Although family centered care and natural environment services have been heralded as the ideal model in early childhood intervention and have been mandated by Part C of IDEA, research demonstrates that family centered principles are still not adhered to in many early childhood programs. Previous research in this area is lacking with regard to the limited diversity of participants (i.e., white, middle-class woman) and perspectives (i.e., childcare providers). This dissertation reports the results of a study that took into account perspectives of multiple stakeholders in early intervention including families, service providers, and program directors in order to understand the full range of difficulties and supports experienced when providing family centered care in the natural environment. This qualitative study used grounded theory methods to analyze information gathered through semi-structured interviews to elaborate the barriers and facilitators experienced in family centered care and natural environment services. The core theme identified in the data was the tension between the resources available to early intervention and the ideals of best practice. This core finding was supported by three themes regarding facilitators and barriers to service provision. Two of these, the need for theoretical buy-in to the model and the challenges of negotiating roles in family centered care, emerged as either facilitators or barriers, depending on service provider roles. The third theme was common across the data and indicated that the major barrier to natural environment services was the management of scarce resources.

Autism spectrum disorders (ASD) are neurodevelopmental disorders that affect social, communication, and behavioral development. Social impairments have been implicated as primary symptoms of ASD and communication impairments are often cited as initial concerns among parents. Yet there is an inconsistency in the literature regarding the existence of restricted interests and repetitive behaviors (RR) in very young children (i.e., those younger than 4 years) with ASD and the association between RR and sensory dysfunction. The purpose of the current project was to identify social deficits that most distinguish very young children with ASD, assess whether RR are present in very young children diagnosed with ASD, and explore the relationship between RR and sensory dysfunction. Results support the hypothesis that social impairments are primary symptoms of ASD. Stereotyped patterns of thought and behavior were present in this sample and were correlated with sensory dysfunction. Implications for theory, diagnosis, and research are discussed.

Over the course of the past three decades, largely due to advances in technology, there has been growth in the fields of early intervention (EI) and pediatrics for infants/toddlers with special health care needs (SHCN). This growth has also brought about a change in the relationship between pediatricians and EI service coordinators, creating an increased need for communication and collaboration between these groups of professionals. In order to address these changes, the American Academy of Pediatrics (AAP) presented recommendations for care coordination and stressed the placement of care coordination practices in the medical and developmental plans of infants/toddlers with SHCN. There have also been recommendations about communication and collaboration strategies from experts in the EI field. The medical home framework and Part C (EI) of the Individuals with Disabilities Education Act (IDEA) seek to establish care coordination systems with a family-centered focus of care. The purpose of this study is to examine care coordination within the context of the pediatric medical home and EI service coordination. Eighty- two pediatricians (n=1746, 4.7%) and 52 service coordinators (n=468, 11.1%) returned The Care Coordination Survey. Responses to the 40-item quantitative survey were analyzed using descriptive statistics and independent sample t-tests. Results indicated that pediatricians and service coordinators are implementing a number of key care coordination practices such as being available to clients/patients at their convenience. However, it was also found that both groups of professionals are not consistently providing a number of recommended care coordination practices such as sharing information between disciplines (e.g., contact information, assessment results). The results also offer implications across disciplines and reveal a need for future research in areas, such as training models across disciplines and developing a care coordination model to fit both disciplines.

Clefts of the lip and palate are one of the most frequently occurring birth defects, affecting approximately 1 in 700 births in the United States. Early childhood special educators are often among the first professionals to provide intervention for children with cleft lip and palate. Early intervention for children with clefts often focuses on speech production skills; however, results of recent research suggest that early intervention in language skills including parent training is warranted. A model of early intervention that uses language intervention to facilitate vocabulary and speech sound development is described. This model has been successful in improving productive vocabulary use and speech sound repertoires and shows promising reduction in compensatory articulation errors. Developmentally appropriate application of the model includes provision of direct intervention to children and parent training to promote naturalistic intervention in everyday settings. Strategies for working collaboratively with speech-language pathologists and members of cleft palate and craniofacial multidisciplinary teams are also described. Finally, answers are provided to frequently occurring questions from parents about cleft palate.

