Early Interventionists Research Articles

Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match): A Virtual Parent-Mediated Intervention Package for Young Children with Developmental Disabilities.

This study aimed to evaluate Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match), a parent-mediated naturalistic developmental behavioral intervention package. An expansion from an earlier pilot study (see Kunze et al., 2021), PRRFCT Match incorporates virtual coaching between a novice coach and parent to implement evidence-based, applied behavior analytic (ABA) techniques during play to increase engagement and decrease unengaged behavior exhibited by their young child with developmental delays(26-50 months old). Ten parent-child dyads were matched with a coach in this concurrent multiple baseline design across participants. Simulating the clinical training level of a novice early interventionist, nine graduate student clinicians received training as coaches on PRRFCT Match implementation and weekly supervision by a research team member. All aspects of training and intervention were delivered virtually. A visual analysis of the data combined with Tau-U revealed a strong basic effect between clinician coaching and parent strategy use. For child participants, a visual analysis and Tau-U results suggest that most increased engagement and decreased their unengaged behavior during the intervention. High variability, overlap, and high engagement at baseline are discussed. This study shows promise for the PRRFCT Match intervention package. The ABA technologies mediated by parents during play increased child engagement and decreased unengagement for most participants.

Feasibility of Remote Coaching With Early Interventionists: NDBI Strategies in Part C

Early intervention supports infants and toddlers with confirmed or suspected autism spectrum disorder (ASD) in achieving optimal outcomes, and caregiver-implemented NDBIs are recommended as a developmentally appropriate intervention approach for very young children and their families. Research highlights discrepancies between early interventionists’ perceptions of their practices and their observed practices, possibly contributing to implementation gaps. Remote coaching is a viable method of supporting early childhood professionals’ use of recommended practices, yet limited research has examined remote coaching with early interventionists in community systems (e.g., Part C). The current feasibility study explored differences between early interventionists’ reported and observed practices and compared bug-in-ear versus video review coaching methods with early interventionists working with families of toddlers with confirmed or suspected ASD. Results demonstrated (a) early interventionists reported higher quality practices than observed, and (b) remote coaching is a community-viable professional development approach in supporting early interventionists’ use of recommended practices.

A comparative study of learning outcomes for hearing-impaired foundation phase learners

Background: Two intervention approaches are implemented in South Africa to alleviate the deleterious consequences of congenital or early onset hearing impairment on language acquisition and subsequent poor learning outcomes.Aim: This study investigated the learning outcomes of foundation phase learners with severe to profound hearing impairment who received Listening and Spoken Language – South Africa (LSL-SA) (adapted Auditory Verbal Therapy) therapy compared to those who received Traditional Speech-Language Therapy (TSLT).Setting: The study was conducted at four early intervention (EI) schools for children with hearing impairment across three provinces in South Africa.Methods: Data were collected through record reviews of their Speech-Language Therapy Outcomes and South African National Department of Basic Education academic report cards. Data were analysed using quantitative statistics.Results: Findings demonstrated that children with hearing impairment enrolled in LSL-SA outperformed those enrolled in TSLT in achieving age-equivalent language outcomes. A higher percentage of learners enrolled in LSL-SA achieved meritorious to outstanding learning outcomes. While a comparable number of learners progressed to mainstream schooling, children with hearing impairment enrolled in LSL-SA are enrolled for a shorter duration until discharge than those enrolled in TSLT. This is an important finding, particularly in low-middle income countries (LMICs).Conclusion: Listening and Spoken Language – South Africa graduates achieved superior learning outcomes dependent on language attainment, providing contextually relevant evidence supporting the effectiveness of the LSL-SA EI approach.Contribution: These context-specific outcomes stress the obligation to upscale and fast-track EI services. Implications for investment in LSL-SA are proposed through collaboration between families, educators, and early interventionists.

Development of a Novel Telemedicine Tool to Reduce Disparities Related to the Identification of Preschool Children with Autism.

