Defining and Assessing Quality in Early Intervention Programs for Infants and Toddlers with Disabilities and their Families: Challenges and Unresolved Issues

Historically, child care quality research has focused primarily on typically developing children cared for in center-based programs. Findings from this research suggests that variations in quality of care have an effect on children's well-being and developmental outcomes. In this paper, we draw on child care quality research to inform our understanding of quality in early intervention services for infants and toddlers with disabilities and their families. Conceptual issues in defining quality and methodological challenges for assessing quality of early intervention services are presented. In the final sections of this paper, we discuss our efforts to design a measure of quality for early intervention programs and present some of the unresolved issues related to the assessment of quality in early intervention programs.     

The Cost-Effectiveness of Adding One Type of Parent Involvement to an Early Intervention Program

The belief that parent involvement is an important aspect of early intervention programs for children with disabilities is widely accepted, but the empirical evidence to support this belief is limited (White, Taylor, & Moss, 1992). Using a randomized experimental design, the present study compared a classroom-based early intervention program with the same program supplemented by a parent involvement component. The parent involvement component consisted of weekly parent meetings focused on (a) training parents to provide additional intervention, (b) providing information on general topics, and (c) providing social support. Outcome data were obtained following intervention and longitudinally on child and family functioning, and on educational outcomes. A cost-effectiveness analysis was completed. With respect to measures of child development and family functioning, there were some small initial effects in favor of the parent involvement group that tended to fade out in later reassessments. However, longitudinal educational outcomes indicate positive effects on child placements and teacher perceptions of the children's functioning in favor of the parent involvement group. The parent involvement component was not immediately cost effective, but may be in the long term.     

Children with disabilities: a longitudinal study of child development and parent well-being.

This Monograph presents the results of the Early Intervention Collaborative Study, a longitudinal investigation of the cognitive and adaptive behavior development of children with developmental disabilities and the adaptation of their parents, extending from infancy through middle childhood. The study was designed to generate and test conceptual models of child and family development and contribute to the knowledge base that informs social policy and practice. The sample for the investigation reported here consists of 183 children with Down syndrome, motor impairment, developmental delay and their families who were recruited at the time of their enrollment in an early intervention program in Massachusetts or New Hampshire. Data were collected at five time points between entry to early intervention and the child's 10th birthday. Home visits were conducted at each time point and included child assessments, maternal interview, and questionnaires completed independently by both parents. Trajectories in children's development and parental well-being were analyzed using hierarchical linear modeling. Predictor variables were measured at age 3 years when children were exiting early intervention programs. Children's type of disability predicted trajectories of development in cognition, social skills, and daily living skills. Children's type of disability also predicted changes in maternal (but not paternal) child-related and parent-related stress. Beyond type of disability, child self-regulatory processes (notably behavior problems and mastery motivation) and one aspect of the family climate (notably mother-child interaction) were key predictors of change in both child outcomes and parent well-being. A different aspect of the family climate--family relations--also predicted change in child social skills. Parent assets, measured as social support and problem-focused coping, predicted change in maternal and paternal parent-related stress respectively. The implications of these findings for both the science of child development and the policies and practices of developmental intervention are discussed.     

Enhancing early literacy skills for preschool children: bringing a professional development model to scale

A quasi-experimental, statewide intervention targeting preschool teachers' enhancement of children's language and early literacy was evaluated. Across 2 years and 20 Head Start sites, 750 teachers participated (500 target, 250 control), with 370 classrooms randomly selected to conduct pre- and posttest assessments (10 randomly selected children per class). The inability to randomize children to classrooms was addressed by examining children's performance for teachers who were control teachers in Year 1 and target teachers in Year 2. We also compared teachers with 2 years of training with teachers with 1 year of training and with control teachers. Greater gains were found for children in target classrooms than for those in control classrooms for all skills, but particularly for language skills, in Year 2, and this varied by program site. The presence of a research-based early literacy curriculum, higher levels of teacher education, and full-day versus half-day programs were significant moderators of intervention effectiveness. The challenges of implementing a statewide initiative across programs that varied in their readiness to implement a cognitively rich experience for preschool children are discussed.     

