Chapter 3
Early Intervention:
Supports and Services
Early Intervention
• Intelligence and skills are not fixed at birth.
The environment surrounding children has a
profound effect on their development
• The purpose of early intervention is to provide
necessary supports and services to optimize the
child's development as early as possible.
• Early intervention refers to a range of services
provided to children, parents, and families during
pregnancy, infancy, and/or early childhood.
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Historical Overview
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1900s: The belief that a person’s abilities were fixed at birth and
could not be changed resulted in many children with disabilities
being placed in institutions
1930s, the belief that nothing could be done to improve
outcomes for children with disabilities was dramatically challenged
when Drs. Harold Skeels and Harold Dye performed a research
study (Noonan & McCormick, 2006). They found that children who
were placed in foster homes or who were adopted fared much better
than did a comparable group of children who remained in an
orphanage (Skeels & Dye, 1939). The fostered-adopted group
achieved normal intelligence, whereas many of the institutionalized
children were classified as mentally retarded.
Samuel Kirk (1950) demonstrated that preschool experience
could increase the rate of mental development & the social
skills of children who were classified as mentally retarded.
Provisions of PL 94-157 to children with disabilities from birth to age
5.
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1972: Abecedarian Study
• One of the longest running studies of the
importance of early intervention and
continues through today. The study
examined the impact of quality early child
care on children from economically
disadvantaged families and found modest
gains of IQ points, and reading and math
scores. The study also found that the
experimental group was more than twice as
likely to enroll in a four-year college or
university.
http://www.youtube.com/watch?v=8YyZ8FkF
sK4
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Historical Overview
In 1986, PL 99-457 was passed and extended the
provisions of PL 94-157 to children with
disabilities from birth to age 5.
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Early Intervention Legislation
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Services for young children with disabilities are now referred
to in IDEA 2004, Parts B and C. Part C serves children from birth
to 2 and encourages states to develop comprehensive, coordinated,
multidisciplinary early intervention systems.
Part C also stipulates that early interventions should be provided, to
the maximum extent possible, in natural environments, or settings
that are typical for children who do not have disabilities (Noonan &
McCormick, 2006).
Children age 3 through 5 with disabilities are addressed in Part B of
IDEA, which provides funds for states to ensure that all preschoolage children with disabilities receive special education and related
services.
Although the current literature defines early childhood intervention
programs as covering from birth to 8 years of age, most programs
actually divide themselves into infancy (birth to age 2), early
childhood (ages 3 to 5), and early school age (ages 5 to 8). During
this time period, the most influential factor in the ecology of the child
is the family.
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Importance of Early Intervention
• Critical developmental time
• Foundation for all future learning
• Strengthens the parent’s capacity to meet their
child’s needs
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Prenatal and Neonatal Identification
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Genetic counseling : Detects potential genetic disorders.
Counselor may suggest tests to determine whether a disability may
exist.
Prenatal testing:
Alpha-fetoprotein test: a blood test taken at 16 weeks to identify
the risk of having a child with a neural tube defect;
sonography, the use of ultrasound, at 3 and 5 months, to view the
child for potential microcephaly and neural tube defects;
amniocentesis, a test in which fluid is withdrawn from the placenta
at 4 to 17 weeks to determine the presence of a number of
disabilities, such as Tay-Sachs disease and Down syndrome.
chorionic villus biopsy, a procedure in which tissue is removed
from the uterus of the pregnant woman during the first trimester.
This test can be used to determine if there is evidence of potential
disabilities. Because there is a high risk of miscarriage following this
test, some physicians will not perform it.
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How do we identify children who are in need of
early intervention?
• The Apgar test, developed in 1952, is still used
to determine the health of a newborn infant. It
measures the heart rate, respiratory effort,
muscle tone, and general physical state,
including skin color. Scores of 0, 1, or 2 are
given in each of the five areas being measured.
A below-average Apgar score (5 or less) at one
and five minutes after birth is used to determine
the possibility of debilitating conditions, the need
for additional testing, and the need for medical
intervention.
http://www.youtube.com/watch?v=PkX286L5a_0
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How do we identify children who are in need
of early intervention?
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Blood and urine tests: taken within the first few minutes following
birth to determine if there is a known curable disorder that should be
treated immediately. One symptom associated with mental
retardation is deficiency of the thyroid gland, which can lead to
cretinism: A congenital condition due to thyroid hormone deficiency
during fetal development and marked in childhood by dwarfed
stature, mental retardation, dystrophy of the bones, and a low basal
metabolism. Also called congenital myxedema, cretinoid dysplasia.
The newborn behavioral observations (NBO) approach is being
introduced to help parents and professionals understand the
preferences and vulnerabilities of the newly born infant (Nugent et
al., 2007a). The patterns revealed by the NBO approach can also
help parents and clinicians decided whether further developmental
assessments are needed (Levine, 2006).
