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The Early Intervention Curriculum: Family-Focused Intervention Strategies, Activities, and Routines. Gerald Mahoney Case Western Reserve University School of Social Work. What is a curriculum?.

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The early intervention curriculum family focused intervention strategies activities and routines l.jpg

The Early Intervention Curriculum: Family-Focused Intervention Strategies, Activities, and Routines

Gerald Mahoney

Case Western Reserve University

School of Social Work


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What is a curriculum?

  • The term curriculum refers to a conceptual framework and organizational structure for decision making about educational priorities, instructional methods and experiences, and evaluation criteria.

  • Curriculum models provide a defined, sequenced series of intervention objectives, learning experiences, instructional procedures and evaluation criteria for attaining a specific developmental outcome.


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Basic Components of the Early Intervention Curriculum

  • Theoretical Model/Conceptual Framework

    • Theoretical Model for EI Curricula should explain:

      • how developmental competence occurs

      • factors that influence development

      • factors that contribute to developmental problems or delays.

    • Theoretical model should be explicit

      • not implied or assumed.


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Theoretical Model

  • Not all theories are the same

    • Sensory Integration

      • Based upon a theory of information processing that originated during the late 1950’s early 1960’s.

      • Information processing theories have changed dramatically in the past 40 or 50 years.

  • “the current fund of research findings may well be sufficient to declare SI therapy not merely to be an unproven, but a demonstrably ineffective, primary or adjunctive remedial treatment for learning disabilities and other disorders” (p. 348).

    • Hoehn, T, & Baumeister, A. (1994) . Journal of Learning Disabilities


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Theoretical Model

  • Good theory is necessary but not sufficient for a good EI curriculum.

    • Good Theory with Increasing Support

      • The failure of Children with Down syndrome to achieve normal development is related to the impact that this condition has on the integrity of the neurological system (e.g., Transmission of impulses across synapses)

    • No validated developmental curriculum based upon this theory

      • No evidence that developmental interventions can enhance neurological functioning of any sort


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Theoretical Model

  • Learning Theory

    • Development can be conceptualized as the accumulation of learned behaviors or responses

    • Children with disabilities have developmental delays because they have not had the opportunities for learning the discrete skills and behaviors that they need.

      • Children with disabilities may require different types of learning opportunities than typically developing children

        • More structure, intentional teaching, extrinsic reinforcement

    • With appropriate teaching (antecedent and consequent events) children with disabilities can learn anything (Bijou)

  • Comments:

    • learning theory is generally not considered to be a valid description of typical development or of the causes for developmental problems or disabilities.

    • The strength of this theory is that it serves as the foundation of an actionable, positivistic instructional methodology that has been used with some success to teach specified human behaviors to children and adults with mental challenges and/or impairments


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Theoretical Model

  • Developmental Theory

    • Children’s development results from their active participation in social and nonsocial activities.

      • Constructivism, Communication Theory

    • Developmental learning is constrained by children’s current level of functioning and their innate/biological capacities to learn.

    • Children with disabilities learn in the same way and in the same sequence as typically developing children

    • Children with disabilities have developmental delays because their learning processes are compromised and limit their capacity to learn

      • Require more practice or developmentally appropriate experiences than typically developing children

  • Comments:

    • developmental theory is generally considered to provide a better description of learning and development and of the factors that contribute to developmental problems than learning theory.

    • Since there is no clear relationship between developmental theory and instructional methodology, special education and early intervention have been reluctant to embrace this as the foundation for practice.

    • The deterministic elements of developmental theory are viewed as antithetical to the basic purpose and tenets of early intervention practice.


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Theoretical Model

  • Ecological Theory of Development

    • Children’s development is affected by the quality of interactions they have with parents and other socializing agents

    • Adverse psychosocial/familial conditions can affect childrens:

      • Frequency and quality of interactions with parents and other socializing agents

      • Frequency and quality of opportunities for developmental stimulation

    • Children with disabilities can be a unique and significant source of stress for parents and other socializing agents

    • The developmental outcomes attained by children with disabilities can be enhanced by addressing this psycho-social factors that interfere with children’s opportunities for quality interactions and other developmental experiences.

