Pub - Educating Young Children With Special Needs PDF

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EDUCATING YOUNG CHILDREN

WITH ADDITIONAL NEEDS
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EDUCATING YOUNG CHILDREN

WITH ADDITIONAL NEEDS
Louise Porter
PhD, MA(Hons), MGE, DipEd
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First published in 2002
Copyright © this collection Louise Porter 2002

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Cataloguing-in-Publication entry:
Educating young children with additional needs.
Bibliography.
Includes index.
ISBN 1 86508 779 3.
1. Special education. 2. Handicapped children—Education.

I. Porter, Louise, 1958– .
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CONTENTS
Figures and tables viii
About the contributors ix
PART I—FOUNDATIONS OF EARLY YEARS EDUCATION 1

1 FUNDAMENTALS OF EARLY EDUCATION 3
Louise Porter
Key points • Introduction • Terminology • Effects of early care and
education • Core values of early years education • Recommended
early education practices • Conclusion • Additional resources
2 COLLABORATING WITH PARENTS 19
Louise Porter
Key points • Introduction • Rationale for collaboration with parents
• The evolving parent–professional relationship • A family-centred
style of service delivery • Families’ service needs in the early years
• Communication issues • Conclusion • Additional resources
3 IDENTIFICATION AND ASSESSMENT 36
Louise Porter
Key points • Introduction • Definitions • Purposes of assessment •
Principles of assessment • Assessment methods • Issues when
testing children with atypical development • Parental involvement
in assessment • Equating contradictory results • Some interpretive
statistics • Setting priorities • A word about labelling • Conclusion
• Additional resources
4 PRINCIPLES OF PROGRAM INDIVIDUALISATION 56
Louise Porter
Key points • Introduction • Program planning • Aims of early child-
hood programs • Program differentiation • Planning transitions •
Program evaluation • Conclusion • Additional resources
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vi CONTENTS
PART II—PROGRAMMING FOR ATYPICAL DEVELOPMENTAL

NEEDS 79
15 VISION 81
James D. Kenefick
Key points • Introduction • Developmental effects of impaired vision
• Components of vision • Atypical vision • Identification of vision
difficulties • Children with atypical development • Programming for
children with vision difficulties • Conclusion • Additional resources
16 MOTOR SKILLS 96
Margaret Sullivan
Key points • Introduction • Factors influencing motor learning and
performance • Conditions associated with atypical physical skills •
Trends in the development of movement control • Promoting motor
learning • Playground games that foster motor learning • Con-
clusion • Additional resources
17 DAILY LIVING SKILLS 117
Zara Soden
Key points • Introduction • Sensory skills • Sensory processing •
Hand function • Self-care activities • Conclusion • Additional
resources
18 HEARING 140
Lindsay Burnip
Key points • Introduction • The importance of hearing • The nature
of hearing loss • Causes of hearing impairment • Intervening with
hearing impairment • Conclusion • Additional resources
19 COMMUNICATION SKILLS 154
Bernice Burnip
Key points • Introduction • The components of communication •
Facilitators of language acquisition • Causes of atypical language
development • Communication disorders • Language delay •
Assessment • Intervention • Conclusion • Additional resources
10 COGNITIVE SKILLS 174
Louise Porter
Key points • Introduction • Early cognitive attainments • Knowl-
edge acquisition skills • Metacognitive skills • Emotional learning
style • Conclusion • Additional resources
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CONTENTS vii
11 EMOTIONAL AND SOCIAL NEEDS 191

Louise Porter
Key points • Introduction • The need for protection and safety •
Self-esteem • Autonomy • Social needs • Social skills interventions
• Conclusion • Additional resources
12 GUIDING CHILDREN’S BEHAVIOUR 210
Louise Porter
Key points • Introduction • Debates about discipline of young
children • Selecting disciplinary methods • Skills for guiding
children • Conclusion • Additional resources
Appendix I—Common causes of atypical development 228

Appendix II—Typical developmental milestones 241
Appendix II—Indicators of advanced development in young children 260
Bibliography 264
Index 296
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FIGURES AND TABLES

FIGURES
3.1 A proposed process for the identification of atypical needs

in young children 46
3.2 Timing of two testings coinciding with a learning plateau 49
3.3 Timing of two testings measuring two growth spurts but only one
plateau 50
3.4 Distribution of abilities within a population 53
4.1 Process of program evaluation 76
5.1 Structure of the eye 84
5.2 Refractive errors 87
6.1 Changes in proportion of the human body during growth 98
6.2 Typical changes in bony alignment during early childhood relative
to the appearance of ‘bow legs’ and ‘knock-knees’ 99
6.3 Preschoolers’ version of a jogger’s wall stretch 111
7.1 Sequence of sensory processing 120
7.2 Mature grasp patterns 127
7.3 Handing an object to be grasped to encourage forearm supination
and thumb opposition 129
7.4 Developmental progression of pencil grip 131
8.1 The ear in cross-section showing regions of conductive and
sensorineural hearing loss 143
8.2 Comparison of the angle of the eustachian tube in children
and adults 146
9.1 The components of communication 156
11.1 Diagram of self-esteem as the overlap between the self-concept
and ideal self 196
TABLES
4.1 Common and differentiated features of programs for young children 61

4.2 Young children’s mode of learning and corresponding modes of
teaching 66
AI.1 Summary of common disabilities 238
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ABOUT THE CONTRIBUTORS

Bernice Burnip, MSpecEd, BSpecEd (Hearing Impairment), BEd, is the author
of chapter 9 and contributed to Appendix II. She has worked as a mainstream and
special education teacher since 1972. For the past 20 years she has worked with
children with additional needs, particularly those with hearing impairments. Her
special interest is in early intervention for young children’s language and speech
difficulties. Since 1993 she has been employed as a lecturer in special education
topics at Flinders University in South Australia and continues to provide speech
and language therapy to children and their parents.
Lindsay Burnip, MEd, DipTch (Primary), DipTch (Ed of the Deaf), DipAud, is
the author of chapter 8. He is an audiologist, having originally qualified and
worked as a primary school teacher and subsequently as a teacher of the deaf. He
is a senior lecturer in the School of Education at Flinders University in South
Australia, formerly coordinating and teaching topics on hearing impairment and
currently specialising in the area of information technology, particularly as
applied to the delivery of distance education topics.
James D. Kenefick, BOpt, is the author of chapter 5. He is a behavioural

optometrist and co-founder and director of Kenefick and Associates, which is a
private practice specialising in children’s vision and associated learning difficul-
ties. He is a co-founder and fellow of the Australasian College of Behavioural
Optometrists and is the current state director for this organisation for South
Australia and the Northern Territory. He is a past president of the Optometric
Association of Australia (SA Division).
Louise Porter, PhD, MA(Hons), MGiftedEd, DipEd, is the author of seven

chapters and editor of this volume. She is a child psychologist and senior lecturer
in special and gifted education topics in the School of Education at Flinders Uni-
versity in South Australia. Her specialty areas are disability and giftedness in
early childhood, professional collaboration with parents, young children’s social
and emotional needs, and children’s behavioural difficulties. She maintains a
private practice, consulting with parents and educators about developmental and
emotional issues of young children. She is the author of several books, including
Student behaviour: Theory and practice for teachers (2nd edn, 2000, Allen &
Unwin, Sydney); Behaviour in schools (2000, Open University Press, Bucking-
ham, UK); Gifted young children: A guide for teachers and parents (1999, Allen
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x ABOUT THE CONTRIBUTORS
& Unwin, Sydney; also Open University Press, Buckingham, UK); Young
children’s behaviour: Practical approaches for caregivers and teachers (1999,
MacLennan & Petty, Sydney); and, co-authored with Susan McKenzie, the text
Professional collaboration with parents of children with disabilities (Whurr,
London; also MacLennan & Petty, Sydney).
Zara Soden, BAppSci (OT), is the author of chapter 7 and contributed to

Appendix II. She is a paediatric occupational therapist with a specialty focus on
children’s sensory processing difficulties and the autism spectrum disorders. She
is currently principally employed by the Flinders Medical Centre, Adelaide,
whose Occupational Therapy department supported her in writing her chapter.
She has lectured at Flinders University in the Bachelor of Applied Science (Dis-
ability Studies) and Bachelor of Special Education awards on daily living skills
in early childhood, and has conducted numerous inservice workshops for early
childhood practitioners and parents on topics such as sensory integration and
relaxation in children.
Margaret Sullivan, BPthy, MAppSci (Pthy), is the author of chapter 6, co-author

of Appendix II and provided advice on physical disabilities for Appendix I.
She is a paediatric physiotherapist in private practice, a frequent presenter of
workshops for early childhood educators and parents, and is also employed at an
Adelaide hospital offering paediatric physiotherapy services. She is a clinical
educator and former lecturer in paediatric physiotherapy at the University of
South Australia, and has taught at Flinders University in the Bachelor of Applied
Science (Disability Studies) and Bachelor of Special Education awards on the
motor development of young children.
ACKNOWLEDGMENT
The authors would like to acknowledge with gratitude the comprehensive and
insightful review of the draft of this text provided by Dr Linda Newman of the
University of Western Sydney.
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PART I
FOUNDATIONS OF EARLY YEARS
EDUCATION
In the first four chapters of this text, the principles and inherent values of early
years education are discussed and applied to young children with additional
educational needs. As described in chapter 1, this label refers to children
with learning difficulties, those with recognised disabilities and those who are
learning at an advanced level—that is, those whom we call ‘gifted’. All these
children are included under this umbrella term, as they might not automatically
be having their needs met in regular educational programs and so are likely to
need adjustments to facilitate their productive engagement.
As well as focusing on the needs of individual children, this text examines
how practitioners can collaborate with the children’s parents or other caregivers,
engaging in a two-way sharing of information and thus enriching and expanding
the knowledge of both parents and professionals. Given that their families are an
integral part of children’s lives, we cannot consider children’s needs apart from
their family context and cannot expect to advance children’s interests unless we
equally support their families.
Even though children who are developing atypically will have some needs
in addition to the usual, not all aspects of their program will have to be modified.
They have many characteristics in common with typically developing children
and so will require many similar educational provisions; even so, aspects of their
program will need to be individualised to take account of their additional needs.
Any such curricular adjustments must be framed on the basis of detailed knowl-
edge of the children’s particular strengths and needs. This can be attained only
through assessment, which is a comprehensive and systematic process of gather-
ing educationally relevant information from a variety of sources.
The main criterion for adjusting programs for children with atypical
development is that the regular program must not be disrupted in the process.
This is most likely to be achieved when regular programs have processes in place
to plan for and meet a diversity of needs in attending children and can equip
practitioners with the knowledge, skills and support for extending their programs
to children whose needs are atypical.

1
FUNDAMENTALS OF EARLY
EDUCATION
LOUISE PORTER
KEY POINTS
• Education in the early years has been shown to benefit children with
developmental disabilities, those experiencing educationally disadvantag-
ing circumstances, and those with typical development.
• Across the spectrum of development, children have many needs in common,
but children with atypical development have additional needs. Society has
the obligation to cater for a range of typical and atypical requirements.
• Although the ideal components of early education programs for children
with atypical needs have been difficult to identify through research, some
core values of early education imply a range of recommended practices.
INTRODUCTION
In the United States, the types of educational services provided to young children
with disabilities are specified by legislation (e.g. see Cook et al. 2000); in the
United Kingdom (see Long 1996; Roffey 1999) and Australia (see Williams
1996) the legislation is less prescriptive for this population, although a general
educational framework governs some practices. Elsewhere, services for these
children are dictated only by local policy or are not yet established practice. As
for children with advanced development, where services exist at all, these are
typically recommended at policy level only, with no legislative backing. Regard-
less of the presence of a local legal imperative, however, the authors of this book
concur with the special education rationale that society has a responsibility to
provide all children with an education that meets their needs—however these are
manifested—and to support their families through relevant service provision
(Guralnick 1997).
3
4 FOUNDATIONS OF EARLY YEARS EDUCATION
This rationale applies equally to children with compromised and with

advanced development. The needs of children with disabilities might seem self-
evident; while a focus on gifted children might seem unnecessary, as these
children are already advantaged in that they can learn more easily than most.
Nevertheless, they are still children and still need to be taught how to learn; they
cannot excel without support (Braggett 1994). Thus, a special education
approach advocates modified provisions for all children with atypical needs.
TERMINOLOGY
Internationally, the early childhood period is considered to span from birth to

8 years of age. However, because of the programming differences between pre-
school and school settings, this text will focus mainly on children who have not
yet entered school.
Remedial programs provided in the early childhood period are often referred
to as ‘early intervention’. The adjective ‘early’ in this term implies the provision
of supports and resources to children and families as soon as a developmental
anomaly is detected, which might be at or even before birth (Bredekamp 1993).
‘Intervention’ can be characterised along a continuum, from typical educational
experiences and informal social supports through to the more structured and
systematic provision of remedial activities for children with atypical develop-
ment (Dunst 2000; Simeonsson et al. 1982).
The aim of early intervention is to optimise children’s learning by making use
of their strengths and attempting to circumvent their difficulties to improve their
daily functioning and wellbeing (Cook et al. 2000). It also aims at supporting
families in their role of meeting their child’s needs. It can achieve this at a number
of levels: primary prevention comprises detecting a condition before it has any
expression in the child’s development, as with screening for PKU, for example
(see Appendix I); secondary prevention seeks to prevent identified risk conditions
from affecting children’s functioning; while tertiary prevention seeks to restrict
the impact of an impairment on development (Guralnick 1997; Meisels 1991).
In Australia, the term intellectual disability is used when children’s cogni-
tive development is significantly delayed or otherwise impaired in comparison
with the typical milestones and timetable. In the early childhood years we tend
to be cautious about making diagnoses so early in children’s lives, and thus
usually employ the term ‘developmental delay’. While justifiably avoiding
bestowing diagnoses based on a short history of development, this term can be
unfortunate, in that the word ‘delay’ might imply that delayed children will catch
up, which is unlikely when the delay is severe.
In the United Kingdom, the terms ‘learning difficulty’ and ‘learning disabil-
ity’ are used synonymously with intellectual disability or developmental delay.
However, elsewhere these same terms are used to refer to difficulties—usually
manifested during the school years—with reading, writing, spelling or compu-
tation, perhaps the best known being dyslexia. These difficulties are both less
FUNDAMENTALS OF EARLY EDUCATION 5
severe and more domain-specific than intellectual disability and so, to avoid con-
fusion, the UK terms will not be employed in this text.
In the USA, the term mental retardation is used synonymously with the two
terms favoured in Australia. However, as well as the stigma which the US label
attracts, it leaves the door open for two misunderstandings, particularly in the lay
community. The first misconception arises from the fact that its root word ‘tardy’
implies that ‘retarded’ children are able to achieve normal development—merely
later than usual. For children with severe disabilities this is not going to be the
case: intellectually, some may never progress beyond dealing with concrete
materials, having very limited capacity to reason in the abstract.
The second misconception leads to the opposite misinformation—namely,
that children who are ‘retarded’ are unable to learn anything at all. This is clearly
not the case.
Having assessed a six year-old’s developmental skills, I subsequently explained at
length to her mother that her daughter had an intellectual disability. As I was prepar-
ing to leave, the mother declared that she was extremely relieved and, on enquiry,
expressed the belief that ‘retarded’ children cannot learn anything and so she had
been hoping that her daughter would not be retarded.
Another cluster of terms comprises the triumvirate of impairment, disability

and handicap. To simplify the World Health Organization’s classification (see Pope
1992), an impairment is a discrete loss of mental or physical functioning, such as
brain damage; a disability refers to the effect of this on the individual, such as the
movement difficulties associated with cerebral palsy; while a handicap is the social
stigma and environmental restrictions that are often imposed on those with dis-
abilities but which are not usually an inevitable feature of their condition.
At the other end of the spectrum of abilities is the equally numerous group of
children with advanced development. In the UK these children are referred to as
highly able but elsewhere they are usually known as gifted. The former term,
while seeming preferable, has the limitation of focusing only on those children
who are currently successful, rather than including children who have the poten-
tial for high performances but whose educational circumstances or accompanying
disabilities impair the expression of their skills. The term ‘gifted’, however, is
unfortunate as it implies getting something for nothing, and ignores the fact that
even very bright children have to put in effort in order to succeed.
Notwithstanding the stigma associated with the term, in this text writers will
use the term ‘gifted’ to mean children who have the potential to display signifi-
cantly advanced skills in any developmental domain. This is distinguished from
‘talented’ (or highly able) children who are already expressing that potential in
the form of advanced achievements (as a rough guide, those who are achieving
around 30% ahead of age). This distinction between giftedness and talent is
proposed by Gagné (1991) and described further by Porter (1999).
Finally, to three aspects of language employed in this book. First is the use of
what is called ‘people first’ language, in which, rather than referring to children
who have disabilities as ‘disabled children’, the contributors refer to them as
people who also have some atypical requirements. Second, we use the term
additional needs to signal the inclusion of gifted children as well as children with
developmental difficulties. Historically, children with disabilities have been
referred to as having special needs. Finally, we use the term ‘educators’ to refer
both to early childhood teachers and to professional caregivers in child care
settings, in the belief that it is not possible to care for children without giving
them an education, and equally impossible to educate children in the early years
without caring for them.
EFFECTS OF EARLY CARE AND EDUCATION
High-quality centre-based care has been found to benefit children’s cognitive and
language development and their confidence and positiveness in interacting with
peers, while producing no deterioration in attachment to their parents (Burchinal
et al. 1996; Field 1991; Field et al. 1988; Ochiltree 1994; Phillips & Howes
1987; Rubenstein et al. 1981). As well as such immediate benefits, Andersson
(1989, 1992) demonstrated that these gains were still present at the ages of 8 and
13 years in children who had attended child care as infants.
As for children with disabilities, such clear findings about the benefits of
early intervention are difficult to obtain. This is because programs differ in their
content and method of delivery; it can be difficult to determine whether develop-
mental gains were due to maturation or resulted from the program; success could
be manifested as the prevention of developmental regression or the avoidance of
secondary disabilities—both of which are difficult to measure; and gains could
be attained in skills that were not specifically targeted or measured, such as
social or emotional qualities or parents’ confidence (Bailey & Wolery 1992;
Casto & Mastropieri 1986; Guralnick 1991; Kemp & Carter 1993; Simeonsson
et al. 1982). Moreover, the findings on the efficacy of intervention programs with
one type of disabling condition might not necessarily hold for other disabilities
(Bailey & Wolery 1992).
Timing of intervention is also a factor in outcomes: it has been assumed
that children benefit most from early intervention when it is begun as soon as a
developmental anomaly is detected. This, however, seems to be true only for
educationally disadvantaged children, those with milder disabilities and children
with autism; for those with other severe disabilities, earlier is not necessarily
better (Casto & Mastropieri 1986; Guralnick 1991)—perhaps because very
young children with significant developmental delays might not yet be ready to
take advantage of formal instruction.
The general conclusion, despite the research difficulties and issues of timing,
is that early intervention is both beneficial and a natural right of children and
families (Kemp & Carter 1993). Although research cannot yet identify the
specific program components that are most essential, the philosophical foun-
dation of early childhood education has generated some core values and these, in
turn, have spawned some recommended practices.
CORE VALUES OF EARLY YEARS EDUCATION
Early childhood education and special education both endorse the premise that
early learning is important and cannot be left to chance: young children’s
programs must be tailored to meet their individual needs, however these are
manifested. Underpinning this process are the following core values.
Ethical service delivery

The first fundamental tenet of early years education is that professionals must
treat children and their families in an ethical fashion—that is, must do what is
right, just and good, rather than what is merely expedient, convenient or practi-
cal (Katz 1995). Given children’s lack of power to advocate on their own behalf,
practitioners must use their influence over children in the children’s best inter-
ests (Australian Early Childhood Association 1991). This generic principle gives
rise to some specific ethical guidelines.
The first of these is promoting the good of others. When catering for
children with atypical development, this principle implies that you must promote
their independent functioning and support the parents’ ability to remain in
command of their family. Thus, early years education is aimed at promoting the
abilities of children and families to exercise choice—both through teaching
children decision-making skills and offering them and their parents or other care-
givers a range of options for them to choose between (Brotherson et al. 1995).
The second principle is that you must do no harm. This means that you will
not ‘participate in practices that are disrespectful, degrading . . . intimidating,
psychologically damaging, or physically harmful to children’ (NAEYC 1989:
26). As well as ensuring that provided services will actually benefit the children
and their families, the injunction to do no harm requires that you do not fail to
deliver a necessary service. Furthermore, any service must be delivered com-
petently by staff with adequate training, experience and supervision.
The third principle is that recipients of services deserve justice—which
means giving all those with whom you work equal and fair treatment, both in the
sense of not discriminating against individuals because of their culture, gender,
religion and so on, and in the sense of balancing the rights and interests of one
group with those of another group. For example, although your main concern
might be a child who has additional needs, you must balance that child’s require-
ments with those of surrounding adults, non-disabled children and other
members of the child’s family. It is unjust if one child’s rights are allowed to
eclipse those of surrounding individuals.
The fourth principle is that parents must have enough information to be able
to give informed consent about the program being provided for their child. Vol-
untary consent requires that they not be threatened with a withdrawal of services
for their child if they select a service option that professionals do not endorse, and
neither can they be promised extravagant benefits if they do participate (Alberto
& Troutman 1999). Furthermore, professionals cannot use emotional blackmail to

coerce parents’ consent (Norris & Closs 1999). Your professional status could
mean that parents are subtly pressured into consenting to your plan of action, so
the onus is on you to ensure that what they are agreeing to represents best practice
(Rekers 1984) and that a range of viable service options have been fully consid-
ered and explored with them (Martin & Pear 1999).
Finally, children and families have a right to choose who has personal
information about them, especially when that information could be used to
discriminate against them (Coady 1994). Exceptions to this confidentiality prin-
ciple occur when team members must share relevant information so that they
each have sufficient knowledge of a child’s or family’s circumstances to provide
relevant services, and when there is a threat of harm to children—such as when
you suspect child abuse.
An ecological perspective of childhood and development

Across time, early childhood education has adopted various views of childhood,
each with corresponding models of education. At any one time no single model
has achieved unanimous support, although each has been dominant at various
points in history.
An early view was that infants start out as empty vessels or ‘adults-in-
waiting’ who are impoverished of adult knowledge, skills, values and culture,
and who passively await the transmission of these to prepare them for later life
(Dahlberg et al. 1999; David 1999). This deficit-based view focuses on achiev-
ing pre-determined outcomes, including the imperative to get young children
‘ready’ for school. Just as in a factory, the children are seen to be the raw material
which is acted upon or manipulated to arrive at a finished product (Moss 1999).
Achievement of this necessarily relies on adult-directed teaching, and perhaps
the use of behaviourist methods in which educators determine what children
should know then model desired skills and reinforce (reward) children for pro-
ducing these.
A second early view is of Rousseau’s innocent child who will achieve virtue
if uncorrupted by the adult world and permitted free and playful self-expression
(Dahlberg et al. 1999). This view of children as potential victims leads to efforts
to shield them from ‘negative’ outside influences while offering enriching
environments. Other than planning the environment, however, this perspective
implies little adult mediation of children’s learning for fear of ‘interfering’ with
the natural unfolding of children’s process of self-discovery.
A third view springs from developmental psychology whereby children of
any given age are seen to share universal characteristics (Dahlberg et al. 1999).
This view sees children as separate from their social context—as psychological
rather than social beings. It leads to a maturational or linear perspective of
development which upholds that children’s skills unfold sequentially according
to a biologically-determined sequence (Richarz 1993; Sandall 1993). Under this
model, the educator’s role is to fashion an environment that will support the
emergence of new skills while recognising that, even so, children’s develop-
mental sequence cannot be altered substantially.
A fourth, postmodern or ecological, view refutes the concept shared by the
previous three perspectives that, compared to adults, children are weak, helpless,
passive, incapable, deficient, dependent and isolated, but are instead integral
parts of their various social environments, actively constructing their own experi-
ences (Dahlberg et al. 1999). They are thus rich, inventive and competent
individuals who can communicate with others from birth and, in so doing, can
construct their own identities and understandings (Dahlberg et al. 1999; Fraser
& Gestwicki 2002). This shifts the educational emphasis away from telling
children what they should know so that in future they acquire valued skills,
towards listening and responding to the richness of their present lives.
In contrast with a developmental perspective, an ecological view sees
children’s development as holistic, dynamic, transactional and singular (Dahlberg
et al. 1999; Ludlow & Berkeley 1994). Taking each of these aspects in turn,
holism tells us that all domains of development (cognitive, language, physical,
social and emotional) are interrelated (Bowman & Stott 1994). This implies that
we cannot assess and program for skills in a single developmental domain,
without regard for their impact on children’s overall functioning and wellbeing.
Second is the appreciation that development is dynamic—which is to say
that individuals’ needs change throughout their lifetime and so the environmen-
tal features that are ideal at one age might not be the same ones that are required
at another. This perspective is expressed as the principle of ‘goodness of fit’
which states that in order to remain facilitating, the environment needs to alter in
response to individuals’ changing needs (Horowitz 1987).
Third, development is transactional, which means that individuals change
their environments just as their environments change them (Sameroff 1990).
Rather than biological and environmental factors being additive in some static
linear equation, instead the two aspects work hand-in-hand to shape children’s
lives. The result is that children will acquire various skills and behaviours at dif-
ferent times, as dictated by the experiences offered by their immediate social
environment and wider culture (Bowman & Stott 1994). Individual children’s
skills must therefore be compared not to the milestones achieved within the
dominant culture but in light of whether their behaviours are functional in, and
valued by, their home setting (Bowman & Stott 1994).
Finally, rather than regarding knowledge or development as universal, the
postmodern view sees it as singular, which is to say that individuals construct
their own unique perspectives. This could be seen as a threat to conformity but
is instead valued as recognising complexity, diversity and difference. This, then,
leads naturally to explication of the concept of pluralism.
Pluralism
A ‘melting pot’ perspective includes children with additional needs in early edu-
cation, but requires the children to conform to the setting; in contrast, pluralism
accepts and honours differences and adjusts the setting to fit the children’s (and
adults’) various needs (Lieber et al. 1998). This pluralistic perspective pertains
to the full range of cultural, family and developmental differences. It requires
that programs are not only developmentally and individually appropriate but
also culturally and humanly appropriate (Stonehouse 1994). To achieve this, edu-
cators cannot apply a formula or packaged curriculum but must respond to the
diversity of children and families in their setting (New & Mallory 1994).
The concept of normalisation is inherent in pluralism. It states that all
children and their families deserve access to all the usual aspects of community
life (Bailey & McWilliam 1990; Guralnick 2000). Over the past 30 years, this
concept has led to a push for mainstreamed education, whereby children with
atypical needs are educated in regular schools, and for integration, which refers
to a continuum from segregated to inclusive placements, depending on which
settings are deemed best to meet individual children’s needs (Cook et al. 2000;
Gow 1990; Guralnick et al. 1995; Wolery et al. 1994b). Still more recently, the
term inclusion has gained increasing favour. This concept goes a step further
than integration in connoting that children with additional needs are fully part of,
rather than being additional to, natural settings (Roffey 1999). Inclusion assumes
that most children are best served in regular settings (including schools, homes
and community services), as this is where they will need to exercise their daily
living skills (Guralnick et al. 1995). It refers to a pluralistic system where there
is not a focus on accommodating children with atypical needs within programs
but on designing programs that can support all children, whatever their needs
(New & Mallory 1994; Salisbury 1991).
The importance of process

