EI Talk: A Blog for Early
Childhood Professionals


Trauma in Early Intervention

Early Childhood Interventions September 28, 2015

As a behaviorist, I have spent many years studying the behavior of young children. My passion drives my desire to know as much as possible about each behavior I see and the child exhibiting that behavior. In a more practical sense, my job as a behaviorist is often to modify, reduce or eliminate problem behaviors in young children. Regardless of the behavior, my starting point is always the same, and that is to attempt to uncover the cause and/or purpose of the child’s behavior. I believe that all behaviors have a root and it is with that information that we have the best chance of making significant and lasting change in that child’s behavior and their life.

In my years of work, some of the most heart wrenching cases I have seen involved children who were victims of some form of trauma or abuse. These children are often referred via some government agency for assessment and evaluation of their behavior. I often learn that the behavior that the child is being referred for is “totally out of character” and didn’t happen until the trauma occurred. I have also noticed that many of the behaviors that teachers and caregivers alike report with the most frequency are those behaviors seen in children who have experienced trauma.

“Children suffering from traumatic stress symptoms generally have difficulty regulating their behaviors and emotions. They may be clingy and fearful of new situations, easily frightened, difficult to console, and/or aggressive and impulsive. They may also have difficulty sleeping, lose recently acquired developmental skills, and show regression in functioning and behavior.” (The National Child Traumatic Stress Network. Downloaded from: http://www.nctsn.org/trauma-types/early-childhood-trauma/Symptoms-and-Behaviors-Associated-with-Exposure-to-Trauma)

Research shows that today’s  children experience more trauma and instability in their home lives than children did in the past. Whether it is homelessness, abandonment, or various forms of abuse, many children don’t experience strong, loving, respectful child-adult relationships. Not being able to develop a secure attachment to their primary caregiver is often a characteristic of children seen in early intervention. Children who have not developed a trusting relationship with a primary caregiver often will have difficulty developing a trusting relationship with a teacher, caregiver, etc. Early interventionists may be in a position to assist caregivers to develop strategies that promote trust. Early interventionists may need to help other caregivers be that secure attachment that many children never got.

There are a variety of strategies like trauma-infused caregiving and trauma-focused cognitive behavioral therapy that have been helpful to caregivers.  Trauma-infused cognitive behavioral therapy  “is designed to reduce negative emotional and behavioral responses following child sexual abuse, domestic violence, traumatic loss, and other traumatic events. The treatment—based on learning and cognitive theories—addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience.” https://www.childwelfare.gov/pubs/trauma/

Children require gentle handling, nurturing and guidance in order to thrive. As adults, it is up to us to adapt to the child of today, and give them the love and guidance they deserve.

Amanda M. Tuck
GU Certificate in Early Intervention ‘15

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The Intersection between Child Maltreatment and Children with Disabilities

Early Childhood Interventions August 04, 2015

Every year more than three million reports of child maltreatment are made in the United States to Child Protective Services. Contrary to popular understanding, child maltreatment is defined by more than just bruises and scars that are visible physical signs of abuse. According to the Center for Disease Control (CDC), child maltreatment includes any act(s) either omission or commission, that threaten or result in the harm of a child under the age of 18 (Child Maltreatment, 2014). Omission, also known as neglect, is the failure to provide for a child’s basic physical, emotional, educational, and/or safety needs. Acts of commission can be words or actions that cause harm or threaten to harm a child (i.e. sexual, physical, psychological, and/or emotional abuse). The perpetrator of child maltreatment can be a parent, caregiver, a friend of the family, a babysitter, a teacher, etc.

Data show that one in three children (33%) receiving special education services for a disability is a victim of maltreatment compared to one in ten children (10%) without disabilities (Preventing Abuse, 2015). Unfortunately, not everyone is aware of how vulnerable children with disabilities are to child maltreatment. The fact that society continues to overlook the extent to which children, in general, experience maltreatment places children with identified disabilities further at-risk. Children with disabilities are more vulnerable, not due to the disability itself, but due to society’s response to disability. If a parent or other caregiver does not have the proper support system, they can unintentionally verbally or physically harm their child in response to the frustration or overwhelming emotions that may arise from caring for a child with a disability.

