Intervention Practices in Kokebe Tsibah Special Unit for Children

Transkript

International Journal of Early Childhood Special Education (INT-JECSE)
Volume 1, Number 1, June 2009
EDITOR-IN-CHIEF:
Ibrahim H. Diken, Ph.D. ,Anadolu University, TURKEY, E-mail: [email protected], [email protected]
ASSOCIATE EDITORS:
Karen Carney, Ph.D., Eastern Michigan University, USA, E-mail: [email protected]
Atilla Cavkaytar, Ph. D., Anadolu University, TURKEY , E-mail: [email protected]
Tevhide Kargin, Ph.D., Ankara University, TURKEY, E-mail: [email protected]
EDITORIAL REVIEW BOARD:
Gonul Akcamete, Ph.D.
Ankara University, TURKEY
Stefanja Alisauskiene, Ph.D.
University of Siauliai, LITHUANIA
E. Sema Batu, Ph.D.
Anadolu University, TURKEY
Sue Buckley, Ph.D.
University of Portsmouth, UK
Sam DiGangi, Ph.D.
Arizona State University, USA
Necate Baykoc-Donmez, Ph.D.
Hacettepe University, TURKEY
Carl J. Dunst, Ph.D.
The Orelena Hawks Puckett Institute, USA
D. Alan Dyson, Ph.D.
University of Manchester, UK
Dilek Erbas, Ph.D.
Erciyes University, TURKEY
Suleyman Eripek, Ph.D.
Climent Gine, Ph.D.
Ramon Llull University, SPAIN
Annemieke Golly, Ph.D.
University of Oregon, USA
Pilar Guties, Ph.D.
Universidad Complutense, SPAIN
Michael J. Guralnick, Ph.D.
University of Washington, USA
Jim Halle, Ph.D.
University of Illinoisat Urbana-Champaign, USA
Angel Jannasch-Pennel, Ph.D.
Arizona State University, USA
Sema Kaner, Ph.D., (Professor Emeritus)
Gonul Kircaali-Iftar, Ph.D., (Professor Emeritus)
Anadolu University , TURKEY
Ahmet Konrot, Ph.D.
Eastern Mediterranean University,
TURKISH REPUBLIC OF NORTHERN CYPRUS
Joao Lopes, Ph.D.
University of Minho, PORTUGAL
Gerald Mahoney, Ph.D.
Case Western University, USA
Ilknur Mavis, Ph.D.
Samuel L. Odom, Ph.D.
University of North Carolina, USA
Michaelene M. Ostrosky, Ph.D.
University of Illinois at Urbana-Champaign, USA
Selda Ozdemir, Ph.D.
Gazi University, TURKEY
Manfred Pretis, Ph.D.
Social Innovative Network, (S.I.I.N.), AUSTRIA
Jean A. Rondal, Ph.D.
USA
Sarah Rule, Ph.D.
Utah State University, USA
Ugur Sak, Ph.D.
Armin Sohns, Ph.D.
Fachhochschule Nordhausen, University of Applied Sciences,
DEUTSCHLAND
Gilbert Stiefel, Ph.D.
Eastern Michigan University, USA
Bulbin Sucuoglu, Ph.D.
Elif Tekin-Iftar, Ph.D.
Seyhun Topbas, Ph.D.
Yildiz Uzuner, Ed.D.
International Journal of Early Childhood Special Education (INT-JECSE) (ISSN 1308-5581) is published twice
(June and December) a year at the www.int-jecse.net
For all issues rearding the INT-JECSE, please contact Assoc. Prof. Ibrahim H. Diken, Editor-In-Chief, INTJECSE, Anadolu University, Faculty of Education, Department of Special Education, Yunus Emre Campus,
26470, Eskisehir, TURKEY, Phone #:+90-222-3350580/3545, Fax # :+90-222-3350579,
E-mail : [email protected] ; [email protected]
CONTENTS
REGULAR ARTICLES
1-14
Early Contingency Learning and child and Teacher Concomitant Social-Emotional
Behavior
Melinda Raab, Carl J. Dunst, Linda L. Wilson, and Cindy Parkey
15-31
Intervention Practices in Kokebe Tsibah Special Unit for Children with
Intellectual Disabilities: An Ethiopian Experience
Fantahun Admas
32-45
An Exploratory Study of the Oral Language and Behavior Skills of Children with
Identified Language and Emotional Disabilities in Preschool
Claudia Rinaldi, Diana Rogers-Adkinson, and Alka Arora
LITERATURE REVIEW
46-78
Erken Çocuklukta Özel Eğitime İlişkin Türkiye’de Gerçekleştirilmiş Lisansüstü Tez
Çalışmalarının Gözden Geçirilmesi
A Review of Master and Doctoral Dissertations in the Field of Early Childhood
Special Education in Turkey
Seray Olcay Gul and Ibrahim H. Diken
INVITED ARTICLE
79-94
Relationship Focused Intervention (RFI): Enhancing the Role of Parents in Children’s
Developmental Intervention
Gerald Mahoney
BOOK REVIEW
95-101
Autism and Developmental Delays in Young Children
Ozcan Karaaslan and Ozlem Kaya
From the Editor,
With a great pleasure, I, as editor-in-chief, am glad to share with you the first issue of a new, online,
open-access, scholarly, peer-reviewed journal, International Journal of Early Childhood Special
Education (INT-JECSE). With its international editorial board members, the INT-JECSE offers
scholarly articles on various issues of young children with special needs (0-8 age) and their families.
The INT-JECSE publishes both English and Turkish works. A structured abstract in English is
required for Turkish-written manuscripts.
The first issue includes three regular articles, one literature review, one invited article, and one book
review. The first issue begins with Raab and her colleagues paper entitled “ Early Contingency
Learning and Child and Teacher Concomitant Social–Emotional Behavior:” In this paper, Raab and
her colleagues used contingency learning games to increase child operant responding, and both the
children’s and their teachers’ concomitant social–emotional behavior associated with operant
responding were mapped onto child learning. They have found that the learning games promoted child
learning. Moreover, operant responding was associated with child and teacher behaviors.
In the second article, Admas presents a qualitative study on the intervention practices of Kokebe
Tsibah special unit for children with intellectual disabilities in Ethopia whereas the third article
Rinaldi and her colleagues explores oral language and behavior skills of children with identified
language and emotional disabilities in preschool in the US. In this study preschool children with
identified language and emotional disabilities were compared to a typically developing group. While
no differences were found on language and behavior skills of preschoolers with language delays and
behavior disorders, preschoolers with language and behavior disorders were significantly different in
terms of language development and behavior ratings.
The only Turkish article with structured English abstract is the fourth article. Gul and Diken review in
this literature review article the master and doctoral dissertations in the field of early childhood
special education in Turkey. As invited author, Mahoney in the fifth article of this issue talks about
“Relationship Focused Intervention (RFI).” By encouraging parents to engage in highly responsive
interactions during daily routines with their children, the RFI focuses on promoting the development
of young children with developmental delays and disabilities, as Mahoney states. Karaaslan and Kaya
in the last article review a book entitled “Autism and Developmental Delays in Young Children”,
written by Gerald Mahoney & James D. MacDonald, published in 2007.
The INT-JECSE is published twice (June and December) a year at the www.int-jecse.net
By looking forward to receiving contributions of professionals of Early Childhood Special Education
around the world, I do appreciate very much those who contributed in the first issue and those who
will contribute.
Looking forward to meeting you again in December…
Ibrahim H. Diken, Ph.D., Anadolu University
Editor-in-chief, INT-JECSE
Contingency Learning, 1
Melinda Raab1
Carl J. Dunst2
Linda L. Wilson3
Cindy Parkey4
Early Contingency Learning
and Child and
Teacher Concomitant
Social–Emotional Behavior*
Abstract
The value-added benefits of young children’s response-contingent learning were
examined in a study of three children (2 females, 1 male) with multiple disabilities and
profound developmental delays. Contingency learning games were used to increase
child operant responding, and both the children’s and their teachers’ concomitant
social–emotional behavior associated with operant responding were mapped onto child
learning. Results showed that the learning games promoted child learning and that
collateral child and teacher behavior were predictably associated with operant
responding. The manner in which the findings extend the results from previous research
are described.
Key words: Response-contingent stimulation, learning games, operant behavior, socialemotional behavior.
Watson’s (1972) seminal paper demonstrating the early operant learning capabilities of
3- and 4-month-old infants, and his observations of the concomitant social-affective
behavior associated with operant responding, sparked interest in understanding the
nature of the concomitant behavior. More than 30 years of research has consistently
found that infants and young children with or without disabilities or delays manifest
social–emotional behavior in response to behavior producing reinforcing consequences,
where the clarity of the behavior/reinforcement relationship heightens the strength of
responding (Dunst, 2007; Fagen, 1993; Gergely & Watson, 1999). It is now generally
acknowledged that contingency detection (Tarabulsy, Tessier, & Kappas, 1996) and
awareness (Watson, 2001), and a child’s apparent recognition of his or her ability to
1
Associate Research Scientist, Orelena Hawks Puckett Institute, Asheville, NC, USA
Research Scientist, Orelena Hawks Puckett Institute, Asheville, NC, USA
Director, Even Start Program, Burke County Public Schools, Morganton, NC, USA
4
Assistant Branch Head, Infant/Toddler Program, North Carolina Department of Human Services, Raleigh, NC, USA
2
3
*
The research described in this paper was supported, in part, by funding from the U. S. Department of Education, Office of Special
Education Programs, Research to Practice Division (H024B0015). Appreciation is extended to the teachers who participated in the
study. Special thanks to Mark Wolery for his comments and feedback on an earlier version of the paper. Correspondence to:
Melinda Raab, Ph.D., Orelena Hawks Puckett Institute, 8 Elk Mountain Road, Asheville, NC, USA 28806 (email:
[email protected]).
International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1
affect environmental consequences (Fagen, 1993), are the source of a sense of a child’s
enjoyment or pleasure.
Researchers have also consistently found that young children’s caregivers manifest
positive affect in response to child displays of competence and most notably newly
acquired behavior (Stern, Hofer, Haft, & Dore, 1985). Goldberg (1977) and others (e.g.,
Granic, 2000; Mowder, 2005) noted as well that when the efforts of persons caring for
infants and young children have intended effects, the caregivers derive gratification in
seeing the consequences of their efforts. Dunst, Cushing, and Vance (1985), in a study
of the operant learning of young children with profound developmental delays and
multiple disabilities, noted that when parents “see their child for the first time manifest
behavior competencies…[they] often manifest a sense of pleasure and enjoyment in
[response to] their child’s newly learned behavior” (p. 44).
Findings from a number of recently completed studies indicate that both children and
their caregivers (parents and teachers) display a host of social–emotional behavior in
response to child operant learning (Dunst, Raab, Trivette, Parkey et al., 2007; Dunst,
Raab, Trivette, Wilson et al., 2007). The participants in these studies were young
children with profound developmental delays and multiple disabilities, none of whom
demonstrated intentional or instrumental behavior or contingency awareness or detection
(Tarabulsy et al., 1996; Watson, 1966) as determined by formal testing, behavior
observations, or parent or teacher report. The parents and teachers both implemented
learning games with the children that were characterized by behavior-based
contingencies where the delivery of reinforcement or the production of an interesting
consequence was dependent on the children’s behavior. Observations of the children and
caregivers were used to collect information about the children’s operant behavior and
both the children’s and caregivers’ social–emotional behavior. In nearly every analysis,
the larger the percentage of game trials that resulted in a reinforcer, the more the
children and caregivers displayed positive affect (smiling and laughter) and the more
they produced positive vocalizations (children) and verbalizations (caregivers).
The results from the Dunst, Raab, Trivette, Parkey et al. (2007) and Dunst, Raab,
Trivette, Wilson et al. (2007) studies, although instructive, could be confounded or
artifactual, because the research designs were correlational rather than experimental. The
research design employed in the study reported in this paper permitted more
experimental control, where the findings, if the same or similar to those reported in our
other studies, would likely not be confounded. This would be the case since the design
we used allowed causal inferences not generally warranted when using quasiexperimental designs (Horner, Halle, McGee, Odom, & Wolery, 2005).
The purpose of this study was to determine if child response-contingent learning was
associated with collateral changes in behavior not the focus of conditioning. More
specifically, we investigated contingency learning in three preschool children with
profound developmental delays and multiple disabilities and determined the manner in
which the social–emotional behavior of the children and their teachers providing the
children contingency learning opportunities was correlated with and mapped onto
operant learning. Demonstrating such an intervention effect would be an example of
value-added benefits to both the children and their caregivers.
Method
Participants
The participants were three children (“Amy,” “Brenda,” and “Cory”) with
developmental disabilities and their teachers. Amy was a 35 month-old female with
cerebral palsy who had a developmental age of 5 months and a developmental quotient
(DQ) of 16 as determined by the Griffiths (1954) developmental scales. Brenda was a 48
month-old female who had a developmental age of 4 months and a DQ of 9. She had
cerebral palsy and a visual impairment. Cory was a 52 month-old male who had a
developmental age of 3 months and a DQ of 6. He had cerebral palsy, a visual
impairment, and a seizure disorder.
The children’s teachers were three Caucasian females between 25 and 30 years of age.
Amy’s and Cory’s teachers had high school degrees, and Brenda’s teacher had a
bachelor’s degree in special education. Amy’s teacher was the lead teacher in an
inclusive preschool classroom at a community childcare program; Brenda’s teacher was
the special education teacher in a preschool classroom at a regional rehabilitation center;
and Cory’s teacher was the lead teacher in a classroom program at a residential center
for children with visual impairments. The teachers had between 3 and 8 years experience
working in the programs.
Design and Procedures
A multiple baseline design across participants (Barlow & Hersen, 1984; Horner et al.,
2005) was used to assess the effectiveness of the learning games for promoting the
acquisition of response-contingent child behavior and for mapping child and teacher
social–emotional behavior onto operant responding. The study phases included baseline,
intervention, and maintenance. The intervention phase was subsequently divided into
acquisition and mastery phases for purposes of mapping social–emotional behavior onto
operant learning. The acquisition phase involved a child first learning responsecontingent behavior, and the mastery phase involved a child’s repeated high-level use of
response-contingent behavior.
Baseline consisted of observations of the teachers implementing routine learning
activities with the children. Teachers were asked to implement 2 or 3 activities that they
were currently using to affect changes in child behavior or promote child learning. The
kinds of activities implemented by the three teachers included physically manipulating a
child to pick up and drop an object, rocking a child back and forth on a therapy ball, and
repeatedly tickling a child to elicit a behavioral response. A learning activity trial was
defined as a discrete effort on the part of a teacher to elicit or evoke a child behavior.
The intervention sessions were implemented over the course of 30 school days. An
intervention session typically included a teacher implementing one or two games with a
child. The mean numbers of games for the children per session were 1.60 (SD = 0.63),
1.75 (SD = .62), and 1.86 (SD = 0.38) for Amy, Brenda, and Cory, respectively. A game
could include up to 15 trials, but for various reasons, the number of trials varied game by
game and session by session. The reasons 15 trials were sometimes not completed
included, but were not limited to, the child not feeling well, the child or teacher being
distracted while playing the games, the teachers having to stop and attend to other
children, and the changes in the classroom schedule necessitating that a game be ended
(e.g., the start of snack or lunch time). The mean number of trials completed per game
was 12.89 (SD = 2.39), 11.33 (SD = 2.42), and 11.32 (SD = 2.05), respectively, for
Amy, Brenda, and Cory. The number of intervention sessions for the three children,
were respectively, 14, 12, and 7.
The maintenance phase included two follow-up observations of each child. Teachers
were asked to implement 2 or 3 games that they currently were using to promote child
learning.
Settings and Materials
The learning games used to promote the children’s acquisition of contingency behavior
were developed together by the teachers and investigators. The children were first
observed to identify behavior the children were capable of producing, the things (people
and materials) the children seemed to enjoy, and stimuli that maintained the children’s
attention. The behavior most often exhibited by the children was selected as behavior
targets, and learning games were developed that involved the use of the behavior to
produce reinforcing consequences. None of the child behavior were used intentionally to
affect environmental consequences as determined by investigator observations, teacher
reports, or formal testing (Griffiths, 1954). That is, the behaviors were manifested
randomly rather than intentionally and did not result in the production of a reinforcer.
The games used to affect child contingency behavior were implemented in a number of
different locations in the classrooms, including the circle time area, gross motor area,
and play table area. The children, depending on the game, were lying on the floor, sitting
in an adapted seat, sitting on the teacher’s lap, or held in the teacher’s arms while
playing the games. The particular position was in part determined by both the behavior
selected as an operant and the materials used as part of a game.
Learning games that included the targeted operant behavior either resulted in a nonsocial
reinforcing consequence (e.g., activating a mechanical switch to make a toy move or
light up) or were reinforced by the teachers (e.g., looking at the teacher followed by the
teacher talking to the child). Procedures described by Dunst (1981) and Lancioni (1980)
were used as guidelines to develop the learning games. The interventions were
implemented by the teachers at times set aside for the study. The number of different
games the children played during the course of the study was 5, 4, and 4, respectively,
for Amy, Brenda, and Cory.
The child behavior that were used as operants included batting or swiping at a mobile or
activity bar, visually fixating on an adult’s face, generalized body movements, and hand
presses or arm pulls to activate a switch device. The reinforcers included the movement
of a toy, the movement and sound of a wind chime or a toy attached to an activity bar,
illumination of a light, the teacher responding socially or verbally to a child (e.g., saying
“Go boom” and touching the child), recorded music or the voice of a familiar person,
and the movement of air from a small battery-operated fan. Each game was
characterized by behavior-based temporal contingencies where a child’s behavior
produced or was followed by a reinforcer (Tarabulsy et al., 1996).
Response Definitions and Measurement
Observations of both the children and teachers were made by the investigators during the
baseline, intervention, and maintenance sessions. During the observations, child learning
and both child and teacher social–emotional behavior were coded.
Activity and game trials. A baseline activity or intervention phase game trial was defined
as a teacher introduction of a stimulus intended to elicit or evoke child behavior. A trial
was operationalized as stimulus introduction followed by a teacher pause to discern a
child’s response to the stimulus. Pauses during the baseline were usually less than a few
seconds whereas those during the intervention phase were 3 to 5 seconds.
Child contingency behavior. A contingency behavior was defined as a behavior that
produced or elicited a reinforcement during an activity or a game trial and that was
unprompted or unaided by the teachers. The measure of child learning was the percent of
activity or game trials per session that were coded as an operant behavior.
Child and teacher concomitant behavior codes. The child concomitant behavior codes
included smiling or laughter and vocalizations. A behavior was coded as a smile or
laugh if there was a closed or open upward turning of the corners of the mouth with or
without an audible laughing sound or an audible laughing sound without smiling. A
behavior was coded as a positive vocalization if the child emitted an audible open vowel
sound (other than laughing). Each concomitant behavior was coded as occurring or not
occurring during an activity or game trial or immediately following the end of a trial.
Teacher behavior codes included social–emotional behavior (smiling or laughter) and
positive teacher comments (recognition of child competence or teacher gratification in
facilitating operant learning) displayed as part of or in response to child behavior. A
behavior was coded as a smile if there was closed or open upward turning of the corners
of the mouth and a behavior was coded as a laugh if there was an audible vocalization
indicative of joy or exuberance. A behavior was coded as competence recognition if a
teacher verbalized about a child’s operant responding (e.g., “Amy has figured out how to
do it.”). A behavior was coded as gratification if a teacher commented about her efforts
being successful (e.g., “I can’t believe I got Cory to do that.”). Concomitant teacher
verbal behavior did not include any behavior that was used as reinforcers but rather were
comments made about child display of competence to other adults. Each of the four
behaviors was coded as not occurring (0), occurring once (1), or occurring more than
once (2) during a learning game.
The measure of child concomitant behavior was the percentage of activity or game trials
that included displays of child social–emotional behavior. The measure of teacher
concomitant behavior was the sum of the ratings for the games played with the children
divided by the total of the possible ratings for the games played during a study phase
multiplied by 100. The two child concomitant behaviors (smiling/laughing, positive
vocalizations) and two teacher concomitant behaviors (smiling/laughter, verbal
recognition/gratification) were mapped onto child operant responding for each study
phase to assess the relationship between child contingency behavior and child and
teacher social–emotional behavior.
Inter-observer Agreement
Twenty-six percent of the games were observed by two raters for establishing interobserver agreement. Agreement was determined for child contingency behavior, the two
child concomitant behavior, and the two teacher concomitant behavior. Percent
agreement was calculated as the number of agreements divided by the number of
agreements plus disagreements multiplied by 100. The percent agreement for child
contingency behavior was 91 (Range = 84 to 96). The percent agreement for the child
concomitant behavior was 91 for smiling or laughter (Range = 89 to 94) and 91 for
vocalizations (Range = 89 to 94). The percent agreement for the teacher concomitant
behavior was 94 for smiling or laughter (Range = 87 to 100) and 98 for positive
comments (Range = 85 to 100).
Results
Child Learning
Figure 1 shows the results for the contingency game interventions. (The sessions that
had missing data were due to child illness, family vacations, teacher work days, and
school holidays or closings.) Small percentages of child behavior resulted in reinforcing
consequences during the baseline condition. The largest majority of the practices used
by the teachers during this phase of the study involved attempts to elicit child behavior
using non-contingent stimulation (e.g., shaking a rattle to elicit head turning).
The introduction of the contingency games had the intended effects for all three
children. Operant responding increased five-fold or more for each child. The
interventions for all three children were subsequently divided into an acquisition phase
during which the children learned response-contingent behavior, and a mastery phase
during which the children developed contingency awareness. At the end of the mastery
phase (last three intervention sessions), 83% to 96% of the game trials resulted in a
reinforcing consequence.
The percent of game trials during the maintenance phase that included child behavior
resulting in a reinforcing consequence were 86, 97, and 70, respectively, for Amy,
Brenda, and Cory. Both Amy and Brenda maintained their high levels of operant
responding, whereas Cory showed a slight decrease. For all three children however, the
levels of operant responding at follow-up were nonetheless considerably higher than
during the baseline condition.
Figure 1. Child production of response-contingent behavior during the different phases
of the study.
Child Concomitant Behavior
The manner in which child smiling, laughter, and vocalizations mapped onto child
response-contingent behavior is shown in Figure 2. The percentage of game trials
producing reinforcing consequences and associated with child concomitant behavior
mapped onto child learning in a manner consistent with expectations. For all three
children, the amount of social–emotional responding increased incrementally from the
baseline to the acquisition to the mastery/maintenance phases of the study.
Teacher Concomitant Behavior
Figure 3 shows the manner in which teacher smiling/laughter and positive verbalizations
mapped onto child operant learning. The amount of social–emotional behavior of each
teacher during the baseline was proportional to the percent of child response-contingent
behavior. Cory produced the least amount of operant behavior during the baseline, and
his teacher displayed the least amount of social–emotional behavior. In contrast, Brenda
produced the largest amount of operant behavior during the baseline, and her teacher
showed the largest amount of social–emotional behavior.
Figure 2. Child production of social–affective and vocal behavior during the different
phases of the study.
50
Child Vocalizations
40
30
20
Cory
Amy
10
Brenda
PERCENT OF TRIALS
Child Smiling/Laughter
0
Baseline
Acquisition
Mastery
Maintenance
LEARNING PHASE
For all three children, the amount of social–emotional teacher behavior nearly doubled
during the intervention and maintenance phases for both Amy and Brenda’s teachers,
and increased more than 8 fold for Cory’s teacher. The marked increase in the social–
emotional behavior of Cory’s teacher is noteworthy because it reflects the pleasure and
gratification derived from a child who essentially produced no operant behavior prior to
the intervention and who learned instrumental behavior indicative of increased
competence.
Figure 3. Teacher production of social–affective and verbal behavior during the
different phases of the study.
80
Teacher Verbalizations
40
Brenda
60
Amy
20
Cory
PERCENT OF TRIALS
Teacher Smiling/Laughter
0
Baseline
Acquisition
Mastery
Maintenance
LEARNING PHASE
Discussion
Results indicated that both child and teacher social–emotional behavior not the focus of
response-contingent learning mapped onto child learning in a manner consistent with
expectations. Findings support the hypothesis that response-contingent learning, and a
child’s recognition of his or her capabilities (contingency detection and awareness),
evoked a sense of child pleasure and enjoyment, and that a caregiver providing a child
learning opportunities that resulted in increased child competence derived gratification
from both the child’s and her own efforts. The collateral social–emotional behavior
associated with response-contingent child behavior is indicative of the value-added
benefits of the contingency learning opportunities for both the children and their
teachers (Dunst, Trivette, Raab, & Masiello, 2008).
Findings reported in this paper both replicate and extend those reported by others (see
Dunst, 2007, for a review). Most previous research of young children with disabilities
has focused almost entirely on child social–emotional concomitants of responsecontingent learning based on incidental observations of collateral behavior. The
exceptions are studies by Hanson and Hanline (1985), Haskett and Hollar (1978), and
O’Brien, Glenn, and Cunningham (1994) who measured increases in child smiling and
vocalizations during the conditioning phases of their studies. Results from this study
extend those findings by demonstrating that child social–emotional behavior is
correlated with differences during the acquisition and mastery phases of responsecontingent behavior.
Results also extend previous research by demonstrating that the benefits of responsecontingent child learning are manifested by children’s caregivers as well. Teachers in
this study both displayed enjoyment in seeing the children demonstrate competence and
derived gratification in their abilities to effect changes in child behavior. Findings differ
from previous research (Dunst, Raab, Trivette, Parkey et al., 2007; Dunst, Raab,
Trivette, Wilson et al., 2007) by demonstrating this value-added benefit experimentally
rather than nonexperimentally. The results are consistent with theory and research
regarding caregivers’ attributions about their role in promoting child learning and
development (Hassall & Rose, 2005).
The results from this study taken together are consistent with theories of behavior and
development that explicitly consider the consequences of behavior as a source of
information for determining efficacious acts (e.g., Horowitz, 1987; Mowder, 2005;
Skinner, 2005). The reinforcement provided the children in response to their behavior
increased and maintained high levels of contingency behavior where the child’s
recognition of his or her capabilities (vis-à-vis social–emotional behavior) presumably
mediated continued interactions with people and objects. Similarly, the teachers’
recognition of child competence as well as their recognition of their ability to affect
changes in child learning presumably functioned as reinforcers for the teachers
maintaining the provision of child learning opportunities. It is now generally recognized
that behavior is best understood in the context of transactional interactions between a
person and the social and nonsocial environments in which his or her learning takes
place (Sameroff & MacKenzie, 2003). This study illustrates a few of the characteristics
and consequences of these kinds of person/environment transactions.
The results have direct implications for practice. The interventions and results show that
rather simple and easily implemented contingency learning games can have rather
dramatic effects on child learning, which included extended benefits to both the child
and his or her caregivers. Interestingly, many of the interventions used with young
children with profound developmental delays and multiple disabilities do not include the
promotion of child behavior competence (Dunst, Raab, Wilson, & Parkey, 2007;
Winefield, 1983). Rather, the interventions typically involve noncontingent stimulation
to evoke child behavior or passive manipulation of child movements. The consequences
are often behavior suppression rather than enhancement. This can be illustrated by
further examination of the data from the study reported in this paper.
Secondary analyses of the intervention and baseline phases of the study found that it
would require between 105 and 150 game trials to evoke 100 contingency behaviors
during the intervention phase but would require between 600 and 3,000 trials of
noncontingent stimulation to evoke 100 contingency behaviors during the baseline
(Dunst, Raab, Wilson et al., 2007). This suggests that response-contingent learning
opportunities, and especially for children who demonstrate few instrumental behavior, is
warranted as a form of early childhood intervention. The reader is referred to Dunst et al.
(2008), Hodapp and Goldfield (1983), Lancioni (1980), and Watson, Hayes, and Vietze
(1982), for examples of methods and procedures for using active child learning games as
a means to promote child competence and affect changes in child and caregiver socialemotional behavior.
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An Ethiopian Experience, 15
Fantahun Admas*
Intervention Practices in
Kokebe Tsibah Special Unit
for Children with
Intellectual Disabilities:
An Ethiopian Experience
Abstract
This paper focuses on the intervention practices of Kokebe Tsibah special unit for children with
intellectual disabilities. The data were collected through interview of three teachers who served for
20 years in the unit, observation of teachers and children, and analysis of documents. Qualitative
data analysis was employed to analyze the data. The results indicated that children with intellectual
disabilities received interventions in the form of educational, adaptive skills and vocational
intervention. Teachers practice intervention in the unit by providing educational intervention,
adaptive skills training and vocational training for children with intellectual disabilities.
Considerable results are recorded through the application of these intervention practices.