At all levels of education, processes of teaching and learning are increasingly
being given more signficance than what the children are being asked to learn. This
is partly in recognition of the rapidly expanding pool of information in society,
which means that knowing facts (content) is less important than knowing how to
acquire them (process). When educating young children, the process that is con-
sidered most crucial is the quality of their relationships with adults. High-quality
relationships comprise adults’ sensitivity to—that is, awareness of—children’s
needs, and their willingness to respond to those needs, as appropriate. These two
aspects are the key to facilitating children’s acquisition and consolidation of skills,
to disposing them positively to put in the effort required to learn, and to meeting
some of their need for intimacy (which within early childhood settings is also
satisfied through facilitation of the children’s relationships with each other).
RECOMMENDED EARLY EDUCATION PRACTICES
The difficulty of researching the effectiveness of programs for children with

disabilities means that we cannot draw definitive conclusions about essential
program components (Kemp & Carter 1993)—not least because what could suit
one child might not be beneficial for another, as reflected in the ‘goodness-of-fit’
principle. Nevertheless, research and the above core values do suggest some
ideal practices to which I shall now turn and which are summarised in Box 1.1.
Box 1.1 Values and recommended practices in early childhood

education
Value Recommended practices
Pluralism Inclusion
Ecological perspective Individually appropriate practice
• Respect for parents Collaboration with parents
• Interrelatedness of development Multidisciplinary programming
• Cultural awareness Consideration of quality of life
Focus on processes Naturalistic teaching
Ethical service delivery Support for staff
Inclusion
Simply locating children in regular settings does not on its own ensure that edu-
cational practices are normalised (Bailey & McWilliam 1990). Instead, a fully
inclusive program requires three elements (Winter et al. 1994):
• access—children’s ability physically to enter a setting with safety;
• engagement—their ability, once present, to take an active part in the activ-
ities on offer and to engage socially with surrounding children and adults;
• options—the provision of various activities from which children can select
those that suit them.
When children with highly atypical needs are educated alongside typically
developing children, practitioners often express doubts about whether those with
additional needs truly fit in. This question has three dimensions: first, the effects
on non-disabled children; second, the developmental effects on children with
atypical development; and third, the social outcomes for children with atypical
needs who are in a group of children dissimilar to themselves.
Taking each question in turn, it is clear that inclusion must not lead to a
diminution of the care and education received by the children without disabilities
(Gow 1990). Evidence on this issue indicates that inclusion helps children with
typical development (and educators) learn about, understand and accept diversity
among individuals (Diamond et al. 1994, 1997; Favazza & Odom 1997; Gural-
nick 1994; Janney et al. 1995; Peck et al. 1992). However, mere contact alone is
not enough to ensure this: the contact between children with and without disabil-
ities must be positive, and staff must have the expertise to respond appropriately
to the additional needs of children—particularly those with severe intellectual dis-
abilities and behavioural disturbances (Green & Stoneman 1989; Guralnick 1994;
Stoneman 1993). Another documented outcome is that inclusion gives typical
children opportunities to practise altruism through supporting their peers who

have additional needs (Hanson et al. 1998)—although this is beneficial only as
long as it is not condescending (Stoneman 1993).
As for the developmental outcomes for children with disabilities, model
inclusive programs and segregated early intervention settings achieve similar
improvements in the children’s intellectual and language development and sus-
tained group play (Bruder & Staff 1998; Cole et al. 1991; Cooke et al. 1981;
Harris et al. 1990; Mills et al. 1998). Nevertheless, the effect of setting on these
developmental skills differs for varying degrees of disability (Cole et al. 1991;
Hundert et al. 1998; Mills et al. 1998).
In terms of the social effects, inclusion does significantly increase the rate of
social interaction and level of constructive play of children with disabilities,
although it does not affect their social problem solving (Guralnick 1981; Gural-
nick & Groom 1987, 1988; Guralnick et al. 1995; Hauser-Cram et al. 1993).
Again, findings differ across degrees of disability, with children with mild devel-
opmental delays deriving more social benefit from inclusive settings than those
with more severe disabilities (Holahan & Costenbader 2000).
Importantly, probably as a result of their lesser social competence, children
with disabilities in inclusive settings are less popular than their typically
developing peers (Diamond et al. 1997; Guralnick et al. 1995; Maris & Brown
2000) and are less likely to develop true reciprocal friendships both within the
program and after hours (Buysse & Bailey 1993; Guralnick 1999; Stoneman
1993). As well as producing loneliness, this could result in their having fewer
opportunities to profit from the example provided by typical children. Social iso-
lation is not necessarily an inevitable outcome, however, and could be improved
by a specific focus on social interaction (see chapter 11); although friendship for-
mation is less amenable to change (Guralnick 1999).
It must be borne in mind that in most instances these results were obtained
in model settings where, moreover, at least one-quarter of the children had dis-
abilities; it is not certain that the same findings would be attained in regular
settings in which only one child with a disability was enrolled, as is common
practice. Nevertheless, the interim conclusion can be drawn that the quality of
the setting and its appropriateness for individual children is more crucial to
program success than its segregated or inclusive nature (Fewell & Oelwein 1990;
Odom 2000). In turn, the capacity of a setting to respond appropriately to indi-
vidual children’s unique needs depends on the following aspects.
• The physical environment (indoor architecture and outdoor play areas) must
be adjusted to assure the children’s safe access to the curriculum.
• Educators must actively facilitate interaction between the children with and
without disabilities.
• The numbers of children per educator must be low enough to give children
the specialised teaching that they require (Fewell & Oelwein 1990) without
having so much adult support that the children do not relate to peers or learn
to master challenges independently.
• Staff require adequate training and support, including planning time

(Bennett et al. 1997; Buysse et al. 1998).
• Educators require consistent support from specialist personnel such as
speech pathologists, occupational therapists or physiotherapists (McDonnell
et al. 1997; Wolery et al. 1994a).
• Services must be well coordinated (Buysse et al. 1998).
• The children’s parents must endorse the inclusive program, which they are
likely to do when it is consistent with their own priorities (Bailey et al.
1998).
• Management of the children’s behaviour must minimise disruptions to sur-
rounding children and adults (Harris et al. 1990).
If these conditions cannot be met, it is unacceptable that children with disabil-
ities be harmed simply to serve a civil rights agenda that demands inclusive
placements for everyone (Cole et al. 1991; Gow 1990). Although the ideal of
inclusion is laudable, ‘one size does not fit all’ and so a continuum of service
options—to respond to a spectrum of needs—must be available to children and
their families (Holahan & Costenbader 2000; Mills et al. 1998).
Individually appropriate practices

The principles of developmentally appropriate practice (Bredekamp & Copple
1997) state that programs for young children need to be appropriate for the
children’s ages (the assumption being that this will usually equate with their level
of development)—but also individually appropriate, to take account of children’s
unique pattern and timing of development, personality, learning style and family
and cultural background (NAEYC 1986). In terms of curricular content, this
means that the activities on offer must be similar to those available to same-aged
peers but also modified, where necessary, to enable all children to access them
(Bredekamp 1993).
An emphasis on developmental appropriateness also has implications for
teaching methods. Early childhood education upholds that young children learn
by relating to and acting on their physical and social environment. This implies
that early education cannot simply employ formal instructional methods in a
downward extension of schooling, as these are not always relevant or benign
when applied to younger children (Elkind 1986).
Some of the negative effects of formal teacher-directed instruction of young
children are that, although it can advance children’s learning in the short term,
the skills can be lost again through a lack of consolidation and so result in less
skill generalisation (less learning) than a child-oriented approach (Mahoney et
al. 1992). Meanwhile, the children’s ability to learn in less structured teaching
environments—and thus their successful inclusion in regular settings—can be
compromised (Copland 1995).
Highly directed programs have additional disadvantages in that children
can become passive in their learning style rather than self-driven, so that their
exploratory play is inhibited and self-initiation is reduced. In turn, this creates

greater reliance on adults and reduced contact with peers (Hauser-Cram et al.
1993). Another disadvantage arises when children receive remedial training in
many developmental domains at once (e.g. speech therapy and physiotherapy),
putting them under pressure to progress in both simultaneously rather than
sequentially as is the normal developmental pattern. Furthermore, such programs
can confront children repeatedly with their weaknesses, whereas it can be impor-
tant to balance remedial work with opportunities for children to engage in activities
in their stronger skill areas and which they enjoy. Finally, highly directive teaching
might increase children’s compliance with adult instruction, which can render
them vulnerable to overt abuse as they are taught not to resist adult commands.
Therefore, teaching methods must embrace naturalistic learning. This,
however, does not prohibit using direct instruction to help children acquire skills
that they are not able to learn independently (Bredekamp 1993). This option
takes account of Vygotsky’s notion of the zone of proximal development and
notions of scaffolding or mediating children’s learning which state that with
suitable support from adults children can achieve more than they can inde-
pendently. In this way, teaching processes do not simply follow children’s
independent achievements but also anticipate and impel children towards higher
functioning (Fleer 1995).
Emphasis on play
These disadvantages of high levels of adult-directed instruction lead to the con-
clusion that play is the best vehicle for advancing young children’s learning
(Hanline & Fox 1993), as knowledge discovered is more meaningful than knowl-
edge that is transmitted.
In the Piagetian perspective, play is understood to reflect children’s present
level of development. In contrast, others believe that children’s play does not
reflect their development so much as drive their attainment of the next develop-
mental skill (Dockett & Fleer 1999)—principally metacognitive skills such as
generating their own structure, solving problems, adjusting their perspective to
accommodate playmates, and so on. These metacognitive skills are crucial for
children’s intellectual development (see chapter 10). According to this view, play
persists in children’s lives as the main vehicle for development until other activ-
ities take its place in driving their development (Dockett & Fleer 1999).
This perspective disputes the notions that children play merely because they
have nothing better to do or that play is only fun and therefore not a significant
activity (Dockett & Fleer 1999). It also counteracts assumptions that play is
immature and that we should rush children through the playing phase so that they
can get on with the more important business of growing up. Instead, the benefits
of play, as listed in Box 1.2, imply that we cannot ‘allow’ children to play only
after they have completed ‘work’—that is, activities that adults have structured
for them—as they will learn more in play than in other forms of activity.
Box 1.2 Benefits of play

Play serves many purposes: it meets children’s need for recreation; advances
their skills in all domains and the dispositions that support ongoing learning;
meets their social and emotional needs; and provides an apprenticeship or
means of acquiring everyday skills needed throughout life.
Recreation
• Play offers immediate enjoyment, entertainment and fun.
Development of skills
• Because it usually involves high levels of physical activity, play advances
children’s physical development.
• Through exploration, experimenting and inventing, play allows children to
build knowledge and skills such as abstract thinking, hypothesis testing
and problem solving. Play is the process by which children construct their
knowledge of the world and so advances their cognitive skills.
• Although play precedes the advent of language, it is itself a system of
symbolic representation that equips children to learn language. At the same
time, play propels them into situations where they must employ communi-
cation skills. It also allows children to explore the rhythms of speech, as
seen in their chanting and invention of nonsense rhymes.
Promotion of dispositions
• Play offers children opportunities to exercise initiative and autonomy.
• It advances metacognitive dispositions such as planfulness and self-
regulation of thinking.
• Play allows children to experience their own potency (efficacy) in the
process of play—that is, a sense that they can control events in their world.
Toys are designed for just this purpose: they are created because the ‘real
thing’ is too difficult or dangerous for children to manipulate.
• Play teaches children persistence, as they apply themselves more
conscientiously to this than to most other activities.
• It teaches them self-restraint because, although during play children are
free to follow their own impulses, they are constrained by the context or
game that they have chosen to play.
• Children who engage in most fantasy play tend to develop high levels of
imagination and creativity.
Social-emotional functions
• By promoting children’s skills, play increases their confidence in their
abilities.
• Play allows children to act out and thus resolve emotional issues.
• When engaged with peers, play gives children a vehicle for understanding
how to form and maintain relationships with others. It requires them to
coordinate their actions with playmates.
Apprenticeship
• As well as advancing the skills and dispositions that are functional in their
lives (as listed above), play socialises children as contributing members of
their culture by teaching them adult roles, rules and behaviours.
Sources: Athey (1984); Berk (2000); Glover (1999); Sheridan et al. (1999).
Collaboration with parents

The ecological perspective recognises that children both influence and are influ-
enced by their families. This means that the wellbeing of children is promoted
by supporting their whole family and having regard for the impact of services on
all family members, rather than on the child with additional needs alone. This
perspective implies a bidirectional relationship between educators and parents, in
which educators learn from parents about their child and their aspirations for him
or her while also providing support for the family. Such support must respond to
family requests and can comprise a completely child-oriented service if that is
what parents want, or can encompass a wider form of support that is focused on
family needs. (This theme is expanded in chapter 2.)
Support for staff

Although educators’ accepting attitude towards children with atypical needs is
essential, that alone is not enough to make inclusion work. Instead, educators must
feel empowered to manage inclusive programs. They will feel empowered when
they know how to secure relevant services to meet children’s needs, can collabor-
ate with other service providers and, when appropriate to their role, can deliver an
effective service themselves (Turnbull & Turnbull 1997). To be confident that they
can successfully meet children’s additional needs, educators require experience
with these children, knowledge about typical and atypical development, personal
support, time to plan, and extra resources including environmental adjustments and
access to specialist personnel and education assistants (Buysse et al. 1998; Din-
nebeil et al. 1998; Janney et al. 1995; Malouf & Schiller 1995; Stoiber et al. 1998;
Wolery et al. 1993, 1995). Of these, knowledge is within your most immediate
control. To that end, the appendices describe some potential causes of develop-
mental disabilities (Appendix I), typical developmental milestones (Appendix II),
and signs of advanced development (giftedness) in young children (Appendix III).
Interdisciplinary team work

Because of the interrelatedness of children’s development and the complex
pattern of atypical development, it is recommended that programs be designed to
meet needs across developmental domains, including children’s unique social
and emotional needs. On occasion this will require that educators have access to
specialists from a range of disciplines to guide program planning and implemen-
tation. This can occur at any of the following three levels (Bondurant-Utz 1994;
McLean et al. 1996):
• Multidisciplinary endeavours comprise separate assessment and program-
ming by various professionals.
• Interdisciplinary assessment and programming occurs when all profes-
sionals share information with parents and each other, and incorporate the
findings of others to yield a unified assessment and program plan but never-
theless deliver these components independently.
• Transdisciplinary assessment and programming occurs when team
members and parents cross disciplinary boundaries to conduct assessment
jointly, perhaps with just one member charged with the tasks of assessment
and subsequent program delivery.
The last format sounds less overwhelming for parents and children, respects
children’s development as integrated, and offers valuable opportunities for indi-
vidual professionals to learn about other disciplines (Bondurant-Utz 1994),
However, in my experience it is difficult to implement unless specialists are co-
located, and is highly inefficient as it takes enormous amounts of time for the
various professionals to pass on their detailed skill and knowledge to a novice in
their specialist field. It is perhaps unrealistic to expect the uninitiated to learn
what a specialist has attained in up to five years of training and perhaps the
equivalent again in professional experience. The result can be that the primary
service provider acquires information but cannot know how to adjust the
program if it is not proceeding as planned.
Thus, transdisciplinary work can mean that children and their families
receive a less skilled service—which is particularly untenable when the stakes
are high, as is the case when children’s development is significantly delayed—
and that fewer families can receive a service as team members’ time is absorbed
by lengthy and multiple training sessions. As with other aspects of services, then,
the constraints within each setting will dictate which style of program delivery is
most effective in individual circumstances.
CONCLUSION
In total, children with recognised disabilities and with advanced development

constitute 6–10% of children. A further 15% will have developmental difficulties
(see Figure 3.4) that, although mild, if left unassisted could have serious reper-
cussions for the children’s continued development. Virtually all of these children
will be receiving early care and education in regular settings.
For many reasons, I believe that this is as it should be. Early childhood pro-
fessionals are inherently child-focused, have a flexible enough structure to allow
them to cope with the demands of a mixed-ability group, and are aware of the
imperative to focus on children’s social, emotional and physical needs as well as
their intellectual skills. Finally, young children tend to respond to each other
non-judgmentally, in which case social inclusion in the early years is possible—
and made more probable with specific adult mediation (see chapter 11).
On the other hand, the small size of most early childhood centres means that
staff are sometimes isolated from colleagues, which makes it difficult for them
to exchange information about programming for children with atypical develop-
ment. This means that early childhood professionals must have additional
support to cater appropriately for these children.
ADDITIONAL RESOURCES
For a detailed review of early intervention, see:

Shonkoff, J.P. and Meisels, S.J. (eds) 2000 Handbook of early intervention
2nd edn, Cambridge University Press, Cambridge, UK
For further information on the ethics of early intervention, see:

Porter, L. & McKenzie, S. 2000 ‘Resolving ethical dilemmas in family-centred
work’ in Professional collaboration with parents of children with disabilities
(pp. 152–78) Whurr, London (also MacLennan & Petty, Sydney)
Stonehouse, A. 1991 Our code of ethics at work Australian Early Childhood
Association, Watson, ACT
For a United Kingdom perspective on collaborative early intervention, see:

Roffey, S. 1999 Special needs in the early years: collaboration, communication
and coordination David Fulton, London
For a discussion of the importance of a play-based curriculum:

Dau, E. (ed.) 1999 Child’s play: revisiting play in early childhood settings
MacLennan & Petty, Sydney
Dockett, S. and Fleer, M. 1999 Play and pedagogy in early childhood: bending
the rules Harcourt Brace, Sydney
Fraser, S. and Gestwicki, C. 2002 Authentic childhood: exploring Reggio Emilia
in the classroom Delmar, Albany, NY
Macintyre, C. 2001 Enhancing learning through play: a developmental perspec-
tive for early years settings David Fulton, London
2
COLLABORATING WITH PARENTS
LOUISE PORTER
KEY POINTS
• Parents’ support for their child’s program is considered a crucial factor in

its success.
• In order to meet the needs of all family members—including the child
with additional challenges—parents must be able to remain in command
of their family life. This means that interventions with a child must not
undermine parents.
• Parents might require a range of services during their child’s early years,
some of which you can supply directly and some of which you can help
them to secure from elsewhere.
INTRODUCTION
The involvement of parents or other primary caregivers in their child’s program is

thought to be the main factor that allows the initial gains of early intervention to
be maintained in the longer term (Cook et al. 2000). Having said this, two limit-
ations must be mentioned. First, any evidence on this score is anecdotal: the only
study concerning children with disabilities which gathered empirical evidence
found no benefits for children’s developmental gains, parent stress or parent–
child interaction patterns from parent-centred early intervention compared with
child-centred programs (Mahoney & Bella 1998). Second, for benefits to accrue,
the form of parents’ involvement is crucial (White et al. 1992): placing parents
in the role of their child’s instructor does not improve outcomes for children—
and can even be detrimental to them and their family (Ramey & Ramey 1992;
White et al. 1992). Instead, the emotional support parents receive from their
child’s educators is likely to be more beneficial than training them to teach their
child formally.
The perspective in this chapter is that children’s needs are best met by taking
every family member into account, by promoting the whole family’s healthy
19
functioning and maintaining the parents’ confidence in their ability to care for all
their children. In turn, their empowerment will improve outcomes for their son
or daughter with additional needs.
RATIONALE FOR COLLABORATION WITH PARENTS
The active inclusion of parents in their child’s early care and education is predi-
cated on the dual notions of parents’ rights to be involved and of the benefits for
children that arise from continuity between their home and care or educational
environments (Powell 1994). These benefits are assumed to arise for the follow-
ing reasons (Dale 1996; Sebastian 1989).
• Parents have the most important and enduring relationship with their
children.
• Children learn more from their home environment than from any other
setting.
• Parents have a strong commitment to their children and families and to
voicing their needs.
• Parents have more detailed knowledge than professionals about their child
across time and in a variety of settings; moreover, this knowledge is more
personal and in-depth than that of professionals.
• In the case of children with recognised disabilities, many parents will know
more about their child’s particular disability and about the service system
than many professionals.
• Parents know their aspirations for their child and family and what is best for
their family.
• Parents’ involvement in their child’s education contributes to children’s
positive attitudes to learning and to themselves as learners (Jones & Jones
1998).
• Parental involvement in their child’s education promotes mutual respect and
understanding between the home and centre or school.
• Accountability is more open when parents are involved in their child’s
program.
• Some parents need extra support and guidance to understand and cater for
their child’s atypical needs.
Through participation in their child’s program, parents can gain skills and confi-
dence in their ability to meet their child’s atypical needs. Meanwhile, educators
can work more effectively when they have information from parents about
previous interventions and about what works for them at home.
Parents and professionals share a common desire to pursue what is best for
the child. By working together, you can fashion a program that maximises the
chances of achieving an optimal outcome for the child, family and yourself
professionally.
COLLABORATING WITH PARENTS 21
THE EVOLVING PARENT–PROFESSIONAL RELATIONSHIP
Although working with parents has been an aim of professional services for much
of their history, over time our views of disability, of parents, of professionals and
of their relationship have changed. Half a century ago, parents tended to see
professionals as having high status by virtue of their specialised knowledge, and
so deferred to professionals’ opinions. Subsequently, as notions of dominance
receded, professionals would communicate more routinely with parents but still
held the decisive role as experts who ‘knew what was best’ for children. Next,
parents became involved in their child’s education, but mainly in peripheral ways
(e.g. organising an excursion or helping to raise funds). In this way, parents and
professionals worked in parallel with each other.
The next major trend was towards coordination between parents and profes-
sionals, which comprised some joint planning and sharing of information. Still the
focus was mainly on teaching parents skills so that they could work with their
children under the direction of the professionals. However, some parents perceived
this educational approach as patronising; much parent training was redundant, as
parents already had excellent skills and did extensive informal teaching of their
children (Foster et al. 1981); while some found that a formal teaching role violated
the uniquely personal aspect of their relationship with their children (Seligman &
Darling 1997).
Finally, the most recent emphasis has been on collaboration, with parents
and professionals determining priorities and planning strategies jointly (Daka-
Mulwanda et al. 1995; Turnbull & Turnbull 1997). Although many parents want
to take an active part in decision making, some are content to leave the decisions
to professionals. For some parents, the process of formulating an individualised
education plan is disempowering rather than empowering, as they find themselves
facing a barrage of professionals and advice in the expectation that they will make
a prudent decision based on incomplete understanding of the information they are
being given. Also, the formality of the meeting and the need to cover so much at
once can leave parents feeling discouraged.
Underpinning a collaborative approach was professionals’ recognition of
parents’ strengths and skills for meeting their child’s needs. This was an
advance on the earlier focus on assessing what resources and skills they lacked
(Powell et al. 1997), but still placed professionals in charge of determining
service priorities, which is inconsistent with a collaborative philosophy (Sokoly
& Dokecki 1995).
A more recent view is that parents’ equal status does not necessarily mean
day-to-day participation in their child’s program (Arthur et al. 1996)—as many
parents have other commitments both within and outside the family. It is also
acknowledged that, like parents of typically developing children, parents whose
child has additional needs have a right not to participate in their child’s education.
This trend towards shared power is dynamic and ongoing, and in my view
has one further step to achieve, as a collaborative stance gives too much power
to the professionals (Porter & McKenzie 2000). Parents consult us for our
knowledge and experience of young children and employ us to support them in
advancing their child’s educational or other needs. Thus, more than being mere
consumers or even equal participants in a partnership with you, parents are
actually your employers. They pay considerable taxes for public services and
high fees for private services; thus, as with all employers, you are directly
accountable to them for your practices.
Under this ‘parents-as-employers’ model, parents are in charge of steering
the services that their child requires. In arguing against such a demand-based
model, it could be asserted that some parents do not know what they need (Dale
1996). Nevertheless, they do know what they wish their children to achieve, and
in response to this message we can apprise them of the services we can offer. Our
main role, then, is listening, rather than talking or telling (Dunst et al. 1988,
1994; Sokoly & Dokecki 1995). At the same time we must recognise that the
most educated and well-resourced parents (in terms of available time, income
and personal support networks) are likely to be those who are most able to articu-
late their goals and thus to receive a wide range of services (Mahoney & Filer
1996). Less-well-resourced parents might be aware of a difficulty but do not ask
for help, as they cannot foresee being able to use it because of the constraints
imposed on them by their circumstances (Dunst et al. 1988). These families will
require additional information about the menu of services available plus support
to overcome any barriers to their access to these (Dunst et al. 1988).
Box 2.1 Summary of trends in parent–professional relationships

Nature of relationship Parents’ roles
Professional dominance Compliance
Routine communication Passive acceptance of decisions
Parallel cooperation Involvement in peripheral activities
Coordination To learn skills deemed by professionals
to be necessary
To act as formal teachers of their
children
Collaboration To share power but choose their own
role and level of involvement
Employer–employee To direct programs so that these meet
their child’s and family’s needs
A FAMILY-CENTRED STYLE OF SERVICE DELIVERY
A family-centred style of service delivery upholds that the interests of a child who
has additional needs are best met by taking every family member’s needs into
account, by promoting the whole family’s healthy functioning and maintaining
the parents’ confidence in their ability to care for all their children, rather than by
focusing solely on the child with additional needs. It is underpinned by recogni-
tion that there are many family types and structures that can raise healthy children
but that this outcome is more likely when families receive a range of informal and
formal social supports.
The family-centred model comprises three key ingredients, the first of which
is building rapport with parents. This is achieved by working on their desired
outcomes for their children, which requires you to have knowledge and skills about
children, typical and atypical development, and the particular needs of each indi-
vidual child in your care. When services for their child meet parents’ expressed
needs, child-focused intervention is compatible with a family-centred approach
(McWilliam et al. 1995, 1998). The second aspect of family-centredness—and the
ingredient that most empowers parents and gives them confidence—is parents’
participation in decision making (Dunst 2000). These first two aspects relate to
what services families receive; the third aspect refers to how you relate to families.
Crucial relational skills comprise positiveness, sensitivity, responsiveness and
friendliness (McWilliam et al. 1998).
Positiveness
Positiveness involves thinking the best about children’s and families’ strengths,
your own skills and the possibility for advancement of children’s development.
This must be balanced with realism, however: it is no kindness to parents to
withhold information about their child’s atypical development out of a misguided
wish to shield them or to protect yourself from confronting them with unpleasant
information. (I give a suggestion for balancing positiveness with realism in the
section on presenting child-focused information.)
Sensitivity
When working with families, it is important to be sensitive to their circum-
stances, as these will affect what they are able to contribute to their child’s
education. If the parents are in the process of separating or of establishing a step-
family, or if one adult is parenting alone, there may be little surplus energy left
to devote to a child’s remedial program, even though in other circumstances the
parents would be willing to participate.
Such demands can fluctuate from time to time, whereas families who are
living in poverty must often endure its many disadvantages in the long term.
When, added to this, the parents themselves have a disability, come from a non-
majority culture or otherwise lack support from the wider community, their
participation can be severely compromised as they focus instead on personal and
family survival.
Meanwhile, all families must fulfil many functions in addition to caring for
and overseeing the education of their children. These include: ensuring the family’s
financial viability, engaging in recreation, socialising outside of the family, and
maintaining close relationships among family members (Turnbull & Turnbull