Another reason why formal reports of abuse may not be made for a child with a disability is due to the lack of belief in the child’s accusation. There is a common distrust, which stems from the stigmatization of disability, that children or adults with disabilities may tell lies, especially if the disability is a psychiatric condition, a cognitive disability, or an emotional disturbance.

Children with disabilities often do not report abuse or neglect because they do not understand what child maltreatment is. Communication impairments may also prevent a child with a disability from reporting abuse. Thus, there is a need for continuous education and training on issues related to the maltreatment of children. . The American Psychological Association recommends that families, professionals, judges, victim advocacy agencies, other caregivers, and individuals with disabilities receive specific training in child maltreatment (Resolution, 2003). Children with disabilities should be taught about abuse in an appropriate, comprehensible manner. Early childhood intervention programs already in place should require that their professionals are continuously trained on the topic of abuse (Preventing Abuse, 2015). Early intervention providers like all health, medical, and social service providers are mandated by law to report any reason for suspicion of child maltreatment. It is critical that providers are appropriately trained and sensitive to cultural variations in child rearing to gather the appropriate information to make a knowledgeable report.

The Head Start office advices mandated reporters to closely monitor children for any extreme changes in their behavior, especially if the child has a disability (Preventing Abuse, 2015). Changes in behavior can easily be attributed to the child’s disability, but they may also be an indicator of abuse. Further, along with visible indicators (bruises, scars, worn out clothing, etc.) people need to be aware of a child’s report of abuse. Any time a person has reason to suspect child maltreatment, it is that individual’s responsibility to monitor and talk to the child about his/her safety. Each law on child maltreatment to the Child Protective Service Agency varies by state, but usually individuals required to report suspicion include early childhood interventionists, teachers, physicians, therapists, and any other professional that regularly works with children.

Even though children with disabilities are protected under the Child Abuse Prevention and Treatment Act (CAPTA) against child maltreatment, it is important to note that the definition provided by the CDC does not account for the diversity in experiences of children with disabilities. For instance, the CDC determines under 18 years of age as the age for abuse and neglect to be considered child maltreatment (Child Maltreatment, 2014). The question emerges on how to proceed in the case of maltreatment of a person with a disability who is above 18 years of age, but whose mental development does not reflect that age. The removal of children with disabilities from their homes after child maltreatment has been identified can also either improve or hinder the child’s life, depending on the quality of their foster care. Hence, partnerships between federal agencies, foster care and professional services, and families and/or other caregivers are pivotal in meeting the needs of children with disabilities who have been maltreated (Resolution, 2003).

To report child maltreatment:

Contact your local child protection or law enforcement agency. If you need assistance with reporting or have questions about reporting abuse, contact ChildHelp USA’s 24­hour hotline at 1­800­422­4453.

Fact or Fiction?

Fiction 1: Only bad people abuse children.

FACT: In fact, not all abusers intentionally harm children. Sometimes the perpetrators have themselves been victims of child maltreatment.

Fiction 2: The majority of child abusers are strangers.

FACT: While abuse by strangers does happen, over 80 percent of child abuse cases in 2013 reported a biological parent as the perpetrator (Child Maltreatment, 2015).

Fiction 3: Child maltreatment is only wrong if it causes the child physical harm.

FACT: Physical abuse is only one type of child maltreatment. Neglect and psychological abuse can be just as damaging to children. The U.S. state and local Child Protective Services (CPS) reported that of the estimated 686,000 victims of child maltreatment, 78% of child victims were victims of neglect, 18% of physical abuse, 9% of sexual abuse, and 11% were victims of other types of abuse (Facts, 2014).

