1. A DEFINITION OF EARLY INTERVENTION
Early intervention consists of a wide variety of educational, nutritional, child care, and family supports, all designed to reduce the effects of disabilities or prevent the occurrence of learning and developmental problems later in life for children presumed to be at-risk for such problems.
[E]arly intervention can be defined as a loosely structured confederation of publicly and privately funded home- and classroom-based efforts that provide (1) compensatory or preventative services for children who are assumed to be at risk for learning and behavior problems later in life, particularly during the elementary school years, and (2) remedial services for problems or deficits already encountered Simply put, early intervention must provide early identification and provision of services to reduce or eliminate the effects of disabilities or to prevent the development of other problems, so that the need for subsequent special services is reduced. (McConnell, 1994, pp. 75, 78)
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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2. FIRST GENERATION RESEARCH ON THE IMPACT OF EARLY INTERVENTION
"Does early intervention make a difference for children and their families?"
Skeels and Dye (1939) - earliest and one of the most dramatic demonstrations of the critical importance and potential impact of early intervention
found that intensive stimulation, one-to-one attention, and a half-morning kindergarten program with 1- to 2-year-old children who were classified as mentally retarded resulted in IQ gains and eventual independence and success as adults, when compared to similar children in the institution who received adequate medical and health services but no individual attention
the study challenged the widespread belief that IQ was fixed and that little could be expected from intervention efforts, and it served as the catalyst for many subsequent investigations into the effects of early intervention
The Milwaukee Project - consisted of parent education and infant stimulation for children considered at risk for retarded development because of their mothers' levels of intelligence (IQs < 70) and conditions of poverty
at age of 3 1/2, the experimental children tested an average of 33 IQ points higher than a control group of children
study sometimes offered as evidence that early intervention can reduce the incidence of mental retardation caused by psychosocial disadvantage.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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3. SECOND-GENERATION RESEARCH ON THE IMPACT OF EARLY INTERVENTION
"What factors make early intervention more or less effective for particular target groups of children?"
Abecedarian Project - children received early intervention that was both intensive and of long duration: a full-day preschool program, 5 days per week, 50 weeks per year
compared with control group children who received supplemental medical, nutritional, and social services but did not receive daily early preschool services, children in the early intervention group made positive gains in IQ scores by age 3, were 50% less likely to fail a grade, and scored higher on IQ and reading and mathematics achievement tests at age 12
Project CARE - compared the effectiveness of home-based early intervention in which mothers learned how to provide developmental stimulation for their infants and toddlers with center-based early intervention
children who received the full-day, center-based preschool program 5 days per week, supplemented by home visits, showed gains in the intellectual functioning "almost identical" to those found in the Abecedarian Project
the IQs of children in the home-based-only treatment group did not improve, perhaps because the home-based treatment was not sufficiently intensive, on a day-to-day basis, as the year round center-based program
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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4. the intensity of the intervention
SECOND-GENERATION RESEARCH ON THE IMPACT OF EARLY INTERVENTION (con't.)
Infant Health and Development Program - provided early intervention services to infants who were born prematurely and at low birth weight
home visits were conducted from shortly after birth through age 3; children began attending a center-based early education program at 12 months of age and continued until age 3. Improvements in intellectual functioning were noted
study found a positive correlation between how much children and their families participated in the early intervention and the intellectual development of the children
These three second-generation studies point to two factors that appear highly related to outcome effectiveness of early intervention:
the intensity of the intervention
the level of participation by the children and their families
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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5. EARLY INTERVENTION FOR INFANTS AND TODDLERS
If a state chooses to provide services of early intervention services to infants and toddlers and their families, it can receive federal funds under IDEA's early intervention provisions. The law covers any child under age 3 who meets one of three categories of eligibility:
Developmental delay includes children with significant delays or atypical patterns of development. Each state's definition of developmental delay must be broad enough to include all disability categories covered by the IDEA, but children do not need to be classified or labeled according to those categories to receive early intervention services.
Established conditions includes children with a diagnosed physical or medical condition that almost always results in developmental delay or disability (e.g., Down syndrome, sensory impairments, fetal alcohol syndrome).
Documented risk includes children who are biologically at-risk of developmental delay or disability because of their pediatric histories or current biological conditions and those considered to be environmentally at-risk for developmental delay because of factors such as extreme poverty, parental substance abuse, homelessness, abuse or neglect, or parental intellectual impairment.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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6. FETAL ALCOHOL SYNDROME
Fetal alcohol syndrome (FAS) is caused by excessive alcohol use during pregnancy, often produces serious physical defects and developmental delays.