1997). Sometimes the demands of a special program violate these other needs: for
instance, placing parents in a formal teaching role can interfere with the amount of
time they have available for recreation, and can limit the exchange of affection
between parent and child as the parent becomes task-focused rather than nurturing.
A second aspect of sensitivity involves listening to parents’ reactions to
their child’s disability. Children’s early years are often the time when parents
first encounter their child’s additional needs. This means that at this time they
may be experiencing an array of conflicting emotions. Some parents may grieve
about the loss of their fantasised perfect baby; some grieve for the loss of control
over their own circumstances because they now have to defer to the decisions of
service providers; some grieve about the changes in their own personal circum-
stances—such as when a mother who was planning to return to paid employment
now finds that she cannot do so (Porter & McKenzie 2000); and, most poignant
of all, many grieve for the limitations that the disability imposes on their child
him- or herself. Having said this, we know more about the reactions of white,
middle-class parents than about other parent groups—even then, exceptions are
common and each person reacts in an individual way.
Whatever their initial emotions, over time most adjust to their unanticipated
circumstances, particularly when they have support from within and outside their
family; and many come to appreciate the positive contributions that their child
makes to their lives (Grant et al. 1998; Sandler & Mistretta 1998; Stainton &
Besser 1998). But in these early days they may still be experiencing uncertainty,
anger, depression or isolation arising from the sense that no-one else understands
what they are going through. They might lack confidence in their ability to meet
their child’s additional needs, and experience sheer exhaustion from going the
rounds of many professionals in an attempt to achieve a diagnosis and design a
suitable intervention.
Meanwhile, parents whose children are intellectually advanced experience
many of the same reactions to their child’s atypical needs as do parents whose chil-
dren have disabilities. Specifically, parents of gifted children may (Porter 1999):
• be confused about giftedness in general or its particular manifestations in
their child (Hickson 1992);
• feel sad on their child’s behalf when he or she does not fit in;
• lack confidence in their own ability to supply what their child requires in
the various developmental, social and emotional domains (Colangelo &
Dettman 1983);
• grieve at the loss of a ‘normal’ child whom they could plug into the school
system at the age of 5 or 6 and extract at the other end with only the usual
challenges and transitions along the way;
• experience frustration at the unsuitability of regular curricula for their child;
• have difficulty advocating for their child’s additional needs;
• feel embarrassed at appearing to be ‘pushy’ when they request a develop-
mentally appropriate program for their child (Silverman 1997);
• feel the need to support siblings who might have average learning abilities,
so that all family members can accept differences without allowing these to
define any one member as deficient or more special than others (Cornell &
Grossberg 1986).
Unlike parents whose children have a disability, however, parents whose children
are advanced often experience little support and sometimes outright hostility from
educators and other parents (McBride 1992), which means that they lack the
personal support and educational adjustments which they and their child require.
A third aspect of sensitivity is listening to parents’ aspirations for their son
or daughter. Professionals must listen to parents’ priorities rather than imposing
their own goals on parents, as this will facilitate parents’ support for the result-
ing program (Ketelaar et al. 1998).
On the other hand, although sensitivity and empathy towards families are
clearly beneficial, you must avoid feeling sympathy for their predicament and
allowing demands on you to escalate unreasonably. Pity does not give families
confidence in their own ability to overcome adversity, and can overwhelm pro-
fessionals with ‘compassion fatigue’ and result in burnout.
Responsiveness
Responsiveness involves providing, arranging for, or recommending services
that the family asks for. However, if requested services contradict your profes-
sional judgment about best practice, you may not feel it possible to supply these
(Powell 1994). Explaining the rationale of programs to parents is one option, but
in so doing we cannot attempt to change parents’ values (Powell 1994). Persis-
tent disagreement is not easily resolved because a fundamental principle of a
pluralistic service is to respect parents’ views. On the other hand, professional
knowledge must also be respected, and so educators cannot be expected to sacri-
fice their beliefs in the interests of working collaboratively. Perhaps parents can
select another service that more closely reflects their values, but in reality few
options can be available when children have additional needs.
Responsiveness can also mean not imposing services that parents do not
want. Although services could potentially benefit a child, this gain can be out-
weighed by the additional stresses placed on the family (Winton 1993). Thus,
some parents might choose not to participate in services, in which case their
wishes must be accepted.
Although responding to families’ requests is important, as with the other
aspects of family-centred services this too can be overdone. Too much helpful-
ness can unwittingly undermine parents, creating dependence on outsiders and
reducing their confidence in their ability to solve their own problems.
Friendliness
In order to receive emotional support, parents mainly want an emotionally
rich relationship with their professional advisers, rather than formal and distant
interactions (Summers et al. 1990). However, for a range of reasons, being

friendly is not the same as being friends. First, friendship has no agenda, whereas
a helping relationship has a particular purpose; second, being paid to deliver a
service renders it a non-friendship; third, personal relationships with clients can
exploit both parties: clients might feel reluctant to question your recommen-
dations in case doing so jeopardised your relationship, while friendships can
increase clients’ dependence on you and burden you with escalating work-related
demands. Therefore, friendliness must be balanced with limits on your profes-
sional relationships.
FAMILIES’ SERVICE NEEDS IN THE EARLY YEARS
Parents require a range of services in their efforts to assist their child with addi-
tional needs. It will be within your role to deliver some of these, whereas others
will be supplied by outside agencies. Even when you do not deliver a particular
service yourself, you have an important role in helping parents to locate appro-
priate services.
Child-focused information
Parents’ first need is for information—on a range of topics as listed in Box 2.2,
which will change through the years. The information that we impart must be
accurate and up to date so that parents can make informed decisions about their
options. This information must be of high quality and easily accessible. To that
end, you might need to help parents to identify, understand and synthesise various
sources of information, including interpreting other professionals’ reports. This
will involve knowledge of disciplines other than your own and a close working
relationship with other members of a multidisciplinary team so that they can teach
you some of the terms in their specialty fields.
Imparting information about disability at times involves using labels to
describe children’s learning difficulties (see chapter 3). In so doing, it is impor-
tant to be sensitive to parents’ understandings of these terms, as in the example
in chapter 1, where I inadvertently talked at cross-purposes with a parent about
intellectual disability. Although their estimates of their children’s abilities and
needs generally tally with that of professionals, parents might resist a particular
label because they regard their child as a whole person who is more complex
than a single label implies (Harry 1992). Their resistance to a particular label,
however, need not stand in the way of participation in their child’s program.
Once their child’s program is under way, parents most often want infor-
mation about how their child is progressing (Westling 1996). This can be a
delicate issue, as you must convey that the child is continuing to learn while not
implying that the child’s skills are approaching the normal range if they are not.
You might find it useful to say something such as, ‘James is communicating
more clearly now, and uses a number of words. This is a big advance on earlier
Box 2.2 Information sought by parents

Parents tend to want information about:
• their child’s additional needs;

• their emotional reactions and those of other family members;
• typical and atypical child development;
• how to recognise and respond to any atypical cues that their child uses to
communicate with them (Guralnick 1991);
• their child’s learning characteristics and future potential or prognosis;
• how to support their child at home;
• how to play with their child at home;
• the range of available services such as respite care, relevant extracurricu-
lar activities, financial assistance to offset additional costs, future schooling
options;
• behaviour management strategies;
• parent support groups.
Source: adapted from Westling and Plaute (1999).
in the year, when he was not speaking at all. His skills then were below the
1-year level. Now they are closer to 2 years’ (say, when James is aged 4).
Participation in planning
Most parents, particularly those with high levels of education, want to exercise
choice about their children’s programs (Freeman et al. 1999; Westling 1996;
Westling & Plaute 1999). To that end, it will help to prepare them in advance
for meetings and listen to them so that their agenda drives the meeting, rather
than topics for discussion being determined by the professionals. While con-
ducting the meetings efficiently, you will need to allow enough time—and
double the usual period when interpreters are being employed (Lynch & Hanson
1996)—so that there is enough time to discuss your thoughts, listen to the
parents and answer their questions (Abbott & Gold 1991). Listening to their
responses will help you to choose terms that they use themselves, which will
ensure that they understand what you are telling them. Where you can, you
will need to avoid jargon and define those terms that you cannot avoid (Turnbull
& Turnbull 1997).
One successful strategy to avoid overwhelming parents with new assessment
information and service options is to tape the meeting, so that they can review it
later or so that an absent parent can still hear the conversation. Alternatively,
minutes of the meeting can be forwarded to parents for them to review what was
discussed. It will help if you can invite parents to meet you briefly again to discuss
issues and questions thus generated.
Identification and assessment

Sometimes you will be the first to observe the signs of atypical development in
individual children. Naturally, you cannot diagnose the cause of these irregular-
ities if that is outside your realm of expertise (Chandler 1994). However, you can
talk with the children’s parents, giving them specific examples of what you have
observed that has raised concern in your mind. When conveying such potentially
upsetting information, it is crucial that you be honest and do not try to shield the
parents from the facts out of some misguided desire to protect them. However,
keep in mind that not all parents will react to your concerns with alarm. Some-
times they will be relieved because your feedback confirms their own misgivings
and empowers them to seek more information.
If as an outcome of your discussions a specialist assessment is launched,
parents need to be involved in all its phases: their participation is essential to
provide a history of their child’s development and to detail their priorities for his
or her immediate and longer-term program, and to ensure that resulting discus-
sion addresses their issues and that programs are designed to meet their needs.
Most want such assessment to be comprehensive, without a sole reliance on
testing, as it can be difficult for their children to display their optimal skills in a
formal setting (McKenzie 1993; Ryndak et al. 1996). When children receive a
wider-ranging assessment in which their parents have been active participants,
the parents are more likely to understand and endorse both the assessment
process and recommendations that arise from it.
Education
Parents usually want educators to be receptive to the information they impart on
their child’s history and present needs, without becoming defensive (Ryndak et
al. 1996). Above all, they want their child’s curriculum to be individualised and
challenging, with specialist services provided (Hodapp et al. 1998; Ryndak et al.
1996). They want their teachers to know about disability in general, and about
their child’s specific disabilities and their impact on his or her development
(Hodapp et al. 1998).
In terms of placement, some parents of children with disabilities prefer inclu-
sive settings for reasons of convenience, the availability of positive role models in
general settings, socialisation benefits and, in the case of less severely disabled
children, for the extra educational challenge (Bennett et al. 1997; Freeman et al.
1999; Guralnick et al. 1995; Hodapp et al. 1998; Ryndak et al. 1996). Even so,
they tend to realise that co-location alone is insufficient for friendships to develop,
and so want teachers to take active steps to facilitate friendships between children
(Palmer et al. 1998a; Ryndak et al. 1996).
Other parents feel that their children’s educational needs are best met in seg-
regated settings (Palmer et al. 1998a, 1998b; Ryndak et al. 1996). Some prefer
these because they are concerned for their child’s physical and emotional safety
in inclusive settings (Bentley-Williams & Butterfield 1996; Westling 1996); they
believe that inclusive settings cannot provide the resources and individualised
programming that their child requires (Hanline & Halvorsen 1989; McWilliam
et al. 1995); and some want their son or daughter to be educated alongside
children who have additional needs on the grounds that these children might be
more ‘forgiving and accepting’ (Hodapp et al. 1998).
Thus, although local preferred practice may be to encourage inclusive place-
ments for children with disabilities, some parents will need to explore both
regular and special placement options and make their selection on the basis of
their own and their child’s particular requirements.
Direct therapy services

Despite evidence that direct therapy—in the form of speech pathology, occu-
pational therapy and physiotherapy—is not superior to the incorporation of
therapeutic activities into the natural setting (Washington et al. 1994), and
despite the lack of evidence that more therapy is better (McWilliam et al. 1996),
during their children’s early years parents tend to seek intensive therapy when
their children have disabilities.
In the face of insufficient therapists and a preference for naturalistic instruc-
tion in early childhood settings, when children are receiving specific remedial
services you will need to negotiate with their specialists to incorporate, where
relevant, their goals into your program. This will aid skill generalisation, provide
the children with more practice than they might receive from infrequent therapy
sessions, and is likely to meet the families’ expressed needs for direct intervention.
Social support
Parents who have a high level of contact with friends and relatives tend to have
higher morale than those with few such supports (Greenberg et al. 1997).
However, parents whose children have additional needs tend to be isolated
from the other preschool or child care parents unless educators enact specific
measures to foster interactions between them (Hanson et al. 1998; Winton 1993).
Ongoing contact avoids the parents’ social isolation, while the children also
benefit from after-hours contact with peers while their parents socialise with
each other.
Advocacy
Although parents can normally be their own advocates, this can sometimes
antagonise service providers, in which case you might have to deflect any criti-
cism that arises within your own service when parents are active in advocating
for their children’s needs (Bennett et al. 1997). On other occasions you might
have to advocate on their behalf for particular services within or beyond your
agency. One commonplace occasion for this role is during meetings between
parents and members of a multidisciplinary team, in which it is easy for parents
to feel overwhelmed and outnumbered. The measures already discussed for

involving parents in planning can be useful here.
Transition planning
The time when parents and their children are most likely to be stressed is when
they are moving from one service to another, such as from preschool to primary
school (Wolery 1989). Like all parents, those whose child has a disability are
excited at the prospect that their child will start school, but it is also a stressful
time (Bentley-Williams & Butterfield 1996). They have to leave familiar pro-
grams and staff, and accept that at school there is generally less opportunity for
their involvement (Bentley-Williams & Butterfield 1996; Fowler et al. 1991;
Hadden & Fowler 1997).
Transition times can reaffirm to parents their child’s different needs (Hanline
1993). Parents must face the reality that the early intervention program did not
and could not have ‘cured’ their child’s disability. If the parents have been
actively involved in the delivery of remedial programs, they can feel cheated and
disillusioned that they gave up so much to achieve so little of what they had
hoped.
The choice of school is a great concern. Like all parents, those whose children
have atypical needs have to adjust to the notion that no school is going to provide
all that their child requires. However, there is likely to be an even greater than
usual disparity between the atypical needs of their child and the schooling options
that are available. Furthermore, sometimes even this choice of school is out of
parents’ control: their child might not be considered eligible for the school of their
choice (Fowler et al. 1991). This adds another layer of complexity and stress to
the family’s planning for transitions.
In order to help plan for their child’s next placement, you will need a long-
term perspective on the family’s concerns, aspirations and involvement to date.
Parents will need information well in advance about the transition process and
their child’s future schooling options (Fowler et al. 1991; Hanline 1993). It is
important to listen to what the family wants of the next service which they and
their son or daughter are entering, so to that end you could ask the following
questions (Hutchins & Renzaglia 1998):
• What do you want your child to achieve in the new setting?
• What experiences has the child already had that could prepare him or her for,
or could be useful in, the new setting?
• What does your child most enjoy doing?
• What sort of assistance and support will your child need in the new setting?
• How does he or she communicate with others?
• In what ways do you (the parents) want to become involved in the new
setting?
• What sort of feedback do you need (a) in the initial days and (b) subsequently,
about how your child is settling in and performing in the new setting?
As you gather parents’ answers to such questions, it will be important to be

clear with them if a service that they want is not available: it does not benefit
them if you promise something that subsequently cannot be provided. Part of
your joint planning, then, might be to develop a plan for surmounting gaps in
services.
Respite care
Respite care is one of the most requested services for families, especially when
their children have behavioural difficulties (Hayes 1998; Rimmerman et al.
1989). The use of respite care increases mothers’ feelings of wellbeing, and as a
result has positive effects for the functioning of families as a whole (Botuck &
Winsberg 1991). Child care can function as a natural source of respite but can be
inaccessible to many parents because of its cost, limited hours, distance from
home or work, and inability to accommodate children’s additional needs
(Warfield & Hauser-Cram 1996), in which case parents might need information
about alternative respite care options.
Counselling
We must not assume that parents with a child with a disability will need coun-
selling—any more than would other families (Seligman & Darling 1997). They
might require different information about their child’s atypical needs compared
with other parents, but this does not necessarily mean that they will need more
emotional support in the form of counselling.
The counsellor who is supporting parents of a child with disabilities may
need to adopt a variety of roles with respect to the services already described:
helping parents to gather information; assisting their access to services; inter-
preting assessment reports; acting as a sounding board, ally or advocate; and
supporting their decisions. In performing these roles, your task is to help parents
to use their present skills to make effective choices in their lives and to act on
these (Nelson-Jones 1988). Thus, counselling does not involve convincing others
of what they should do, but allowing them to discover for themselves which solu-
tions fit for them (Geldard 1998).
Coordination of services
A crucial aspect of service provision is service coordination (McWilliam et al.
1995). Privatisation, outsourcing and increasingly restrictive eligibility criteria for
publicly funded services can make it difficult for parents to locate appropriate
services for their children (McWilliam et al. 1995). Faced with such difficulties,
many parents find a case manager to be an asset in helping them to negotiate a
complex service system, especially when their child has multiple needs
(Dinnebeil et al. 1999; Westling 1996; Westling & Plaute 1999). Others want to
assume this role for themselves to retain control of their own circumstances
(Dunst et al. 1988). The implication, clearly, is that professionals need to ask
parents about their preferences.
Referral to other services

A final service that parents might require from time to time is referral to an
agency that can supply a service you are not equipped to offer—such as special-
ist practitioners or community-based leisure activities. To perform a referral
function, you will need to know about a range of services, including their
location, eligibility criteria, waiting time, costs and contact phone numbers. For
leisure activities for children with disabilities, it can be particularly beneficial to
locate a program attended by one of the non-disabled children in your centre,
as the children’s contact in two locations can help them to socialise in both
(Beckman et al. 1998). Your group of parents can supplement your own knowl-
edge by nominating services they have personally found useful, which you can
then collate into a resource list.
COMMUNICATION ISSUES
Communication between parents and service providers and within an interdis-

ciplinary team has been identified as crucial to collaboration (Dinnebeil et al. 1996,
1999). Trust and mutual respect underpin the three clusters of communication
skills—namely, listening, being assertive, and solving problems collaboratively.
Each of these is best employed according to who is feeling concern at the time.
Three scenarios are possible.
First, when parents have an issue to discuss with you, your main task is to
listen to these. Listening entails giving speakers your attention, avoiding judgment
and resisting imposing your solutions on them. It requires that you accept their
feelings—even when you do not understand why they feel as they do.
Second, when you are disturbed by someone else’s actions, you need to be
assertive by stating the effect of the behaviour on you, without being aggressive.
This requires using the word ‘I’ rather than ‘you’, as this distinguishes assertive-
ness from aggression. I have found that the most useful assertive method is an
empathic assertive statement (Jakubowki & Lange 1978). This comprises a
three-part statement whereby you reflect the other person’s concern, state your
alternative perspective, and then ask how the two can be reconciled.
Third, when you both are being inconvenienced by an issue, you will each
need to be assertive, listen to each other, and then solve the problem jointly. This
entails defining the problem, listing potential solutions, selecting one of these,
implementing it, and then checking that the solution is achieving the desired
outcome.
These three skills will need to be variously employed during challenging
communications with parents.
Problem solving with parents

When a child is experiencing a difficulty at your centre, you will need to
collaborate with the parents to find a solution. In so doing, it pays not to give
parents advice about what should be done, as dispensing solutions is an exercise
of power and, as Bailey (1987) observes, is something done for families rather
than with them.
Instead, Heath (1994) suggests that, before selecting which course of action
you will follow, you and the parents could:
• restate your priorities for the child;
• identify the types of solutions that are possible in the circumstances, based
on parents’ information about what works for them at home and on your
knowledge of what has already been tried in your setting;
• identify the relevant characteristics of the child—temperament, age, size,
abilities, interests, responses to earlier interventions, and so on;
• identify the needs of the surrounding adults and children;
so that you can select a solution that is compatible with your broader goals for
the child and which satisfies the needs of all those involved.
If during your discussion parents are expressing their concern in a way that
you find intimidating, you nevertheless need to respond with courtesy. Generally
the parents feel that they have a valid reason for their behaviour, and their frus-
tration is seldom directed at you personally but at their own powerlessness.
When they express their complaints offensively, however, you could redirect the
discussion to what they want to accomplish (Jones & Jones 1998). For example:
‘I accept that you are angry that Simon’s clothes went missing. Perhaps now we
can plan for it not to happen again.’ It might be useful to impose a time limit or
schedule a subsequent appointment to give parents time to calm down and
yourself time to gather additional information.
Communicating with parents from non-majority cultures

Just as you plan for the diversity of needs of the children in your care, so too do
you need to plan to work collaboratively with parents whose cultural back-
grounds vary. In a culturally diverse society it is not possible or even desirable to
work with every parent in the same way (a’Beckett 1988).
Culture can affect many aspects of parent–professional interactions. First, it
can disenfranchise migrant parents, as they are more likely to be living in poverty
and have the least access to support from social services (Salend & Taylor 1993).
Their experience of discrimination and the fact that they do not know the local
education system (as they received their education in their home country) can
mean that they are reluctant to engage with professionals or join parent groups,
thus leaving them particularly isolated (Marion 1980).
Second, their competence and confidence in speaking English can deter some
parents from being involved (Lynch & Stein 1987). In turn, this disengagement
and their lack of facility with language denies you information about their child
that would assist you in programming for him or her. Obviously, it also affects
how much information they can receive from you as, even when they can use
everyday language, they might have difficulty comprehending technical terms and
jargon (Rosin 1996; Salend & Taylor 1993).
For parents who speak but are not confident about reading English, informal
contacts will be more important than written exchanges. Rather than waiting for
difficulties to occur and meetings to become formal, it will help if you can locate
a culturally sensitive translator or invite a community volunteer to accompany
non-English-speaking parents on a regular basis at drop-off or collection times so
that you can pass on day-to-day information about their child’s experiences. It is
wise to avoid using their son or daughter as a translator, as that burdens a child
with inappropriate responsibility, while translators who are children or family
friends can be exposed to information that parents regard as personal and so can
make parents feel uncomfortable both at the time and in their subsequent rela-
tionship with their interpreter (Lynch & Hanson 1996; Salend & Taylor 1993).
Third, culture affects the esteem in which professionals are held. Some
parents will regard professionals as experts whose opinions cannot be questioned
and with whom they must relate formally, while others who value interdepend-
ence between individuals will seek a collaborative style of interaction with you
(Lynch & Hanson 1996; Salend & Taylor 1993).
Fourth, their cultural beliefs can dictate how parents understand the cause of
their child’s disability: some are reluctant to expose their child and themselves to
outside scrutiny, as they believe that the disability reflects negatively on them
(Salend & Taylor 1993), or they might passively accept it as ‘God’s will’ or as a
justified punishment for their own former misdemeanours—and so resist inter-
vention measures (Lynch & Hanson 1996).
Fifth, parents’ cultural background can cause parents to emphasise priorities
for their children in domains other than academic achievement, which is the trad-
itional focus in Western cultures (Lopez 1996). Many value social cooperation
above competition and social and emotional development over academic
success. Therefore, you will need to clarify parents’ priorities for their child’s
education.
Sixth, their culture affects family membership. In some families, grandparents
or other extended family members have a crucial role either as an elder or as a
major care provider for a child. It will be important, therefore, to negotiate which
family members should be included in any meetings (Salend & Taylor 1993).
Finally, culture affects communication styles—differences in personal
space, use of eye contact, wait time, voice intonation, which words are permis-
sible, facial expressions, emotional expression, and the use of touch (Rosin 1996;
Salend & Taylor 1993). There is no guaranteed way to avoid the miscommuni-
cation that can arise when others misinterpret your body language, but problems
can be minimised when you are aware of the potential for crossed wires.
Cultural competence can be attained by becoming aware of the assumptions
and values implicit in your own culture, being sensitive to the fact that these will
not be universally shared, and attaining and applying information about other
cultures through reading and personal and professional contacts with individuals
who bridge cultures (Lynch & Hanson 1996). When you are ignorant of parents’
cultures, it can be a simple matter just to ask them about the practices in
their country. Generally, they do not expect others to know the practices of every
country in the world and are glad to explain some of the values they hold dear.
Asking them about their beliefs also avoids assumptions that they will conform
to cultural stereotypes.
Communicating with parents of typically developing children

Parents of the typically developing children in your care have a right to reassur-
ance that a child with a disability will not require a disproportionate amount of
staff time, resulting in reduced care of their own child. However, you will need
to decide on a case-by-case basis how much information you should tell the other
parents about the attendance of a child with a disability, as disclosure could
create unnecessary anxiety or be construed as a tacit invitation for protest
(Chandler 1994); conversely, if you do not discuss the issue with your parent
group, some might feel that you are not receptive to their legitimate concerns.
Your decision will need to be made in consultation with the parents whose child
has additional needs.
CONCLUSION
Whether working with parents whose children have previously recognised

disabilities or gifts, those whose disabilities or gifts emerge during their
participation in your program, or those parents whose children have typical
needs, you must be sensitive to their requirements and respond, where appropri-
ate, to their expressed needs.
In so doing, you must take care not to add to the demands that parents are
already experiencing, particularly at the time of discovery of their child’s addi-
tional needs or during transitions from one service to another. It will be important
to listen to their concerns and aspirations and endeavour to adapt services to their
individual circumstances, rather than asking parents to conform to program
demands.
For more detail on collaborating with parents of children with disabilities and an
extensive reading list for further reference, see Porter, L. and McKenzie, S. 2000
Professional collaboration with parents of children with disabilities Whurr,
London (also MacLennan & Petty, Sydney)
3
IDENTIFICATION AND
ASSESSMENT
LOUISE PORTER
KEY POINTS
• Assessment is a systematic process of data gathering, aimed at establish-

ing children’s strengths and educational needs.
• Testing is but one part of the assessment process which can allow edu-
cators to prioritise children’s needs.
• Labels can lower expectations for children’s achievements but at the same
time can help describe, explain or predict their developmental pattern,
which can help parents and educators to anticipate children’s needs.
INTRODUCTION
Early childhood educators have an ethical obligation to collect information that

helps design an appropriate service for children and their families (McConnell
2000). For those children whose additional needs have already been recog-
nised, much assessment information will already have been gathered, perhaps
by a range of specialists. In that case, your job will be to interpret their assess-
ment reports so that you can adjust your program to meet the children’s
additional needs. However, the language of these reports can seem impenetra-
ble at times, and so this chapter explains some of the information you might
encounter in them.
A second group of children—who constitute a far greater number—will
have atypical developmental patterns that formerly have not been recognised.
For these children, assessment comprises talking with the parents about their son
or daughter’s developmental history and observing the children in a variety of
contexts. In order to make sense of the information you have received in these
ways, it will be useful to refer to checklists that tell you when children usually
36
IDENTIFICATION AND ASSESSMENT 37
achieve the various skills in each developmental domain (see Appendix II).
Having recognised the ways in which particular children’s development is
departing from the usual, you can make necessary adjustments to your program
and, when the departure from the norms seems extreme, can advocate that
parents seek more detailed specialist assessment.
DEFINITIONS
Educational assessment refers to the gathering of information about children’s

learning levels, style and skills in order to make instructional decisions about
meeting their needs (McLoughlin & Lewis 2001). Testing is but one element
of educational assessment and involves eliciting children’s responses to ques-
tions under structured conditions (McLoughlin & Lewis 2001). These two
definitions tell us that there is far more to educational assessment than purely
testing—that is, assessment requires gathering information in a range of ways
from a range of sources, in a range of situations and over time. This process
will need to be systematic and collaborative and follow a logical sequence
from data collection to design of an educational program (McLoughlin &
Lewis 2001).
Two remaining terms include diagnosis, which refers to the effort to estab-
lish the cause of a condition and to outline appropriate treatment implied by that
condition; and evaluation, which examines the effectiveness of a program, as
distinct from focusing on individual children (Cook et al. 2000).
PURPOSES OF ASSESSMENT
For children who are suspected of having delayed or advanced development,

assessment can serve many purposes (Taylor 2000). Why we are assessing indi-
vidual children will have implications for how we proceed with that assessment
(McCormick & Schiefelbusch 1984):
• Screening occurs before concern has been raised about individual child-
ren’s developmental pattern. It takes a broad, naturalistic look at children’s
development, aiming to identify individuals who might need additional
assessment.
• Description of current skills determines whether children’s development is
atypical and reveals the nature of children’s developmental patterns
(McLoughlin & Lewis 2001), which will involve identification of their
strengths and relatively weak skill areas.
• Curriculum planning. Having established the nature of children’s addi-
tional needs, assessment must be able to guide decisions about what
supplementary services individual children require and how to deliver these.
• Decisions about placement. Placement decisions will involve making

a choice about which settings will most benefit children with atypical
development and which age group of peers will best support their learning
and social and emotional growth.
• Classification. This is a common reason for the assessment of children who
are suspected of having developmental delays or advances. Classification is
a controversial function of assessment, although by definition giftedness and
disability are relative to normal development and so issues of classification
are inevitable. This is not necessarily negative, as classification can perform
a social justice function of highlighting those individuals who need tailored
educational provisions.
• Monitoring children’s progress. A final purpose of assessment is to
monitor how children are responding to an educational program. Monitoring
serves three purposes (Wolery 1996b): to check that the conclusions and pri-
orities generated by earlier assessments are still relevant; to build a record of
children’s progress over time so that educators’ accountability is promoted
and to celebrate children’s achievements; and to determine whether and how
programs should be modified in response to children’s accomplishment or
non-attainment of earlier goals. For reasons discussed later in this chapter,
normed tests are not ideal for this purpose, so more naturalistic measures
will be preferable.
PRINCIPLES OF ASSESSMENT
A key principle of assessment is that it must be multidimensional—that is, it

must employ multiple measures, from multiple sources, over multiple develop-
mental domains and fulfil multiple purposes (as just listed) (Neisworth &
Bagnato 1988). A second fundamental principle is that assessment must
examine not only the qualities and needs of individual children but also the
environmental factors that contribute to their present developmental status
(Neisworth & Bagnato 1988). Third, assessment must recognise that, although
skills in the various developmental domains can be assessed separately, the
domains are in fact interdependent (Meisels & Atkins-Burnett 2000). This
implies that specialist assessors must share information so that they can develop
a multidimensional picture of the whole child, not just isolated skills.
The following additional principles should guide the assessment process for
children who are suspected of having additional educational needs.
Advocacy
The principle of advocacy contends that assessment should uphold the interests
of all children and aim to improve services for individuals (NAEYC 1988).
Methods should be selected on the basis of whether they meet children’s needs,
rather than being administratively convenient, for instance. They must also avoid
the negative effects on children that arise through misuse of the findings or from
labelling children.
Programming relevance (utility)

