Cordelia Robinson

Parent Education in Early Intervention A Call for a Renewed Focus

Parent education as a key component of early intervention has been greatly deemphasized during the past 15 years, we believe, because of the perceived inconsistencies between the purposes and goals of parent education and family-centered approaches to early intervention. We argue that research indicating that parent involvement is critical to early intervention effectiveness and that parents want information about specific ways they can help their childrens development supports the need for parent education in early intervention. We propose that the early intervention field address the concerns expressed about the lack of sensitivity in parent education approaches, develop strategies for parent education that are consistent with contemporary family service concepts, address the need for explicit instruction of service providers in parent education strategies, and conduct research on the immediate and long-term effects of parent education on children and families.

Screening for autism spectrum disorders in children with down syndrome: population prevalence and screening test characteristics.

Objective: We assessed the prevalence of autism spectrum disorders (ASD) and screening test characteristics in children with Down syndrome. Method: Eligible children born in a defined geographic area between January 1, 1996, and December 31, 2003, were recruited through a population-based birth defects registry and community outreach, then screened with the modified checklist for autism in toddlers or social communication questionnaire, as appropriate. Screen-positive children and a random sample of screen-negative children underwent developmental evaluation. Results: We screened 123 children (27.8% of the birth cohort). Mean age was 73.4 months (range, 31–142). Compared to screen-negative children, screen-positive children had similar sociodemographic characteristics but a lower mean developmental quotient (mean difference: 11.0; 95% confidence interval: 4.8–17.3). Weighted prevalences of autistic disorder and total ASD were 6.4% (95% confidence interval [CI]: 2.6%–11.6%) and 18.2% (95% CI: 9.7%–26.8%), respectively. The estimated minimum ASD prevalence, accounting for unscreened children, is 5.1% (95% CI: 3.3%–7.4%). ASD prevalence increased with greater cognitive impairment. Screening test sensitivity was 87.5% (95% CI: 66.6%–97.7%); specificity was 49.9% (95% CI: 37.0%–61.4%). Conclusion: The prevalence of ASD among children with Down syndrome aged 2 to 11 years is substantially higher than in the general population. The modified checklist for autism in toddlers and social communication questionnaire were highly sensitive in children with Down syndrome but could result in many false positive tests if universal screening were implemented using current algorithms. Research needs include development of specific ASD screening algorithms and improved diagnostic discrimination in children with Down syndrome. Timely identification of these co-occurring diagnoses is essential so appropriate interventions can be provided.

The effects of early motor intervention on children with Down syndrome or cerebral palsy: a field-based study.

This study reports the results of a field-based investigation of the effects of two motor intervention approaches-neurodevelopmental treatment and developmental skills-on children with two different diagnoses. The sample included 50 children, of whom 27 were diagnosed as having Down syndrome and 23 as having cerebral palsy. Children had a mean chronological age of 14 months at the beginning of the study. The severity of their motor impairment was assessed with the Gross Motor Function Classification System for Cerebral Palsy. Childrens motor functioning was examined at entry into the study and after they received 1 year of motor intervention services. Dependent measures included childrens general development, rate of motor development, and quality of movement. Pre-post comparisons indicated that children made significant changes in their motor development age and quality of movement over the course of intervention. However, there was no evidence that motor intervention accelerated development or improved quality of movement beyond what could be expected on the basis of maturation. Furthermore, no differential intervention effects were associated either with childrens diagnosis or treatment model. Regression analyses indicated that the rate of motor development children attained after 1 year of intervention was highly related to their rate of development at the onset of intervention and, to a lesser degree, to the number of sessions of intervention children received. These results are discussed in terms of the need for the field of motor intervention to develop new treatment paradigms.

Caregiver Report of Executive Functioning in a Population-Based Sample of Young Children With Down Syndrome

The current study describes everyday executive function (EF) profiles in young children with Down syndrome. Caregivers of children with Down syndrome (n  =  26; chronological ages  =  4-10 years; mental ages  =  2-4 years) completed the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P; G. A. Gioia, K. A. Espy, & P. K. Isquith, 2003 ), a caregiver report measure of everyday/functional EF skills in multiple domains. On the BRIEF-P, elevations were noted on a global EF composite as well as the Working Memory and Plan/Organize scales in particular (relative to norms developed for typically developing children of a similar mental age). These results suggest a specific pattern of EF weaknesses in young children with Down syndrome, consistent with the extant literature that has focused primarily on older individuals who have been tested using laboratory EF tasks.

Child Welfare Referrals to Part C

Interagency coordination on behalf of eligible infants and toddlers and their families is a defining feature of Part C of the Individuals with Disabilities Education Act. In the present study, enrollment data for child welfare services and Part C services were examined to assess the degree of overlap between the two service systems. Results indicated that only a small proportion of young children receiving child welfare services also were enrolled in Part C early intervention services. These findings suggest that more effective procedures are needed for identifying the developmental problems of infants and toddlers enrolled in child welfare services and for enrolling them into Part C early intervention services.

Evaluation of Paraprofessional Home Visiting Services for Children with Special Needs and Their Families

This study evaluated the impact of supportive paraprofessional home visiting on mothers and their young children who had or were at risk for developmental disabilities and who were at risk for receiving inadequate parenting. Families were randomly assigned to intervention and comparison groups. Upon exit, mothers in the intervention group rated services as more helpful and demonstrated moderately better mental health than did mothers in the comparison group. Children in the intervention group were more likely to have received an Individualized Family Service Plan. The two groups did not differ in the quality of their home environments, service utilization, or child outcomes. The results of these findings are discussed in terms of the need for direct training of parents and the characteristics of families who can benefit most from the services that paraprofessionals provide.

An Empirical Comparison of Formulas Evaluating Early Intervention Program Impact on Development

Early childhood special educators are increasingly challenged to demonstrate program impact. When appropriate control groups are not available, several investigators have proposed evaluating child developmental progress with various formulas which attempt to compensate for differential preintervention rates of development. This study applied a set of these formulas to Bayley data for three groups of handicapped infants. The results of the analyses indicate that these formulas fall into two classifications—those that measure rate of development and those that measure change in rate of development. Finally, issues and cautions in the use and interpretation of these formulas for evaluating program impact are discussed.

Rejoinder: Toward a Contemporary Vision of Parent Education

a considerable extent, these comments have begun the dialogue that was our primary goal in developing this article. In many cases, the responses have clarified and supported our arguments about current views of parent education; in some cases, the authors challenged our thinking and offered counterarguments that deserve careful consideration. Every author added perspective, breadth, and a better view of the complexities associated with parent education and working with families in the con-

Multidomain Assessment Instruments

Multidomain instruments for screening or diagnostic purposes can have advantages for those involved in early intervention programs for infants, toddlers, and preschoolers. Purposes of assessment and criteria for instrument utility are presented. Five multidomain screening tools and three multidomain diagnostic instruments are reviewed with respect to their validity, reliability, and utility.

Assessment of the Severely Handicapped Preschool-Aged Child:

Issues in the assessment of preschool-aged children who have severe to profound handicapping conditions are considered in the context of characteristics of the population and purposes of assessment. Specifically, the utility of standardized assessment of infants and pre-schoolers for the purpose of program planning is examined. The process of assessment is discussed and a model is proposed for analyzing underlying cognitive requirements of assessment tasks and for using the results of such an analysis for program planning.