The wait for ASD evaluation dramatically increases with age, with wait times of a year or more common as children reach preschool. Even when appointments become available, families from traditionally underserved groups struggle to access care. Addressing care disparities requires designing identification tools and processes specifically for and with individuals most at-risk for health inequities. This work describes the development of a novel telemedicine-based ASD assessment tool, the TELE-ASD-PEDS-Preschool (TAP-Preschool). We applied machine learning models to a clinical data set of preschoolers with ASD and other developmental concerns (n = 914) to generate behavioral targets that best distinguish ASD and non-ASD features. We conducted focus groups with clinicians, early interventionists, and parents of children with ASD from traditionally underrepresented racial/ethnic and linguistic groups. Focus group themes and machine learning analyses were used to generate a play-based instrument with assessment tasks and scoring procedures based on the child's language (i.e., TAP-P Verbal, TAP-P Non-verbal). TAP-P procedures were piloted with 30 families. Use of the instrument in isolation (i.e., without history or collateral information) yielded accurate diagnostic classification in 63% of cases. Children with existing ASD diagnoses received higher TAP-P scores, relative to children with other developmental concerns. Clinician diagnostic accuracy and certainty were higher when confirming existing ASD diagnoses (80% agreement) than when ruling out ASD in children with other developmental concerns (30% agreement). Utilizing an equity approach to understand the functionality and impact of tele-assessment for preschool children has potential to transform the ASD evaluation process and improve care access.

Spoken language bilingualism for deaf students

Language has always been at the core of our practice in deaf education, but in the current context, it is time to explore new language possibilities for deaf students. Over the past two decades, the combination of widespread implementation of universal newborn hearing screening (UNHS) and early amplification with hearing technologies, including cochlear implants (CIs), has afforded meaningful access to spoken language during the critical language development period for most deaf children. Early interventionists and educators have taken a new perspective of encouraging spoken language bilingualism in home languages and the majority language. This shift has opened doors to education in spoken language bilingual settings (e.g., French immersion), doors formerly closed to deaf students. This paper presents some preliminary qualitative data, highlighting parent decision-making, from a mixed method case study of deaf Francophone participants (N = 4) enrolled in grades 4-12 at French minority schools in southern Ontario.

Evaluation of a rapport‐building intervention for early interventionists working with children on the autism spectrum

AbstractRapport, or the therapeutic relationship between a therapist and client, is essential for successful intervention. In behavior analytic interventions for autistic children, practitioners commonly use pairing to establish rapport. A limited body of research has evaluated how to train interventionists to pair with their child clients. Furthermore, fewer studies have examined the effects of pairing on client behavior. Therefore, we implemented behavioral skills training to teach interventionists pairing skills and assessed the effects of presession pairing on child interfering behavior using a concurrent multiple probe design (with replication). We implemented a pairing protocol before early intensive behavioral intervention sessions with four children (3–5 years old) on the autism spectrum. Interventionists mastered pairing skills during training sessions, which were generally maintained when working with child clients. When interventionists implemented presession pairing, child participants demonstrated fewer interfering behaviors. We discuss implications of our preliminary findings and future directions.

Early Interventionists’ Perspectives About Changes in Caregiver Coaching During COVID-19: A Mixed Methods Study

Caregiver coaching is a recommended practice in early intervention; however, many barriers exist that can prevent early interventionists (EIs) from implementing it. This mixed method study was designed to understand if EIs’ perceived use of caregiver coaching changed after Illinois’ COVID-19 pandemic stay-at-home order. Questionnaire data and interview data were analyzed together to explore changes reported by participants. Findings show that participants believed they used coaching practices and coached within routines more often following the stay-at-home order and that their changes in caregiver coaching had an impact on families (e.g., increased caregiver engagement, child progress, more meaningful intervention). Findings suggest that the stay-at-home order evoked a much-needed change in caregiver coaching. Implications include the need for research on contributors to EIs’ use of caregiver coaching and how to effectively use modeling. Implications for practice suggest that EIs should explain coaching to families and individualize their approach to promote family engagement in their children’s intervention.

Implementing Caregiver Coaching in Early Intervention With Families of Children Who Are Deaf or Hard of Hearing

Caregiver coaching is a common component of early intervention services, but providers may be unfamiliar with methods of coaching for families of children who are Deaf or hard of hearing (DHH). This article provides guidance for early interventionists to implement caregiver coaching to facilitate language development in their children who are DHH. While the paper is written mainly for general interventionists who may be less familiar with the special needs of families with children who are DHH, the coaching guidance provided here may also be of value to early intervention providers who routinely serve this population as a model for coaching.