Assessment must measure skills that are relevant either to an intended program
or in the child’s life (Hansen & Linden 1990). That is, the information gained
must be educationally useful. Assessment methods must be able to answer the
educational questions being asked so that children’s strengths and needs can be
assessed and thus built into the educational program. To achieve this, tests that
yield only a single global score will be less useful than those which provide
scores for varying domains of development, for example.
Defensibility
This criterion refers to how we assess individual children (Miller 1978, in
McCormick & Schiefelbusch 1984). Methods used should be based on the best
available research and knowledge. Any tests that are part of the assessment
process must be used only for the purpose for which they were designed and
must be valid and reliable—that is, technically sound in their construction
and suitable for the ages and ability levels of the children being tested (Hooper
& Edmondson 1998; NAEYC 1988). Second, not only must the tests have
acknowledged strengths, they must also have few limitations, particularly for the
purpose for which they are being used (Hansen & Linden 1990).
Equity
Although based on knowledge of the typical sequence of development, assess-
ment must also take into account those cultural experiences which will alter
children’s developmental milestones (Meisels & Atkins-Burnett 2000). Assess-
ment methods must be culturally fair—which is to say that they should not
disadvantage any groups within the community (Hooper & Edmondson 1998).
This is a particular issue for children whose primary language is not English or
who are bilingual, and for those whose mode of communication is not spoken
language. It is imperative that children’s lack of facility with English is not
mistaken for a developmental delay or disability (Gonzalez 1974; Marion 1980).
To minimise error with these children, examiners could provide the test in the
children’s first language (McLoughlin & Lewis 2001). However, this is not a
complete solution, as items have differing levels of difficulty across languages,
and so the norms might not apply when a test is delivered in a language other
than the one intended (Figueroa 1989). Also, children from various cultures will
interpret the demands of the testing session differently and, given that examiners
are not allowed to clarify what is being asked of the children, this can penalise
those whose experience to date has not prepared them for the formality of such
an endeavour (Lynch & Hanson 1996; Miller-Jones 1989).
A second element of equity is that examiners must satisfy themselves that
the child being assessed has been exposed to opportunities to learn the skills
being measured. For example, young blind children have not yet had the time to
compensate for their lack of vision and learn concepts that can come more natur-
ally to sighted children (Brambring & Tröster 1994).
Mainstream tests are often accused of bias for producing differential results
across cultures. However, the same groups that routinely perform less well on the
tests also perform less well in educational settings (Pyryt 1996). That is to say, the
test results are accurate in that they equate to real-life performances. The issue
instead is that society is biased in disadvantaging particular groups within it.
Comprehensiveness
Assessment procedures must minimise what is termed false negatives—that is,
when children with additional needs are overlooked. To avoid false negatives,
assessment must sample a wide range of behaviours across various developmen-
tal domains, in a range of settings, gathering information from many sources
(Hansen & Linden 1990). Particularly when children have additional needs in
many domains, it is important that many professionals are involved in assess-
ment and can collaborate to build a comprehensive picture of the children’s skills
and needs. This comprehensiveness is particularly important when classification
or placement decisions rest on the findings (NAEYC 1988).
Skilled administration
Personnel who are skilled at and familiar with assessing young children should
be the ones to administer tests to this age group (NAEYC 1988). On the other
hand, assessment should not rely on tests that can be administered only by
specialists if (as is usually the case) there are too few of these to administer the
tests. Such scarce resources can be saved by identifying most children by other
means and reserving tests for the remaining minority of children whose skill
levels are difficult to assess in more naturalistic ways (see Figure 3.1).
Second, testers must know how to communicate their findings appropriately
to both lay and professional readers of their assessment reports (Hansen &
Linden 1990). To aid communication, it is useful if parents and others working
with individual children are told something about the content of the test, what
information it can provide and its limitations.
Pragmatism
Assessment should be efficient in terms of the administration time and cost and
should not unduly burden children with prolonged testing (Fallen 1985). On the
other hand, comprehensiveness requires that when children’s developmental dif-
ficulties are already suspected, for instance, screening devices not be used as
they sample too few skills and may result in false negatives.
ASSESSMENT METHODS
When assessing to identify individuals’ atypical needs, the stakes are high (Hart
1994, in Taylor 2000). The conclusions drawn will affect which services the
Box 3.1 Early screening for neonates

The Apgar scale is an early screening test for newborns that reflects the
degree of oxygen deprivation occurring during birth (Heward 2000).
Measures on the five dimensions listed below are taken one minute, and again
five minutes, after birth. A low total score at the first minute is not alarming but
signals the need for some resuscitation; the five-minute measure assesses
how successful that action has been (Heward 2000). If there has been little
improvement between evaluations, this signals that the baby is ‘at risk’ and
thus requires paediatric follow-up.
Points given
Heart rate Absent 0
Less than 100 beats per minute 1
Over 100 beats 2
Breathing Absent 0
Slow or irregular 1
Regular 2
Skin colour Pale, blue 0
Body pink, extremities blue 1
Pink all over 2
Muscle tone Limp 0
Some movements 1
Active movements 2
Reflex response Absent 0
Grimace only 1
Crying 2
children are eligible to receive, the type of program designed for them, and
perhaps their placement. Therefore, the instruments used for assessment must be
more than impressionistic and must have the power accurately to identify addi-
tional educational needs. Thus, performance-based assessments such as
portfolios are not described here, as their purpose is generally to document
children’s products for purposes other than monitoring children’s development
(see Helm et al. 1998). Nevertheless, the measures described in this section rep-
resent a combination of subjective and objective measures, whose aim is to give
a comprehensive picture of individual children’s particular needs.
Parental reports
Assessment must begin with establishing effective communication with the
people who know children best—which is usually their parents or other primary
caregivers (Meisels & Atkins-Burnett 2000). You can gain parents’ knowledge of
their child’s development by asking them about his or her milestones, needs and
interests—both at enrolment and subsequently throughout their child’s partici-

pation in your program.
Despite often being dismissed as inaccurate, parents have detailed knowl-
edge of their children’s development, motivation and personalities which allows
them to be accurate reporters of their children’s abilities. For children with
typical and mildly delayed development, parents’ assessments generally coincide
with teachers’; although for children at the extremes of development (severe
disabilities or giftedness) parents tend to underestimate their children’s skills
(Chitwood 1986; Hundert et al. 1997). Even so, parents’ identification of gifted-
ness is still more accurate than teachers’, as evidenced in studies reporting
teachers’ accurate recognition rates of between 4.3% and 22%, compared with
parents’ accuracy of between 61% and 100% (Ciha et al. 1974; Jacobs 1971; Sil-
verman et al. 1986).
Thus, the additional information you receive from parents will be invaluable
in program planning, to inform your intervention with immediate difficulties,
and for opening the communication channels that will permit longer-term
problem solving. (More is said about parental communication in chapter 2.)
Observation
Given that you are in many cases the first education professional with whom
children will have contact, your role in recognising children’s additional needs is
a crucial one. Observation involves describing in specific terms what individual
children do, either in spontaneous situations or in activities you have contrived
in order to observe specific skills. Structured observation can enhance the picture
of children’s skills and can help identify those whose abilities are mixed—who,
perhaps, have adequate knowledge but are unable to demonstrate it because of
how they approach tasks.
A successful approach to observing children’s development is to nominate a
small group of children to observe for a week, rotating your focus children week
by week until you have detailed observations of all the children in your group.
In this way you can collect dynamic data about all the children, allowing you not
only to assess their needs but also to gauge the adequacy of your program in
meeting those needs.
As well as focusing on individual children, you can observe the educational
program in order to assess its appeal and effectiveness in general, for particular
children, or for fostering particular behaviours such as cooperative play (Taylor
2000). You might park yourself near to, say, the puzzle table for some minutes
on consecutive days and observe whether the supplied activities are actually
proving too difficult for the majority of children to access, are too easy for the
children, or are unattractive in some way. Recognising this will allow you to
substitute more suitable activities.
Compared with more formal assessment means, observation has the advan-
tage that tasks can be varied to suit individual children, giving them the best
opportunity to display their skills (Fallen 1985). However, without reference to
checklists that detail the usual timing of developmental milestones, simply

observing children’s activities would be like ‘solving riddles without clues’
(Tannenbaum 1983: 60). Unguided observations are likely to underidentify the
needs of many children.
Developmental checklists
Without consuming considerable amounts of staff time, at enrolment you can
record on a checklist individual children’s current development and update
the record each time they achieve what is for them the next developmental mile-
stone. This process can sensitise parents and educators to atypical development
and avoid some local bias. Some centres, for instance, serve advantaged families
that support advanced development in their children, whose sophisticated develop-
ment might be overlooked because staff come to see it as ‘normal’. Similarly,
when children from educationally disadvantaging backgrounds cluster in the one
location, all might seem to possess average skills when instead a significant
number could have learning difficulties.
On the other hand, checklists can have their problems. The main one of these
is that they can detail when children attain particular skills but are less useful
guides to how the children should be approaching tasks. This can be overcome
partly by what Neisworth and Bagnato (1988) describe as judgment-based
assessment, in which children’s attention skills, comprehension, memory and
concept development can be observed and an intuitive judgment formed about
their present skills and needs. Second, checklists can indicate that children’s
skills are delayed or advanced, but not by how much. Without understanding the
extent, some children will be burdened unnecessarily with special programs,
while others will wallow without receiving needed assistance. This introduces
the need for normed tests.
Normed tests
Ultimate confirmation of children’s developmental status can be achieved only by
comparing their attainments to typical or ‘normal’ development. Tests that can do
this are termed ‘norm-referenced’ or normed tests. They can cover a range of devel-
opmental domains, such as the psychologist’s IQ test; or one single domain, such
as an assessment by a speech pathologist or occupational therapist. Resulting
scores are usually expressed in terms of ‘mental age’, ‘reading age’, ‘developmen-
tal levels’, ‘intelligence quotients’ (IQs) or other comparative measures.
The purpose of comparing children’s results with each other’s is to deter-
mine whether individual children are progressing at the expected or normal
developmental rate. This type of comparative information can be useful when
previous assessment measures have not been able to clarify the nature of
children’s needs or when educators need to compare how efficiently children can
perform certain tasks compared with typically developing children, perhaps to
assess the likely success of a transition to a regular setting.
While this endeavour of comparing children’s performances with typical

development attracts little dissent in the domains of language or motor skills,
there has been a long-standing chorus of criticism of normed ‘intelligence’ or
broad developmental tests (also known as IQ tests), so it is on these that this dis-
cussion will concentrate.
The first criticism arises from what is usually taken to be a strength of these
tests—namely, that reputable tests are reliable. This means that individual
children attain similar results on a number of administrations of the test, and that
different testers will score the same child similarly. However, this degree of reli-
ability has been achieved only by highly prescriptive administration procedures,
which might not excite children’s best performances and so do not represent ad-
equately their everyday behaviours.
Second, detractors claim that, although the test results for young children
tend accurately to describe their performances at the time, scores are less con-
sistent over months and years and so predictions are not possible. This comes
about because very young children’s ability profiles can change dramatically
during the developmental years; their environments can alter; and because test
tasks at the younger ages bear very little resemblance to mature intelligence, in
which case scores on tests for young children are less likely to tally with those
for older individuals (Anastasi & Urbina 1997; Gallagher & Moss 1963; Neis-
worth & Bagnato 1992). Nevertheless, individuals with extreme scores are more
likely than those in the average range to attain similar results in future testings
(Sattler 1992): their actual scores might change by perhaps five to nine points
over one to six years (Cahan & Gejman 1993; Spangler & Sabatino 1995), but
their rankings within a group will alter very little (Tannenbaum 1992). These pre-
dictions are based on groups, however, and so for individuals—and young
children in particular—we cannot be confident of their future developmental tra-
jectories. This, perhaps, is unnecessary, however, as program planning requires
only that we understand their needs as they are manifested now, not as they
might be in the future.
Third, normed tests can include only those items on which scoring disagree-
ment is minimal. This restricted sample of items leads to the accusation that the
tests—especially IQ tests—are not valid (e.g. see Sternberg 1982). Validity refers
to whether the tests measure anything worthwhile. Critics say that because the
sample of items in normed tests is so limited, the resulting score is itself of limited
use. This complaint is true, to some extent. However, other, more valid or relevant
skills could be included in the tests but could not be scored accurately, which
would be akin to measuring length using a piece of elastic. Measuring length is,
in certain circumstances, a valid thing to do, but if your instrument is unreliable
there is no point in using it at all. The result would be even less meaningful than
a reliable but restricted measurement.
A related criticism is that, as test items are selected simply because they dis-
tinguish among children of varying developmental levels, they can have little
functional relevance in children’s lives. Colour naming, for instance, does tend
to distinguish between 2- versus 3-year developmental levels, yet is a skill that
has minimal functional application. This makes it difficult to design teaching

activities based on test content: all the tests can do is indicate a general area in
which additional instruction might be useful (Bondurant-Utz & Luciano 1994;
Neisworth & Bagnato 1992). Conversely, when the tests are used to guide
program content, educators might set about teaching skills (such as colour
naming) that have little educational value, when instruction time could instead
be used for teaching more ecologically useful skills. Perhaps, however, we are
expecting too much for one instrument to be a tool both for assessment and for
determining specific program content.
A further shortcoming of the tests is their assumption that all children enjoy
roughly similar opportunities to acquire typical skills and knowledge, which
clearly is not so for children from educationally disadvantaging backgrounds or
those with particular disabilities. In instances when this assumption is not accurate,
testing can result in mislabelling as delayed or disabled children from disadvan-
taging backgrounds and the underidentification of these same children as gifted.
Advocates of testing recognise this flaw but pose two rebuttals to this criti-
cism. The first is that testing can result in the delivery of services to those social
groups who generally achieve least well on the tests; in this way, social justice is
advanced for those who are disadvantaged. Second, advocates claim that bias
would not be eliminated by abolishing testing and would still leave us with many
decisions to make, with less defensible bases on which to make them: subjective
impressions of children by advantaged members of the dominant culture would
disadvantage certain children even more than testing currently does (Pendarvis &
Howley 1996; Worthen & Spandel 1991). Thus, although imperfect, the tests are
still the most technically sound instruments presently available and should not be
displaced by even less sound assessment measures (Kaufman & Harrison 1986).
A final criticism arises from the fact that test results are used by agencies to
determine priorities for service allocation. If children are deemed eligible for
services, normed testing is of direct benefit to them and their families. However,
limited services mean that some needy children miss out. This, though, is due to
the restricted amount of funds society allocates to service provision. The fault
does not lie with the tests.
The potential for overreliance on normed testing requires that assessment
involve many phases (as depicted in Figure 3.1). Furthermore, assessment must
look more widely than test scores alone, as is only sound practice. This is con-
firmed by the originator of one of the most common batteries of IQ tests, David
Wechsler (1958: 7), in his definition of intelligence as:
The aggregate or global capacity of the individual to act purposefully, to think ration-
ally, and to deal effectively with his [or her] environment (emphasis mine).
This definition implies that assessors must not only establish children’s inherent
skills but also assess children’s functional adaptation to their particular environ-
ment. By supplementing test findings with other assessment procedures and
information across developmental domains, most of the above disadvantages of
IQ tests can be overcome.
ISSUES WHEN TESTING CHILDREN WITH ATYPICAL

DEVELOPMENT
Normed tests have limitations that apply variously to individuals across all ages
and ability levels. However, young children and especially those with disabilities
pose some unique assessment challenges, particularly related to the principles of
defensibility, equity and skilled administration described earlier in this chapter.
These challenges relate to the unique characteristics of the child being tested,
the impact of these on the relationship between the child and tester, and the
soundness of the test itself when applied to young children with atypical
developmental patterns (Taylor 2000). A further issue for this population is the
I Provision of learning opportunities

• for play
• which reflect a variety of interests
• which stimulate children’s development
• in a variety of domains
• and promote interaction with peers
IIb Teacher/caregiver
observations of the
IIa Parent reports
child’s social, emotional
and observations
cognitive and physical
responses to the
curriculum
If atypical
development
is suspected
VII Program evaluation
VII Program evaluation

III Formalised observation
• checklists
• judgment-based assessment
If atypicality is If atypicality is
suspected but identified and
confirmation is psychometric
required, refer for confirmation
is not required
IV Standardised testing
• general development skills
• in specific domain/s in which
atypical development is suspected
V Determination of priorities
VI Program modification
• environment
• process
• content
• product
Figure 3.1 A proposed process for the identification of atypical needs

in young children
overreliance on developmental tests as the only tool of assessment and overuse

of these tests for individuals.
Characteristics of the child

As with testing children of any age, a wide range of variables can influence
test results (McCormick & Schiefelbusch 1984). These factors can comprise
immediate influences such as medication side-effects, illness, lack of sleep,
anxiety, lack of motivation and numerous other temporary variables that can
interfere with children’s performance on the day. The younger the children and
the more compromised their arousal system (see chapter 7), the more significant
these issues become in assessment.
A deeper problem relates not to children’s immediate wellbeing during the
testing session but to the opportunities that they have had for learning. When
children’s disabilities have imposed frequent or extended hospitalisation or
otherwise resulted in restricted exploration of their environment, they will have
had fewer opportunities to learn the usual skills that typical children can acquire
naturally. Yet test norms compare children with disabilities with others whose
life experience is dissimilar to theirs. Thus, when individual children have not
been exposed to typical experiences, either a normed test should not be carried
out, or testers should interpret the findings as a reflection of both the children’s
capacities and their restricted experience, with the relative impact of each being
indeterminable.
A second issue affecting children with disabilities in particular is that when
they have difficulties in one developmental domain, these can contaminate their
performance in another—for example, inattention can impair their demonstration
of their intellectual skills; language comprehension difficulties can restrict their
ability to self-instruct—to guide themselves—through each step of non-verbal
problem-solving tasks; behavioural difficulties and their management can limit
children’s engagement with testing; and their sensory or physical disabilities will
impair their performance of gross or fine motor tasks. Sometimes the testing is
aimed at establishing the nature of such difficulties, but if it actually aims to
measure children’s intellectual functioning, the test content and assessment
process must circumvent these other disabilities (McLoughlin & Lewis 2001).
Relationship between the child and tester

The very formal manner of normed testing is at odds with the needs of very
young children (Kaufman 1990), and that formality can impede building rapport
with them and encouraging them to perform at their best. Other personal charac-
teristics—such as racial differences between the tester and child—can also
impede the building of rapport (Taylor 2000). Furthermore, children with develop-
mental delays appear to be particularly penalised when being assessed by adults
whom they do not know (Fuchs & Fuchs 1986; Fuchs et al. 1985). This is
probably because when being asked by an unfamiliar adult to complete items
that they find difficult, their anxiety interferes with their performance; whereas
anxiety is less likely to be provoked in children who find the items easier. This
implies that prior acquaintance between the tester and children is likely to
improve the accuracy of results.
A further issue affecting the relationship between children and testers is
where the testing is carried out. Although there are advantages in testing children
at home where they and their parents are less anxious and more comfortable
(Lynch & Hanson 1996), natural domestic interruptions can disrupt the testing
session. Of even more significance is that the children are seldom accustomed to
such a formal situation at home and might refuse to participate, whereas in
another familiar location—such as a preschool or care centre—the children are
more apt to follow adults’ directives. Thus, decisions about location need to be
made in consultation with parents informed by knowledge of the children’s
temperament and emotional needs.
All of these issues affect children across the ages and ability ranges but are
of more significance to those with disabilities as, in many cases, so much rests
on the findings—including the children’s placement, diagnosis and eligibility for
services. Because the stakes are so high, then, errors in testing are of increased
importance for this group of children.
Qualities of the test

Tests need to be suitable for use with the target population—in our case, for use
with young children or those with atypical development. Although few gifted
children are untestable on broad developmental measures, almost one-half of
very young children with disabilities cannot be tested on currently available tests
(Neisworth & Bagnato 1992). This signals that, particularly for this population
of children, other measures must either replace or supplement the information
gleaned from formal testing.
• Reliability and validity. One reason for children’s untestability is that, as
already mentioned, normed tests have been carefully constructed to produce
reliable results. This is essential, but imposes inflexible administration pro-
cedures on testers and children. This particularly penalises young children
and those with atypical development, as testers cannot take the children’s
unique individual needs into account and alter the testing conditions to allow
them to display optimal performance.
• Test design and format. A second reason for children’s untestability is the
high floor of most tests: for instance, when test items begin at a develop-
mental level of 2 years, 4-year-old children with considerable developmental
delays might pass few or no items, thus giving no information about where
their individual strengths and needs lie. To overcome this, testers might
deliver a smorgasbord of items from a range of tests. This destroys norming,
but can at least give some descriptive information on which to base edu-
cational planning.
Another issue to do with test format is the duration of testing sessions.

Children with certain disabilities will be slow at performing the test tasks;
while those with advanced development might complete most items in every
subtest. In either case, the testing session is prolonged, requiring of these
children a superlative concentration span. If they cannot sustain this, their
results could reflect fatigue rather than their actual abilities.
Repeated administration of tests

Children with additional needs are more prone than most populations of children
to be overtested, which wastes their time and uses up valuable resources, often
unnecessarily. Although ongoing assessment is essential for monitoring
children’s progress and to evaluate their programs, it is a dubious practice to use
normed tests for this purpose because the tests are not sensitive to small incre-
ments in development (Bondurant-Utz & Luciana 1994) and because children’s
learning occurs in growth spurts followed by periods of skill consolidation.
Figure 3.2 shows that if our first testing (at T1) happened to fall after a spurt, and
our second (at T2) was unwittingly timed before the next spurt, the child would
seem to have made no progress in the interim.
On the other hand, our two assessments could take in two growth spurts, and
happen to miss one period of consolidation, making it seem as if the child’s
progress is double what it is in fact, creating unrealistic expectations for the
child’s future developmental progress. This is depicted in Figure 3.3.
Another issue with repeating normed tests is that the children sometimes
remember the items. Practice effects can mean that you cannot rely on the results
LEARNING
T1 T2
Figure 3.2 Timing of two testings coinciding with a learning plateau

LEARNING
T1 T2
Figure 3.3 Timing of two testings measuring two growth spurts but
only one plateau
of the likes of IQ tests, which attempt to assess children’s ability to perform

novel tasks (because, if the tasks were familiar, all you would be measuring is
children’s access to an enriching environment, in which case parental income
would be an equally good measure).
PARENTAL INVOLVEMENT IN ASSESSMENT
Many of the shortcomings of tests can be overcome by involving parents in all

phases of assessment. Having parents attend testing sessions is often advised
against on the grounds that they might later teach the test items to their children.
However, I caution them that this would contaminate the results of future assess-
ments, on which they might need to rely for educational planning.
I find that parents’ attendance during testing improves the accuracy of the
results: the children do not have to accompany a stranger, with consequent reduc-
tions in their performance, and parents can explain an answer which seems
unusual or which I do not understand because the child’s speech is unfamiliar to
me. When the parents and I subsequently talk about what I observed, they can
tell me whether their child’s performance on the day was typical or whether it
surprised them in any way; and they can supplement and clarify the findings with
their own intimate knowledge of their son or daughter. Finally, their participation
demystifies the testing process, allowing us to discuss the tests’ limitations and
what these mean for the confidence we can place in the results.
These discussions can enable parents to clarify the meanings of terms that
will appear in the assessment report and to understand its conclusions. Finally,
their participation thus far empowers them to contribute to recommendations,
which cannot be framed without information from parents and any other profes-
sionals who have ongoing contact with the child.
EQUATING CONTRADICTORY RESULTS
A skilled and experienced tester is able to choose a test that can provide the
information being sought, as long as those who know the child give information
about the questions they need answered. If the subsequent information gained
from a test does not tally with the referring person’s knowledge of the child, it is
possible that the test results are flawed, given the many aspects that can contamin-
ate test findings.
If you encounter an apparent contradiction, you can ask the tester for an
explanation of discrepancies. It may be that the child was ill or otherwise un-
comfortable during the assessment; that a test of, say, memory might tap only
short-term recall, whereas in natural settings you tend to see the products of
long-term memory and so the test is measuring skills that are slightly different
from those suggested by its title; or there may be a more suitable instrument for
obtaining the information being sought.
Sometimes an assessment is flawed simply because it is not comprehensive
enough (Wolery 1996a); in other cases, the data are adequate but there is a dif-
ference in judgment about their implication for programs. A second opinion or
further assessment procedures could assist with such differences in judgment.
This must be balanced, however, with requirements that assessment be efficient
and the realisation that sometimes, even if we assessed children in great depth,
we might arrive at a diagnosis but be no closer to knowing how to respond to the
child’s day-to-day behaviour and needs.
SOME INTERPRETIVE STATISTICS
When children have been referred for testing, specialists’ reports will contain
some numbers which are important to understand so that the information
conveyed is meaningful and can be used to help plan individual programs for
children. This section describes some key statistics used in specialist assess-
ments, which are also summarised in Figure 3.4.
The first statistic to know is the average score on the particular test used in
an individual child’s case. Many normed tests have borrowed the formula origi-
nally devised for IQ tests of reporting the average (or mean) score as 100 points;
if not, practitioners might add a note explaining what the average score is on a
particular test.
Comparing individual children’s scores to the average is a good place to