Hearing assessments should be given at birth.: John Tracy Clinic
in LA!
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What Puts Children at Risk?
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Events occurring during pregnancy or at birth can cause a child to be born
with disabilities. Eg. German measles during the first trimester to insufficient
oxygen supply and toxemia: presence of toxins in the blood. Diabetes can
lead to fetal malformation and control of diabetes can prevent the
occurrence of many disabilities (Graham & Morgan, 1997).
Rosetti’s (1986) study of the increased risk of having a child with disabilities
if the mother is over the age of 35 is being reexamined in light of the
growing number of professional women who are delaying the birth of a first
child until later in their careers.
Environmental stressors are the major cause of disabilities in children by
age 6. Many poor child-rearing strategies are due to a lack of education or
neglect. Recently, there has been a high incidence of child abuse (Cosmos,
2001; Sameroff & Feise, 2000). Studies (Money, 1984) show that some
severely physically abused children, besides incurring emotional deficits,
can actually stop growing physically and intellectually. Poverty can lead to a
lack of prenatal care and malnutrition.
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• Substance abuse by either the father or
mother of an infant may lead to later
disabilities in the child. The heavy use of
alcohol by the mother may lead to fetal alcohol
syndrome—evidenced by facial abnormalities,
heart disease, small size, and some degree of
mental retardation. The abuse of the body
brought about by heavy smoking by the mother
can lead to premature birth and later
complications for the child. Illicit drug use by the
mother can lead to a wide range of behavior
problems (Cohen & Erwin, 1994).
http://www.come-over.to/FAS/faschar.htm
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March of Dimes
• http://www.marchofdimes.com/mission/mission.h
tml
• According to March of Dimes (2008), an at-risk
infant is one who, because of low birth weight,
prematurity, or serious medical complications,
has a greater chance of having developmental
delays or cognitive or motor deficits. Batshaw
(2002) indicated three general types of
conditions that put these children at risk: (1)
genetic disorders, (2) events occurring during
pregnancy or at birth, and (3) environmental
conditions.
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Educational Responses
• The Individualized Family Service Plan(0-3 years old)
• Multidisciplinary teams are established. When all
necessary information has been gathered, the
multidisciplinary team, which includes the family,
meets to discuss the case and to determine the
appropriate measures to be taken. Parents can choose
whether or not to involve their children in the provided
services. IDEA 2004 encourages educating young
children in natural environments—that is, settings that
are normal for children of that age who do not have
disabilities (Carta & Kong, 2007; Norman & McCormick,
2006).
• Activity-based, embedded approaches are
particularly useful in promoting and enhancing
young children’s social competence (Squires &
Bricker, 2007).
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• To assist teachers in providing quality programs
to infants and toddlers, the National Association
for the Education of Young Children (NAEYC)
and the National Education Association (NEA)
have published guidelines called
developmentally appropriate practice (DAP).
• High-quality early intervention programs are
based on developmentally appropriate practices
(DAP).
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RTI Model Learning Environment
• http://www.youtube.com/watch?v=nkK1bT8ls0M&fea
ture=related
• http://www.crtiec.org/
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Tier (level)I: Universal screening and Progress Monitoring Tier I
would see high-quality learning environments with universal
screening to look at all children’s needs and periodic progress
monitoring taking place for all preschool children
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Tier II: If a child is found not to be thriving within this environment,
the teachers can provide more support using Tier II activities,
– Embedded activities
– Consultations with other professionals
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Tier III: More intensive support and explicit involvement with other
professionals: such as more intense services by the speechlanguage teacher.
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RTI model
• Intended to reduce the need for special
education by improving and providing services
early
• Services are individualized and based on
evidence-based strategies.
• There is a high quality of “general” intervention,
and resource
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Tier I: Foundation of quality, universal
screening, progress monitoring
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Tier II: More intensive response to children
who need additional support to be successful
(embedded & explicit), progress monitoring, use
of standard protocols, collaborative problemsolving
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Tier III: Additional support that is more intense
and individualized, assessments & progress
monitoring, collaborative problem-solving
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Family-centered approach
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The family-centered approach is one of the strongest movements in
special education. It is focused on the belief that the family
needs to be at the center of any early intervention system: IFSP
Cultural responsiveness is essential when working with families
(Fowler, Ostrosky, & Yates, 2007; Garcia & Magnuson, 2000). The
text gives the following criteria as an important part of assessing the
appropriateness of services for children and families from a variety
of cultural backgrounds.
(1) What is the child’s primary language, and how is it used in the
home?
(2) What are the parents’ expectations about the use of language to
communicate? How is language use valued in the home?
(3) What are the preferred strategies of learning: verbal, nonverbal,
observation, imitation?
(4) To what degree is the family acculturated? Do they agree or
disagree about cultural values and mores?
(5) What goals does the family have for the child?
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