EARLY CHILDHOOD / EARLY INTERVENTION Effective Early Intervention The Developmental Systems Approach By Michael J. Guralnick, Ph.D. fter decades of rapid evolution and groundbreaking research, the field of early intervention can be understood within a common framework: the Developmental Systems Approach (DSA). ACreated by a highly influential leader in the field, Dr. Michael Guralnick, this evidence-based, relationship-oriented, family-centered framework focuses on strengthening the quality of key family patterns of interaction that influence a child’s development. In this important text, Dr. Guralnick organizes and analyzes the most current research in early intervention through the lens of the DSA. Starting with a clear explanation of the foundations of early intervention, the book then applies the DSA to four vulnerable populations: Children at risk due to biological factors, specifically preterm birth; children at environmental risk; children with developmental delays; and children with autism spectrum disorder. Readers will • Understand the developmental science that applies to all children • Learn how child development is influenced by three family patterns of interaction—parent-child transactions, family-orchestrated child experiences, and parent support for child health and safety • Explore the influence of family resources as well as child-specific risk and protective factors on a child’s development in the context of early intervention • Discover what early interventions are effective, as supported by intervention science • Learn the fundamentals of applying the DSA framework to designing inclusive community-based

Michael J. Guralnick

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Effective Early Intervention

The Developmental Systems Approach

by Michael J. Guralnick, Ph.D. University of Washington Seattle, Washington

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Names: Guralnick, Michael J., author. Title: Effective early intervention: the developmental systems approach / by Michael J. Guralnick, Ph.D., University of Washington, Seattle, Washington. Description: Baltimore : Paul H. Brookes Publishing, Co., [2019] | Includes bibliographical references and index. Identifiers: LCCN 2018023332 (print) | LCCN 2018040659 (ebook) | ISBN 9781681252896 (epub) | ISBN 9781681252902 (pdf) | ISBN 9781681252889 (pbk.) Subjects: LCSH: Child development. | Families. Classification: LCC HQ772 (ebook) | LCC HQ772 .G865 2019 (print) | DDC 305.231--dc23 LC record available at https://lccn.loc.gov/2018023332

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Contents

About the Author ... vii Preface ... ix Acknowledgments ... xi

Section I Introduction and Overview

Chapter 1 Foundations of Early Intervention ... 3 Chapter 2 Environmental Influences on Development: Family Patterns of Interaction and Family Resources ... 23 Chapter 3 Early Intervention in the Context of the Developmental Systems Approach ... 49

Section II Children at Biological Risk: Preterm Birth

Chapter 4 Preterm Birth: Developmental Science ... 65 Chapter 5 Preterm Birth: Intervention Science and Community Systems ... 85

Section III Children at Environmental Risk

Chapter 6 Environmental Risk: Developmental Science ... 125 Chapter 7 Environmental Risk: Intervention Science and Community Systems ... 147

Section IV Children With Developmental Delays

Chapter 8 Developmental Delay: Developmental Science ... 197 Chapter 9 Developmental Delay: Intervention Science and Community Systems ... 225

Section V Children With Autism Spectrum Disorder

Chapter 10 Autism Spectrum Disorder: Developmental Science ... 247 Chapter 11 Autism Spectrum Disorder: Intervention Science and Community Systems ... 293

v

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vi Contents

Section VI Applying the Developmental Systems Approach to

Community Programs

Chapter 12 Advancing the System of Early Intervention ... 337

Author Index ... 349 Subject Index ... 361

Excerpted from Effective Early Intervention: The Developmental Systems Approach By Michael J. Guralnick, Ph.D.

About the Author

Michael J. Guralnick, Ph.D., University of Washington, Seattle

Michael J. Guralnick, Ph.D., University of Washington, Seattle Michael J. Guralnick, Ph.D., is Director of the Center on Human Development and Disability (CHDD) and Professor of Psychology and Pediatrics at the University of Washington. Comprised of both a University Center for Excellence in Developmental Disabilities and a Eunice Kennedy Shriver Intellectual and Developmental Disabilities Research Center, the CHDD is one of the largest interdisciplinary research and training centers in the United States addressing issues directly related to developmental disabilities. More than 600 faculty, staff, and doctoral and postdoctoral students operate within the four CHDD buildings on the campus of the University of Washington and in other university and community sites to conduct basic and translational research, to provide clinical services to individuals and their families, to provide interdisciplinary clinical and research training, and to provide technical assistance and outreach

Michael J. Guralnick, Ph.D., University childhood inclusion. He has published more than 150 articles and book chapters (including eight edited volumes), and his publica- Michael J. Guralnick, Ph.D., is Director of tions have appeared in a diverse group of the Center on Human Development and well-respected journals spanning a range Disability (CHDD) and Professor of Psy-of disciplines. Major research has included chology and Pediatrics at the University of a randomized clinical trial to determine Washington. Comprised of both a Univer-the effectiveness of a comprehensive early sity Center for Excellence in Developmental intervention program in promoting the Disabilities and a Eunice Kennedy Shriver peer-related social competence of young Intellectual and Developmental Disabilities children with developmental delays and a Research Center, the CHDD is one of the multi-context investigation of the factors largest interdisciplinary research and train-influencing the peer interactions and peer ing centers in the United States addressing social networks of children with Down synissues directly related to developmental dis-drome. Current projects focus on the peer abilities. More than 600 faculty, staff, and relationships of children with autism, the doctoral and postdoctoral students oper-further development and application of the ate within the four CHDD buildings on the Developmental Systems Approach to early campus of the University of Washington and intervention, and international activities

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viii About the Author

Childhood, and the Academy on Intellec-Directors. He served as editor of the jour- tual and Developmental Disabilities, and nal Infants and Young Children from 2003 a former Chair of the Intellectual and De -to 2009 and is the founder and Chair of the velopmental Disabilities Research Center International Society on Early Intervention.

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Preface

Systems of services and supports for young has also created challenges for communi- vulnerable children and their families are ties to design and implement conceptually now fundamental features of numerous sound and highly effective intervention and diverse communities throughout the programs. world. Indeed, decades of research, pro-A central thesis of this book is that the gram development, professional training, field has now reached a stage in its develop- legislation, and policy initiatives have con-ment in which systems of early intervention tributed to establishing community-based can be understood within a common frame- systems of early intervention with the work. As described throughout this volume, expectation that both children and families the common framework proposed is the will benefit sub stantially. While there are Developmental Systems Approach (DSA) limits with respect to what can be accom-and is based on an integration of develop- plished today, our field of early intervention mental science, our knowledge of risk and continues to explore new approaches and disability, intervention science, and com- strategies that, if effective, can be incorpo-munity practices. With a focus on the for- rated into current systems of services and mation of relationships, the DSA is a family- supports. centered framework designed to enhance Any observer of the rapid evolution of the quality of the key family patterns of the field of early intervention over the past interaction that influence children’s devel- few decades can only be impressed by both opment. This volume suggests that such a the passionate commitment to young chil-framework can guide the establishment, dren and their families and the correspond-refinement, and future directions of com- ing evidence-based development of creative prehensive and inclusive community-based approaches to promote the well-being of early intervention systems. those children and families. The extraor-The context of this overarching frame- dinary diversity of children who are vul-work ensures a respect for children’s dif- nerable to developmental problems has led ferent learning styles and consideration to an equally extraordinary array of con-of both their strengths and constraints. ceptual models, curricula, instructional Through the early intervention problem- approaches, and intervention strategies solving process, the intent of the DSA is that communities can draw upon to orga-to provide children with tools to exercise nize early intervention systems. However, their rights to pursue their own goals and this very level of diversity and complexity to do so with necessary supports. A similar

ix

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x Preface

respect for family diversity, including their and children with an autism spectrum disor- goals and their priorities, is integral to the der diagnosis. For each of these groups, sug- many components of the DSA’s level of fam-gestions are presented with respect to how ily resources. those communities that find the approach The introductory chapters in the first and evidence sufficiently compelling can section of this volume provide an overview adopt the DSA framework and put it into of the DSA, emphasizing both its systems practice. nature and relevance to all children. High-The potential of our field to advance lighted is the complexity of the known and further within the context of the DSA potential interactions occurring among framework is considered in the final chap- the various components of the DSA at the ter. A long-term vision is presented, recog- level of the child, the level of family pat-nizing the potential to do far better when terns of interaction, and the level of family problem solving and innovation are car- resources. In the next four sections, evi-ried out within a well-established develop- dence is examined with respect to both the mental framework. This is especially the developmental mechanisms governing child case when connected with supportive and development suggested within the DSA and creative policy initiatives. From a practice the corresponding intervention science for perspective, this volume presents a con- four highly prevalent vulnerable groups. temporary developmental approach and a The groups included are children at risk due corresponding organizational framework to biological factors, specifically preterm capable of enhancing comprehensive and birth; children at risk due to environmental inclusive community-based systems of early factors; children with developmental delays; intervention.