Exploring Perceptions and Use of Compassionate Care with Early Interventionists and Caregivers: A Mixed Methods Investigation

Exploring Perceptions and Use of Compassionate Care with Early Interventionists and Caregivers: A Mixed Methods Investigation

Ethics in the Early Intervention System: A Mixed Methods Exploration

Early interventionists may frequently encounter ethical dilemmas due to the complex nature of early intervention (EI) service delivery (e.g., EI system infrastructure and building and sustaining collaborative relationships within the system). Therefore, the purpose of this research study was to explore the experiences of EI professionals related to ethical dilemmas. We used a sequential mixed methods design to first survey professionals about their experiences with ethical dilemmas ( n = 427). Then, we interviewed a smaller sample ( n = 45) to learn about early interventionists (EIs) experiences with ethics, including their constructed meanings of ethical dilemmas, the types of ethical dilemmas they have experienced, and their experiences and processes navigating ethical dilemmas. Results show that EI professionals define ethical dilemmas differently, which influences what they view as a dilemma and how they problem solve. Additionally, professionals identified the need for support and guidelines related to ethical dilemmas.

Inclusion of Infants and Toddlers With Significant Support Needs Across Natural Environments: What Can Early Interventionists Do?

Infants and toddlers with significant support needs (SSNs) receive early intervention services under Part C of the Individuals with Disabilities Education Improvement Act. These services occur in a variety of children’s natural environments, which may include their home, child care, community parks, extended family members’ homes, etc. It is important that early interventionists who provide developmental services to children with SSNs and their caregivers are equipped with strategies they can use to promote meaningful inclusion of this unique population. This paper illustrates what high-quality inclusion can look like and provides strategies that early interventionists can implement with various caregivers in a child’s life.

Early mathematical performance of deaf and hard of hearing toddlers in family-centred early intervention programmes

ABSTRACT Research indicates that establishing a strong foundation in early mathematics is essential for later academic learning. Previous research with students who are deaf or hard of hearing (DHH) has shown varying differences in the performance and achievement when compared to typically hearing (TH) students. While the majority of research in this area has been conducted in the United States, studies in other countries suggest that these differences may be global. The present study investigated the early mathematics abilities of 3-year-old DHH children enrolled in family-centred early intervention in the Netherlands. Fifty-three DHH and TH children were given an adapted version of the Early Mathematics Performance Diagnostic. Results showed that on average, the DHH and the TH children performed similarly on all domains, except for Measurement. Likewise, both groups showed similar mathematical knowledge in most early mathematics tasks measuring sub-concepts such as counting objects, shape matching, or measuring weight. Differences were identified in some basic tasks measuring the sub-concepts (e.g. rote counting, measuring time, solving puzzles), however, not on the more advanced tasks measuring these same sub-concepts. These findings are important for parents, teachers, and early interventionists.

Building Better Bridges

Infants and toddlers with disabilities (ages birth to 2 years) and their families receive services under IDEA Part C, and children and youth with disabilities (ages 3–21 years) receive special education and related services under IDEA Part B. IDEA mandates the provision of opportunities for parent involvement in early intervention (Part C), preschool special education (Part B), and transition between the two (Individuals with Disabilities Education Act [IDEA], 2004). Despite the emphasis in federal law on collaboration with families and communicating information to them, parents do not feel well supported during the transition period (Douglas, Meadan, & Schultheiss, 2022). The limited research on this transition shows that primary caregivers lack understanding of how their roles change during this transition period. The authors of the current study conducted four focus groups to evaluate the perceptions of parents, early interventionists, and preschool special educators, all from predominantly minority populations, regarding the transition process for early intervention to preschool for young children with disabilities. Primary themes were identified: (1) lost in transition, (2) restricted choices lead to restrictive placements, and (3) discontinuity. These challenges are discussed and recommendations are provided.