Stakeholders should fully involve in the intervention of children with intellectual disabilities.
Key words: Intellectual disabilities; intervention; educational intervention; adaptive skills;
vocational skills.
Learning is a means to achieve desired goals in life and a key to understand how the
ever-changing world looks like. It has been defined in a manner that learning is a
relatively permanent change in behavior or knowledge as a result of experience and
practice. Or it is a change in person‟s mental structures (schemas, beliefs, goals,
expectations and other components) that creates the capacity to demonstrate deferent
behaviors (Eggen & Kauchak, 2004) from the behaviorists and cognitive theorists‟
views.
Children with intellectual disabilities need to learn different behaviors and academic
skills that would help them to live independently. However, teaching children with
intellectual disabilities needs effort, time, resources, trained manpower and other things
that are prominent to bring about changes in the lives of these children. Sometimes, the
process of teaching these children demand more than expected and teachers feel that the
teaching of children with mental retardation is a tiresome work with little promising
*
Lecturer and Doctoral student, Addis Ababa University, Department of Special Needs Education, P.O. Box 150391
Addis Ababa , Ethiopia, Email: [email protected]
result. The limited/slow changes in students with intellectual disabilities are sources of
negative experiences in teachers (Fantahun, 2006). However, teachers of students with
intellectual disabilities in Kokebe Tsibah special unit have great hope in making their
students self-sufficient and helping them to lead independent lives in every way
possible. In this regard, they have been reporting that promising outcomes of the
teaching process are recorded. The considerable numbers of students with intellectual
disabilities in the unit are reportedly integrated in the regular class after few years
stay/learning in the unit. The researcher was surprised with the changes brought in
children with intellectual disabilities in the unit. Specially, the educational intervention
provided by the staff was attracting the attention of the researcher.
Two years before while the researcher was graduate (Masters) student and conducting
research for master‟s thesis, same participants had informed him about the
improvements that have been seen in the everyday activities of the children with
intellectual disabilities in the unit. Taking this opportunity as an advantage to know what
is going on in the special unit as the practices of intervention, the researcher tried to
investigate the practices of intervention and the outcomes recorded in the unit. Children
with intellectual disabilities in the unit benefit from the teaching learning process and
some of the students bring about changes that are unexpected even by their parents. For
instance, some of the students used to come to the unit on the back of their parents but
now they can even run as evidenced on the playground of the unit. These changes are
results of organized efforts mainly from teachers as they are concerned with choosing
instructional methods that facilitate effective and efficient learning and teaching
strategies (Beirne-Smith, Patton, & Ittenbach, 1994).
The teachers‟ efforts should also be supported by materials and technological
advancements to facilitate the teaching learning process in the unit. Materials can run
from text and other print materials to teaching machines, computers, and programmed
learning materials (Beirne-Smith et al., 1994). Besides the teachers‟ efforts and
materials, the appropriate supports over a sustained period generally improve the life
functioning of the person with mental retardation (AAMR, 1992).
Children with intellectual disabilities are different in interest, limitation, and intellectual
functioning. Thus, these children can benefit from individual and small group activities
which in turn help them in the acquisition of target behaviors and knowledge. Therefore,
educational programming for school age children with mental retardation involves a
number of interrelated and mutually influencing components. Educational programs
must be designed, implemented and evaluated systematically to have an effect on the
development of each learner (Beirne-Smith et al., 1994).
Efforts have been made by teachers and other stakeholders to help children with mental
retardation to function successfully in school, home and community settings. In the
process of helping these children, the focus areas of intervention including self-care,
mobility, communication, social interaction, academics, health and safety, leisure and
vocational pursuits. Therefore, specially teachers must target useful learning objectives
in each of these areas (Beirne-Smith et al., 1994).).
In Ethiopia, some children with intellectual disabilities are learning in different
integrated classes, special schools, special classes and units. The objectives in the
education of children with intellectual disabilities are productivity, independence and
participation. The major goals of education is not to compensate intellectual disabilities
per se; rather instruction is directed toward the development of critical skills necessary
for adulthood- for success in daily life, citizenship and a future career (Winzer, 1990).
The Kokebe Tsibah special unit is one of the units which has been trying to help
children with intellectual disabilities to make them independent and self sufficient
through a variety of intervention techniques. Therefore, this study attempts to show the
intervention practices implemented in Kokebe Tsibah Special unit for children with
intellectual disabilities.
The purpose of this study is, in general, to investigate the intervention experiences
practiced at Kokebe Tsibah special unit for children with intellectual disabilities. This
research is believed to teach some lesson about intervention practices in Ethiopia and it
would help to understand what is going on in the Kokebe Tsibah special unit in terms of
intervention. In light of this, the following specific questions are formulated to frame the
study:
1. What intervention practices are practiced in the Kokebe Tsibah special unit?
2. What educational and vocational intervention is given for the children with
intellectual disabilities?
3. How do teachers implement interventions for children with intellectual
disabilities?
Method
Participants
The Kokebe Tsibah primary school, under Yeka subcity education bureau in Addis
Ababa education bureau, has a special unit which admits and teaches children with
intellectual disabilities since 1987.The unit has currently three teachers and 60 students
with intellectual disabilities in the special unit and 25 in the integrated class.
Participants of the study were teachers of students with intellectual disabilities in
Kokebe Tsibah special unit. They have 20 years of teaching experience in the unit. All
of the teachers (two females and one male) participated in the interview.
Data Collection
Interview. Semi-structured interview was prepared and used to collect data pertinent to
the study. Face to face interview was conducted with the three teachers for 1:30 hour
each. The themes of the interview were admission, assessment, intervention practices,
strategies and dimensions of intervention. Interviewees were guided whenever they left
the main theme and probes were made to enrich the data until the data repeat
themselves. The interviews were conducted by the researcher himself. The interviews
were tape recorded and transcribed verbatim. The interviews were held in the
participants‟ offices and classrooms
Observation. Students and teachers were observed while learning and teaching in the
class, working in the garden and playing in the playground. Students with intellectual
disabilities were also observed in different settings (e.g., TV room, vocational room) and
field notes were taken. The workshops, garden, and classrooms were observed. The
teachers were also observed while assisting students in the physical education period in
the playground.
Document analysis. Available documents like students‟ report card, unit‟s yearly plan
and objectives, unpublished magazine for the annual parents‟ day, assessment tools,
weekly timetable and other relevant documents were analyzed.
Data Analysis
The data were transcribed verbatim. The transcribed data were read thoroughly and
themes and categories were created. After the review of the data, logical analysis and
interpretation was made from the thematic categorization of the data. The data analysis
was also done according to the questions raised and the discussion was given according
to the categorized and thematized data. The data from observations and document
analysis were also used to strengthen the data from interview and the trustworthiness of
the data was also crosschecked.
Results
The results are presented in the logical flow with qualitative data presentation and the
interviewees‟ sayings are anonymously put directly when appropriate and needed. The
findings are presented based on the data through interview, observation and document
analysis. Thus, the narration of the fact in each entry is due the data from at least one of
the above mentioned instruments of data collection.
Identification and Assessment
Prior to service provision or intervention, identification and assessment should take
place and the information from the identification and assessment would help the service
provider or interventionist to provide appropriate service. Students with intellectual
disabilities at Kokebe Tsibah special unit are admitted with the diagnosis from different
medical centers, the assessment made by the unit itself and based on the information
from parents. In this respect, one of the participant teachers said that “most of the time
hospitals refer or send children with intellectual disabilities to our unit. The unit also conducts
identification and assessment to crosscheck the results from medical centers”. However, the
assessment made by these parties is not that much comprehensive, to address the needs,
identify the abilities and design intervention procedures. The assessment result would
not also tell about the child‟s disability level that is mild, moderate, and severe or
profound in terms of severity, or intermittent, limited, extensive or pervasive in terms of
intensities of support service.
The other participant further elaborated the case that students are admitted in grade C
first for short or long time and they learn skills like how to eat, use toilet, dress, tying
shoelace, sitting on chair etc. By the time completing these activities, students could be
promoted to class B or A [Based on progress students can be promoted from Grade C to
B, from B to A and from A to inclusive classroom].
In relation to the admission procedure, one of the participants said:
We accept new comers and place in grade C then we evaluate and
promote to B or A as per their performance in their stay. The evaluation
mechanism is based on their performance in awareness and academics.
On average, one child could stay for about five years in grade C.
The document analysis also revealed that information from the family, health centers/
hospitals and the unit is helpful to place students with intellectual disabilities and taken
into consideration for different decisions. The family provides information about the
adaptive behaviors of the child that could partly help to determine the kind of services
given to the child with intellectual disability. The health centers/hospitals also report
about the disability though it is often times similar and short to further analysis. But still
it is important to determine whether the child has intellectual disability or not. The
assessment made by the unit focuses on the education of the child and it is helpful to
identify the child‟s interest in educational and vocational trainings.
The need for [Objective of] Intervention
The Kokebe Tsibah special unit was established in 1987. This unit was established to
teach and help children with intellectual disabilities and to disseminate information and
create or raise awareness in the society to prevent the possible occurrence of the
disability. In this regard, the unit has been working for the last 20 years and scored
considerable results in improving the lives of many children with intellectual disabilities.
Through these efforts, many former students are helping themselves or at least function
successfully at home with their parents in the areas of adaptive skills. Thus, the unit has
its own purpose in helping and teaching children with intellectual disabilities to make
them self sufficient or independent. One of the teachers in the unit expressed the point as
follows:
Though children with intellectual disabilities cannot join universities, we
need them to learn and lead themselves, work to their level best, direct
themselves and live independent life. We teach them to make free from
others’ help and let them work and experience independence. We need them
be self-sufficient and have their own source of income whatever it is. If there
is an opportunity, they can be employed in different private and public
companies, institutions etc.
In the same fashion, another teacher of the unit disclosed that they have been teaching
children with intellectual disabilities and some of them are becoming independent.
The documents analysis also indicated that the Kokebe Tsibah Special Unit has general
and specific objectives to be met in the process of teaching children with intellectual
disabilities. The unit has the following general objectives. These are: Helping children
with intellectual disabilities to come to school, improving situations to make children
with intellectual disabilities self-sufficient and have independent lives in the community,
and helping children with intellectual disabilities to develop confidence through
academic and vocational education. These general objectives entail the following
specific objectives: Helping children with intellectual disabilities (CIDs) to lead
independent life, preparing CIDs for inclusive education, creating and raising awareness
in the community to increase the functioning of CIDs in it, providing vocational training
in collaboration with GOs and NGOs, conducting research and using mass media to
change unfavorable attitude of the society, facilitating medical and rehabilitation
services for CIDs, fostering inclusive education for CIDs, and providing teaching and
other materials for CIDs These general and specific objectives are guiding principles in
providing quality services and intervention practices for students with intellectual
disabilities in the unit. However, shortage of materials and manpower impede the
endeavor of the teachers in the unit.
Dimensions of Intervention Practices
Children with intellectual disabilities have been given academic and vocational trainings
(intervention) to improve their living situations. The intervention practices at Kokebe
Tsibah special unit are given in different ways. The major focus areas are academics,
adaptive and vocational skills. However, the intervention practices are practiced in
planned or unplanned manner. There is weekly program of teaching children with
intellectual disabilities and the subjects and vocational trainings given are language,
math, social skills, sport, practical academics, personal hygiene, and vocational
trainings. The adaptive skills are addressed in one way or another in the process of
vocational and educational interventions.
The weekly timetable in the unit showed that there was uneven distribution of subject
matters and vocational skills taught per week and students were let to practice what they
need. Besides, one period lasts for only 30 minutes.
More specifically, the Kokebe Tsibah special unit has been providing these services by
dividing into three. These are:
1. Academics: the academic content is offered based on the individual child
response. It may not respect the academic calendar and may take two or three
years to cover the content
2. Adaptive skills: the ten adaptive skills are the focus areas.
3. Vocational skills: children with intellectual disabilities will not be successful in
higher level academics and much emphasis is given to the vocational training. In
this regard, they are given different skill trainings which then prepare them for
vocational training. In the unit, however, the vocational training does not replace
the academic learning since they support each other
These three dimensions of intervention help children with intellectual disabilities to
bring about considerable improvements in several aspects after joining the unit. The
teacher from the unit explained the process of service provision in the three areas as
follows:
The process starts from the assessment of the child‟s limitation. The assessment will
help to determine whether the child can be successful in the vocational or academic
areas. Then different kinds of interventions would be provided to the child. For
example, if the child is capable of learning academics, the child will be sent to the
regular class. If not, that child will be given different vocational trainings here in the
unit.
Educational [academic] Intervention
The educational intervention of children with intellectual disabilities comprises different
subject matters. Through these subjects, students learn and improve intellectual
functioning and adaptive skills. Children with intellectual disabilities learn language,
environmental sciences and math in the unit.
Language plays a great role in facilitating and easing other support services or
intervention provisions. Children with intellectual disabilities in the unit learn language
and benefit from it. Language teaching needs assessment of the child‟s problems,
strengths and identification of needs. If the child cannot speak, the intervention could be
given accordingly. It starts from letter identification and goes complex skills in the
logical order. One of the interviewees explained the way of teaching language and the
help of language for intervention as follows:
Language is a tool for communication. It is a key for everything. If you can
communicate with a child, you can intervene or teach. Unless a child can speak, it
would be difficult to teach. When he/she starts speaking we teach letters, words,
sentences and then help him/her to explain his/her idea. For example, we tell them
story and they will tell it back to the class turn by turn. Through this story telling,
the child can develop language, communicative skill, confidence etc. Though they
have no speech problem, they cannot speak because they have no access to speak or
to talk with their family, peers or neighbors. No one is willing to talk with them at
home, they have no right to claim and they develop shame and guilty feelings. To
avoid this and teach language, we use different techniques. Most families deny this
chance as they assume these children are weak in language and cognition. They let
them to sit at the corner of the house and do not want to communicate with them.
The language intervention can be given by making the child to off the candle, chew
sugarcane and chew gum. The family of the child also involves in the intervention of
language by providing him/her sugarcane, gum and talk with. This improves child‟s
language ability. In addition, children deliver speech for their classmates in the class.
Besides language, math plays an important role in the teaching –learning programs of
children with intellectual disabilities. Learning numbers helps children with intellectual
disabilities to acquire knowledge and improve the abilities in the area of adaptive skills.
They learn numbers using sand, perforated eucalyptus tree seeds, blocks, boxes and
other materials. Students then count these stuff and learn counting numbers. The teacher
of children with intellectual disabilities explained the application of math in different
areas as follows:
Learning numbers is decisive. We teach them numbers to use buses, to shop, to
differentiate cents, to know changes. The main reason is to make them capable of
using numbers in their life like use of money. Those who are expected to join
regular class learn addition and subtraction in one and two digits.
Physical education is another subject given as educational intervention in the unit.
Through this subject, teachers mainly treat the physical limitations of children with
intellectual disabilities. Besides the physical limitations, the communication and social
skills are also addressed. Incredible results were recorded by applying physical
education in the unit in the area of physical strength and movement. Those who cannot
sit, walk, move or in general, those who came to the unit on the back of their parents
benefit from physical education.
Many of the students were not strong/physically fit while coming to this school. So
teachers assess the problems and design physical exercises. If students do the activity for
ten minutes today, tomorrow it may take15, and then 20 minutes. Physical exercise is
considered as best intervention mechanism in this unit.
On her words, one of the participants said the following:
Physical education is the major subject in the unit. I have been teaching the
subject. These children have a number of problems. They might not walk,
play, sit etc. then we identify the affected area to intervene. We will massage
the body, the hand and the leg while the child is lying on the mat. Checking
the joints and if they work properly, the child will do simple physical
activities. The intensity and duration of the exercise will increase through
time. Physical activity helps students with intellectual disabilities to walk
easily, to play, to move place to place…if the problem is severe they are given
tasks like moving the stairs carrying dumbbell or working in the garden.
Considerable improvements can be seen in children after some time when
doing these activities. Then the child will do physical exercise according to
the program like soccer, skipping rope, volleyball.
Adaptive skills training
Adaptive skills area is another limitation in children with intellectual disabilities which
need due attention and the unit has planned the intervention techniques in this area. The
focus areas are communication, self-care, social skills, home living, community use,
self-direction, health and safety, functional academics, leisure and work. It is indicated
in the annual plan to teach students these adaptive skills. However, all students do not
have the same problem and/or all these adaptive skill limitations. The efforts are made
according to every individual student‟s need and limitation.
The unit has annual plan to teach the 10 adaptive skill areas for these children. These
adaptive skill areas are taught in relation to the students‟ daily living activities.
Communication skills are taught while teaching language as an academic subject in the
unit. Teaching safety education/ Self-care is given great emphasis in the unit. In this
lesson, teachers teach the students how to cross road, how to pass holes, how to protect
oneself from dog bite, etc. Students learn about road/traffic signs and techniques of
protecting oneself while crossing the road. For example, the student should pass/cross
the road after checking whether there is incoming or outgoing car or not.
In the unit, teachers teach dressing by using samples of zipping, tying, buttoning and
students practice these activities practically. There are towels, shoes, dishes, cups and
other materials to teach self help and care skills practically. For instance, children are
given shoe and shoelace separately then they try to tie it. Teachers use cups to teach
them how to drink tea, coffee, and water and let them identify materials. One of the
participants explained this process in the following manner, “Students learn toileting,
combing, brushing. For example each student had Colgate for brushing teeth. We teach them
how to wash their cloth, body etc. there is towel, ointment and soap for this purpose ”. In the
same fashion, another participant said, “Students eat breakfast here. The objective is to teach
self-care that is, how to eat, how to prepare food, how to wash dishes, how to use cups, how to
handle spoon and fork”.
Social skills are taught when students with intellectual disabilities are mixed with
regular students for some lessons. They perform drama together, play football together
and learn different social skills. It is also taught in the class through coffee ceremony
and they learn how to invite the neighbor for coffee, for example. Some regular
schoolteachers visit students with intellectual disabilities and introduce themselves,
provide rewards like candy, balloon which in turn enhance the social functioning of
these students.
One of the teachers who participated in the study expressed the social skill
training process in this way:
We have weekly football competition and child –to-child programs with
regular students to improve the social skills of these students. In the child-tochild program, they discuss about reproductive health, HIV/AIDS and related
issues which have dual purpose in improving social skills and creating
awareness.
Home living skills are also taught in the unit. In this regard, teachers teach students how
to clean home/classroom, tables and chairs after breakfast practically. Students clean or
wash their classroom every Friday. They also learn how to prepare wot1, chop onion, bed
making and sweeping in the class. At home before eating lunch, students are informed to
change their uniform, wear pyjama, sandals, and take rest. They are taught home living
skills practically and theoretically in the class. Bed, blanket, shoes and other materials
are found in the class to teach them home living skills practically.
Teachers at Kokebe Tsibah special unit also teach Community use to help students to
live in the community or properly function in the community. Students learn where and
when to use clinics, police stations and other public services. For example, there are
students coming from Shiro meda, Kotebe and these students should learn number to
identify and use buses to travel from home to school and from school to home. One
student was raped last year and she directly went to police station. In general, in this area
teachers teach their students about the appropriate use of community resources.
Self-direction is challenging for most of the students. Some students are coming here
with the help of others or supported by employed people for this purpose. Through time
teachers teach self-direction and students can come alone to school. In relation to selfdirection, students learn time management, money management, planning etc at their
level.
Like other adaptive skills areas, students with intellectual disabilities at Kokebe Tsibah
special unit learn about health and safety. They discuss about HIIV/AIDS, reproductive
health and how to protect themselves from being raped (specially females), HIIV/AIDS
and how to cross the roads, bridges, holes etc.
Functional academics is related to learning at school. Teachers teach the basic skills
used for academic functioning that are useful for independent living. These skill areas
include learning like reading, writing, and math skills. They learn numbers, letters,
language etc. Students with intellectual disabilities in the unit also learn basic academic
skills which prepare them for integrated class.
Students with intellectual disabilities in the unit develop leisure interests through
different recreation related practices in school. Thereby, they develop skills how to pass
leisure time and enjoy it. Recreation centers should have they gone, but the unit has no
budget. However, they celebrate International Disability Day and Parents‟ Day for the
purpose. Every Thursday, they have football match with regular students that gives them
greatest satisfaction and feel confidence
Gardening and vocational trainings in the unit help students to experience work and
assume responsibilities. In the unit, students with intellectual disabilities work on the
school garden and have cabbage, carrot and flower totally controlled by these students.
The carpet making, basket making, and embroidery works are worth mentioning in
improving the abilities of these students to hold work.
Vocational intervention
It is well known that children with intellectual disabilities show limitations in the area of
intellectual functioning, social competence and practical skills. Teachers in the unit
believe that they [children] will not be successful in academics and will not assume
responsibilities or join universities. However, they can lead independent life and
vocational training is of paramount importance in this respect. The Kokebe Tsibah
special unit has its own plan to train students. Vocational training is answering the
questions of making children with intellectual disabilities self-sufficient and
independent.
Prevocational training is given to make students ready to practice the actual vocational
training and vocation. The prevocational training involves many random activities which
help students to coordinate different body parts to be ready for the actual vocation.
Vocational training starts from drawing random lines. Students with intellectual
disabilities learn drawing from the black board. They then draw pictures, shade colors
and explain their ideas, feelings and emotions. The vocational intervention is organized
in the unit in the categories of gardening, drawing and handcraft.
Gardening: Students with intellectual disabilities learn what farming mean, its use, its
beauty, and satisfaction. Teachers and some students together dig and the others form
the plot and plant seedlings themselves. These benefit them in two ways that to fit
physically and learn farming/gardening. At the time of cultivation, they can identify the
flowers from the weeds, for example. Students have planted cabbage, carrot and flowers
in the school garden.
Drawing: Drawing helps to teach the eye hand coordination, to relax the fingers and
hand. Students are given the paper and pencil and they do whatever they want. They
draw random lines, shade a given area with color and draw pictures. They do the task
differently, some do nicely and others not. Those who perform correctly are given
another advanced task (grain print, leaf print, vegetable print etc).
Handcraft: Students with intellectual disabilities learn many vocations. They produce a
variety of products like carpet, basket, sweater, chairs, tables and generate income for
the unit. Few students generate income for themselves from what they have learned in
the school and lead independent life. Teachers teach them embroidery, sweater work,
carpeting, printing, spinning, etc. For example, one student learned bag and basket
making in the unit and now she is leading her life and earning money from this vocation.
She has „Equb‟ at three places.
Efforts needed in the intervention process
To improve the intellectual functioning and adaptive skills of children with intellectual
disabilities, great endeavor is needed. High repetition of the content and perseverance
will help teachers to bring about improvements. For example, learning to tie shoe needs
much time and efforts both from the student with intellectual disabilities and the teacher.
Thus, it is difficult for the student to learn the task once rather with repetition for weeks
or months. Practical or concrete tasks are relatively easy to learn than theoretical and
abstract things. Even the practical work might need much time. For example, to learn a
given handcraft, the child might need a year, two or more. It is not as easy as others do.
The same happens in the area of academics. As reported by teachers, there is one student
in the unit for the last twenty years but he could not identify Amharic letter “ha” or “be”.
However the student knew his environment and does different activities. He has no hope
in the area of academics but things are promising in vocational trainings. Now he can
come to school himself, does well in carpet making. His interest is music. He plays
music, dancing and beating drum. This guy will be effective if there are musical
instruments but the constraints do not let teachers to listen the interest of this student.
Teachers in the Kokebe Tsibah special unit have been teaching in the same unit for the
last 20 years in order to change the lives of these children. They are playing a key role in
the intervention process to help these children in every way possible. One of the
participants explained the process of intervention as follows:
We are selfless; our mission is to help students with intellectual disabilities. We
have been doing what we can do to see these children independent, selfsufficient. The government should take part in this stake. Training these children
vocations in a given center would help them than learning academics. They can
be hired in different factories like soap, coca-cola, bulb. If the government does
something in employing these children they can help themselves. They can work
gardening in the governmental organizations, for example. However, the society
has negative attitude towards these children and assume that they are patients
or insane.
Stakeholders’ contribution in the intervention practices
Role of parents
The involvement of parents in their children‟s education is of paramount importance and
inseparable. However, some parents are not willing to take part in the intervention
process. Many of the parents want to see the improvement of their children without their
involvement or contribution. Teachers teach parents to train their children at least
washing their dining tray or assist in every way possible. Some parents are willing to
play their role and teach their children at home. It depends to the family‟s education,
socioeconomic status, and awareness. Some parents even refuse to come to school when
needed but others hire tutors for their children. Some assume the school as the place to
send their children to get relief. Others follow up their children‟s improvement and
communicate with teachers regularly. To the other end, some do not want to come even
once on the parents‟ day.
Administrative supports
The ministry of education and the Addis Ababa education bureau have not played as
such important role, in general. The Yeka sub city education bureau has special needs
education expert. But the expert went to the unit once and didn‟t show up since then. He
did not give professional support to the teachers. The subcity and Addis Ababa
education bureau did not ask as what has been done and did not help the unit inasmuch
as possible. The higher offices support is not encouraging. On the other hand, the school
administration has endeavored to the extent it can. Now the unit is facing serious
manpower shortage and lack of classrooms. The existing staff members are planning to
leave in the coming few years. In grade C, for example, the classroom is too narrow and
it also serves as workshop room. As a whole, the administration support counts little and
the unit is endangered.
Evaluation of intervention Practices
The intervention provisions are evaluated against the children‟s score in each area. There
is a checklist to evaluate the improvements monthly. This helps to further design the
appropriate intervention services accordingly. After the evaluation, teachers can provide
the intervention at the individual basis according to the result they have from the
checklist. The academic and behavioral assessments are done to evaluate the
improvements. The parents also participate in the evaluation process. As per the
continuous assessment, students are given the report card at the end of the academic
year.
Improvements
Previously, there was unfavorable attitude towards children with intellectual disabilities
that they were considered as useless and incapable. After long walk, these children are
considered as citizens and have the right to education and to lead independent life. As a
result, teachers in the unit are teaching theses students to make self-sufficient to the level
of their capacity. They can work and live independently if appropriate intervention is
given.
Teachers in the unit brought about many changes through applying different techniques
in the intellectual and adaptive skills in many of their students with intellectual
disabilities. For example, while coming from home, some children could not walk, eat
and drinking properly. They give trainings and these children brought about changes that
are pleasing and promising. Therefore, teachers evaluate changes and improvements
when the student eats properly, moves here and there with his/her friends, understands
the environment, live within the society etc. These are indicators of improvements due to
the intervention they apply. The evaluation is made against the data recorded previously.
Specifically, the followings are some of the outcomes recorded from the intervention
practices in the unit: Students with intellectual disabilities who used to come to school
with the help of their parents now can come alone, many students are promoted from
special class to inclusive class, many students are trained in vocational education and are
producing different products which subsidize and increase the unit‟s income, many of
the students with intellectual disabilities can shop independently and receive the
changes, students show improved communication skills and communicate with others,
and students show improvements in the areas of self-care, safety, and support their
teachers in different activities.
Discussion
This study attempts to disclose the intervention practices in Kokebe Tsibah special unit.
As a result the reader can understand what is going on in the unit. In the study, the
admission procedure, the dimensions of the intervention practices, the practicing efforts,
stakeholders‟ role and the practice evaluation are addressed.
Identification and assessment is an important procedure to identify students, determine
eligibility and design the intervention mechanism. Comprehensive and accurate
assessment is critical to the delivery of appropriate educational services to students with
mental retardation (Beirne-Smith, et al., 2006). In line with the above explanation, the
students with intellectual disabilities in the Kokebe Tsibah special unit are identified and
the service is given based on the assessment results from different parties, the unit,
parents and medical centers. However, it is difficult to say that the identification and
assessment in Kokebe Tsibah special unit is appropriate and accurate.
The dimensions of the intervention practices in the unit cover the intellectual
functioning, the adaptive skills and the vocational trainings. The intellectual functioning
is addressed through teaching academics or practical academics in the unit. The
educational intervention comprises language, math, and physical education. This
intervention mechanism is purposefully applied to improve the intellectual functioning.
However, academics is challenging for children with intellectual disabilities. In
agreement with this, after reviewing research findings, Eggen and Kauchak indicated
that these students often fail to acquire basic learning strategies – such as maintaining
attention, organizing new material, and studying for tests that typically developing
students pick up naturally (Choate, 1997; Heward, 2003; cited in Eggen & Kauchak,
2004). Students in grade A learn more of academics to join inclusive classes in the unit
because educational programs stress the most critical functional skills. Winzer
strengthens that educational intervention is directed toward training pupils with mild
mental retardation eventually to live and work independently in the general community
(Winzer, 1990).