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Foundations of Early Intervention

hildren become members of a family involving immediate and extended family and a community long before they members, but also those involving individ-

Care born. Visions of new dimensions uals in the neighborhood and workplace.

of family life, enhanced personal relation-To be sure, instances of children’s illness, ships, and expanded community connec-unpredictable behavior, or unevenness in tions merge with visions of the child as a development create palpable tension for developing individual. As time goes by, these caregivers. Fortunately, these very real visions are somehow transformed into real-concerns about their child often dissipate ity, not quite like the ones that were antici-with an increased understanding of their pated, but often similar enough nevertheless. child’s behavior, the truly transient nature Especially during the first few years of life, of many problems, and the continuing evidence for a child’s rapid growth and de -achievement of expected developmental velopment is abundant, as is the emergence milestones. Even when parents themselves of the child’s unique style of engaging the face very difficult personal circumstances, world. These developments take seemingly the vast majority find ways to adapt and to self-directed paths and are driven by forces create an optimal developmental environ- not entirely clear to even the most vigilant ment for their child, in the hope of realizing and perceptive of parents. Also emerging their original visions. during this early period is a special sense Yet, the situation is dramatically differ- of enjoyment and satisfaction as the child ent when concerns regarding a child’s devel- bonds with family members and becomes opment persist or when unusual vulnera- integrated into more stable family routines. bility is apparent. In some instances, the Of course, even in the best of situations, increased likelihood that children will be numerous problems arise. Disruptions to facing developmental difficulties is evident family routines created by unexpected child immediately after birth—as occurs in the needs easily occur, and new resources, case of genetic syndromes that are easily often drawing heavily on a family’s social recognizable, when a child is born extremely network, are required to assist with parent-preterm, or when other biological factors ing tasks that are ever increasing in mag-exist that substantially increase a child’s nitude and complexity. Relationships at all vulnerability. For others, at various points levels are affected, including not only those in time, trauma, infectious disease, or other 3

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 4 health-related problems, such as seizures, may signal potential long-term developmental difficulties. In most instances, however, problems gradually emerge over the early childhood period as parents and others

problems gradually emerge over the early childhood period as parents and others become aware of the child’s unusual developmental and behavioral patterns. In all of these circumstances, when some threshold level of concern about a child’s development is reached, a process is initiated whereby professionals become involved and conduct assessments of the child’s cognitive, language, motor, social-emotional, and sensory-perceptual development. Such professionals also gather related information from health records and family histories and conduct additional follow-up, including medical and more in-depth developmental testing to complete this initial process. As a result of this diagnostic/ assessment process, categorical diagnoses (e.g., developmental delay, autism spectrum disorder [ASD], deafness, specific language impairment) may be assigned to the child. Etiologic information, especially following genetic testing that indicates the likely underlying cause of the developmental problems, may also become available. Given the often-changing nature and course of initial concerns, other diagnostic categories may be considered over time with varying degrees of certainty. Some children may not receive a specific diagnosis at all but are fol-

degrees of certainty. Some children may not receive a specific diagnosis at all but are followed closely by professionals who consider them to be at high risk for future difficulties. Of course, even when a specific diagnostic category and etiology are established with confidence, they do not capture the remarkable diversity and complexity of an individual child’s behavior, nor do they define a rigid developmental trajectory. Yet whether a diagnostic category is applied with confidence at a particular point in time or whether the specific etiology of the child’s apparent developmental problems can be identified, the fact remains that this process has a profound impact on all family members and those in the family’s social net-

FOR MORE, go to http://bit.ly/EffectiveEI Guralnick health-related problems, such as seizures, and the constraints that follow may well call may signal potential long-term developmen-for a substantial restructuring of the family’s tal difficulties. In most instances, however, original vision for their child. Without quesproblems gradually emerge over the early tion, working through complex psychologichildhood period as parents and others cal processes requiring extensive revisions become aware of the child’s unusual devel-and adjustments of life cycle expectations is a highly stressful experience. During the In all of these circumstances, when early childhood period, a major challenge some threshold level of concern about for families with a child who is so vulneraa child’s development is reached, a pro-ble as a consequence of biological factors is cess is initiated whereby professionals how to provide patterns of interaction that become involved and conduct assessments create an optimally supportive developmenof the child’s cognitive, language, motor, tal environment. Supporting this goal con-

become involved and conduct assessments create an optimally supportive developmenof the child’s cognitive, language, motor, tal environment. Supporting this goal consocial-emotional, and sensory-perceptual stitutes the primary task for early intervendevelopment. Such professionals also gather tion systems. related information from health records and Child vulnerability takes many forms, family histories and conduct additional fol-and the family environment contains many low-up, including medical and more in-depth potential sources of risk as well. Although developmental testing to complete this ini-most families have the resources to cope and tial process. As a result of this diagnostic/ adjust to changing circumstances and everyassessment process, categorical diagnoses day challenges to effectively support their (e.g., developmental delay, autism spectrum child’s development, the demands placed on disorder [ASD], deafness, specific language many families who are themselves vulnerimpairment) may be assigned to the child. able can quickly deplete those resources. Etiologic information, especially follow-When a lack of material resources is coming genetic testing that indicates the likely pounded by personal issues that can preunderlying cause of the developmental prob-vent parents from providing optimal care lems, may also become available. Given the and support for their child, the risk for child often-changing nature and course of ini-developmental problems, even in the absence tial concerns, other diagnostic categories of other major child vulnerabilities, is submay be considered over time with varying stantial. For example, as discussed later in degrees of certainty. Some children may not this volume, the severe and chronic absence receive a specific diagnosis at all but are fol-of parental financial resources makes it diflowed closely by professionals who consider ficult to support a child’s basic needs for them to be at high risk for future difficulties. safety, nutrition, and general health and Of course, even when a specific diag-interferes with supportive parent-child patnostic category and etiology are estab-terns of interaction as well. Similarly, prolished with confidence, they do not capture found parental difficulties involving illegal the remarkable diversity and complexity of drug use, abuse of alcohol, mental health an individual child’s behavior, nor do they concerns, and limited or inappropriate abildefine a rigid developmental trajectory. Yet ities and skills as caretakers also contribute whether a diagnostic category is applied to substantially increasing a child’s vulnerwith confidence at a particular point in time ability to developmental problems. In many or whether the specific etiology of the child’s of these situations, a child’s risk for expeapparent developmental problems can be riencing a general developmental delay, a identified, the fact remains that this process learning difficulty, or a behavior problem, has a profound impact on all family mem-and even physical harm, is considerably bers and those in the family’s social net-elevated. These and other environmentally

work. Over time, the nature of a child’s vul-based difficulties often co-occur with bionerability with respect to biological factors logical risk factors or specific biologically

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Foundations of Early Intervention

opmental environment as possible for their child.

child. SYSTEMS OF SUPPORT Throughout history, all societies have developed at least informal systems of supports to nurture children within their communities, often involving extended families and community networks. This is especially the case during the early childhood period, primarily the time between birth through 5 years of age, which is the focus of this volume. Given the complexities and challenges of daily life in contemporary societies, many of these informal systems remain intact today but have been supplemented by more formal structures such as child care, preschool programs, and organized parent groups. The availability of these formal supports and their quality varies considerably from community to community, but nevertheless, such structures provide important

from community to community, but nevertheless, such structures provide important resources for families during the early childhood years. For clearly vulnerable children, a different and more comprehensive array of formal systems of support for families has emerged in modern societies. Instead of relying solely on grass roots community programs or market forces, formal support systems have been established in many countries around the world through a series of important legislative efforts (see Bruder & Guralnick, 2012). The legislative history of early intervention in the United States provides an interesting and instructive example of how these systems evolved (for reviews, see Hauser-Cram & Warfield, 2009; Trohanis, 2008). In brief, programs to support maternal and child health and development began with the