The purpose of this study was to evaluate and systematically replicate the effectiveness of the DANCE training for a staff member to be an effective change agent for the children in her care, while maintaining the organization's and family's values. The study was conducted in an organization that values and focuses on building rapport, avoids the use of coercive procedures, and teaches children in a caring and meaningful way. A multiple baseline across indoor and outdoor settings was used to evaluate the effects of the package. Results demonstrated that DANCE training was an effective procedure to teach a staff member how to increase teaching interactions. Harmonious engagement, instructional engagement and vocal approximations also increased while challenging behavior maintained at zero levels.

Early detection and intervention are theorized to facilitate better outcomes in autistic children. However, response to early intervention varies considerably between individuals, some children show significant improvement, while others show minimal response to the intervention. Some pre-treatment individualized characteristics as well as intervention-specific factors were theorized to moderate outcomes, but literature revealed often mixed findings making difficult to understand whether and to what extent these factors facilitate learning during treatment. To parse the heterogeneity of the autistic population, recent studies have also attempted to investigate biological factors related to clinical and behavioral profiles. However, to date it is unknown whether and how biological information can provide insight into the variability of treatment outcomes. With this in mind, we attempted to expand the current knowledge by first investigating whether pre-treatment child’s characteristics and blood leukocyte gene expression patterns could predict developmental trajectories during treatment. Leveraging a cohort of 41 autistic toddlers who received the same early intervention and provided a blood sample, we were able to analyze the effect of starting treatment very early (i.e., <24 months) on treatment trajectories. We also provided for the first-time evidence that both pre-treatment blood leukocyte gene expression patterns and clinical-behavioral characteristics are important for predicting developmental change during intervention, and that pretreatment epigenetic mechanisms such as histone acetylation may be a key biological process that influence how a child respond to early intervention. Lastly, we carried out a mega-analysis of a large international consortium, isolating individual child characteristics and treatment related factors to examine their key role in moderating child developmental trajectories throughout the course of early intervention. The final dataset comprised 645 autistic toddlers who received two types of interventions either Early Start Denver Model (ESDM) or other treatment as usual/community interventions (TAU/COM). This mega-analysis provided strong evidence that individual factors, such as cognitive level and age at treatment start, predict most outcomes, and on-average, ESDM may promote some developmental skills better than COM/TAU. Taken together, these results advance our understanding of “what works, for whom, for what and why” questions, identifying new biological predictors and providing an alternative methodology that can effectively examine the individual variability of treatment outcomes.

Schools are required by law to identify and support English Language Learner (ELL) students. However, ELL students across grade levels consistently score well below their English-proficient peers in math. Because of this, it is imperative that the literature on effective instruction for these students remain current. Research that is available in this area has demonstrated positive relations between early ELL math performance and several demographic and school factors, including: socioeconomic status (SES), primary language proficiency, English proficiency, high-quality computer instruction, heterogeneous achievement grouping, bilingual instruction, use of cooperative learning activities, all-day kindergarten programs (as opposed to half-day), and school settings that have access to greater resources. However, this research is both limited and dated. The current study updated this literature using a recent large-scale dataset. The results indicated that a significant gap in math performance continues to exist between ELL and English- proficient students. This gap is present at kindergarten entry and persists through the spring of kindergarten. In addition, math performance at kindergarten entry was significantly accounted for by students’ Spanish proficiency and SES. Models predicting math growth over kindergarten from the instructional strategy of playing math-related games and a classroom emphasis on recognizing ordinal numbers were also significant. Contrary to previous research, the adequacy of instructional materials and student program type were not significant predictors of kindergarten math growth in this study. This research provides preliminary evidence of effective strategies for instructing ELL students, although several limitations to these findings are discussed, as are implications and future directions.