begin interpreting their results. However, you will also need to know whether an
individual child’s score is different enough from the average to warrant special
programs. For this purpose we need another statistic, which is called a standard
deviation. This figure tells you whether a particular child’s score falls near to or
a long way from (that is, deviates from) the average. If the score falls near the
average, a child is likely to be well provided for by a regular program; if the score
deviates a long way from the mean, the child is likely to need some special edu-
cational provisions.
When a child’s score is converted into a standard deviation, an average
score obviously has a standard deviation value of zero, because the score does
not depart at all from the average. Thus, a standard deviation score of zero is
‘normal’. However, because individuals do not achieve each developmental
milestone at exactly the same age as all others, scores with values near to zero
are also regarded as normal. In terms of standard deviation values, this normal
range falls between –1 and +1 standard deviations. Children achieving scores
within this range are developing typically. This comprises just over 68% of
children.
As to scores falling outside this range, taking the lower end of the continuum
first, traditionally we have defined children whose scores fall between –1 and –2
standard deviations as being ‘at risk’ or potentially developmentally compro-
mised. Just over 13% of children fall within this category. When children’s
reported scores fall within this range you might offer some extra stimulation
activities, perhaps in a naturalistic way, with the aim of advancing their skills
nearer to the norm. You would monitor their progress and institute more formal
programs if their scores subsequently encroached into the disabled range.
Standard deviation scores of –2 and below signify the disabled range. Over
2.5% of children achieve such scores. These are the children for whom it is
important to supply modified educational experiences.
This pattern of scores is mirrored at the upper end of the ability continuum.
That is, children whose scores fall between +1 and +2 standard deviations are
said to have abilities in the ‘high average’ or ‘bright–normal’ range. Just over
13% of children achieve at this level. Meanwhile, standard deviation scores of +2
and above are taken to indicate significantly advanced development, or ‘gifted-
ness’. As is the case in the disabled range, over 2.5% of children are considered
to be gifted. And, similar to children with disabilities, this group of children may
well require program adjustments.
A final statistic that you might encounter is the percentile rank (PR). This
number tells us that this child ‘did as well as, or better than, x% of the cohort’.
For instance, if the child’s percentile ranking was 23, this means that she
achieved as well as or higher than 23% of children of her age. However, this
score quickly becomes extreme: for instance, within the normal range of –1 to
+1 standard deviations, percentile ranks span from 16 to 84! This points to two
disadvantages of percentile rankings: first, they incorrectly give the impression
that tests are capable of making very fine discriminations between children;
Number of cases
2.14% 2.14%
0.13% 0.13%
Standard 13.59% 34.13% 34.13% 13.59%
deviations Mean +1
–4 –3 –2 –1 +2 +3 +4
test score
Percentile
ranks 1 5 10 20 30 50 70 80 90 95 99
Weschler IQs
(SD = 15) 55 70 85 100 115 130 145
Stanford-Binet IQs
(SD = 16) 52 68 84 100 116 132 148
Figure 3.4 Distribution of abilities within a population
Source: adapted from Sattler (1992:17). Reproduced with the permission of Jerome M.
Sattler Publishing Co.
second, they imply that these differences are clinically significant, when in many
cases they are not—all the children between PRs of 16 and 84 are within normal
limits, and yet their numbers seem very disparate.
SETTING PRIORITIES
The above statistics allow us to prioritise goals for children’s programs by per-
mitting us to compare their scores across tests. If, for instance, a child is
achieving on a developmental test at 84 and a language comprehension test at 34,
how can we compare these two numbers? The answer is to convert both raw
scores to standard deviations (which testers do by using tables supplied in the
test manual). As an example, let’s say that we found that the child’s achievement
on the developmental test was at –1 standard deviations (that is, at the lower end
of normal limits), but on the language comprehension test her score fell at –2.5.
This tells us that she has a specific language difficulty—within the disabled
range, and considerably below her other intellectual skills. Accordingly, we can
now design a language program for her.
A second criterion by which we can set priorities for children’s programs is

to consider the impact of instruction on individuals’ quality of life. For instance,
when children have delays in two domains—say, forming grammatical sentences
and not having toileting control—the latter might be deemed a higher priority
because a lack of independent toileting control can significantly increase
parents’ workload and jeopardise children’s social inclusion and so has a greater
impact on the quality of life of children and their families.
A WORD ABOUT LABELLING
In the assessment process there is a trend away from diagnosing children’s deficits
because of the stigma that labels can attract. The focus has shifted to analysis of
children’s specific instructional needs and determination of the services they
require as a result (Cook et al. 2000). However, notwithstanding the sometimes
negative effects of labels on the individuals who receive them, diagnostic labels
that arise from assessment can be useful to families, by describing, explaining
and, at times, predicting the developmental progress of their child.
• Description. A label can cluster together an otherwise confusing array of
symptoms into a single known entity. Attention deficit hyperactivity disorder
(ADHD), for instance, groups together a cluster of inattentive, impulsive and
overactive behaviours which otherwise might seem incomprehensible. The
danger, however, with descriptive labels such as ADHD is that they can be
misinterpreted as explanations.
• Explanation. A label can explain why a child has particular impairments.
For instance, it is known that children with Down syndrome often have some
cardiac problems, in which case a diagnosis of that syndrome will alert
medical practitioners to screen for heart problems as well as developmental
effects. The danger with explanatory labels, however, is that they are some-
times used to excuse underachievement, in the belief that one impairment
causes or ‘explains’ others, when the two might not inevitably coexist. For
instance, sometimes gifted children’s emotional outbursts are blamed on
their giftedness, or behavioural difficulties are attributed to children’s intel-
lectual disabilities, when the two could be unrelated.
• Prognosis. A label can give parents some idea of the expected progress of a
child’s condition throughout life. The obvious danger here is that most prog-
nostic information is based on groups of children rather than individuals
which, given our incomplete theoretical knowledge and brief acquaintance
with young children, means that we must be cautious in predicting their
developmental trajectories.
Thus, when labelling any children—particularly those who are young and so
have a short developmental history on which to base conclusions—we must keep
in mind the explanatory limits of a particular diagnosis. Also we must be aware
that children who share a diagnosis nevertheless can manifest it in differing
ways. This implies that educational interventions must focus more on the indi-
vidual than on the label.
CONCLUSION
Rowe (1990: 544) asserts that some professionals rely on tests ‘like a drunk
might depend on a lamp-post—for support rather than illumination’. Instead, our
best assessment instrument is human (Borland & Wright 1994), and requires us
to know individual children well (Shaklee 1992). Tests do not allow us to see
everything, so comprehensive assessment requires that educators use a range of
informative measures to gain the fullest possible understanding of children’s
abilities and educational needs.
Naturally, assessment is not an end in itself but a means to achieving an
end—namely, translating the information gained into a relevant program for
individual children (Wolery 1996a). Thus, selected assessment measures must be
viewed as tools only, which in themselves accomplish little: what counts is how
these tools are used (Rowe 1990). Properly used, great benefits can accrue from
identifying the needs of individual children and devising programs to meet those.
This leads into the subject of program planning, which is the topic of Chapter 4.
Anastasi, A. and Urbina. S. 1997 Psychological testing 7th edn, Prentice Hall,
Upper Saddle River, NJ
Beaty, J.J. 2002 Observing development of the young child 5th edn, Merrill
Prentice Hall, Upper Saddle River, NJ
McLean, M., Bailey, D.B. Jr and Wolery, M. eds 1996 Assessing infants and
preschoolers with special needs 2nd edn, Merrill, Englewood Cliffs, NJ
McLoughlin, J.A. and Lewis, R.B. 2001 Assessing students with special needs
4th edn, Merrill, Upper Saddle River, NJ
Taylor, R.L. 2000 Assessment of exceptional students: educational and psycho-
logical procedures 5th edn, Allyn & Bacon, Boston, MA
4
PRINCIPLES OF PROGRAM
INDIVIDUALISATION
LOUISE PORTER
KEY POINTS
• Children with additional learning needs require an educational program

which is guided by the same principles as any early childhood curricula.
• Such children require an individualised program that is integrated, inter-
disciplinary and differentiated.
• Modifications to the learning environment, teaching processes, program
content and learning products will be necessary for children who are not
learning typically within the regular early childhood program.
INTRODUCTION
Just as a range of views of children (see chapter 1) give rise to various

approaches to teaching, so too various views of the purposes of early childhood
education underpin the design of curricula (Dahlberg et al. 1999; Moss 1999).
Early childhood education has been seen to fulfil a range of functions: from off-
setting the disadvantages perceived to be posed by some children’s homes, in
which case the educator is a protector; to providing substitute parental care; to
supporting parents’ participation in the labour force, in which case educators
become ‘service providers’ promoting ‘consumer’ satisfaction (Dahlberg et al.
1999). A fourth model conceptualises child care and preschool centres as places
for children whose dual role is to provide educational experiences that comple-
ment the learning children gain elsewhere and to strengthen social networks
within the community (Dahlberg et al. 1999; Moss 1999).
Because centres are located within particular local contexts, their specific
workings will be individual to them, arrived at in negotiation with their com-
munity. Thus, it is neither possible nor desirable to describe appropriate
programs for every setting as practices must be tailored to suit individual
56
PRINCIPLES OF PROGRAM INDIVIDUALISATION 57
children and their contexts. This chapter therefore confines itself to the descrip-
tion of some principles for guiding your decisions about curricula planning and
about which adjustments might be appropriate in your environment and for indi-
vidual children with additional needs.
PROGRAM PLANNING
There are two broad approaches to curriculum programming. The first is a top-
down approach in which adults determine which skills and information are of
value to children and then set about teaching these. The top-down approach is
largely adult-driven, with educators framing programs:
• in accord with their philosophy of education;
• guided by their understanding of childhood;
• on the basis of their theory of learning;
• drawing on their own training and experience;
• in light of guidelines and policy directions provided by their governing
authorities;
• according to parental values and preferences;
• in response to awareness of each child’s interests, experience and abilities in
a range of domains; of how each child learns; and knowledge of with whom
each child plays (Theilheimer 1993);
• taking into account their resources and constraints.
This top-down process of generating a program is not necessarily unrespon-
sive to children’s needs, but is nevertheless largely originated by the educator.
It is also at the heart of the push to impose on young children a more academic
curriculum (see Rodger 1999), which is often advocated in the interests of
developing an increasingly skilled future work force.
In contrast with imposing a curriculum on children, a bottom-up approach
sees children as already enriched and vibrant human beings (Dahlberg et al.
1999) whose need to generate identities and understandings of the world are the
starting point for, rather than an afterthought in, curriculum planning. Advocates
of this model say that the fact that many young children can learn an academic
curriculum does not mean that they should (Katz 1988). They argue that
children’s dispositions and indepth understanding can be harmed by confronting
them too early with tasks whose content and processes are too demanding, that
when children are deprived of physical play in favour of academic work, neural
pathways in the brain that are essential for academic success cannot be strength-
ened, and that young children’s eyesight (being long-sighted and not yet able to
track) can be compromised by prolonged close work.
Rather than attempting to instil a predetermined curriculum, the bottom-up
approach respects and responds reflectively to the skills and interests of children
and their parents. However it does not simply indulge these or rely on impro-
visation or chance: it utilises educators’ expertise and active teaching while also
engaging children’s (and parents’) competence (Fraser & Gestwicki 2002). It

is ‘child originated and teacher framed’ (Forman & Fyfe 1998, in Fraser &
Gestwicki 2002: 168).
This, then, generates a reciprocal process of planning, in which educators
pay attention to children’s thinking and analyse the topics that are engaging
them, while also taking into consideration which topics will be of long-term
value to the children (Fraser & Gestwicki 2002). This information will generate
the basis of the program, to which the children and parents, in turn, will respond,
upon which further adjustments will be made, and so on.
AIMS OF EARLY CHILDHOOD PROGRAMS
The broad aim of education is for children to acquire knowledge and skills in a
variety of areas and to develop the dispositions and ability to use their infor-
mation and skills to solve problems and generate understandings of themselves
and their world (Dahlberg et al. 1999; Johnson & Johnson 1992). Beyond this
general goal, the following specific aims of early childhood programs have been
nominated by various authors (Bailey & Wolery 1992; Katz & Chard 1989;
NAEYC & NAECS/SDE 1991; Smidt 1998; Wright & Coulianos 1991).
Facilitate competence
This involves skill acquisition, fluency of use, skill maintenance (the ability to
use skills after instruction has ceased) (Wolery & Fleming 1993), and the ability
to detect when to employ a particular skill so that competence can be transferred
(generalised) across situations (Perkins et al. 1993). It also encompasses being
able independently to use functional skills in natural settings (this aim tending to
be highlighted mainly for children with disabilities).
Naturally, the aim to foster competence spans all developmental domains,
including:
• using language to communicate and to facilitate thinking and learning;
• understanding the relationships among objects, people and events;
• developing conceptual knowledge of the world;
• practising higher-order thinking and problem-solving skills;
• becoming literate;
• developing numeracy skills;
• becoming competent in management of one’s body;
• acquiring basic physical skills and maintaining a desirable level of health
and fitness.
Positive dispositions towards learning

A second aim is to encourage in children positive attitudes to learning and to
themselves as learners so that they remain willing to put in the effort required
to achieve. These dispositions include, for example: engagement, playfulness,
motivation, persistence, independence, cooperativeness, curiosity, enthusiasm

for learning, confidence, patience, exploration, planfulness, adventurousness,
intellectual rigour, creativity, open-mindedness, self-awareness and self-control
(Lambert & Clyde 2000; Perkins et al. 1993).
Emotional support for children

Early years education also aims to safeguard children’s emotional develop-
ment by:
• establishing a safe and caring physical and emotional environment that
supports and protects all children’s right to learn and grow personally;
• helping children establish satisfying and successful social relationships;
• developing in each child a healthy self-esteem.
A supportive community
The aim to support social networks encompasses the following aspects:
• collaboration with the children’s parents (or other primary caregivers) in
achieving their goals for their child;
• connecting with the cultures of the families participating in early childhood
programs and the broader community;
• imparting understanding of and respect for social and cultural diversity;
• supporting educators, both personally and professionally.
Clearly, these aims are not value-neutral. This is inevitable, as a key function
of education is to socialise children; it becomes problematic only if we forget to
question the legitimacy of our aims for children in general, for our particular
context, or for individual children.
PROGRAM DIFFERENTIATION
Curricula are an organised framework, detailing (Richarz 1993):

• the environment in which learning and teaching will occur;
• the teaching and learning processes to be employed—that is, what educators
will do to help children grow in understanding of themselves and their
physical and social world;
• the content that children are to learn, which encompasses the planned or
spontaneous opportunities that will be provided;
• the products that will record what individual children have achieved.
Curriculum or program differentiation refers to adjustment of all these elements
as required, so that activities are relevant to children with differing learning
needs and preferences (Kulik & Kulik 1997). Individualisation or differentiation
of programs or curricula must allow for differences in both the pace (quantity)
and depth (quality) of children’s learning (Piirto 1999). At the same time, it
should build on what the children already can do, rather than on what they
cannot do (Smidt 1998).
Individualisation of the curriculum necessitates greater flexibility in your
role, organisation of the setting and structure of the program. While keeping
in mind long-term goals, your moment-to-moment decision making needs to
remain fluid and opportunistic, taking advantage of spontaneous opportunities
to capitalise on the children’s ideas and interests (Kostelnick 1992).
It might go without saying, but adjustments to programs for children with
additional needs should be based on need. This has two implications: first, that
it is important to identify those needs accurately; second, that just as need is the
criterion for adjusting programs for children with disabilities, so too must it be
the criterion when children’s development is advanced. Program adjustments for
gifted children are instead often provided on the basis of whether the children are
‘deserving’—that is, displaying exemplary behaviour (Borland 1989). However,
the fact that these children are able to function within expectations indicates that
the present program is already meeting their needs; the children who actually
require adjustments to their program are those whose behaviour attests to some
difficulties.
When planning for the individual needs of children with disabilities or gifts,
local policy might dictate that an individualised curriculum plan be negotiated.
Around the world, these go by many titles, including negotiated curriculum plan
(NCP), individualised education plan (IEP) or an Individualised Family Service
Plan (IFSP) (Cook et al. 2000). Whatever its title, the plan will contain a
summary of the assessment information, a statement about the family’s aspir-
ations for their son or daughter and resulting program priorities, and a description
of the services to be provided and their setting (Cook et al. 2000). Less formal
plans are likely to be used for children with lesser developmental difficulties and
those with advanced development, although all efforts at individualisation will
encompass adjustments to the learning environment, teaching processes,
program content, and the products through which children demonstrate their
learning (see Table 4.1).
Differentiation of the environment

The environment refers to the physical structure of a setting, its organisation and
its social climate. Within an ecological perspective, the environment is seen as
the ‘third teacher’—with the first being the children themselves and the second
being their social relationships with adults and other children (Fraser & Gest-
wicki 2002).
As Fraser and Gestwicki (2002: 100) observe, ‘Space does indeed speak’:
appropriately arranged settings can further many program aims. First, the space
communicates a welcome to children, families, educators and visitors and
signals their ownership of the space by reflecting their personal interests and
requirements (Fraser & Gestwicki 2002). Second, the level of stimulation, attrac-
tiveness and fun influences the participation of the children. Third, the structure
Table 4.1 Common and differentiated features of programs for young children
Environmental organisation Process Content Product
Common elements
• structured yet flexible • facilitative relationships • programs based on children’s • demonstration of key
• organisation •between educators and •interests •knowledge and skills
• supportive climate •children • an integrated curriculum • a range of mediums
• encouragement of exploration
• high but realistic
• expectations
• high-quality teaching
Differentiation methods
• adult-child ratios • naturalistic instruction • tailored activities: • tiered products
• group size • adult-directed teaching – simple vs complex • teach expressive skills
• flexible time allotment • mediation of social interaction – concrete vs abstract
• adaptation of buildings • facilitation of transitions – small vs large steps

• and play areas • technological adaptations – knowledge acquisition vs
• placement – concept mastery
• grouping – uni- vs multi-faceted
– structured vs open-ended
– breadth vs depth
• tiered activities
• selected toys and activities
• access to specialists
Source: adapted from Porter (1999:174).

should help children to feel safe, allow them to exercise choice, invite inves-
tigation, permit them to use ideas and materials creatively, and give them
independent access to materials and play, thus giving them confidence that they
can have control of themselves during their play (Fraser & Gestwicki 2002;
Robson 1996; Smidt 1998). Fourth, the physical layout allows the program to
flow smoothly, for example by keeping traffic areas free of congestion.
Various elements of the physical and social environment can be adapted to
enable children with atypical development to engage in purposeful and meaning-
ful activity (Kostelnick 1992). Environmental adjustment will not only promote
children’s development but has the advantage of being naturalistic and relatively
unobtrusive (Sandall 1993).
Maintain appropriate adult–child ratios

Although an accepted canon of early years education is that there should be high
numbers of adults to children to foster optimal development, particularly when
the children have additional needs, the presence of a greater number of adults
makes it less likely that children with disabilities will interact socially with peers
and increases their dependence on adults during mastery tasks (Hauser-Cram et
al. 1993). Thus, when extra adults are available to assist children with additional
needs it is important for adults not to shadow those children constantly and thus
create dependency or act as a barrier between the children and peers.
Restrict group size

The size of a group will either enable or hinder personal interactions between
group members. Groups could have one adult to five children (with a total group
size of six people) or three adults to 15 children, which maintains the same
adult–child ratio but yields a group size of 18 members. The dynamics in these
two groups will differ considerably, with very young children and perhaps older
children with developmental delays being less able to cope well in a larger group.
These children may require smaller groups, particularly at times when their skills
are being extended such as during group story time, or when group size imposes
extended waiting time on children with limited concentration.
Allot time flexibly

In many instances children need prolonged and continuous periods of time in
which to develop and sustain the themes of their play, consolidate their skills, or
complete engrossing projects. Therefore their time must not be fragmented and
intruded upon unnecessarily by the imposition of timetabled activities. In other
cases, individual children’s limited concentration skills or quick mastery of
concepts might call for rapidly changing activities.
Adapt buildings and play areas

The judicious placement of displays, toys and equipment can stimulate
children’s interactions with their environment (Sandall 1993). In addition, chil-
dren with disabilities can require specific environmental adjustments so that
they can safely access the setting independently. For instance, blind children
need their environment to be laid out logically so that it is predictable; there
needs to be sufficient room for specialised equipment and the negotiation of
obstacles; children with sensory impairments might require adjustments to the
acoustics or lighting in the room; those with physical or vision disabilities will
require even walking surfaces, ramps for wheelchairs, and toys and equipment
that are safe and adapted for successful use. On the other hand, educators must
avoid environmental adaptations being so extensive that it becomes difficult for
children to adjust to natural settings where few such adaptations exist (Lewis &
Taylor 1997).
Place children with true peers

Placement decisions centre on the age and ability levels of surrounding children.
In terms of age, to foster modelling, children with developmental delays might
be suited to placement within a group of younger children with similar develop-
mental levels to their own. On the other hand, typically developing 3-year-olds
are less able than 4-year-olds to adjust their communication style to accommo-
date older children with delays, in which case they might not be ideal social
companions (Guralnick et al. 1998).
Even when placed alongside younger typically developing children, there
are likely to be differences not only in what the various children can achieve but
in how they achieve it (McCollum & Bair 1994). Also, if the children with dis-
abilities are physically large, they might look out of place among a group of
younger children, rendering such a placement unsuitable.
On the other hand, placement alongside age mates can put children with
delayed development in danger if, for instance, they are still mouthing or eating
materials such as glue or nails which are part of the regular children’s activities,
or if the climbing equipment that suits typical children is dangerous to them. If
the children with disabilities are unsteady on their feet, they can be scared of
being knocked over by very active children and so lose confidence in moving
about independently.
Meanwhile, gifted children might have no intellectual peers within a group of
same-aged children and so need access to children who are older than themselves.
This is a main reason for their early entry to school, as older children are not gen-
erally available in preschool settings in the year before school. (See Box 4.2.)
Plan group composition

Grouping refers to the span of ages and developmental levels within a group.
Heterogeneous (also known as mixed-age, mixed-ability or vertical) grouping
offers children a wide range of potential playmates, giving younger or less able
children access to older companions who can extend their learning and allowing
children to adopt a variety of roles within their play (Bouchard 1991; Katz et al.
1990; Lloyd 1997; Roberts et al. 1994). This is of less benefit to the older and
gifted children, of course, while same-ability grouping can be more beneficial for
language-based activities such as story time (Bailey et al. 1993).
Box 4.2 Developmentally appropriate placement for gifted

learners
One method of meeting gifted children’s advanced learning needs involves
what is usually termed ‘acceleration’. This entails allowing them to enter
school early or, once in school, to skip an entire grade (or more) or go up to a
higher grade for certain subjects (which is termed ‘partial acceleration’).
Some writers argue, however, that the term acceleration is a misnomer as it
implies an attempt to speed up the children’s development itself, when the
term really only means providing gifted children with a curriculum that
matches their needs and abilities. Therefore, Feldhusen et al. (1996) suggest
that we replace the term acceleration with the concept of appropriate
developmental placement.
Appropriate developmental placement aims to enhance children’s
achievement by providing a closer match between their needs and abilities
and the curriculum they receive and to allow them to socialise more success-
fully as there will be a closer intellectual match between them and their older
classmates (Benbow 1991; Rogers & Kimpston 1992). Despite a few docu-
mented cases of children being disadvantaged by early entry to higher
grades at school, the bulk of research consistently reports that acceleration
meets gifted children’s academic, social and emotional needs, particularly for
carefully screened children. (For a full review, see Porter 1999.) In light of such
findings, the following criteria have been found to be crucial to the success of
early placement (Bailey 1997; Braggett 1992, 1993).
• The school has to be willing to accept the child.
• The classroom where the child is entering needs to be flexibly structured.
• The receiving teacher must be sympathetic to the idea of early entry and
must be willing to fill any gaps in a child’s skills that have resulted from
missing some educational experiences.
• The child must be interested in early entry, although adults must be careful
not to give children the impression that it will solve all of their academic or
social difficulties.
• The parents’ wishes are crucial as their support will affect how well the
children cope.
As well, it can help (but is not essential) for the children to be socially mature,
to be willing to mix with older classmates, and to have the requisite fine motor
and reading skills to be able to cope with academic tasks. These skills are not
essential because within any class there is a wide range of abilities in such
domains, and so lack of maturity in any of them need not on its own preclude
an early placement if all other criteria are met.
Any advanced placement must be treated as a trial and its effects moni-
tored closely (Braggett 1992) and other means of meeting gifted learners’
needs—such as enrichment—must also be set in place, as simply offering
the children the same curriculum earlier is unlikely to meet their needs
adequately.
Having a broad span of ages is a challenging teaching arrangement (Mason

& Burns 1996) which, on its own, does not generate the above advantages
(Mosteller et al. 1996; Veenman 1995, 1996): the benefits of heterogeneous
grouping appear to come from the adults’ acceptance of diversity and corre-
sponding philosophical commitment to meeting children’s individual needs
(Bouchard 1991; Lloyd 1997).
Conclusion: environmental adjustments

A conducive environment is necessary but not sufficient to promote children’s
learning: setting up activities does not amount to providing a program but instead
is only the context in which learning can occur (Lambert & Clyde 2000). It is
children’s experiences within a setting that provoke their learning. Hence, the
next section highlights the importance of the teaching and learning processes
employed in the setting.
Differentiation of teaching and learning processes

It is self-evident that teaching processes need to be efficient in helping children
acquire and practise skills and dispositions that are a priority for them but, at the
same time, educators must minimise the extent to which teaching methods intrude
on or restrict children’s natural learning (Atwater et al. 1994; Bailey & McWilliam
1990; Carta et al. 1991; Johnson & Johnson 1992; Wolery & Bredekamp 1994).
The dominant teaching method employed will differ at various stages of
children’s development, as shown in Table 4.2, ranging from showing, telling
and describing what infants are experiencing, to facilitating exploration and
self-discovery, explaining cause-and-effect relationships and assisting children’s
experimentation (Belgrad 1998). These methods will also differ according to
whether the children are acquiring a new skill, consolidating a skill or extending
their mastery (Lambert & Clyde 2000).
The following measures can allow you to individualise teaching methods in
response to particular children’s needs.
Develop a facilitative relationship with children

In keeping with the concept that early years education must be responsive to and
designed for children, the pedagogical role of the educator is to facilitate
children’s understandings of themselves and their world, rather than to impose
preconceived concepts on them. This will empower children to drive their own
learning (Lambert & Clyde 2000).
A key means for helping children to understand their world is to engage in
dialogues with them about what they are discovering. Being the most experi-
enced communication partners, adults are responsible for shaping such
conversations with children. To describe this responsibility, Wells (1986 in Smidt
1998) uses the analogy of teaching a child to catch a ball: when teaching a young
child to catch, the adult prompts the child how to hold her hands and makes sure
to lob the ball gently and directly into the child’s outstretched arms—but the
Table 4.2 Young children’s modes of learning and corresponding

modes of teaching
Developmental level Modes of play or learning Modes of teaching
0–18 months Imitation Direct instruction
• showing
• telling
• describing
18–30 months Exploration Provision of a safe
Inquiry environment
Discovery Questioning
30–48 months Prediction testing Mediation
(trial-and-error learning) Explaining cause-and-effect
Discovery
4+ years Construction Facilitation
Provision of opportunities
Mediation
Source: adapted from Belgrad (1998:374).
adult is prepared to run wherever necessary to retrieve the ball when it is thrown
back to him or her. Thus, conversations with children have to follow their lead,
with adults responding to children’s ideas and questions and elaborating on their
experience so that they can make sense of what they encounter (Smidt 1998).
Having touched on the intellectual aspect of dialogues, it must be empha-
sised that conversations must also be emotionally engaging: the intellect cannot
work without affective involvement (Maxwell 1996), while intimacy with adults
will go a long way towards meeting children’s emotional needs. Therefore, your
interactions with children must be warm and fun and offer opportunities for
personal two-way discussions in which you listen to what is engaging them,
rather than asking questions whose answers you already know (such as, ‘What
colour are you using now?’), offering corrections or giving directives (Maxwell
1996; NCAC 1993). Further, your feedback needs to focus on the learning
processes and dispositions that the children are exercising—such as the under-
lying ideas, problem solving efforts, planning, persistence, and so on—rather
than commenting only on end products.
Use predominantly naturalistic instruction