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention based conditions affecting the child, creat-in the context of the Social Security Act of ing extraordinary barriers to optimal child 1935 (PL 74-271; mainly Title V and Title XIX) development. Therefore, another critical and related legislation (see Hutchins, 1994; component of early childhood intervention Ireys & Nelson, 1992). Similarly, the Head systems is to address risk and protective fac-Start program, and more recently the Early tors associated with a family’s resources, to Head Start program, was developed and enable parents to provide as optimal a devel-established across the nation, focused on opmental environment as possible for their providing early childhood supports to children living in poverty. Emphasizing the link between health and child development, these programs also continued efforts to establish a comprehensive array of community-based Throughout history, all societies have devel-integrated services, designed to promote

a comprehensive array of community-based Throughout history, all societies have devel-integrated services, designed to promote oped at least informal systems of supports children’s cognitive and social competence to nurture children within their communi-(Gilliam, 2008; Zigler & Valentine, 1979). ties, often involving extended families and Although many of these early federally community networks. This is especially initiated programs involved children with the case during the early childhood period, established disabilities, widespread supprimarily the time between birth through port for young children with disabilities did 5 years of age, which is the focus of this not occur until the United States Departvolume. Given the complexities and chal-ment of Education began to take responlenges of daily life in contemporary societ-sibility (Long, 2013; Meisels & Shonkoff, ies, many of these informal systems remain 2000; Smith & McKenna, 1994; Wise & Richintact today but have been supplemented by mond, 2008). Beginning with the Handimore formal structures such as child care, capped Children’s Early Education Act of preschool programs, and organized parent 1968 (PL 90-538), followed by the Education groups. The availability of these formal sup-for All Handicapped Children Act of 1975 ports and their quality varies considerably (PL 94-142), and culminating with the Edufrom community to community, but never-cation of the Handicapped Act Amendments theless, such structures provide important of 1986 (PL 99-457), a formal support sysresources for families during the early child-tem for infants, toddlers, and preschoolers with established disabilities was put in For clearly vulnerable children, a differ-place. Children with certain risk factors ent and more comprehensive array of formal could also be served within this framesystems of support for families has emerged work. Continuing legislation has refined and in modern societies. Instead of relying solely extended this early intervention system for on grass roots community programs or mar-vulnerable children and their families and ket forces, formal support systems have encouraged adherence to program rules and been established in many countries around regulations (Individuals with Disabilities

been established in many countries around regulations (Individuals with Disabilities the world through a series of important legis-Education Improvement Act [IDEA] of 2004, lative efforts (see Bruder & Guralnick, 2012). PL 108-446). The legislative history of early intervention As a result of these and related initiain the United States provides an interest-tives, numerous model programs focusing ing and instructive example of how these on supports and interventions for vulnerasystems evolved (for reviews, see Haus-ble children and their families were develer-Cram & Warfield, 2009; Trohanis, 2008). oped, implemented, and evaluated. Many In brief, programs to support maternal and were adopted and modified by community child health and development began with the programs for more widespread implementa-

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 6 programs were devised, new professional training programs were established, and creative connections among disciplines and agencies in the context of services and supports were forged. Indeed, despite the many flaws that are apparent today, a true early intervention system exists in the United States with the expectation that this system of services and supports represents the

ideal combination of well-documented practices and sound clinical judgment.

CHARACTERISTICS OF THE EARLY INTERVENTION PROGRAMS The characteristics of early intervention programs that emerged as part of the system that paralleled the comprehensive legislation in the United States outlined in the previous section developed unusually diverse characteristics. This is likewise the case for programs developed around the world during this period. In part, these wide-ranging differences were due to efforts to address the specific concerns of subgroups of vulnerable children with unique risks or disabilities, identified at different developmental periods. However, even considering this diversity, nearly overwhelming differences in philosophy, goals, approach, content, and emphases were apparent in the available early intervention programs (see Bailey, 1997; Bruder, 1997). Compounding this complexity was the fact that reasonably rigorous evaluations of effectiveness were spotty at best, with support for one or another model, curriculum, or program often being based on limited or inconsistent evidence. Replication, especially following sound methodologies meeting established standards suggesting that the models were evidence-based, was rare. Nevertheless, a comprehensive review of the state of the evidence for early intervention practices, conducted 10 years following the enactment of the Education of the Handicapped Act Amendments of 1986 (PL 99-457), captured the extraordinary creativity of the diverse

FOR MORE, go to http://bit.ly/EffectiveEI Guralnick programs were devised, new professional age and identified those interventions and training programs were established, and approaches that appeared to be most effeccreative connections among disciplines and tive (Guralnick, 1997b). Additional efforts agencies in the context of services and sup-along these lines have continued as numerports were forged. Indeed, despite the many ous new forms of intervention and models flaws that are apparent today, a true early have become available and been evaluated. intervention system exists in the United Many of these interventions have focused on States with the expectation that this sys-specific subgroups of children (Guralnick, tem of services and supports represents the 2005b, 2012, 2013, 2017; Hill, Brooks-Gunn, ideal combination of well-documented prac-& Waldfogel, 2003; Rogers & Talbott, 2016; Votruba-Drzal & Dearing, 2017). Moreover, some general systems guidelines, including essential structural features for early intervention programs supported by a research base as well as generally agreed upon val- The characteristics of early intervention ues and principles, can now be found in legprograms that emerged as part of the sys-islation (Bruder, 2010; Guralnick & Conlon, tem that paralleled the comprehensive leg-2007; Long, 2013). In fact, many of these

programs that emerged as part of the sys-islation (Bruder, 2010; Guralnick & Conlon, tem that paralleled the comprehensive leg-2007; Long, 2013). In fact, many of these islation in the United States outlined in principles and values have now achieved the previous section developed unusually international consensus (Guralnick, 2008). diverse characteristics. This is likewise To be sure, the complexity and diverthe case for programs developed around sity of child risk and disability conditions the world during this period. In part, these and the circumstances of the families themwide-ranging differences were due to efforts selves have brought attention to specific to address the specific concerns of sub-groups and subgroups, as researchers and groups of vulnerable children with unique other professionals seek an understanding risks or disabilities, identified at different of the generality and limitations of interdevelopmental periods. However, even con-vention program accomplishments. Espesidering this diversity, nearly overwhelming cially when examining the effectiveness of differences in philosophy, goals, approach, early intervention program practices, carecontent, and emphases were apparent in the ful consideration must be given not only to available early intervention programs (see what works, but also for whom and under Bailey, 1997; Bruder, 1997). Compounding what conditions. Considering outcomes this complexity was the fact that reason-within this framework of “second generaably rigorous evaluations of effectiveness tion” research (Guralnick, 1997a, 2001) is were spotty at best, with support for one clearly important, with the expected benefit or another model, curriculum, or program of bringing research and practice into betoften being based on limited or inconsistent ter alignment. However, in view of the comevidence. Replication, especially following plexity and diversity of programs that have sound methodologies meeting established evolved to meet individual child and family standards suggesting that the models were needs, an overarching vision is necessary evidence-based, was rare. Nevertheless, a to avoid becoming mired in myriad, often comprehensive review of the state of the inconsistent, details of early intervention evidence for early intervention practices, program philosophy, design, content, impleconducted 10 years following the enactment mentation, and outcome. Fortunately, this of the Education of the Handicapped Act field may have reached the point in which it Amendments of 1986 (PL 99-457), captured is now possible to attempt to organize and the extraordinary creativity of the diverse analyze these diverse accomplishments

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Foundations of Early Intervention

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention intervention decision making at all levels of research, practice, and community-based systems development. Although admittedly ambitious, the primary goal of this volume is to provide such a comprehensive understanding and to organize and examine the many recent accomplishments in the early intervention field within that framework. In so doing, the analyses of specific research findings themselves will be more meaningful, links between seemingly disparate areas will be established, the developmental mechanisms at work will become more apparent, and new directions for research will emerge. In addition, the ability to address future developmental, educational, clinical, and organizational issues within

community programs in more creative and consistent ways may well be enhanced.

of normative development, a developmental focus on risk and disability, and intervention science in the context of early intervention practice (Guralnick, 2001, 2006, 2011, 2017).

