities were more prevalent (Dunn, Beach, & Kontos, 1994).

Young children in developmentally appropriate programs also seemed more confident in their own cognitive skills. Children described their cognitive competence more positively when they attended child-initiated rather than academically oriented programs (Mantzicopoulos, Neuharth-Pritchett, & Morelock, 1994; Stipek et al., 1995). Sherman and Mueller (1996) observed better reading and mathematics achievement scores for children attending developmentally appropriate kindergarten through second grade. Preschool children in Marcon's (1992) study had more positive progress reports overall, and specifically on math and science, when they attended child-initiated classrooms.

Studies following children over time suggest there may be academic benefits to developmentally appropriate programming. Children experiencing preschool programs rated high on developmental appropriateness do well academically in first grade (Frede & Barnett, 1992). In addition, children of low socioeconomic status attending appropriate kindergarten classrooms tend to have better reading achievement scores in first grade than children attending inappropriate classrooms (Burts et al., 1993). The fact that differences between children in more and less appropriate classrooms are evident a year or more later suggests that children's learning environments during these early years are critically important.

Certain structural features are also related to the effectiveness of early intervention, regardless of the curriculum model used. Successful programs are reported to be more highly structured than less successful ones (Shonkoff & Hauser-Cram, 1987; Strain & Odom, in press). Maximum benefits are reported in programs that clearly specify and frequently monitor child and family behavior objectives; precisely identify teacher behaviors and activities to be used in each lesson; utilize task analysis procedures; and regularly use child assessment and progress data to modify instruction. In addition to structure, the intensity of services, particularly for children with severe disorders, appears to affect outcomes. Individualized instruction and services to meet child needs also increase effectiveness. This does not necessarily mean one-to-one instruction; rather, group activities are structured to reflect the instructional needs of each child.

An effective early intervention program must have continuity during transition periods. With more and more children participating in early childhood programs before they enter school, there is an increasing focus on the transition that occurs when children move from preschool to kindergarten (Lombardi, 1992). Many children have problems adjusting to elementary school programs that have a different philosophy, teaching style, and structure than those programs in which they participated during their earlier years.

More recently, there has been a growing consensus that the key to effective services for young children is bridging the gap between different types of programs and ensuring continuity in key elements that characterize all good early childhood programs. This notion of continuity is not new. In the late 1960s and early 1970s, efforts such as Project Developmental Continuity and Follow-Through were designed to ensure that the principles of good early childhood programs continued into the early years of elementary school (Lombardi, 1992). Today's concept of continuity has changed in several respects. First, there is now much more consensus regarding what constitutes appropriate practice in all types of early childhood programs from infancy through the primary grades. There is also growing recognition that parent involvement is a key to a child's success and should be encouraged as children move on to elementary school. Finally, the need for supportive services for both children and families has intensified. Comprehensive family support and health services are critical components throughout the early years.

Support services play an important role in ensuring that such services are provided. There is a growing recognition that schools are the central base for child and family services. New relationships between schools and other health and human service providers are emerging as comprehensive services are integrated into public education. Supportive services that include school and parent representation promote collaborative processes and community development. The uniting of school and community resources, and the clear recognition that the school is embedded in its community, sustain healthy educational environments and contribute greatly to continuity for children and families (Lombardi, 1992).

Conclusion

An effective Early Childhood Intervention Program includes elements to aid in a child's physical, psychological, social, and spiritual development in the context of family, relationships, and cultural setting. It would be possible to develop a scale based on the factors discussed in this paper to produce a quantitative assessment of Early Childhood Intervention Programs. This assessment scale would rate programs for having, or not having, those factors. Such a scale would be helpful in assessing the strengths and weaknesses of programs and for addressing areas that need improvement.