Early Intervention:
The Integration of
Science and Practice
Michael J. Guralnick, PhD
Director, Center on Human Development and Disability
Professor of Psychology and Pediatrics
University of Washington
Seattle, WA, USA
Challenge for Early Intervention
Expectation is that systematic,
comprehensive, experientially-based
Early Interventions will:
– enhance the development of children
already exhibiting delays (known or
unknown etiology); alter trajectory;
prevent secondary complications
– prevent delays from occurring
for children at risk
Current Status: Services and Supports
High Resource Countries
Expected
and
Accepted
Percent Receiving
Services
100
75
50
25
0
1975
1986
2016
Current Status: Services and Supports
Policy Initiatives : Service Systems Sectors
Education, Child Care, Health, Social Services, Mental Health
Early Intervention Systems
Are In Place
Current Status: Services and Supports
Low and Middle Resource Countries
23% at risk for or with an established disability
(Walker, 2011)
Long-term Strategic Plans
• Building Infrastructure
• Professional Training
• Combating Negative Attitudes
• Primary Prevention Programs
Why Focus on the Early Childhood
Period?
Pragmatic/Humanitarian
• Meeting family needs in most stressful period
• Support and strengthen families
• Family-centered supports and services have become
the central feature of early intervention programs
– Linkage developmental perspective
Why Focus on the Early Childhood
Period?
Plasticity
• Unique window of opportunity to
alter developmental trajectory
Early Intervention System
- Neurobiological and behavioral mechanisms
Responsiveness to environmental input
Developmental cascade
Why Focus on the Early Childhood
Period?
Investment: Long-term Benefits
• Financial perspective
• Quality of life
Who Are These Vulnerable Children?
Environmental
Risk
Developmental
Delay
Biological Risk
(preterm)
(genetic risk)
Autism Spectrum
Disorder
Developmental
Level
1
2
3
4
Biological Risk
Developmental
Level
Environmental Risk
5
1
2
3
4
Chronological Age (years)
Chronological Age (years)
Developmental
Delay
Autism Spectrum
Disorder
1
2
3
4
Developmental
Level
Developmental
Level
What Happens in the Absence of Early
Intervention?
5
Chronological Age (years)
1
2
3
4
Chronological Age (years)
(Guralnick, 2005, 2012, 2013, 2016)
5
5
Why Do Declines in Development
Occur Over Time?
• Emerging Genetic Influences
• Toxic Burden
• Artifact of More
Complex Test Items
• Less Than Optimal
Environmental Experiences
– Allow Biological or Historical
Constraints to Exert Unusual
Level of Influence on:
Family Patterns of Interaction
Level of Child Development
Constraints
Developmental
Resources
Constraints
Organizational
Processes
Cognition
Executive function
Language
Metacognition
Motor
Social cognition
Social-emotional
Motivation
Sensory-perceptual
Non-Optimal
Environment
Emotion regulation
Family Patterns
of Interaction
Social and Cognitive
Competence
Stressors
What are the Important Family Patterns
of Interaction (Environmental Influences)?