THE DEVELOPMENTAL SYSTEMS APPROACH The overarching framework adopted to carry out these analyses is referred to as the Developmental Systems Approach (DSA; Guralnick, 2005a). Presented in the first three introductory chapters in this volume, the DSA emphasizes family patterns of interaction that are affected by the presence of a child at biological risk or one with an established disability, how those alterations in family patterns affect the provision of an optimal developmental environment for the child, and the role of early intervention in bringing about or restoring as optimal an environment as possible. The DSA also considers environmental risk factors in the form of limited family resources, which can increase child vulnerability operating through nonoptimal family patterns of interaction. As will be discussed, an essential feature of this framework is the ability of the DSA to integrate the developmental science of normative development, a developmental focus on risk and disability, and intervention science in the context of early intervention

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention intervention decision making at all levels of orientation as a core concept (Lerner, research, practice, and community-based Theokas, & Bobek, 2005; Sameroff, 2010). systems development. Although admittedly This includes the transactional model ambitious, the primary goal of this volume (Sameroff, 2009), the developmental psyis to provide such a comprehensive under-chobiological systems view (Gottlieb, Wahlstanding and to organize and examine the stein, & Lickliter, 1998), the organizational many recent accomplishments in the early perspective (Cicchetti & Tucker, 1994; Rutintervention field within that framework. In ter & Sroufe, 2000), developmental systems so doing, the analyses of specific research theory (Ford & Lerner, 1992), bioecological findings themselves will be more mean-theory (Bronfenbrenner, 2001; Bronfenbreningful, links between seemingly disparate ner & Morris, 1998), the parenting process areas will be established, the developmen-model (Belsky, 1984), and dynamic systal mechanisms at work will become more tems theory (Thelen & Smith, 1998), among apparent, and new directions for research others. These systems approaches provide will emerge. In addition, the ability to important insights into the interactions address future developmental, educational, occurring among biological mechanisms, clinical, and organizational issues within particularly those with a genetic basis,

feature of this framework is the ability of the the emerging model of neuroconstructivism DSA to integrate the developmental science (Karmiloff-Smith, 2009). of normative development, a developmental

address future developmental, educational, occurring among biological mechanisms, clinical, and organizational issues within particularly those with a genetic basis, community programs in more creative and emerging developmental and behavioral consistent ways may well be enhanced. patterns, and environmental influences. At the heart of these systems models is an emphasis on the hierarchical organization of development. In this organization, the various components in the developmen- The overarching framework adopted to tal system have the potential to interact with carry out these analyses is referred to as one another, to combine and recombine to the Developmental Systems Approach (DSA; form more complex subsystems, and to Guralnick, 2005a). Presented in the first function in a manner that creates integrated three introductory chapters in this volume, developmental processes over time. This the DSA emphasizes family patterns of cascade of events as development proceeds interaction that are affected by the presence is critical to understanding developmental of a child at biological risk or one with an systems (Bornstein, Hahn, & Wolke, 2013; established disability, how those alterations Cox, Mills-Koonce, Propper, & Gariépy, in family patterns affect the provision of 2010). The result is a coherent developmenan optimal developmental environment for tal trajectory in which children increasthe child, and the role of early intervention ingly become socially and cognitively comin bringing about or restoring as optimal petent as they pursue goals of interest. Of an environment as possible. The DSA also importance, these systems developmental considers environmental risk factors in the approaches also provide a framework for form of limited family resources, which models focused on developmental risk and can increase child vulnerability operating disabilities, including the highly influential through nonoptimal family patterns of inter-developmental psychopathology approach action. As will be discussed, an essential (Cicchetti, 2006; Rutter & Sroufe, 2000) and

focus on risk and disability, and intervention LEVEL OF CHILD DEVELOPMENT IN THE science in the context of early intervention DEVELOPMENTAL SYSTEMS APPROACH practice (Guralnick, 2001, 2006, 2011, 2017).

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 8 are central to the DSA with respect to establishing children’s competencies in carrying out social and cognitive tasks. The first emphasizes “developmental resources”: fundamental contributions by each of the conventionally identified and defined major domains of development (cognition, language, motor, social-emotional, and sensoryperceptual) that underlie children’s developing competence. These domain-specific abilities, skills, and knowledge become more differentiated over time as developmental resources become more numerous and complex. Moreover, when additional resources do become available to a child within a domain (e.g., increased vocabulary), more possibilities for combining resources within and across domains are created. In these instances, development is characterized by increasing degrees of integration. At the same time as these domain-specific patterns are emerging, the second construct, a series of organizational processes, develops. Organizational processes are higher-order processes that coordinate, integrate, and organize existing developmental resources, and do so in an integrated fashion when needed to achieve some child-specific goal. Five such organizational processes are central

FOR MORE, go to http://bit.ly/EffectiveEI Guralnick are central to the DSA with respect to estab-emotion regulation. When one or more of lishing children’s competencies in carry-these organizational processes are engaged ing out social and cognitive tasks. The first in a harmonious and synchronous manner to emphasizes “developmental resources”: successfully address child-specific tasks or fundamental contributions by each of the goals, children are said to display social and conventionally identified and defined major cognitive competence. Successful demondomains of development (cognition, lan-strations of competence are generally conguage, motor, social-emotional, and sensory-sistent with normative and cultural expectaperceptual) that underlie children’s develop-tions. Figure 1.1 illustrates the relationships

guage, motor, social-emotional, and sensory-sistent with normative and cultural expectaperceptual) that underlie children’s develop-tions. Figure 1.1 illustrates the relationships ing competence. These domain-specific abil-among these major components of the DSA ities, skills, and knowledge become more at the level of child development. differentiated over time as developmental Notably, there exist well-identified and resources become more numerous and com-specific family patterns of interaction, plex. Moreover, when additional resources described in detail in Chapter 2, that are do become available to a child within a essential to support both the growth, difdomain (e.g., increased vocabulary), more ferentiation, and integration of children’s possibilities for combining resources within developmental resources and the increased and across domains are created. In these sophistication and functioning of organizainstances, development is characterized tional processes. This is the case even when by increasing degrees of integration. At the children’s developmental resources and same time as these domain-specific patterns organizational processes are constrained as are emerging, the second construct, a series a result of biologically based factors. Howof organizational processes, develops. Orga-ever, the DSA further suggests that when nizational processes are higher-order pro-children have established delays or disabilcesses that coordinate, integrate, and orga-ities or are at risk for developmental probnize existing developmental resources, and lems due primarily to biological factors, do so in an integrated fashion when needed family patterns of interaction may become to achieve some child-specific goal. Five less than optimal (i.e., experience stresssuch organizational processes are central ors), thereby compromising the develop-

Goal Structure

Figure 1.1. Model illustrating how organizational processes and developmental resources, framed by a goal structure, constitute the basis for a child’s social and cognitive competence.

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Foundations of Early Intervention

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention Moreover, various levels of child vulnerability can be created by nonoptimal family patterns of interaction that are already present as a consequence of limited family resources, such as the existence of environmental risk factors. Accordingly, within the DSA framework, early intervention must collaborate with families to devise strategies to establish, support, and enhance those family patterns of interaction that will have a positive impact on children’s developmental resources and organizational processes. The net effect of these interventions will be seen in the enhanced development of children’s social and cognitive competence, which becomes evident as they pur-

sue important goals across developmental periods.

periods. Developmental Goals In many respects, the rapid developmental growth that occurs during the first few years of life can be viewed through the lens of children’s increasing attempts to carry out an everchanging and more demanding series of goals or tasks. Indeed, such goal-directed behavior is evident in early infancy (Meltzoff, 1995; Woodward, 2009). As can be imagined, these goals span an enormous range of sophistication during the early childhood years, and the nature and complexity of those goals are governed by many factors, including accommodating to culturally specific demands (see Feldman & Masalha, 2010). At early stages, many goals are prompted by specific, often immediate, stress-reducing needs, such as maintaining one’s physiological state within a certain range or coping with the experience of discomfort due to the temporary absence of a primary caregiver. However, other discrete goals such as exploring interesting objects are apparent as well. Over time, more sophisticated, longer-term, and complex goals that reflect ongoing efforts toward initiating, maintaining, and understanding relationships, as well as developing one’s

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention Moreover, various levels of child vulnera-point is that the specific goals children seek bility can be created by nonoptimal fam-to achieve are both constrained by and rely

ily patterns of interaction that are already upon emerging developmental resources present as a consequence of limited family and organizational processes.

