New and Effective Interventions for Young Children with Special Needs Sharon Landesman Ramey, Ph'D S

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New and Effective Interventionsfor Young
Children with Special Needs Sharon Landesman
Ramey, Ph.DSusan H. Mayer Professor of Child
and Family Studies Director,Georgetown
UniversityCenter on Health and EducationHead
Starts 7th National Research ConferenceWashingto
n, D.C.June 29, 2004
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Purpose of this Master Lecture

• To provide practical suggestions to improve the
  lives of children and families served by Head
  Start now and later
• To share key facts about childhood disabilities
  pertinent to Head Start
• To review results from efficacious interventions
  and think about how these apply to Head Start

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Personal Stories

• My own family experiences related to childhood
  disabilities both support and bring alive how
  important the following are family responses
  and support, professional guidance and judgment,
  enriched learning and social environments

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Childhood Disability Facts

• Most disabilities occur AFTER birth
• The precise cause of most childhood disabilities
  remains uncertain
• Professionals often disagree about the diagnoses
  for young children
• The majority of childhood disabilities are
  preventable injuries, untreated illnesses, and
  environmental neglect/deprivation

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Early Intervention Facts

• The vast majority of early intervention
  strategies remain untested and/or unproven
• Highly intensive interventions consistently
  produce the largest and most lasting benefits
• Biological risks can be effectively countered by
  multi-pronged, high quality early educational
  interventions
• The field has a long history of serious errors in
  predicting a childs potential and future
  achievement also evidence of bias and racism

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How Science has Fuelled Policy and Informed
Practice

• Universal education and treatment
• Early intervention and neuroplasticity
• Quality of Life considerations
• Behavioral teratology
• Limits of prenatal care
• Invisibility of intellectual disability

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What is Policy?

• Affirmation of what matters/values
• Mechanism for ensuring implementation of agreed
  upon values, commitments
• Blueprint for the future
• Hoped for solution to a problem
• Idea of what should be done

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What is Practice?

• What happens when policy is implemented
• What happens in nature
• What professionals/experts do to help solve a
  problem, improve a condition
• A set of procedures, interventions, supports,
  protective strategies with intended positive
  outcome(s)

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Science, policy, practice linkages

• Poor quality experiences take a serious
  cumulative toll on behavior and health
• The right environment promotes meaningful gains
• Intensity of treatment is crucial to consider
• To create sustainable change, what happens next
  also counts
• Spillover and interaction effects are important
• The human factor in service delivery is crucial
  (to prevent institutionalization in community)

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Randomized Controlled Trials

• Nonambulatory children with profound MR
• Adults in groups homes, institutions
• Children with neuromotor disorders
• Children from very low resource homes
• Children in orphanages
• Head Start children and families
• Very high risk pregnant women

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Naturalistic Studies

• Statewide surveys of persons in all residential
  and training settings
• Prenatal exposure to teratogens
• Observations in community settings
• Evaluations of early interventions
• Statewide epidemiology
• Follow-up of large birth cohorts

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What Ive Learned (as a scientist in MR/DD)

• Theres no substitute for a good design
• Its okay to study things that matter
• Always use the very best methods
• Seek help from your fiercest critics
• If you learn something and dont share it, it
  doesnt count
• Stay connected with the real world

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Intensive Movement Therapy With Casting for Young
Children With Hemiparetic Cerebral Palsy A
Randomized Controlled Crossover TrialTaub,
Ramey, DeLuca, Echols (2004), Pediatrics
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Spillover Effects

• Increased positive social-emotional
  responsiveness
• Reduced behavioral problems
• Improved communication skills
• Decreased sensory aversion to touch
• Improved gross motor and mobility skills
• Increased self-confidence and independence

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Abecedarian Preschool Program
Treatment Group
Control Group
Nutritional supplements
Nutritional supplements
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Supportive social services
Supportive social services
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Free primary medical care
Free or low-cost medical care
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Preschool treatment
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Intensive
(full day, 5 days/week
50 wks/yr, 5 yrs)
"Partners for Learning" curriculum
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Cognitive/Fine Motor

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Social/Self
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Motor
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Campbell Ramey, American Educational Research
Journal, 1995
Language
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Individualized pace
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Long-term Benefits of Intensive Early Educational
Intervention

• Higher IQs
• Higher reading
• Higher math
• Increased education
• Increased employment
• Increased interactional skills
• Spillover to mothers (ed, jobs)

• Decreased special ed
• Decreased grade retention
• Decreased teen parenting
• Decreased criminal activity

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Major challenges for the field

• Eliminating policy mistakes
• Conveying key findings to inform practice
• Getting direct caregivers to provide intensive
  supports over time
• Helping advocates use science well
• Covering costs of high quality behavioral and
  educational interventions

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How Head Start can improve lives of children and
families affected by disability

• By demonstrating best practices in the care and
  education of young children
• By showing high expectations for achievement in
  both learning and social development for all
  children
• By promoting health and safety practices that
  will minimize secondary or future disabilities
• By reducing the multiple risk problem that
  leads to most serious lifelong disabilities
• By exchanging information with families and
  professionals about new and effective treatments
  

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Seven Essentials in ChildrensEveryday
Experiences

• 1. Encourage exploration
• 2. Mentor in basic skills
• 3. Celebrate developmental advances
• 4. Rehearse and extend new skills
• Protect from inappropriate disapproval
• Communicate richly and responsively
• 7. Guide and limit behavior

Ramey Ramey (1999), Right From Birth, 1999
Ramey Ramey (1999), Going to School, Goddard
Press