1. Early Intervention: The Integration of Science and Practice
Michael J. Guralnick, PhD
Director, Center on Human Development and Disability
Professor of Psychology and Pediatrics
University of Washington
Seattle, WA, USA

2. Challenge for Early Intervention
Expectation is that systematic, comprehensive, experientially-based Early Interventions will:
enhance the development of children already exhibiting delays (known or unknown etiology); alter trajectory; prevent secondary complications
prevent delays from occurring for children at risk

3. Current Status: Services and Supports
High Resource Countries
100
Expected and Accepted 75
Percent Receiving Services 50 25
1975
1986
2016

4. Current Status: Services and Supports
Policy Initiatives : Service Systems Sectors
Education, Child Care, Health, Social Services, Mental Health
Early Intervention Systems
Are In Place

5. Current Status: Services and Supports
Low and Middle Resource Countries
23% at risk for or with an established disability
(Walker, 2011)
Long-term Strategic Plans
Building Infrastructure
Professional Training
Combating Negative Attitudes
Primary Prevention Programs

6. Why Focus on the Early Childhood Period?
Pragmatic/Humanitarian
Meeting family needs in most stressful period
Support and strengthen families
Family-centered supports and services have become the central feature of early intervention programs
Linkage developmental perspective

7. Why Focus on the Early Childhood Period?
Plasticity
Unique window of opportunity to alter developmental trajectory
Early Intervention System
Neurobiological and behavioral mechanisms
Responsiveness to environmental input
Developmental cascade

8. Why Focus on the Early Childhood Period?
Investment: Long-term Benefits
Financial perspective
Quality of life

9. Who Are These Vulnerable Children?
Biological Risk
(preterm)
(genetic risk)
Environmental
Risk
Developmental
Delay
Autism Spectrum
Disorder

10. What Happens in the Absence of Early Intervention?
Environmental Risk
Developmental Level 5 4 3 2 1
Chronological Age (years)
Biological Risk
Developmental Level 5 4 3 2 1
Chronological Age (years)
Developmental Level 5 4 3 2 1
Chronological Age (years)
Developmental Delay
Autism Spectrum Disorder
Developmental Level 5 4 3 2 1
Chronological Age (years)
(Guralnick, 2005, 2012, 2013, 2016)

11. Why Do Declines in Development Occur Over Time?
Emerging Genetic Influences
Toxic Burden
Artifact of More Complex Test Items
Less Than Optimal Environmental Experiences
Allow Biological or Historical Constraints to Exert Unusual Level of Influence on: Family Patterns of Interaction

12. Level of Child Development Family Patterns of Interaction
Developmental
Resources
Organizational
Processes
Cognition
Language
Motor
Social-emotional
Sensory-perceptual
Executive function
Metacognition
Social cognition
Motivation
Emotion regulation
Constraints
Constraints
Social and Cognitive
Competence
Stressors
Non-Optimal Environment
Family Patterns of Interaction

13. What are the Important Family Patterns of Interaction (Environmental Influences)?
Relationships: Parent-Child Transactions
Discourse framework
Instructional partnership
Socioemotional connectedness
Development Over Time
Discourse framework
Instructional Partnership
Socioemotional connectedness
Expansions, modeling, contingent responding
Scaffolding; zone of proximal development
Secure attachment

14. Relationship Formation
Instructional partnership
Discourse framework
Socioemotional connectedness
Sensitive - Responsiveness
Positive Affect
Engagement

15. Child Social and Cognitive Competence Family Patterns of Interaction
Stressors
Stressors
Family Patterns of Interaction
Parent-Child Transactions
Discourse framework
Instructional Partnership
Socioemotional connectedness
Expansions, modeling, contingent responding
Scaffolding; zone of proximal development
Secure attachment

16. Child Social and Cognitive Competence Family Patterns of Interaction
Stressors
Stressors
Family Patterns of Interaction
Environmental Risk
Family Resources
Personal Characteristics of Parents
Material Resources
Mental and physical health
Intellectual ability
Attitudes and cognitive readiness
Coping style
Perceived confidence and competence
Financial resources
Social support