  • Comments

    • Ecological theory is the cornerstone for family services in EI

    • No child focused curricula are based directly on ecological theory

    • Recent emphases on parent education and parent-child interaction have evolved for ecological theory


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Theoretical Model

  • Hybrid Model – Combination of Theories

    • Naturalistic Intervention

      • Learning Theory + Developmental Theory

        • Uses incidental teaching model to promote specific skills in the context of child-initiated, developmentally appropriate activities

    • Relationship Focused Intervention

      • Ecological Theory + Developmental Theory

        • Focus on enhancing the quality of parent-child interaction (e.g., parental responsiveness) as a means of encouraging children’s participation in developmentally appropriate activities and experiences


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Theoretical Model

  • Eclecticism

    • Pragmatic (What Works) versus Theory Driven

    • Based on notions that:

      • different practices (curricula) work with different children and families

      • Different practices are required to address different developmental concerns

    • Derived more from clinical experience than empirical research

      • Little reliable evidence to indicate that different practices are effective with different populations

        • e.g. Autism requires more structured interventions than non-autistic children

    • Different from using a curriculum to address the individualized needs of children

    • Can result in interventionists using practices that are incompatible with each other


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Eclectic Autism Programs

  • Combine various curricula and services commonly used with children with ASD

    • IBI

    • Floortime

    • Sensory Integration

    • Developmentally Appropriate Practice

    • Speech Therapy

  • Studies show that this is not as effective as the use of IBI alone


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Basic Components of the Early Intervention Curriculum

  • Intervention Goals

    • EI Curricula must address Goals that reflect the purposes of early intervention

    • A goal is the long term objective/ultimate desired outcome

      • Maximize children’s functioning

        • Cognitive

        • Communication

          • literacy

        • Social-emotional

        • Motor

        • Adaptive Functioning

          • Home

          • School

    • Goal attainment is best assessed through the use of standardized developmental tests

      • Frequently not done in EI because of training and requirements for standardized testing

      • Tests may not be standardized for or appropriate for use with children with certain disabilities

      • Tests may not measure what children are taught


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Basic Components of the Early Intervention Curriculum

  • Intervention Objectives

    • Outcomes that are promoted to help achieve a goal.

    • Intervention objectives are what we are trying to help children and parents learn and do in order to attain a desired goal.

      • Cognitive, Communication, Social Emotional, Motor, etc.

    • Intervention Objectives are driven by Theory.

      • Behavioral Theory- discrete developmental and or functional skills

      • Developmental Theory- general developmental activities or behaviors such as play, communication, joint attention, trust, cooperation

      • Ecological Theory - parent, family or community outcomes such as parent-child interaction, reduced parental stress, family support, access community services and supports


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Intervention Objectives

  • Confusion between Intervention Goals and Intervention Objectives

    • many perceive the objective to be the goal

  • The Goal of an EI Curriculum is not merely to achieve an objective- It is to promote the goal of EI

    • EI goal is not attained

      • If a child learns the words that are targeted as his/her objectives but does not improve their rate of communication functioning or rate of development.

      • If a child is included in a classroom but does not increase his rate and quality of interaction with peers


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Intervention Objectives

  • Intervention Objectives must be measurable

    • Requirement of IFSP or IEP

    • Accountability

    • Program modification

  • YET, Measurability does not mean that

    • intervention objective is good or bad

    • intervention objective has actually been achieved.

      • The more measurable an objective, the more concrete it is, and the more likely it will be attained

      • Yet very measurable objectives can be attained without

        • impacting the child’s general level of functioning

        • achieving the goals of EI.

      • “8/10 mastery criteria” is an objective rating that is often a poor indicator of whether this is an objective that children will remember and use spontaneously.