References

Preventing Abuse of Children with Cognitive, Intellectual and Developmental Disabilities. (2015, February 18). Retrieved April 24, 2015, from http://eclkc.ohs.acf.hhs.gov/hslc/tta­system/teaching/Disabilities/Staff Support and Supervision/Support and Supervision for Staff Serving Children with Disabilities/PreventingAbuse.htm

Child Maltreatment 2013. (2015, January 15). Retrieved April 21, 2015, from

http://www.acf.hhs.gov/sites/default/files/cb/cm2013.pdf#page=78 

Facts at a Glance 2014. (2014, January 14). Retrived April 22, 2015, from http://www.cdc.gov/violenceprevention/pdf/childmaltreatment­facts­at­a­glance.pd

Resolution on the Maltreatment of Children with Disabilities. (2003, February 1). Retrieved

April 24, 2015, from http://www.apa.org/about/policy/maltreatment.aspx 

Sandra Briseno
GU ‘17

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Caring for Mothers and Children: a Holistic Approach

Early Childhood Interventions May 08, 2015

Perinatal depression. Many people, when they hear the term, are confused about its meaning. “Does it have to do with the baby blues? Is it the same as postpartum? What does the prefix ‘peri-’ mean?” Both this apparent lack of pertinent knowledge and the enduring stigma against mental illness contribute to the barriers parents face when this debilitating depression seeps into the joy that would usually surround the birth of their child.

A diagnosis of perinatal depression indicates that a parent experiences a major or minor depressive episode, or the milder but longer-lasting dysthymia, during the months of pregnancy and/or within a year after birth (Field, 2011). Although there may not be widespread awareness about the issue, perinatal depression is not an uncommon condition, with both mothers and fathers experiencing symptoms. More prevalent than its male counterpart, maternal depression generally affects anywhere between 5 to 25 percent of pregnant and postpartum mothers, with rates steeply escalating to the range of 40 to 60 percent in populations of low-income and teenage mothers (Knitzer, 2008). While studies show that several other factors can also increase a mother’s risk for perinatal depression, a few commonalities emerge amidst the research, including a personal or family history of depression, stress from life events and circumstances, a lack of social networks and support, difficulties with or absence of a partner, and repercussions of an unplanned or unwanted pregnancy (Field, 2011). Also undoubtedly appearing more frequently within the Latina population, maternal depression nevertheless occurs across all races and classes, and thereby influences family life in a variety of households (Le, Perry, & Stuart, 2011). With these consequences of maternal depression reaching far into numerous homes, it is crucial that we research any impacts that negatively affect children and implement programs that simultaneously support mother and child.

Because mothers experiencing perinatal depression often suffer from further medical symptoms and/or other external hardships at the same time, deciphering the direct effects of maternal depression on early development can be a difficult task. Nevertheless, many researchers have rigorously demonstrated that maternal depression increases a child’s risk for numerous different negative outcomes, both very early and later on in life. Several studies have shown that maternal depression is correlated with higher incidences of preterm delivery and low birth weight, both of which themselves can cause multiple complications for new babies as they develop (Field, 2011). The most commonly reported concerns of mothers experiencing perinatal depression are their infant’s excessive crying and disorganized sleeping patterns. These sleep problems can continue into childhood, along with other delays in cognitive, social-emotional, and behavioral development (Field, 2011; Earls, 2010). By decreasing a mother’s capability for positive interaction, attentiveness, and empathy with her child, perinatal depression can result in a child’s insecure attachment to their mother, which in turn can lead to the child’s later behavior problems (Earls, 2010). Depending on the gender of the child and the timing of the depressive episode, different research has found that maternal depression is associated both with externalizing behavior problems, like noncompliance and aggression, and with internalizing behavior issues, like anxiety and withdrawal, in preschool-age children. Similar findings demonstrate that perinatal depression even predicts a higher chance of these children later developing conduct disorder and major depression themselves (Field, 2011).

With such strong associations between perinatal depression in mothers and adverse

consequences for their children, one might think that the identification and intervention services for these populations would be equally as robust. Unfortunately, with several barriers to accessible treatment, including stigma, financial strain, and transportation difficulty, a large proportion of mothers diagnosed with perinatal depression obtain no mental health treatment (Le et al., 2011). Furthermore, as both Alvarez, Meltzer-Brody, Mandel, and Beeber (2015) and England and Simms (2009) point out, these services rarely integrate both parental mental health and children’s early intervention into one programs. Because developmental delays and perinatal depression are typically noticed and assessed in uncoordinated agencies (if at all), this disconnection ignores the “complex interplay” between the two factors (Alvarez et al., 2015). However, crafting comprehensive and creative approaches to simultaneously address both early child development and maternal mental health might offer numerous benefits for families, as some emerging initiatives have testified.