present as a consequence of limited family and organizational processes. resources, such as the existence of environmental risk factors. Accordingly, within the Developmental Resources DSA framework, early intervention must collaborate with families to devise strat-Children’s developmental resources can be egies to establish, support, and enhance used effectively to achieve diverse goals those family patterns of interaction that will and, of equal importance, to enable new and have a positive impact on children’s devel-more sophisticated, often longer-term, goals opmental resources and organizational pro-to emerge. Consider the remarkable develcesses. The net effect of these interventions opmental changes in language ability that will be seen in the enhanced development occur during early childhood as children of children’s social and cognitive compe-become capable of both understanding and tence, which becomes evident as they pur-expressing complex linguistic forms. The sue important goals across developmental ability to question, comment, and otherwise engage in meaningful discourse about the world constitutes a critical developmental resource. These changes in developmental resources are made possible through In many respects, the rapid developmen-advances in phonology, dramatic increases tal growth that occurs during the first few in vocabulary, the emergence of morphosynyears of life can be viewed through the lens tactical systems, and a grasp of the rules of of children’s increasing attempts to carry discourse (for reviews, see Wagner & Hoff, out an everchanging and more demand-2012; Waxman & Lidz, 2006). The “units” or ing series of goals or tasks. Indeed, such components of these language-based develgoal-directed behavior is evident in early opmental resources continue to become infancy (Meltzoff, 1995; Woodward, 2009). differentiated within this developmental As can be imagined, these goals span an domain (e.g., larger vocabulary) and become enormous range of sophistication during the more sophisticated (e.g., more complex early childhood years, and the nature and syntax). Increasing as well is the ability to complexity of those goals are governed by organize and recombine these resources many factors, including accommodating to in a hierarchical way. Access to all compoculturally specific demands (see Feldman & nents of developmental resources associ- Masalha, 2010). At early stages, many goals ated with this domain contributes to chilare prompted by specific, often immediate, dren’s continuing achievements in language

self-regulation, knowledge and skills, and tive abilities that enable children to begin self-efficacy, become more prominent. A key to mentally represent their experiences

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 10 and expand their working memory (Garon, Bryson, & Smith, 2008; Schneider & Ornstein, 2015). Mental representation includes the social realm, as children begin to understand and reason about the mental states of others who interact with them (e.g., their intentions or emotions). As development proceeds, this ability, often referred to as “theory of mind” (Baron-Cohen, Tager- Flusberg, & Lombardo, 2013), becomes an essential developmental resource to help children achieve their interpersonal or social goals. Clearly, advances in cognition generate developmental resources in

social goals. Clearly, advances in cognition generate developmental resources in various forms that can be applied to childspecific goals (Halford & Andrews, 2006). The processes underlying this remarkable growth are becoming increasingly well understood. Of most significance, it is evident that children’s own actions with and observations of the physical and social world provide the “data” with which they generate hypotheses about the causal structure of the events they experience. Children appear to function as “rational constructivists,” extracting principles from their experiences to generate higher-order and specific principles of understanding and action (Gopnik & Wellman, 2012; Walker & Gopnik, 2014; Xu & Kushnir, 2013). Statistical and inferential mechanisms drive these learning processes. Ideally, by being provided with as high-quality an array of family patterns of interaction as possible, children will have sufficient information to construct accurate representations of the world and generate principles to help them engage that world

FOR MORE, go to http://bit.ly/EffectiveEI Guralnick and expand their working memory (Garon, instruments that focus on developmental Bryson, & Smith, 2008; Schneider & Orn-milestones and developmental levels are stein, 2015). Mental representation includes available, and equally valuable laboratorythe social realm, as children begin to under-type measures exist. These measurements stand and reason about the mental states can provide information regarding the curof others who interact with them (e.g., their rent status of a child’s developmental progintentions or emotions). As development ress for discrete components (e.g., vocabu-

of others who interact with them (e.g., their rent status of a child’s developmental progintentions or emotions). As development ress for discrete components (e.g., vocabuproceeds, this ability, often referred to as lary count) or more organized subsystems “theory of mind” (Baron-Cohen, Tager-(e.g., pragmatic language use). Flusberg, & Lombardo, 2013), becomes an Even though assessments of a child’s essential developmental resource to help current developmental status can be children achieve their interpersonal or obtained in a domain-specific way, all social goals. Clearly, advances in cogni-domains are interdependent, especially tion generate developmental resources in throughout the early childhood period. That various forms that can be applied to child-is, advances in one developmental resource specific goals (Halford & Andrews, 2006). domain typically depend on a correspond- The processes underlying this remark-ing level of development in other domains, able growth are becoming increasingly well thereby providing an illustration of the understood. Of most significance, it is evi-interactions occurring within a systems dent that children’s own actions with and framework. For example, the mental state observations of the physical and social ability with respect to understanding the world provide the “data” with which they emotions, intentions, and desires of others generate hypotheses about the causal struc-depends upon corresponding advances in ture of the events they experience. Children the domain of social-emotional development appear to function as “rational constructiv-(for reviews, see Lewis, 2000; Thompson & ists,” extracting principles from their expe-Lagattuta, 2006). More specifically, for the riences to generate higher-order and spe-domain of social-emotional development, cific principles of understanding and action the ability to recognize complex emotions (Gopnik & Wellman, 2012; Walker & Gopnik, is required for an accurate understanding of 2014; Xu & Kushnir, 2013). Statistical and other’s mental states, a cognitive domain. All inferential mechanisms drive these learning of this relies upon developmental resources processes. Ideally, by being provided with provided by intact sensory-perceptual abilas high-quality an array of family patterns ities, such as visual acuity and spatial oriof interaction as possible, children will have entation of faces, which themselves become sufficient information to construct accurate more differentiated and sophisticated over representations of the world and generate time (for reviews, see Kellman & Arterberry, principles to help them engage that world 2006; Saffran, Werker, & Werner, 2006). Simin a competent manner (see Meltzoff, Wais-ilarly, the deployment of attentional and motor skills in the context of parent-child Conceptually distinct developmental exchanges, for example, are associated resources can be measured and tracked. with later mental state language abilities. This is the case not only for cognition This suggests developmental continuity for and language, but also for motor, social-this emerging developmental resource as emotional, and sensory-perceptual domains well as linkages with experiential factors as well. Even for less easily defined social-(Kristen, Sodian, Thoermer, & Perst, 2011). emotional developmental resources, numer-Fundamental cognitive abilities, such as ous useful instruments are available that information processing skills, also have utilize a variety of approaches (Brownell, the potential to influence so many domains

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Foundations of Early Intervention

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention influences (Bornstein, Hahn, & Wolke, 2013). Language, in particular, is dependent on cognitive skills related to memory, attention, processing speed, and representational competence (Rose, Feldman, & Jankowski, 2009). These cognitive skills facilitate language development in many ways, including helping to segment the auditory stream, processing rapidly changing speech, and assisting the child to shift attention and engage in different aspects of the social exchange in social communicative contexts. As another example, advances in most domains are expressed as motor behaviors. Developed at rapid race in the first 2 years of life, motor behaviors such as reaching, grasping, and manipulating are observable skills that allow children to communicate about their internal states and help them to generate new developmental resources to maximize their ability to accomplish their goals (Adolph & Berger, 2005). Indeed, motorically mature children set into motion what is best considered a developmental cascade of developmentally supportive (e.g., eliciting more learning opportunities and fostering exploration) events, leading to many devel-

opmental advances over time (Bornstein, Hahn, & Suwalsky, 2013).

Hahn, & Suwalsky, 2013). Organizational Processes Developmental resources are tapped when children are faced with accomplishing a particular goal; growth in social and cognitive competence corresponds to growth in these resources. However, in order for growth to occur, these resources must be coordinated, integrated, and organized in a systematic manner in the service of a task or goal. This requires a different and far more integrated array of higher-order or overarching processes, referred to here as organizational processes (see Figure 1.1). As conceptualized within the DSA, the five organizational processes noted earlier are as follows: 1) EF, 2) metacognition, 3) social cognition, 4) motivation, and 5) emotion reg-