  • Subjective ratings can be used to measure intervention objectives but less reliably

    • Intervention curricula could be effective and valuable even though they target intervention objectives that are difficult to measure


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Basic Components of the Early Intervention Curriculum

  • Curriculum Methods and Strategies

    • Instructional strategies are dictated by the nature of the objectives

      • If the intervention objective is for the child to learn specific developmental and functional behaviors then we must use some form directed instruction:

        • Modeling

        • Shaping

        • Prompting

        • Elicited Imitation

        • Extrinsic Reinforcement


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Curriculum Methods and Strategies

  • If the intervention objective is for the child to become more engaged in developmental learning activities such as initiation, exploration, practice, communication, then we must use some form responsive instruction to attain these objectives:

    • Turntaking

    • Matching

    • Imitating Child,

    • Follow the Child’s Lead

    • Acceptance

    • Expansion/Conversational recast


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Curriculum Methods and Strategies

  • Hybrid curricula (activity based/incidental teaching/pivotal response training) evolved from learning theory

  • often target specific behaviors and skills as the intervention objectives

    • Responsive instructional procedures are used to increase the child’s level of engagement

    • Directive instructional procedures are used to teach the child specific skills in situations in which they are engaged.


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Curriculum Methods and Strategies

  • Environment

    • Related partly to nature of objectives

      • Learning Theory – Skills and behaviors

        • Environment arranged to maximize the probability that child will engage in behaviors that are associated with the skills and behaviors that are targeted as intervention objectives

        • Toys and materials selected as props for teaching targeted behavior

      • Developmental Theory- General developmental behaviors

        • Environment arranged to maximize opportunities for child initiated play and communication.

          • Diversity of play experience is emphasized over specificity of play experiences

        • Emphasizes providing children developmental appropriate toys and materials that are matched to children’s current level of developmental functioning


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Curriculum Methods and Strategies

  • Environmental Arrangement

    • Related partly to nature of objectives

      • Hybrid – Skills and behaviors

        • Environment arranged to maximize opportunities for child initiated play and communication.

          • Diversity of play experience is emphasized over specificity of play experiences

        • However, toys and materials embedded in environment as props for teaching targeted behavior


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Curriculum Methods and Strategies

  • Activities and Routines

    • Generally driven more by EI policies and funding than by curriculum

      • Family Centered Practices

        • Parent Participation versus Professional

        • Family Choice

      • Natural environment

        • Home

        • Child care

        • Daily activities and routines

      • Intensity

      • Multidisciplinary vs. Transdisciplinary

  • Contemporary EI Curricula must be adaptable to EI policies and funding constraints


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EI Curriculum and Early Intervention Policies

  • IFSP

    • Must be capable of being responsive to parents concerns about their children

  • Individualized Instruction

    • EI Curricula

      • Individualized Planning

        • Can not be aged based

        • Must be adaptable to children’s current level of functioning

          • Often associated with developmental assessment

      • Must be capable of addressing child's’ unique learning style or abilities

        • Autism

        • Down syndrome

        • Sensory/ Motor Impairments

      • Must be adaptable to learning style and constraints of families


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Utility

  • Manualized – clearly described, detailed procedures for planning, conducting and assessing intervention.

  • Comprehensive- curriculum addresses a broad range of outcomes

  • Practical

    • resources necessary to implement the curriculum are easily accessible

    • Evidence that providers can implement intervention

      • Field Tested

      • Certification

    • Intervention is appropriate for population

      • SES, Mental Health

      • Available resources


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Considering Commercially Available EI Curriculum

  • Lovaas

  • Hawaii (Portage, Carolina)

  • Transdisciplinary Play Based Intervention

  • AEPS

  • Floor Time

  • Responsive Teaching

  • Enabling and Empowering Parents


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Evidence Based

  • Nearly every EI curriculum is evidenced based

  • Different Kinds of Evidence

    • Evidence to support theoretical model (Good)

    • Evidence to support effectiveness of intervention methods to promote intervention objectives (Good-Better)

    • Evidence to support overall effectiveness of curriculum at attaining intervention goal

      • Descriptive Pre- Post- (Good)

      • Quasi Experimental- (Better)

      • Causal Model-(Better than Better)

      • Randomized Control– (Best)


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Evidence Based

  • If you implement a fully developed curriculum, that is useable and compatible with EI policy,

  • but there is no evidence of effectiveness,

  • you have no idea that what you are doing or asking parents to do will actually help to enhance children’s developmental well being.