The adaptive skills are also areas in which children with intellectual disabilities show
limitation. The Kokebe Tsibah special unit has planned to address these areas and
promising results are recorded. The Ten adaptive skill areas are addressed in one way or
another. Wizer (1990) said that maximum development of intellectual, personal, social,
emotional and motor skills are necessary for vocational competence and independent
living. The unit has been giving emphasis to the physical education, communication and
vocational trainings. In agreement with this, Winzer (1990) advised to give stress on
self-care, mobility training, communication, social interaction, academics, health and
safety, leisure time and vocational pursuits.
Teachers must be concerned
with targeting useful learning objectives. Students require instruction in basic academic
skills, personal and social competence, and occupational skills. Studies on the learning
characteristics of children with mild mental retardation show that even if their rate of
learning is slower and level reached not as high, their learning curves approximate those
of non-handicapped pupils (Winzer, 1990).
Majority of the students are learning vocational skills which in turn help them to lead
independent life. The vocational skills are helpful to these students and considerable
number of students is even relying on their skill to generate income. The vocational
skills taught in the unit are supported by prevocational skills like gardening, handcrafts
and drawing. These prevocational skill trainings are used as laboratory and ease the
training of vocational skills for students with intellectual disabilities. After the training
of prevocational skills, students learn vocational skills and produce different products
like chair and table from carton, carpet from wool, sweater from tread and generate
income for the unit.
Teachers in the unit play a considerable role for the last twenty years. They reported that
they are self less to help the students with intellectual disability in the unit. In agreement
with result, many teachers of children with special needs plan to stay in the profession
only to help children with special needs (Fantahun, 2006). The administrative bodies in
higher offices of education are not answering the timely questions about “Education for
All” and many children with special needs are left behind.
The practice evaluation showed that many students with intellectual disabilities are
benefited from the academic and vocational trainings given in the unit. Quite a number
of students joined the inclusive classes since the opening of the unit. Similarly, the
vocational training helped many students to lead independent lives at least in some
areas.
Conclusion and Recommendations
This study attempts to reflect the intervention practices in the Kokebe Tsibah special
unit. However, it is difficult to reflect the whole business of the unit in relation to
intervention with this small-scale study. The results showed that the intervention
practices are focusing on the intellectual, adaptive and vocational skills. Promising
results are documented in the intervention of these areas. Students with intellectual
disabilities brought about promising improvements in the above-mentioned areas of
focus. Physical education has been considered as the best intervention mechanism
which addresses the intellectual, social and practical skills of children with intellectual
disabilities.
To conclude, the intervention practices in the Kokebe Tsibah special unit is promising
and students with intellectual disabilities are benefited more from the intervention
practices. Based on the findings, the following recommendations are made: The
identification and assessment procedures should be comprehensive and should give all
the necessary data, the intervention practices should be supported by Yeka sub city
education bureau and Addis Ababa education bureau, the number of teachers should
increase to provide quality intervention for children with intellectual disabilities, teacher
should be given an opportunity to upgrade their education level so that they can befit
themselves and students, and teachers are doing tiresome work and they should get
benefits which compensate their effort.
References
American Association on Mental Retardation (1992).Mental retardation: Definition,
classification, and system of supports (9th ed.). Washington, DC: Author
Beirne-Smith, M., Patton,J.R., & Kim,S.H. (2006).Mental retardation: An introduction
to intellectual disabilities( 7th ed.). Upper Saddle River, NJ: Pearson.
Beirne-Smith, M.,Patton, J.,& Ittenbach, R. (1994). Mental retardation (4th ed.). Upper
Saddle River,NJ: Merrill.
Eggen, P. & Kauchak, D (2004). Educational psychology: Windows on classrooms (6th
ed.). Upper Saddle River, NJ: Pearson
Fantahun Admas (2006). Psychosocial experiences of teachers of children with special
needs in and outside the school setting. Unpublished master‟s thesis, Addis
Ababa University, Addis Ababa.
Winzer, M. (1990).Children with exceptionalities: A Canadian perspective (2nd ed.).
Scarborough, ON: Prentice-Hall.
Language and Behavior, 32
Claudia Rinaldi1
Diana Rogers-Adkinson2
Alka Arora3
An Exploratory Study of
the Oral Language and
Behavior Skills of
Children with Identified
Language and Emotional
Disabilities in Preschool*
Abstract
As the pre-school initiative in the USA continues to grow in the public school
sector, the need to understand and be prepared to address the needs of this
population of students is vital. This paper provides an exploratory analysis of
language and behavioral skills in children aged three to five years old served in
inclusive public preschools. Preschool children documented with language
impairments (LI), or emotional and behavioral disorders (ED) were compared to
a typically developing group using the Test of Early Language Development-3 and
the Preschool and Kindergarten Behavior Scales. Results suggest that
preschoolers with identified language delays or behavior disorders were
significantly different in both language development and behavior ratings when
compared to typical developing peers. Second, no significant differences were
found between students with language delays and socio-emotional disabilities.
Implications regarding the need for comprehensive screening, continuous
assessment, targeted intervention, and professional development for teachers
across both developmental areas in the early childhood education settings are
presented.
Key words: language disabilities, emotional and behavioral disabilities, inclusion,
preschool
1
2
3
Ph.D., Boston College ([email protected])
Ph. D. University of Wisconsin-Whitewater ([email protected])
Ph.D., Boston College, ([email protected])
*
Correspondence to: Claudia Rinaldi, Ph.D., Assistant Professor, Lynch School of Education, Boston College, 117
Campion Hall, 140 Commonwealth Ave., Chestnut Hill, MA 02467, ([email protected])
Effective preventative or early intervention strategies that may reduce the incidence of
disabilities in school-aged children has been at the forefront of discussion for both
general and special education as a result of the most recent reauthorization of the
Individuals with Disabilities Education Act (IDEA-2004) (Benner, Rogers-Adkinson,
Mooney, & Abbott, 2007) in the USA. In addition, the federal government has expanded
the Pre-K initiative (Federal Register, 2006, S300.807-300/808, p.274) to the individual
states. Currently 40 of 50 states have adopted the Pre-K initiative and are developing
universal preschool programs (Educational Marketer, July 2006, p.3). The growth in
public schools providing preschool instruction for all students brings new challenges.
Children previously referred to special education programs for early childhood may be
served in more inclusive programs including Head Start, Public Preschool, Private
preschool, daycare, and family daycare among others.
As public schools open their doors to preschool aged children, services must also be
ready to respond to the student needs. One main approach towards serving this new
population is to use universal screening tools for evaluating school readiness (Campbell
& Halbert, 2002). Unfortunately, because universal screening is not a widely adopted
practice in preschools settings across the U.S.A., initial referrals for students
experiencing language, academic, and socio-emotional and behavioral difficulties only
address the areas of concern identified by the pre-school teacher or parent during the
special education referral process. In addition, this process tends to occur later in the
school years when children begin to fail academically. In fact, in spite of the recent
Response to Intervention (RTI) movement in the USA, the “wait to fail” model
continues to be a common practice and referral is delayed until students are experiencing
more critical academic difficulties in later grades (Rous, 1999; Vaughn, Mathes, LinanThompson & Francis, 2005).
Most often neglected through initial referrals and pre-referral intervention practices
(PIT) is emotional or behavioral competence, especially for young children (Hester,
Baltodano, Hendrickson, Tonelson, Conroy, & Gable, 2004). Yet, current research has
suggested strong links between the maturation processes of language ability and
behavioral self-regulation (Prizant, 1999; Rogers-Adkinson & Hooper, 2003). This
paper furthers this research by exploring the possible co-occurrence of delays in both
domains for young children, who are served in public preschools, and who were initially
identified as exhibiting only a language disorder or an emotionally disturbance under the
Individuals with Disabilities Education Act (IDEA).
Review of the Literature
The co-occurrence of behavioral difficulties and language ability has been extensively
explored (Baker & Cantwell, 1987; Fantuzzo et al, 1999). Most of the research has been
on school-aged children (Benner, Nelson, & Epstein, 2002; Nelson, Benner, & Cheney,
2005; Rinaldi, 2003) with some studies suggesting the impact of these co-occurring
disorders may increase over the developmental period (Hooper, et al, 2003; Nelson,
Benner, & Rogers-Adkinson, 2005).
Research in children with severe language disabilities suggest that they are at higher risk
for psychiatric disorders with children scoring within the severe clinical range of
expressive or receptive language ability exhibiting less pro-social behaviors than
children with moderate language disabilities in clinical settings (Hart, Fujiki, & Briton,
2005). In fact, Rinaldi (2003) reported that 50% to 75.4% of 4th and 5th graders with
emotional and behavioral disorders (ED) served in public school self-contained
classrooms scored at clinical levels in semantic and syntactic language skills. Yet, other
research shows the prevalence rates for children who have co-occurring ED and
language and/or communication disabilities range from 20% to 65% (Baker & Cantwell,
1987; Brinton & Fujiki, 1993; Hummel & Prizant, 1993; Trautment et al., 1990; WarrLeeper, Wright, & Mack, 1994) as evaluated in clinical settings.
In looking at this co-occurrence, researchers have demonstrated that school-age students
eligible for special education services under the category of Emotional Disturbance (ED)
displayed moderate to large language disabilities that appear to be relatively stable
across age and gender (Nelson, Benner & Cheney, 2005). Specifically, Nelson, Benner
& Cheney (2005) explored students K through 5th grade (n=56) with identified ED under
IDEA and found that 86% of their sample also met criteria for language disorders but
were not receiving services for these needs.
Additional research has also addressed students with language disability (LI) as a
primary area of disability. This population was also shown to have more externalizing
emotional difficulties and reading disabilities. In fact, research uniquely looking at the
language abilities of preschool children have also established that strong oral language
skills and behavioral and emotional skills of preschool students are strong predictors of
future success in reading (Hummel & Prizant, 1993; Paez & Rinaldi, 2006; Rinaldi &
Paez, 2008; Spira, Bracken, & Fischel, 2005; Tomblin, Zhang, Buckwalter, & Catts,
2000).
Public preschool populations have had less exploration to date with the prominent work
occurring in Head Start settings (Fantuzzo et al, 1999; Kaiser, Cai, Hancock & Foster,
2002; Stanton-Chapman, Chapman, Kaiser, and Hancock, 2004). Head Start refers to a
Federal direct service program providing comprehensive child and family development
services for families with children from age 3 to age five. Head Start services for
children focus on health, mental health, child development and early education services.
The research in Head Start settings has focused upon risk factors for children in Head
Start related to potential language delays and emotional competence. Children
experiencing factors such as poverty, maternal complications during pregnancy or birth,
and parental low education and minority status suggest that these children are at greater
risk for LI (Stanton-Chapman, Chapman, Kaiser, & Hancock, 2004). However, Head
Start preschools are not district led, and thus address potentially different populations
from those found in the neighborhood public preschool programs.
Research in preschool programs for children that are typical and atypical developing is
limited in scope but some research has been reported. For example, preschool children
with LI have been suggested to experience increased difficulty in both the exhibition of
problem behaviors and poor performance of positive social skills based upon
observational analysis (McCabe & Marshall, 2006). Others have reported that children
with LI were noted to have more aggressive and disruptive behavior and smaller periods
of engagement than typical peers (Qi& Kaiser, 2003; Qi& Kaiser, 2004). Yet others
have reported that 50% of 3 year-old boys with low language skills showed higher
evidence of problem behavior, and that most boys and girls with low language skills and
high problem behavior had lower than average social skills. In addition, McCabe (2005)
found similar negative patterns of behavioral disabilities both at home and school with a
language delayed preschool special education population. However, minimal studies to
date have explored preschoolers with already identified special education eligibility in
LI and ED in public school settings receiving services under universal pre-schooling
initiatives not under Head Start.
Thus, research in the area of ED and language impairments in young children lacks
specificity of the uniqueness and occurrence of oral language disabilities and difficulties
and socio-emotional and behavioral disorders of preschool children eligible for special
education services under IDEA and served in inclusive public preschool settings. We
hypothesize that students receiving special education services for ED or LI will have
significantly lower oral language skills and co-occurring socio-emotional skills than
typically developing peers. Additionally, we also hypothesize that there are no
significant differences in both areas, language skills and socio-emotional skills between
the students with ED or LI and when compared to typically developing peers. Lastly, we
also hypothesize that each group, ED and LI, would have greater levels of severity in the
particular disability category with co-occurring delays in the secondary category. These
questions are important as new preschool teachers move into public preschool
classrooms, they need to be ready to not only provide the special education services
identified in the child’s individualized educational plan through screening, continuous
monitoring, and targeted instruction but also to request support for professional
development around co-occurring disabilities. These questions are important as greater
understanding of the relationship of language and behavior is critical for providing
effective services in the expanding pre-kindergarten/preschool programs in the USA.
Method
Participants
The study took place in a rural area of the Midwest portion of the USA in a district
serving 10,555 students (75% Anglo, 15% Hispanic, 8% African-American, and 2%
other). The preschool population served was a total of 6.9% of the PreK-12 enrollment
in that district. Thirty-three percent of preschool students were served under IDEA.
Participants included thirty-seven children, 26 males and 11 females currently attending
a preschool program. The children were aged three-to-five years with and without
disabilities in an inclusive setting. Subjects were excluded from the study if an
articulation disorder or cognitive delay were noted in the educational records. The public
school pre-school program utilized an inclusion model with typical peers attending the
program as role models. Eighty percent of the students met guidelines for free and
reduced lunch. Out of 37 children from three groups, fourteen were peer models as
control, eight children were currently diagnosed as emotional disability and fifteen
children experienced language disability as established within the Individual with
Disabilities Education Act (IDEA, 2004). All children identified with a disability had a
primary and only diagnosis of either LI** or EBD***; no secondary area of disability was
identified in the educational records of the students. The students with LI and ED met
eligibility under Wisconsin’s special education category as part of IDEA. Controls were
selected based upon participation as a peer confederate in the pre-school program and
having no referral or concerns regarding potential need for special educations services.
Consent from 3 students was not obtained and therefore they were not included in this
sample. All subjects were Anglo with the exception of two African-American children.
Children were between 3 and 5 years of age with a mean age of 4.7 years (SD .8
months). In addition, all subjects were determined to have an IQ within the normal range
as it was used as a criterion for eligibility in the disability areas for LI and ED. Because
the requirement for a cognitive score (i.e. IQ) to be in the average or above range, it was
deemed not necessary to be shared with the researchers by the district’s human subjects
review board. The classroom staff included a full time special education teacher, a parttime speech language therapist and classroom volunteers with a ratio of 1 teacher for
every 8 students in the classroom.
Dependent Measures
We collected data for the dependent measures of behavioral competence and language
ability. Behavioral competence was assessed utilizing the Preschool and Kindergarten
Behavior Scale (Merrell, 1994). The PKBS consists of an index of positive social skills
observed, and clinical scales in the areas of problem behavior based upon developmental
norms. It consists of 34 social skill items that are then divided into subscales in the areas
of social cooperation, social interaction and social independence. Forty-two problem
behavior items are also included that then can be scored in subscales of selfcentered/explosive, attention problems/overactive, externalizing, social withdrawal, and
**
Wisconsin definition of LI refers to difficulties in speech or sound production impairment under the following requirements: 1)
the child’s conversational intelligibility is significantly affected and the child displays at least one of the following: the child
performs on a norm-referenced test of articulation or phonology at least 1.75 standard deviations below the mean for his or her
chronological age or demonstrates consistent errors in speech sound production beyond the time when 90 percent of typically
developing children have acquired the sound or one or more of the child’s phonological patterns of sounds are at least 40 percent
disordered or the child scores in the moderate range of phonological process use in formal testing and the child’s conversational
intelligibility is significantly affected.
***
Wisconsin definition of EBD refers to an emotional behavioral functioning that departs from generally accepted, age,
appropriate ethnic or cultural norms that it adversely affects a child’s academic progress, social relationships, personal adjustment,
and classroom adjustment and meets one of the following: 1) severe, chronic, and frequent behavior that is not the results of
situational anxiety, stress or conflict; 2) occurs in school and in at least one other setting, c) displays an inability to develop or
maintain satisfactory interpersonal relationships, inappropriate affective or behavior response to a normal situation, pervasive mood
of unhappiness, anxiety, or depression, physical symptoms, pains or fears associated with personal or school problems, inability to
learn that cannot be explained by intellectual, sensory or health factors, extreme withdrawal from social interactions, extreme
aggressiveness for a long period of time, and other inappropriate behaviors that are so different from children of similar age, ability,
educational experience, and opportunity that the child or other children in a regular or special education program are negatively
affected.
anxiety/somatic problems. This assessment was developed as a universal screening tool
for identifying children at risk or experiencing serious behavioral and emotional
problems between the ages of three to six. Internal consistency reliability estimates for
the Social Skills and Problems Behavior total scores were found to be .96 and .97,
respectively. The classroom special education teacher rated each child utilizing the
Likert-type responses between 0 (never) to 3 (often).
Language competence was assessed through the administration of the Test of Early
Language Development-3 (Hresko, Reid, & Hammill, 1999). The TELD-3 provides a
receptive and expressive score that is combined to provide an overall spoken language
quotient based upon developmental norms. This test is can be used as another universal
screening tool. The Receptive Language Subtest measures the comprehension of
language and it includes tasks such as following directions, determining syntactic correct
forms of the English language, and identification of vocabulary. The Expressive
Language Subtest measures the ability to communicate orally. Tasks in this subtest
include answering questions, participating in conversation and identifying complex
sentences and appropriate vocabulary. Thus, the Spoken Language Quotient combines
both receptive and expressive abilities and is the best indicator of a child’s overall oral
language ability. Internal consistency reliability coefficients for the TELD were found
to be .91. The authors trained in the administration of assessment tools administered the
test to each student individually.
Procedures and Design
The preschool selected was a part of a public elementary school serving Pre-K-6. The
school had established the preschool program as a result of a district initiative for Pre-K
education. The classroom served students between the ages of 3-5. We obtained parental
consent and evaluated 37 preschool students in the school in an individual basis for an
average administration time of 35 minutes in a quiet area outside of their classroom.
Each student was administered the Test of Early Language Development-3 (Hresko,
Reid, & Hammill, 1999) per standard administration procedures. The Preschool and
Kindergarten Behavior Scale (Merrell, 1994) was rated by the classroom special
education teacher and scored by the second author per the manual instructions.
A multivariate analysis of variance (MANOVA) was used to find the differences among
the groups. The analysis facilitated results for the following three research hypotheses:
(1) preschool students in the EBD group and LI group would have similar deficits in
social behavior and language skills and (2) preschool students with already identified
emotional behavioral disorders (EBD) or language disability (LI) would vary
significantly from the typical developing peers, and that 3) each group, LI and ED,
would have greater levels of severity in the particular disability category with cooccurring delays in the secondary category For the first and 3rd research hypothesis a
MANOVA technique was used with two groups and five dependent measures. The two
groups were EBD and LI group. For the second hypothesis, the EBD and the LI group
were combined to form an experimental group (DIS: Disabled and this group was
compared with the control (or the typical peers) group using MANOVA techniques.
Results
Descriptive statistics means and standard deviations for each measure of the TELD and
the PKBS in this study are presented for group membership (control, DIS (both ED and
LI), ED, and LI) in Table 1.
Table 1
Means and Standard Deviations for the dependent
Dependent Measures
Group 1
Control
(n=14)
M
SD
Group 2
Behavior Disorder
(n=8)
M
SD
Group 3
Speech &
Language
Disorder
(n=15)
M
SD
Social Skills Total
112.7
14.7
86.3
20.0
96.8
19.8
Problem Behavior Total
102.7
5.3
120.5
16.2
105.0
15.6
Receptive Language
104.2
13.1
92.6
14.6
86.4
13.4
Expressive Language
90.5
9.1
84.6
7.4
78.2
8.7
Spoken Language Quotient
(Receptive + Expressive)
96.8
12.3
86.3
11.4
78.8
11.4
The Spearman partial rank-Order correlations among the dependent variables are
provided in Table 2. The table shows all the variables are highly correlated to each other
except the variable of problem behavior total. This measure is highly correlated to the
variable social skill total but not to the rest of the measures in the study. However, this
variable was kept in the analysis as theoretically it is part of the assessment tool used to
screen for behavior and emotional problems.
The results from the overall MANOVA test to determine the differences between the
two groups of students with identified disabilities (ED and LI) in terms of five
dependent measures gave the following result: F (5, 17) = 2.15, p = 0.11. The omnibus
F-test in this case is not significant at the set level ( = 0.5). This is in accordance with
the original hypothesis that preschool students in the ED group and LI group are not
statistically different from each other on the dependent measures and a new variable was
created named DIS (disabled LI + ED). This analysis also supported our third hypothesis
since the means for each group, LI and ED, had greater levels of severity in the
particular disability category with co-occurring delays in the secondary category. We
identified a delay based on commonly used guidelines of 1 standard deviation below the
mean.
Table 2
Partial Correlations by Group Membership (Disability Status) for Language Skills by
Social Skills and Problem Behavior
Social Skills
Total
-0.46*
Problem
Total
Receptive
0.44*
-0.20
Expressive
0.40*
-0.06
0.65*
Spoken Language Q
0.46*
-0.16
0.94*
Problem Total
Receptive
Expressive
0.86*
* Correlation is significant at the 0.01 level
The results from the overall MANOVA to test the differences between the control and
the DIS group on the five dependent measures gave the following results: F (5, 31) =
3.1, p = 0.02. The omnibus F-test in this case is significant at the set level ( = 0.5). This
shows that the preschool students with already identified disabilities, [DIS (i.e. ED and
LI)] are significantly different from their typically developing peers (control group).
Discussion
There is substantial evidence that emotional behavioral disorders and language deficits
are likely to co-occur in school age children (Baker & Cantwell, 1987; Benner, Nelson
& Epstein, 2002; Nelson, Benner, & Cheney, 2005; Rinaldi, 2003). However, limited
research has replicated this co-occurrence in pre-K students in district led public
preschool settings. The purpose of this study was to (a) establish that preschool students
receiving services for ED or LI in public school programs share significant difficulties in
both areas of language skills and social-emotional skills, and (b) establish that preschool
children identified with ED or LI were significantly different in language skills and
social behavior than typically developing peers in this setting. Our results suggest that
indeed, preschool students with ED and LI do share similar difficulties in language skills
and social behavior despite the fact that they had only met eligibility for either ED or LI
only. Results support previous findings in a variety of contexts such as those in clinical
settings and Head Start.We also found that both groups are statistically different than
their typical peers in both language and behavioral-emotional skills as expected.
In addition, findings support those of Kaiser et al (2000) who reported that 3-year old
boys with low language skills also exhibited problem behavior in a clinical setting; and
McCabe’s (2005) study who found negative patterns of behavior skills, in home and
preschool, of children identified with LI. It further suggests that although students
maybe identified with one area of disability, their needs may extent to other areas that
can eventually impact academic progress. Acknowledging this occurrence is important
for practicing teachers who will have students with and without LI and ED and need to
be preventive in delivering services in both areas, not just the one addressing their
primary area of disability or difficulty. It is also vital for teachers to recognize that
serving preschool children must occur within the context of the classroom as language
skills mediate behavior.
Although we would expect differences between students already identified with a
disability compared to typical developing peers, the importance lies on the need to focus
on preventive comprehensive screening, evaluation, and intervention in both domains
inclusive of socio-behavioral skills and language development. The fact that significant
differences where not found between the ED and the LI groups suggest that teachers and
special education personnel need more information to plan, monitor and meet the
individual needs of these children and that services need to be more sensitive to
children’s difficulties in both domains. Our study furthers the research by establishing
the co-occurrence of ED and LI of students ages 3-5 in public school pre-school
programs and highlighting the need for schools to address, through screening,
monitoring, and instruction, both domains for children identified with either disability.
In summary, the results of our exploratory study suggest that both students with EBD or
LI scored significantly below (i.e. clinical levels) on language measures and behavior
scales. This is important as this suggests that when assessing young children, measures
of both must be administered to get a more holistic and comprehensive picture of the
child. In addition intervention must mediate this interaction as well since we could not
establish the differences between the LI and ED group.
Limitations and Future Research
The results of this exploratory study suggest the importance of recognizing pre-school
students with ED or LI may have co-occurring difficulties in both domains and that
instruction planning in the Individualized Family Service Plan must integrate progress
monitoring and coordination of services in both areas regardless of identification
classification of EBD or LI. However, the findings described are preliminary and
exploratory of a district funded public school program with a limited number of students
enrolled. Thus, generalization should be used with caution.
Future research should increase the sample size across multiple universal public
preschool programs that include a stratified sample of the current population of the USA
public school system. In addition, the research should include a variety of sources of
data such as structured observations and parental reporting to confirm severity of
reported behaviors. Moreover, future research should evaluate the multidisciplinary
evaluations conducted by school districts or early intervention organizations to evaluate
the comprehensiveness of the assessment and its implication for eligibility and
identification. This would provide extensive information of the depth of assessment
practices conducted and its appropriateness in differentiating between socio-behavioral
or language difficulties. In addition, it can provide guidance on instructional
programming of pre-school students who are at-risk for developing ED or LI served in
public preschools.
Further, research should also address the language development and socio-behavioral
skills of culturally and economically diverse population of preschoolers to see if the
results replicate to that rapidly growing population of second language speakers.
Practical Implications
We suggest educators conduct careful monitoring of oral language development and
socio-behavioral skills of each individual child in order to appropriately identify
effective interventions and their impact on pre-readiness skills. Although, this should be
a critical part of the Individualized Family Service Plan, we suggest that informal
assessment procedures (i.e. task analysis, dynamic assessment, informal oral language
assessment, response to intervention, etc.) be used weekly to track progress in these
areas as suggested by recent literature on response to intervention models. We further
suggest that socio-behavioral interventions be a critical component for services for
children exhibiting language delays and socio-emotional difficulties. This can be done
trough professional development training in structures such as those of Positive
Behavioral Supports, areas where empirical research has reported significant training
needs and significant outcomes (Stormont, Lewis, Covington, & Smith, 2005). PBS
refers to procedures required under IDEA to help student interact appropriately in a
program guided by positive consequences rather than punishment in multiple settings
(i.e. home and school) within a particular school wide structure (Hallahan & Kauffman,
2003). School-wide Positive Behavioral Supports has shown promise on preventing and
remediating students’ socio-behavioral skills in typical preschool classrooms and should
also be explored (Duda, Dunlap, Fox, Lentini, and Clarke, 2004) in this type of setting.
(Stormont, Lewis, Covington, & Smith, 2005). It is important to build upon currently
existing structures and research supporting positive behavior support (PBS) as IDEA
indicates that positive behavioral supports within preschools is effective to address
language based behavioral manifestations (Mandlawitz, 2007).
As more states move towards the implementation of universal preschools services,
(preschools educators need preventive programs that incorporate professional
development in the implementation of positive behavioral supports and progress
monitoring of behavior and language development such as Response to Intervention and
recommended by IDEA of 2004. In particular, these models would address increased
collaborative interventions and address language skills, and pragmatic skills, as related
to prosocial behavior that are critical in the prevention of more entrenched behavioral
problems and academic failure during the elementary and secondary school years.
Summary
This research continues to provide critical information regarding the developmental
interaction of early language delays and behavioral competence of preschool age
children served in public school settings. Multidisciplinary and comprehensive
screening, referral, assessment, and identification processes should be carefully
monitored and evaluated in order to observe common trends of children who experience
delays in either language or social-behavioral development or both. Staff and support
personnel need to be trained to implement behavioral interventions across domains such
as those of positive behavioral supports ensuring the overlap of social skills, behavior,
and language skills are addressed during early intervention programming and preschool
settings. Finally, further research is needed to determine if early intervention that
integrates positive behavioral supports and responsiveness to intervention in preschools
setting, for this population, can reduce or prevent the longitudinal impact of cooccurring high incidence disabilities in school-aged children.
