Maltreated infants and toddlers: predictors of developmental delay.

OBJECTIVE: The aim of this study was to examine the relationship of child, caregiver, and maltreatment characteristics at the time of the investigation with low scores on developmental measures obtained 18 and 36 months after substantiation in a nationally representative sample of maltreated infants and toddlers. METHOD: A proxy for developmental delay was constructed based on a criterion of 2 or more scores > or = 1 SD below the mean in the domains of adaptive behavior, cognition or communication at each assessment time point. Twenty-three percent of children were classified as having developmental delay, 26% with inconsistent low scores, and 51% with no low scores. An ordered logistic regression was conducted to determine factors associated with low scores. RESULTS: Case worker report of special needs at the time of the investigation, living in continuous poverty, and with caregiver characteristics of cognitive impairment and not having a high school education were associated with low scores. Failure to provide and "other" types of maltreatment, which included sexual abuse and abandonment, were more highly associated with low scores 18- and 36-month postinvestigation. A notable finding was that 15% of children were <6% height/weight. Parameter estimates from an ordered logistic regression are presented to explain the increased likelihood of low scores. CONCLUSION: Characteristics associated with low scores and the developmental delay proxy are identifiable at the time of investigation of maltreatment of infants and toddlers, emphasizing the urgency of providing early intervention developmental services to avoid developmental delay and to maximize outcomes in this highly vulnerable population.

Dimensions of behavior of toddlers entering early intervention: child and family correlates.

This study examined the nature and correlates of the behavioral characteristics of a nationally representative sample of 1612 toddlers 18-31 months of age entering Part C early intervention services in the U.S. Factor analysis of 15 items describing child behavior collected as part of an extensive telephone interview of parents yielded four dimensions of behavior: difficult behaviors, lack of persistence, distractible, and withdrawn. Demographic and personal characteristics of the child and family were found to be related to the four behavioral dimensions. Parent reports of behavior of toddlers with fair or poor health or those with communication difficulties were less positive for all behavioral dimensions, suggesting the development of toddler behavioral characteristics is influencing or being influenced by other facets of development.

ICF and ICD codes provide a standard language of disability in young children.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the utility of a hierarchical algorithm incorporating codes from the International Classification of Functioning, Disability and Health--ICF (WHO, 2001) and the International Statistical Classification of Diseases-ICD (WHO, 1994) to classify reasons for eligibility of young children in early intervention. METHODS: The database for this study was a nationally representative enrollment sample of more than 5,500 children in a longitudinal study of early intervention. Reasons for eligibility were reviewed and matched to the closest ICF or ICD codes under one of four major categories (Body Functions/Structures, Activities/Participation, Health Conditions, and Environmental Factors). RESULTS: The average number of reasons for eligibility provided per child was 1.5, resulting in a population summary exceeding 100%. A total of 305 ICF and ICD codes were used with most (77%) of the children having codes in the category of Body Function/Structures. Forty-one percent of the sample had codes of Health Conditions, whereas the proportions with codes in the Activities/Partipication and Environmental Categories were 10 and 5%, respectively. CONCLUSIONS: The results demonstrate that ICD and ICF can be jointly used as a common language to document disability characteristics of children in early intervention.

Thirty-six-month outcomes for families of children who have disabilities and participated in early intervention.

OBJECTIVE: Infants and toddlers with disabilities in the United States and their families are eligible for early intervention services under Part C of the Individuals With Disabilities Education Act. The purpose of this study was to assess family outcomes at the end of early intervention (near the child's third birthday). METHODS: A nationally representative sample of 2586 parents in 20 states completed a 40-minute telephone interview on or near their child's third birthday. This article summarizes data related to perceived family outcomes at the end of early intervention. RESULTS: At the end of early intervention, most parents felt competent in caring for their children, advocating for services, and gaining access to formal and informal supports. They also were generally optimistic about the future. Most (82%) parents believed that their family was better off as a result of early intervention. Parents were somewhat less positive in their perceived ability to deal with their child's behavior problems or gain access to community resources, and lower family outcome scores were found for parents of minority children, children with health problems, and children who were living with a single adult. CONCLUSION: Results suggest that Part C early intervention provides important supports for families of young children with disabilities. The findings reinforce the need for experimental research to identify factors that are most likely to lead to successful outcomes for all families. In the meantime, early identification and expeditious referral are important so that maximum benefit can be realized for children with disabilities and their families.

First experiences with early intervention: a national perspective.

BACKGROUND: Families of young children with disabilities are eligible for early intervention services as mandated by Part C of the Individuals With Disabilities Education Act. Although prior research has shown that families are generally satisfied with early intervention, this research has not been based on a nationally representative sample of families, nor has it systematically examined perceptions of the initial experiences entering early intervention. OBJECTIVE: This study was designed to determine families' initial experiences in determining their child's eligibility, interactions with medical professionals, effort required to obtain services, participation in planning for services, satisfaction with services, and interactions with professionals. METHOD: We interviewed a nationally representative sample of 3338 parents of young children with or at risk for disability. All the children had recently entered an early intervention program operated under the auspices of Part C of the Individuals With Disabilities Education Act. RESULTS: The average age at which families reported a concern about their child was 7.4 months. A diagnosis was made, on average, 1.4 months later, the child was referred for early intervention an average of 5.2 months after the diagnosis, and the individualized family service plan was developed 1.7 months later or at an average age of 15.7 months. Most families were very positive about their entry into early intervention programs. They reported discussing their concerns with a medical professional and finding that person helpful. Families reported relative ease in accessing services, felt that services were related to their perceived needs, rated positively the professionals working in early intervention, and felt that they had a role in making key decisions about child and family goals. A small percentage of families experienced significant delays in getting services, wanted more involvement in service planning, or felt that services were inadequate, and nearly 20% were unaware of the existence of a written plan for services. Minority families, families with limited income, and families with less-educated mothers were more likely to report negative experiences. CONCLUSIONS: We conclude that the beginning of early intervention services generally is highly successful and responsive, a finding that should give pediatricians more confidence in referring families for early intervention services. However, research and local evaluation efforts are needed to develop strategies to assure that all families receive services in a timely and appropriate fashion.