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention influences (Bornstein, Hahn, & Wolke, these processes are involved in specific 2013). Language, in particular, is dependent efforts that enhance children’s developmenon cognitive skills related to memory, atten-tal resources (e.g., engage in tasks that gain tion, processing speed, and representational specific information). In many instances, competence (Rose, Feldman, & Jankowski, most or all five organizational processes are

tion, processing speed, and representational specific information). In many instances, competence (Rose, Feldman, & Jankowski, most or all five organizational processes are 2009). These cognitive skills facilitate lan-engaged to some extent, whether the goal is guage development in many ways, including primarily social or cognitive. helping to segment the auditory stream, pro-Although difficult to define and meacessing rapidly changing speech, and assist-sure, these five organizational processes are ing the child to shift attention and engage in nevertheless central constructs in the field different aspects of the social exchange in of child development. Each has been extensocial communicative contexts. As another sively analyzed, evaluated, and tracked over example, advances in most domains are time and been linked to children’s developexpressed as motor behaviors. Developed ing social and cognitive competence (e.g., for at rapid race in the first 2 years of life, EF correspondence to social and cognitive motor behaviors such as reaching, grasp-competence, see Blair & Razza, 2007; as well ing, and manipulating are observable skills as Riggs, Jahromi, Razza, Dilworth-Bart, & that allow children to communicate about Mueller, 2006). In many respects, each of their internal states and help them to gen-these organizational processes can be conerate new developmental resources to max-ceptualized as being composed of an orgaimize their ability to accomplish their goals nized system of higher-order components, (Adolph & Berger, 2005). Indeed, motori-which work together to constitute the orgacally mature children set into motion what nizational process itself; many of these is best considered a developmental cascade organizational processes share some of the of developmentally supportive (e.g., eliciting same components. Moreover, most of the more learning opportunities and fostering organizational processes in the DSA have exploration) events, leading to many devel-an identifiable neurobiological basis, charopmental advances over time (Bornstein, acterized by interconnected neural systems (e.g., Blair, 2002; Grossman, 2015; Johnson, 2001; Yeates et al., 2007), with the availability and recombination of specific neural cir-

2001; Yeates et al., 2007), with the availability and recombination of specific neural circuits underlying plasticity and competence Developmental resources are tapped when (Johnson, 2000; Mercado, 2008). children are faced with accomplishing a EF is a higher-order cognitive proparticular goal; growth in social and cog-cess that frames all of the developmental nitive competence corresponds to growth resources and the other organizational proin these resources. However, in order for cesses in a manner that is consistent with a growth to occur, these resources must be projected task outcome or goal; the focus is coordinated, integrated, and organized in a on long-term planning (see Anderson, 2002; systematic manner in the service of a task Banich, 2009; Espy, 2016; as well as Welsh, or goal. This requires a different and far Friedman, & Spieker, 2006). Although this more integrated array of higher-order or construct, like the other organizational prooverarching processes, referred to here as cesses, has a unifying function (see Garon organizational processes (see Figure 1.1). et al., 2008), EF relies on specific component As conceptualized within the DSA, the five abilities consisting, in this case, of working organizational processes noted earlier are memory, attentional shifting, and the ability as follows: 1) EF, 2) metacognition, 3) social to inhibit a prepotent response or strategy cognition, 4) motivation, and 5) emotion reg-in order to maintain a coherent goal orienta-

ulation. These processes are the organiza-tion (Best & Miller, 2010; Blair, 2006; Blakey, tional forces for goal attainment. Moreover, Visser, & Carroll, 2016; Diamond, Barnett,

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 12 Thomas, & Munro, 2007). Although assessment of EF and its component processes is complex, major advances in the measurement of this organizational process during early childhood have been achieved with tasks appropriate to children in this age range (Carlson, 2005; Garon et al., 2008;

tasks appropriate to children in this age range (Carlson, 2005; Garon et al., 2008; Garon, Smith, & Bryson, 2014; McClelland & Cameron, 2012; Miller & Marcovitch, 2015). The organizational process of metacognition overlaps conceptually with and, in some respects, can be thought of as being embedded within EF (Borkowski & Burke, 1996; Sternberg, 1998). However, a distinctive aspect of metacognitive processes is an emphasis on children’s developing awareness of and knowledge about the strategies they can utilize when faced with a particular task (Kuhn, 2000), including those involving memory (Geurten & Willems, 2016). As Pintrich (2000) noted, metacognitive knowledge involves the what, how, when, and why to use the various cognitive strategies available, as well as the monitoring of those strategies. Complex strategies involved in knowledge acquisition, for example, provide information that can further refine and understand the goal being pursued (Kuhn, 2001). These knowledge acquisition activities are central to this organizational process and rely upon numerous strategies related to gaining access to information, formulating questions, and generating possible outcomes relevant to a given goal. Effective use of metacognitive strategies is the key to

FOR MORE, go to http://bit.ly/EffectiveEI Guralnick Thomas, & Munro, 2007). Although assess-most appropriately select and execute a parment of EF and its component processes is ticular response during a goal sequence. A complex, major advances in the measure-number of such social-cognitive or social-inment of this organizational process during formation processing models have been put early childhood have been achieved with forward, each containing many similar comtasks appropriate to children in this age ponents and mechanisms (Beauchamp & range (Carlson, 2005; Garon et al., 2008; Anderson, 2010; Crick & Dodge, 1994; Dodge, Garon, Smith, & Bryson, 2014; McClelland & Pettit, McClaskey, Brown, & Gottman, 1986; Cameron, 2012; Miller & Marcovitch, 2015). Guralnick, 1999; Lemerise & Arsenio, 2000; The organizational process of metacog-Rose-Krasnor, 1997). As is the case for all of nition overlaps conceptually with and, in the organizational processes, developmental some respects, can be thought of as being resources are drawn upon to support each embedded within EF (Borkowski & Burke, of the processes’ components. Examples of 1996; Sternberg, 1998). However, a distinc-relevant developmental resources required tive aspect of metacognitive processes is an for the various components of the social cogemphasis on children’s developing aware-nition organizational process are the ability ness of and knowledge about the strategies to accurately recognize facial expressions they can utilize when faced with a particular (for the encoding component), the ability to task (Kuhn, 2000), including those involv-infer others’ social intentions (for the intering memory (Geurten & Willems, 2016). As preting component), having a repertoire of Pintrich (2000) noted, metacognitive knowl-prosocial responses or strategies available edge involves the what, how, when, and (for the generating alternative responses why to use the various cognitive strategies component), and having sufficient language available, as well as the monitoring of those or motor skills (for the executing the desired strategies. Complex strategies involved in response component). The selection of alterknowledge acquisition, for example, pro-native responses in any interpersonal probvide information that can further refine and lem-solving sequence is a complex process understand the goal being pursued (Kuhn, in which many factors need to be consid- 2001). These knowledge acquisition activ-ered (e.g., context, past history, friend/nonities are central to this organizational pro-friend). Accordingly, many aspects of meta-

2001). These knowledge acquisition activ-ered (e.g., context, past history, friend/nonities are central to this organizational pro-friend). Accordingly, many aspects of metacess and rely upon numerous strategies cognitive and EF organizational processes related to gaining access to information, for-also are involved in socially focused tasks. mulating questions, and generating possible The vigor and persistence with which outcomes relevant to a given goal. Effective goals are addressed, and even the frequency use of metacognitive strategies is the key to and choice of the goals themselves, are transferring knowledge from one situation closely linked to the fourth organizational process involving motivation and reward For goals that primarily require an systems (Morgan, MacTurk, & Hrncir, understanding of social circumstances, a 1995). The sometimes astounding level of related organizational process, social cog-focused and sustained attention that may be nition, can be identified. More specifically, seen even in young children as they strive when confronted by tasks or goals involving to master a particular toy or understand interpersonal problem solving, a number of how objects in the world work suggests social-cognitive components are relevant the power of this process (Piaget, 1952). that, together, form a coherent organiza-The seemingly constant effort to acquire tional process. Components of that process information through questioning provides include encoding social information, inter-another example of this motivational propreting that social information, generating cess (Frazier, Gelman, & Wellman, 2009)

alternative responses, and considering con-and serves as an important mechanism for textual information that will help a child transmitting cultural values. For children so

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Foundations of Early Intervention

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention involved, these activities are clearly highly rewarding and appear to be intrinsically motivated. There also exists a tendency to engage in or master goals that are primarily social in nature and can be thought of as a form of social mastery motivation (Wachs & Combs, 1995), with a corresponding degree of socially rewarding features. Over time, successes and failures in social and nonsocial tasks influence motivational processes and contribute to the creation of a child’s sense of self-efficacy. Ultimately, a set of beliefs, values, and goal structures emerge regarding a child’s expectations for his or her own success and failure with respect to specific goals; in other words, the child’s expectations for achievement (Pintrich, 2000; Ryan & Deci, 2000; Wigfield, Eccles, Schiefele, Roeser, & Davis-Kean, 2006). Accordingly, the organizational process of motivation has widespread implications for children’s social and cognitive competence

motivation has widespread implications for children’s social and cognitive competence and, ultimately, the selection of goals to be attempted. The fifth and final organizational process, emotion regulation, is conceptualized primarily as a process that can influence the outcomes of social or cognitive goals through its interactions with other organizational processes (see Cole, Martin, & Dennis, 2004; Eisenberg & Spinrad, 2004). Among other effects, the experience of an emotion influences attention and makes certain responses or strategies within a goal structure more probable. This involves appraisals of the emotion-generating situation that regulate tendencies to approach or avoid aspects of a task. Of importance, regulating these emotions is an effortful process (Rothbart & Rueda, 2005) that consists of strategies that alter the often highly charged and rapidly changing emotional experiences that can arise at any point during goal attainment activities (see Izard & Stark, 2008). If these emotion regulation strategies are successful, the result is an adaptive process that either facilitates or at least does not interfere with other organiza-