Effects of three interventions on the reading skills of children with reading disabilities in grade 2

In a longitudinal intervention study, the effects of three intervention strategies on the reading skills of children with reading disabilities in Grade 2 were analyzed. The interventions consisted of computerized training programs: One bottom-up intervention aimed at improving word decoding skills and phonological abilities, the second intervention focused on top-down processing on the word and sentence levels, and the third was a combination of these two training programs (n = 25 in each group). In addition, there were two comparison groups, 25 children with reading disabilities who received ordinary special instruction and 30 age-matched typical readers. All reading disabled participants completed 25 training sessions with special education teachers. All groups improved their reading skills. The group who received combined training showed higher improvements than the ordinary special instruction group and the typical readers. Different cognitive variables were related to treatment gains for different groups. Thus, a treatment combining bottom-up and top-down aspects of reading was the most effective in general, but individual differences among children need to be considered.     

Promoting Prosocial Behaviours Among Preschool Children With and Without Disabilities

A multiple probe across subjects design was used to evaluate the effectiveness of an intervention program on promoting prosocial behaviours among preschool children with and without disabilities. The intervention was carried out with three integrated groups of children, each comprised of one child with a disability and two peers without disabilities, created from three mainstreamed preschool classrooms. The intervention was successful in promoting increases in positive social interactions among the children with disabilities and their peers without disabilities. For two of the three groups the children with disabilities engaged in an equal or greater percentage of positive social initiations than their peers without disabilities. Increases in positive social responses to positive social initiations were similar for children with and without disabilities. Intervention phase behavioural changes generalised to both immediate group conditions, but did not generalise to deferred classroom conditions. Variability of response to intervention across groups highlights the need to develop and implement interventions on an individualised basis. The results indicate that further research is needed regarding the promotion of deferred generalisation effects as well as understanding the effects that trainer presence may have on the generalisation of the targeted social behaviours. There is also a need for the investigation of the potential for gender‐related effects including differential activity levels, ability for sustained attention, and group composition.     

Attitudes Toward Deafness and Security of Attachment Relationships Among Young Deaf Children and Their Parents

This study investigated deaf children's "security of attachment" relationships with their hearing parents and the relationship of parental attitudes toward deafness. Subjects included 30 deaf children and their hearing parents. The children ranged in age from 20 to 60 months. Instruments used included the Attachment Q-Set, the Attitudes to Deafness Scale, and parental interviews. As a group there were no differences between security of attachment scores of deaf children toward either of their parents; however, there were marked differences within individual dyads of mother-child/father-child relationships. In addition, negative correlations were found between parents' attitudes towards deafness scores and their deaf children's security of attachment scores. Implications for the field include the importance of inclusion of fathers in attachment studies and fathers' active participation in early intervention programs. The relationship between parental attitudes toward their children's disability (deafness) and attachment relationship provides further evidence for the critical role of early intervention in the development of children with special needs.     

Early Intervention,Families, and Adolescents With Down Syndrome

Developmental assessments are reported for two cohorts of Brisbane children with Down syndrome at chronological ages from 11 to 14 years. Cohort 1 was born during 1973 to 1974 while Cohort 2 was born from May 1976 to December 1978. These cohorts provided an opportunity of studying the long‐term effects of early intervention as a history‐graded influence on development; one cohort was born before early intervention became widely available whereas by the time the other children were born, a variety of programs were being offered children with disabilities. No significant cohort differences were found in MA at 11 years, 12 years and 14 years CA, in non‐verbal scores at 11 years and 12 years CA, or in adaptive behaviour scores near 13 years CA. There was no evidence of a final plateau in MA. When the cohorts were divided on the basis of early intervention commencement age, frequency and duration of attendance, there were again no group differences. SES, mothers’ education, and gender were significant predictors of MA but gender did not add significantly to non‐verbal scores. Cognitive function was strongly associated with adaptive behaviours. It was concluded that early intervention studies need to investigate social disadvantage and biological impairment not only as separate issues, but as a combination of the two. There is also a continuing need to identify the specific elements associated with SES and maternal education that influence development in children.     