17. Effects on Family Patterns of Interaction
Discourse framework
Instructional partnership
Socioemotional connectedness
Quality of Parent-Child Transactions
Intensity and Number of Stressors

18. Sources of Parent-Child Transaction Difficulties
Genetic Etiologies
Down Syndrome
Expressive language
Morphosyntactic weakness
Task motivation

19. Genetic Etiologies Williams Syndrome Developmental Influence Over Time
Eye Movement Planning Problems
Visual Exploration
Spatial-Cognitive Abilities
Visual Attention
Relationships
Joint Attention
Developmental Influence
Over Time
Language and Cognitive Development
(Karmiloff-Smith, 2009)

20. Genetic Etiologies Fragile X Syndrome Emotion regulation Gaze aversion
Working memory
Social anxiety
Motivation

21. Child Social and Cognitive Competence Family Patterns of Interaction
Stressors
Stressors
adjust
moderate
Family Patterns of Interaction
Parent-Child Transactions
Discourse framework
Instructional partnership
Socioemotional connectedness
Family Orchestrated Child Experiences
Parent’s social network
Peer network
Stimulating environment
Child care
Community activities
Preschool program
Focus on special interests and needs
Health and Safety Provided by Family
Protection from violence
Preventative health
Environmental hazards
Family Resources

22. Child Social and Cognitive Competence Stressors Stressors
adjust
moderate
Family Patterns of Interaction
Parent-Child Transactions
Family Orchestrated Child Experiences
Health and Safety Provided by Family
Discourse framework
Discourse framework
Parent’s social network
Protection from violence
Peer network
Stimulating environment
Instructional partnership
Instructional partnership
Preventative health
Child care
Environmental hazards
Socioemotional connectedness
Socioemotional connectedness
Community activities
Preschool program
Focus on special interests and needs
Family Resources

23. Child Social and Cognitive Competence Stressors Stressors
adjust
moderate
Family Patterns of Interaction
Parent-Child Transactions
Family Orchestrated Child Experiences
Health and Safety Provided by Family
Discourse framework
Parent’s social network
Parent’s social network
Protection from violence
Peer network
Peer network
Stimulating environment
Stimulating environment
Instructional partnership
Preventative health
Child care
Child care
Environmental hazards
Socioemotional connectedness
Community activities
Community activities
Preschool program
Preschool program
Focus on special interests and needs
Focus on special interests and needs
Family Resources

24. Child Social and Cognitive Competence Stressors Stressors
adjust
moderate
adjust
moderate
Family Patterns of Interaction
Parent-Child Transactions
Family Orchestrated Child Experiences
Health and Safety Provided by Family
Discourse framework
Parent’s social network
Protection from violence
Protection from violence
Peer network
Stimulating environment
Instructional partnership
Preventative health
Preventative health
Child care
Environmental hazards
Environmental hazards
Socioemotional connectedness
Community activities
Preschool program
Focus on special interests and needs
Family Resources

25. Developmental Science
Similar Declines to be Expected Due to Stressors for All Four Vulnerable Groups (Environmental Risk, Biological Risk, Developmental Delay, Autism Spectrum Disorder)
Developmental Mechanisms of Influence Apply to All Groups
Association Studies (likely causal influences)
Unique Adjustments by Group, Subgroup, and Individual Child and Family Unit
Overall Goal of Early Intervention is Clear: Optimize Family Patterns of Interaction

26. Evaluate Risk and Protective Factors at all Three Levels
Intervention Process
Evaluate Risk and Protective Factors at all Three Levels
Engage in Problem-Solving Process with Family and Intervention Team to Optimize Family Patterns of Interaction
Continuity over Time
Comprehensiveness
Relationships
Consider in Intervention Phase

27. Family Patterns of Interaction
Health and Safety Provided by Family
Protection from violence
Preventative health
Environmental hazards
Parent-Child Transactions
Discourse framework
Instructional partnership
Socioemotional connectedness
Family Orchestrated Child Experiences
Parent’s social network
Peer network
Stimulating environment
Child care
Community activities
Preschool program
Focus on special interests and needs

