A primary role of an early interventionist is to document the development of a young child. We collect this type of information for a variety of reasons, including to: determine skill level, determine strengths, determine patterns of development, etc. We collect information in five primary developmental domains: adaptive, cognitive, communication, motor, and social-emotional. We use assessment tools, evaluation tests, screening procedures to make these determinations. Using procedures that are structured helps us feel confident that the differences we may see are accurate. Assessing children early is key to the identification of delays and referral to services and supports that may be of help to promote functional participation of the child in everyday activities.
However, there are so many tools and tests available that all appear to do the same thing. SO— “What’s the difference?!” This blog will outline the basic differences among five commonly used early intervention assessments: Assessment, Evaluation, And Programming System for Infants and Children-2ndEd. (AEPS-2), Ages and Stages Questionnaires, 3rd Ed. (ASQ-3), Battelle Development Inventory, 2nd Ed.(BDI-2), Bayley Scales of Infant and Toddler Development-3rd Ed.(BSID-III), and the Hawaii Early Learning Profile (HELP).
Each of these tools collects information about the child’s status in the five major developmental domains: motor, cognition, communication, social-emotional, and adaptive. Although these tools are similar there are some clear differences that indicate the strengths of each one. AEPS is widely regarded as one of the best curriculum-based, criterion-referenced tools in the early childhood field. ASQ-3 is considered an accurate, family-friendly way to screen children for developmental delays between one month and 5½ years. The BDI-2 and the BSID-III are norm-referenced standardized tools that determine if a child is delayed in comparison to his or her age group peers. The BDI-2 has also been shown to be useful to monitor change in development over time.
The following chart describes each of these five tools on five main elements of test/tool construction: purpose, type, content, administration and scoring.
The psychometric qualities of a tool are also important to consider, because reliability and validity are important to help a practitioner determine which tools will give them the most accurate information for their purposes. Reliability provides information on consistency of each assessment tool while validity refers to how well a test measures what it is purported to measure.
Pricing and availability are other issues to take into account when a practitioner tries to choose the right assessment. Please see the chart below to find the cost, ordering information and website for each tool.
The United Arab Emirates (UAE) one of the Arabic Countries of the Middle East is comprised of seven emirates. Situated on the Arabian Gulf, east of Saudi Arabia and north of Oman, the UAE has a long history of local tribal lifestyle and of later European influences. The country has dramatically emerged into the mainstream of modernism over the past 42 years. The economy is driven by oil and gas and recently tourism. In 1951, the Trucial States Council was formed, bringing all the leaders of the various groups throughout the region together. Seven emirates, Abu Dhabi, Dubai, Sharjah, Ras-Al-Kahaimah, Fujairah, Umm Al Qaiwain, Ajman, joined together forming the United Arab Emirates in 1971.
The major religion of the country is Islam. Ninety-six percent of the population is Muslim and the rest are Christian or Hindu . The population of the UAE is approximately 8 million people, of which only 20-22 percent are Emirati citizens. Most of the population is made up of expatriates, about 50% of whom are from the Indian subcontinent. The population as a high percentage of young people (Table 1). According to the World Health Organization approximately 11 percent of the UAE population has a disability. This percentage is consistent with what the WHO projects is the world’s population of people with disabilities.
The Government of the UAE is committed to the welfare of children. Children who are citizens receive free health care and education. The standards of health care are considered to be generally high in the United Arab Emirates. During the strong economic years the government spent a significant amount of money on health care. According to the government, total expenditures on health care from 1996 to 2003 were US $436 million.
The UAE is interested in developing services for people with disabilities. The UAE Disability Act (Federal Law No. 29/2006) was passed in 2006 to protect the rights of people with disabilities. This law stipulates that UAE nationals with disabilities have the same rights to work and occupy public positions. In addition, the UAE ratified the United Nations Convention on the Rights of Persons with Disabilities on the March 19, 2010.
In March 2014, HH Sheikh Mohammed Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE, in his capacity as the Ruler of Dubai, issued Law No. (2) of 2014 “to protect the rights of people with disabilities in the emirate of Dubai”. The law supports Federal Law No. (29) concerning the rights of people with disabilities, and supports providing high-quality medical care and social services, boosts public awareness of people with disabilities, contributes to integrating people with disabilities into society, and reaffirms their participation in social development .