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EÇÖZE’de Lisansüstü Tezler, 46
Seray O.Gül1
İbrahim H. Diken2
Erken Çocuklukta
Özel Eğitime İlişkin
Türkiye’de
Gerçekleştirilmiş
Lisansüstü Tez
Çalışmalarının Gözden
Geçirilmesi
Özet
Bu çalışmanın amacı Türkiye’de gerçekleştirilen erken çocuklukta özel eğitim
(EÇÖZE) kapsamı içerisindeki lisansüstü tez çalışmalarını gözden geçirmektir. Bu
çalışma kapsamında belirlenen ölçütleri karşılayan ve erken çocukluk dönemindeki
gelişimsel gerilik/yetersizlik/yetersizlik gösteren çocuklar, aileleri ve onlara sunulan
hizmet ve uygulamaları konu alan toplam 24 tez çalışmasına ulaşılmıştır. Ulaşılan
tez çalışmaları konularına göre kategorilere ayrılmış, her bir kategorideki tez
çalışmalarına ilişkin bilgi verilmiş ve aynı kategorideki tez çalışmaları
karşılaştırmalı olarak incelenmiştir. Ulaşılan tez çaşlışmaları konularına göre yedi
kategoride analiz edilmiştir. Beceri öğretimi kategorisinde dokuz, okul öncesi
dönemde kaynaştırma kategorisinde dört, ailelere çocuklarına öğretim sunma
becerisi kazandırma kategorisinde üç, gelişimsel gerilik/yetersizlik gösteren
çocukları birbirleri ve normal gelişim gösteren akranları ile karşılaştırma
kategorisinde üç, annelerin duygu-durumlarını inceleme kategorinde üç, çocuklara
sunulan hizmetler kategorisinde iki ve çocuklara ilişkin bir durumu betimleme
kategorisinde bir tez çalışması karşılaştırmalı olarak incelenmiştir.
Anahtar Sözcükler: Gelişimsel gerilik/yetersizlik/yetersizlik, erken çocuklukta özel
eğitim, lisansüstü tezler
Doktora öğrencisi, Anadolu Üniversitesi, Eğitim Bilimleri Enstitüsü, Özel Eğitim ABD, Zihin Engelliler Öğretmenliği
Doktora Programı, [email protected]
2
Doç. Dr., Anadolu Üniversitesi, Eğitim Fakültesi, Özel Eğitim Bölümü, [email protected]
1
Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1
Erken çocukluk dönemi olarak adlandırılan 0-6/8 yaş arası dönem, gelişim için
çok önemli bir dönemdir. Bu dönemde çocukların gelişimi çok hızlıdır ve
çocuklar birçok beceriyi öğrenmeye hazırdır (Birkan, 2001). Kanık (1993) bu
dönemi çocukların anne-babalarından, okul öncesi eğitim kurumlarından,
arkadaşlarından ve çevrelerinden birçok beceriyi öğrenerek eğitimin daha sonraki
basamakları için gerekli altyapıyı oluşturdukları dönem olarak tanımlamaktadır.
Heward (1996), Kroth ve Edge (1997) ise yaşamın ilk yıllarındaki öğrenme
yaşantılarının, normal gelişim gösteren çocuklar için olduğu kadar gelişimsel
gerilik/yetersizlik gösteren çocuklar için de önemli olduğunu vurgulamaktadır
(Akt., Birkan, 2001). Geçmişten günümüze ülkemizde yasal düzenlemelerde
meydana gelen değişimler de erken çocuklukta özel eğitim (EÇÖZE) ve
hizmetlerinin önemini vurgular niteliktedir. Türkiye'de ilk olarak 1982 yılında
gelişimsel geriliği olan çocukların eğitimine yönelik bazı yasal düzenlemeler yer
alırken, 1990'lı yıllara gelindiğinde Portage ve Küçük Adımlar gibi programlar
gelişimsel geriliği olan çocukların erken eğitim alabilmelerini sağlamıştır (Birkan,
2001). 1997 yılında çıkan 573 sayılı Kanun Hükmünde Kararname ile okul öncesi
eğitim, özel gereksinimli çocuklar için zorunlu eğitimin bir parçası haline gelmiş,
bu yasa ile anne-babalara çocukları için alınacak eğitim kararlarına katılma hak ve
sorumluluğu tanınmıştır. 18 Ocak 2000 tarihinde yayımlanan ve 2006’da yeniden
gözden geçirilen Özel Eğitim Hizmetleri Yönetmeliği ile ise 0-36 ay ve 36-72 ay
arasında özel eğitim gereksinimleri belirlenmiş çocuklar için okul öncesi eğitim
zorunlu ve kaynaştırma modeline dayalı hale getirilmiş, ailenin eğitim ve
hizmetlere katılımının önemi ve gerekliliği vurgulanmıştır (Birkan, 2001; Gürsel,
2003; Özbaba, 2000).
EÇÖZE, şemsiye bir kavram olarak 0-36 aya yönelik erken özel eğitim (early
intervention) ve 36-72 aya yönelik okulöncesi özel eğitim (preschool special
education) dönemlerini kapsamaktadır. EÇÖZE bu bağlamda, erken çocukluk
döneminde gelişimsel geriliği olan ya da gelişimsel gerilik/yetersizlik riski
altındaki çocuklara ve ailelerine sunulan farklı destek (eğitsel, gelişimsel, sosyal,
sağlık, beslenme gibi) sistemlerini içerebilen hizmet sunma süreci olarak
tanımlanabilmektedir. Cavkaytar (1998) yasalarda söz edilen EÇÖZE sürecine
aile katılımını, anne-babaların çocuklarının eğitimine destek olmaları ve bu
süreçte aktif olarak rol almaları bağlamında ele almaktadır. Anne-babaları
çocuklarının ilk ve sürekli öğretmenleri olarak gören (DiPipi-Hoy ve Jitendra,
2004) ve aile-uzman işbirliğinin çocuğun eğitimindeki önemini vurgulayan
(Fiedler, Clark ve Simpson, 2004) yaklaşımların etkisiyle de ailelere çocuklarına
öğretim sunma becerisi kazandırmayı ve aileleri bu süreçte etkin kılmayı
amaçlayan aile eğitimi (Öncül, 2004) ve rehberliği (Tezel, 2003) uygulamaları
giderek yaygınlaşmaktadır. Ailelerin, çocuğun gelişiminde çok daha etkili
olabilmeleri için eğitime ihtiyacı olduğu kadar farklı disiplinlerden uzmanlar
tarafından desteklenmeye de ihtiyacı vardır (Berger, 2007; Shea ve Bauer, 1991).
Erken çocukluk dönemi, çocuğun gelişimsel geriliğe sahip olduğunun yeni
farkedilmeye başlandığı bir dönemdir. Bu nedenle, gelişimsel gerilik/yetersizlik
gösteren çocuk gibi aile üyeleri de bu dönemde zor bir süreçten geçmekte,
karmaşık pek çok duyguyla baş etmeye çalışmakta (Işıkhan, 2005), çocuğu ve
kendisi için en uygun ve nitelikli hizmet, kaynak ve desteklere ulaşmaya (Bilgiç,
2007; Özdemir, 2005) ihtiyaç duymaktadır. Bu sürecin başarılı bir şekilde
atlatılmasında aile üyelerinin olumlu bir duygu durumuna sahip olması (Görgü,
2005), çocuk için değerlendirme, tanılama ve yönlendirme sürecinin sağlıklı bir
şekilde gerçekleştirilmesi (Yalçıntaş, 2006), gelişimsel gerilik/yetersizlik gösteren
çocuğun okul öncesi dönemde kaynaştırma uygulamalarına katılması (BaysalMetin, 1989; Odluyurt, 2007; Varlıer, 2004) ile toplum, uzman, akran ve diğer
ailelerden gelecek maddi- manevi her türlü destek büyük önem taşımaktadır
(Tezel, 2003).
EÇÖZE sürecinde önemli yer tuttuğu düşünülen konulara, erken çocukluk
dönemindeki gelişimsel gerilik/yetersizlik gösteren çocuklar ile ilgili tez
çalışmalarında da değinilmektedir. Tez çalışmaları uygulama, öğretim süreci,
yöntem, veri toplama araçları, yurt içinde ve dışında yürütülen program ve
çalışmalar gibi pek çok konuda geniş, kapsamlı ve güvenilir bilgilere ulaşmamızı
sağlayan en önemli kaynaklardır. Türkiye’de özel eğitim alanında yapılan tez
çalışmaları incelendiğinde, EÇÖZE konusunda yürütülmüş tez çalışmalarına
rastlanmış (Diken, Ünlü ve Karaaslan, 2008) ancak bu tezlerin ayrıntılı olarak
incelendiği herhangi bir bilimsel çalışmaya ulaşılamamıştır. Türkiye’de yürütülen
ve EÇÖZE’yi konu alan tezlerin bir çalışmada toplanması ve bu tezlere ilişkin
gerekli bilgilerin (çalışılan örneklem, örneklemin özellikleri, çalışmanın yöntemi,
kullanılan veri toplama araçları, uygulama süreci gibi) sunulması erken çocukluk
dönemindeki gelişimsel gerilik/yetersizlik gösteren çocuklar ile ilgilenen kişilerin
gerekli bilgilere ulaşmasını kolaylaştırmasına yardımcı olacaktır. Ayrıca böyle bir
çalışma, araştırmacılara henüz ele alınmamış konular ya da araştırılmış konularda
eksik kalmış yönler konusunda yönlendirici bilgiler sunması açısından da önemli
görülmektedir. Bunlara ek olarak, ortak özellik gösteren çalışmaların benzeşen ve
farklılaşan yönlerinin ortaya konulması, çalışmalara ilişkin farklı bir bakış açısı
kazandırırarak ileride yapılacak araştırmalara ışık tutabilecektir. Dolayısıyla, bu
çalışma ile Türkiye’de gerçekleştirilen EÇÖZE kapsamı içerisindeki lisansüstü tez
çalışmalarının gözden geçirilmesi amaçlanmıştır.
Erken çocukluk dönemiyle ilgili yapılan tez çalışmalarını belirlemek üzere
Yükseköğretim Kurulu'nun internet sitesinden tarama yapılmıştır. Tarama
sırasında erken çocukluk dönemi, okul öncesi dönem, zihinsel engelli çocuk,
gelişimsel gerilik, gelişimsel yetersizlik ve 0-6/8 yaş gibi anahtar sözcükler
kullanılmıştır. Ayrıca zihinsel yetersizlik ve gelişimsel bozukluk alanlarında
yapılan tez özetlerini içeren Zihinsel Yetersizlik ve Gelişimsel Bozukluk
Alanlarında Lisans Üstü Tez Bibliyografyası (Diken, Ünlü ve Karaaslan, 2008)
adlı kitaptan 0-6/8 yaş dönemindeki gelişimsel gerilik/yetersizlik gösteren
çocuklar ve aileleri ile yapılan tez çalışmaları tespit edilmiştir. YÖK'ün internet
sitesinden elektronik erişim olanağı bulunan tezlere buradan ulaşılmış; diğer
tezlere ise tezin yapıldığı üniversitelerin kütüphanelerinden ulaşılmıştır. Tezlerin
belirlenmesinde şu kriterler dikkate alınmıştır: (1) tezin 0-6/8 yaş dönemindeki
çocuklar ya da onların aileleri ile ilgili olması, (2) çalışma gruplarını oluşturan
çocukların gelişimsel gerilik/yetersizlik tanısı olması, ve (3) çalışmaların yüksek
lisans ya da doktora tezi olması. 0-6/8 yaş arasında gelişimsel
gerilik/yetersizlik/yetersizlik gösteren çocuklar ve aileleriyle ilgili daha fazla tez
ve veriye ulaşılabilmesi amacıyla tezin yapıldığı yıl ya da bölüm önkoşul olarak
belirlenmemiştir.
Yapılan kaynak taraması sonucunda, 2008 yılı itibariyle erken çocukluk
dönemindeki gelişimsel gerilik/yetersizlik gösteren çocuklar, aileleri ve onlara
sunulan hizmet ve uygulamaları konu alan toplam 24 tez çalışmasına ulaşılmıştır.
Tezlerin analiz edilmesi aşamasında çalışmalar konularına göre kategorilere
ayrılmış, her bir kategoride hangi tezlerin yer aldığı belirtilmiştir. Her bir tezde
çalışılan beceri, davranış vb.’ye ilişkin bilgi verilmiş, o kategoride ele alınan
çalışmalarda çalışılan örneklem ve örneklemin çalışmanın amacı açısından önem
taşıyan özellikleri açıklanmıştır. Benzer ya da ortak özellik taşıdığı vurgulanan
araştırmalar karşılaştırmalı olarak incelenmiş ve araştırmaların bulgularına ilişkin
kısaca bilgi verilmiştir.
Tez çalışmalarına ilişkin önemli olduğu düşünülen
özellikler tablolar şeklinde sunulmuştur.
Bulgular ve Yorum
Bu çalışma kapsamında ulaşılan tezler ele aldıkları konulara göre yedi kategoride
toplanmıştır. Bu kategoriler; beceri öğretimi (Akköse, 2008; Altunel, 2007; Ardıç,
2008; Bakkaloğlu, 2004; Canay, 2003; Çetin, 1995; Çuhadar, 2008; Erbaş, 2001;
Odluyurt, 2007), okul öncesi dönemde kaynaştırma (Baysal-Metin, 1989;
Odluyurt, 2007; Özbaba, 2000; Varlıer, 2004), ailelere çocuklarına öğretim sunma
becerisi kazandırma (Birkan, 2001; Özcan, 2004; Tuş-Gümüşçü, 1996), annelerin
duygu-durumlarını inceleme (Görgü, 2005; Richter-Kanık, 1998; Tezel, 2003),
gelişimsel gerilik/yetersizlik gösteren çocukları birbirleri ve normal gelişim
gösteren akranları ile karşılaştırma (Bilgiç, 2007; Özenmiş, 2000; Zeteroğlu,
2006), çocuklara ilişkin bir durumu betimleme (Çağlar, 2006) ve çocuklara
sunulan hizmetler (Özdemir, 2005; Yalçıntaş, 2006) olarak belirlenmiştir.
Odluyurt (2007)’un tez çalışması okul öncesi öğretmenlerinin, okul öncesi
dönemdeki gelişimsel gerilik/yetersizlik gösteren çocukların sahip olması gereken
kaynaştırmaya hazırlık becerilerine ilişkin görüşlerinin alınması ve çocuklara
kaynaştırmaya hazırlık becerilerinin öğretilmesini kapsayan iki bölümden
oluşmaktadır. Bu nedenle tez hem beceri öğretimi kategorisinde hem de okul
öncesi dönemde kaynaştırma kategorisinde ele alınmış ve incelenmiştir.
Beceri Öğretimi
0-6/8 yaş dönemindeki gelişimsel gerilik/yetersizlik gösteren çocuklara herhangi
bir beceriyi öğretmeyi, uygun olmayan davranışları söndürmeyi ya da olumlu
davranışlar kazandırmayı konu almış tez çalışmaları beceri öğretimi kategorisinde
ele alınmıştır. Beceri öğretimini konu alan toplam dokuz (Akköse, 2008; Altunel,
2007; Ardıç, 2008; Bakkaloğlu, 2004; Canay, 2003; Çetin, 1995; Çuhadar, 2008;
Erbaş, 2001; Odluyurt, 2007) tez çalışmasına ulaşılmıştır. Bu amaçla yürütülen
çalışmalarda 24’ü erkek 12’si kız olmak üzere toplam 36 katılımcı ile çalışılmıştır.
Katılımcıların hepsi 3-8 yaş grubundadır. Bu kategoride 0-3 yaş dönemindeki
gelişimsel gerilik/yetersizlik gösteren çocuklara beceri öğretimini konu alan hiçbir
çalışmaya rastlanmamıştır. Katılımcılar, tanılarına göre incelendiğinde 2’sinin
serebral palsy, 14’ünün down sendromu, 4’ünün gelişimsel gerilik/yetersizlik,
13’ünün ise otistik bozukluk tanısına sahip oldukları görülmüştür. Diğer üç
katılımcının ise dil ve konuşma yetersizliği olduğu belirtilmiştir.
Öğretimi hedeflenen beceriler açısından incelendiğinde Bakkaloğlu (2004) ve
Odluyurt (2007)’un çalışmalarında geçiş becerilerinin öğretimini, Akköse
(2008)’nin mutfak araçlarını adlandırma becerisinin öğretimini, Altunel (2007)’in
soru cevaplama becerisinin öğretimini, Ardıç (2008)’ın tuvalet becerisinin
öğretimini, Canay (2003)’ın söylenen komutu yerine getirme becerisinin
öğretimini, Çetin (1995)’in büyük kas becerilerinin öğretimini ve Çuhadar (2008)’
ın serbest zaman becerilerinin öğretimini konu aldığı görülmüştür. Beceri öğretimi
kategorisinde davranış problemlerinin söndürülmesini ve olumlu davranışların
kazandırılmasını (Erbaş, 2001) konu alan tek bir çalışmaya ulaşılmıştır.
Bakkaloğlu (2004) ve Odluyurt (2007) tez çalışmalarında, çocukların okul öncesi
dönemde başarılı olabilmeleri için sahip olmaları gereken kaynaştırmaya hazırlık
becerilerinin öğretimini ele almışlardır. Her iki araştırmada da bu becerilerin neler
olduğu öğretmen görüşlerine başvurularak ve alanyazın taraması yapılarak
belirlenmiştir. Ancak Bakkaloğlu çalışmasında amaç olarak yalnızca geçiş
becerilerinin öğretimini ele aldığı için bu tez çalışması yalnızca beceri öğretimi
kategorisinde incelenmiştir. Odluyurt’un tez çalışması ise daha önce belirtilen
nedenlerden dolayı okul öncesi dönemde kaynaştırma kategorisinde de ele
alınmıştır. Bakkaloğlu (2004) çalışmasında yönergelere uyma, sıra alma, bağımsız
çalışma ve materyalleri toplama becerilerini kazandırılması gereken hazırlık
becerileri olarak ele alırken, Odluyurt (2007) grup etkinliklerinde sunulan iki
basamaklı yönergeleri takip etme, etkinliklere parmak kaldırarak katılma ve
“............ istiyor musun?” sorusuna başını sallayarak isteğini belirtme becerilerini
ele almıştır. Her iki çalışmada da etkinlik temelli bir öğretim yaklaşımı
kullanılmıştır. Bakkaloğlu (2004) ve Odluyurt (2007)’un çalışmaları dışında bu
kategoride aynı becerinin öğretimine odaklanan başka bir çalışmaya
rastlanmamıştır.
Beceri öğretimi kategorisinde incelenen çalışmalarda dikkat çeken diğer bir bulgu
ise iki çalışmada hedeflenmeyen bilgi ediniminin ele alınmış olmasıdır. Akköse
(2008) ve Altunel (2007) çalışmalarında hedeflenmeyen bilgi edinimini de amaç
olarak almışlardır. Her iki çalışmada da hedeflenmeyen bilgi ediniminde belirgin
bir artış olduğu sonucuna ulaşılmıştır. Hedeflenmeyen bilgi edinimi, öğretime
ayrılacak zamanın arttırılmasına gerek kalmadan daha fazla yeni becerinin
öğrenilmesini sağladığı için öğrenmenin en hızlı olduğu 0-6/8 yaş dönemindeki
çocuklarla gerçekleştirilen çalışmalarda ele alınması gereken bir konudur.
Beceri öğretimini konu alan tez çalışmalarının bulgularını öğretimde kullanılan
yöntem ve programlara bağlı olarak iki başlıkta özetleyebiliriz: Hedef becerinin
öğretiminde yanlışsız öğretim yöntemlerinin kullanıldığı çalışmalardan elde
edilen bulgular ve farklı uygulamaların ve eğitim programlarının kullanıldığı
çalışmalardan elde edilen bulgular. Hedef becerilerin öğretiminde yanlışsız
öğretim yöntemlerinin kullanıldığı çalışmalar incelendiğinde Akköse (2008)’nin
mutfak araçlarının ismini söyleme becerisinin öğretiminde, Altunel (2007)’in soru
cevaplama becerisinin öğretiminde ve Odluyurt (2007)’un da kaynaştırmaya
hazırlık becerilerinin öğretiminde eşzamanlı ipucuyla öğretim yöntemini
kullandıkları, Canay (2003)’ın ise söylenen komutu (al, ver, koy, göster, otur, gel,
tak, çıkart ve aç) yerine getirme becerisinin öğretiminde ipucunun giderek
azaltılmasıyla öğretim yöntemini kullandığı görülmüş ve yanlışsız öğretim
yöntemleri ile sunulan öğretimin hedef becerilerin öğretiminde etkili olduğu
sonucuna ulaşılmıştır.
Hedef becerilerin öğretiminde farklı uygulamaların ve eğitim programlarının
kullanıldığı çalışmalardan birinde Bakkaloğlu (2004) Etkinliğe Dayalı Müdahale
Programı’nın çocukların yönergelere uyma, sıra alma, bağımsız çalışma ve
materyalleri toplama becerilerini kazanmaları üzerindeki etkisini incelerken, bir
diğerinde Çetin (1995) yürüme, koşma, sıçrama, minder, top, denge, engel seti,
bisiklet ve merdiven kategorilerindeki hareketlerde Portage Erken Çocukluk
Dönemi Eğitim Programı kullanılarak verilen eğitimin çocukların kaba motor
becerileri kazanmaları üzerindeki etkisini incelemiştir. Bu iki çalışmada
diğerlerinden farklı olarak uygulanan programın öğretilen beceri üzerindeki etkisi
ön test son test ölçümleri ile belirlenmiştir.
Hedef becerilerin öğretiminde farklı uygulamaların ve eğitim programlarının
kullanıldığı çalışmalar kategorisinde yer alan bir başka çalışmada ise Ardıç (2008)
uyarlanmış yoğun tuvalet eğitiminin otistik özellikler gösteren çocukların tuvalete
çiş yapma ve kuru kalma becerilerini edinmesi üzerindeki etkisini incelerken,
Çuhadar (2008) resimli etkinlik çizelgeleri ile sunulan öğretimin otistik özellikler
gösteren çocukların serbest zaman becerilerini öğrenmeleri üzerindeki etkisini
incelemiştir. Erbaş (2001) ise çalışmasında problem davranışları azaltıp iletişim
davranışlarını arttırmada sönmeyle birlikte uygulanan işlevsel iletişim öğretiminin
etkililiğini araştırmıştır. Sözü edilen programların hedef becerilerin öğretiminde
etkili olduğu görülmüştür.
İzleme ve genelleme süreci incelendiğinde, beceri öğretimine odaklanan tez
çalışmalarının beşinde izleme (Akköse, 2008; Altunel, 2007; Canay, 2003;
Çuhadar, 2008; Odluyurt, 2007) ve yedisinde genelleme (Akköse, 2008; Altunel,
2007; Bakkaloğlu, 2004; Canay, 2003; Çuhadar, 2008; Erbaş, 2001; Odluyurt,
2007 ) sürecinin planlandığı ve bu süreçlere ilişkin veri toplandığı sonucuna
ulaşılmıştır. Çalışmaların tümünde katılımcıların edindikleri becerileri öğretimden
sonra koruduğu ve bu becerileri farklı ortam, kişi ve araç-gereçlere genelledikleri
görülmüştür. Beceri öğretimi kategorisinde yer alan tez çalışmalarına ilişkin
önemli olduğu düşünülen bilgiler Tablo 1’de sunulmuştur.
Okul öncesi dönemde kaynaştırma
Okul öncesi dönemde kaynaştırma kategorisinde okul öncesi eğitim
öğretmenlerinin ve ailelerin gelişimsel gerilik/yetersizlik gösteren çocukların okul
öncesi eğitim kurumlarında kaynaştırılmasına ve kaynaştırma uygulamalarına
ilişkin görüş, öneri ve tutumlarını konu alan ve kaynaştırmanın, çocukların
gelişimi üzerindeki etkisini inceleyen tez çalışmaları incelenmiştir. Bu ölçütleri
karşılayan dört tez çalışması (Baysal-Metin, 1989; Odluyurt, 2007; Özbaba, 2000;
Varlıer, 2004) bulunmaktadır.
Okul öncesi dönemde kaynaştırma uygulamalarına ilişkin görüş, öneri ve
tutumları konu alan çalışmalarda 110 öğretmen ve 340 veli olmak üzere toplam
450 kişi ile çalışılmıştır. Çalışmalara dahil edilen velilerin 40’ı 3-6 yaş
dönemindeki gelişimsel gerilik/yetersizlik gösteren çocukların velisi iken, 300’ü
3-6 yaş dönemindeki normal gelişim gösteren çocukların velisidir.
Baysal-Metin (1989) ise yaptığı tez çalışmasında okul öncesi dönemde
kaynaştırma programına katılan (deney grubu) ve katılmayan (kontrol grubu)
down sendromu tanısı bulunan 4-6 yaş grubundaki 12 çocuk ile çalışmış; kontrol
ve deney grubundaki çocukların bilişsel, dil, motor, sosyal ve özbakım gelişim
alanlarındaki gelişimlerini karşılaştırmış ve kaynaştırma programlarına katılan
down sendromlu çocukların, özel eğitim sınıfındaki down sendromlu çocuklara
göre bilişsel, sosyal, özbakım ve motor gelişim alanlarında istatistiksel olarak
önemli aşamalar kaydettikleri; uygulanan Denver Gelişim Tarama Testi ve Seattle
Performans Gelişim Ölçeği’nden daha yüksek puan aldıkları sonucuna ulaşmıştır.
Okul öncesi dönemdeki kaynaştırma uygulamalarının 3-6 yaş grubundaki
çocuklarının gelişimi üzerindeki etkisini inceleyen başka hiçbir tez çalışmasına
rastlanmamıştır.
Kaynaştırmaya ilişkin tutum ve görüşleri inceleyen araştırmaların her ikisinde de
(Özbaba, 2000; Varlıer, 2004) gelişimsel gerilik/yetersizlik gösteren öğrencilerin
okul öncesi dönemde kaynaştırma uygulamalarından yararlanmasının uygun olup
olmayacağı, okul öncesi dönemdeki kaynaştırma uygulamaları nedeniyle
yaşanacak sorunlar ve okul öncesi dönemdeki kaynaştırma uygulamalarının
sağlayacağı katkılar ortak olarak ele alınan konulardır. Özbaba (2000)
çalışmasında öğretmen ve velilerin belirtilen konulara ilişkin tutumlarını
belirlemeye çalışırken, Varlıer (2004) yalnızca öğretmenlerin görüşlerini
belirlemeye çalışmıştır. Her iki çalışmada da öğretmenlerin eğitim düzeyi, özel
eğitim konusunda eğitim alma durumları ve deneyimlerine ilişkin bilgi
toplanmıştır. Özbaba (2000) çalışmasında bu değişkenler ile öğretmenlerin
tutumları arasındaki ilişkiyi de incelemiştir.
Özbaba (2000) ve Varlıer (2004)’in tez çalışmalarında ele aldıkları konular
arasındaki benzerlik, çalışmalardan elde edilen bulgulara da yansımıştır.
Gelişimsel gerilik/yetersizlik gösteren öğrencilerin okul öncesi eğitimi
kaynaştırma ortamında alıp almamasına ilişkin olarak Varlıer örneklemi oluşturan
öğretmenlerin tümünün özel gereksinimli öğrencilerin okul öncesi eğitim alması
gerektiği konusunda olumlu görüş belirttikleri, Özbaba ise öğretmenlerin bu
konuya ilişkin tutumlarının olumlu olduğu sonucuna ulaşmıştır.
Tablo 1
Beceri Öğretimini Konu Alan Tezler
Kaynak*
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
İ\G
GAG\
UG
SG
Bulgular
Çetin,
1995
Hacettepe
Üni.
Fiziksel eğitimin,
3-6 yaş
grubundaki down
sendromlu
çocukların büyük
kas motor
becerileri
üzerindeki etkisi
Nicel
araştırma
Yaşları 3-6
arasında
değişen 4’ü
kız 4’ü erkek
8 down
sendromlu
çocuk
E\E
H\H
H
Erbaş,
2001
Anadolu
Üni.
Sönmeyle
birlikte ve sönme
olmaksızın
kullanılan
işlevsel iletişim
öğretiminin
gelişim geriliği
olan
katılımcıların
problem
davranışlarını
azaltıp iletişim
davranışlarını
arttırma
üzerindeki
etkililiklerinin
karşılaştırılması
Dil ve
konuşmada
yetersizlik
gösteren,
yaşları 3-5
arasında
değişen 2’si
erkek 1’i kız
olmak üzere
toplam 3
çocuk.
H\E
E\E
E
Canay,
2003
Anadolu
Üni.
İpucunun giderek
azaltılmasıyla
öğretimin otistik
çocuklara
söylenen komutu
yerine getirilmesi
becerisinin
öğretimi
üzerindeki
etkiliği
Tek
denekli
araştırma
1.
bölümde
dönüşüm
lü
uygulam
alar
modeli.
2.
bölümde
çoklu
uygulam
alar
modeli
olarak
bilinen
ABCBC
Tek
denekli
araştırma
Yoklama
evreli
denekler
arası
çoklu
yoklama
modeli
Yürüme, koşma,
sıçrama,
minder, top,
denge, engel
seti, bisiklet ve
merdiven
kategorilerindek
i hareketlerde
verilen eğitimin
çocukların kaba
motor becerileri
kazanmalarında
etkili olduğu
sonucuna
ulaşılmıştır.