Commentary on “Early Developmental Trends in High-Risk Neonates Later Diagnosed With Autism Spectrum Disorder”

“How could I apply this information?” The number of children in the United States diagnosed with autism spectrum disorder (ASD) increased in the past 20 years from 1 in 150 in 2000 to 1 in 44 children in 2021.1 Although the disorder can be reliably diagnosed as early as 2 years or age, most children are not diagnosed until 4 years or age. This creates a substantial gap for children and families who need support. Motor skills offer an important opportunity for early interventionists, and specifically physical therapists, to screen for ASD if an association between early motor performance and later diagnosis can be established. Using the Test of Infant Motor Performance (TIMP), a well-validated early motor assessment, with a population of infants known to be at elevated risk2 may be a logical first step toward early detection. Yet, this study clearly establishes that testing of early motor performance does not detect differences in children who are later diagnosed with ASD. Specific items might have predictive value, rather than total scores. These findings support the importance of holistic developmental evaluation and the importance of advanced transdisciplinary training for providers who serve young, at-risk infants to understand how these domains interact and change across early development and in relationship to ASD. “What should I be mindful of when applying this information?” Medical management of prematurity is constantly advancing. Differences in medical care may create different risks and developmental outcomes. Longitudinal follow-up, across all developmental domains, is critical to understand these changing risks and outcomes. The authors discuss that standardized tests may not detect subtle indicators of ASD. Eye gaze and shifting, self-regulation, social interactions, and play skills should be considered. Physical therapists should continue to use assessment of motor skills, paired with screening of social, communication, and play skills, to detect signs of ASD early and refer to appropriate health care partners. Beth Ennis, PT, EdD, PCS University of St Augustine for Health Sciences St Augustine, Florida Sandra Jensen-Willett, PT, PhD, PCS Munroe-Meyer Institute University of Nebraska Medical Center Omaha, Nebraska

How early interventionists support families experiencing vulnerable circumstances: A closer look at family-centered practice

Guidance from national professional organizations (e.g., the Division for Early Childhood) and professional standards characterize specific practices for the provision of birth through age 2 early intervention services for all families. However, research focused on the family-centered practices (FCPs) that providers use to support families experiencing vulnerability is limited. Therefore, this phenomenological study focused on how early interventionists across disciplines (EIs) described the implementation of services in a rural northeastern state. We conducted nine statewide focus groups with EIs (N = 67) to understand (a) how EIs defined the vulnerable circumstances of the families they serve, and (b) what FCPs EIs report using with families in these identified vulnerable circumstances. Thematic qualitative analysis was used. Results suggest that much of their services align with the key elements of FCP. Providers’ use of individualizing services more than any other family centered element is discussed as this may influence aspects of coaching and service delivery.

Exploring Access and Utilization of Early Intervention Services Among Families Experiencing Homelessness: A Qualitative Study.

Children experiencing homelessness face particular barriers to accessing early interventions. Our study sought to explore the experiences of families in accessing Early Intervention Program services (EI) while living in a family shelter. Semi-structured in-depth interviews were undertaken with nineteen caregivers who had recently experienced or were contemporaneously experiencing homelessness from three shelter sites in Boston, Massachusetts. Our findings demonstrate the role of the shelter both in inhibiting and promoting access to early intervention. Shelter-related barriers included limited physical space, lack of care continuity amidst frequent relocations, and mistrust due to feelings of stigma. Early interventionists played a crucial role in mitigating challenges but were often unable to fully overcome these and other barriers tied to shelter environments. Effective strategies included flexibility in accommodating shifting schedules, provision of socioemotional support, and proactively linking caregivers to additional upstream resources. Efforts to mitigate shelter-related challenges will require interdisciplinary collaboration at both local and state levels. Further efforts should focus on providing increased continuity of care in a manner that acknowledges the structural barriers of homelessness.