Services for people with disabilities are offered primarily in three types of programs:
o Governmental Centers, which are run by the federal, or local government (state), offering free services especially to the citizens .
o Semi-governmental Centers, usually organized by non-profit charitable organizations, offering free or semi free services.
o Private centers or schools or rehabilitation clinics which require a fee or payment for services.
Services offered to people with disabilities according to age group include the following (Table 2) :
Each emirate (state) has its own rules and regulations regarding programs for people with disabilities. The emirate of Sharjah has a long history of concern for people with disabilities. Sharjah City for Humanitarian Services (SCHS ) is a large, local, non-profit organization founded in 1979 as a branch of the Arab Family Organization in the Gulf region. The purpose of the Arab Family Organization is to support Arab families and provide needed social services. SCHS is considered the first institute in UAE to provide specialized services to persons with disabilities.
The vision of the SCHS is to be a leader in advocacy, inclusion, and empowerment for persons with disabilities in the United Arab Emirates and the Arab world. The mission is to provide services in early intervention, community outreach, education, rehabilitation, and job placement for people with disabilities assisting them to become independent, self-reliant members of society.
Sharjah City for Humanitarian Services (SCHS) has almost 500 employees, serving around 3000 persons with disability yearly. People served include all age groups. What is unique is that the SCHS serves all residents, including non-emirates. SCHS has three branches in the Emirate of Sharjah. SCHS offers a variety of programs via specialized centers, departments, and schools covering several programs:
• Al Amal school for the students with hearing Impairments and Al Amal Kindergarten for students with hearing Impairments , ( nursery to secondary level (preschool to grade 12).
• Al Wafa Schools for developmental training for students with intellectual disabilities from age 5 years and above.
• Sharjah Autism center for children with autism from age 5 years and above.
• Early intervention center for children from birth till age 5 years.
• Physical and Occupational Therapy Dept. for children with motor and sensory impairments from 0-18 years.
• Vocational Rehabilitation and Training Dept. from age 15 years and above.
• Sharjah City Audiology Center for all people with hearing impairments (hearing test and follow up) all age group.
• There is also a unit for people with visual impairment offering the services for all age groups.
As mentioned there is three branches of SCHS in Sharjah having the same mentioned facilities and programs organized regionally throughout Sharjah:
SCHS Middle region (Al Thiad branch).
SCHS East region (Khorfakkan Branch).
SCHS East region (Kalbaa branch).
One of the most important centers of SCHS is the early intervention center (EIC ) established in 1992 servicing children from birth till 5 years of age. This center is the first one in the region, to offer services to young children, their families and the community. The Center has a variety of departments and facilities:
o Social services department
o Family counseling and training department including home based services
o Speech-language therapy department
o Educational department including a preschool program for children 3-5 years
o Visual impairment department all ages
o Physical and Occupational Therapy department
o AVT and Audiology test department for all ages
o Psychology department
There is also a screening program at the local nursery and preschool programs, and an inclusion follow up program with the local schools .
The Center serves about 350 children annually and has served around 2700 children since official opening in 1992. Each year 120 new children are enrolled in the center services.
Finally the SCHS is looking to influence the community’s attitude throughout Sharjah to guarantee real integration and inclusion for people with disabilities in all aspects of life (Educational, Medical, Social) .
Islam sees disability as morally neutral. It is seen neither as a blessing nor as a curse. Clearly, disability is therefore accepted as being an inevitable part of the human condition. It is simply a fact of life which has to be addressed appropriately by the society of the day, thus, people with disabilities are given an opportunity for independency. Also, federal law 29/2006 of the UAE provides Emirates with disabilities the right to be part of the society. However, implementing federal law 29/2006 continues to be challenging.
Although there is interest in integrated, inclusionary services most services in the UAE continue to be delivered through centers for special needs. Additionally, the UAE lacks schools that accept children with disability without restrictions. There continues to be a lack of services and service providers to serve all children with disabilities even using segregated, isolated programs, especially in early intervention. Creating appropriate early childhood services using contemporary evidence based programs for children birth to three needs to be emphasized.