Relationships: Parent-Child Transactions
Discourse
framework
Instructional
partnership
Socioemotional
connectedness
Development Over Time
Discourse
framework
Instructional
Partnership
Socioemotional
connectedness
Expansions, modeling,
contingent responding
Scaffolding; zone of
proximal development
Secure
attachment
Relationship Formation
Instructional partnership
Discourse framework
Socioemotional connectedness
Sensitive Responsiveness
Positive Affect
Engagement
Child Social and Cognitive Competence
Stressors
Stressors
Family Patterns of Interaction
Parent-Child Transactions
Discourse
framework
Instructional
Partnership
Socioemotional
connectedness
Expansions, modeling,
contingent responding
Scaffolding; zone of
proximal development
Secure
attachment
Child Social and Cognitive Competence
Stressors
Family Patterns of Interaction
Stressors
Environmental Risk
Family Resources
Personal Characteristics of Parents
Mental and
physical health
Intellectual ability
Attitudes and
cognitive readiness
Material Resources
Coping style
Financial resources
Perceived
confidence and
competence
Social support
Quality of Parent-Child
Transactions
Effects on Family Patterns of Interaction
Discourse framework
Instructional partnership
Socioemotional connectedness
Intensity and Number of Stressors
Sources of Parent-Child Transaction
Difficulties
Genetic Etiologies
Down Syndrome
• Expressive language
• Morphosyntactic
weakness
• Task motivation
Genetic Etiologies
Williams Syndrome
Eye Movement Planning Problems
Visual
Exploration
Relationships
Spatial-Cognitive
Abilities
Visual
Attention
Joint Attention
Language and Cognitive Development
Developmental
Influence
Over Time
(Karmiloff-Smith, 2009)
Genetic Etiologies
Fragile X Syndrome
•
•
•
•
•
Emotion regulation
Gaze aversion
Working memory
Social anxiety
Motivation
Child Social and
Cognitive Competence
adjust
moderate
Family Patterns of Interaction
Parent-Child
Transactions
Discourse
framework
Instructional
partnership
Socioemotional
connectedness
Family Orchestrated Child
Experiences
Parent’s social network
Peer network
Stimulating
environment
Child care
Community activities
Preschool program
Focus on special
interests and needs
Family Resources
Health and Safety
Provided by Family
Protection from
violence
Preventative health
Environmental
hazards
Child Social and
Cognitive Competence
adjust
moderate
Family Patterns of Interaction
Parent-Child
Transactions
Discourse
framework
Instructional
partnership
Socioemotional
connectedness
Family Orchestrated Child
Experiences
Parent’s social network
Peer network
Stimulating
environment
Child care
Community activities
Preschool program
Focus on special
interests and needs
Family Resources
Health and Safety
Provided by Family
Protection from
violence
Preventative health
Environmental
hazards
Child Social and
Cognitive Competence
adjust
moderate
Family Patterns of Interaction
Parent-Child
Transactions
Discourse
framework
Instructional
partnership
Socioemotional
connectedness
Family Orchestrated Child
Experiences
Parent’s social network
Peer network
Stimulating
environment
Child care
Community activities
Preschool program
Focus on special
interests and needs
Family Resources
Health and Safety
Provided by Family
Protection from
violence
Preventative health
Environmental
hazards
Child Social and
Cognitive Competence
adjust
moderate
Family Patterns of Interaction
Parent-Child
Transactions
Discourse
framework
Instructional
partnership
Socioemotional
connectedness
Family Orchestrated Child
Experiences
Parent’s social network
Peer network
Stimulating
environment
Child care
Community activities
Preschool program
Focus on special
interests and needs
Family Resources
Health and Safety
Provided by Family
Protection from
violence
Preventative health
Environmental
hazards
Developmental Science
• Similar Declines to be Expected Due to Stressors
for All Four Vulnerable Groups (Environmental
Risk, Biological Risk, Developmental Delay,
Autism Spectrum Disorder)
• Developmental Mechanisms of Influence Apply to
All Groups
• Association Studies (likely causal influences)
• Unique Adjustments by Group, Subgroup, and
Individual Child and Family Unit
Overall Goal of Early Intervention is Clear:
Optimize Family Patterns of Interaction
Intervention Process
Evaluate Risk and Protective Factors at all