Characteristics of mastery motivation and its relationship with parenting stress in toddlers with language delay

Mastery motivation is a multifaceted, psychological force that stimulates a child to master skills or tasks and is positively associated with language-related competences. Children with developmental delay might have lower levels of motivation, and their parents might face escalated parenting stress as well. The aims of this study were to identify the characteristics of mastery motivation in toddlers with language delay by intergroup and intragroup comparison, and to investigate the associations between specific components of parenting stress and toddler's mastery motivation. Eighty Chinese-speaking Taiwanese toddlers aged 19 to 42 months and their parents (fifty toddlers with language delay and thirty toddlers with typical development) participated in the study. The language delay group was selected based on maternal reports of vocabulary production with the Mandarin-Chinese Communicative Development Inventory and direct assessment with an individualized developmental test or intelligence test. The Revised Dimensions of Mastery Questionnaire (DMQ 18) with Preschool version, and the Parenting Stress Index Short Form were used to measure three domains of child mastery motivation and parents' components of parenting stress, respectively. Toddlers with language delay were rated as having lower gross motor and social mastery motivation than their peers with typical development; however, they showed the strength/weakness intragroup characteristics of higher gross motor motivation and lower social motivation with other children. Parental stress in the language delay group was significantly negatively correlated with mastery motivation, and the component of Parent-Child Dysfunctional Interaction was negatively associated with toddlers' Total Mastery Motivation, social motivation, and two indicators of expressive aspect after controlling for toddlers' age, cognitive ability, and family social-economic status. In conclusion, it is necessary for early interventionists to observe parenting stress and mastery motivation during the process of early intervention.

The beauty of universal design for learning (UDL) and why everyone in early childhood education and intervention should be using it

This article seeks to highlight the importance of consciously implementing universal design for learning principles in practice in early childhood intervention. Universal design for learning (UDL) is based on three principles: 1) providing multiple means of engagement, 2) providing multiple means of representation, and 3) providing multiple means of action and expression. The term UDL is being championed in New Zealand schools but there are few examples of how early childhood settings and early childhood kaiako can utilise it. Highlighting the three UDL principles and how they link with Te Whāriki, the early childhood curriculum, is important when supporting kaiako and early interventionists to reflect on their practice through the UDL lens. When kaiako and early interventionists focus on providing multiple ways of engaging children, multiple ways of representing information, and multiple ways of enabling action and expression, then the early childhood environments will truly be inclusive. This article outlines the three UDL principles and provides specific examples of enactment of these in early childhood environments.

Mealtime Developmental Skills: Surveying the Knowledge of Early Interventionists

Young children with visual impairment and their families often require specialized assistance through early intervention to develop adaptive routines, cues, and environmental settings during mealtimes and other daily tasks. There is little empirical data in the area of mealtime routines available to support families of young children with visual impairment, and the need for research-based interventions is great. The purpose of this initial needs assessment survey was to gather information as little is already known about what teachers of students with visual impairment trained in early intervention (TSVI-EIs) and other early interventionists who work with infants and toddlers with visual impairment already know about the development of independent mealtime skills. The results of this survey indicate that early intervention professionals would like additional opportunities to learn about mealtime routine strategies for young children with visual impairment, confirm their current experiences and knowledge, and identify additional training and resources.

"Music Therapy Was Never on the Table": Perspectives of Parents of Young Autistic Children.

Parent coaching of music interventions is emerging as a viable model for families with young autistic children, yet recruitment difficulties have been apparent in previous studies. Understanding parent perspectives of early intervention services is critical to ensure that interventions are acceptable, feasible, and effective for all family members. In order to understand possible parental resistance to this type of parent education, we explored perspectives regarding music therapy, research, and parent coaching in parents of young autistic children. Fourteen parents attended virtual focus groups to discuss their experiences. We used a descriptive phenomenological approach to uncover the essence of their experience. Our findings indicate that, contrary to our preconceptions, participants did not show negative dispositions towards music therapy, research, or parent coaching. Instead, most participants had very little or no knowledge of music therapy services. They had limited experience with research in general, and only two participants had experienced music therapy directly. Several participants had varying amounts of experience with parent participation or parent coaching outside of music therapy and shared positive experiences with it. Parents seemed willing and eager to learn music strategies to support their children and saw value in the use of music for their child's development. First-contact providers (i.e., early interventionists and diagnosticians) and social media seem influential in parents' decision-making as they navigate early intervention services soon after diagnosis. Music therapy organizations are encouraged to design targeted efforts to make information on music therapy available through these sources.