Fetal Alcohol Syndrome Disorder (FASD) affects an estimated 40,000 infants each year (SAMSHA, 2003). FASD is an umbrella term describing a range of characteristics that can occur in children prenatally exposed to alcohol. The characteristics may include physical,
behavioral, and/or learning disabilities that last a lifetime. According to National Organization on Fetal Alcohol Syndrome (NOFAS, 2014) FASD includes 4 distinct syndromes associated with prenatal alcohol exposure.
Associated with Prenatal Alcohol Exposure (ND-PAE), and
Alcohol Related Neurodevelopmental Disorder (ARND) are the
FASD is characterized by unique physical features and a variety of problems that can impact learning and social participation. Physical features of FASD are depicted in the figure:
Other characteristics of the syndrome may include: intellectual disabilities, learning disabilities, poor impulse control, language deficits, memory deficits, and poor social adaptability. Fetal Alcohol Syndrome is the leading cause of intellectual disabilities in children (Shapiro & Batshaw, 2013) yet it is 100% preventable. It is unclear how much alcohol is needed to affect a fetus. According to the CDC, the U.S. Surgeon General, and the American Academy of Pediatrics, there is no known safe amount of alcohol to drink while pregnant. There is also no safe time during pregnancy to drink and no safe kind of alcohol. Research indicates that even drinking small amounts of alcohol while pregnant can lead to miscarriage, stillbirth, prematurity, or sudden infant death syndrome.
If ways can be found to curb the intake of alcohol among pregnant women, a huge number of children would not have the live with the negative consequences alcohol exposure. Services and supports are needed and necessary to prevent women from drinking while pregnant. Prevention of drinking during pregnancy, especially during the critical first few months is challenging for a host of reasons. Alcohol consumption in pregnant women is not a single issue.
A study done in Washington State among women who had given birth to children with FASD provides insight into the intricacies of this issue. Intersecting social challenges include mental health disorders, physical and/or psychological abuse, and lack of education. Ninety-six percent of women who gave birth to a child with FAS had at least one mental health disorder, 95% had a history of sexual or physical abuse, 61% had less than a high school education, 25% had some college education, 77% had an unplanned pregnancy, and of that group 81% did not use birth control although most of the women ( 92%) wanted some form of birth control, and 59% had an annual gross household income of less than $10,000 (Grant, et al, 2009).
Unlike other characteristics of vulnerable populations, alcohol consumption cuts across ethnic, racial, and economic lines. Perreira and Cortes (2006) found that all segments of the population admitted to drinking alcohol while pregnant: 17% White, non-Hispanic, 9.7% Black, non-Hispanic, and 6.4% Hispanic. Almost 12 % of those who said they were born in the United States drank alcohol during pregnancy, as opposed to 8.2 percent who said they were foreign born. It is evident that this issue is persistent throughout the country and that there is not a specific demographic which can be targeted to address the problem. Additionally, as demonstrated by the findings from Washington state alcohol consumption in pregnant women may be symptomatic of much more complicated issues that have far and long reaching effects.
Deciding where to begin to address the cause of the problem is difficult and complex. Do organizations first target the poverty, the mental illness, the maltreatment, the low maternal education, the lack of access to birth control, or the lack of prenatal care? Thus far, policy has focused not on the mother but on the child, often taking the child out of the home, as is evidenced by the overwhelming number of children in the foster care system who have FAS. Children in foster care are 10-15 times more likely to be affected by prenatal alcohol exposure than other children (FASD Center for Excellence, 2007). The most notable prevention measure is the FDA regulation that all alcohol products contain a warning label that alcohol can damage a fetus. Additionally, there are some public relation campaigns and public service announcements targeting high risk populations.
