Associations Between Early Intervention Home Visits, Family Relationships and Competence for Mothers of Children with Developmental Disabilities.

Objectives To examine the association between intensity of home visits in early intervention (EI), perceived helpfulness of home visits in EI, and positive family relationships as predictors of maternal competence at age 3, as well as moderating effects of predictors, controlling for child characteristics, family demographics, and negative life events. Methods Data were drawn from the Early Intervention Collaborative Study (EICS), a 24-year longitudinal investigation of approximately 190 families of children with developmental disabilities who participated in EI programs in Massachusetts and New Hampshire. The primary analytic strategy was multivariable regression modeling. Each independent predictor was tested individually and then all together to build the final model. Interactions between independent predictors were also examined. Results After controlling for child and family characteristics and negative life events, the intensity of home visits was not significantly associated with maternal competence at age 3. However, the helpfulness of home visits (ß = 2.94, S.E. = 1.12, p < .01) and positive family relationships (ß = 5.11, S.E. = 1.08, p < .001) were associated with higher maternal competence when the child was 3 years old. Conclusions for Practice Recommendations for programs and policy include collecting life course data on families, particularly on their family relationships and experiences in EI and home visiting, assessing family relationships at the beginning of EI using a strengths-based perspective, and closely monitoring the quality of services.

The effect of the Infant Health and Development Program on special education use at school age.

OBJECTIVES: To evaluate the effect of an intensive early intervention on special service use at school-age. STUDY DESIGN: The Infant Health and Development Program was a randomized controlled trial of an intervention for low birth weight (<2500 g) infants ages 0-3 years. We used multivariate logistic regression to test the association between intervention and risk of special education, remedial reading and math, and speech therapy at age 8 years. We also compared rates of service use between study arms among those with learning disabilities (LDs). RESULTS: There were 875 complete cases at 8-year follow-up. There were no statistically significant differences between groups in risk of special education (risk ratio [RR] 0.86, 95% CI 0.64-1.15), remedial reading (RR 0.88, 95% CI 0.68-1.14), remedial math (RR 0.92, 95% CI 0.63-1.34), or speech therapy (RR 0.87, 95% CI 0.62-1.23). The treatment arms did not differ in rates of LDs, and service use for those with LDs was low and unaffected by study group. CONCLUSIONS: Early gains in IQ from infant interventions may not protect children as they face the educational demands of grade school. Only a fraction of those having a LD were receiving school-based support services, indicating a high level of unmet need among low birth weight children with disabilities.

The influence of the family environment on adaptive functioning in the classroom: A longitudinal study of children with developmental disabilities.

BACKGROUND: No study has examined trajectories of school-based adaptive functioning (AF) for children with developmental disabilities (DD). This is a critical gap in the literature, since AF is context dependent, and high levels of AF at school facilitate meaningful participation at school. AIMS: This study examined trajectories of school-based AF for 170 children with DD from age 3 to 15 years, and indicators of the early childhood home and family environment as predictors of these trajectories. METHODS: Multilevel modeling was used to explore trajectories of school-based AF and identify early childhood home and family predictors of these trajectories. RESULTS: Children's school-based AF raw scores increased over time. There was significant variability in initial status and rate of change of AF. As hypothesized, higher quality mother-child interaction predicted more positive functioning. CONCLUSIONS: Findings indicate the influence of the early childhood home and family environment on school-based AF over time.

The well-being of mothers of adolescents with developmental disabilities in relation to medical care utilization and satisfaction with health care.

Parents of children with disabilities have been found to be more likely to experience stress and depressive symptoms than parents of typically developing children as a result of the increased challenges inherent in their parenting role. This study investigated the utilization of and satisfaction with adolescent health care services reported by mothers and their relation to maternal well-being. Participants included 73 mothers and their adolescents with developmental disabilities who had been recruited as infants and toddlers from early intervention programs to participate in a longitudinal investigation, the Early Intervention Collaborative Study. Data were collected through parent reports and structured assessments with adolescents. Regression analyses were conducted to test whether utilization and maternal satisfaction with care related to maternal depressive symptoms or parenting stress after controlling for child and family characteristics. The results demonstrated that both utilization and maternal satisfaction with health care added unique variance in predicting lower levels of maternal stress and depressive symptoms.

Early Intervention Services Improve School-age Functional Outcome Among Neonatal Intensive Care Unit Graduates.