Early education rests on two fundamental principles: first, that children learn best
when they are actively engaged rather than only passively participating; second,
that children need opportunities for autonomous learning (Bredekamp & Copple
1997). Together, these principles highlight that children must be proactive in their
own learning (Maxwell 1996), which implies a preference for naturalistic teaching
over formalised instruction. Naturalistic instruction encompasses a number of
approaches which share the following characteristics (Rule et al. 1998):
• The context comprises routine events—although these are not accidental, as

the educator will structure certain events to evoke and sustain children’s
engagement so that they can acquire and practise those skills that are a
priority for them.
• Interactions follow the children’s lead or capitalise on their interests.
• Natural consequences prevail, whereby the children’s success—rather than a
contrived external reward—reinforces their efforts.
• Because instruction occurs in natural contexts, teaching focuses on func-
tional skills.
You can use activity-based instruction to promote children’s learning by
inspiring exploration through the provision of attractive toys and activities,
embedding your intervention into the children’s self-initiated activities, and
offering specific activities that both interest the children and allow you naturally
to incorporate their developmental priorities (Diamond et al. 1994). Responding
to child-initiated activities is likely to encourage higher-order skills such as
exploration, persistence and problem solving, and thus will promote the general-
isation that is possible only with true mastery (Losardo & Bricker 1994;
Mahoney & Wheedon 1999).
One common naturalistic teaching strategy is termed mediation. Mediated
learning—as distinct from direct learning through the senses—occurs when
adults interpret the environment for children, reflecting the children’s interests,
needs and capabilities (Klein 1992). This is also known as scaffolding and takes
considerable adult skill: to set the stage, to recognise the children’s responses,
and to follow through with support in order to advance children’s thinking skills
(Barclay & Benelli 1994).
In mediated learning, adults initially direct children’s thinking processes
towards a higher level than they can achieve alone, and then the children pro-
gressively acquire the ability to take over this executive control function
themselves (Moss 1992). To achieve this transfer, they need many opportunities
to participate actively in the joint problem-solving process (Moss 1992).
Once children’s engagement is recruited, mediation involves responding to
and provoking children’s ideas and suggestions, providing cues or prompts,
demonstrating approaches to tasks, asking open-ended questions (which usually
start with who, why, what, when or how), asking challenging questions that
provoke thoughtful responses, identifying problems, reflecting on the children’s
inferred emotions, and offering and asking for feedback (Cavallaro et al. 1993).
The aim is for the adults and children to co-construct understandings (Fraser &
Gestwicki 2002). This reciprocal process will incorporate the following five key
strategies (Klein 1992).
• Focus. You can select salient aspects of the activity and help children to
focus on these through accentuation or exaggeration (Klein 1992; Moss
1992). For example, with young babies, you might ‘dance’ a toy to within
easy reach; with older infants, you could point out important features: ‘Hey,
look at this! What do you think it’s for?’
• Meaning. You can convey your intellectual interest in and emotional excite-
ment about an activity. Children will then internalise (learn) to find such
activities interesting and develop the commitment that is necessary for sus-
tained effort and success.
• Expansion. You can expand children’s cognitive awareness beyond their
immediate activity by making spontaneous comparisons between the present
task and others they have achieved, pointing out strategies for memory
storage and recall, and so on.
• Simplification. You can remove elements of the task that are too difficult for
a child, or complete those aspects yourself so that the child is able to
complete the remaining aspects independently. For example, when complet-
ing a difficult puzzle, you might remove only a few pieces from the
completed puzzle and allow the children to replace just those missing pieces
so that they experience success.
• Feedback. You can express excitement and satisfaction with children’s
achievements by, for example, making explicit positive statements about
their efforts (e.g. ‘You took care balancing that block and now it’s staying
put!’). This teaches children how to monitor and judge outcomes for them-
selves and will enhance effort and reflection (Moss 1992).
This mediating process will be reciprocal, wherein you respond to the children’s
actions as well as requiring them to respond to you (Lambert & Clyde 2000). In
this way, the children can control the pace of their learning and, ultimately, are
empowered to practise new skills independently.
Provide adult-directed teaching, as required

To be effective in meeting the diverse needs of children, educators must have a
range of teaching methods at their disposal (Carta et al. 1991). Thus, although
early childhood curricula are based on children’s exploration and discovery, when
children are acquiring new skills or concepts, having difficulty becoming engaged
or sustaining attention, developing high-level cognitive strategies, or requiring
remedial instruction, you will need to guide their learning. Once they are engaged,
you might need to offer those with learning difficulties extra cues, prompts and
encouragement to continue to be involved (McCollum & Bair 1994) and give
them additional time in which to respond to your overtures or directives (Wolery
et al. 1994).
The balance between naturalistic and adult-directed instruction will depend
on the skill to be taught, its functional priority and the context, with more direc-
tive methods employed only once children have shown that they are not profiting
sufficiently from more naturalistic approaches (Atwater et al. 1994).
Facilitate social play

Adult involvement in children’s social play is essential to support the children
when their play flags and to guide the extension of their ideas. Children with dis-
abilities—especially intellectual delay—are likely to need particular assistance
to interact with typical peers and, once engaged, to maintain their interactions
with others (Cavallaro et al. 1993). In supporting the children, you might choose
one of the following strategies (Ward 1996).
• Play in parallel with children so that they will begin to copy you. This adds
to or extends their own play ideas.
• Become an active co-player. At the invitation of children, you can become
a co-player, joining in their existing play and responding to their comments
or actions, thus complementing and extending their ideas.
• Direct the play. Sometimes you might take more control of the direction of
children’s play, either by making suggestions from the side or by participat-
ing in the play. This is useful when children do not seem able to engage in
more advanced play without adult prompts. As soon as they can assume
control of its direction themselves, you can ease out of the play (Ward 1996).
At all of these levels you can pose questions, make suggestions, and expand
on the children’s thinking and cooperative skills to enable them to elaborate on
their ideas and exercise increasingly sophisticated thinking processes.
Facilitate transitions between activities

When children cannot move about the setting independently, you will need to
plan alternative means by which they can change activities. This will assist them
to remain engaged and to act on their preferences, and will provide them with the
challenge necessary to prevent secondary disabling conditions such as when an
inability to move limits their exploration and hence their cognitive development
(Erwin 1993).
Make technological adaptations

Some children will require vision or hearing aids, electronic toys, voice-activated
computers or augmentive communication systems to help them independently
negotiate and interact with their environment. Specialists in each developmental
domain can advise you about the appropriate use of such equipment within your
program.
Differentiation of curriculum content

There has been a passionate debate in early years education and special edu-
cation about whether developmental theory offers adequate guidance for
selecting the content of early years programs. The debate centres on whether the
developmental sequence tells us what young children should be learning, or
merely describes what most typically learn (see Kessler 1991). Advocates of a
developmental model claim that teaching skills in the sequence in which they
usually unfold means that children are not set up to fail; but critics contend that
slavish adherence to a developmental model can mean that educators hold back
from teaching functional skills on the grounds that the children are not develop-
mentally ‘ready’ to learn them. The results are that programs can remain
childlike and irrelevant to children and their families, and educators’ low expec-
tations can render children unnecessarily incompetent.
Those who favour the alternative, ecological, model of program planning
instead recommend that educators teach skills that are useful in children’s
environments—particularly their present settings but also having regard for the
skills that children will need in their next placement, such as school. This model
recognises that there are many pathways to achievement other than the purely
sequential route through developmental milestones (Sandall 1993). Develop-
mentalists, however, claim that this approach can result in teaching skills that are
too sophisticated for the children’s abilities (Mirenda & Donnellan 1987),
forcing them to learn by rote rather than fully comprehending what they are
encountering (Katz 1988). The result can be that the children are less likely to
maintain their skills over time or apply their skills in other settings (that is,
generalise what they have learned).
A blend of the two models is possible: educators could decide to teach the
next skill in the typical developmental sequence in each domain, but prioritise
these according to whether the skills are likely to be useful to the children; or, in
reverse, they could establish priorities on the basis of which skills will be func-
tional for children but adjust teaching in light of awareness of the children’s
current developmental status which will imply how difficult the task might be for
them to achieve (Mirenda & Donnellan 1987).
However, you might have recognised that this is a ‘top-down’ debate that fails
to question the implied role of adults as originators of children’s learning and
whose intrapersonal focus does not take sufficient account of children’s social
and cultural environments. The debate reported earlier concluded that rather than
imposing a set curriculum on children, educators need to follow children’s lead,
responding to their engagement in a way that allows them to construct their indi-
vidual understandings of themselves and their world (Dahlberg et al. 1999).
This model has two caveats: first, educators cannot simply wait around for
children to become involved but must actively initiate ideas and provoke children’s
questioning by the content of the program. Second, when children are not
managing naturally to learn skills or acquire dispositions that will be useful to them
in the long term, you must be willing to assist them to do so. This, after all, is the
basis of early intervention.
Despite these debates about how to select priorities for individual children’s
learning, a core principle of the bottom-up approach to programming is that, in
order to foster positive dispositions towards learning, program content should be
drawn from the children’s interests and educational needs rather than from a
predetermined sequence of instruction (Dunn & Kontos 1997; NAEYC &
NAECS/SDE 1991). Children’s interests are significant because they help them
resolve inner conflicts, so it is important that adults help children to explore their
own topics rather than redirecting them to more traditional tasks (Cohen 1998).
Focusing on these interests avoids their erosion and children’s consequent under-
achievement and deflects from a deficit model of education, in which the focus
is on what children cannot do (Cohen 1998).
While children’s interests change over time, the underlying themes of their
play are remarkably similar throughout childhood (Cohen 1989, 1998). Some
children are interested in being in control of themselves and their world; some
are fascinated by the natural world; some centre their play on exploring social
relationships; some seek to express themselves artistically and emotionally; and
others are interested in learning about symbols such as words and numbers
(Cohen 1998). These interests can be encouraged by helping the children to
gather resources, asking them questions and, when the time is right, extending an
interest into a new curricular area (Cohen 1998).
A second principle is that all young children share a fundamental need for
opportunities to make sense of their world through an integrated program. Inte-
gration encompasses a range of aspects: first, it implies that traditional content
areas are incorporated naturally into all activities (Barbour 1992; Nidiffer &
Moon 1994). Second, it recognises that all learning is interrelated and so the
whole child is the focus, rather than dividing children’s skills into the various
developmental domains (Sandall 1993). Third, integration also implies an inte-
gration of the children’s worlds—home, the school or preschool, culture and
community (Holden 1996).
Because all children have these core requirements in common, many early
childhood experiences are equally valuable for all. At other times children with
additional needs will require adjustments to the content of their programs in
response to their disparate needs. This individualisation of program content can
entail the following measures.
Offer tailored activities

The following features of activities can be varied in line with the ability levels of
the children and the complexity of the learning task (Tomlinson 1996).
• Simple versus complex tasks. When children are acquiring new content or
processes, they will need tasks to be simple; when they are consolidating
knowledge and skills, they will be more motivated by tasks that are complex.
• Concrete versus abstract examples. At entry level, children will need
concrete learning experiences; if children are advanced in the task at hand,
they will be more able to apply their sophisticated knowledge to abstract
problems.
• Small steps versus larger leaps. When a task is intellectually demanding,
children will need it to be broken into smaller steps; when children already
possess the requisite subskills, they can take larger leaps in their learning.
• Knowledge acquisition versus concept mastery. Children whose develop-
ment is advanced will often have more prior knowledge than their age mates
so will need less repetition, revision and consolidation time than less able
children (Kanevsky 1994). Thus, there can be less need to teach them isolated
facts, leaving time for them to focus on broader concepts. The reverse is likely
to be the case for children whose development is delayed. They will require
more repeated practice of skills before achieving mastery (Wolery 1991).
• Unidimensional versus multifaceted. When children are novices within a

field of interest, they might need to explore it along a single dimension;
when they already grasp the basics, they can explore it in a more multidiscip-
linary manner, making more connections between ideas and examining
issues from various perspectives.
• Structured versus open-ended. When children are comfortable with an
area, they can cope with open-ended activities; when they are not sure
of their grounding in a domain, they are likely to prefer more structured
activities.
• Breadth versus depth. All children will need to acquire a broad range of
skills across domains; when they have attained these, they can be encour-
aged to achieve deeper understanding (Patton & Kokoski 1996; Van
Tassel-Baska 1997).
Provide tiered activities

The provision of tiered activities takes two forms (Montgomery 1996):
• differentiation of inputs, whereby you provide different activities at differ-
ent levels of difficulty but which share a common theme. The children can
self-select which activities suit them or you could target certain children and
support them to attempt more demanding tasks;
• differentiation of outcomes, whereby you set a common task which children
enter at their own level and then respond according to their level of sophisti-
cation.
Offering tiered activities requires that you establish appropriate starting points
for the children, based on your recognition of their prior knowledge (Eyre 1997).
Select toys and activities that further program goals

Materials do not teach children as such, but they do set the stage for social and
physical interactions that promote learning (Wolery & Fleming 1993).
Children with developmental delays and disabilities tend to interact with toys
and materials less spontaneously and for shorter periods of time, and so may
need additional guidance to become engaged and support to remain on task
(Kontos et al. 1998; Richarz 1993). Toys that will invite engagement include
those that the children prefer, are functional and relevant in their daily lives and
appropriate to a wide range of abilities (Bailey & Wolery 1992). Such naturally
attractive materials can draw children’s interest, while suitable adjustments to
toys and materials can make it easier for them to manipulate these and so
remain engaged.
Meanwhile, when your goals for individual children are social, you can
provide toys that invite social play. These comprise the likes of dress-up clothes,
dolls and doll houses, large blocks, housekeeping materials, puppets and vehicles
such as wagons, as against toys that tend to lead to isolated or parallel play such
as small building blocks, playdough, books, and craft activities (Ivory &
McCollum 1999).
Purposeful selection of activities can be guided by observing how the

children typically use the materials provided. If they are not engaging with
the materials as intended, the tasks can be modified to further their participation
and enjoyment.
Arrange access to specialists

Children with disabilities can benefit either from direct instruction from a
relevant specialist or from consultation between yourself and specialist educators
so that therapeutic activities can be incorporated into the early childhood
program.
Conclusion: teaching processes and content

Teaching processes and curricular content, while distinguishable in theory, are
inseparable in practice: children cannot learn problem solving unless there is a
problem (some content) to solve, and they cannot learn any content unless they
have adequate learning processes and the disposition to employ these (NAEYC
& NAECS/SDE 1991). One example of a union between content and learning
processes is provided by project-based learning in which, with adult guidance,
children apply a range of cognitive and metacognitive skills (processes) and dis-
positions to answering a question or solving a problem (content) that they have
selected for themselves (see Katz & Chard 1989).
Product differentiation
Products allow children to demonstrate the knowledge, skills and dispositions
that they have exercised during their participation in the program. They make
children’s learning visible, communicate to the children that their efforts are
valued, communicate to parents about their children’s learning, and invite the
children’s reflection on what they have achieved (Fraser & Gestwicki 2002;
Helm et al. 1998). They are ‘a visible trace of the process that children and
teachers engage in during their investigations together’ (Fraser & Gestwicki
2002: 129).
Products can reflect individual or cooperative effort and can span samples of
the children’s writing and art; lists recorded by the educator but generated by the
children, as in brainstorming discussions; extracts from children’s journals or
educators’ logs; displays of children’s constructions; photographs of impermanent
constructions such as sand creations; or audio or video tapes of children’s music
or language experiences (Helm et al. 1998). These can be assembled in individ-
ual children’s portfolios, displayed within the centre or sent home.
The National Association for the Education of Young Children (1986)
cautions that such outputs should not be inhibited by adult-imposed standards
of completion, achievement or failure. Instead, to help parents appraise
their children’s products, they need an accompanying explanation of what their
children have been doing and how it is significant, both in its breadth and depth
(Fraser & Gestwicki 2002).
A curriculum that is negotiated between the children and educators will nec-
essarily result in products that are different for different children. Thus, the final
aspect of the individualisation of programs—the differentiation of products—
will occur naturally. Nevertheless, the following measures could be additional
means of ensuring product differentiation.
Solicit tiered products

Some children will be interested in and capable of producing mature expressions
of their learning. Meanwhile, children with disabilities might need simplified
modes of expression of their learning: for instance, they might not draw until a
much later age than other children, and so you might instead photograph a con-
struction they have made so that they have lasting evidence of their achievements.
When children are often absent because of a chronic illness or disability, it can
be important to take particular care to document what they do produce during
their limited attendance so that they too have proof of their achievements
(MacNaughton & Williams 1998).
Teach expressive skills

For children with language disabilities, their ability to communicate may limit
their ability to record and express what they have learned. In such cases, add-
itional speech or language therapy can both assist them in that domain and give
them the means to express their learning. In other domains, children may seek to
demonstrate their skills through musical expression and dance or drama, so these
will be necessary components of your program.
PLANNING TRANSITIONS
The goals for transitions include (Hanson et al. 2000; Wolery 1989):
• ensuring that services which individual children continue to need are un-
interrupted, while implementing new services that respond to the children’s
changing needs;
• avoiding a duplication of assessment and planning procedures in the former
and future settings;
• minimising disruption and stress for the children and their families so that
the children are well prepared to function successfully in the new setting and
the parents can become independent of personnel in the former program
while still receiving adequate support.
Chapter 2 provides a discussion of how to involve parents in planning the tran-
sition of their child to the next setting, such as primary school. This is also a
curricular issue of preparing children to function successfully in the next
setting—teaching both some essential content and necessary learning processes
or behaviours, such as being able to wait for teacher attention, observing
routines, following directions, working independently, participating in groups
and socialising with peers (Hanline 1993; Rule et al. 1990; Salisbury & Vincent
1990). However, these skills must be taught only when the children are develop-
mentally able to succeed at them: for example, requiring 3-year-olds to attend a
group story time on the grounds that they will need to know how to do it when
they are 5 is developmentally unsound. Furthermore, if schools cannot accom-
modate children with atypical development, perhaps we need to consider
restructuring classrooms rather than demanding developmentally inappropriate
splinter skills of young children.
Thus, at the same time as providing activities that will prepare children for
their next environment, it is important that you accept where the children are
now, not just have an eye on where you want them to be (Stonehouse 1988). It is
important not to rush children into learning the next developmental skill as if
their present developmental state is deficient in some way, but to give them time
to consolidate what they already know so that they will be able to generalise it
to new settings (Kostelnick 1992). Katz (1988, in Richarz 1993) calls this ‘hori-
zontal’ relevance, whereby the experiences that children are offered in early
childhood are relevant to their lives at the time, in contrast with ‘vertical’ rele-
vance in which their curriculum is aimed at preparing them for the next
environmental setting.
In terms of the actual transition, it is common practice to integrate children
who have been attending a segregated facility into regular schools gradually, some-
times on a part-time basis for one or two terms. My practical observations have
been that this can lead to a prolonged period in which the children feel out of place
in both settings and are regarded by peers (and teachers) as not truly part of either
group. For this reason, all things being equal, when entry to a new setting is occur-
ring, it might be best for preparatory visits to span no more than a few weeks.
PROGRAM EVALUATION
Once modifications have been enacted, programs must be monitored to check that
they are catering appropriately for individual children (Wolery 1996). To facilitate
program evaluation, the original intervention plan needs to describe who will
collect what kinds of monitoring information and how they will do so and in what
settings; and it should give responsibility to particular team members to review
the updated information and plan any necessary program revisions (Wolery
1996). The decisions involved in this last aspect are illustrated in Figure 4.1.
Monitoring can detect whether goals need modification because they have
been attained or are proving unrealistic. It can also detect those times when
children are not progressing because, although the original plan is still relevant,
it is not being enacted as intended (Wolery 1996). This can come about because
unanticipated or changed circumstances have made it impractical to implement
the original measures, in which case these need to be redrafted, or because team
members have unwittingly lost sight of the goals and need only a reminder to
enact the planned measures.
Does the child achieve

the goal at the desired level
of proﬁciency?
No Yes
Is the child’s skill Yes Provide extra

experience to promote:
improving? • skill consolidation
• ﬂuency
• generalisation.
No
Is the program
being implemented
as devised? Yes
No
Can constraints to Yes Correct the

implementation be implementation.
overcome?
No
Teach a simpler skill: Teach a higher-level

• teach a prerequisite skill.
• break into smaller steps
• increase natural
reinforcers.
Figure 4.1 Process for program evaluation
CONCLUSION
Modifications to programs need a clear rationale and to be planned systemati-

cally so that changes meet the children’s unique needs without disrupting the
overall program. Thus, program differentiation for children with atypical develop-
ment comes down to a question of balance: providing for their unique learning
needs while also keeping in mind what needs they have in common with all
children, and balancing what you can offer one child while still meeting the
needs of the group.
For children with disabilities, the most significant challenge is designing
instruction so that they are, first, motivated and, second, able (as a result of true
mastery and skill consolidation) to apply their new skills in natural settings. Only
then can true learning be said to have occurred. Although this goal is universal,
we must recognise that all learning occurs within local and wider social contexts
and thus that no one approach will suit every child: it is important to be flexible
about meeting individual children’s needs and to be responsive to their social
context as well as their personal characteristics.
The following text describes teaching techniques for young children, with exten-
sive reference to children with disabilities:
MacNaughton, G. and Williams, G. 1998 Techniques for teaching young children:
choices in theory and practice Longman, Sydney
For a detailed description of the policy on developmentally appropriate practices

that underpins the US system of accreditation of early childhood centres and
guides the Australian accreditation system for child care centres, see:
Bredekamp, S. and Copple, C. (eds) 1997 Developmentally appropriate practice
in early childhood programs revised edn, National Association for the Edu-
cation of Young Children, Washington, DC
National Association for the Education of Young Children website:
http://www.naeyc.org
The following text gives a rich account of child-centred programming:

Fraser, S. & Gestwicki, C. 2002 Authentic childhood: exploring Reggio Emilia
in the classroom Delmar, Albany, NY
The following texts contain extensive advice on program modifications for

young gifted children:
Harrison, C. 1999 Giftedness in early childhood Gerric, Sydney
Morelock, M.J. and Morrison, K. 1996 Gifted children have talents too: multi-
dimensional programmes for the gifted in early childhood Hawker
Brownlow Education, Melbourne
Smutny, J.F., Walker, S.Y. and Meckstroth, E.A. 1997 Teaching young gifted
children in the regular classroom: identifying, nurturing, and challenging
ages 4–9 Free Spirit Publishing, Minneapolis, MN

PART II
PROGRAMMING FOR ATYPICAL
DEVELOPMENTAL NEEDS
Having detailed in Part I the principles that underpin early years education,
authors of the chapters in Part II will describe some common instances of
atypical development in each of the developmental domains in turn, and will
detail how practitioners can adjust early education programs to accommodate
young children’s additional needs.
It must be borne in mind, however, that although it is necessary to discuss
each developmental domain separately, children can have difficulties in more
than one skill area, and so the recommendations about fostering development in
one domain need to be set alongside and balanced with the recommendations
for advancing children’s learning in another. For example, although it might be
beneficial to give children additional experience in physical skills which they are
not acquiring as expected, their current emotional status might instead mean that
they would become overwhelmed if put under pressure to learn new skills at this
time. Thus, as mentioned in Part I, children’s development must be viewed as a
whole, such that their needs in one domain must temper decisions about inter-
vening in another.
All the authors in Part II have framed their recommendations with this in
mind, and emphasise that activities provided for young children need to be
playful and enjoyable for them. Their social needs must also be considered by
not singling out individual children for specific intervention—instead offering
groups of children modified activities that might specifically benefit a given
child but which all can equally enjoy.

5
VISION
JAMES D. KENEFICK
KEY POINTS
• Vision teaches infants about the world beyond their immediate grasp.
Moreover, it allows them to interpret auditory input and information about
the position of their body, and so also assists language development and
motor skill learning.
• During the early childhood years many children are naturally long-
sighted, but this is resolved if their visual system is functioning normally
and they are exposed to rich visual experiences.
• Caregivers and educators can observe for signs of vision impairment in
children, but routine specialist assessment is recommended for all children
prior to school entry.
• Children with significant vision impairment often have associated disabil-
ities, necessitating a coordinated program based on specialist advice about
their individual needs.
INTRODUCTION
Blindness refers to the inability to perceive light; legal blindness is diagnosed

when, even with corrective lenses, an individual’s field of vision is restricted
from the usual 180 degrees to 20 degrees (which is commonly termed ‘tunnel
vision’) or their visual acuity is below 6/60 (which means that they can see at
6 metres what a normally sighted person can see at a distance of 60 metres,
the imperial equivalent being 20/200 feet) (Pagliano 1998). Only one child in
3000 is legally blind (Heward 2000).
A further one child in 1000 has a significant vision impairment, which refers
to conditions of the visual system that interfere with efficient learning but still
permit the children to rely on their vision as their main means of learning (Lowe
1990). Together, children who are blind or have a vision impairment constitute
81
82 PROGRAMMING FOR ATYPICAL DEVELOPMENTAL NEEDS
1% of the population of children with disabilities (Heward 2000; Menacker &

Batshaw 1997).
Half of all cases of childhood blindness are genetic and thus present from
birth, with a further third of children losing their sight before 1 year of age,
usually as a result of infections or other traumas (Howard et al. 2001; Lowe
1990; Menacker & Batshaw 1997). This has such a pervasive effect on all
developmental domains that blindness in infancy is considered a ‘developmental
emergency’ (Hyvarinen 1994, in White & Telec 1998).
There are, however, many children with less severe vision difficulties that
will affect their learning, particularly when their difficulties are not detected and
treated. Perhaps as many as one-third of children have refractive errors (defined
below), although the majority of these (all but 2%) respond to corrective lenses
or other means (Pagliano 1998).
DEVELOPMENTAL EFFECTS OF IMPAIRED VISION
Like the auditory system, vision provides information from beyond arm’s reach.
The visual system is used during early development to direct infants’ hands to an
object that interests them so that it can then be manipulated and inspected to gain
understanding and concept knowledge. As children acquire 80% of their infor-
mation about the world through vision, concept development can be fragmented
and delayed if their vision is impaired (Pagliano 1998).
Combining visual and auditory information allows children to interpret
spatial distances and positions (Getman 1993). If their visual system is faulty
in some way, children might not be able to integrate anything more than
whatever they can reach or place in their mouths. As a result, their development
of discrimination skills will take far longer.
Children also use vision to make sense of their own movement and changes
in posture. The world looks and feels different when infants are lying horizon-
tally from when they are sitting upright. However, when infants’ vision is
distorted, they can become confused and later have difficulty when moving
around in space independently (Lowe 1990; White & Telec 1998). If children
have poor vision on one side of their body or have difficulty using their eyes
together, their visual image may not match how their bodies feel when they
move. In children who have physical disabilities a similar process occurs, where
it is difficult for them to integrate their visual and physical feedback. These
children can learn to adapt, but more usually they compromise—either by not
looking or by avoiding particular movements that confuse them.
Children who have vision difficulties may have associated problems with
hand–eye coordination. They might not be able to locate a toy with their
hand—that is, direct their hand to where they think the object is. When they miss
the object with their hand, children with normal vision will look again, redirect
their hand, look again, and so on, until they successfully grasp the object.
However, children with vision difficulties will tend to look once, feel for the
VISION 83
object, and if they continue to miss it will search for it tactually rather than by
looking again. This can set up a developmental difficulty, in that the children will
not use their visual system as a directing system but only as a rough guide. Later
development of difficulties with eye–hand coordination can have this as its basis.
There is also a relationship between vision problems and hearing difficul-
ties. One of the advantages of a long-distance receptor such as vision is that it
enables individuals to interpret or localise the origin of particular sounds. If there
is a clear visual image of the sound source, babies can understand noises and
what causes them. When infants cannot generate a visual image to match a
sound, they can become frightened or alarmed by noises. This can occur even
when their sense of hearing is intact.
As might be expected, language and social skills are also affected by
significantly impaired vision. Eye contact sets the stage for social interaction
while eye gaze establishes and maintains topics of conversation, without which
children with severe vision impairments can be deprived of the necessary
practice at language and with observing the subtleties of social interaction
(Howard et al. 2001; Kingsley 1997). Furthermore, infants need vision to imitate
mouth movements, so the speech of blind children can be delayed.
Finally, while low vision can restrict visual and motoric inspection of the
environment, motivation to explore can be reduced, as children with severely
impaired vision can experience the world as chaotic and unpredictable and so
withdraw (White & Telec 1998). Also, fearful of their safety, parents and other
caregivers can unintentionally limit these children’s investigation of their
environment (Hallahan & Kauffman 2000).
COMPONENTS OF VISION
When light enters the eye, it is bent (refracted) at the cornea and focused by
adjustments to the shape of the lens—see Figure 5.1. The light then passes on to
the retina at the back of the eye, whereupon a message is sent through the optic
nerve to the occipital (pronounced ok-sip-it-al) lobe of the brain, which is
responsible for interpreting visual input.
The nervous system