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention involved, these activities are clearly highly 2007). Of note, influences by developmenrewarding and appear to be intrinsically tal resources related to social-emotional motivated. There also exists a tendency to development, particularly basic tendencies engage in or master goals that are primarily toward reactive control (e.g., impulsivity/

motivated. There also exists a tendency to development, particularly basic tendencies engage in or master goals that are primarily toward reactive control (e.g., impulsivity/ social in nature and can be thought of as a low inhibition), are to be expected (Eisenform of social mastery motivation (Wachs & berg et al., 2013). Combs, 1995), with a corresponding degree Although organizational processes can of socially rewarding features. Over time, be parsed into the constructs described successes and failures in social and nonso-herein and measured accordingly, one of cial tasks influence motivational processes the most striking characteristics of these and contribute to the creation of a child’s organizational processes is their interdesense of self-efficacy. Ultimately, a set of pendence. In one sense, processes can be beliefs, values, and goal structures emerge thought of as “borrowing” and utilizing regarding a child’s expectations for his or well-developed components or series of her own success and failure with respect components from one another and applyto specific goals; in other words, the child’s ing those components, when required to expectations for achievement (Pintrich, do so, by a given task, social or nonsocial 2000; Ryan & Deci, 2000; Wigfield, Eccles, (Beer & Ochsner, 2006; Kaplan & Berman, Schiefele, Roeser, & Davis-Kean, 2006). 2010). Inhibition and attention are compo- Accordingly, the organizational process of nents that are commonly utilized by varimotivation has widespread implications for ous processes within specific goal strucchildren’s social and cognitive competence tures. Moreover, reciprocal influences and, ultimately, the selection of goals to be among these organizational processes are apparent, and many of the mechanisms of The fifth and final organizational pro-influence have been identified (Liew, 2012). cess, emotion regulation, is conceptualized The linkages among metacognition, social primarily as a process that can influence cognition, and EF are perhaps most apparthe outcomes of social or cognitive goals ent in tasks related to social competence through its interactions with other orga-goals (Guralnick, 1999; Yeates et al., 2007). nizational processes (see Cole, Martin, & Related linkages from these three processes Dennis, 2004; Eisenberg & Spinrad, 2004). to motivation and emotion regulation orga- Among other effects, the experience of an nizational processes exist as well, with peremotion influences attention and makes haps the best example found in so-called certain responses or strategies within a “hot” EF that is engaged in tasks requiring goal structure more probable. This involves emotion regulation (Blair, 2002; Zelazo & appraisals of the emotion-generating situ-Carlson, 2012; Zelazo & Cunningham, 2007). ation that regulate tendencies to approach Linkages between social cognition and emoor avoid aspects of a task. Of importance, tion regulation (Bell & Wolfe, 2004; Dodge, regulating these emotions is an effortful 1991; Guralnick, 1999; Leerkes, Paradise, process (Rothbart & Rueda, 2005) that con-O’Brien, Calkins, & Lange, 2008; Yeates et sists of strategies that alter the often highly al., 2007) and between EF and motivation

process (Rothbart & Rueda, 2005) that con-O’Brien, Calkins, & Lange, 2008; Yeates et sists of strategies that alter the often highly al., 2007) and between EF and motivation charged and rapidly changing emotional (Borkowski & Burke, 1996) are particularly experiences that can arise at any point well established. during goal attainment activities (see Izard Similarly, as reflected in Figure 1.1 and & Stark, 2008). If these emotion regulation noted previously, developmental resources strategies are successful, the result is an and organizational processes depend on adaptive process that either facilitates or at one another as goals are pursued. In addileast does not interfere with other organiza-tion, they mutually influence one another’s

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 14 (Benson, Sabbagh, Carlson, & Zelazo, 2013), as does the association between attentional or information processing mechanisms and EF (Cuevas & Bell, 2014). Associations among early gesture, language, and EF have also been established (Kuhn et al., 2014). Clearly, an understanding of these interac-

also been established (Kuhn et al., 2014). Clearly, an understanding of these interactions and relationships requires a systems framework. As indicated earlier, substantial neurobiological evidence supports the integrated features and connectivity of neural systems along with regional specialization. This is most apparent with respect to the operation of organizational processes when engaged in a goal structure (Blair, 2006; Garon et al., 2008; Johnson, 2001; Karmiloff-Smith, 2009; Yeates et al., 2007). Accordingly, evidence at this level is compatible with the ways in which the five organizational processes identified within the DSA are presumed to

function to support children’s social and cognitive competence.

ORGANIZATION AND PURPOSE OF THIS BOOK The DSA was introduced in this chapter as an overarching framework that will serve to guide understanding of existing accomplishments in the field of early intervention for vulnerable children and their families and to plan future directions. Details of this approach to early intervention as applied to different groups of vulnerable children will be presented in subsequent chapters of this volume. Of importance, central to the DSA is its consistency with and integration of the developmental science of normative development, a developmental focus on risk and disability, and intervention science. This first chapter provided background information on normative child development as conceptualized within the DSA, particularly the role of developmental resources and organizational processes as the foundation for children’s emerging social and cognitive

FOR MORE, go to http://bit.ly/EffectiveEI Guralnick (Benson, Sabbagh, Carlson, & Zelazo, 2013), and integrative nature of child developas does the association between attentional ment and the way it is organized to achieve

(Benson, Sabbagh, Carlson, & Zelazo, 2013), and integrative nature of child developas does the association between attentional ment and the way it is organized to achieve or information processing mechanisms increasingly complex goals selected by the and EF (Cuevas & Bell, 2014). Associations child. among early gesture, language, and EF have In the next chapter, specific environalso been established (Kuhn et al., 2014). mental factors are discussed in the form Clearly, an understanding of these interac-of family patterns of interaction that are tions and relationships requires a systems responsible for supporting and promoting children’s developmental resources and As indicated earlier, substantial neuro-organizational processes, and hence chilbiological evidence supports the integrated dren’s social and cognitive competence. features and connectivity of neural systems Three family patterns of interaction are along with regional specialization. This is identified (parent-child transactions; fammost apparent with respect to the operation ily orchestrated child experiences; health of organizational processes when engaged and safety provided by the family) and are in a goal structure (Blair, 2006; Garon et al., directly linked to numerous aspects of a 2008; Johnson, 2001; Karmiloff-Smith, 2009; child’s development discussed in this chap- Yeates et al., 2007). Accordingly, evidence ter. Indeed, it is suggested that these family at this level is compatible with the ways patterns of interaction apply to all children, in which the five organizational processes irrespective of vulnerability. In anticipation identified within the DSA are presumed to of future discussions regarding early interfunction to support children’s social and vention for developmentally vulnerable children, it is these family patterns of interaction that can be stressed or perturbed by a child at risk for developmental problems or one with an established delay or disability, thereby further increasing children’s vul- The DSA was introduced in this chapter as nerability. The relationship between a faman overarching framework that will serve ily’s resources and their influence on family to guide understanding of existing accom-patterns of interaction is also considered in plishments in the field of early intervention the next chapter and serves as a framework for vulnerable children and their families for understanding the influences of enviand to plan future directions. Details of this ronmental risk as well as protective factors approach to early intervention as applied to from a systems perspective. Accordingly, as different groups of vulnerable children will discussed in the second chapter, within the be presented in subsequent chapters of this DSA framework, effective early intervenvolume. Of importance, central to the DSA tions are those that develop comprehensive is its consistency with and integration of the programs to establish, support, or enhance developmental science of normative devel-all three family patterns of interaction as opment, a developmental focus on risk and means of fostering children’s developmendisability, and intervention science. This tal resources and organizational processes

opment, a developmental focus on risk and means of fostering children’s developmendisability, and intervention science. This tal resources and organizational processes first chapter provided background infor-as well as their integration to promote chilmation on normative child development as dren’s social and cognitive competence. conceptualized within the DSA, particularly Early intervention in the context of the the role of developmental resources and DSA is then considered more extensively in organizational processes as the foundation Chapter 3, the final introductory chapter. for children’s emerging social and cognitive Emphasized in this chapter is the array of