28. Heterogeneous Group of Children with Developmental Delays
Intervention group 80 60
General Development Quotient 40
Control group 20
home visiting
structured curriculum 30 40 50 60
Intervention
Follow-up
Months
Chronological Age (years)
(Thomaidis et al., 2000)

29. Preterm Children Intervention group Cognitive Development Index
110
Intervention group
105
100 95
Cognitive Development Index 90
Control group 85 80 12 24 36
Age in Months
(Infant Health & Development Program)

30. Early Learning Composite Chronological Age (years)
Autism (toddlers)
Intervention group 80 70
Early Learning Composite
(Mullen) 60
Control group 50 40 2
(baseline) 3 4
Chronological Age (years)
(Dawson, et al., 2010)

31. Autism (toddlers) Intervention group Control group80
Intervention group 70
Vineland Adaptive Behavior Composite (Standard Score) 60
Control group 50 40 2
(baseline) 3 4
Chronological Age (years)
(Dawson, et al., 2010)

32. Chronological Age (years)
Down Syndrome
1.00
Intervention groups (all)
0.80
0.60
Developmental Rate
0.40
Woods et al. (1984)
Scharav & Shlomo (1986)
Schnell (1984)
Berry et al. (1984)
0.20 1 2 3 4 5
Chronological Age (years)

33. Chronological Age (months)
Developing Countries .2
Iron-Deficient Anemia .1
Parent-Child Intervention
-.1
Positive Social-Emotional Behavior
-.2
-.3
Surveillance Only
-.4 6 12 18
Chronological Age (months)
(Lozoff, et al., 2010)

34. Family Orchestrated Child Experiences: Preschool
Pre-Academic: Universal Preschool Program: Inclusion
Typically Developing Children 15
Intervention 10
Children with Mild and Moderate Delay
Early Literacy
(raw scores) 5
No Intervention 4 5
Chronological Age (years)
(Phillips & Meloy, 2012)

35. Family Orchestrated Child Experiences: Preschool
Quality of Peer Relationships 50 .4 40 .3 30
Responsive to Peer (Proportion)
Total Positive Interactions .2 20 .1 10
Inclusive
Specialized
Intervention
Control
(Guralnick, 1981,1988)
(Guralnick, et al., 2006)

36. Autism: Infant Intervention
120
Intervention
100 80
Developmental Quotient (Mullen) Visual Reception 60 40
Declined Treatment 20
Parent-Child Training (Pilot Study)
Sensitive responsiveness
Low intensity (12 sessions plus boosters)
Prevent cascade of events 9 12 15 18 24 36
Chronological Age (months)
100
Intervention 80
Developmental Quotient (Mullen) Language 60 40
Declined Treatment 20 9 12 15 18 24 36
Chronological Age (months)
(Rogers, et al., 2014)

37. Related Benefits Reduce emotional distress Enhance parental coping
Build support networks
Promote parenting confidence and competence
Fewer special services required
Greater productivity
Enhanced community integration
Family Outcomes

38. How Successful Has This Focus on the Early Childhood Period Been?
Pragmatic/Humanitarian – Strengthen Families
Plasticity – Enhance Child Development
Investment: Long-term Benefits – Financial and Quality of Life
Expected and Accepted

39. Challenges for Research and Future Advances
Variability in Outcome Efficacy Studies
Moderating Factors
Sensitivity to environmental input (genetic)
Subgroups
genetic etiology
common biological pathways
historical factors
similar behavioral profiles
Understanding Factors Influencing Longer-Term Outcomes

40. Challenges and Future Directions for Community Practices
Scaling-Up to Early Intervention Community-Based Systems
Lower levels of effectiveness in outcomes
Fading out of effects over time
Reasons for Practice Concerns
Heterogeneous set of intervention strategies—many not evidence-based
Policies not applied in an effective or systematic fashion
Limited Resources

41. Reason for Progress and the Future of Early Intervention
Integration of Science and Practice
Developmental Science
Intervention Science
Early Intervention Practice

42. Family Patterns of Interaction Early Intervention System
Social
Services
Mental
Health
Child Care
Health
Education
System of Supports