Vision impairment can be caused by damage to the optic nerve or occipital lobe
of the brain. Early infections, particularly in the first three months of fetal
development, traumatic brain injury or seizures are common causes of cortical
vision impairment (Howard et al. 2001).
The eye
Impaired vision can result from irregularities in the eye. During the earliest days
of life, babies’ vision is quite blurred beyond 1 metre (Leat et al. 1999). But as
the eye grows during childhood it changes its shape and thus its focus. After
babies’ initial few weeks, during which time their refractive status is unstable,
Retina
Iris
Cornea
Macula
Lens Vitreous
Pupil
Optic nerve
Figure 5.1 Structure of the eye
the eyes gradually settle to become moderately long-sighted (or hyperopic). Over
the proceeding months and years until adolescence, the vision system sets up a
process of reducing that hyperopia. In adults the ideal outcome is emmetropia
(see Figure 5.2a), which is where the vision components are in balance. Distance
vision is clear and no effort is required to maintain clarity of vision. The process
of achieving emmetropia is termed emmetropisation.
Chronological age gives children time, but might not give them the experi-
ence necessary to initiate appropriate emmetropisation. For example, infants
with physical or other developmental disabilities might not experience the same
rich environment as non-disabled babies. This can delay the development of their
visual skills and the emmetropisation process.
Eye use
In some cases the visual system is healthy and the child able to see clearly but
the control of the eyes may be immature. From being a purely reflexive system
during the earliest days of life, the visual system subsequently develops
dramatically. The nerves in the critical area at the back of the eye, which is called
the macula, become increasingly sensitive and fine detail can be detected, as long
as infants receive appropriate stimulation in the form of light and patterns of light
(Kavner 1985), without which there can be a lifelong negative effect on individ-
uals’ vision.
The next stage is that babies start to move their eyes, which allows a wider
view and the inclusion of more objects. Eye movement fosters the early develop-
ment of visual skills for discriminating between objects with various colours,
movements or sounds associated with them, allowing babies to look selectively
at objects to discern their relative value or interest. In order for all this to happen
VISION 85
there needs to be integration between the clear vision of the central field and
peripheral vision.
To be truly efficient, children’s eye movements need to be accurate. Ordin-
arily, the first eye movement for babies is a very basic horizontal saccadic
movement—that is, a movement from left to right. This can be a reflexive
response to sound, light or movement and becomes more deliberate when
inspecting or satisfying their interest in a stimulus, such as a mobile above
the crib.
To increase peripheral vision it may be more efficient to move the head,
which in turn requires some motor control. In other circumstances it can be more
efficient to move only the eyes. Therefore, it is important that children develop
the skill to move their eyes independently of their head, which is dependent on
their integration of early reflexes.
ATYPICAL VISION
This section introduces the commonest cases of atypical vision, comprising

strabismus (turned eye), amblyopia (lazy eye), nystagmus (oscillating eye move-
ments) and high refractive errors. Defective colour vision is also described.
Strabismus
Strabismus is also termed ‘cross-eyed’, as it basically describes how the eyes
look. The turning in form of strabismus is known as esotropia and is by far the
commonest variant found in younger children, with between 2% and 4% of the
paediatric population affected. Most children with significant esotropia present
from birth are identified readily. However, variable esotropia can go unnoticed
for some years. This is when the angle of the eye-turn varies during the day,
according to the child’s wellbeing or health, or depending on the task being per-
formed. Variable esotropia can appear for the first time when children begin to
do work at close range for continuous periods. Prior to this, toddlers may only
ever have scribbled, and in many cases scribbling can be done without any atten-
tion from the vision.
The reason that esotropia is such a significant problem is that the eye which
has turned in does not receive adequate information or visual stimulation to
develop fully. It is crucial that the eye develop an appropriate connection
between the nerves and the part of the brain that interprets visual information.
If the eye is turned in, it will not develop its true visual potential. This is one of
the leading causes of amblyopia, or ‘lazy eye’. When this condition develops
children can experience significant problems with binocular vision—that is,
using both eyes together. In some cases of alternating strabismus (where one eye
will go in and the other remains straight, then the eyes later change to give the
opposite effect), neither eye might develop weakness but the eyes learn to work
independently rather than together.
A second form of strabismus, exotropia, is not simply the opposite of

esotropia. From the point of view that the eye turns out rather than in, it may
seem the opposite, but its significance for vision development is quite different.
Exotropia typically happens at a later age, usually after 3–4 years of age. This
means that one eye is unlikely to become weak or ‘lazy’. This therefore is a good
thing. However, children with exotropia still have the difficulty that they are
using one eye, rather than both eyes together. This will affect their eye–hand
coordination in the future. Another effect is that when reading their two eyes do
not aim together, creating confusion and occasionally even double vision. These
children will also have difficulties with catching a ball because they cannot accu-
rately judge the speed of a ball as it approaches them. Throwing balls, however,
may not present a problem for them. Therefore, when a significant difference in
throwing and catching skills is obvious, an eye problem should be considered as
a possible cause.
Obviously, then, it is important to have the eyes as straight as possible as
soon as possible, which will require intervention from a vision specialist. In
some cases, corrective lenses or glasses will be sufficient; specific training for
amblyopia might be useful (i.e. patching or other activities to stimulate the
development of vision in the neglected eye), although often a combination of
lenses, exercises and surgery is required.
Amblyopia
Amblyopia refers to reduced visual acuity, usually in one rather than both eyes,
which cannot be corrected by lenses (Caloroso & Rouse 1993). It affects 2% of
the population and arises when the individual’s two eyes see with differing
acuity, and so the brain ignores the picture from one eye (Menacker & Batshaw
1997). Strabismic amblyopia is due to one eye being turned in; refractive ambly-
opia is due to an imbalance in the power of the eyes. When treated early, lenses
might be all that is required to allow the development of normal vision. However,
in some cases additional specific treatment will be necessary.
Nystagmus
Nystagmus is characterised by a rhythmical oscillation of the eyes (Leat et al.
1999). Individuals with nystagmus typically have a relatively normal variation of
refractive error—that is, they can be long- or short-sighted. I believe it is as if
the eyes, unable to see clearly at the macula, then start performing a searching
motion to gain information as best they can. The visual system of individuals with
nystagmus is like a camera taking many very quick photos, trying to work out
exactly what it is they are looking at.
Near vision is often very difficult for children with nystagmus, and they
often require additional help through magnification or enlargement of text. In the
short term or as young children, their coordination will develop reasonably well,
but they will have underdeveloped eye–hand coordination skills.
VISION 87
High refractive errors

Refraction simply means the bending of light—in this case, so that it focuses in
one point on the retina to generate a clear image (Heward 2000). Errors in refrac-
tion can result in the rays of light converging in front of the retina, which is
termed myopia or short-sightedness (see Figure 5.2b); in the rays being destined
to converge behind the retina and so being out of focus at the retina itself, which
is termed hyperopia or long-sightedness (see Figure 5.2c); or in distorted con-
vergence due to irregularities in the shape of the cornea, which is termed
astigmatism (see Figure 5.2d). All three errors result in blurred vision, with indi-
viduals who have myopia having better acuity of vision at close range and those
with hyperopia functioning better at distance.
Clinically I have found that only a small percentage of children under
5 years of age have significant refractive errors, although in uncommon cases
high levels of hyperopia, myopia and astigmatism can occur. Given that it is most
likely that young children will be hyperopic (long-sighted), any suggestion of
myopia (short-sightedness) in preschool children should be carefully followed
up. It is such an unusual visual condition in this age group that it must be inves-
tigated. Furthermore, any sudden change in the child’s vision should be
considered urgent as refractive changes usually occur gradually, so eye disease
must be investigated as a possible cause of the sudden change.
(a) Emmetropia (b) Short-sightedness

(myopia)
(c) Long-sightedness (d) Astigmatism

(hyperopia)
Figure 5.2 Refractive errors

Defective colour vision

The retina comprises millions of cells, those on the periphery being known as
rods (which are responsible for black/white detection and night vision) and the
central cones for colour vision (Pagliano 1998). The latter are of two types:
red/green and blue/yellow colour receptors. Colour blindness is very rare in
that it involves the complete failure of colour detection by the cones, with
resulting absence of colour perception. More commonly in Europeans (at a rate
of around 8% in males and 1% in females), the red/green receptors are slightly
defective, resulting in colour confusion (Menacker & Batshaw 1997). Only
Polynesians have been recorded to have genetic defects in blue/yellow recep-
tors and even then at a much lower rate than for the corresponding condition in
Europeans.
The defective gene occurs on the X-chromosome and so in the absence of
damage to the retina is likely to appear in boys when their maternal relatives have
colour vision deficiencies and in girls when, in addition, their father has a colour
vision defect. The defect is evident when individuals are viewing small patches
of colour rather than large-sized items, when locating a colour within an array of
multiple hues, or when lighting is inadequate. In these circumstances, affected
children will confuse green with brown and navy with purple, for instance, the
discrimination between each colour pair relying on the amount of red that is
present in the blended colour.
Colour vision deficiencies have no practical disabling effects, although in
adulthood some occupational fields such as cosmetic consultancy, interior design
and various branches of medicine might not be ideal vocations for those with
impaired colour perception.
IDENTIFICATION OF VISION DIFFICULTIES
Ideally, vision screening should be conducted by vision professionals—but only

in Kentucky in the USA is this required by law (Shaw 2001). Until such time as
compulsory screening becomes a more widespread phenomenon or parents
voluntarily take young children more routinely for vision checks, non-vision
practitioners need to be alert to signs of potential vision difficulties so that a
higher percentage of children with vision difficulties can be identified and sub-
sequently assisted.
Observation
Screening kits and checklists are available to aid identification, but there are also
specific behaviours that practitioners can look out for to identify children who
are experiencing vision difficulties that require specialist assessment. These
signs are listed in Box 5.1.
VISION 89
Box 5.1 Indicators of vision difficulties in young children

Eye use
Children with vision difficulties might:
• Avoid looking at objects.
• Be surprised at expectations that they should see things in the near
distance.
• Frown or squint in an attempt to focus due to refractive errors or problems
with binocular vision.
• Experience recurrent frontal headaches, but if these are constant might not
report them as they do not realise that headaches are abnormal.
• Display excessive head tilt, cover or close one eye, or place books dra-
matically to one side (particularly on vertical surfaces such as easels) while
doing close tasks. These strategies allow one eye to receive the majority of
visual information and so indicate that the children’s eyes are not working
together.
• Have to get extremely close to the page. This could be due to a refractive
error or to problems with binocular vision or eye coordination.
• Have difficulty using their two eyes together. This can show up by the early
school years as difficulties in visual inspection and with scanning lines of
printed words. While reading, these children skip words or lines and often
lose their place on pages. They might complain that the print blurs after a
short time. To compensate for their vision difficulties, they might whisper to
themselves while reading or use a hand or finger to keep their place on the
page, both of these persisting past the typical age.
• Have unusually large pupils (which can indicate myopia) or very small
pupils (suggesting possible hyperopia).
• Experience increased photophobia (glare sensitivity). Glare sensitivity in
dark-eyed children may be particularly significant, as ordinarily they are
less likely to be sensitive to glare than children with light-coloured irises.
• Experience frequent reddened or watering eyes and rubbing of eyes after
short bursts of close work. This can be caused by mild eye strain or uncom-
fortable or tired eyes, which the children do not report as they assume it to
be normal.
Gross motor skills
Children with low vision can display:
• Late or hesitant walking not due to other causes.
• Asymmetrical posture.
• Difficulties with coordinated movement such as throwing, catching, running,
hopping, skipping, kicking, jumping, climbing stairs and self-swinging.
• Physical clumsiness, particularly when their two eyes themselves are poorly
coordinated. This can result in behaviours as obvious as bumping into,
stumbling or tripping over objects, which is especially worth noting if indi-
vidual children constantly bump into objects on one particular side.
• Misjudgment of depth and contours: some children seem often to stop short
of obstacles, as if they have poor depth perception. This can occur partic-
ularly if one eye is out of focus compared with the other.
• Dramatic reactions—even fear—to a change in contours, such as where

there is a change of floor covering from carpet to tiles. This is an extreme
problem with depth perception. It is as if these children perceive the
change but do not appreciate whether it is significant or not.
• Frequent placement of objects just on the edge of the table rather than
nearer the centre, as if they cannot judge where the edge is. This is an indi-
cation that the visual system and motor skills are not well integrated.
Eye–hand coordination
Vision difficulties can lead to the following effects on eye-hand coordination.
• Children are very slow at developing their hand preference, which can
cause them to be reluctant or less skilled at eye–hand tasks. As the devel-
opment of eye preference closely mirrors both in direction and in time the
development of hand preference, delays in establishing hand dominance
can imply delays in establishing eye dominance.
• They might continually swap hands during tasks (past the usual age).
• Delayed eye–hand coordination can be due to incoordination of the two eyes
and can be seen in difficulties with: cutting out, pasting and other paper
tasks; using a knife and fork together; completing puzzles; assembling small
construction toys (e.g. Lego); drawing; and dressing themselves.
Behavioural signs
Children with vision impairments can display:
• Impulsive reactions to visual input. This can come about when children
have difficulty visually attending to objects. They might inspect these
extremely briefly and then act quickly to approach or escape, without giving
themselves time to judge the objects’ interest or danger value.
• Caution in moving about in strange places.
• Avoidance of close work.
• Distractability. Children with vision impairments can be peripherally driven
and thus be distracted by what is going on around them rather than what is
in front of them in their central field of vision.
• Signs of exhaustion such as tiring readily, becoming disengaged, or con-
stantly fidgeting or shifting in their seat during prolonged close work. The
effort to achieve optimal vision can result in these behaviours.
Sources: Getman (1993); Lowe (1990); Pagliano (1998).
Professional assessment
Children who have been identified to have potential problems with their vision
should be assessed by an appropriate clinician. The relevant vision professionals
include the following:
• Optometrists are practitioners who have a university degree and who look
at how the eyes work. A doctor’s referral is not necessary for an appoint-
ment. Optometrists are able to recognise diseases of the eye, but will refer
VISION 91
individuals to an ophthalmologist for any medical treatment. Behavioural

optometrists have special postgraduate training in developmental and func-
tional vision.
• Ophthalmologists are medically trained doctors who specialise in diseases of
the eye. A referral is necessary for an appointment with an ophthalmologist.
• Orthoptists are trained in the area of, and deal specifically with, problems
with the muscles of the eyes. In some instances, a referral from an ophthal-
mologist to an orthoptist is necessary.
For young children, the best option is to have them assessed by a paediatric
specialist in ophthalmology or optometry. If serious problems are suspected, the
children might then be referred to a low-vision clinic (Pagliano 1998).
Because of the developmental nature of vision skill acquisition and because
it is rare for a vision problem to exist in isolation, the clinician will want back-
ground information on the children’s gross motor, language and social
development as well as performing a vision assessment. The aim of a vision
assessment is to observe the children performing a series of visual tasks, as well
as actually measuring the eyes. In almost all cases, the initial consultation will
be able to achieve the following:
• assessment of children’s visual acuity—that is, the clearness of sight;
• objective measurement of their refractive status—that is, the presence of
myopia, hyperopia or astigmatism;
• assessment of basic binocularity—the use of the two eyes together;
• examination of eye movement, looking for a full range of unrestricted
movement that indicates the degree of children’s control of their eyes;
• basic saccadic (horizontal) eye movements and the ability to separate head
and eye movements;
• pupil assessment;
• eye health.
During an assessment by a behavioural optometrist, eye–hand development,
hand preference, sighting eye preference (eye dominance) and basic pencil grasp
and release will also be observed. Ideally, children should be observed drawing
or playing with blocks at some time during the assessment, perhaps while they
are in the waiting area.
CHILDREN WITH ATYPICAL DEVELOPMENT
All children and particularly those with recognised disabilities require careful
observation of their ability to use their eyes efficiently.
Children who are blind

Blindness can be an isolated disability, although most of its causes—such as
prenatal infections—simultaneously cause other disabilities as well. The
outcome is that around 70% of congenitally blind children also have other dis-
abilities: 25% have an intellectual disability, 10% also have hearing losses, 8%
have epilepsy, 6% have cerebral palsy, and 6% have congenital heart defects
(Lowe 1990). These children need an individualised program devised in consul-
tation with a range of specialists to assist them in domains where they experience
an impairment and to capitalise on their residual sensory perception and develop-
mental strengths.
Children with cerebral palsy

Virtually all children with cerebral palsy experience focusing and eye move-
ment problems, with the majority having strabismus (a squint) and between
50% and 60% having refractive difficulties, the most common of which is hyper-
opia—that is, long-sightedness (Duckman 1987; Pellegrino 1997; Wesson &
Maino 1995). Those whose CP is due to prematurity can have retinopathy,
which is where, without early detection and treatment, vascular damage to the
retina causes it to become detached and blindness results (Bernbaum &
Batshaw 1997; Pellegrino 1997). Children with ataxia (see Chapter 6) can have
nystagmus (the oscillating eye movements described earlier), while children
with hemiplegia often have impaired vision of one part of their visual field
(Pellegrino 1997).
These children, therefore, commonly need corrective lenses as well as assis-
tance for their dynamic visual skills—that is, how they use their eyes. It is often
beneficial to provide them with opportunities to move their eyes in a more co-
ordinated manner through basic eye aiming and tracking activities. Monocular
(one eye) and binocular activities should be attempted. These can be designed by
the children’s vision specialist and, where appropriate, included in their early
childhood program.
Children with Down syndrome

Children with Down syndrome have a higher than usual incidence of significant
vision problems including hyperopia, myopia, astigmatism, nystagmus, and
10 times the usual incidence of strabismus (Roizen 1997; Wesson & Maino 1995).
Difficulties with eye–hand coordination and depth perception are common.
Given these vision problems, both ophthalmologists and optometrists need
to be involved in the assessment of these children’s eye health and vision (Roizen
1997). Assessment needs to be carried out at an early age with routine check-ups
periodically, as some children do not have any outward signs of eye health
problems and seldom complain about their vision.
Prescribing lenses is important, and encouraging the children to wear their
glasses is also crucial so that they learn to tolerate their lenses. Training sessions
need to be brief to take account of the children’s reduced concentration span, but
it is imperative that they have the opportunity through individualised programs
to develop their visual skills so that they will be able to use their vision more
VISION 93
efficiently and so that they do not become overly reliant on their other senses,
such as touch.
Gifted and talented children

The natural inquisitiveness of gifted children often means that they are interested
in reading and other close tasks at an earlier age than usual. As the visual system
requires time to develop fully, problems may arise from excessive demands on
the focusing or tracking systems of these young children.
The signs of focusing difficulties are the same as already mentioned for all
children; tracking difficulties can become evident as the children move to books
with more text or more lines of text with fewer picture cues. A sudden loss of
interest in reading or avoidance may indicate a developmental mismatch between
the children’s visual and intellectual abilities.
This mismatch can be dealt with by vision exercises and perhaps lenses in an
attempt to let the visual system ‘catch up’ so that the children can pursue their
advanced interests in close work, or by restraining the children’s overuse of eyes by
restricting the time they spend reading or by making reading and other close tasks
less demanding visually. Porter (pers. comm.) advises explaining to the children
that, although their brains are growing up more quickly than usual, their eyes can
only grow up at ‘body speed’. This helps the children to understand their tracking
difficulties and encourages them to be patient with their physical limitations until
these are resolved naturally with improved maturity of the visual system.
PROGRAMMING FOR CHILDREN WITH VISION

DIFFICULTIES
Depending on his or her particular vision difficulties and residual vision, each
child will function differently in the environment. The aim for children with
significant vision impairment is to give them knowledge of the realities around
them and the confidence to cope with these (Lowe 1990).
Environmental adjustments
Children with significant vision impairment need their environment to be
arranged logically and consistently, with floor surfaces plain and matt to avoid
glare, fittings painted in contrasting colours to highlight their location, and
changes in floor levels signalled well in advance by texture or colour changes
(Lewis & Taylor 1998; Pagliano 1998). Doors should be left open or closed, but
not ajar (Pagliano 1998).
These children tend to require double the usual illumination levels but
with glare-reduced lighting so that shadows do not create visual confusion
(Lewis & Taylor 1998). Enhanced illumination is likely to be particularly nec-
essary for children with macular disease or retinitis pigmentosa (which is a
degenerative condition of the retina). Their requirement for additional light

suggests the need to remove artwork from windows and to provide portable
lights (Pagliano 1998).
The children need to be seated where they can function best and where there
is minimal glare (Lowe 1990). Those who are short-sighted will need to be close
to the adult in group activities; those with tunnel vision might need to be at the
back of a group, as their viewing area widens with distance; those with photo-
phobia should sit away from windows (Lowe 1990).
Other physical aides such as a sloped book rest or desktop easel can help the
children avoid fatigue from crouching closely over books or drawing paper
(Lowe 1990). Aids such as Braille machines or large-print books will be neces-
sary for those with more severely impaired vision.
Teaching to overcome secondary difficulties

Children with low vision need assistance in all developmental domains:
• awareness of their body in space—that is, orientation training that teaches
them to use their other senses to gauge their position;
• mobility training to give them confidence to move independently;
• training in self-help, language and social skills;
• listening training, teaching them to be aware of, discriminate between,
identify the source of, and assign meaning to sounds (Arter 1997; Heward
2000; Pagliano 1998);
• specialist teaching of early literacy skills and Braille (if required);
• specific remediation for any associated disabilities.
Some of these topics are covered in this book; for specific guidance relevant to
blindness, you will need to consult the children’s vision and other specialists.
Vision training exercises

Exercises can improve children’s use of their eyes—specifically their ability to
use their eyes and hands together, track moving objects, shift their focus effi-
ciently from one object to another (horizontally, vertically and near-to-far), and
use both eyes together to develop eye convergence or eye teaming skills. Having
identified children’s vision difficulties, behavioural optometrists will devise
vision therapy activities that encourage these skills. This programming is usually
done in a prescriptive way—that is, by identifying individual children’s needs
and designing relevant remedial activities. Most of these exercises require brief
but repeated practice, much of which will take place at the children’s homes.
Nevertheless, to afford additional practice, under instruction from an optom-
etrist, it might be possible for you to conduct some specific eye skill exercises
with individual children during their time in your care.
VISION 95
CONCLUSION
Children’s vision skills can be promoted in early childhood environments in order

to prevent and minimise vision problems later on and to promote the development
of eye–hand coordination skills, the ability to read comfortably and efficiently and
to change focus rapidly with changes in visual demands.
Vision difficulties are often subtle yet very significant educationally. When
children can be assisted before their vision problems become entrenched and
before they have experienced repeated failure, we can avoid detrimental effects
to their self-esteem, their attitude to themselves and to learning (Howell &
Peachey 1990).
Within Australia, to obtain the names of local behavioural optometrists, you can
refer to the website of the Australasian College of Behavioural Optometrists
(ACBO) (www.acbo.org.au) or contact the ACBO National Secretariat on
(+61 3) 9729-5822.
Currently available screening tests by health professionals have generally
focused on detecting vision anomalies rather than vision skills. Therefore there is
a need for a new ‘family’ of screening tests. These are slowly becoming available
in the marketplace. You can contact [email protected] for
preschool and primary school vision screening kits. The observations checklist is
available from OEP USA (at www.oep.org). This looks at the development of
vision from 6 months and earlier and gives general guidelines for what is to be
expected.
For texts on children with severe vision impairments, I recommend:

Arter, C., Mason, H.L., McCall, S., McLinden, M. and Stone, J. 1999 Children
with visual impairments in mainstream settings David Fulton, London
Mason, H., McCall, S. Arter, C., McLinden, M. and Stone, J. (eds) 1997 Visual
impairment: access to education for children and young people David
Fulton, London
Strickling, C. 1998 Impact of vision loss on motor development: information for
occupational and physical therapists working with students with visual
impairments Texas School for the Blind and Visually Impaired, Austin, TX
6
MOTOR SKILLS
MARGARET SULLIVAN
KEY POINTS
• The aim of programming for young children with movement difficulties is

to help them become active solvers of movement challenges and enjoy
moving safely and confidently about their environment.
• Children’s motor learning depends on the growth and maturation of many
biological systems and on their having extensive experience with goal-
directed, active movement.
• Children need a range of playground skills in their early years: climbing,
balancing, running, jumping and ball skills. Aside from the enjoyment
these activities bring, all have an important role for fitness and in the mus-
culoskeletal and skill development of young children.
INTRODUCTION
Generally speaking, young children with an obvious physical disability and a

clear diagnosis will already be receiving services from relevant therapists whom
you could consult about inclusive curricular practices. On the other hand, you
might be the first to notice that certain children in your care have delays in
learning to sit or walk, experience many subtle difficulties on playground equip-
ment, fall often, or move in an unusual way. This large group of children warrant
our special attention. Often they do not meet the criteria for specialist services,
yet they struggle to keep up with their peers because of their sensorimotor
problems.
Programming for young children with movement difficulties aims to help
them become active solvers of movement challenges and enjoy moving safely
and confidently so that they may benefit from the social, recreational and fitness
opportunities of physical activity throughout life. Depending on the children’s
particular difficulties, additional specific aims can comprise promoting the best
96
MOTOR SKILLS 97
use of their sensorimotor ability, preventing deformity, correcting muscle im-

balance and improving muscle strength.
The methods used to assist children will vary according to the type and degree
of their motor difficulties, the presence of associated problems such as sensory or
health concerns, and the wishes and expectations of the children and their parents
or carers. Interventions will need to focus on the children’s most urgent sensory or
motor needs at the time, updating interventions as these needs change. Physiother-
apists can advise you on functional movement training and on how to overcome
problems of physical access as appropriate for each child and setting and, with
other specialists, can assist with programming advice and differential diagnosis
between the various conditions where motor difficulties can be seen.
A multi- or interdisciplinary approach is needed because often more than
one developmental domain is affected, such as when children with cerebral palsy
also have vision or hearing impairments. There may also be medical issues, such
as the use of medication to influence muscle tone or to control epileptic seizures
or respiratory infections, the use of orthotics or orthopaedic surgery to prevent or
correct deformities of the trunk or limbs, or orofacial or abdominal surgery to
manage severe and prolonged difficulties with eating and drinking.
FACTORS INFLUENCING MOTOR LEARNING AND

PERFORMANCE
When we are assisting young children to move about the nursery or playground,
we are attempting to promote their motor learning. Children’s motor learning
depends on the growth and maturation of their anatomy and physiology, in
particular the nervous and musculoskeletal systems, plus extensive practice of
goal-directed, active movement—and a dynamic interaction between all these
elements (Shumway-Cook & Woollacott 2001). An example of this interplay is
that toddlers have better head control than babies. This comes about because
toddlers’ nervous system is more mature, their ratio of head to trunk size is
smaller than for infants (see Figure 6.1) and so their neck muscles do not have to
work so hard to hold their head steady (a musculoskeletal factor), and because
toddlers have had more practice at a variety of movements requiring different
types of head control (i.e. task-specific practice).
Motor learning also depends on children’s knowledge of the results of
movements that they have attempted—that is, sensory feedback (Gentile 1987).
This feedback allows children to fine-tune motor control as the movement
continues or is repeated; sensory feedforward mechanisms then help children to
anticipate or prepare for future movement (Shumway-Cook & Woollacott 2001).
Motor learning and performance are also subject to individual differences and
prevailing environmental conditions. For example, although all human beings
learn to walk using roughly similar patterns of movement, the gait pattern
they choose to use at any given time will be shaped by their biomechanical
characteristics (height, weight, leg length and bony alignment; see Figure 6.2);
1/2 1/3 1/4 1/5 1/6 1/7 1/8
2 months 5 months Newborn 2 6 12 25
Fetal age Years
Figure 6.1 Changes in proportion of the human body during growth