Problem
davranışları
azaltıp iletişim
davranışlarını
arttırmada
sönmeyle
birlikte
uygulanan
işlevsel iletişim
öğretiminin 2
çocuk için etkili
olduğu
bulunmuş; 1
çocuk için ise
uygulamaların
etkililikleri
arasında fark
bulunamamıştır.
Yaşları 5-6
arasında
değişen otizm
tanısı olan 2
erkek 1 kız
çocuk
E\E
E\E
H
Otistik bireylere
ipucunun
giderek
azaltılmasıyla
öğretimin
söylenen
komutun
(al,ver,koy,göst
er,otur,gel,tak,çı
kart,aç) yerine
getirilmesi
becerisinin
öğretiminde
etkili olduğu
görülmüştür.
*Yıla gore düzenlenmiştir. İ: İzleme, G: Genelleme,GAG: Gözlemciler Arası Güvenirlik, UG: Uygulama Güvenirliği, SG:
Sosyal Geçerlik, E: Evet, H. Hayır
Tablo 1
Beceri Öğretimini Konu Alan Tezler (Devam)
Kaynak*
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
İ\G
GAG\
UG
SG
Bulgular
Bakkaloğlu,
2004
Ankara Üni.
Etkinliğe dayalı
müdahale
programının
çocukların
yönergelere
uyma, sıra alma,
bağımsız
çalışma ve
materyalleri
toplama
becerilerini
kazanmaları
üzerindeki etkisi
Otistik özellik
gösteren
öğrencilere
“nerede, ne
zaman, ne
olur?”
sorularına sözel
olarak cevap
verme
davranışlarının
öğretiminde
küçük grup
düzenlemesiyle
sunulan
eşzamanlı
ipucuyla
öğretimin
etkililiği
Nicel
araştırm
a
Yaşları 42-65
ay arasında
değişen 3’ü
kız 4’ü erkek,
2’si serebral
palsi, 5’i
down
sendromu
tanısı almış 7
çocuk.
H\E
E\E
E
Etkinliğe dayalı
müdahale
programının
çocukların
hedeflenen 4
beceriyi
edinmesinde
etkiliği olduğu
sonucuna
ulaşılmıştır.
Tek
denekli
araştırm
a
Yoklam
a evreli
davranış
lar arası
çoklu
yoklama
modeli
Yaşları 5-7
arasında
değişen otizm
tanısı bulunan
2’si erkek 1’i
kız toplam 3
çocuk.
E\E
E\E
H
Okul öncesi
dönemdeki
gelişimsel
yetersizlik
gösteren
çocukların
kaynaştırmaya
hazırlık
becerilerini
edinmesinde
etkinlikler içine
gömülen
eşzamanlı
ipucuyla
öğretimin
etkiliği
Tek
denekli
araştırm
a
Yaşları 3 yaş3yaş 5 ay
arasında
değişen,
gelişimsel
geriliği olan
1’i kız 2’si
erkek 3 çocuk
E\E
E\E
E
Küçük grup
öğretim
düzenlemesiyle
sunulan
eşzamanlı
ipucuyla
öğretimin otistik
özellik gösteren
öğrencilere
“nerede, ne
zaman ve ne
olur?”
sorularına sözel
olarak cevap
verme
becerilerinin
öğretiminde
etkili olduğu
görülmüştür
Gelişimsel
yetersizlik
gösteren 3
denek
kaynaştırmaya
hazırlık
becerilerini
ölçütü karşılar
biçimde
edinmişlerdir. 2
denek
edindikleri
becerileri 7
hafta boyunca
korumuştur.
Altunel,
2007
Anadolu
Üni.
Odluyurt,
2007
Anadolu
Üni.
*Yıla gore düzenlenmiştir. İ: İzleme, G: Genelleme,GAG: Gözlemciler Arası Güvenirlik, UG: Uygulama Güvenirliği, SG:
54
Tablo 1
Beceri Öğretimini Konu Alan Tezler (Devam)
Kaynak*
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
İ\G
GAG\
UG
SG
Bulgular
Akköse,
2008
Anadolu
Üni.
Eşzamanlı
ipucuyla
öğretimin
mutfak araç
isimlerinin
öğretimi
üzerindeki
etkiliği ve
öğretimi yapılan
becerinin
genellenmesind
e çoklu
örneklerle
genelleme
yaklaşımının
etkisi
Tek
denekli
araştırm
a
Yoklam
a evreli
davranış
lar arası
çoklu
yoklama
modeli
Yaşları 4-6
arasında
değişen
otizm,down
sendromu ve
zihinsel
yetersizlik
tanısı bulunan
2’si erkek 1’i
kız 3 çocuk
E\E
E\E
H
Eş zamanlı
öğretimin
mutfak
araçlarının
ismini söyleme
becerisinin
öğretiminde
etkili olduğu,
çoklu örneklere
göre genelleme
yaklaşımı
kullanılarak
öğrenilen
becerinin farklı
örneklere
genellenmesinin
sağlandığı
sonucuna
ulaşılmıştır.
Ardıç,
2008
Anadolu
Üni.
Otistik
özellikler
gösteren
çocuklara
tuvalet
becerilerinin
öğretiminde
uyarlanmış
yoğun tuvalet
eğitminin
etkililiğinin
incelenmesi
Tek
denekli
araştırm
a
Denekle
r arası
yoklama
evreli
çoklu
başlama
düzeyi
modeli
Yaş
ortalamaları
4.1 olan ve
otizm tanısı
bulunan 3
çocuk
H\H
E\E
E
Çuhadar,
2008
Anadolu
Üni.
Resimli etkinlik
çizelgeleri ile
sunulan öğretim
sürecinin otistik
özellikler
gösteren
çocukların
serbest zaman
becerilerini
öğrenmeleri
üzerindeki etkisi
Tek
denekli
araştırm
a
Denekle
r arası
yoklama
evereli
çoklu
yoklama
modeli
Yaşları 4-6
arasında
değişen otizm
tanısı bulunan
3 erkek çocuk
E\E
E\E
E
Uyarlanmış
yoğun tuvalet
eğitimi
yönteminin
otistik özellikler
gösteren
çocuklara
tuvalete çiş
yapma ve kuru
kalma
becerilerinin
edinim
düzeyinde
öğretilmesinde
etkili olduğu
sonucuna
ulaşılmıştır.
Resimli etkinlik
çizelgeleri ile
sunulan
öğretimin
katılımcıların
resimli etkinlik
çizelgesini
izleme ve
etkinliği yerine
getirme
davranışını
kazanmasında
etkili olduğu
sonucuna
ulaşılmıştır.
*Yıla göre düzenlenmiştir. İ: İzleme, G: Genelleme, GAG: Gözlemciler Arası Güvenirlik, UG: Uygulama Güvenirliği, SG:
International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1
Her iki çalışmada ortak olarak ele alınan diğer konular ise kaynaştırma
uygulamalarında yaşanacak sorunlar ve bu tür uygulamaların sağlayacağı
yararlardır. Varlıer (2004) kaynaştırmaya ilişkin olumlu görüş belirten
öğretmenlerin bile kaynaştırmaya ilişkin “sınıf ve davranış kontrolünde güçlük
yaşanması, öğretmenin özel gereksinimli öğrenciler konusunda bilgisiz ve
deneyimsiz olması, normal gelişim gösteren öğrencilerin özel gereksinimli
öğrenciyi kabullenememeleri, özel gereksinimli öğrenci ile diğer öğrencilerin
iletişim kuramaması” gibi pek çok sorun yaşadıkları, bilgi ihtiyacı içinde oldukları
ve kaynaştırmanın hem özel gereksinimli öğrenci hem de normal gelişim
gösteren öğrenci için olumlu katkı sağladığına inandıkları sonucuna ulaşmıştır.
Özbaba (2000) ise kendisi tarafından geliştirilen beşli likert tipi tutum ölçeğinde
kaynaştırmanın neden olduğu sorunlara ve sağladığı katkılara ilişkin maddelere
yer vermiştir. Ancak verileri analiz ederken yalnızca öğretmenler ile ilgili olarak
ele alınan eğitim düzeyi, özel eğitim konusunda eğitim almış olma, kaynaştırma
konusunda eğitim almış olma ve deneyim gibi değişkenlerin öğretmenlerin
kaynaştırmaya ilişkin tutumlarında bir farklılığa yol açıp açmadığını analiz etmiş
ve ele alınan değişkenlerin anlamlı bir farklılığa yol açmadığı sonucuna
ulaşmıştır. İki çalışma arasındaki en önemli fark Varlıer (2004)’in çalışmasında
yalnızca okul öncesi eğitim öğretmenlerinin kaynaştırmaya ilişkin görüşlerine
odaklanırken, Özbaba (2000)’nın farklı branşlardaki öğretmenlerin tutumlarına
odaklanmasıdır.
Odluyurt (2007) tez çalışmasında gelişimsel gerilik/yetersizlik gösteren
çocukların okul öncesi dönemde kaynaştırma uygulamalarında başarılı olmasında
etkili olan hazırlık becerilerine ilişkin okul öncesi eğitim öğretmenlerinin
görüşlerine başvururken, Özbaba (2000) öğretmenlerin ve velilerin kaynaştırmaya
ilişkin tutumlarını belirlemeye çalışmıştır. Varlıer (2004) ise kaynaştırmaya ilişkin
okul öncesi eğitim öğretmenlerinin görüş ve önerilerini incelemiştir. Tüm
araştırmalarda görüş, öneri ve tutumlar araştırmacılar tarafından geliştirilen
değerlendirme araçları kullanılarak belirlenmeye çalışılmıştır. Okul öncesi
dönemde kaynaştırma kategorisinde yer alan tez çalışmalarına ilişkin önemli
olduğu düşünülen bilgiler Tablo 2’de sunulmuştur.
Ailelere öğretim sunma becerisi kazandırma
Ailelere belli bir programı uygulama becerisi kazandıran ve bu programda başarılı
olan ailelerin çocuklarına öğretim sunmasını konu alan tez çalışmaları ailelere
öğretim sunma becerisi kazandırma kategorisinde ele alınmıştır. Bu özellikleri
taşıyan üç tez çalışmasına (Birkan, 2001; Özcan, 2004; Tuş-Gümüşçü, 1996)
ulaşılmıştır. Birkan (2001) tez çalışmasında ailelere Küçük Adımlar Programı’nı
uygulama becerisi kazandırmayı amaçlarken, Özcan (2004) ise kendisi tarafından
geliştirilen Tuvalet Becerisi Öğretimi Aile Eğitim Programı’nı uygulama becerisi
kazandırmayı amaçlamıştır.
Tuş-Gümüşçü (1996)’nün tez çalışması bazı özellikleriyle bu kategoride yer alan
diğer tez çalışmalardan farklılık göstermektedir. Tuş-Gümüşçü (1996)’nün tez
çalışmasının asıl amacı ailelere Portage Erken Çocukluk Dönemi Eğitim
Programı’nı kullanarak çocuklarına öğretim sunma becerisi kazandırmak değil, ev
merkezli bir program olan Portage Programı’nın bebeklerin gelişimi üzerindeki
Tablo 2
Okul Öncesi Dönemde Kaynaştırmayı Konu Alan Tezler
Veri
Toplama
Araçları
Kaynak
*
Tezin Amacı
Yönte
m
Denekler ve
Özellikleri
BaysalMetin,
1989
Hacette
pe Üni
Kaynaştırma
programının, bu
programa katılan 46 yaş grubundaki
down sendromlu
çocukların
gelişimleri (bilişsel,
dil, motor, sosyal ve
özbakım gelişim
alanlarına)
üzerindeki etkisi
Nicel
Araştı
rma
Deney
grubunda,
kaynaştırma
programına
katılan 2’si kız,
4’ü erkek
toplam 6 down
sendromlu
çocuk (yaş
ortalamaları 5
yaş 3 ay);
kontrol
grubunda ise
özel eğitim
sınıfında eğitim
gören 2’si kız,
4’ü erkek olmak
üzere toplam 6
down
sendromlu
çocuk (yaş
ortalamaları 5
yaş 9 ay)
-Kişisel
bilgi formu
-Denver
Gelişim
Tarama
Testi
-Seattle
Performans
Gelişim
Ölçeği
-Süreli
Gözlem
Formu
Kaynaştırma
programlarına katılan
down sendromlu çocuklar,
özel eğitim sınıfındaki
down sendromlu
çocuklara göre bilişsel,
sosyal, özbakım ve motor
gelişim alanlarında
istatistiksel olarak önemli
aşamalar kaydetmişlerdir.
Özbaba,
2000
Marmar
a Üni.
Kurumda normal
gelişim gösteren
çocuğu ve özürlü
çocuğu bulunan
ailelerle kurumda
görev yapmakta
olan eğitimcilerin
okul öncesi eğitim
kurumlarındaki
kaynaştırma
uygulamalarına
karşı tutumlarının
bazı değişkenler
açısından
incelenmesi
Nicel
araştır
ma
40’ı özürlü
çocuk velisi,
260’ı normal
gelişim gösteren
çocuk velisi
olan toplam 300
veli ve 32
eğitimci olmak
üzere 332 kişi.
-Anket
-Kişisel
bilgi formu
-Tutum
ölçeği
Anne-babalara ait
değişkenlerden özürlü
çocuğa sahip olma,
programa katılan özürlü
çocuktan rahatsız olma,
özürlü çocuğun
programdan etkilenme
durumu, sahip olunan
özürlü çocuğun özür türü,
programa katılım süresi
değişkenlerinin
tutumlarda anlamlı bir
farklılığa yol açtığı,
öğretmenlerle ilgili
değişkenlerin ise anlamlı
bir farklılığa yol açmadığı
bulunmuştur.
Bulgular
*Yıla göre düzenlenmiştir.
Tablo 2
Okul Öncesi Dönemde Kaynaştırmayı Konu Alan Tezler (Devam)
Yönte
m
Denekler ve
Özellikleri
Okul öncesi
eğitim
öğretmenlerinin
özel gereksinimli
öğrencilerin okul
öncesi eğitim
kurumlarında
kaynaştırılmasına
yönelik görüş ve
önerilerinin
belirlenmesi
NicelNitel
araştır
ma
30 okul öncesi
eğitim
öğretmeni
Okul öncesi
dönemde
gelişimsel
yetersizlik
gösteren çocuklar
için gerekli
kaynaştırmaya
hazırlık
becerilerinin
belirlenmesi
Nicel
araştır
ma
Kaynak*
Tezin Amacı
Varlıer,
2004
Anadolu
Üni.
Odluyurt
2007
Anadolu
Üni.
Veri
Toplama
Araçları
Yarı
yapılandırıl
mış
görüşme
formu
Araştırmacı
günlüğü
36-72 aylık
çocuklara
eğitim veren
okul öncesi
eğitim
kurumlarında
görev yapan 48
öğretmen
Okul Öncesi
Dönemde
Gelişimsel
Yetersizlik
Gösteren
Öğrencilerin
Sahip
Olması
Gereken
Kaynaştırm
aya Hazırlık
Becerilerine
Yönelik
Görüş
Belirleme
Anketi
Bulgular
Tüm öğretmenler özel
gereksinimli öğrencilerin
okul öncesi eğitim alması
gerektiği konusunda
birleşmektedirler.
Kaynaştırmaya istekli
olan öğretmenlerin bile
kaynaştırmayla ilgili pek
çok sorun yaşadıkları,
bilgi ihtiyacı içinde
oldukları, bu ihtiyacı
karşılamak için de
toplantı, konferans,
seminer gibi çözüm
yolları önerdikleri
görülmüştür.
Grup etkinliklerinde
sunulan 2 basamaklı
yönergeleri takip
etme,etkinliklere parmak
kaldırarak katılma ve
………. istiyor musun?
sorusuna başını sallyarak
isteğini belirtme becerileri
öğretilmesi gereken
hazırlık becerileri olarak
belirlenmiştir.
etkisini incelemektir. Tuş-Gümüşçü (1996) bu amaçla bebeklere kazandırılacak
becerileri ve bu becerilerin kazandırılmasında kullanılacak etkinlikleri kendisi
belirlemiş, öğretilecek beceri için hazırlanan etkinliği bebeğe uygulamış ve daha
sonra ailenin de aynı etkinliği çocuğuna uygulamasını sağlamıştır. Başka bir
deyişle uygulama hem araştırmacı hem de aile tarafından yürütülmüştür. TuşGümüşçü (1996) çalışmasında ayrıca ailelere değerlendirme yapmayı ve çocuğun
gelişimini izlemeyi de öğretmiş, kendisi ve aileler tarafından sunulan öğretimin
çocukların gelişimi üzerindeki etkisini incelemiştir. Bu nedenle bu tez çalışması
beceri öğretimi kategorisinde değil, ailelere öğretim sunma becerisi kazandırma
kategorisinde ele alınmıştır.
Amaçlarda ortaya çıkan farklılıklar katılımcıların seçimine de yansımıştır.
Ailelere öğretim sunma becerisi kazandırmayı amaçlayan tez çalışmalarında
yaşları 3-6 arasında değişen gelişimsel gerilik/yetersizlik gösteren çocuğa sahip
toplam 7 anne ile çalışılmıştır. Tuş-Gümüşçü (1996) ise tez çalışmasında yaşları
7-30 ay arasında değişen 7’si kız 9’u erkek olmak üzere toplam 16 down
sendromu tanısı olan bebek ve anneleri ile çalışmıştır. Bebeklerin 10’u deney, 6’sı
ise kontrol grubunu oluşturmuştur. Ulaşılan tez çalışmaları arasında bu tez 0-3 yaş
grubundaki çocuklara beceri öğretimini konu alan tek çalışma olma özelliği
taşımaktadır.
Birkan (2001) ve Özcan (2004)’ın tez çalışmalarının katılımcılarda aranan
önkoşul özellikler, deneklerin seçimi, çalışmanın yürütülmesi ve
değerlendirilmesi aşamaları birbirine oldukça benzerdir. Her iki tez çalışmasında
da katılımcıların seçimi için bir toplantı gerçekleştirilmiş ve 3-6 yaş arasında
gelişimsel gerilik/yetersizlik gösteren çocuğa sahip olma ve okuma- yazma bilme
önkoşul becerilerine sahip anneler arasından araştırmaya katılmaya gönüllü olan
anneler belirlenmiştir. Araştırmanın bir sonraki adımında Birkan annelere Küçük
Adımlar Programı’nı, Özcan ise Tuvalet Becerisi Öğretimi Aile Eğitim
Programı’nı uygulama becerisi kazandırmıştır. Araştırmanın son adımında ise
programı uygulama becerisi kazanan annelerin çocuklarına ilgili becerileri
öğretmesi hedeflenmiştir. Bu amaçla araştırmacılar ev ziyaretleri ve toplantılar
yaparak anneler tarafından gerçekleştirilen öğretim uygulamalarını gözlemlemiş
ve bu uygulamalara ilişkin veri toplamıştır. Her iki araştırmadan elde edilen
sonuçlar incelendiğinde annelerin hem eğitim programlarını uygulama becerisini
edinmede hem de çocuklarına öğretim sunmada başarılı oldukları ve çocukların
anneleri tarafından yapılan öğretim sonucunda ilgili becerileri edindikleri
gözlenmiştir.
Tuş-Gümüşçü (1996)’nün çalışması ise araştırmanın amacı, örneklemi, süreci ve
dolayısıyla bulguları açısından Birkan (2001) ve Özcan (2004)’ın çalışmalarından
farklılık göstermektedir. Tuş-Gümüşçü deney grubunda yer alan ve erken gelişim
programına alınarak hem araştırmacı hem de aileleri tarafından Portage Erken
Çocukluk Dönemi Eğitim Programı uygulanan down sendromlu bebeklerin bütün
gelişim alanlarında kontrol grubundaki bebeklerden daha fazla ilerleme
kaydettikleri ve çalışmaya katılan ailelerin çocuklarına öğretim sunma becerisinde
artış olduğu sonucuna ulaşmıştır.
Her 3 çalışmada da annelere, çocuklarına öğretim sunma becerisi kazandırılmış,
baba, büyük anne-baba gibi diğer aile üyelerine gelişimsel gerilik/yetersizlik
gösteren çocuklarına öğretim sunma becerisi kazandırmayı amaçlayan hiçbir
çalışmaya rastlanmamıştır. Ailelere öğretim sunma becerisi kazandırma
kategorisinde yer alan tez çalışmalarına ilişkin önemli olduğu düşünülen bilgiler
Tablo 3’de sunulmuştur.
Gelişimsel gerilik/yetersizlik gösteren çocukları birbirleri ve normal gelişim
gösteren akranları ile karşılaştırma
0-6 yaş dönemindeki gelişimsel gerilik/yetersizlik gösteren çocuklar ile normal
gelişim gösteren çocukları ya da farklı tanılara sahip çocukları belli özellikleri,
davranışları ve gelişimleri açısından karşılaştıran tez çalışmaları gelişimsel
gerilik/yetersizlik gösteren çocukları birbirleri ve normal gelişim gösteren
akranları ile karşılaştırma kategorisinde ele alınmıştır.
Tablo 3
Ailelere Öğretim Sunma Becerisi Kazandırmayı Konu Alan Tezler
Kaynak*
Tezin Amacı
Yöntem
Tuş-Gümüşçü
1996
Hacettepe
Üni.
Portage Erken
Eğitim
Programının 1024 aylar
arasındaki down
sendromlu
bebeklerin
uyarım, özbakım,
motor, sosyal,
bilişsel ve dil
gelişim alanları
üzerindeki
etkisinin
incelenmesi
Nicel
araştırma
Birkan
2001
Anadolu Üni.
Küçük Adımlar
kursunun gelişim
geriliği gösteren
çocuğa sahip
annelerin bu
programı
kullanarak kendi
çocuklarını
değerlendirme,
kendi çocukları
için öğretim
programı
hazırlama,kendi
çocuklarına
öğretim yapma
becerisini
kazanmalarına ve
kazandıkları
beceriyi
sürdürmelerine
etkisi.
Tuvalet
becerilerini
öğretim
programında
başarılı olan
anneler tarafından
sunulan eğitimin
çocukların bu
beceriyi
öğrenmeleri
üzerindeki
etkililiği
Tek
denekli
araştırma
.
Davranışl
ar arası
yoklama
evreli
çoklu
yoklama
modeli
Özcan
2004
Anadolu Üni.
Tek
denekli
araştrıma
Yoklama
evreli
denekler
arası
çoklu
yoklama
modeli
Denekler ve
Özellikleri
Deney grubunda
yaşları 10-24 ay
arasında değişen
down
sendromlu 5 kız
5 erkek toplam
10 bebek,
kontrol
grubunda
yaşları 7-30 ay
arasında değişen
down
sendromlu 2 kız
4 erkek toplam
6 bebek
0-6 yaş arasında
gelişimsel
geriliğe sahip 4
çocuğun annesi
GAG\
UG
H\H
SG
Bulgular
H
Erken gelişim
programına alınan
ve aileleri ve
araştırmacı
tarafından portage
uygulanan down
sendromlu
bebeklerin bütün
gelişim
alanlarında
ilerleme
kaydettikleri
bulunmuştur.
E\E
E
Tüm annelerin
Küçük Adımlar’ı
uygulama
becerilerini %100
düzeyinde
sergiledikleri ve
öğrendikleri
becerileri
sürdürdükleri
görülmüştür
Yaşları 32-37
arasında değişen
3 anne ve
yaşları 4-5
arasında
değişen, 2’sinde
otistik özellikler
de bulunan 3
zihin engelli
erkek çocuk
E\E
H
Programda
başarılı olan
annelerin program
doğrultusunda
yaptığı tuvalet
becerisi öğretimi
çalışmaları
sonucunda zihin
özürlü çocukların
tuvalet becerisini
öğrendikleri
görülmüştür
*Yıla göre düzenlenmiştir. GAG: Gözlemciler Arası Güvenirlik, UG: Uygulama Güvenirliği, SG: Sosyal Geçerlik, E: Evet,
H. Hayır
Bu amaçla gerçekleştirilen üç tez çalışması (Bilgiç, 2007; Özenmiş, 2000;
Zeteroğlu, 2006) bulunmaktadır. Özenmiş (2000) tez çalışmasında zihin engelli
tanısı olan ve olmayan çocukların nesneyle oyun davranışlarını karşılaştırırken,
Zeteroğlu (2006) otizm tanısı bulunan çocuklarla normal gelişim gösteren
çocukların dil, bilişsel, psiko-motor ve sosyal-duygusal gelişim alanlarındaki
gelişim düzeylerini karşılaştırmış ve ek olarak anne-babaların öğrenim düzeyinin
çocukların gelişimine etkisini incelemiştir. Bilgiç (2007) ise gelişimsel
gerilik/yetersizlik (GG) ve yaygın gelişimsel bozukluk (YGB) tanısı olan
çocukları sosyo-demografik, klinik ve anne-baba özellikleri açısından
karşılaştırmıştır.
Bu kategorideki tez çalışmaları kapsamında toplam 139 gelişimsel
gerilik/yetersizlik gösteren çocuk ve 75 normal gelişim gösteren çocuk ile
çalışılmıştır. Anne ve babanın sosyo-demografik özelliklerini de inceleyen
araştırmalarda 199 anne-baba ile çalışılmıştır. Gelişimsel gerilik/yetersizlik
gösteren 139 çocuğun 15’inin zihin engeli, 29’unun gelişimsel gerilik/yetersizlik,
95’inin ise yaygın gelişimsel bozukluk tanısı bulunmaktadır. Gelişimsel
gerilik/yetersizlik gösteren 139 çocuğun 109’u 17-48 ay yaş grubunda, 30’u ise
49-72 ay yaş grubundadır. Her üç çalışmada da hangi yaş aralığındaki çocukların
çalışmaya dahil edileceği takvim yaşları temel alınarak belirlenmiş; ancak
Özenmiş (2000) tez çalışmasında çocukları takvim yaşları yerine, gelişimsel
yaşlarını temel alarak karşılaştırmıştır.
Özenmiş (2000)’in tez çalışmasının sonucunda gelişimsel gerilik/yetersizlik
gösteren ve göstermeyen çocuklar arasında nesne ile oyun davranış miktarları
açısından önemli bir fark bulunamamıştır. Zeteroğlu (2006)’nun çalışmasında ise
gelişimsel gerilik/yetersizlik gösteren çocukların tüm gelişim alanlarında normal
gelişim gösteren çocuklardan daha düşük puanlar aldıkları görülmüştür. Nesne ile
oyun davranışı da gelişimin önemli bir parçası olduğuna göre çalışmaların
sonuçları arasındaki farklılık dikkat çekicidir. Çalışmalarda kullanılan veri
toplama araçlarının özelliklerinin bu farklılıkta önemli bir payı olduğu
düşünülmektedir.
Özenmiş (2000) çalışmasında kendisinin geliştirdiği Nesne ile Oyun Gözlem
Formu’nu kullanmış, bu formu geliştirirken hem gelişimsel gerilik/yetersizlik
gösteren hem de göstermeyen çocuklar tarafından sergilenen oyun türlerini
dikkate almış, normal gelişim gösteren çocuklar tarafından sergilenen, ancak
gelişimsel gerilik/yetersizlik gösteren çocuklar tarafından sergilenemeyen üst
düzey nesne ile oyun türlerini forma dahil etmemiştir. Ayrıca çalışmada çocuklar
aynı takvim yaşına sahip akranları ile değil aynı gelişim yaşına sahip akranları ile
karşılaştırılmıştır. İki grup arasında anlamlı bir farkın bulunamamasında bu
özelliklerin etkili olduğu düşünülmektedir. Zeteroğlu (2006) ise çalışmasında
standart bir test olan Gazi Erken Çocukluk Gelişimi Değerlendirme Aracı
(GEÇDA)’nı kullanmıştır. GEÇDA normal gelişim evreleri ve özellikleri dikkate
alınarak hazırlanan bir değerlendirme aracı olduğu için gelişimsel
gerilik/yetersizlik gösteren çocuklar bu değerlendirme aracından normal gelişim
gösteren akranlarına göre daha düşük puanlar almış olabilir.
Bilgiç (2007) ise tez çalışmasında Özenmiş (2000) ve Zeteroğlu (2006)’ndan
farklı olarak, farklı tanılara sahip olan çocukları sosyodemografik, klinik ve anababa özellikleri bakımından incelemiş ve iki grubu benzer ve farklı özellikleri
açısından karşılaştırmıştır. Bu çalışmanın sonucunda YGB’li çocukların GG
olanlara göre daha erken dönemde kliniğe başvurdukları saptanmıştır. GG
grubunda parçalanmış aile oranı YGB grubuna göre anlamlı düzeyde daha yüksek
bulunmuştur. Her iki grupta da “konuşma gecikmesi” en sık belirtilen yakınma
olmuştur. Aile Değerlendirme Ölçeği puanları incelendiğinde ise duygusal tepki
verebilme alt alanlarında hem annelerde hem babalarda, iletişim alanında ise
annelerde GG grubunun YGB grubuna göre daha fazla sorun belirttiği
görülmüştür. Bu kategoride yer alan tez çalışmalarına ilişkin önemli olduğu
düşünülen bilgiler Tablo 4’de sunulmuştur.