OBJECTIVE: To evaluate the effect of community-based early intervention (EI) services the on functional outcomes of high-risk infants at school age. METHODS: This was a retrospective cohort study using data from the US Department of Education's National Early Intervention Longitudinal Study. Participants were enrolled in 1997 to 1998 with follow-up through 5 years and had a neonatal intensive care unit (NICU) admission, birth weight >400 g, and gestational age >23 weeks. Kindergarten outcomes were teacher assessments of academic and physical skills compared with classmates. Because treatment assignment is determined according to level of clinical need, we used repeated measures, marginal structural models with inverse probability of treatment weighting to account for confounding by indication. RESULTS: Of 405 participants, 47% had academic ratings average/above average and 71% had physical skills ratings average/above average. Odds of average/above average academic skills were lower for those with delayed EI enrollment (adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI], 0.43-0.99) and trending, although not significantly, higher for those with greater service duration (aOR, 1.47; 95% CI, 0.98-2.22) and breadth (odds ratio, 1.74; 95% CI, 0.95-3.20). Odds of average/above average physical skills were lower for those with delayed EI enrollment (aOR, 0.61; 95% CI, 0.40-0.93) and higher for those with greater intensity (aOR, 1.06; 95% CI, 1.00-1.13) and breadth (aOR, 1.86; 95% CI, 1.03-3.35), approaching significance for those with greater service duration (aOR, 1.41; 95% CI, 0.96-2.09). CONCLUSIONS: Longer, more intense services were associated with higher kindergarten skills ratings in children at risk for disabilities. Our novel findings support the effectiveness of large-scale EI programs and reinforce the importance of referral after NICU discharge.

The influence of early intervention, informal support and the family environment on trajectories of competence for fathers raising children with developmental disabilities.

BACKGROUND: Scant research disentangles the relationship between parenting competence, early intervention (EI) services, the family environment and informal support among fathers of children with developmental disabilities. AIMS: (1) To determine the trajectory of parental competence for fathers of children with DD from age 3 to age 15. (2) Controlling for child and family characteristics, determine the main effects of the family environment, informal support, and EI services on paternal competence when their child with a developmental disability was age 3. (3) To determine whether there were lasting effects of the family environment, informal support, and the EI service system on differences in paternal competence over time. METHODS: This study used multilevel modeling to analyze longitudinal data from 93 American fathers from the Early Intervention Collaborative Study. RESULTS: There was no significant change over time in paternal competence after controlling for various covariates. Fathers who initially reported low levels of competence when their child was three reported continuously lower competence over time. Family relationships, positive supports, and perceived helpfulness of home visits were significant predictors of paternal competence at age three. CONCLUSION: Implications for programs and policy include developing and adopting rigorous ways to measure and carefully monitor service provision, including assessments of paternal competence, family relationships and informal supports at the start of early intervention, and fostering continuous collaborations between providers, researchers and clinicians to address challenges in data collection.

Setting the stage: early child and family characteristics as predictors of later loneliness in children with developmental disabilities.

Children with developmental disabilities often report having few friends. Researchers have tended to focus on social skill deficits, neglecting other potent predictors of children's feelings of loneliness. In a sample of 82 children with developmental disabilities, we examined characteristics of the child at age 3 (i.e., the conclusion of early intervention services) as well as family income and emotional climate as predictors of children's reported feelings of loneliness at school during middle childhood (age 10). Children with lower levels of externalizing behavior problems at age 3 and from families with a more positive family climate, as indicated by the Family Environment Scale, reported less loneliness at age 10. Implications for children, families, and early intervention services are discussed.

Trajectories of Internalizing and Externalizing Behavior Problems in Children with Developmental Disabilities.

Children with disabilities tend to have higher levels of behavior problems than other children. Such problems have implications for psychopathology in the young adult years, with possible effects on life course opportunities such as employment and independent living. This investigation examines the developmental course of both internalizing and externalizing behavior problems by employing person-centered analyses to construct patterns of change in behavior problems in 169 children (54 % male) with early diagnosed disabilities, from age 3 to age 18. Early childhood predictors of these patterns indicated that more adverse patterns of both types of behavior problems were predicted by higher maternal depressive symptoms. Greater impacts on the family of having a child with a disability predicted more adverse patterns of internalizing behavior problems. More adaptive patterns of externalizing behavior problems were predicted by positive maternal sensitivity to a child's distress. These findings suggest the need for early intervention focused on the family system.

Spilling over: Partner parenting stress as a predictor of family cohesion in parents of adolescents with developmental disabilities.