Family Predictors of Maternal and paternal Involvement in Programs for Young Children with Disabilities

The study of family variables has become increasingly critical in understanding outcomes typically considered program driven. Research linking family variables to parental involvement in early intervention programs for young children with disabilities is generally lacking. The purpose of this study was to determine the combined influence and predictive ability of family characteristics on maternal and paternal involvement in early intervention programs. Service providers rated mothers' and fathers' involvement in early intervention programs Mother and fathers completed a battery of self-report questionnaires related to a variety of constructs, such as family functioning, marital adjustment, social supports, stress, coping, and parental involvement. Structural equating modeling was used to test the predictive ability of family variables. Two different models were developed for mothers and fathers. Results indicated significant outcomes for both group, largely supporting the proposed model. The coping variable emerged as a significant predictor of maternal and paternal involvement as well as a mediator variable between family functioning and parental involvement.     

Violence and the changing universe of disabilities

The field of special education has primary responsibility for providing specialized services to young children with disabilities in the schools. Increasingly, it is recognized that many disabilities identified among young children may be attributable to environmental variables, such as violence, poverty, toxic materials exposure, and family dysfunction. Issues of violence hold particular relevance for special education professionals. Recent studies report that young children with disabilities are 1.7 times more likely to be victims of maltreatment than children without disabilities. For children with disabilities living with the effects of violence, the infrastructure of special education as it is now developing may be the most promising approach to individual and systems intervention. Comprehensive community-based initiatives are replacing fragmented practices. The new collaborations can multiply the results of intervention or support programs beyond those attainable through any single approach. Views expressed in this article are solely those of the author and do not reflect policies of the U.S. Department of Education.     

Linking Assessment and Intervention for Developmental/Functional Outcomes of Premature,Low-birth-weight Children

Prematurity and low birth weight (LBW) are two major biological factors that put infants and young children at high risk for developmental delays or disabilities. While survival rates for premature and LBW children have improved, incidence figures have changed little over the past 20 years; in fact, the incidence of LBW has increased. Although the vast majority of LBW children have normal outcomes, as a group, they have higher risk for subnormal growth, illnesses, and neurodevelopmental problems. The purpose of this article is to examine the factors that influence the effectiveness of early intervention for premature, LBW children and to describe a strategy for linking assessment and early intervention. Linking assessment and intervention involves comprehensive assessment; a team approach to both assessment and intervention; empowering and enabling families; and the development of functional goals and objectives.     

Does Teaching Young Children with Disabilities to Read Facilitate their Language Development? A Critical Review of Current Theory and Empirical Evidence

Instruction in reading has been an important component of many early intervention programs for children with disabilities over the past two decades. Justification for the inclusion of reading, prior to the age when it is traditionally taught to children with normal development, has included the importance of reading as a life skill and the value of teaching reading in a systematic, individualised program with the reduced risk of failure. It has also been argued that the teaching of reading, at a time when oral language skills are emerging, will enhance the development of speech and language skills. This proposition is an interesting one in view of the belief, commonly held by educators, that reading needs to be established on a firm language base and that good language skills will enhance the acquisition of reading skills. This paper explores the theoretical and empirical support for the teaching of reading as a supportive language development program for young children with disabilities.     

Spoken language development in oral preschool children with permanent childhood deafness

This article documented spoken language outcomes for preschool children with hearing loss and examined the relationships between language abilities and characteristics of children such as degree of hearing loss, cognitive abilities, age at entry to early intervention, and parent involvement in children's intervention programs. Participants were evaluated using a combination of the Child Development Inventory, the Peabody Picture Vocabulary Test, and the Preschool Clinical Evaluation of Language Fundamentals depending on their age at the time of assessment. Maternal education, cognitive ability, and family involvement were also measured. Over half of the children who participated in this study had poor language outcomes overall. No significant differences were found in language outcomes on any of the measures for children who were diagnosed early and those diagnosed later. Multiple regression analyses showed that family participation, degree of hearing loss, and cognitive ability significantly predicted language outcomes and together accounted for almost 60% of the variance in scores. This article highlights the importance of family participation in intervention programs to enable children to achieve optimal language outcomes. Further work may clarify the effects of early diagnosis on language outcomes for preschool children.     