By framing the use of alcohol in pregnant women as a symptom of a larger issue, the conversation regarding policy could shift away from simply putting warning labels on alcoholic beverages and taking the child out of the home to policies that address the complexity of the problem and the intersecting needs of the mother. Prevention is obviously a key component of any policy or program created to address this problem. Nurse practitioner and gynecologists/ obstetricians training should include recognition of alcohol use, anticipatory guidance on the effects of alcohol consumption while pregnant, and recognizing and supporting women with mental health concerns, domestic violence, social service needs, etc. Most importantly, treatment could be determined by recognizing that the pregnant woman who is drinking may have complex health and social service needs as opposed to a “drinking problem”. This same perspective could be used to inform decisions regarding the child after it is born. Indeed, if the child needs to be taken out of the home, efforts could be made to also treat the mother for the larger issue of her alcohol or substance abuse. Lastly, because there is such a high percentage of children with alcohol related disabilities in foster care, it is also important to train foster parents on how best to support the child. By doing this, the child and the foster family are given an opportunity to develop a close relationship and experience success for the child. Dealing with alcohol related disabilities is hard for any family and thus support and knowledge surrounding the disability is key.
FASD is 100 % preventable. However, due to a variety of reasons and the myriad of complex interrelated issues, the likelihood of eliminating developmental disabilities due to alcohol is slim. Policies can, however, begin to address the interrelated issues of the pregnant woman by viewing her alcohol consumption as a symptom and not the root issue. Additionally, foster families can be better educated about the support needed for children diagnosed with FAS. The disabilities caused by prenatal alcohol consumption are serious and need to be taken as such. The reasons and issues surrounding the pregnant woman’s drinking are also serious and need to be taken as such.
Grant T.M., Huggins, .J.E, Sampson, .P.D, Ernst, .C.C, Barr, .H.M., Streissguth, A.P.(2009). Alcohol use before and during pregnancy in western Washington, 1989-2004: Implications for the prevention of fetal alcohol spectrum disorders. American Journal of Obstetrics and Gynecology, 200(3): 278.e:1-8
Phares, T., Morrow, B., Lansky, A., Barfield, W., Prince, C., Marchi, K., Braveman, P., William SAMSHA, 2003
Shapiro, B. & Batshaw, M. (2013). Developmental Delay and Intellectual Disabilities. In M. L. Batshaw, N. J. Roizen, & G.R. Lotrecchiano, G.R. (Eds.), Children with disabilities. pp. 291-306. Baltimore: Paul H. Brooks Publishing Co.
— Sophie Siebach Georgetown University College, 2015
Statistics show that poverty and disability are deeply intertwined. Nationally, 28 percent of children with disabilities fall below the Federal Poverty Level (FPL), compared to only 16 percent of children without disabilities (Emerson, 2007). This relationship is bidirectional, meaning that experiencing the environmental and psychosocial hazards that often accompany poverty increases the risk of disability, and the direct and indirect costs of having a disability increase the likelihood of falling into poverty, or at least of experiencing material hardship. These risk factors accumulate and interact over time; thus it is essential to intervene as early as possible in order to maximize positive outcomes for children with disabilities who have additional vulnerabilities such as being in poverty.
Research shows that the effectiveness of early intervention (EI) in such vulnerable populations is substantial (Long, 2013). The purpose of EI is to support families in their care of their children to facilitate the child’s participation and sense of membership in his or her family and community (Long, 2013). Many early interventionists follow the biomedical model, which focuses on managing or eradicating symptoms in “patients” rather than looking at a person and his or her capabilities and limitations within a social and environmental context (Halfon, Houtrow, Larson, & Newacheck, 2012). It would be far more beneficial, however, to approach children with disabilities and their families, especially those who experience additional vulnerabilities such as poverty, with a more family-centered approach. Before interacting with vulnerable families, early interventionists should consider their approach to early intervention, what they know about families that could influence their interactions, and what they should provide for them, given their needs and limitations.
Early interventionist’s use of an ecological approach will increase the likelihood that they will incorporate a systems perspective based on a strengths based, relationship, taking into account the life course of the child and family. Bronfenbrenner’s ecological systems approach posits that children develop in a system of nested environments, from their family and child care experiences (microsystems) to larger societal and cultural values and laws (macrosystem), and that these systems interact dynamically and change over time (Zajicek-Farber, 2013). From this perspective, the goal of intervention is not just to manage symptoms, but to improve the child’s social, physical, and psychological functioning within the contexts or environments he or she is expected to participate in. Using a relationship- and strengths-based approach means that early interventionists need to first develop a trusting, collaborative relationship with children and families, and to focus on their strengths (rather than limitations) that might be used as resources in helping to improve the child’s functioning and quality of life.