The prevalence of conduct problems in children impacts upon families, educational settings, and broader society within Australia. Conduct problems develop early in an individual's life and can lead to more serious problems including substance abuse and delinquency in adolescence and adulthood. Given the high incidence of conduct problems in children, the need for prevention and early intervention strategies to target the onset and development of this phenomenon is paramount. This thesis focuses on early intervention strategies for reducing the incidence of conduct problems in children and explores a multi-modal early intervention and prevention program targeting children and families at-risk of the development of conduct problems. A randomised controlled trial involving 455 children was conducted to evaluate the efficacy of this program. Participants were drawn from ten Education Queensland primary schools in the Mount Gravatt district of Brisbane, Queensland, Australia. The 455 children were randomly assigned to either experimental or control conditions for the purposes of the program's evaluation. From this initial cohort, an indicated sample of 1 52 participants was identified through a universal screening process. This sample included children who were considered more at-risk of conduct problems. Participants designated to experimental conditions engaged in the school component of the program, with 66 of the experimental group receiving an additional indicated component facilitated in the school setting. Further, a selection of parents of children in the experimental group participated in the home component of the intervention. The retention rate for families engaged in the study was high with 96% of participants remaining engaged in the study throughout the evaluation process. The findings that emerged from the study revealed significant differences between participants who engaged in the intervention program compared with those designated to control conditions. Positive changes in the behaviour of students reported at the school level were statistically significant. However, while some changes were identified in the home setting, the treatment effects of the program were not significant. These findings were sustained at the six-month follow up period. Conclusions drawn from this study were conceptualised within the framework of current advances in the social science literature that focus on conduct problems and early intervention and prevention. The outcomes of the research emphasise the significance of comprehensive interventions programs for children and families at-risk that focus on both school and home settings and that are easily implemented in, and cost-effective to, community populations. Recommendations from this research serve to inform ftiture research agendas in early intervention and prevention and specialists in the fields of psychology and education.

<p>Syftet med studien var att undersöka hur olika behandlingsenheter i Sverige utvärderade effekterna av interventioner för barn med autism 0-6 år, oavsett om det rörde sig om enstaka åtgärder eller hela program. Det var också intressant att se om, och i så fall hur, man tog hänsyn till risker och möjligheter som kunde bidra till variation i utfallen. Kontakt togs med samtliga landstings, och två privata, behandlingsenheter. Brev innehållande information om studien och en enkät med studiens frågor skickades ut.</p><p>Resultaten visade att man i första hand utvärderade effekterna genom någon form av bedömningstest t ex. PEP, VABS eller ADOS. Något som kan ifrågasättas var huruvida dessa test påvisade en direkt effekt av en interventionsmetod, då dels en förändring hos barnet måste anses naturlig allteftersom barnet blir äldre och dels pga. att testet genomfördes utanför barnets vardagsmiljö. Man tog visserligen hänsyn till risk- och möjlighetsfaktorer genom att anpassa interventionerna efter barnet, familjen och närmiljön men fastställde inte omfattningen av dessa faktorers påverkan.</p><p>Instrument och metoder för att känna igen risk- och möjlighetsfaktorer, hur de ska hanteras och mätas samt vilken påverkan de har för utfallet behöver utvecklas, och en samstämmighet över hur tillförlitligheten ska säkerställas både när det gäller vilka instrument som ska användas och vilka rutiner som ska gälla behöver komma till stånd. Indirekta interventionsmetoder som innefattar utbildning av, rådgivning och stöd till familj och närmaste bör också utvecklas då dessa både påverkar utfallet av de interventioner man gör samt interaktionen mellan barnet och dess närmaste.</p> / <p>The purpose of this study was to determine how the effects of interventions in autistic children 0-6 years were evaluated in Sweden, regardless of whether it concerned separate measures or entire programs. Furthermore there was an interest to see if and how risk and opportunity factors were taken into account regarding their contributions to the differences in outcome. Contact was established with all county council and two privately run treatment units. A letter containing information about the study and a questionnaire was sent to each.</p><p>The result showed that the most common method to evaluate the effects was with some kind of test i.e. PEP, VABS or ADOS. It is an open question whether these tests were able to provide a measure of a direct effect of an intervention method, as a progress in development is to be expected naturally regardless of intervention, and also as the tests are performed outside the everyday environment. Risk and opportunity factors are taken into consideration as interventions are adjusted to the child, its family and others concerned but the extent of their influence is not specifically taken into account in evaluation efforts</p><p>Instruments and methods for evaluating risk and opportunity factors need to be developed. A consensus is urged in how to confirm the reliability and validity of measurements both regarding what instruments to be used and which routines to be used in evaluation. Indirect measures that include education of, advising and supporting the family and others concerned should be designed as these both contribute highly to the outcome of the direct measures as well as the interactions between the child and its close environment.</p>