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Lovaas (PRO-ED)AKA - UCLA Program, ABA, Discrete Trial Training

  • Theoretical Model

    • Learning Theory

  • Intervention Goals

    • Self Help

    • Language

    • Play and Pre-academic

  • Intervention Objectives

    • Discrete Skills and Behaviors

  • Intervention Strategies and Procedures

    • Discrete Trial Training – Modeling Prompting Shaping Reinforcement, Assessment, Generalization Training

    • In Home or Classrooms

  • IFSP/Individualization

    • Designed to address skills and behaviors that are most concern to parents

    • Can be responsive to parent identified concerns

    • Parent participation recommended but difficult for parents to implement on their own.

  • Evidence Base

    • Theoretical – good

    • Intervention Goals – Better to Best

    • Intervention Objectives – Non-existent (relies on other ABA studies)

  • Usability

    • Moderately Detailed Curriculum guide describes instructional strategies, some objectives and some procedures (ME Book)

    • Materials developed by provider

    • Labor intensive

    • Can be used in classroom settings/ Not a routines based intervention


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AEPS – Birth to Three Intervention

  • Theoretical Model

    • Hybrid – Naturalistic intervention – Learning and developmental theory

  • Intervention Goals Comprehensive

    • Motor Fine & Gross

    • Communication

    • Cognitive

    • Social-Emotional

  • Intervention Objectives

    • Developmental Skills and Behaviors organized in sequence but according to Developmental domain.

  • Intervention Strategies and Procedures

    • Incidental Teaching and some Responsive Strategies

    • In Home or Classrooms

  • IFSP/Individualization

    • Curriculum based assessment

    • Can be responsive to parent identified concerns

    • Parent participation a major feature of 0-3 but can also be used in child care/ classrooms

  • Evidence Base

    • Theoretical – good – loosely connected to child development theory and research

    • Intervention Goals – No evidence regarding the effects of AEPS on Goal Attainment with 0-3

    • Intervention Objectives – Non-existent (Based on assumption that activity based intervention is more effective than traditional ABA instructional strategies) AEPS_Citations.pdf

  • Usability

    • Attractive, highly detailed curriculum guide describes instructional strategies AEPS_SampleInterventions.pdf

    • Materials developed by provider

    • Curriculum embedded in routine play and child care activities.

    • Some evidence that it is difficult to target multiple objectives in early childhood special education classroom


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Family outcomes Bailey, DB; Hebbeler, K; Spiker, D, et al.Source: PEDIATRICS   Volume: 116   Issue: 6   Pages: 1346-1352 2005

  • At the end of early intervention, most parents felt competent in caring for their children, advocating for services, and gaining access to formal and informal supports. They also were generally optimistic about the future. Most (82%) parents believed that their family was better off as a result of early intervention. Parents were somewhat less positive in their perceived ability to deal with their child's behavior problems or gain access to community resources, and lower family outcome scores were found for parents of minority children, children with health problems, and children who were living with a single adult.


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  • Author(s): Dunst CJ, Bruder MB, Trivette CM, Hamby DW Source: PSYCHOLOGICAL REPORTS    Volume: 96    Issue: 1    Pages: 231-234    Published: FEB 2005   Times Cited: 0     References: 7     Abstract: 1,000 parents of infants and toddlers enrolled in early childhood intervention programs were surveyed about the number of learning opportunities provided their preschool children using different approaches to early intervention. Findings showed that more learning opportunities were reported when participation in everyday activity settings was conceptualized as a type of intervention rather than as settings for professionals to conduct their interventions.