These programs have adopted myriad strategies to incorporate the alleviation of maternal depressive symptoms, the promotion of child well-being, and the improvement of the mother-child relationship. In Pittsburgh, Pennsylvania, for example, The Helping Families Raise Healthy Children Initiative fostered increased communication and collaboration between separate service agencies by hosting cross-system trainings and networking meetings (Schultz, Reynolds, Sontag-Padilla, Lovejoy, Firth, & Pincus, 2013). The initiative’s findings suggest that, with well-defined protocol, “screening for parental depression can be integrated into routine care in the…early intervention system” of the Individual with Disabilities Education Act (Schultz et al., 2013). Having already then established relationships between these early intervention specialists, behavioral health practitioners, and maternal health organizations, the initiative increased the rate of appropriate referrals made, which in turn nearly doubled the rate at which mothers attained treatment or families engaged in relationship-based practices.

Providing another strong example, Early Head Start, a federal “comprehensive family support and child development program,” is a major frontrunner in addressing maternal depression and its potential outcomes on children (Knitzer et al., 2008). With a growing number of Early Head Start programs successfully screening for maternal depression, Early Head Start concentrates on improving the mother-child relationship and enhancing parenting practices in their program. Utilizing home-visiting services allows Early Head Start the important opportunity to prevent or detect perinatal depression in mothers having trouble leaving their house due to transportation, mobility, or mental health issues (National Center on Parent, Family, and Community Engagement, 2013). Studies have shown that depressed parents participating in Early Head Start are more likely to lessen their depressive symptoms and to improve their parenting practices through more positive interactions and less harsh discipline. Meanwhile, compared to peers not enrolled in Early Head Start, their children demonstrate gains in vocabulary and engagement, along with decreases in aggression and negativity (Knitzer et al., 2008).

With trial initiatives and nationwide programs alike showcasing the possibilities for comprehensive care, it is clear that both mothers and children benefit from integrated services addressing perinatal depression and its possible detrimental outcomes. With the collaboration of community organizations, the continuation of screening practices, and the provision of home visits, it is time to support both mothers and their children in the way best suited to their needs.

References

Alvarez, S. L., Meltzer-Brody, S., Mandel, M., & Beeber, L. (2015). Maternal depression and early intervention: A call for an integration of services. Infants and Young Children, 28 (1), 72-87. doi: 10.1097/IYC.0000000000000024

Earls, M. F. (2010). Clinical report: Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. American Academy of Pediatrics, 126, 1032-1039. doi: 10.1542/peds.2010-2348

England, M. J. & Simms, L. J. (2009). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention.Washington, D.C., National Academic Press.

Field, T. (2011). Prenatal depression effects on early development: A review. Infant Behavior and Development, 34, 1-14. doi: 10.1016/j.infbeh.2010.09.008

Knitzer, J., Theberge, S., & Johnson, K. (2008). Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, 2.

Le, H., Perry, D. F., & Stuart, E. A. (2011). Randomized controlled trial of a preventative intervention for perinatal depression in high-risk Latinas. Journal of Consulting and Clinical Psychology, 79 (2), 135-141.

National Center on Parent, Family, and Community Engagement. (2013). Family well-being: A focus on parental depression. Understanding Family Engagement Outcomes: Research to Practice Series.

Schultz, D., Reynolds, K. A., Sontag-Padilla, L. M., Lovejoy, S. L., Firth, R., & Pincus, H. A. (2013). Transforming systems for parental depression and early childhood developmental delays: Findings and lessons learned from the Helping Families Raise Healthy Children initiative. Santa Monica, CA: RAND Corporation.

Amber Rybnick
Georgetown University,
College, Class of 2016

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Walkers, Jumpers, Exersaucers: The Good, The Bad, The Ugly

Early Childhood Interventions April 13, 2015

Infant devices such as walkers, jumpers, and exersaucers are a frequent topic of concern in early intervention. These devices are widely marketed as helping promote a baby’s development and parents often feel they have to have them in order to meet their child’s needs. Additionally, some babies really seem to enjoy the time they spend in their devices. Research on the safety of these devices as well as on their effects on development, however, has not been as positive.

