Intervention Practices in Kokebe Tsibah Special Unit for Children
Transkript
Intervention Practices in Kokebe Tsibah Special Unit for Children
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. Anadolu University, TURKEY 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) Ankara University, TURKEY 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. Anadolu University, TURKEY 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. Anadolu University, TURKEY Armin Sohns, Ph.D. Fachhochschule Nordhausen, University of Applied Sciences, DEUTSCHLAND Gilbert Stiefel, Ph.D. Eastern Michigan University, USA Bulbin Sucuoglu, Ph.D. Ankara University, TURKEY Elif Tekin-Iftar, Ph.D. Anadolu University, TURKEY Seyhun Topbas, Ph.D. Anadolu University, TURKEY Yildiz Uzuner, Ed.D. Anadolu University, TURKEY 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] International Journal of Early Childhood Special Education (INT-JECSE) Volume 1, Number 1, June 2009 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 International Journal of Early Childhood Special Education (INT-JECSE) Volume 1, Number 1, June 2009 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 Contingency Learning, 2 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 3 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 4 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 5 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 6 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 7 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 8 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 9 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 10 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Contingency Learning, 11 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. 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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] International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 16 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 17 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, International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 18 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 19 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: International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 20 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 21 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, International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 22 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 23 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 24 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 25 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 26 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: International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 27 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 28 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 29 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 30 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 An Ethiopian Experience, 31 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 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]) International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 33 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). International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 34 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 35 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 36 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 37 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 38 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 39 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 40 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 41 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Language and Behavior, 42 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. 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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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 47 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, Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 48 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 49 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, Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 50 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 51 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 52 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 53 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 EÇÖZE’de Lisansüstü Tezler, 54 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: Sosyal Geçerlik, E: Evet, H. Hayır Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 54 EÇÖZE’de Lisansüstü Tezler, 55 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: Sosyal Geçerlik, E: Evet, H. Hayır Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 56 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 57 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 58 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. *Yıla göre düzenlenmiştir. 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 59 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 60 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 61 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 62 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 63 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. *Yıla göre düzenlenmiştir. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 64 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 sonucuna ulaşılmıştır. 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 65 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 *Yıla göre düzenlenmiştir. 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 66 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 67 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 sonucuna ulaşılmıştır. 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. *Yıla göre düzenlenmiştir. 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, Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 68 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 69 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 70 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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 71 “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: Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 72 (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. Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 73 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 74 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 Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 EÇÖZE’de Lisansüstü Tezler, 75 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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Uluslararası Erken Çocuklukta Özel Eğitim Dergisi (INT-JECSE), Haziran 2009, 1:1 International Journal of Early Childhood Special Education(INT-JECSE), June 2009, 1:1 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] International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 80 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 81 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 82 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). International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 83 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 84 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 85 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 86 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 87 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 88 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 89 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 pre- post- 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 90 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 91 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 92 References Beckwith, L., & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. 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The importance of parenting during early childhood for school-age development. Developmental Neuropsychology, 24(2-3), 559-591. Landry, S. H., Smith, K. E., & Swank, P. R. (2006). Responsive parenting: Establishing early foundations for social, communication, and independent problem-solving skills. Developmental Psychology, 42(4), 627-642. Mahoney, G. (1992). The Maternal Behavior Rating Scale-Revised. Available form the author, Family Child Learning Center, 143 Northwest Ave (Bldg A), Tallmadge, Ohio. 44278. Mahoney, G. & Bella, J. (1998). The effects of family-centered early intervention on child and family outcomes. Topics in Early Childhood Special Education. 18(2), 83-94 Mahoney, G., Boyce, G., Fewell, R., Spiker, D., Wheeden, C.A. (1998). The relationship of parent-child interaction to the effectiveness of early intervention services for at-risk children and children with disabilities. Topics in Early Childhood Special Education 18(1), 5-17. Mahoney, G. and MacDonald, J. (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). Mahoney, G., Wheeden, C.A. & Perales, F. (2004). Relationship of preschool special education outcomes to instructional practices and parent-child interaction. Research in Developmental Disabilities.25 (6), 493-595. Masur, E.F., & Turner, M. (2001). Stability and consistency in mothers‟ and infants‟ interactive style. Merrill-Palmer Quarterly, 47(1), 100-120. McCollum, J.A. (1984). Social interaction between parents and babies: variation of intervention procedure. Child Care, Health, and Development, 10, 301-315. McCollum, J. A., & Hemmeter, M. L. (1997). Parent-child interaction intervention when children have disabilities. In M. J. Guralnick (Ed.), The effectiveness of early intervention (pp. 549-576). Baltimore: Brookes. Nelson, K. (1973). Structure and strategy in learning to talk. Monograph of the Society for Research in Child Development, 38. Sussman, F. (1999). More than words: The Hanen program for children with autism. Toronto, CA: The Hanen Centre. Trivette, C. (2003). Influence of caregiver responsiveness on the development of children with or at-risk for developmental disabilities. Bridges, 1(6), 1-13. Van den Boom, D.C. (1994) The influence of temperament and mothering on attachment and exploration: An experimental manipulation of sensitive International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Relationship Focused Intervention, 94 responsiveness among lower-class mothers with irritable infants. Child Development, 65, 1457-1477. Vereijken, C.M.J.L., Ricksen-Walraven, M., & Kondo-Ikemura, K. (1997) Maternal sensitivity and infant attachment security in Japan: A longitudinal study. The International Society for the Study of Behavioural Development, 21, (1), 35-49. Weiss, R.S. (1981). INREAL intervention for language handicapped and bilingual children. Journal for the Division of Early Childhood, 4, 40-52. White, K. R., & Boyce, G. C. (Eds.) (1993). Comparative evaluations of early intervention alternatives [Special issue]. Early Education and Development, 4(4). International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 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] International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Autism and Developmental Delays, 96 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Autism and Developmental Delays, 97 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Autism and Developmental Delays, 98 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 International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Autism and Developmental Delays, 99 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Autism and Developmental Delays, 100 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1 Autism and Developmental Delays, 101 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. International Journal of Early Childhood Special Education (INT-JECSE), June 2009, 1: 1