Three Levels
Engage in Problem-Solving Process with
Family and Intervention Team to Optimize
Family Patterns of Interaction
Consider in
Intervention
Phase
Continuity over Time
Comprehensiveness
Relationships
Family Patterns of Interaction
Parent-Child
Transactions
Discourse
framework
Instructional
partnership
Socioemotional
connectedness
Family Orchestrated Child
Experiences
Health and Safety
Provided by Family
Parent’s social network
Peer network
Stimulating
environment
Protection from
violence
Child care
Community activities
Preschool program
Focus on special
interests and needs
Environmental
hazards
Preventative health
General Development Quotient
Heterogeneous Group of Children with
Developmental Delays
Intervention group
80
60
Control group
40
20
home visiting
structured curriculum
30
40
Intervention
50
60
Follow-up
Months
Chronological Age (years)
(Thomaidis et al., 2000)
Cognitive Development Index
Preterm Children
110
Intervention group
105
100
95
90
Control group
85
80
12
24
36
Age in Months
(Infant Health & Development Program)
Early Learning Composite
(Mullen)
Autism (toddlers)
Intervention group
80
70
60
Control group
50
40
2
3
4
(baseline)
Chronological Age (years)
(Dawson, et al., 2010)
Vineland Adaptive Behavior
Composite (Standard Score)
Autism (toddlers)
80
Intervention group
70
60
Control group
50
40
2
3
4
(baseline)
Chronological Age (years)
(Dawson, et al., 2010)
Down Syndrome
Developmental Rate
1.00
Intervention groups (all)
0.80
0.60
0.40
Woods et al. (1984)
Scharav & Shlomo (1986)
Schnell (1984)
Berry et al. (1984)
0.20
0
1
2
3
4
Chronological Age (years)
5
Positive Social-Emotional Behavior
Developing Countries
.2
Iron-Deficient Anemia
.1
0
Parent-Child Intervention
-.1
-.2
-.3
Surveillance Only
-.4
6
12
18
Chronological Age (months)
(Lozoff, et al., 2010)
Family Orchestrated Child Experiences:
Preschool
Pre-Academic: Universal Preschool Program: Inclusion
Typically Developing Children
15
Intervention
10
Children with Mild
and Moderate Delay
Early Literacy
(raw scores)
5
No Intervention
0
5
4
Chronological Age (years)
(Phillips & Meloy, 2012)
Family Orchestrated Child Experiences:
Preschool
50
.4
Responsive to Peer
(Proportion)
Total Positive Interactions
Quality of Peer Relationships
40
30
20
10
0
Inclusive
Specialized
(Guralnick, 1981,1988)
.3
.2
.1
0
Intervention
Control
(Guralnick, et al., 2006)
Developmental Quotient
(Mullen) Visual Reception
Autism: Infant Intervention
120
Intervention
100
80
60
40
Declined Treatment
20
0
9
12
15
18
24
36
Developmental Quotient
(Mullen) Language
Chronological Age (months)
100
Intervention
80
60
40
Declined Treatment
20
Parent-Child Training
(Pilot Study)
• Sensitive
responsiveness
• Low intensity (12
sessions plus boosters)
• Prevent cascade of
events
0
9
12
15
18
24
Chronological Age (months)
36
(Rogers, et al., 2014)
Related Benefits
•
•
•
•
Reduce emotional distress
Enhance parental coping
Build support networks
Promote parenting confidence
and competence
• Fewer special services required
• Greater productivity
• Enhanced community integration
Family
Outcomes
How Successful Has This Focus on
the Early Childhood Period Been?
• Pragmatic/Humanitarian – Strengthen
Families
• Plasticity – Enhance Child Development
• Investment: Long-term Benefits – Financial
and Quality of Life
Expected
and
Accepted
Challenges for Research and
Future Advances
Variability in Outcome
Efficacy Studies
Moderating Factors
• Sensitivity to environmental input (genetic)
• Subgroups
- genetic etiology
- common biological pathways
- historical factors
- similar behavioral profiles
Understanding Factors Influencing
Longer-Term Outcomes
Challenges and Future Directions
for Community Practices
Scaling-Up to Early Intervention
Community-Based Systems
• Lower levels of effectiveness in outcomes
• Fading out of effects over time
Reasons for Practice Concerns
• Heterogeneous set of intervention
strategies—many not evidence-based
• Policies not applied in an effective
or systematic fashion
• Limited Resources
Reason for Progress and the
Future of Early Intervention
Integration of Science
and Practice
Developmental
Science
Intervention
Science
Early
Intervention
Practice
Family Patterns of Interaction
Early Intervention System
Social
Services
Child Care
Health
Education
System of Supports
Mental
Health