Family cohesion relates to positive outcomes for both parents and children. Maintaining cohesion may be especially challenging for families of adolescents with developmental disabilities, yet this has been studied infrequently in this group. We investigated cohesion in these families, particularly with respect to partner stress, using the notion of the 'spillover effect' as a model. Adolescents with disabilities and their parents participated. Parents reported on teen adaptive and problem behaviours and on marital satisfaction, parenting stress, and family cohesion. The stress of one partner was tested as a predictor of the quality of family cohesion reported by the other. Adolescent behaviour problems were negative predictors of family cohesion in mothers, and marital satisfaction positively predicted cohesion for both parents. Above other factors, greater partner stress predicted poorer family cohesion for both fathers and mothers. Marital satisfaction acted as a suppressor of this relation. To improve the overall climate of families, care providers should take into consideration individual relationships, including the marital relationship. In addition, the possibility of spillover from one individual to another should be recognized as a factor in family functioning. Family-centred practices are likely to lead to greater feelings of cohesion and overall better individual and family well-being.

Parenting stress and child behavior problems within families of children with developmental disabilities: Transactional relations across 15 years.

Parents of children with developmental disabilities (DD) are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Few studies have considered the reverse direction of effects, however, in families where a child has a DD. The present study investigated transactional relations between child behavior problems and maternal stress within 176 families raising a child with early diagnosed DD. There was evidence of both child-driven and parent-driven effects over the 15-year study period, spanning from early childhood (age 3) to adolescence (age 18), consistent with transactional models of development. Parent-child transactions were found to vary across different life phases and with different domains of behavior problems.

Early mastery motivation as a predictor of executive function in young adults with developmental disabilities.

The role of early childhood mastery motivation as a predictor of executive function 20 years later was examined in a sample of 39 individuals who had early diagnosed developmental disabilities. Multilevel modeling was used to analyze predictors of accuracy and response time on a Flanker task measuring executive function. As predicted, participants had relatively poorer performance on trials requiring inhibition and rule switches. Individuals with Down syndrome, in comparison to other participants, demonstrated longer response times. Young adults who had higher levels of persistence on mastery motivation tasks during early childhood displayed higher levels of accuracy and shorter response times on the executive function task. Possible mechanisms by which early mastery motivation relates to later executive function are discussed.

Social determinants of state variation in special education participation among preschoolers with developmental delays and disabilities.

Children with developmental disabilities are at risk for secondary complications and lower academic performance, which contributes to lower health and well-being and may be ameliorated by access to special education services. This paper examines state variability in preschool special education participation among a United States population-based cohort with parent-reported developmental delays and disabilities. Analyses explore the extent to which observed variability can be explained by state socio-economic attributes and special education policy and funding. Rates of special education varied significantly across states and were highest in states with least income inequality and lowest in states with most income inequality. Place variation in preschool special education participation stems, in part, from child characteristics, but to a larger extent, from state socio-economic attributes.

Modeling the social determinants of caregiver burden among families of children with developmental disabilities.

This study described predictors of caregiver burden among parents of children with developmental disabilities. The sample, obtained from the 2005-2006 National Survey of Children With Special Health Care Needs, included 12,225 children, aged 5 to 17 years, with a developmental disability. Structural equation modeling assessed the relationships between the factors of Caregiver Burden, Ease of Accessing and Navigating the Health Care System, and Unmet Health Care Needs. Caregiver burden was inversely associated with ease of accessing and navigating the health care system (ß â€Š=  -0.094, SE (ß)  =  0.045) and positively associated with unmet health care needs (ß â€Š=  0.428, SE (ß)  =  0.036). Parents of poor, minority, and uninsured children experienced significantly greater caregiver burden. Bolstering services, particularly for vulnerable families, may ameliorate caregiver burden.

The effect of state early intervention eligibility policy on participation among a cohort of young CSHCN.