Syftet med studien var att undersöka hur olika behandlingsenheter i Sverige utvärderade effekterna av interventioner för barn med autism 0-6 år, oavsett om det rörde sig om enstaka åtgärder eller hela program. Det var också intressant att se om, och i så fall hur, man tog hänsyn till risker och möjligheter som kunde bidra till variation i utfallen. Kontakt togs med samtliga landstings, och två privata, behandlingsenheter. Brev innehållande information om studien och en enkät med studiens frågor skickades ut. Resultaten visade att man i första hand utvärderade effekterna genom någon form av bedömningstest t ex. PEP, VABS eller ADOS. Något som kan ifrågasättas var huruvida dessa test påvisade en direkt effekt av en interventionsmetod, då dels en förändring hos barnet måste anses naturlig allteftersom barnet blir äldre och dels pga. att testet genomfördes utanför barnets vardagsmiljö. Man tog visserligen hänsyn till risk- och möjlighetsfaktorer genom att anpassa interventionerna efter barnet, familjen och närmiljön men fastställde inte omfattningen av dessa faktorers påverkan. Instrument och metoder för att känna igen risk- och möjlighetsfaktorer, hur de ska hanteras och mätas samt vilken påverkan de har för utfallet behöver utvecklas, och en samstämmighet över hur tillförlitligheten ska säkerställas både när det gäller vilka instrument som ska användas och vilka rutiner som ska gälla behöver komma till stånd. Indirekta interventionsmetoder som innefattar utbildning av, rådgivning och stöd till familj och närmaste bör också utvecklas då dessa både påverkar utfallet av de interventioner man gör samt interaktionen mellan barnet och dess närmaste. / The purpose of this study was to determine how the effects of interventions in autistic children 0-6 years were evaluated in Sweden, regardless of whether it concerned separate measures or entire programs. Furthermore there was an interest to see if and how risk and opportunity factors were taken into account regarding their contributions to the differences in outcome. Contact was established with all county council and two privately run treatment units. A letter containing information about the study and a questionnaire was sent to each. The result showed that the most common method to evaluate the effects was with some kind of test i.e. PEP, VABS or ADOS. It is an open question whether these tests were able to provide a measure of a direct effect of an intervention method, as a progress in development is to be expected naturally regardless of intervention, and also as the tests are performed outside the everyday environment. Risk and opportunity factors are taken into consideration as interventions are adjusted to the child, its family and others concerned but the extent of their influence is not specifically taken into account in evaluation efforts Instruments and methods for evaluating risk and opportunity factors need to be developed. A consensus is urged in how to confirm the reliability and validity of measurements both regarding what instruments to be used and which routines to be used in evaluation. Indirect measures that include education of, advising and supporting the family and others concerned should be designed as these both contribute highly to the outcome of the direct measures as well as the interactions between the child and its close environment.