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Foundations of Early Intervention

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention family patterns of interaction and to family resources. This interactive pattern of complex developmental pathways among and within the three levels of the DSA (level of the child, level of family patterns of interaction, level of family resources) provides a framework for the design, implementa-

action, level of family resources) provides a framework for the design, implementation, and evaluation of early intervention programs. This is followed by four sections with chapters applying the DSA framework to examine the developmental science and the effectiveness of early intervention for specific vulnerable groups: children at risk due to biological factors (preterm birth); children at risk due to environmental factors; children with established developmental (cognitive) delays; and children with or at risk for an ASD diagnosis. The first chapter in each section addresses developmental science. In particular, expected child developmental outcomes in terms of their social and cognitive competence that occurs in the absence of early intervention will be summarized. When possible, information will be related to children’s developmental resources and organizational processes. Accordingly, a profile of children’s characteristics will be established along with child-specific factors that should be considered in the provision of early intervention. Information will also be summarized with respect to children’s influences (adjustments required and stressors) on each of the family patterns of interaction as well as on a family’s resources that can inform early intervention program design. Possible developmental mechanisms as revealed by association studies connecting

FOR MORE, go to http://bit.ly/EffectiveEI Foundations of Early Intervention family patterns of interaction and to family and how effective these strategies are will be resources. This interactive pattern of com-the key issues considered in those chapters. plex developmental pathways among and Consistency with the developmental path-

resources. This interactive pattern of com-the key issues considered in those chapters. plex developmental pathways among and Consistency with the developmental pathwithin the three levels of the DSA (level of ways and reciprocal influences described in the child, level of family patterns of inter-the DSA will also be discussed. action, level of family resources) provides Findings from intervention science that a framework for the design, implementa-have been published since 1997 will be the tion, and evaluation of early intervention primary focus, moving forward from the research summarized since my last com- This is followed by four sections with prehensive review of the field in an edited chapters applying the DSA framework to volume (Guralnick, 1997b). Earlier invesexamine the developmental science and the tigations that are considered foundational effectiveness of early intervention for spe-studies or those that continue to follow chilcific vulnerable groups: children at risk due dren and examine longer-term outcomes will to biological factors (preterm birth); children also be included. No attempt will be made to at risk due to environmental factors; chil-include every major study that bears on early dren with established developmental (cogni-intervention effectiveness for each group tive) delays; and children with or at risk for examined. Rather, studies will be selected an ASD diagnosis. The first chapter in each because they provide new and useful inforsection addresses developmental science. mation about effectiveness, are representa- In particular, expected child developmental tive of a group of similar studies with similar outcomes in terms of their social and cogni-findings, and provide sufficient information tive competence that occurs in the absence that can be understood within the DSA. Bias of early intervention will be summarized. in the selection of studies is admittedly a When possible, information will be related concern. However, every effort was made to to children’s developmental resources and select studies that represent the knowledge organizational processes. Accordingly, a base current at the time of this volume’s pubprofile of children’s characteristics will be lication, despite inconsistencies in findings established along with child-specific factors common to all fields. Readers will have to that should be considered in the provision of judge for themselves the various weight to

that should be considered in the provision of judge for themselves the various weight to early intervention. Information will also be give to the studies selected and those that summarized with respect to children’s influ-may have been omitted. ences (adjustments required and stressors) An important question revolves around on each of the family patterns of interaction whether sufficient consistency exists among as well as on a family’s resources that can the developmental framework, pathways of inform early intervention program design. influence, and outcomes. If a reasonable Possible developmental mechanisms as level of consistency can be identified, there revealed by association studies connecting exists the potential for generating a unifythe various levels and components of the ing approach to early intervention. Studies DSA will also be examined in this context. that have been conducted did not, of course, Following this background and intro-attempt to conform to the DSA. However, ductory information, the following chapter every effort will be made to interpret and in each section consists of an analysis of the understand these studies within that frameeffectiveness of existing early intervention work, especially with respect to developstrategies and programs within the frame-mental mechanisms. In so doing, these analwork of the DSA based on the available lit-yses can be informative in evaluating the erature. More specifically, how intervention overall validity of the causal patterns dis-

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Guralnick

FOR MORE, go to http://bit.ly/EffectiveEI 16 of vulnerable children, as well as determine

of vulnerable children, as well as determine the extent to which children benefit from these approaches to early intervention. Detailed critiques of each investigation included in the analysis, both conceptual or methodological, as is common in analyses of this type, will not be the focus of each of the chapters. Certainly, these issues are relevant and will be discussed as appropriate, as that information is essential in order to identify those early intervention practices in which early intervention professionals can have the most confidence. In the end, it is hoped that this type of integrative analysis, one framed within a specific conceptual approach, will result in the identification of practices likely to produce the most effective early intervention outcomes. Moreover, this analysis and corresponding overall framework should be capable of identifying tasks that remain to be accomplished in the early intervention field and perhaps even

tasks that remain to be accomplished in the early intervention field and perhaps even suggest principles that have broad systems and practice relevance. It is important to point out that this volume does not seek to address children with all risk and disability conditions. This reflects both limits to the author’s expertise as well as limitations in the existing research literature to contribute to an understanding within the DSA. In particular, children with primary sensory or motor disorders will not be considered. Similarly, no separate chapter addresses children who exhibit language and communication disorders that are not associated with the vulnerable groups specifically considered in this volume. However, language and communication issues are obviously critical and are discussed and integrated within the other chapters. Nevertheless, the four vulnerable groups selected for consideration in this volume are highly prevalent, each with a well-defined and well-organized literature. Moreover, although many children in each of the four groups discussed display an increased incidence of behavior problems, that important issue is not directly consid-

Guralnick of vulnerable children, as well as determine problems, recent approaches suggest that the extent to which children benefit from the DSA can contribute to understanding these approaches to early intervention. of relevant developmental mechanisms in

these approaches to early intervention. of relevant developmental mechanisms in Detailed critiques of each investigation this complex area (Crnic, Neece, McIntyre, included in the analysis, both conceptual or Blacher, & Baker, 2017). methodological, as is common in analyses Despite these limitations, in the final of this type, will not be the focus of each of chapter I will attempt to identify general the chapters. Certainly, these issues are rel-principles and practices that apply across evant and will be discussed as appropriate, all groups examined within a systems peras that information is essential in order to spective. These principles and practices will identify those early intervention practices then provide the foundation and vision for a in which early intervention professionals proposal that applies the DSA to the design can have the most confidence. In the end, it and implementation of comprehensive and

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EARLY CHILDHOOD / EARLY INTERVENTION

Effective Early Intervention The Developmental Systems Approach

fter decades of rapid evolution and groundbreaking research, the field of early intervention can be understood within a common framework: the Developmental Systems Approach (DSA). ACreated by a highly influential leader in the field, Dr. Michael Guralnick, this evidence-based, relationship-oriented, family-centered framework focuses on strengthening the quality of key family

patterns of interaction that influence a child’s development. In this important text, Dr. Guralnick organizes and analyzes the most current research in early intervention through the lens of the DSA. Starting with a clear explanation of the foundations of early intervention, the book then applies the DSA to four vulnerable populations: Children at risk due to biological factors, specifically preterm birth; children at environmental risk; children with developmental

delays; and children with autism spectrum disorder. Readers will

• Understand the developmental science that applies to all children • Learn how child development is influenced by three family patterns of interaction—parent-child

• Learn how child development is influenced by three family patterns of interaction—parent-child transactions, family-orchestrated child experiences, and parent support for child health and safety • Explore the influence of family resources as well as child-specific risk and protective factors on a

• Explore the influence of family resources as well as child-specific risk and protective factors on a child’s development in the context of early intervention

• Discover what early interventions are effective, as supported by intervention science • Learn the fundamentals of applying the DSA framework to designing inclusive community-based

systems of early intervention An invaluable reference for early childhood researchers, faculty, and policy makers, this visionary book is the key to establishing inclusive community-based early intervention systems that nurture

ISBN-13: 978-1-68125-288-9 ISBN-10: 1-68125-288-0

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