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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

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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 interventionrefers to a range of services provided to children, parents, and families during pregnancy, infancy, and/or early childhood.

Historical Overview

  • 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.

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.

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.

Early Intervention Legislation

  • 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 preschool-age 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.

Importance of Early Intervention

  • Critical developmental time

  • Foundation for all future learning

  • Strengthens the parent’s capacity to meet their child’s needs

Prenatal and Neonatal Identification

  • 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.

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.

How do we identify children who are in need of early intervention?

  • 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!

What Puts Children at Risk?

  • 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.

  • 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).

March of Dimes


  • 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.

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).

  • 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).

RTI Model Learning Environment



  • 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

  • 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

  • Tier III: More intensive support and explicit involvement with other professionals: such as more intense services by the speech-language teacher.

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

  •  Tier I: Foundation of quality, universal screening, progress monitoring

  •  Tier II: More intensive response to children who need additional support to be successful (embedded & explicit), progress monitoring, use of standard protocols, collaborative problem-solving

  •  Tier III: Additional support that is more intense and individualized, assessments & progress monitoring, collaborative problem-solving

Family-centered approach

  • 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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