FAS is diagnosed when a child has two or more cranofacial malformations and growth is below the 10th percentile for height and weight.
Children with a history of prenatal alcohol exposure and some but not all of the diagnostic criteria for FAS are sometimes labeled fetal alcohol effects (FAE)
The incidence of FAS is estimated at 1 to 3 per 1,000 live births; however, FAS birth rates among alcoholic women are about 25 per 1,000.
FAS is one of the leading known causes of mental retardation, with an incidence figure higher than Down syndrome, cerebral palsy, and spina bifida.
Children with FAS often experience sleep disturbances, motor dysfunctions, hyperirritability, challenging behaviors such as aggression and conduct problems, and poor academic achievement.
Children with FAS are usually born to mothers who are heavy drinkers; however, research has determined no safe level of drinking during pregnancy.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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7. INDIVIDUALIZED FAMILY SERVICES PLAN
IDEA prescribes family-focused early intervention services, delivered according to an Individualized Family Services Plan (IFSP) that must contain:
1. the child's present levels of development, based on objective criteria;
2. the family's resources, priorities, and concerns relating to enhancing the development of the family's infant or toddler with a disability;
3. the major outcomes expected to be achieved for the infant or toddler and family, and the criteria, procedures, and timelines used to determine the degree to which progress toward achieving the outcomes is being made and whether modifications or revision of the outcomes or services are necessary;
4. the specific early intervention services necessary to meet the unique needs of the infant or toddler and family, including frequency, intensity, and method of delivering the services;
5. the natural environments in which early intervention services shall appropriately be provided, including a justification of the extent, if any, to which the services will not be provided in a natural environment;
6. the projected dates for initiation of services and anticipated duration of services;
7. the identification of the service coordinator from the profession most immediately relevant to the infant's or toddler's or family's needs will be responsible for implementation of the plan and coordination with other agencies and persons; and
8. the steps to be taken to support a successful transition of the toddler with a disability to preschool or other appropriate services. (PL , Section 1436)
The IFSP must be evaluated once a year and reviewed with the family at 6-month intervals.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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8. SPECIAL EDUCATION FOR PRESCHOOLERS
IDEA requires states to provide preschool services to all children with disabilities ages 3 to 5 years. The regulations governing these programs are similar to those for school-age children, with these major exceptions:
Preschool children do not have to be identified and reported under existing disability categories (e.g., mental retardation, orthopedic impairments) in order to receive services.
Each state, at its discretion, may also serve children (from ages 3 through 9) who are (a) experiencing developmental delays as defined by the state and as measured by appropriate diagnostic instrument and procedures in one or more of the follow areas: physical development, cognitive development, communication development, social or emotional development, or adaptive development; and (b) who, by reason thereof, need special education and related services.
IEPs must include a section with instructions and information for parents.
Local education agencies may elect to use a variety of service delivery options (home-based, center-based, or combination programs) and the length of the school day and school year may vary.
Preschool special education programs must be administered by the state education agency; however, services from other agencies may be contracted to meet the requirement of a full range of services.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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9. SCREENING, IDENTIFICATION, AND ASSESSMENT IN ECSE
Assessment and evaluation in early childhood special education is conducted for at least four different purposes, with specific evaluation tools for each purpose:
Screening quick, easy-to-administer tests to identify children who may have a disability and who should receive further testing
Diagnosis in depth, comprehensive assessment of all major areas of development to determine a child's eligibility for early intervention or special education services
Program Planning curriculum-based, criterion-referenced assessments to determine a child's current skill level, identify IFSP/IEP objectives, and plan intervention activities
Evaluation curriculum-based, criterion-referenced measures to determine progress on IFSP/IEP objectives and evaluate the program's effects
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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10. SIX KEY DOMAINS OF CHILD DEVELOPMENT
Cognitive skills pre-academic skills such as sorting or counting, remembering things they have done in the past, planning and making decisions, integrating newly learned information with previously learned knowledge and skills, solving problems, and generating novel ideas
Motor skills general strength, flexibility, endurance, eye-hand coordination, large- muscle movement and mobility such as walking, running, throwing and small-muscle, fine-motor control needed to pick up a toy, write, or tie a shoe
Communication and language skills encompass all forms of communication development, including a child's ability to respond nonverbally with gestures, smiles, or actions, and the acquisition of spoken language—sounds, words, phrases, sentences, and so on
Social competence and play skills sharing toys and taking turns, cooperating with others, and resolving conflicts
Affective and emotional development children should feel good about themselves and know how to express their emotions and feelings
Self-care and adaptive skills adaptive skills such as dressing/undressing, eating, toileting, toothbrushing, handwashing
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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11. CURRICULUM GOALS IN ECSE
Early childhood special education programs should be designed and evaluated with respect to the following outcomes or goals:
1. Support families in achieving their own goals
2. Promote child engagement, independence, and mastery
3. Promote development in all important domains
4. Build and support social competence
5. Facilitate the generalized use of skills
6. Prepare and assist children for normalized life experiences with their families, in school, and in their communities
7. Help children and their families make smooth transitions
8. Prevent or minimize the development of future problems or disabilities
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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12. DEVELOPMENTALLY APPROPRIATE PRACTICE
Virtually all early childhood educators share a common philosophy that learning environments, teaching practices, and other components of programs that serve young children should be based on what is typically expected of and experienced by children of different ages and developmental stages.