From a life course perspective, the goal of EI is to improve functioning and quality of life not just for children with disabilities in the moment, but to look ahead and anticipate needs across the lifespan so as children transition to and experience adulthood, they can maintain these improvements throughout their lives (Long, 2013). This is especially important when interacting with families because many have worries, fears, and questions about their children’s futures and what they will look like. Additionally, a lot of supports fall away as children with disabilities transition to adulthood, so it is important to look forward and prepare for the future very early on. Interacting with families in poverty in particular (who likely experience resource limitations and lack of information) from a life course approach could have further benefits for children because it impresses on parents the importance of each visit and each component of the intervention, and how every facet is necessary to lead to benefits for their children in the long term.
Before interacting with families in poverty or with other vulnerabilities, early interventionists should know what cultural beliefs, coping styles, priorities, strengths, and limitations families face on a regular basis. Cultural beliefs shape families’ relationships, behaviors, parenting practices, trust of professionals, and how they feel they can influence their children’s development. Early interventionists should pay particular attention to potential limitations and additional stressors that a family experiences. Strength-based interactions provide flexibility that may be necessary to provide the support needed to meet family needs.
When interacting with children and families with particular vulnerabilities, such as being in poverty, early interventionists should be particularly careful to be culturally sensitive and appropriate, sensitive to limitations, flexible, responsive, and understanding. All communications (both verbal and written) should be in the family’s preferred language, and should be in terms that are easy for families to understand and not riddled with technical jargon. Early interventionists should also be sure to share as much information as necessary to help families make informed decisions. Professionals should be sure to answer any questions that families have in a responsive, sensitive, and thorough way.
Best practice early intervention include establishing a collaborative partnership with families based on their strengths. Early intervention should empower families by informing them in a culturally appropriate and sensitive way and by modeling for them practices in which they can engage with their child on their own to promote his or her positive development. For vulnerable families in particular, early interventionists should be sure to connect them with community resources that will promote positive development, including transportation, health services, and assistance programs such as welfare, TANF, and WIC. It is especially important that professionals emphasize and facilitate the availability of these services because many families in poverty are not informed about programs for which they are eligible that could improve quality of life for themselves and their children. Professionals should also identify social supports that parents have and help them seek additional ones through support groups, mental health services, and other programs, because these parents are more likely to feel isolated and have mental health issues that could hinder the well-being of themselves and their children (Zajicek-Farber, 2013). Connecting families with these resources augments moderating and protective factors for children with disabilities who are at high risk because of the interaction between poverty and disability.
Overall, early interventionists should be respectful of children and families with vulnerabilities (especially being in poverty, which is associated with myriad other risks) and their desires, priorities, goals, limitations, and ultimate decisions. They should be cognizant of how the way they approach, think about, and interact with vulnerable families influences the course of the early intervention and thus the outcomes of the child with disabilities. Thus, early interventionists should make concerted efforts provide services that are family-centered, focusing on the child, in context, and across his or her lifespan, and his or her family.
Emerson, E. (2007). Poverty and people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 13, 107-113.
Halfon, N., Houtrow, A., Larson, K., & Newacheck, P.W. (2012). The changing landscape of disability in childhood. The Future of Children, 22 (1), 13-42.
Long, T. (2013). Early Intervention. In M. L. Batshaw, N. J. Roizen, & G.R. Lotrecchiano, G.R. (Eds.), Children with disabilities. pp. 547-557. Baltimore: Paul H. Brooks Publishing Co.
Zajicek-Farber, M. (2013). Caring and Coping: Helping the Family of a Child with a Disability. In M. L. Batshaw, N. J. Roizen, & G.R. Lotrecchiano, G.R. (Eds.), Children with disabilities. pp. 757-672. Baltimore: Paul H. Brooks Publishing Co.
Shannon Reilly Georgetown University, College, Class of 2015