Çocuklara ilişkin varolan bir durumu betimleme
Çocuklara ilişkin varolan bir durumu betimleme kategorisinde herhangi bir
uygulamada bulunulmaksızın varolan bir durumu gözleme yoluyla veri toplanan
ve sonuca ulaşılan çalışmalar incelenmiştir. Bu amaçla yapılmış tek bir tez
çalışmasına (Çağlar, 2006) ulaşılmıştır. Çağlar (2006) bu çalışmasında 5 yaşında
otistik çocuğa sahip bir annenin mutfak etkinliği sırasında çocuğuyla
etkileşimlerinde kullandığı stratejileri betimlemeyi amaçlamıştır. Araştırmanın
örneklemini 1 anne ve 5 yaşında otizm tanısı bulunan bir çocuk oluşturmaktadır.
Bu araştırma erken çocukluk döneminde dil gelişiminin incelenmesinde
“çocukların, dili, günlük yaşam içinde yer alan rutin işler ve oyunlar sırasında
ortaya çıkan etkileşimler sonucunda öğrendikleri görüşünü temel alan ve bu
süreçte okul öncesi dönemdeki deneyimlerin önemini vurgulayan” sosyal
etkileşimci yaklaşımı temel alması nedeniyle önemlidir.
Çağlar (2006), annenin otistik çocuğuyla etkileşimleri sırasında yoğun olarak
kullandığı sözel stratejilerin soru sorma, azaltma, genişletme, pekiştirme,
ödüllendirme, vurgulama, komiklik yapma, şarkı söyleme, etiketleme ve açıklama
yapma olduğu sonucuna ulaşmıştır. Annenin kullandığı sözel olmayan etkileşim
kalıplarının ise göz kontağı kurma, jest ve mimikleri kullanma, yanıt vermesini
bekleme, görsel ipucu verme ve yardım etme olduğu saptanmıştır. Çocuklara
ilişkin var olan bir durumu betimleme kategorisinde yer alan tez çalışmalarına
ilişkin önemli olduğu düşünülen bilgiler Tablo 5’te sunulmuştur.
Çocuklara sunulan hizmetler
Erken çocukluk dönemindeki gelişimsel gerilik/yetersizlik gösteren çocukların
tanılanmasını, sunulacak özel eğitim ve rehabilitasyon hizmetleri ile sağlık
hizmetlerinin değerlendirilmesini ve incelenmesini konu alan tezler çocuklara
sunulan hizmetler kategorisinde ele alınmıştır.
Bu amaca yönelik iki tez çalışmasına (Özdemir, 2005; Yalçıntaş ,2006)
ulaşılmıştır. Özdemir çalışmasında özel eğitim ve rehabilitasyon kurumlarına
yönlendirilen 0-3 yaş arasındaki çocukların bu yönlendirme sırasında hizmete
ulaşmalarını ve sürdürmelerini etkileyen etmenlerin neler olduğunu ve alınan
hizmetlerin ne denli aile merkezli destek programı niteliği taşıdığını incelemiştir.
Yalçıntaş ise 24-72 ay arasında olan otistik çocuklara sağlıklı ve erken tanı
koymayı sağlayacağı düşünülen Kendini Kontrol ve Atipik Davranışlar Ölçeği
(KADÖ)’nin uyarlama, geçerlik ve güvenirlik çalışmasını tezinde konu olarak
almıştır.
Tablo 4
Gelişimsel Gerilik/yetersizlik Gösteren Çocukları Birbirleri ve Normal Gelişim
Gösteren Akranları ile Karşılaştırmayı Konu Alan Tezler
Kaynak*
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
Veri Toplama
Araçları
Özenmiş,
2000
Ankara
Üni.
Gelişimsel yaşa
göre eşleştirilen
zihinsel engelli
olan ve olmayan
çocukların
nesneyle oyun
davranışlarının
karşılaştırılması.
Nicel
araştırma
12-42 aylık 15’i
zihinsel engelli
olan,
15’i
engelli olmayan
30 çocuk ve bu
çocukların
anneleri.
Kimlik bilgi
formu
Zeteroğlu,
2006
Gazi Üni.
25-72 aylar
arasındaki otistik
çocuklarla normal
gelişim gösteren
çocukların
gelişimlerinin
karşılaştırılması,
ebeveynlerin
öğrenim
düzeylerinin
çocukların
gelişimleri
üzerindeki
etkilerinin
incelenmesi.
Yaygın gelişimsel
bozukluk ve
gelişimsel
gerilik/yetersizlik
tanısı konulmuş
olan bebek ve
küçük çocukların
sosyodemografik,
klinik ve ana-baba
özellikleri
bakımından
incelenmesi ve iki
grubun benzer ve
farklı
özelliklerinin
saptanması.
Nicel
araştırma
25-72 aylar
arasında otistik
özellikler
gösteren 60
çocuk ve yine
aynı yaş
aralığında
normal gelişim
gösteren 60
çocuk olmak
üzere toplam
120 çocuk ve
anne-babaları
Gazi Erken
Çocukluk
Gelişimi
Değerlendirme
Aracı
17-45 ay
aralığındaki
35’i YGB (5 kız
30 erkek) ve
29’u GG (9 kız
20 erkek) tanısı
olan toplam 64
çocuk
-Ankara Gelişim
Tarama Envanteri
-Vineland Uyum
Davranış Ölçeği
-Klinik Problem
Çözme İşlevi
-Bebeklik ve
Erken Çocukluk
Döneminde
Ruhsal
Bozuklukların ve
Gelişimsel
Sorunların Tanı
Sınıflaması
-DSM-IV Tanı
Ölçütlerine Göre
Eksen-I
Bozuklukları için
Yapılandırılmış
Klinik Görüşme
-Aile
Değerlendirme
Ölçeği
-Genel Sağlık
Anketi
Bilgiç,
2007
Ankara
Üni.
Nicel
araştırma
Nesneyle Oyun
Davranış Formu
Kimlik Bilgi
Formu
Bulgular
Gruplar arasında nesneyle
oyun davranış miktarları
açısından istatistiksel
olarak anlamlı bir fark
bulunmamıştır.
Normal gelişim gösteren
çocukların dil, bilişsel,
psikomotor, sosyal
duygusal gelişim
alanlarında otistik
çocuklardan daha yüksek
puan aldıkları; lise ve
üniversite mezunu annebabaların otistik
çocuklarının gelişim
puanlarının ilkokul
mezunu anne-babalardan
daha yüksek olduğu
görülmüştür.
YGB’li çocukların GG
olanlara göre daha erken
dönemde kliniğe
başvurdukları saptanmıştır.
GG grubunda parçalanmış
aile oranı YGB grubuna
göre anlamlı düzeyde daha
yüksek bulunmuştur. Her
iki grupta da “konuşma
gecikmesi” en sık belirtilen
yakınma olmuştur. Aile
Değerlendirme Ölçeği
puanları incelendiğinde ise
duygusal tepki verebilme
alt alanlarında hem anne
hem babalarda, iletişim
alanında ise annelerde GG
grubunun YGB grubuna
göre daha fazla sorun
belirttiği görülmüştür.
Tablo 5
Çocuklara İlişkin Varolan Bir Durumu Betimlemeyi Konu Alan Tezler
Kaynak
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
Veri Toplama
Araçları
Çağlar,
2006
Marmara
Üni.
5 yaşında otistik
çocuğa sahip bir
annenin mutfak
etkinliği
sırasında
çocuğuyla
etkileşimlerinde
kullandığı
stratejilerin
betimlenmesi
Nitel
araştırma
36 yaşında
üniversite
mezunu bir
anne, 5
yaşında
otizm tanısı
bulunan kızı
ve anneanne
Saha notları
Görüşme formu
Ses ve görüntü
kayıtları
Bulgular
Annenin otistik
çocuğuyla etkileşimleri
sırasında soru sorma,
azaltma, genişletme,
pekiştirme,
ödüllendirme,
vurgulama, komiklik
yapma, şarkı söyleme,
etiketleme ve açıklama
yapma sözel
stratejilerini kullandığı
Annenin kullandığı
sözel olmayan etkileşim
kalıplarının ise göz
kontağı kurma, jest ve
mimikleri kullanma,
yanıt vermesini
bekleme, görsel ipucu
verme ve yardım etme
olduğu saptanmıştır.
Bu kategoride yer alan tez çalışmaları kapsamında erken çocukluk dönemindeki
gelişimsel gerilik/yetersizlik tanısı bulunan 54, otizm tanısı bulunan 150, zihin
engelli tanısı bulunan 50 ve normal gelişim gösteren 50 çocuk olmak üzere toplam
304 çocuk, 174 anne, 14 baba, 4 anne-baba ve 12 akraba ile çalışılmıştır.
Özdemir (2005) çalışmasında, ülkemizde gelişimsel geriliği olan çocukların erken
destek hizmetlerine ulaşmakta geciktiği, erken destek kurumlarının bilimsel
etkinliği kanıtlanmış “Aile Merkezli Erken Destek Hizmeti” niteliğine ulaşmadığı
ve bu konuyla ilgili gerekli düzenlemelerin yapılmadığı sonucuna ulaşmıştır.
Yalçıntaş (2006) ise, KADÖ’nün 24-72 ay arasında olan otistik çocuklar için
güvenilir ve geçerli bir araç olduğu, otistik çocukları normal gelişim gösteren
çocuklardan ve zihinsel yetersizliği olan çocuklardan kendini kontrol davranışı ve
atipik davranışlar bakımından ayırt edebildiği sonucuna ulaşmıştır.
Her iki çalışma da erken çocukluk dönemindeki gelişimsel gerilik/yetersizlik
gösteren çocuklara sunulan hizmetleri konu almaları açısından benzerlik
gösterirken, ele aldıkları hizmet alanları açısından farlılaşmaktadır. Özdemir
(2005) yönlendirme ve yönlendirme sonrası sunulan hizmetlere odaklanırken,
Yalçıntaş (2006) değerlendirme sürecine odaklanmıştır. Bu tez ayrıca erken
çocukluk dönemindeki otistik özellik gösteren çocukları değerlendirme ve
tanılamayı sağlayacak bir ölçeği alanyazınına kazandırması açısından önemlidir.
Çocuklara sunulan hizmetler kategorisinde yer alan tez çalışmalarına ilişkin
önemli olduğu düşünülen bilgiler Tablo 6’da sunulmuştur.
Tablo 6
Çocuklara Sunulan Hizmetleri Konu Alan Tez Çalışmaları
Kaynak*
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
Veri Toplama
Araçları
Özdemir,
2005
Ankara
Üni.
Özel eğitim ve
rehabilitasyon
kurumlarına
yönlendirilen 0-3
yaş arasındaki
çocukların bu
yönlendirme
sırasında hizmete
ulaşmalarını ve
sürdürmelerini
etkileyen
etmenlerin neler
olduğunun, alınan
hizmetlerin ne
denli aile merkezli
erken destek
programı
(AMED) niteliği
taşıdığının
belirlenmesi
Nicel
araştırma
0-36 ay
arasında
gelişimsel
geriliği
olduğu tespit
edilip özel
eğitim ve
rehabilitasyon
hizmetlerine
yönlendirilen
54 çocuk.
-Erken Çocukluk
Döneminde Gelişimi
Destekleme
Hizmetleri
Değerlendirme
Ölçeği
-Gelişimi İzleme ve
Destekleme Rehberi
(GİDR)
-Vineland Uyum ve
Davranış Ölçeği
(VUDÖ)
Ülkemizde gelişimsel
gecikmesi olan
çocukların erken destek
hizmetlerine ulaşmakta
geciktiğini, erken destek
kurumlarının bilimsel
etkinliği kanıtlanmış
“Aile Merkezli Erken
Destek Hizmeti”
niteliğine ulaşmadığı ve
bu konuyla ilgili gerekli
düzenlemelerin
yapılmadığı sonucuna
ulaşılmıştır.
Yalçıntaş,
2006
Gazi Üni.
Neisworth,
Bagnata, Salvia ve
Hun (1999)
tarafından
geliştirilen özgün
adı “Temperament
and Atypical
Behavior Scale”
olan “Kendini
Kontrol ve Atipik
Davranışlar
Ölçeği” nin 24-72
aylığa kadar olan
Türkiye’deki
otistik çocuklar
için uyarlama,
geçerlik ve
güvenirlik
çalışması
Nicel
araştırma
24-72 aylar
arasında
otizm tanısı
almış 150
çocuk, 50
normal
gelişim
gösteren
çocuk ve 50
zihinsel
yetersizliği
olan çocuk.
Otizmli
çocuğa sahip
125 anne, 13
baba, 12 diğer
akraba;
normal
gelişim
gösteren
çocuğa sahip
33 anne, 12
baba, 5 diğer
akraba;
zihinsel
yetersizliği
olan çocuğa
sahip 39
anne, 9 baba,
2 diğer akraba
Kendini Kontrol ve
Atipik Davranışlar
Ölçeği (Erken
Çocukluk Dönemi
Gelişimsel
Bozukluklarının
Belirtileri)(KADÖ)
KADÖ’nün 24 ile 72
aylık arasında olan
otistik çocuklar için
güvenilir ve geçerli bir
araç olduğu, otistik
çocukları normal gelişim
gösteren ve zihinsel
yetersizliği olan
çocuklardan kendini
kontrol davranışı ve
atipik davranışlar
bakımından ayırt
edebildiği sonucuna
ulaşılmıştır.
Bulgular
Annelerin duygu durumlarını inceleme
Buraya kadar incelenen tüm tez çalışmaları çocuklar, gelişimleri, sunulan öğretim
ve destek hizmetler ile ilgiliydi. Son kategori olan annelerin duygu durumları
kategorisi ise, tamamen 0-6/8 yaş dönemindeki gelişimsel geriliğe sahip
çocukların annelerinin duygu durumuna odaklanması ve uygulamaların odak
noktasının çocuklar değil, anneler olması nedeniyle diğer kategorilerden farklılık
göstermektedir.
0-6/8 yaş arasında gelişimsel gerilik/yetersizlik gösteren çocuğa sahip olmanın
annelerde yarattığı stres, olumsuz duygu durumu ile algılanan sosyal destek,
psikolojik müdahale ve eğitim programlarının etkilerini belirlemeyi amaçlayan tez
çalışmaları annelerin duygu durumlarını inceleme kategorisinde ele alınmış ve
değerlendirilmiştir.
Yukarıda belirtilen özellikleri karşılayan üç tez çalışması (Görgü, 2005; RichterKanık, 1998; Tezel, 2003) bulunmaktadır. Görgü (2005) çalışmasında 3-7 yaş
arası otistik çocuğa sahip olan annelerin algıladıkları sosyal destek düzeyi ile
depresyonları arasındaki ilişkiyi incelerken, Tezel (2003) kendisi tarafından
geliştirilen bir psikolojik destek programının annelerin duygu durumları
üzerindeki etkisini incelemiştir. Richter- Kanık (1998) ise, annelere yönelik olarak
kendisi tarafından hazırlanan ve sunulan erken eğitim programının down
sendromlu bebeğe sahip annelerin stres düzeyleri üzerindeki etkisini incelemiştir.
Tezel ve Görgü çalışmalarında, annelerin sosyodemografik özellikleri, algıladığı
sosyal destek, aile yapısı ve özellikleri gibi değişkenlerin duygu durumları
üzerindeki etkisini vurgulamıştır. Çalışmaların ikisinde de ortak olan ve annelerin
duygu durumları üzerinde etkisi olduğu düşünülen sosyo-demografik değişkenler;
yaş, eğitim durumu, meslek, gelir durumu ve başka bir çocuğa sahip olup olmama
değişkenleridir.
Bu kategori kapsamında incelenen çalışmalara 1-3 yaş arasında serebral palsy
tanısı bulunan çocuğa sahip 20, yaşları 3 ile 7 arasında değişen ve otizm tanısı
olan çocuğa sahip 165 anne ve yaşları 2-30 ay arasında değişen ve down
sendromu tanısı bulunan çocuğa sahip 16 anne olmak üzere toplam 201 anne
katılmıştır. Richter-Kanık çalışmasında ek olarak hazırladığı eğitim programının
anne-bebek etkileşimi üzerindeki etkisini de incelemiş; bu amaçla yaşları 7-30
arasında değişen ve down sendromu tanısı bulunan 16 çocuğu da çalışmaya dahil
etmiştir.
Tezel (2003) tez çalışmasında ele aldığı sosyo-demografik değişkenlerin program
ve annelerin duygu durumu üzerindeki etkisini incelememesine karşın tezinin
tartışma bölümünde uygulanan programın başarısız olmasının grupları yalnızca
eğitim, yaş, meslek, gelir düzeyi ve çocuk sayısı açısından eşleştirmesinden
kaynaklanabileceğini; aile yapısı, dinamikleri, destek faktörleri, annenin çocuğunu
algılama biçimi gibi özelliklerin de dikkate alınması gerektiğini belirtmiştir.
Görgü (2005) ise, annelerin depresyonlarını yordamada annenin eğitim durumu,
sahip olunan çocuk sayısı, gelir düzeyi gibi değişkenlerin etkili olduğu sonucuna
ulaşmıştır. Richter-Kanık (1998), erken eğitimin annelerin stres düzeylerinde
azalmaya neden olduğu sonucuna ulaşmış; ancak yaş, meslek, eğitim düzeyi ve
başka bir çocuğa sahip olup olmama gibi değişkenlere ilişkin bilgi toplamasına
rağmen bu değişkenlerin annelerin stres düzeyleri üzerindeki etkisini
incelememiştir. Ayrıca Richter-Kanık hazırladığı eğitim programının anne-bebek
etkileşimini olumlu yönde etkilediği sonucuna ulaşmıştır. Annelerin duygu
durumları kategorisinde yer alan tez çalışmalarına ilişkin önemli olduğu
düşünülen bilgiler Tablo 7’de sunulmuştur.
Tablo 7
Çocuklara Sunulan Hizmetleri Konu Alan Tez Çalışmaları
Kaynak*
Tezin Amacı
Yöntem
Denekler ve
Özellikleri
Veri Toplama
Araçları
RichterKanık,
1998
Ankara Üni
Erken eğitimin
down sendromlu
bebeğe sahip
annelerin stres ve
anne-bebek
etkileşim düzetleri
üzerindeki
etkisinin
incelenmesi
Nicel
araştırma
Yaşları 7-30
ay arasında
değişen ,
down
sendromu
tanısı
bulunan16
çocuk ve
annesi
Stres Envanteri
Anne-bebek
Etkileşimi Gözlem
Formu
Erken eğitimin annelerin
stres düzeylerinde
azalmaya neden olduğu
ve anne-bebek
etkileşimini olumlu
birşekilde etkilediği
Tezel, 2003
Marmara
Üni.
Psikolojik destek
programına
katılan ve
katılmayan engelli
bebek annelerinin
negatif ve pozitif
duyguları arasında
bir farklılığın olup
olmadığının
incelenmesi
Nicel
araştırma
1-3 yaşları
arası zihin ve
hareket
engelli çocuk
anneleri.
Deney
grubunda 10,
kontrol
grubunda 10
olmak üzere
toplam 20
anne
-Çocuk ve Aile Bilgi
Formu
Psikolojik destek
grubuna katılan ve
katılmayan annelerin
pozitif ve negatif
duygularında süreç
sonunda anlamlı bir fark
tespit edilememiştir.
3-7 yaş arası
otistik çocuğa
sahip olan
annelerin
algıladıkları
sosyal destek
düzeyi ve
depresyonları
arasındaki ilişki
ile bunları
yordayıcı
olabilecek
değişkenlerin
belirlenmesi
Nicel
araştırma
3-7 yaş arası
otistik çocuğa
sahip 135
anne
Kişisel bilgi formu
Görgü,
2005
Marmara
Üni.
-Pozitif -Negatif
Duygu Ölçeği
-Program
Değerlendirme
Anketi
Çok Boyutlu
Algılanan Sosyal
Destek Ölçeği
Beck Depresyon
Ölçeği
Bulgular
Otistik çocuk annelerinin
yaşının, medeni
durumlarının, otistik
çocuğun doğum
sırasının, cinsiyetinin,
yaşının, çocuğa tanı
koyma süresinin
annelerin algıladıkları
sosyal destek düzeyiyle
depresyonlarını
yordamadığı
görülmüştür.
Annenin eğitim durumu,
ev dışında bir işte
çalışma, eşin eğitimi
durumu,
aylık gelir, sahip olunan
çocuk sayısı, otistik
çocuğu ilk farkeden kişi,
çocuklara
doğumdan itibaren
bakan kişi, şuan bakıcı
yardımı alıp almama ve
otizm
derecesini algılama
değişkenlerinin ise
annelerin algıladıkları
sosyal destek düzeyi
ile depresyonlarını
yordadığı görülmüştür.
Sonuç ve Öneriler
Bu çalışmada, 2008 yılı itibariyle Türkiye’de 0-6/8 yaş arasındaki gelişimsel
gerilik/yetersizlik gösteren çocukları, ailelerini, sunulan öğretim ve hizmetleri
konu alan 14’ü Yüksek Lisans, 8’si Doktora ve 2’si Tıpta Uzmanlık Tezi olmak
üzere toplam 24 tez çalışmasına ulaşılmış, bu tezler konularına göre 7 kategoride
toplanmıştır. Bu tez çalışmaları kapsamında 65’i zihin engeli, 2’si serebral palsy,
57’ si down sendromu, 90’ı gelişimsel gerilik/yetersizlik, 258’i otizm, 3’ü dil ve
konuşma yetersizliği tanısı bulunan ve 125’i normal gelişim gösteren 597 çocuk
ile çalışılmıştır. Çalışmalarda ayrıca, 110 öğretmen, 300 normal gelişim gösteren
çocuk ailesi ve 622 gelişimsel gerilik/yetersizlik gösteren çocuk ailesinden veri
toplanmıştır.
Çalışmaların 13’ü nicel araştırma (Bakkaloğlu, 2004; Baysal-Metin, 1989; Bilgiç,
2007; Çetin, 1995; Görgü, 2005; Özbaba, 2000; Özdemir, 2005; Richter-Kanık1998; Özenmiş, 2000; Tezel, 2003; Tuş-Gümüşçü, 1996; Yalçıntaş, 2006;
Zeteroğlu, 2006), 8’i tek denekli araştırma (Akköse, 2008; Altunel, 2007; Ardıç,
2008; Birkan, 2001; Canay, 2003; Çuhadar, 2008; Erbaş, 2001; Odluyurt, 2007),
1’i nitel araştırma (Çağlar, 2006), 2’si ise hem nitel hem nicel araştırma
(Odluyurt, 2007; Varlıer, 2004) özelliği taşımaktadır.
Çalışmalarda kullanılan veri toplama araçları incelendiğinde; veri toplama
araçlarının araştırmanın amaç ve özelliklerine göre çeşitlilik gösterdiği, bazı
araştırmalarda veri toplama araçlarının araştırmacının kendisi tarafından
geliştirildiği (Akköse, 2008; Altunel, 2007; Ardıç, 2008; Bakkaloğlu, 2004;
Canay, 2003; Çağlar, 2006; Çuhadar, 2008; Erbaş, 2001; Odluyurt, 2007; Özbaba,
2000; Özcan, 2004; Özenmiş, 2000; Richter-Kanık, 1998; Varlıer, 2004),
bazılarında ise standart testlerin kullanıldığı (Baysal-Metin, 1989; Bilgiç, 2007;
Birkan, 2001; Çetin, 1995; Görgü, 2005; Özdemir, 2005; Richter-Kanık, 1998;
Tezel, 2003; Tuş-Gümüççü, 1996; Yalçıntaş, 2006; Zeteroğlu, 2006) görülmüştür.
Tüm araştırmalarda ortak olan tek veri toplama aracı ise, her araştırmanın amacına
bağlı olarak geliştirilmiş kişisel bilgi formlarıdır.
Uygulama yapılan araştırmaların 10’unda uygulama güvenirliği verisi (Akköse,
2008; Altunel, 2007; Ardıç, 2008; Bakkaloğlu, 2004; Birkan, 2001; Canay, 2003;
Çuhadar, 2008; Erbaş, 2001; Odluyurt, 2007; Özcan, 2004), 11’inde gözlemciler
arası güvenirlik verisi (Akköse, 2008; Altunel, 2007; Ardıç, 2008; Bakkaloğlu,
2004; Birkan, 2001; Canay, 2003; Erbaş, 2001; Odluyurt, 2007; Özcan, 2004;
Özenmiş, 2000; Richter-Kanık, 1998), 6’sında ise sosyal geçerlik verisi (Ardıç,
2008; Bakkaloğlu, 2004; Birkan, 2001; Çuhadar, 2008; Erbaş, 2005; Odluyurt,
2007) toplanmıştır.
İncelenen tez çalışmalarının dokuzunda çocuklara belli bir becerinin öğretimi
üzerine odaklanılmış; öğretim, araştırmacı tarafından sunulmuştur. Belli bir
becerinin öğretimine odaklanan çalışmalarda; dil, özbakım, sosyal ve motor
gelişim alanlarına ait becerilere ilişkin öğretim sunulmuş, bilişsel gelişim alanına
ait becerilerin öğretimini konu alan bir çalışmaya rastlanmamıştır. 3-6/8 yaş
dönemi ilköğretime hazırlık sürecini kapsayan bir dönem olmasına rağmen
okuma-yazmaya hazırlık becerilerinin öğretimi üzerine odaklanan bir tez
çalışmasına da ulaşılamamıştır. İleri araştırmalarda erken çocukluk döneminde
önemli olduğu düşünülen farklı becerilerin öğretimine odaklanılması, alandaki
uzmanlara ve ailelere beceri öğretimi konusunda yol gösterici olabilir.
Tez çalışmalarının üçünde ailelere öğretim sunma becerisi kazandırılmış, öğretim
sunma becerisi kazanan ailelerin ise çocuklarına öğretim sunması beklenmiştir.
Bu kategoride yer alan çalışmaların birinde Portage Erken Çocukluk Dönemi
Eğitim Programı, birinde Küçük Adımlar Programı kullanılırken diğer çalışmada
ise araştırmacı tarafından hazırlanan aile eğitim programı kullanılmıştır. İleride
yapılacak araştırmalarda, bu tür aile eğitim programlarının geliştirilmesi,
yaygınlaştırılması ve yurt dışında etkili olan programların kültürümüze
uyarlanması üzerine odaklanılarak aileler ve eğitimcilerin rahatlıkla
kullanabileceği programlar alana kazandırılabilir.
Hem beceri öğretimi hem de ailelere öğretim sunma becerisi kazandırma
kategorilerinde yer alan tez çalışmalarında, çocuklara öğretim sunularak onların
belli bir beceriyi kazanmaları amaçlanmıştır. Çocukların öğrenmeye en açık
oldukları ve gelişimin en hızlı olduğu dönem olması nedeniyle erken çocukluk
dönemine odaklanan tez çalışmalarının büyük bir çoğunluğunda beceri
öğretiminin konu olarak ele alınması beklendik bir durumdur, ancak tek başına
beceri öğretimi çocuğun gelişiminde yeterli değildir. Çocuğun gelişiminde tek bir
faktör, tek başına etkili olamaz (Shonkoff ve Meisels, 2000). Özellikle 0-6/8 yaş
döneminde çocuğun gelişimi, ailesi (aile yapısı, sosyo-ekonomik düzeyi, ailenin
eğitim düzeyi gibi) içinde yaşadığı sosyal çevre ve kültürden bağımsız olarak
düşünülemez. İleride konu ile ilgili yapılacak çalışmalarda gelişim sürecinin çok
boyutlu olarak ele alınması ve çocuğun gelişiminde etkili olabilecek kültürel
değişkenlerin de ele alınması gelişim sürecini açıklamada kültürel ve sosyal
bağlamın önemini ortaya koyabilir. Ayrıca çocuğun gelişiminde etkili olduğu
düşünülen ilişki temelli yaklaşım, ekolojik yaklaşım gibi farklı yaklaşımların 06/8 yaş dönemindeki çocukların gelişimleri üzerindeki etkileri de ileriki
araştırmalarda ele alınması gereken konulardan biridir.
Beceri öğretimi ve ailelere öğretim sunma becerisi kazandırmayı konu alan tez
çalışmalarında dikkat çeken diğer bir bulgu ise çalışmaların önemli bir kısmının
3-6 yaş grubundaki çocuklar ile yürütülmüş olmasıdır. 0-3 yaş grubundaki
çocuklara yönelik öğretim çalışmalarının yaygınlaştırılması, uygulanan program
ve öğretimin çocukların gelişimine olan etkisini daha iyi görmemizi sağlayabilir.