Walkers were originally developed to provide a means of mobility for exploration before a child learns to walk. DiLillo, Damashek, and Peterson (2001) found that parents use walkers and exersaucers for entertainment, perceived developmental benefit, and easy availability.

Concerns have arisen regarding the safety of these devices. Injuries have been reported related to the device itself such as pinching fingers and toes in device hardware and injuries caused because the child is more mobile. Increased mobility in these devices has led to burns when a child can maneuver close to a hot stove, poisonings when a child can bring themselves closer to cabinet sinks and other storage areas, and falls down stairs when a child gets too close to the edge (AAP 2001). Mandatory standards that were implemented in 1971 addressed the incidence of pinch injuries and, as a result, those injuries have decreased. Voluntary standards to address tip overs and falls were implemented in 1996, thus these injuries have decreased also.

However, providers should be aware that many families purchase these expensive devices from second-hand stores or receive them handed down from family members or friends and therefore, a provider cannot assume that the walker a child is using meets safety standards. The American Academy of Pediatrics recommends against the use of walkers entirely due to questions around the safety of the devices. The AAP recommends that when families choose to use a device, they should select one that does not roll (an exersaucer), however, they caution that data on injuries with these devices are not yet available.

Safety concerns have also been observed with jumper devices that hang over doorways. Concerns related to falls are common. There have also been incidents in which children gained too much momentum and swung into door frames. Generally, devices that remain stationary are recommended over the jumpers over doorways.

The infamous Bumbo® seat has been recalled several times for safety modifications. Children have been able to tip out of the Bumbo® leading to injuries. The current recommendation is that the parent or caregiver supervise the child in the Bumbo® at all times. Also, children should only be placed in a Bumbo on the floor. They should never be placed in the Bumbo ®on top of a counter, couch, or other surface.

The impact of these devices on a baby’s development is also concerning. Siegel and Burton 1999 found that babies who spent time in walkers sat, crawled, and walked later than the control group that did not use the devices. In addition, the babies in the walker group scored lower on the Bayley Scales of Infant Development-Mental and Motor, indicating that the devices may not have the positive impact on cognitive development as once thought.  Another study (Kauffman & Ridenour, 1977) showed that children who spent time in walkers were more likely to use abnormal patterns of movement such as tiptoe walking when first learning to walk. However, there are other studies that indicate that the use of walkers provide a child a means of independent mobility that promotes cognitive development through independent environmental exploration (Kermoian &Campos).

The best place for a baby to learn to move their body is on the floor. There, the baby can learn to use his or her own muscles to initiate movement. Seats that help support a baby in these devices do not require the muscles to work as hard and often place the baby’s hips in a position of excessive external rotation and abduction. In addition, when babies spend less time on the floor, they lose opportunities to perform skills such as crawling that develop trunk and upper body strength.

When families ask if it is ok to use these devices, always make sure they are aware of the safety concerns around the particular device they are using. It is best for the baby to play on the floor, but if a family’s routines indicate a device is necessary, it should be used in moderation. Parents should also be cautioned about the amount of time a child spends in a seating device such as an infant carrier or bouncer chair as these devices also inhibit a baby’s movement and can impede development. A general rule of thumb is that no more than 15-20 minutes of an infant’s day should be spent in infant devices. What explanation have you used to help parents understand this issue?

For more information:

American Academy of Pediatrics. (2001). Injuries associated with infant walkers. Pediatrics, 108(3), 790-792. http://pediatrics.aappublications.org/content/10J8/3/790.full

Kermoian R. & Campos JJ. (1988). Locomotor experience: a facilitator of spatial cognitive development. Child Development, 59: 908-917.

DiLillo, D., Damashek, A., Peterson, L. (2001). Maternal use of baby walkers with young children: recent trends and possible alternatives. Injury Prevention, 7, 223-227.

Kauffman, I.B., Ridenour M. (1977). Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills, 45, 1323–1329.

Siegel, A.C., Burton, R.V. (1999). Effects of baby walkers on motor and mental development in human infants. J Dev Behav Pediatr, 20,355–361.

 

— Jamie Holloway

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