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Odom SL, Wolery JOURNAL OF SPECIAL EDUCATION    Volume: 37    Issue: 3    Pages: 164-173    Published: FAL 2003  

  • Abstract: Over the last decade, the field of early intervention/early childhood special education (EI/ECSE) has emerged as a primary service for infants and preschool children with disabilities and their families. Systems for providing early intervention for infants and toddlers exist in every state, and all state Departments of Education are responsible for special education for preschool children. In EI/ECSE, a unified theory of practice has emerged and draws from a range of psychological and educational theories. A strong, evidence-based set of practices that service providers and caregivers use to promote the development and well-being of infants and young children with disabilities and their families underlies this theory of practice. The purpose of this article is to describe the tenets of this theory and identify evidence-based practices associated with each.


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  • Evidence based practices do not mean an effective curriculum.


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  • Author(s): Bailey DB, Aytch LS, Odom SL, Symons F, Wolery M Source: MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS    Volume: 5    Issue: 1    Pages: 11-20    Published: 1999   Times Cited: 18     References: 85     Abstract: Early intervention for infants and toddlers with disabilities was established as a national commitment in the form of federal legislation in 1986. Since then, we have witnessed steady growth in the number of children and families served, although the most recent report to Congress indicates that only about 1.7% of the population of infants and toddlers is served in early intervention programs. All states and territories currently are participating in this optional program. Federal regulations stipulate the components of an early intervention system that must be in place if states are to receive federal funding. However, a great deal of flexibility is allowed in how these broad regulations are implemented, resulting in considerable cross-state variability in who is served and the amount and type of services received. This article describes the current status of early intervention and discusses five issues we believe to be critical in the coming decade: (1) determining the outcomes expected of early intervention; (2) determining appropriate models and intensity of treatments; (3) factoring quality into the efficacy equation; (4) accounting for child, family, and community variables in determining efficacy; and (5) integrating emerging perspectives and knowledge from neuroscience and genetics. (C) 1999 Wiley-Liss, Inc.


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  • Author(s): McWilliam RA, Young HJ, Harville K Source: TOPICS IN EARLY CHILDHOOD SPECIAL EDUCATION    Volume: 16    Issue: 3    Pages: 348-374    Published: FAL 1996   Times Cited: 15     References: 32     Abstract: The purpose of this study was to determine (a) the major challenges in providing specialized therapies to infants, toddlers, and preschoolers with disabilities; (b) what models of service delivery are used and why; (c) what makes the provision of therapy services go well; and (d) what strategies are used for overcoming barriers to effective services. Focus groups were conducted with early intervention therapists, nontherapist professionals, administrators, and parents. Results showed that a shortage of pediatric therapists and policy/administrative constraints caused services to be of lower quality than desired. We also found that concepts of ''needing'' therapy were muddled and that most people said that ''more is better'' as long as the quality is high enough.


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  • Author(s): Guralnick MJ Source: JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES    Volume: 18    Issue: 4    Pages: 313-324    Published: DEC 2005   Times Cited: 5     References: 98     Abstract: The field of early intervention is vibrant, generating expectations that systematic, comprehensive, experientially based interventions will alter developmental trajectories and prevent secondary complications. In this article, the existing knowledge base in the field is reviewed. It emphasizes the importance of an overall developmental framework, what is known through intervention science and the emergence of guiding principles for programme design and development. This is followed by a discussion of future prospects for improving early intervention outcomes in four areas. First, the importance of designing studies that provide information about carefully defined subgroups is discussed. This issue of specificity of outcomes is crucial in order to determine boundaries for effectiveness and to direct attention to areas of special concern. Second, prospects for translational research are discussed with particular reference to our knowledge of the core developmental processes affected. Third, the need to focus on the increasingly apparent mental health and social competence difficulties of even young children with intellectual disabilities is considered. Finally, the complex problems and potential solutions associated with the transfer of model intervention programmes to communities as part of early intervention systems are described.