OBJECTIVE: This purpose of this study was to describe differences in early intervention (EI) participation according to state among a cohort of young children with parent-reported developmental delays and disabilities. METHODS: Data were obtained from the 2005-2006 National Survey of Children With Special Health Care Needs to describe state differences in EI participation. Multilevel modeling was used to estimate the relative contributions of child sociodemographic and developmental characteristics, and state EI eligibility policy on EI participation. RESULTS: The overall rate of EI participation was 45.7% (23.1%-83.3% across the states). EI participants were less likely to be Hispanic, live in a multiracial family, be poor, have a developmental delay, or have a less severe condition/delay. The predicted probability of receiving EI was lower for children who lived in states with more strict EI eligibility criteria than those with liberal criteria (.43 vs .52). Poverty influenced this association, with the adjusted probabilities of receiving EI for poor (<100% federal poverty level) and nonpoor (>185% federal poverty level) children being .18 and .36, respectively (P < .05). Among nonpoor children, those who lived in states with strict eligibility criteria were nearly as likely as poor children who lived in states with liberal eligibility criteria to receive EI (.33 vs .36; P < .05). CONCLUSIONS: The results of this study reveal marked disparities and unmet needs in EI participation as a function of both characteristics of the child and the state program. Improving developmental services for vulnerable populations requires addressing these sources of disparity.

The Brookline Early Education Project: a 25-year follow-up study of a family-centered early health and development intervention.

BACKGROUND: Clinicians, scientists, and policy makers are increasingly taking interest in the long-term outcomes of early intervention programs undertaken during the 1960s and 1970s, which were intended to improve young children's health and educational prospects. The Brookline Early Education Project (BEEP) was an innovative, community-based program that provided health and developmental services for children and their families from 3 months before birth until entry into kindergarten. It was open to all families in the town of Brookline and to families from neighboring Boston, to include a mixture of families from suburban and urban communities. The goal of the project, which was administered by the Brookline Public Schools, was to ensure that children would enter kindergarten healthy and ready to learn. OBJECTIVE: Outcome studies of BEEP and comparison children during kindergarten and second grade demonstrated the program's effectiveness during the early school years. The goal of this follow-up study was to test the hypotheses that BEEP participants, in comparison with their peers, would have higher levels of educational attainment, higher incomes, and more positive health behaviors, mental health, and health efficacy during the young adult period. METHODS: Participants were young adults who were enrolled in the BEEP project from 1973 to 1978. Comparison subjects were young adults in Boston and Brookline who did not participate in BEEP but were matched to the BEEP group with respect to age, ethnicity, mother's educational level, and neighborhood (during youth). A total of 169 children were enrolled originally in BEEP and monitored through second grade. The follow-up sample included a total of 120 young adults who had participated in BEEP as children. The sample differed from the original BEEP sample in having a slightly larger proportion of college-educated mothers and a slightly smaller proportion of urban families but otherwise resembled the original BEEP sample. The demographic features of the BEEP and comparison samples were similar. The young adults were asked to complete a survey that focused on the major domains of educational/functional outcomes and health/well-being. The study used a quasi-experimental causal-comparative design involving quantitative analyses of differences between the BEEP program and comparison groups, stratified according to community. Hypotheses were tested with analysis of variance and multivariate analysis of variance techniques. Analyses of the hypotheses included the main effects of group (BEEP versus comparison sample) and community (suburban versus urban location), as well as their interaction. RESULTS: Young adults from the suburban community had higher levels of educational attainment than did those in the urban group, with little difference between the suburban BEEP and comparison groups. In the urban group, participation in the BEEP program was associated with completing >1 additional year of schooling. Fewer BEEP young adults reported having a low income (less than 20000 dollars); the income differences were accounted for largely by the urban participants. The percentage of subjects with private health insurance was significantly lower in the urban group overall, but the BEEP urban group had higher rates of private insurance than did the comparison group. More than 80% of both suburban samples reported being in very good or excellent health; the 2 urban groups had significantly lower ratings, with 64% of the BEEP group and only 41.67% of the comparison group reaching this standard. Overall, suburban participants reported more positive health behaviors, more perceived competence, and less depression. Among the urban samples, however, participation in BEEP was associated with higher levels of health efficacy, more positive health behaviors, and less depression than their peers. CONCLUSIONS: No previous study has focused as extensively on health-related outcomes of early education programs. BEEP participants living in urban communities had advantages over their peers in educational attainment, income, health, and well-being. The educational advantages found for BEEP participants in the early years of schooling included executive skills such as planning, organizing, and completing school-related tasks. It is likely that these early advantages in executive function extended beyond education-related tasks to other activities as participants became responsible for their own lives. The long-term benefits revealed in this study are consistent with the findings of previous long-term studies that indicated that participants in high-quality intervention programs are less likely to cost taxpayers money for health, educational, and public assistance services. The BEEP program appears to have somewhat blunted differences between the urban and suburban groups. The results of this study add to the growing body of findings that indicate that long-term benefits occur as the result of well-designed, intensive, comprehensive early education. The health benefits add a unique and important extension to the findings of other studies.