This philosophy and the guidelines for practice based on it are called developmentally appropriate practice (DAP) and are described in materials published by the National Association for the Education of Young Children (NAEYC). DAP recommends the following guidelines for early childhood education programs:
Activities should be integrated across developmental domains.
Children's interests and progress should be identified through teacher observation.
Teachers should arrange the environment to facilitate children's active exploration and interaction.
Learning activities and materials should be real, concrete, and relevant to the young child's life.
A wide range of interesting activities should be provided.
The complexity and challenges of activities should increase as the children understand the skills involved.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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13. DAP AND EARLY CHILDHOOD SPECIAL EDUCATION
Most early childhood special educators view the DAP guidelines as providing a foundation or context within which to provide early intervention for children with special needs, but a curriculum based entirely on DAP may not be sufficient for young children with disabilities because (Wolery et al., 1992):
1. Many children with special needs have delays or disabilities that make them dependent upon others.
2. Many children with special needs have delays or disabilities that keep them from learning well on their own.
3. Many children with special needs develop more slowly than their typically developing peers.
4. Many children with special needs have disabilities that interfere with how they interact, and, as a result, they often acquire additional handicaps.
Bricker et al. (1998) note two significant differences between DAP and ECSE:
Special educators must target specific goals and objectives to meet the unique developmental needs of individual children, while DAP is concerned with more general developmental goals applicable to a broad range of children.
ECSE uses comprehensive and repeated assessments to determine learning objectives and to monitor progress; DAP, by contrast, does not require the use of assessment or evaluation tools.
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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14. DEVELOPING LANGUAGE IN PRESCHOOLERS WITH DISABILITIES
Good teachers do three things to ensure effective intervention for language-delayed children (Allen, 1980a):
1. They arrange the environment in ways that are conducive to promoting language by:
providing interesting learning centers (blocks, housekeeping and dramatic play, creative and manipulative materials)
balancing child-initiated and teacher-structured activities
presenting materials and activities that children enjoy
2. They manage their interactions with children so as to maximize effective communication on the part of each language-impaired child by:
using every opportunity to teach "on the fly”
3. Validate child progress and thus program effectiveness by monitoring the appropriateness of
environmental arrangements
their own behavior
the children’s behavior
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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15. SERVICE DELIVERY ALTERNATIVES FOR EARLY INTERVENTION
Hospital-based programs - provide early intervention services to hospitalized newborns and their families
Home-based programs - parents assume the primary responsibility of caregivers and teachers for their child with disabilities
Advantages
home is the child's natural environment, and parents his/her first teachers
significant others in the child’s life can play an important role
activities and materials are more likely to be natural and appropriate
parents who are actively involved have an advantage over parents who feel guilt, frustration, or defeat at their seeming inability to help their child
less costly to operate than center-based program
Disadvantages
not all parents are able or willing to spend the time required
parents who are struggling with the realities of day-to-day survival are unlikely to meet the added demands of involvement in an early intervention program
children may not receive as wide a range of services as they would in a center-based program
the child may not receive sufficient opportunity for social interaction with peers
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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16. SERVICE DELIVERY ALTERNATIVES FOR EARLY INTERVENTION (con’t.)
Center-based programs - provide early intervention services in a special educational setting outside the home
Advantages
increased opportunity for a team of specialists from different fields to observe each child and cooperate in intervention and assessment
opportunity for contact with typically developing peers
parents feel some relief at the support they get from the professionals who work with their child and from other parents with children at the same center
Disadvantages
expense of transportation
cost and maintenance of the center itself
the probability of less parent involvement than in home-based programs
Combined home-center programs - provide a combination of center-based activities and home visitation
offer many of the advantages of the two types of programs and negates some of their disadvantages
W. L. Heward, Exceptional Children, 6e,  2000 by Prentice-Hall, Inc. All rights reserved.
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