Çocuklara sunulan hizmetler kategorisinde biri yönlendirme ve yönlendirme
sonrası sunulan hizmetleri, biri de değerlendirme sürecini konu alan iki tez
çalışması yer almaktadır. Erken özel eğitim sürecinde tanılama, değerlendirme,
sunulan hizmetler ve bu hizmetlerin niteliği, çocuğun gelişimini etkileyen önemli
faktörler olmasına rağmen bu konuya odaklanan çok az çalışmaya rastlanmıştır. 06/8 yaş dönemindeki çocukların gelişimini sağlıklı bir şekilde değerlendirmek,
gelişimsel geriliği erken fark etmek; gerekli önlemleri almayı, dolayısıyla uygun
eğitim ve hizmetlere ulaşmayı sağlayacak, aile ve uzmanların çocuğun
gelişiminde olumlu etki yaratacak kararlar almalarında yol gösterici olacaktır. Bu
nedenle gelişimsel gerilik/yetersizlik gösteren çocukların sağlıklı bir şekilde
değerlendirilmesi ve erken yaşta fark edilmelerini sağlayacak değerlendirme
araçlarının geliştirilmesi; uygun ortam ve hizmetlere yönlendirilmeleri ile
sonuçlanacak bir sistemin oluşturulması için bilimsel araştırmalara ihtiyaç
duyulmaktadır.
Okul öncesi kaynaştırma uygulamalarını konu alan tez çalışmaları, okul öncesi
dönemde kaynaştırmaya ilişkin tutum ve görüşleri belirlemeye odaklanmış, tek bir
çalışmada kaynaştırma uygulamalarına katılan ve katılmayan çocukların
gelişimleri karşılaştırılmıştır. Okul öncesi dönemde kaynaştırma uygulamalarının
başarılı olmasında öğretmenlerin, akranların ve ailelerin kaynaştırmaya ilişkin
tutum, görüş ve yaklaşımları önemli olmakla birlikte tek başına etkili değildir.
Kaynaştırma uygulamalarının başarıya ulaşmasında ortam uyarlamaları ve
öğretimsel uyarlamalar önemli bir yer tutmaktadır. İleriki araştırmalarda bu tür
uygulamaların neler olabileceği üzerinde durulabilir.
Ailelere, çocuklarına öğretim sunma becerisi kazandırma ve gelişimsel
gerilik/yetersizlik gösteren çocuğa sahip ailelerin duygu durumlarını incelemeyi
konu alan araştırmalarda, örneklem grubunun ya tamamını ya da önemli bir
bölümünü annelerin oluşturduğu görülmüştür. Ailede gelişimsel gerilik/yetersizlik
gösteren bir üyenin varlığı yalnızca anneleri değil, baba, kardeşler gibi diğer aile
üyelerini de etkileyen bir süreçtir. Ülkemizde bu sürece büyük baba ve büyük
anneleri de dahil etmek mümkündür. İleride yapılcak araştırmalarda baba, kardeş,
büyük baba ve büyük annelerin çocuğun eğitimine aktif katılımının ya da onlar
tarafından sunulacak öğretimin çocuğun gelişimi üzerindeki etkisi incelenebilir.
Benzer bir bakış açısıyla gelişimsel gerilik/yetersizlik gösteren bir çocuğun
varlığı, duygusal ve psikolojik olarak yalnızca anneyi değil, babayı ve normal
gelişim gösteren kardeşi de etkileyen bir durumdur. İleriki araştırmalarda bu
durumun diğer aile üyeleri üzerinde yarattığı duygusal ve psikolojik etkilerin de
araştırılması aile içi iletişimin ve ilişki ağının sağlıklı bir şekilde sürdürülmesine
katkı sağlayabilir.
Sonuç olarak bugüne kadar yapılmış tez çalışmalarının, erken çocuklukta özel
eğitime ilişkin farklı konu ve boyutları ele alan, farklı örneklem gruplarıyla
yürütülen ve erken özel eğitim sürecine bütüncül olarak yaklaşan farklı
araştırmalar ile desteklenmesi hem uzmanlara hem ailelere ve en önemlisi de
erken özel eğitim sürecindeki çocukların gelişimlerine önemli katkılar
sağlayacaktır.
“Structured Abstract”
A Review of Master and Doctoral Dissertations in the Field of Early Childhood
Special Education in Turkey
The period between birth and the age of 6 to 8 called the early childhood period is
the time when development of children is rapid. Heward (1996), Kroth and Edge
(1997) emphasize that learning experiences during this period are as crucial for
normally developing children as those with development delays/disabilities (As
cited in Birkan, 2001). The changes that took place in Turkish legislation
regarding individuals with special needs from the past to the present day place a
great importance on special education services in early childhood.
Early childhood special education (ECSE) is an umbrella concept covering early
intervention for young children from birth to 36 months as well as preschool
special education for those aged between 36 and 72 months. In this context;
ECSE, in general terms, can be defined as the process of providing services which
might include different support systems both for children with developmental
delays or at risk of developmental delays during the early childhood period and
their parents (such as educational, developmental, social, health and nutrition
support).
The ECSE process and main considerations within this process are addressed in a
number of postgraduate studies (master and doctoral dissertations) carried out in
Turkey about individuals with development delays/disabilities during the early
childhood period (Diken, Ünlü ve Karaaslan, 2008). However, no study reviewing
these works in detail has so far been found. Synthesing and reviewing research
(such as examining the sample covered, characteristics of the sample, method
used in the study, data collection means used, implementation process) about
ECSE carried out in Turkey seems to be important since it will not only help
individuals caring for children with development delays/disabilities in early
childhood to access necessary data but also provide researchers with leading
information about aspects which have not yet been discovered or sufficiently
addressed in relation to the issues in the ECSE. In addition; disclosing similar and
different aspects of the studies with common dimensions will introduce a new
perspective regarding the studies so that light can be shed on future research.
Thus, the aim of the present study is to review postgraduate studies (master and
doctoral dissertations) within scope of the ECSE carried out in Turkey.
At first, postgraduate studies (master and doctoral dissertations) within scope of
the ECSE carried out in Turkey were identified and accessed through the web site
of the Higher Education Council of Turkey. Moreover, studies regarding children
from birth to age 6 to 8 with development delays/disabilities in the early
childhood period and their parents were identified in the book titled Postgraduate
Studies Bibliography on Mental Retardation and Pervasive Developmental
Disorders in Turkey (Diken, Ünlü ve Karaaslan, 2008), which includes summaries
of the studies concerned with Mental Retardation and Pervasive Developmental
Disorders. Following criteria were respected in identifying the studies to select:
(1) Relevance to the children from birth to age 6 to 8 or their parents, (2)
Existence of development delays/disabilities in children and (3) the studies being
a postgraduate master or doctoral dissertation.
Findings
As of 2008, 24 studies were found in Turkey concerning children with
development delays/disabilities during early childhood, their parents and the
services provided for them; 14 were master, 7 were PhD dissertations whereas 2
were for a specialization in Medicine. During the analysis, the studies were
classified by subject and categorized. All studies were divided into 7 categories
according to the subject covered. These included skill instruction (Akköse, 2008;
Altunel, 2007; Ardıç, 2008; Bakkaloğlu, 2004; Canay, 2003; Çetin, 1995;
Çuhadar, 2008; Erbaş, 2001; Odluyurt, 2007), preschool inclusion (Baysal-Metin,
1989; Odluyurt, 2007; Özbaba, 2000; Varlıer, 2004), helping parents acquire skill
of instructing their children (Birkan, 2001; Özcan, 2004; Tuş-Gümüşçü, 1996),
examining mothers’ emotional status (Görgü, 2005; Richter-Kanık, 1998; Tezel,
2003), comparing children with development delays/disabilities and without
disaiblities (Bilgiç, 2007; Özenmiş, 2000; Zeteroğlu, 2006), describing situation
regarding children (Çağlar, 2006), and services provided for children (Özdemir,
2005; Yalçıntaş, 2006). All studies was carried out on 597 children in total; 65 of
whom were identified in these studies as children with mental retardation, 2 had
cerebral palsy, 41 had Down Syndrome, 90 had developmental delays/disabilities,
258 had autism, 3 were diagnosed with language and/or speech disabilities and
125 were considered to be children with normal development.
In the category of skill instruction; it was observed that Bakkaloğlu (2004) and
Odluyurt (2007) addressed the teaching of the preparatory skills for inclusion,
Akköse (2008) dealt with teaching the skill of naming kitchen appliances, Altunel
(2007) dealt with teaching the skill of answering questions, Ardıç (2008)
researched teaching of toilet skills, Canay (2003) focused on teaching the skill of
fulfilling the order given, Çetin (1995) studied teaching large muscle skills and
finally Çuhadar (2008) covered teaching free-time skills. In the category of
teaching skills, only one study was found which dealt with sustaining behavioral
problems and the acquisition of positive behaviors (Erbaş, 2001). As for the
category of preschool inclusion; Odluyurt (2007) investigated the views of
preschool teachers in relation to preparation skills that are effective for children
with development delays/disabilities to be successful in preschool integration
practices while Özbaba (2000) tried to discover the attitudes of the teachers and
the parents regarding integration. Varlıer (2004) examined the views and
recommendations of the preschool teachers about integration. In connection with
all the research; an attempt was made to identify views, recommendations and
attitudes using the assessment methods developed by researchers. Finally BaysalMetin (1989) compared development recorded by children with Down syndrome
between the experimental group (those who attended the integration program
during the preschool period) and control group in their thesis.
Under the category regarding parents’ acquisition of the skill of instructing their
children; Birkan (2001) targeted helping parents implement the Small Steps
Program and Baysal-Metin (1989) focused on the Portage Early Childhood Period
Education Program whereas Özcan (2004) concentrated on implementing the
Family Education Program for Toilet Skills Teaching which he developed. In the
category regarding the comparison of children with development
delays/disabilities without disabilities, Özenmiş (2000) compared behaviors about
playing with objects displayed by children with and without diagnosis of mental
delays/disabilities while Zeteroğlu (2006) compared normal children and those
diagnosed with autism in terms of their development in language, cognitive,
psycho-motor and socio-emotional development areas along with influence of the
parents’ education level on development of the children. Bilgiç (2007) compared
children with developmental delays/disabilities and pervasive developmental
disorders in socio-demographic, clinical aspects and the characteristics of their
parents.
In the category of describing a situation regarding children; Çağlar (2006) aimed
to define strategies adopted by mother of a 5-year old autistic child during kitchen
interactions with her child. In the category of services provided for children,
Özdemir (2005) studied on the factors affecting access to and sustaining access of
children aged 0-3 years to special education and rehabilitation as well as the
extent at which services provided represent parent-centered support programs.
Yalçıntaş (2006) dealt with adaptation, validity and reliability of the Self-Control
and Atypical Behaviors Scale, which is expected to assist in obtaining early and
appropriate diagnosis for autistic children of 24-72 months. Under the category
related to mothers’ emotional status; while Görgü (2005) examined the
relationship between the extent of social support perceived by mothers of autistic
children aged 3-7 years and depression they go through, Tezel (2003) addressed
the influence of a psychological support program that he developed on mothers’
emotional status. Also, Richter-Kanık (1998), evaluate the effect of early
intervention on stress level of mothers, with developmentally delayed young
children (with down syndrome) and on mother-infant interaction.
Discussion and Conclusion
Nine of the postgraduate studies (master and doctoral dissertations) focused on
teaching children a certain skill; as a part of these studies, instruction is provided
regarding language, self-rating, social and motor development skills, but no study
regarding the instruction of cognitive development skills was found. Although the
period between 3 and 6/8 years covers the preparation for elementary education,
there was no study focusing on the teaching of preparation skills regarding
reading and writing. As a part of future research; it might be helpful to focus on
teaching different skills that are considered to be important during early childhood
for specialists in this area as well as parents.
As a result of the 3 studies, parents could acquire skill of instructing their
children, and those parents were expected to teach their children accordingly. The
Portage Early Childhood Period Program was used in one of the studies; Small
Steps Program in another and the parents’ education program developed by the
researcher was used in the other. Within scope of the future research, focus might
be placed on developing and expanding such education programs as well as
harmonizing foreign programs with the situation in Turkey so that new programs
that parents and educators can easily use might be developed.
Some of the postgraduate studies address both the categories of the skills teaching
of the children and helping careers to acquire teaching skill. As the early
childhood period is the time when children are most open to learning and are
rapidly developing, it is expected normal that majority of the studies focusing on
that period addressed teaching of skills; however, teaching of skills is not
sufficient on its own in development of the children. Dealing with the
development process as a multidimensional concept and emphasizing cultural
variables that might be influential in development of the children in future studies
might indicate importance of the cultural and social context in explaining the
development process.
Another remarkable finding in the studies about the teaching of skills and helping
parents to acquire the skill of instructing their children is the fact that majority of
the studies were carried out on children aged 3 to 6 years. Investigating the
instruction activities for children aged 0 to 3 years might contribute to the
understanding of the effect of the implemented program and instruction on
younger children’s development.
In the category of the services provided for children there were 2 studies; one
concerning advice services and post-advice services and the other is about the
assessment process. To conduct proper assessment regarding development of the
children from birth to 6/8 years and the early diagnosis of the developmental
delays/disabilities would assist in ensuring action was taken in terms of access to
the appropriate education and support services, and help parents and specialists
take decisions that could positively impact on the child’s development. Therefore,
scientific studies are needed to develop a means of assessment which will allow
an early diagnosis of the children with development delays/disabilities and the
establishment of a system which would help in ensure that these children received
education and support appropriate to their assessed needs. Studies regarding
preschool inclusion focused on identifying attitudes and perspectives regarding
inclusion in the preschool period. One study compared the development of two
groups of children those who were and those who were not involved in inclusion
practices. The attitudes, opinions and approaches of teachers, peers and parents
towards inclusion are important for success of the preschool inclusion practices,
however, they are not effective on their own. Media adaptations and instructional
adaptations play a significant role in the success of the inclusion practices. In the
future, time and energy can be investigated in potential implementations in this
area.
In the research concerning helping parents to acquire the skill of teaching their
children and emotional status of the parents of the children with developmental
delays/disabilities, it was observed that either the entire or the majority of the
sample group was composed of mothers. The existence of an individual with
development delays/disabilities within the family affects not only mothers but also
the other family members such as the father and the siblings. Future studies
should be carried out on the impact of the active participation of the father,
siblings and grandparents in the teaching process on development of the children
with development delays/disabilities. Furthermore, emotional and psychological
effects on the other members of the family should be studied in the future, since
this might contribute to appropriate continuation of communication in the family
and the developing of a wider relationship network.
In conclusion it is necessary to continue the research that has been carried out in
the postgraduate studies during early childhood period. Addressing various issues
and aspects regarding ECSE, conducting investigations with varying sample
groups and approaching the process of special education from an integrative
perspective will make significant contributions to the knowledge and
understanding of those involved in the development of children with development
delays/disabilities, which is the specialists, carers and parents. Most importantly,
this research will benefit the children who need effective and appropriate early
childhood special education.
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Relationship Focused Intervention, 79
Gerald Mahoney1
Relationship Focused
Intervention (RFI):
Enhancing the Role of
Parents in Children’s
Developmental
Intervention
Abstract
This article describes Relationship Focused Intervention (RFI) which attempts to
promote the development of young children with developmental delays and
disabilities by encouraging parents to engage in highly responsive interactions
during daily routines with their children. This approach to intervention is based upon
the Parenting Model of child development and was derived from research on parentchild interaction. Evidence is presented that RFI can be effective both at helping
parents to learn how to interact more responsively with their children as well as at
promoting children’s development and social emotional function. The argument is
made, that although there is no research comparing the effectiveness of RFI to
interventions derived from the Educational model of child development which places
less emphasis on parent involvement and stresses direct instructional activities, still
the effectiveness of all interventions appears to be related to the degree to which
parents are involved in and become more responsive with their children. As such RFI
may not simple be an alternative model for early intervention, but may reflect a
paradigm shift pointing to the effectiveness of parent involvement and responsive
interaction as key elements of early intervention practice.
Keywords: Relationship focused intervention, developmental delays and disabilities,
parents, young children.
1
Prof., Case Western Reserve University, Cleveland, Ohio, USA 44106, [email protected]
The purpose of this article is to describe the relationship focused approach to
developmental intervention that has been gaining increasing usage in early intervention
services for children with disabilities, especially in programs for children who are under
three years of age. The description of this intervention will include the origins of this
approach, its underlying conceptual framework, as well as a description of some of the
more recent studies which have demonstrated its effectiveness.
The two approaches that are most commonly used to promote the development and
functioning of young children with delays and developmental disabilities in early
intervention are (1) enriched developmental stimulation and (2) applied behavioral
analysis. The enriched developmental stimulation approach, which is commonly
reflected in classroom-based early intervention programs, focuses on providing an array
of experiences that are thought to be ideally suited to enhancing children‟s knowledge of
basic cognitive concepts, such as colors, shapes, numbers and letters. It also provides
children opportunities to develop their expressive and receptive language skills through
group activities such as circle time (saying their names, days of the week, seasons of the
year, and discussing major holidays and events), songs, and reading/story telling as well
as social interaction with teachers/professionals and other children. This approach to
developmental intervention evolved from the general nursery school/kindergarten
movement that was initially designed to provide children from socially and
economically disadvantaged backgrounds the types of experiences they were presumed
to be lacking in their natural environments which were thought to necessary for the
development of basic cognitive and communication skills. One of the goals of this
approach is provide children the preparation they need to participate successfully in the
regular elementary school curriculum.
The applied behavioral analysis (ABA) approach emphasizes structured individualized
instruction that focuses on specific cognitive and linguistic skills that children may be
lacking compared to typically developing children who are the same age. ABA is based
upon the assumption that children‟s developmental delays can be conceptualized in
terms of the specific cognitive, language and social behaviors or competencies that they
would normally be expected to possess at their current chronological age. The
remediation of developmental delays is thus accomplished by systematically teaching
the specific skills and concepts that characterize each child‟s delays. This approach is
most commonly used in clinics and classrooms, although many intervention programs
encourage parents to use ABA procedures in the home environment to promote
children‟s skill acquisition during natural, daily routines.
Both of these approaches have evolved from an “educational model” in which childhood
disabilities have been conceptualized as the result of children having learning problems.
Insofar as the failure of children with disabilities such as Down syndrome or autism to
acquire basic developmental skills is the result of their learning limitations, remediation
has been conceptualized either as a process of providing more opportunities for these
children to learn than children without disabilities might normally experience (i.e.,
preschool special education classrooms); or to provide highly structured learning
experiences to compensate for children‟s learning inefficiencies (e.g., ABA).
Furthermore, just as teaching basic academic and social skills can be successfully
addressed in classroom or clinical settings, so too these two approaches have attempted
to address the developmental learning needs of young children with disabilities in these
same types of educational settings. To the extent that parents are recruited to become
involved in either of these approaches, they have been asked to use the same kinds of
instructional methods and learning activities at home with their children that
professionals use in classrooms and clinical settings. However, parent involvement has
not been considered to be essential to the effectiveness of either of these approaches.
Rather, professionals have implemented these approaches as if the learning and
developmental attainments that result from this form of intervention would enhance
children‟s development by augmenting the developmental learning opportunities and
supports that children naturally receive from their parents and others at home.
The relationship focused approach to intervention (RFI) represents a marked departure
from these two approaches. RFI attempts to enhance the development and social
emotional well being of children by focusing primarily on parents as the agent of
intervention, and deemphasizing the direct instructional activities conducted by
professionals in clinics or classrooms. Rather than focusing on increasing the amount of
stimulation that children receive or instructing children to learn specific words and
behaviors, this approach attempts to maximize the quality or effectiveness of parents
with their children during daily activities and routines.
RFI is derived from the
“parenting model” of child development (Goodman, 1992) which asserts that parents
and other caregivers are the primary psychosocial influences on the development of all
children, including children with disabilities. It can be characterized as an interactional
approach which views development as being influenced jointly by children‟s genetic
makeup and biological integrity as well as by the quality of interactions and experiences
that parents and other caregivers provide them during daily routine activities.
The term “relationship focused” comes from the child development research literature
from which this approach was derived. During the past thirty years, child development
professionals have been interested in determining how parents influence children‟s
development and what the magnitude of this influence might be. Most of this research
has addressed this issue by observing parents interacting with their children and by
determining how variations in the way parents interact with, or relate to, their children
contribute to children‟s development and social emotional functioning.
Results from this research have consistently indicated two findings. First, the kinds of
experiences parents provide does account for a significant portion of the variability in
the developmental outcomes that all children attain, including children with disabilities.
Parents do not cause the developmental delays of children neurodevelopmental
disabilities. Rather, the genetic or biological conditions that cause children‟s disabilities
in most cases play the greatest role in determining the developmental outcomes these
children attain. Yet despite the fact that biological or genetic conditions compromise the
ability of children to learn and develop, still the way parents interact with children plays
an important role in contributing to the developmental outcomes children attain. In fact,
the magnitude of the influence that parents have on the development of children with
disabilities is comparable to the influence that parents have on typically developing
children, ranging from approximately 10 to 40% of the variability.
Second, parents‟ level of responsiveness is one of the main factors that contribute to
children‟s development, at least during the first five years of their lives. For example,
research investigating how parents enhance their children‟s cognitive development has
reported that compared to the other interactive qualities such as the amount of
stimulation parents provide their children or the frequency that parents try to teach their
children specific skills and behaviors, responsiveness is the only parenting quality that
consistently predicts children‟s Development Age or Intelligence Quotient (IQ) (e.g.,
Beckwith & Cohen, 1989; Beckwith, Rodning, & Cohen, 1992; Bradley, 1989; Fewell,
et. al., 1996; Landry, et. al., 1997). Moreover, neither the amount of reinforcement or
praise nor types of toys or other stimulation that parents provide their children appears to
influence children‟s rate of development, at least, as measured by standardized
developmental tests.
Parental responsiveness has also been identified as the primary characteristic that
influences children‟s communication development (Bornstein, Tamis-LeMonda &
Haynes 1999; Hoff-Ginsberg & Shatz, 1982; Nelson, 1973). Children have been
reported to attain higher levels of communication the more often their parents respond to
their communicative behaviors and interpret their attempts to communicate as though
they were meaningful.
For example, Nelson (1973) compared the language
development of children whose parents corrected them for using incorrect word forms to
children whose parents responded to their incorrect word usage “as if it were
meaningful”. Children whose parents responded to incorrect language “as if it were
communicative”, attained higher levels of communication than children whose parents
corrected them when they mispronounced or used language inaccurately.
Parental responsiveness is also associated with children‟s social-emotional functioning.
Several studies have reported that responsiveness affects children‟s attachment to their
parents, which is one of the most important socio-emotional behaviors in the early years
of life (Birigen & Robinson, 1991; Kochanska, Forman & Coy, 1999; Vereijken,
Ricksen-Walraven & Kondo-Ikemura, 1997). In addition, during the preschool years,
the one parenting quality that predicts how well children get along with their peers and
act independently is their mothers‟ responsiveness with them (Crockenberg & Litman,
1990; Isabella, 1993; van den Boom, 1995).
These findings have lead to the investigation of two questions that are the basis for
relationship focused intervention. First, can intervention procedures be developed that
are effective at teaching and encouraging parents to engage in more responsive
interactions with their children? Second, do changes in parental responsiveness that are
promoted through intervention enhance or promote children‟s development and social
emotional well being?
1. Can intervention promote changes in parent’s style of interacting with their
children? Perhaps the most difficult challenge in developing relationship focused
intervention was to identify procedures that could be used to promote changes in
parents‟ style of interacting with their children. This includes both clinical and
methodological challenges. Clinically, this required that professionals have a high level
of sensitivity and respect for the personal and emotion-laden nature of parent‟s style of
interacting with their children. Most parents try to interact with their children in a way
that they believe is in the best interests of their child‟s welfare. As a result, it is only
natural that parents may interpret suggestions from professionals as to how they should
interact with their children as a criticism of their parenting skills. Furthermore, the way
that parents interact with their children is a complex multi-determined phenomenon.
Among other factors it is influenced by family, cultural and religious values and
experiences. For example, parents‟ style of interacting with their children is almost
always affected by the way that their parents interacted with them. Parents‟ interactions
are also affected by their personality, psychological health and physical well being, as
well as by their knowledge and beliefs about child development. To add to this
complexity, spouses who may have different experiences, values, or knowledge of child
rearing often attempt to influence each other„s style of interacting with their children.
The methodological challenge was to determine the procedures that would be most
effective at encouraging parents to modify how they interact with their children. At least
three different procedures have been used to modify parents‟ interactions and to enhance
their responsiveness with their children.
One is to discuss with parents what
responsiveness is and the importance of responsiveness for children‟s development. The
second is to model responsive interaction with the child in the hope that by observing
them parents can learn to use this style of interaction. The third is to use interactive
strategies to (a) demonstrate how to interact responsively with a child, (b) encourage
parents to modify specific behaviors while interacting with their children, and (c)
provide parents feedback.
Investigators discovered that although the first two procedures may be useful in some
instances, by themselves neither is effective at encouraging parents to modify their
interactive behavior. Discussions about responsiveness appear to be the most
ineffective. Even if parents agree with professionals about the importance of engaging in
responsive interactions with children, in discussing this parents and professionals often
have different notions about what responsiveness is, and such discussion seldom lead to
any concrete plan of action. While modeling is more effective at helping parents
understand what responsiveness entails, it involves several steps that make it difficult for
parents to change their style of interaction. It requires that parents: (1) identify from
what they have observed the key behaviors they should copy; (2) incorporate these
behaviors into their own interactions based upon their understanding of what these
entail; and (3) identify and stop using interactive behaviors they instinctively do that
interfere with their carrying out the behaviors the professional are modeling (e.g., asking
too many questions, or changing play activities with which the child is involved).
The one method that has proven to be most effective is the use of responsive interactive
(RI) strategies. These are brief suggestions that help to promote various interactive
behaviors that are associated with responsiveness. At a minimum responsive interaction
entails:
Reciprocity- interactions that are characterized by a balanced, “give and take”
relationship;
Contingency- interactions that have an immediate and direct relationship to a
child‟s previous behaviors that support and encourage the child‟s actions,
intentions, and communications;
Shared Control- guidance and direction that facilitates and expands the actions
and communications which the child initiates or leads;
Affect - expressive, animated and warm interactions that are characterized by
enjoyment or delight with the child;
Match- interactions and requests that are adjusted to the child‟s developmental
level, interests, and behavioral style or temperament
More than 100 RI strategies have been described in various RFI curricula [e.g., Hanen
(Sussman, 1999), ECO (MacDonald, 1989), Floor Time (Greenspan & Weider, 1997),
INREAL (Weiss, 1981)]. These include strategies designed to promote reciprocity (e.g.,
Take One turn and Wait); Contingency (e.g., Respond immediately to little behaviors),
Shared Control (e.g., Follow my child‟s lead; Playful obstruction); Affect (e.g., Interact
for fun); and Match (e.g., Do what my child can do). RI strategies have a number of
advantages for working with parents. First, they provide specific responsive behaviors
on which to focus. Rather than trying to attain global goals such as interacting “more
responsively”, RI strategies provide mini-steps to becoming more responsive. Second,
RI strategies are easy to remember, so that parents have little difficulty thinking about
them while playing or interacting with their children. Third, RI strategies provide an
objective standard that professionals can use to provide feedback on how parents are
currently interacting with their children. Responsive interactive strategies help parents
engage in more responsive interactions before this is their natural style of interacting
with their children. As parents use these strategies and discover how they impact their
children, they begin to understand and appreciate the implications of this style of
interaction, which motivates them to incorporate them into their routine interactions.
Ultimately, repeated efforts to use these strategies results in parents developing the habit
of interacting more responsively with their children.