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  • Theories of child development have served as the principal foundation for curriculum model development. Variations among curriculum models reflect differences in values concerning what is more or less important for young children to learn, as well as in the process by which children are believed to learn and develop. These variations inform the role of teachers, the curriculum's focus, the classroom structure, and the ways in which children participate in learning. 

  • Early childhood curriculum models also vary in terms of the freedom granted to teachers to interpret implementation of the model's framework. Some curriculum models are highly structured and provide detailed scripts for teacher behaviors. Others emphasize guiding principles and expect teachers to determine how best to implement these principles. Curriculum models, regardless of their goals and the degree of flexibility in their implementation, however, are designed to promote uniformity across early childhood programs through the use of a prepared curriculum, consistent instructional techniques, and predictable child outcomes. 


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  • Meaningful OUTCOMES

    • Functional Outcomes

    • Developmental outcomes

    • Process outcomes


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  • Author(s): Shelden ML, Rush DD Source: INFANTS AND YOUNG CHILDREN    Volume: 14    Issue: 1    Pages: 1-13    Published: JUL 2001   Times Cited: 11     References: 131     Abstract: The Individuals with Disabilities Education Act (IDEA) has always contained the provision that early intervention services for eligible infants, toddlers, and their families be provided in natural environments. The reemphasis on natural environments in the 1997 reauthorization of thr IDEA, however, has caused states and early intervention programs to increase efforts to ensure that Part C services provide and support learning experiences within the context of the. child's family and community. This emphasis on natural environments and, in some cases, the move away from segregated, clinic-based service delivery models have been challenging. This article presents 10 common myths about service delivery in natural environments and the literature available to refute them.


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  • Author(s): Abbeduto L, Boudreau D Source: MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS    Volume: 10    Issue: 3    Pages: 184-192    Published: 2004   Times Cited: 1     References: 101     Abstract: In this article, we consider the theoretical debates and frameworks that have shaped research on language development and intervention in persons with mental retardation over the past four decades. Our starting point is the nativist theory, which has been espoused most forcefully by Chomsky. We also consider more recent alternatives to the nativist approach, including the social-interactionist and emergentist approaches, which have been developed largely within the field of child language research. We also consider the implications for language development and intervention of the genetic syndrome-based approach to behavioral research advocated by Dykens and others. We briefly review the impact and status of the debates spurred by the nativist approach in research on the course of language development in individuals with mental retardation. In addition, we characterize some of the achievements in language intervention that have been made possible by the debates spurred by nativism and the various alternatives to it. The evidence we consider provides support for all three alternatives to the nativist approach. Moreover, successful interventions appear to embody elements of several of these approaches as well as other theoretical approaches (e.g., behaviorism). We conclude that language intervention must be theoretically eclectic in its approach, with different strategies appropriate for teaching different features of language, at different points in development, and for children displaying different characteristics or learning histories. (C) 2004 Wiley-Liss, Inc.


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  • Author(s): NOVICK R Source: TOPICS IN EARLY CHILDHOOD SPECIAL EDUCATION    Volume: 13    Issue: 4    Pages: 403-417    Published: WIN 1993   Times Cited: 9     References: 43     Abstract: In the current controversy over the appropriateness of using developmentally appropriate practice (DAP) with young children with disabilities, the philosophies of early childhood special education (ECSE) and early childhood education (ECE) have frequently been characterized as incompatible. This article contrasts the differences between the two disciplines and discusses a service delivery approach, known as activity-based intervention (ABI). Combining strategies from both ECSE and ECE, this model utilizes behavior analytic techniques within child-directed activities. Although ABI and DAP appear to be compatible in many ways, DAP's emphasis on emotional development creates a dilemma. In part, because emotional development is difficult to evaluate, it has not been a focus of ECSE. This dilemma, as well as its implications for intervention, is discussed. It is argued that the continued comparison and integration of the philosophies of ECE and ECSE may enhance education for all young children.


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  • Empirical comparisons of early childhood curriculum models have been dominated by two questions:

    • (1) To what extent are the programs experienced by children really different from each other? and

    • (2) Are some programs better than others in producing desired outcomes? 


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