A meta-analytic review of interventions to improve children’s attitudes toward their peers with intellectual disabilities

Children’s biases toward their peers with intellectual disabilities tend to have negative developmental and social consequences for those with intellectual disabilities. As a result, researchers developed intervention programs to reduce biases toward children with intellectual disabilities. This meta-analysis is a quantitative summary of 59 studies and 144 hypothesis tests involving intervention programs to change children’s attitudes toward their peers with intellectual disabilities. Results revealed an overall significant effect (d = 0.44): following intervention programs, children’s attitudes toward their peers with intellectual disabilities increased. Moderators indicate that the most effective interventions were those that occurred over multiple sessions, involved active engagement in multiple strategies and social interactions, emphasized equal status contact that was unstructured or indirect, and had little adult guidance. Interventions had no effect on changing children’s perceptions of competence and participants in junior high had more negative attitudes following the interventions. Findings provide guidance for researchers, educators, and counselors who seek methodologies to reduce biases toward children with intellectual disabilities.     

Language Intervention: Computer Training for Young Children with Special Needs

Three studies that explore the usefulness and effectiveness of computers for training language skills of young children with communication disabilities are reviewed. A study of eight toddlers with Down syndrome compared traditional individual language intervention with computer-based instruction for developing comprehension of vocabulary and early grammatical patterns over a period of three months. Both approaches showed a similar, highly significant effect, indicating that computer-based intervention was as successful as traditional one-to-one language therapy.
A second study used 52 children (ages 4–10) who were enrolled in special education classes for children with severe language, learning and behavioral disabilities. The effectiveness of adding twice a week, 30-minute interactive computer language training sessions to the regular classsroom language curriculum was examined. Children showed significantly more progress in vocabulary, general language ability and social communication during the 10 week period they were receiving the computer training.
Lastly, the effectiveness of using a parent volunteer to work with toddlers on computer-based language tasks was compared with language progress when these children worked with a professional speech language pathologist. Four out of five of the children showed more progress when working with the parent volunteer.
The article concludes with a discussion of educational considerations for planning computer-based language intervention and includes a sample language lesson for the computer as well as software evaluation guidelines.     

Longitudinal Studies of Alternative Types of Early Intervention: Rationale and Design

In 1985, the US. Department of Education awarded a competitively bid contract to Utah State University to conduct a series of longitudinal studies on the effects and costs of alternative types of early intervention programs for children having disabilities. Issues addressed by this set of studies included the effects and costs of varying (a) the intensity of intervention, (b) the age at which intervention is begun, and (c) the ways in which parents are involved in intervention programs. This article summarizes the historical context in which these studies were implemented, the rationale for conducting this type of study, and the procedures incorporated into the design of each study to ensure that the results would be useful to practitioners and other researchers.     

A comparison of two reading interventions for children with reading disabilities

This study compared the effectiveness of two reading interventions in a public school setting. Forty-five second-grade children with reading disabilities were randomly assigned to a 6-week phonological awareness, word analogy, or math-training program. The two reading interventions differed from each other in (a) the unit of word analysis (phoneme versus onset-rime), (b) the approach to intervention (contextualized versus decontextualized), and (c) the primary domain of reading instruction (oral versus written language). Results indicate that children in both reading programs achieved significant gains in beginning reading skills, learning the specific skills taught in their respective programs, and applying what they had learned to uninstructed material on several transfer-of-learning measures, in comparison to children in the control group. For children in both reading intervention groups, the most significant mediator of growth in oral reading fluency was a child's initial level of word identification skill. Implications of these findings are that systematic, high quality reading intervention can occur in a small group, public school setting and that there are several different paths to the remediation of children with reading disabilities.     

Longitudinal Studies of Alternative Types of Early Intervention: Rationale and Design

In 1985, the US. Department of Education awarded a competitively bid contract to Utah State University to conduct a series of longitudinal studies on the effects and costs of alternative types of early intervention programs for children having disabilities. Issues addressed by this set of studies included the effects and costs of varying (a) the intensity of intervention, (b) the age at which intervention is begun, and (c) the ways in which parents are involved in intervention programs. This article summarizes the historical context in which these studies were implemented, the rationale for conducting this type of study, and the procedures incorporated into the design of each study to ensure that the results would be useful to practitioners and other researchers.