All of the RFI studies reported to date have encouraged parents to use RI strategies
similar to those described above. All of these studies have focused on the impact of RFI
on children, but only a few have reported the impact of RI strategies on parental
responsiveness. For example, Landry, Smith and Swank (2003, 2006) randomly
assigned 264 parent-child dyads to either an RFI treatment that was conducted over a 6
month period of time to a developmental feedback intervention. The sample included
both full term and very low birthweight infants who were approximately six months old
at the start of treatment. While the actual ratings of mothers‟ interactive style were not
reported, mothers who received the RFI treatment had significantly greater levels of
contingent responsiveness and warm sensitivity and lower levels of restrictiveness and
redirection both at the completion of intervention and at a 3 month follow-up than
mothers who did not receive the RFI. Aldred, Green and Adams (2004) compared the
effects of a social communication intervention which taught parents to use RI strategies
to a standard treatment control group with a sample of preschool aged children with
autism and their parents. After 12 months of intervention, Treatment mothers had 15%
higher levels of responsiveness and lower levels of directiveness with their children than
did control mothers. In two RFI studies conducted with parent-child dyads in which the
children had disabilities and were under three years of age, Mahoney and his colleagues
reported that global ratings of parental responsiveness increased by approximately 25%
after 12 months of intervention. However, in both studies there was wide variability in
the impact that RI strategies had on parents. Only 50% of a sample of 40 mothers
increased their responsiveness in the first study (Mahoney & Powell, 1998); while 70%
of a sample of 50 mothers increased their responsiveness in the second study (Mahoney
& Perales, 2005). Thus, while research evidence indicates that RI strategies can be an
effective method for encouraging parents to become more responsive with their children,
there is also evidence that they are not effective with all parents.
Undoubtedly the varying levels of effectiveness of RI strategies is not simply a
reflection of the validity of the strategies as intervention tools, but is also related to the
varying skills of professionals at teaching these strategies to parents as well as to the
different levels of parent acceptance of this form of intervention. It is important to note
that for parents who are not involved in intervention, parents‟ style of interaction tends
to be relatively stable over time (Masur & Turner, 2001). Perhaps the complex array of
factors of personal and psychosocial factors that affect parenting style make this a
process that is resistant to change. From this perspective, it could be argued that any
significant changes in parent‟s interactive style promoted through RI strategies are
remarkable accomplishments and underscore the power of this approach.
2. Do changes in parental responsiveness that are promoted through intervention
enhance or promote children’s development and social emotional well being? For the
past 30 years, More than 20 RFI studies have been reported investigating the effects of
this type of intervention on behavior and rate of development of children with
developmental delays and disabilities (c.f., McCollum and Hemmeter, 1997; Trivette,
2003). In general, this research has produced some very promising results. First, it has
clearly established that enhancements in parents‟ interactions with their children,
particularly as reflected in increases in responsiveness, are often associated with
improvements in the quality of children‟s involvement or participation in interactions
with their parents (Hemmeter & Kaiser, 1994; McCullom, 1984). Second, when RFI is
carried out for six months or longer, it can result in improvements in both children‟s
cognitive and language functioning as well as social emotional well being(Landry,
Smith & Swank, 2003, 2006; Mahoney & Powell, 1988; Seifer, Clark & Sameroff,
1991). In the following I will describe results from an RFI study that I reported with a
sample of young children with disabilities and their parents which illustrates these
findings.
Responsive Teaching (Mahoney & MacDonald, 2007) is a RFI curriculum that is
designed to enhance children‟s cognitive, communication and social emotional
functioning. Similar to other RFIs, parents are taught to use several RI strategies as a
means of increasing their level of responsiveness with their children during routine
interactions. These strategies are taught to parents in weekly individual parent child
sessions in which professionals describe and demonstrate RI strategies, and then coach
parents in their use of the strategies. Interventionists often recommend that parents
spend brief periods of time practicing to learn how to implement these strategies at
home, yet the focus of this intervention is on encouraging parents to use these strategies
during the routine interactions that they normally have while caring for and socializing
or playing with their children.
Mahoney and Perales (2005) reported an evaluation of Responsive Teaching with a
sample of 50 children and their parents. The average age of the children at the start of
intervention was 30 months. Twenty of the children were diagnosed with Autism
Spectrum Disorders (ASD) while the other 30 had a variety of neurodevelopmental
delays (NDD). The intervention took place over a one year period of time during which
the sample received an average of 32 RT sessions that lasted approximately one hour
each.
Not only did pre-post comparisons indicate that the intervention promoted significant
increases in parents‟ responsiveness, but it also resulted in significant and dramatic
improvements in children‟s cognitive, communication and social emotional functioning.
On average children‟s rate of cognitive development increased by 64% during
intervention, while their rate of language development increased by approximately
150%. Intervention also had a significant impact on children social emotional
functioning as measured by improvements in two standardized assessments of social
emotional functioning. This effect was stronger for children ASD who were showing
many more problems in this domain than children with other types of disabilities.
Overall children with ASD made significantly greater improvements in all domains than
did children with NDD. However, this effect appeared to have less to do with children‟s
diagnoses, than it did with the significantly greater improvements in responsiveness
made by parents of children with ASD.
Some of the children who participated in this intervention were receiving other child
directed early intervention services in addition to Responsive Teaching. Yet for the
majority of children Responsive Teaching was the only intervention they received.
However, the effects of Responsive Teaching on children‟s development were not
associated with the number of other interventions they were receiving. Rather the key to
its effectiveness was the degree to which parents learned and integrated Responsive
Teaching strategies into their routine interactions with their children. In fact, the
changes in responsiveness that parents made during intervention accounted for between
10 to 20% of the variability in the developmental improvements that children made.
Children only made significant improvements in their developmental functioning when
parents increased their responsiveness with them and the magnitude of their
improvements were associated with how much parents increased their responsiveness.
When parents were successful, children made significant developmental gains, and the
magnitude of their developmental improvements were associated with the changes in
responsiveness that parents made. If parents did not change their responsiveness during
intervention, children made little or no developmental improvements.
RFI – “Alternative Intervention” versus “Intervention Paradigm Shift”
As described at the outset of this article, RFI is based upon a radically different
conceptual framework than the majority of developmental interventions that are used
with children with disabilities today. RFI is based upon the parenting model which
emphasizes the importance of parents playing the primary role in intervention and
promoting children‟s development by engaging in responsive interactions. Interventions
that are based upon the educational model such as the Enhanced Developmental
Stimulation and ABA approaches tend to view professionals, as opposed to parents, as
the principal agents of intervention as well as emphasize instructional practices that
direct and encourage children to learn higher level behaviors more than responsive
interaction. An important question to consider is whether RFI is simply an alternative
method for developmental intervention that is no more or less effective than other
approaches, or whether RFI reflects a paradigm shift that points to processes that are
absolutely critical for developmental intervention.
Unfortunately, at this point, studies that could be used to address this question
comparing the relative effectiveness of RFI to evidence based interventions based upon
the educational model have yet have yet to be reported. However, Mahoney and
colleagues have reported two studies that suggest that the factors that are targeted in
RFI, parent mediated intervention and responsive interaction, play a critical role in a
wide range of interventions.
In one study, they conducted a secondary analysis of 629 children and their parents who
had participated in four different early intervention research studies (Mahoney, et. al.,
1998). The sample included 298 parent child dyads from the Infant Health and
Development Program (IHDP) (Brooks-Gunn, et. al., 1994); 238 dyads from the
Longitudinal Studies of Alternative Types of Early Intervention (White & Boyce, 1993);
42 subjects from the Play and Leaning Strategies Program (PALS) (Fewell & Wheeden,
1998), and 47 subjects from the Family Centered Outcomes Study (Mahoney & Bella,
1998). The common elements of these four intervention studies were that children began
participating when they were under three years of age, and observations of parent child
interaction were collected that could be used to determine how the effects of intervention
were associated with mothers‟ style of interacting with their children. In all four studies,
mothers‟ style of interacting with their children was assessed with the same instrument,
the Maternal Behavior Rating Scale (Mahoney, 1992)
These interventions differed from each other in terms of the developmental disabilities
and risks of the children that were involved as well as the types and intensity of
intervention services children received. The IHDP was an intensive and comprehensive
intervention derived from the educational model that involved low birthweight children
and their parents. This intervention was initiated when children came home from
neonatal intensive care units and continued until children were three years old. The first
year of this intervention consisted primarily of weekly home visits in which parents
received information about play activities they could do to support their children‟s
development. During the second and third years, parents continued to receive monthly
home visits, while children also received a high quality preschool experience for 25
hours each week.
The Longitudinal Studies were conducted with children with disabilities who were
enrolled in early childhood special education programs. This multi-site study compared
different iterations of interventions derived from the educational model (enhanced
classroom interventions) versus standard practice classroom interventions. Children
received from 2 to 5 days per week of early intervention services. In some cases, parents
also received parent education classes related to how to manage their children at home.
Since none of the early intervention enhancements varied in terms of their impact on
children‟s development (White & Boyce, 1993), in this study, children who received
enhanced classroom interventions were compared to children who received standard
early intervention services.
The PALS project was an RFI that evaluated the effects of a three month parenting
intervention (24 sessions, 30 minutes each) that was designed to teach teenage mothers
how to engage in more responsive interactions with their typically functioning children.
The Family Service Outcomes Study examined the impact of the family support services
that were provided during weekly intervention sessions on children with disabilities who
were enrolled in early intervention programs over a 12 month period of time.
Data analyses investigated how improvements in children‟s developmental functioning
were associated with mothers‟ style of interaction. In two of the studies, IHDP and
PALS, intervention had a statistically significant effect on children‟s development. In
addition, in both of these studies, mothers increased their level of responsiveness with
their children during intervention. In the IHDP, mothers‟ responsiveness at 30 months
was significantly associated with the gains that children made during intervention. In
fact, mothers‟ responsiveness accounted for approximately 20% of the variability in
children‟s rate of development when they were 24 and 36 months old, while the
intervention services that children and parents received (e.g., home visiting and
preschool) accounted for only 4% of the variance.
In the PALS program, after three months of intervention the children in the treatment
group attained developmental quotients that were 9 points higher than children in a notreatment contrast group. In addition, consistent with the focus of this intervention, the
responsiveness of mothers in the treatment group was significantly greater for treatment
mothers than for mothers in the contrast group. A regression analysis that examined the
contributions of children‟s development at pretest and mothers‟ responsiveness at posttest to the developmental status of children at the end of intervention indicated that
mothers‟ responsiveness was the only significant predictor of children‟s development,
accounting for 10% of the variance.
In the other two studies, Family-Centered Outcomes and the Longitudinal Studies, there
were no significant changes in children‟s rate of development during intervention. In the
Family Centered Outcomes study, children‟s developmental quotients changed from 62
at pretest to 63 at posttest; while in the Longitudinal Studies developmental quotients for
children in both the Expanded and Typical treatment groups were 67 at pretest and 68 at
posttest. In addition, in both of these studies there were no significant prepost- changes
in mothers‟ responsiveness with their children. It is interesting to note that even though
mothers‟ responsiveness did not change during the Longitudinal Studies, intervention,
mothers‟ responsiveness was the only factor that was significantly associated with
children‟s rate of development both at the beginning and end of intervention. Neither the
type nor intensity of intervention services children received in this project had any
influence on the rate of development children attained during intervention.
In the second study Mahoney and colleagues (Mahoney, Wheeden, & Perales, 2004)
examined the impact of preschool special education that was based upon the Educational
model over the course of one school year on a sample of 70 children with disabilities.
These children were between 3 to 5 years of age (Mean Chronological Age = 41 months)
at the beginning of the school year and had moderate levels of developmental delay
[Mean Developmental Quotient = 59 (Bayley Scales of Mental Development)]. The
children came from 41 classrooms which operated 4 half days each week for a total of
36 weeks. We classified these classrooms according to the type of instructional model
teachers were implementing. Approximately 27 children were receiving services in
developmentally oriented classrooms in which teachers focused on providing
developmentally appropriate activities in child selected play and instructional activities;
15 children were receiving services in which teachers focused on didactic instruction
related to children‟s individualized educational objectives in teacher directed individual
and group activities; and 28 children received naturalistic intervention services in which
teachers blended child selected developmental activities with teacher directed
instructional activities. We then examined the impact of these instructional models on
children‟s developmental growth and parents‟ style of interaction. Results indicated no
significant improvements in children‟s developmental functioning over the course of this
intervention. Children‟s developmental quotients averaged 59 at the beginning of
intervention and 60 at the end of intervention. While the three types of instructional
models clearly affected the classroom experiences children received, there were no
differences between these models in terms of their impact on children‟s development.
Pre- post comparisons also indicated that parents‟ style of interacting with their children
did not change during the course of the school year. This result was not surprising,
because these preschools had little if any direct involvement with parents and they made
no efforts to influence parents‟ interactions with their children. Despite this, parents‟
level of responsiveness with their children was the only variable that was associated with
children‟s development at the end of intervention. That is, while the preschool classroom
experience had no effect on children‟s development regardless of the type of
instructional model that was used, parents‟ level of responsiveness accounted for 10% of
the variability of their children‟s developmental quotients.
Overall these findings, which are based studies of nearly 700 children and their parents,
provide evidence that is highly supportive of the principles of the parenting model which
is the conceptual framework for RFI. They suggest that: (1) parents are the major
influence on their children‟s development even when their children participate in
intervention: and that (2) the effectiveness of intervention is highly associated with
parents becoming more responsive with their children during the course of intervention.
Children‟s rate of development while they participated in these interventions was highly
associated with how responsively their mothers and other primary caregivers interacted
with them. Responsiveness had a much stronger relationship with children‟s rate of
development during intervention than did the services that children received, regardless
of the type or intensity of these services. Intervention appeared to accelerate children‟s
development when it enhanced mothers‟ responsiveness. When interventions did not
affect mothers‟ responsiveness, children‟s rate of development during intervention was
comparable to their rate of development prior to intervention, which was also associated
with mothers‟ responsiveness. The effects of mothers‟ responsiveness on children‟s
development during intervention appeared to occur with all children, and did not vary
according to the nature or etiology of children‟s developmental disabilities.
These results suggest that developmental interventions that are based upon the
educational model can augment the effects that parents have on their children‟s
development; but that even when these interventions are high quality and intensive, their
influence is still not as great as the influence that parents have on their children. For
example, the centerpiece of the IHDP was the 25 hour per week high quality preschool
experience that children received when they were between 12 to 36 months of age. Yet
results from our analyses indicated that improvements in parents‟ responsiveness, which
were an unintended consequence of the home visiting component of the IHDP,
accounted for nearly five times more variability in children‟s developmental outcomes
than the high intensity preschool experience. However, our results also indicate that high
quality child directed intervention services do not impact children‟s rate of development
if they do not also enhance the effectiveness of parents. In both the Longitudinal Studies
as well as in the investigation preschool special education classes reported by Mahoney,
et. al., 2004, intervention did not enhance the effectiveness of parents at interacting with
their children. In both studies, regardless of the quality and intensity of the child directed
services, children failed to show improvements in their rate of development during
intervention.
Summary
In this article, I have described relationship focused intervention which attempts to
promote the development of young children with developmental delays and disabilities
by encouraging parents to engage in highly responsive interactions during normally
daily routines with their children. I described how this approach to intervention is based
upon the parenting model and how it is related to research on parent-child interaction. I
presented evidence that this approach to intervention can be effective at helping parents
learn how to interact more responsively with their children. I also presented evidence
that changes in parental responsiveness that are promoted through RFI can have a
significant impact on children‟s behavior and rate of developmental functioning.
I contrasted RFI with prevailing early intervention approaches derived from the
educational model. Interventions derived from the educational model tend to be
implemented primarily by professionals and emphasize directive instructional practices.
In contrast, RFI focuses on parents as primary interventionists and encourages the use of
responsive interaction as a means of promoting children‟s development. Although these
two intervention models have not been compared directly, research was described which
indicates that improvements in parental responsiveness are the key to intervention
effectiveness, regardless of whether the intervention is based upon the educational
model or any other model of child development. These findings suggest that RFI is not
just another alternative intervention model; but rather is a paradigm shift in early
intervention, particularly related to the principles of parent involvement and responsive
interaction. While RFI is a viable and exciting method for providing early intervention,
there is great need to continue to investigate the role of parent involvement and
responsive interaction in early development intervention.
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Autism and Developmental Delays, 95
Book Review by
Ozcan Karaaslan1
Ozlem Kaya2
Autism
and
Developmental Delays
in Young Children
Gerald Mahoney & James D. MacDonald,.
PRO-ED, Inc, Texas, 2007
Autism and Developmental Delays in Young Children (Mahoney & MacDonald, 2007)
describes a child development curriculum that can be used with young children with
disabilities and their parents called Responsive Teaching.
This approach to
developmental intervention is designed to encourage parents to engage in highly
responsive interactions with their children during the course of daily routine activities as
the primary means of enhancing children’s development. Since this curriculum
addresses three domains of child development, it can be used by various professionals
who work with parents and children together, including early intervention specialists,
special education teachers, speech pathologists, parent educators, nurses and child
psychologists.
This book is organized into four sections that include 9 chapters and a complete set of
curriculum materials that can be copied. The first section of this book, which includes
the first 3 chapters, provides an overview of the curriculum. In chapter 1 the authors
explain some of the general features and assumptions of this curriculum. This
curriculum was derived from child development research and theory which primarily
included research investigating the ways that parents influence the development of their
children, particularly as related to parent-child interaction. Since this research indicates
that parental responsiveness is one of the main factors associated with the developmental
outcomes that both typically developing children and children with disabilities attain,
this curriculum is focused on teaching parents how to interact more responsively with
their children in their daily routine activities and social interactions. Responsive
Teaching was developed and field tested with infants and preschool aged children with
1
Doctoral Candidate, Anadolu University, Graduate School of Educational Sciences, Department of Special Education, Program in
Education of Individuals with Mental Retardation, Eskisehir, Turkey, [email protected]
2
Dr., Anadolu University, Faculty of Education, Department of Special Education, Eskisehir, Turkey, [email protected]
autism and other developmental disabilities. However, since it was derived from
research conducted with a broad range of children, Responsive Teaching can be used as
a general child development curriculum with all children.
Chapter 2 provides the rationale for why developmental intervention should focus on
working with parents. A common practice in early intervention and early childhood
special education is for professionals to work directly with children, and to pay limited
attention to involving parents directly in their children’s intervention. Chapter 2 argues
that this practice may be a very ineffective procedure for implementing developmental
intervention for at least three reasons. First, the strong attachment relationships that are
particularly evident between parents and children during the early childhood years
means that children are more attuned and responsive to the interactions and information
provided by their parents than they are to other people. Second, children are apt to be
learning developmental skills and concepts at any moment throughout the day. Parents
and other primary caregivers are more likely than professionals to be with their children
when their children are ready to learn. Third, the authors point out that during the course
of a year parents engage in far more interactions with children than professionals. In
fact, the authors present a hypothetical analysis of the opportunities professionals have
to interact with a child compared to parents. At a minimum, parents engage in 20 times
more interactions over the course of the year than professionals. Since children are more
apt to learn from their parents than from professionals, the work that professionals are
doing with children may be offset by the kinds of interactions and stimulation that
parents provide. Rather than focusing on providing developmental learning experiences
in the limited amounts of time they have to work with children, the authors maintain that
professionals’ would be more effective if they focused on encouraging parents to
maximize the quality of their daily routine interactions with their children. In the third,
chapter the authors provide an overview of the curriculum which is described in greater
detail in subsequent chapters in this book.
The second section of this book describes the theoretical and empirical foundations for
Responsive Teaching. Chapter 4 provides a comprehensive review of the research
related to parental responsiveness and explains how this parenting quality is
operationalized in the curriculum. The authors observe that although researchers have
investigated how a wide range of the experiences that children receive at home effect
children’s rate of development, if children are receiving at least minimal levels of
opportunities to play and communicate with their parents or caregivers, the only
parenting quality that is reliably associated with children’s development is parents’
responsiveness. Numerous studies have documented that parental responsiveness is
significantly associated with three domains of developmental functioning, including
cognition, communication and social emotional functioning, regardless of the nature of
children’s disability or the economic status and culture of the parents. The authors point
out that Responsiveness is a complex interactive behavior that has at least five
components: Reciprocity (e.g., interactions that are characterized by a balanced, “give
and take” relationship); Contingency (e.g., interactions that have an immediate and
direct relationship to a child’s previous behaviors that support and encourage the child’s
actions, intentions, and communications; Shared Control (e.g., guidance and direction
that facilitates and expands the actions and communications which the child initiates);
Affect (e.g., expressive, animated and warm interactions that are characterized by
enjoyment or delight with the child); and Match (e.g., interactions and requests that are
adjusted to the child’s developmental level, interests, and behavioral style). In RT, the
intervention strategies that are used to help parents learn and use each these components
of responsive interaction are referred to as Responsive Teaching strategies. RT
strategies are simple suggestions for parents to modify or monitor their interactions with
their children. The curriculum includes 63 RT strategies that are designed to help parents
increase their use of the five components of responsive behavior. For example, a strategy
to promote reciprocity is “Take One Turn and Wait”; Contingency, “Respond
immediately to little behaviors”; Shared Control, “Follow my child’s lead”; Affect,
“Interact for fun”; and Match, “Do what my child can do”. These strategies provide
practical and concrete suggestions about how parents can modify their interactions with
their child to become more responsive. RT strategies help parents to experience the
various components of responsive interactive behaviors before this is their spontaneous
style of interacting with their child.
Chapter 5 addresses the question of “How does responsive interaction promote
children’s development?” The notion of attempting to promote children’s development
by focusing on interacting responsively is quite different from the instructional practices
that are recommended in most other early intervention curricula. Most of the r curricula
that are being used in this field today focus on providing children specially designed
activities and directed instruction that are designed to teach them developmental skills
and behaviors that they do not yet know. RT strategies focus less on encouraging
children to learn new skills and behaviors and more on encouraging children to do things
they already can do. The authors describe research which suggests that by engaging in
responsive interactions, adults are encouraging children to learn and use the processes
that are the foundations for developmental learning which are called pivotal
developmental behaviors. The authors list 16 pivotal behaviors which contemporary
child development theory has identified to be the learning processes children use to
develop their cognitive, communication and social emotional behaviors (See Table 1).
The authors argue, that although it is important for adults to help children learn new
developmental skills and behaviors, the most important way they influence children’s
development is by encouraging them to use the pivotal behaviors that are the
foundations for developmental learning. The major portion of this chapter describes how
these pivotal behaviors contribute to children’s developmental functioning in each of the
three developmental domains addressed by RT.
Chapter 6 describes a research study (Mahoney & Perales, 2005) that the authors
conducted to investigate the effectiveness of Responsive Teaching. It included 50
parent-child dyads in which the children were an average of 30 months old at the start of
intervention. All of the children were diagnosed as having Autism (n=20) or other
Developmental Disabilities (n=30). The study was conducted over a 12 month time
Table 1
Pivotal Developmental Behaviors that are used to promote children’s development in
Responsive Teaching
Pivotal
Behaviors
Developmental Domains
Cognition
Communication
Social play
Initiation
Exploration
Problem solving
Practice
Joint activity
Joint attention
Vocalization
Intentional
Communication
Conversation
Social-Emotional
Functioning
Trust
Empathy
Cooperation
Self-regulation
Feelings of confidence
Feelings of control
period during which each parent-child dyad was offered weekly one hour intervention
sessions that focused on teaching parents RT strategies. Results from this evaluation
produced several findings that supported the effectiveness of this intervention. First, prepost comparisons indicated that that the intervention was effective at promoting
parenting responsiveness. Second, there were also significant improvements in
children’s use of pivotal behaviors. Third, the intervention was associated with dramatic
improvements in children’s development. On average children’s rate of cognitive
development increased by approximately 60% and their rate of language development
increased by nearly 150%. Fourth, there were also statistically significant improvements
in children’s social emotional functioning as measured by two standardized tests. Fifth,
children with autism made significantly greater improvements in development and social
emotional functioning than did children with developmental disabilities. Sixth the
improvements that children made in developmental functioning were associated with
both improvements in mothers’ responsiveness and increases in their pivotal behavior.
The authors argue that that this finding provides the strongest support for the causal
relationship between RT and the developmental improvements that children attained
during intervention
The third section of this book provides guidelines and recommendations for
implementing RT with parents and children. Chapter 7 describes each of the
components of the RT curriculum and the procedures for planning intervention sessions.
RT was designed to conform to requirements to specify interventions goals, objectives,
strategies and evaluation procedures. The goals of RT are defined in terms of the three
developmental domains that it addresses. For example if there is a concern about a
child’s behavior problems, the goal would be” to promote the child’s social emotional
functioning”; while if a child has delays in language development the goal would be “to
promote the child’s communication functioning”. Intervention objectives are the pivotal
developmental behaviors that are listed on Table 1 that are targeted to address the child’s
intervention goal(s). RT also includes the Pivotal Behavior Wizard to help professionals
identify the pivotal behavior that would be best suited for addressing the child’s
developmental or social emotional needs.
Intervention strategies include the 66 RT strategies that are described above and more
than 130 Discussion Topics that can be used to explain to parents what a pivotal
behavior is and why it is important to children’s developmental functioning. For each
pivotal behavior, the curriculum provides a detailed description of six to ten RT
strategies that can be used for promoting the behavior and up to 10 Discussion Points for
explaining the pivotal behavior to parents. For each pivotal behavior, there is a menu of
RT strategies and Discussion Points that can be used to address it. Intervention session
plans are developed by selecting one to two RT strategies and Discussion Points to
present to parents.
Two procedures are recommended for evaluating children’s progress in RT. First,
Pivotal Behavior Rating Scales are provided as a means of assessing children’s progress
in the use of the pivotal behavior intervention objectives that are being addressed.
Second, the authors recommend the use of standardized developmental tests as a means
of documenting whether children are attaining their intervention goals. These tools
should be administered at the beginning of intervention and at 6 to 12 month intervals.
Chapter 8 includes a recommended format for conducting RT sessions. The authors
claim that this intervention can be implemented both with individual parent-child dyads
as well as with larger groups of parents and children. The suggest that the individual
format may be most effective because it allows interventionists to tailor the session to
the unique developmental needs of the child as well as to the learning style and capacity
of parents. In either case, they recommend that sessions include the following sequence
of components:
Rapport: Greet parents and have informal conversations about how they are doing with
the recommended activities from the previous session);
Purpose and Rational e: Explain the intervention objectives being addressed in the
session and the rationale for targeting the pivotal behavior. The interventionist then
describes the RT strategy that the parent will be asked to use with their child.
Demonstration and Practice of RT Strategies: The interventionist demonstrates a
strategy and asks parents if they understand it. The parent is then invited to practice
using the strategy with the child following which the interventionist provides the parent
feedback and coaching.
Family Action Planning. The interventionist and parent develop a written plan for how
the parent can use the RT strategies and information presented in the session during
daily home activities.
Chapter 9 provides a more detailed discussion of several activities that professionals can
suggest for parents to follow through with the content presented during the session. This
chapter also discusses several common problems that prevent parents from using RT,
and provides suggestions for addressing these.
The fourth section of this book provides resproducible copies of all the curriculum
materials that are needed to implement RT. In addition to each of the curriculum tools
describe above, this also includes the Curriculum Outline. This provides a complete
description and rationale for each of the pivotal behaviors that can be targted as
intervention objectives to address children’s developmental and socail emotional needs.
For of the 16 pivotal behaviors there is a definition of the pivotal behavior, a 4 to 10
page discussion of “facts to consider” about the pivotal behavior , as well as a complete
description of the Discussion Points and RT startgies that can be used to address this
behavior. The Curriculum Outline provides all of the information that interventionists
need to develp intervention session plans.
In summary, Autism and Developmental Delays in Young Children presents one of the
most comprehensive “relationship based” intervention curriculum published to date.
There are several strengths to this curricula that make it noteworthy. First it describes a
parent –mediated intervention that parents can carryout in the context of their routine
activities with their children. In addition, it addresses three developmental domains and
is based upon an intervention philosophy that is highly compatible with contempoarry
child development theory. This curriculum is well developed such that all of the tools
and materials needed to implement it are included in this book. Perhaps, one of the most
important strengths is its research base. Responsive Teaching has been derived directly
from child development research findings, and the authors have conducted prelimnaries
evaluations which are highly supportive of its effectivenss.
Depite these strengths, this curriculum is very different from the majority of curricula
that are currently being used in early intervention programs. İn paticular, it is a radical
departure from some of the more popular behaviorally oriented curricula. While
professionals with a strong background in child development will likley feel comfortable
with many of the intervention concepts included in this curriculum, professionals with
strong preferences for behavioral interventions may find this to be confusing and
challenging to use. Nonetheless, insofar as professionals are looking for an evidence
based curriculum that can be used to involve parents in their children’s intervention,
particularly children with autism and other developmental disabilities, this book offers a
highly promising method.
References
Mahoney, G. and MacDonald, J. D. (2007). Autism and developmental delays in young
children: The Responsive Teaching curriculum for parents and professionals.
Austin, TX: PRO-ED.
Mahoney, G & Perales, F. (2005). A comparison of the impact of relationship-focused
intervention on young children with Pervasive Developmental Disorders and
other disabilities. Journal of Developmental and Behavioral Pediatrics, 26(2),
77-85.

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GRAMMAR SUBJECTS VOCABULARY Body Parts