Source: Papalia and Olds (1992:94).
current level of alertness, motivation and perhaps aerobic fitness; prior

experience and habit; cultural and gender-specific conditioning; and other
environmental features such as their footwear, the type of surface, and whether
and how they are carrying a load.
CONDITIONS ASSOCIATED WITH ATYPICAL PHYSICAL

SKILLS
Some children consistently appear ‘clumsy’ or awkward in their gross and fine
motor play. Others avoid physical activity. These difficulties can be due to a
range of conditions such as vision impairments (see Chapter 5) and physical or
other disabilities, some of which I shall now discuss.
Cerebral palsy
One group of children with coordination difficulties are those who have cerebral
palsy. Cerebral palsy refers to persistent disorders of movement, postural control
and muscle tone resulting from non-progressive damage to the developing brain
(Stanley 1994) (see Appendix I). Brain injury occurring later in childhood is
called traumatic or acquired. Although with cerebral palsy the damage to the
central nervous system is not itself progressive, when young infants with
cerebral palsy begin to move their ability to control their movement may appear
to worsen. For example, children may have normal muscle tone when they are
lying and resting, but when they pull to standing at furniture their calf muscles
may become very tight, preventing heel contact with the floor. (For further infor-
mation on these children, see Additional resources.)
MOTOR SKILLS 99
Infant 18 months 31/2 years 7 years
Figure 6.2 Typical changes in bony alignment during early childhood

relative to the appearance of ‘bow legs’ and ‘knock knees’
Source: Tachdjian (1997:119).
Children with mild cerebral palsy can be slow to achieve independent

sitting; have difficulty moving from lying to standing; have immature balance,
resulting in frequent falls; have difficulty climbing, especially descending;
become stiffer in their affected limbs when making strong efforts with other
body parts; and have difficulty modulating the speed and strength of their move-
ments. There may also be slight problems in the apparently ‘unaffected’ body
parts. For instance, children with diplegia (see Box 6.1) may have minor
problems with hand skills (Shumway-Cook & Woollacott 2001).
There are many types and degrees of severity of cerebral palsy (one system
of classification of which is given in Box 6.1), so no two children have exactly
the same abilities or potential disability. Functional problems can range from
barely noticeable to ‘profound’, with the mildest forms not always evident early
in infancy.
The commonest types of cerebral palsy in children who are walking inde-
pendently are spastic hemiplegia and spastic diplegia. When their difficulties are
mild, these children’s condition is the most likely to go undetected. Therefore, it
is important to look out for indications of these two forms of cerebral palsy.
Children with mild spastic hemiplegia:
• commonly use one hand much more than the other;
• avoid weight-bearing on their affected side, so may creep or crawl leaning
mostly on their sound side;
• may bottom-shuffle in sitting instead of crawling;
• walk and run with a slight limp;
• appear to stand on their toes on one foot;
• dislike touch on their affected limbs such as when dressing or bathing;
• tend to ignore their affected arm and leg and any toys placed on that side of
their body;
Box 6.1 Classification of cerebral palsy

Type of muscle tone
• Hypotonic: tone is too low—child looks ‘floppy’.
• Hypertonic: tone is too high—movement is jerky and restricted.
• Fluctuating: extremely variable tone.
Body parts affected
• Hemiplegia: mainly one side of body affected.
• Diplegia: mainly lower trunk and both lower limbs affected.
• Quadriplegia: all four limbs, neck and trunk affected.
The terms hemiparesis and quadriparesis are sometimes substituted for hemi-
plegia and quadriplegia to signify a mild degree of movement disorder.
Type of movement disorder experienced
Many children with cerebral palsy have problems with eating, drinking and
speech because of their abnormal muscle tone, neonatal reflexes being either
weak or persisting beyond infancy, and reduced control of posture and
movement. Some also have poorly coordinated eye movements. Most have
muscle weakness.
• Spastic: restricted, jerky movement, stiff postures, muscle imbalance
around joints (with potential for joint contracture), low tone at rest but high
tone on effort.
• Rigid: consistently high muscle tone, very restricted movement and
postural reactions.
• Athetoid: involuntary writhing or jerky movements accompanying excite-
ment or efforts to move; extreme variations of muscle tone (with children
with tension athetosis having high muscle tone).
• Ataxic: low muscle tone, incoordination; poor postural stability; some have
upper limb tremor accompanying volitional movement.
• Hypotonic: very low muscle tone consistently; extreme difficulty moving or
holding postures against gravity; weak survival reactions (e.g. gag reflex).
• Mixed: a combination of more than one of these types.
In North America, the term ‘dyskinesis’ is sometimes applied to the various
forms of the athetoid type (Wilson-Howle 1999).
• compensate very well with their sound side and resist your efforts to have
them use the affected limbs.
The second group of children whose mild cerebral palsy sometimes goes
unrecognised are those with mild spastic diplegia. These children:
• do most of the effort of creeping and crawling with their upper body—for
example, by drawing their knees together and using short strides of the knee
or bunny-hopping (leaning on their hands and dragging their knees behind);
• commonly sit between their heels;
• persistently pull to stand at furniture with their knees drawn together, over-
using their arms and upper trunk, then standing up on their toes;
MOTOR SKILLS 101
• have a lot of difficulty lowering from standing at furniture;

• walk with short strides, often on toes, and with movements that look stiff and
jerky, bracing one knee against the other;
• may be slightly clumsy with fine motor skills.
Spina bifida
Another group of children with difficulties in movement control are those who
have spina bifida (described in Appendix I). Children with its most severe form,
myelomeningocoele (pronounced mi-lo-men-in-jo-seal), will have partial or
complete paralysis of the muscles supplied by nerves below the level of their
spinal lesion. They usually also have reduced sensation and bladder or bowel
control. Reduced tactile awareness of their lower limbs can result in the children
not noticing friction burns caused by creeping and dragging their bare legs and
feet across rough carpet. Therefore, you will need to be vigilant of their skin con-
dition and teach the children to use their vision to check their limb placement.
They may also have osteoporotic or fragile leg bones resulting from reduced
weight-bearing and walking. You may need to take special care that classmates
do not trip over their legs when preschoolers are asked to sit together on a mat.
Many children with spina bifida will use standing frames, various assistive
walking devices and wheelchairs (often beginning with castor carts low to the
floor) from early in their preschool years. They will usually be in the care of a
physiotherapist and other medical and allied health professionals who can advise
you on their mobility training, manual handling, continence care and related
needs. Detailed information can also be found in such texts as Burns and Mac-
Donald (1996).
Developmental coordination disorder (DCD)

Some children’s coordination difficulties cannot be explained by recognised
physical or intellectual disabilities or rapid growth spurts. Historically, a variety
of descriptive labels have been applied to this group of children, although an
international symposium in Canada recently decided to adopt the term ‘develop-
mental coordination disorder’ (Fox & Polatajko 1994), as defined by the
American Psychiatric Association (1994).
Simply put, children with DCD usually have normal intelligence with no
overt disability but minor difficulties in many sensory domains, which combine
to interfere significantly with fine and gross motor skills, social development and
their ability to function in daily life (see Box 6.2). These difficulties may
manifest differently at different ages, with specific learning difficulties and low
self-esteem often becoming evident in the school years (Gillberg & Gillberg
1989; Losse et al. 1991). However, appropriate intervention programs can do
much to help these children (Watter 1996).
Interdisciplinary assessment is essential to distinguish DCD from other
conditions such as specific language impairment, the attention deficit disorders,
Box 6.2 Characteristics of young children with developmental

coordination disorder (DCD)
The following features are common in preschoolers with DCD (and are some-
times present in part in other conditions), although not all are present in any
one child.
• Muscle tone is often unusual, commonly too low; sometimes too high.
• Range of joint movement may not be age-appropriate, commonly being
excessive; sometimes limited.
• Habitual toe-walking may persist beyond the toddler years.
• Reduced proprioception (reduced joint position sense) can show up in
poor limb placement during climbing; fidgeting; leaning on the back of the
hand instead of the palm when sitting or pushing objects; and poor pre-
writing skills (see chapter 7).
• Weak motor planning (dyspraxia). Children with DCD can have motor
planning problems because of various sensoriomotor difficulties, including
poor proprioception and visuospatial perception. Motor planning difficulties
show up as difficulties using appropriate muscle groups in the correct order
and timing (Lundy-Ekman et al. 1991); difficulties starting a movement; being
slow to learn a movement sequence and so needing much repetition and
verbal or physical cueing; having trouble with action songs or copying
gestures; having difficulty transferring a new motor skill to another context.
• Balance difficulties. Children with DCD often cannot right themselves
quickly if pushed off balance; fall over often without being tripped; like to
keep on the move or act the clown by falling (to avoid having to balance);
avoid activities that challenge their balance; have poor single-leg stance;
and sit, walk and run with their feet widely spaced.
• Reduced functional strength and endurance, such that they fatigue easily.
• Coordination difficulties of upper and lower body, left and right sides, and
eye–hand skills. The children’s movement lacks rhythm and smoothness
and may look heavy; strong effort is accompanied by unwanted background
movement; they exert too much or too little force (Lundy-Ekman et al. 1991);
cannot perform rapid, alternating movements (e.g. drumming); and have
difficulty crossing their body midline (e.g. in ball-catch or drawing).
• Difficulty with visual judgments about space leads to frequent collisions
with other children or equipment; weak ball skills; climbing difficulties such
as bumping their head and misjudging heights; and weakness at copying
another’s gestures.
• Unusual responses to touch (see chapter 7).
• Weak memory for visual or auditory patterns, as shown when the
children have trouble remembering rhythms or a short sequence of verbal
instructions, or the rules in games or dances (Watter 1996).
• Reduced attention span or impulsivity.
• Behavioural difficulties. As a result of frustration at their awareness of their
failures or because of the effort of compensating for their sensorimotor
difficulties, children with DCD may exhibit difficult behaviours, especially
when tired. These may include irritability, low frustration tolerance, aggres-
sion, low self-esteem and withdrawal or, conversely, clowning rather than
making a serious attempt at a task.
MOTOR SKILLS 103
global developmental delay, autism spectrum disorder or mild cerebral palsy, all
of which share some of the sensorimotor and behavioural features of DCD.
Your programming adjustments will depend on children’s specific combi-
nation of sensorimotor difficulties, but are likely to span sensory preparation
activities (see chapter 7) and activities to promote well-timed and coordinated
movement, motor planning, balanced muscle length, functional strength, fitness
and confidence.
Intellectual disabilities
As is the case in all other developmental domains, children with intellectual
disability acquire motor skills more slowly than average and take longer to
generalise motor skills learned in one context to another slightly different situ-
ation. When intellectual disability is the sole cause of their motor developmental
delay, the children commonly have low muscle tone and poorly developed
postural adjustments and balance reactions. This leads to difficulty with control
of movement against gravity, distrust of situations that challenge their balance,
and assumption of a wide-based stance. Low tone in facial muscles can lead to
eating, drinking and speech difficulties.
Children with intellectual disability often have trouble initiating functional
movement, but can complete a familiar movement sequence if it is begun for
them. Motor planning, especially in novel situations, is weak. Arousal levels (see
chapter 7) and motivation strongly affect their rate of learning. Behavioural tech-
niques can assist (see chapter 12).
One category of children with an intellectual disability are those who have
Down syndrome (see Appendix I). In terms of the effect of this syndrome on
motor learning, these children’s low muscle tone, lax ligaments and sensory
difficulties affect their control of posture and movement. Infants with Down
syndrome are often tactile-sensitive on the soles of their feet and dislike weight-
bearing in standing. (See chapter 7 for sensory preparation techniques.)
Of those individuals with Down syndrome, 14–20% have atlantoaxial insta-
bility. This is excessive movement between the top two vertebrae of the neck,
associated with lax ligaments. This may cause no symptoms and go undetected,
but children with identified instability should avoid contact sports, diving, or any
activity likely to put strain on the neck such as somersaults or strenuous tram-
polining. In extreme cases surgery can be necessary to relieve pressure on the
spinal cord. If in doubt, refer the children’s parents to their paediatrician or local
Down Syndrome Society.
Toe-walking
When typically developing infants first learn to walk or when toddlers are
carrying an object, they can walk on their toes for a time (Van Sant & Goldberg
1999). When it is the only unusual feature in a child’s movement, it can resolve
itself in time. However, all persistent toe-walking warrants careful assessment,
as it can lead to shortening of the Achilles tendons and weakness of calf

muscles.
In children with sensory processing problems (e.g. in DCD, mild cerebral
palsy or the autism spectrum disorders), toe-walking may occur in association
with other ‘soft neurological signs’, including unwanted background movement
such as upper limb flexion or mouth-opening accompanying strong effort or
emotion. In that case, tendon and muscle stretches and sometimes orthotics or
therapeutic taping may be useful.
Toe-walking can also occur in a more sinister condition affecting boys,
called Duchenne muscular dystrophy (DMD) (see Appendix I). Three-year-olds
with DMD typically will walk with a waddling, high-stepping gait, up on their
toes, with a pronounced ‘sway back’. They may appear to have excessive bulk in
some muscle groups around the hips, thighs and calves (pseudohypertrophy). If
the children are still walking they may show a positive Gower’s sign: that is,
when asked to stand up from sitting or kneeling on the floor without using props
to lean on, they tend to ‘walk their hands’ up their thighs to assist their hips to
straighten. Some resort to Gower’s manoeuvre only when tired, so observe them
after strenuous play. A firm diagnosis of Duchenne’s muscular dystrophy
requires a full medical work-up including history, muscle biopsy and blood
tests. Discussion with a physiotherapist can help you determine whether to
suggest that parents seek such an assessment. Subsequent management of the
toe-walking will occur as part of programming for the children’s overall neuro-
muscular difficulties.
Limps
Although children will limp briefly when they have hurt their leg or foot, per-
sistent limps can be caused by a variety of factors, including muscular imbalance
or coordination problems, as in cerebral palsy or developmental coordination
disorder; leg length discrepancies; disease or malalignment of any lower limb
joint; trauma; hairline fractures; soft tissue damage; low back injury; and even
bone cancer (although this is rare). Any painful limp that persists for more than
two days and cannot be explained by a minor local injury should be investigated,
initially by the family’s general practitioner.
Giftedness
Children with advanced learning capabilities often acquire motor skills early—
particularly skills that require cognitive control such as balance, compared with
skills that rely only on strength or endurance (Roedell et al. 1980). They can
generally learn new physical movements with ease (Moltzen 1996), can locate
themselves readily in the environment, and have superior coordination, environ-
mental perception and planning skills (Porter 1999).
On the other hand, some gifted children take little interest in physical activity.
Instead some prefer literacy-based activities; some consider the unsophisticated
MOTOR SKILLS 105
active play of their age mates trivial or dislike its boisterous or competitive
element; some shun physical activity because, compared with their extremely
advanced intellectual skills, they feel relatively incapable in the physical arena
(Porter, pers. comm.). These children can be at risk of reduced physical fitness,
while a lack of practice of motor skills can lead to declining proficiency over time.
In my clinical experience, a very small subgroup of gifted children can also have
developmental coordination disorder. Even as preschoolers these children are
acutely aware of their lack of physical prowess and are adroit at avoiding physical
activity.
To overcome these children’s avoidance of physical activity, you can encour-
age them into activities that have a high intellectual component, such as active
dramatic play where they can develop their own rules. (This is less likely to be
successful, however, if they have no playmates at their own intellectual level with
whom to share such play.) Parents can also be alerted to extracurricular activities
such as gymnastics, while in the school years sports such as orienteering, archery
and horse riding can appeal to these children’s intellect at the same time as
offering physical exercise. Teaching children responsibility for their own health
and fitness, perhaps using children’s health websites to set up their own fitness
program, can empower and motivate these children to be more physically active.
TRENDS IN THE DEVELOPMENT OF MOVEMENT

CONTROL
Within a population of able-bodied children with optimal development, large

variations exist in the rate and order at which they learn new motor skills
(Shepherd 1995). Even individual children do not learn these skills at the same
steady pace throughout childhood: at times they may consolidate rather than
acquire new skills or even regress temporarily while they are acquiring new
abilities in other domains (Alexander et al. 1993). Nevertheless, the following
are recognised trends in children’s development of movement control (see also
Appendix II). Children with atypical development may acquire some of these
key components of movement control but imperfectly, or in a different develop-
mental sequence. This has implications for programming, as listed in Box 6.3.
Stability and mobility, and antigravity control

Efficient movement control requires body orientation (involving a dynamic inter-
play between stabilising a body part and moving it), and manipulation of objects
(Gentile 1987). This ever-changing interplay involves a constant controlled
response to gravity—either bracing a body part against its effect, or moving
against gravity.
Three-dimensional control, weight shift and rotational elements

Infants and young children must learn to control movement in three dimensions
relative to their long body axis. This includes learning to control weight shift in
Box 6.3 Principles of programming for motor learning

• Young children with low levels of motivation or arousal associated with pro-
longed illness, significant intellectual disability or sensory deficit will be at
risk of delayed development of motor skills. Providing these children with an
environment conducive to optimal arousal levels (see chapter 7) and oppor-
tunities to explore and practise pleasurable, active, goal-oriented
movement (Bower et al. 1996) will help motivate motor learning.
• In order to achieve their potential for motor learning, children with sensory
deficits will need programming that includes sensory enhancement or
assists them to compensate with their stronger senses (Freeman 1993).
• Because motor learning is task- and context-specific (Shepherd 1995),
infants and young children need many opportunities to practise similar-but-
slightly-different motor tasks, to assist them to generalise skills to other
contexts. For example, a new walker could be encouraged to walk on level
floors at first, then on floors with different surface texture, then on rugs, in
the sandpit, on grass, pavement and on gentle slopes.
all directions, and to twist one body segment on another, as in crawling or

running.
Reduction of unwanted background movement

Young infants’ actions are characterised by mass, poorly scaled movement.
As control develops throughout early childhood, only the body part directly
involved with the action moves, and other joints are held stable (Wolff et al.
1983). Refined, precise movement gradually becomes possible.
Sequencing and scaling of muscle activity

As superfluous background movement is progressively reduced, infants and
young children become more adept at ordering the sequence in which teams of
muscles will act (often across several joints at once), and the force and duration
of that muscle activity. With practice these muscle synergies become increas-
ingly automatic.
Muscle length
Because of restricted space for movement in the last two months prior to birth,
full-term infants are born with shorter flexor muscles (those mainly in the front
of the neck, trunk and limbs which bend the body part forwards) and longer
extensors (muscles mainly on the back of the body which straighten the trunk or
limb). One of the byproducts of early motor learning is to balance muscle length
around joints to permit efficient control of movement.
Postural control or balance

These terms refer to individuals’ ability to make rapid and subtle postural adjust-
ments in order to maintain or realign their body’s centre of mass over their base
MOTOR SKILLS 107
of support (Horak 1987). For balance, we need sensory input signalling a threat
to our equilibrium, and motor output to respond to that threat. Sensory input for
balance (some operating in both feedback and feedforward modes) comprises:
• vision—both structural aspects of the visual system and efficiency of eye
movements. This sense is the most dominant, especially in infants and
preschoolers;
• proprioception (or somatosensation in US terms), which contributes infor-
mation about joint position and muscle tension and becomes useful from
around 3 years of age (Foudriat et al. 1993);
• the vestibular sense in the inner ear, which matures later and, from around
7 years of age, can assist individuals to resolve situations of sensory confu-
sion about balance (Shumway-Cook & Woollacott 1985).
Motor output for balance involves activating teams of muscles in the right order
and at the right force to adjust our posture effectively. Children with difficulties
sequencing and scaling muscle activity will lack precision in the postural adjust-
ments required for balance (Shumway-Cook & Woollacott 2001). There is a
large learning component to this process, beginning in infancy, superimposed on
developmental and maturational changes to the nervous and musculoskeletal
systems.
As well as maturation and experience of locomotion and physical activity,
for efficient postural control we need reasonably normal muscle tone and
strength and adequate range of joint movement. Children with stiff ankles (e.g.
as caused by juvenile chronic arthritis or mild cerebral palsy) may maintain
standing balance by making compensatory movements around hip level. If that
fails, they may take a step to reposition their base of support, rather than relying
on their limited ankle movement. Considering all these sensory input and motor
output factors, it becomes evident that there are many potential ways to assist the
balance difficulties of preschoolers.
PROMOTING MOTOR LEARNING
To assist children’s motor learning, the aim is to enable them to perform goal-
directed movement (e.g. when infants reach for and grasp a toy or when toddlers
climb onto their parent’s lap for a hug). If children are not achieving this or if
their movement is inefficient, practitioners will analyse the component skills
(sensory and motor) that are weak or missing in the children’s performance and
train these aspects specifically in programming. In so doing, it is crucial that the
activities given to assist children’s motor learning are purposeful and appealing.
Sensory preparation may sometimes have to begin a movement lesson.
Once children have partial mastery of the component skills and the goal-
directed movement, the next step is to help them generalise skills to
similar-but-slightly-different contexts, with less and less direct assistance from
adults. In this way, children can develop an expanding repertoire of sensorimotor
skills, which they can adapt and modify to solve new movement challenges. By
this process they learn confidence and enjoyment of physical activity.
Suggestions for promoting motor development in infants or toddlers who are
not yet walking are readily available elsewhere but it is important to highlight five
issues here. First, children need to experience the world from different heights and
angles so those with physical disabilities will need opportunities to play at floor
level as well as from their wheelchair or standing frame, so that they can see the
world from different perspectives (Nixon & Gould 1999). There are also musculo-
skeletal, physiological and social reasons for these children to experience a
variety of play positions, including assisted standing, each day. A second issue is
that when young children require you to help them move about in their castor cart
or wheelchair, it must be borne in mind that infants and toddlers typically pause
to inspect what they discover in transit. Therefore, your speed of pushing will
sometimes need to mirror this slow pace so that children with physical disabilities
have similar opportunities for exploration. Third, children who cannot move about
independently will need systematic assistance to move from one activity to
another so that they are not stranded at an activity that they have completed.
Fourth, children who cannot move independently will need active assistance to
become involved in physical play. Finally, in all instances when you are lifting or
moving children, you will need to avoid injury to yourself and them by practising
safe handling techniques. For detailed guidance about these issues for individual
infants and children, you will need to consult with their visiting allied health pro-
fessional. (See also Additional resources.)
The remainder of this chapter concentrates on strategies to promote fitness
and gross motor skill development for preschoolers who are walking independ-
ently but experiencing some difficulties of motor learning or performance. As
no two children have the same mix of abilities and disabilities, the following
programming suggestions cannot be applied in a recipe-like fashion but call for
improvisation and adjustment, according to how the children respond.
If you have any worries about children’s safety while engaging in physical
activity—such as when children have asthma or other cardiorespiratory
problems, or the neck instability sometimes associated with Down syndrome—
you should consult their parents and, with permission, their medical practitioner
or allied health professional for advice. (See also Additional resources.)
Weight shift and weight-bearing

Weight-bearing is a powerful sensory stimulation, and improved weight shift
is necessary for improved gait and running and to enable children to change
positions. For infants with hemiplegia, many techniques of handling, lifting and
carrying have been devised to promote weight-bearing through the affected
side (see Additional resources). Toddlers and preschoolers can be motivated to
practise weight shift on and off the affected leg by moving or marching to music
and action songs. Walking up and down stairs and climbing also teach children
to weight-bear through both sides alternately.
MOTOR SKILLS 109
To improve upper body weight shift and weight-bearing in children with

hemiplegia, DCD, intellectual disabilities or sensory processing difficulties, any
functional activity involving pushing through two hands or leaning through an
affected hand achieves weight-bearing through the palm. Examples include
rolling a big barrel, propping on an affected or neglected hand while side-sitting
on the floor for story time, or leaning on both hands while climbing over a bolster.
Reduction of unwanted background movement

Unwanted background movement sometimes results when children with cerebral
palsy or DCD attempt a task that proves too difficult. They might draw their legs
together, stand on their toes, have unusual arm posturing or jaw opening or, like
any children, simply become irritable with tiredness. If this happens, try sim-
plifying the task: giving the children a rest, or alternating between sitting and
standing activities. You could also modify their position in relation to equipment:
for example, children with hemiplegia will have less unusual arm posturing if
you move their toys or work from the side to midline, or encourage them to grasp
the edge of their book or table with the affected hand. For older preschoolers,
gentle verbal or physical prompts (e.g. to close their mouths or swing their arms)
can teach them to self-regulate unwanted background movement. If these strat-
egies do not work, seek a physiotherapist’s advice.
Sequencing and scaling of muscle activity

Poor coordination can lead to children’s using muscle groups in the wrong order
or at incorrect force. This can cause jumping that looks and sounds heavy, with
poor shock absorption, endurance and rhythm. Climbing, balance and ball skills
can also lack finesse and children may be impulsive and unsafe. Sequencing and
scaling of muscle activity is one skill component that is fostered by the play-
ground games mentioned later in this chapter.
Moving one body part independently of another

Children with diplegia have trouble moving one lower limb independently of
the other and have poor control of rotation around their long body axis. For these
and other children, games to assist their development of movement control
include:
• climbing;
• stomping;
• using giant strides;
• kicking;
• ‘twister’ game or similar, involving working out how to place hands, feet,
elbows or knees on different-coloured circles on a floor mat;
• reaching around behind in sitting or standing, as in two-handed batting with
a baton at a suspended ball, or reaching around to pass a ball to the child

behind in a file;
• ‘animal walks’ on their knees;
• action songs involving asymmetrical movements of limbs and body rotation;
• marching and stepping through a horizontal ladder (either flat on the ground
or raised to thigh height);
• bike riding.
Balancing muscle length and strength

Premature infants are born with less of the physiological flexion of full-term
infants, and often need extra help to learn control of their flexor muscles. Posi-
tioning them in ‘nests’ or hammocks and special techniques of handling, carrying
and dressing them can also promote the balanced use of flexors and extensors for
head and trunk control and reaching (Creger 1995).
In children with cerebral palsy, DCD or intellectual disability, certain muscle
groups can become short because of postural habit and persistent imbalance of
muscle strength. Weight-bearing through the palm, crawling through tunnels, and
rolling out playdough with the palms are all useful muscle-stretching activities for
the upper limbs. Climbing and squatting to play can help active lengthening of
tight hip, calf and foot muscles. Meanwhile, children with diplegia can also take
part in ‘twist-and-turn’ games to elongate tight trunk muscles.
For toddlers with persistent toe-walking, parents or carers can perform manual
calf stretches and encourage the children to squat to play, while older preschoolers
can be taught a simple form of the jogger’s wall stretch (see Figure 6.3). In more
severe cases, serial casting is required. This can produce gains lasting five months
or longer (Cusick 1990), and can be repeated at intervals throughout the children’s
growth years. Other management options include orthotics, drug therapy (muscle
relaxants), therapeutic taping to re-educate children via sensory feedback about the
new position of their ankle to achieve heelstrike, and orthopaedic surgery later in
childhood to lengthen the Achilles tendon or calf muscles.
PLAYGROUND GAMES THAT FOSTER MOTOR LEARNING
The playground is a natural setting in which to help children achieve goal-

directed movement, as in this environment children naturally want to participate
in games that involve climbing, balancing, jumping, hopping, running or using
balls, and so are inherently motivated to learn the motor skills that will assist
their lifelong participation in physical activity. As well as enabling expertise in
the preschool playground, these motor skills are necessary for sport and dance.
When teaching component skills, it can help to work with children in small
groups, so that no one child feels singled out. Also, it makes sense to modify how
you use your present equipment, so that activities are novel without requiring a
huge financial outlay for customised materials.
MOTOR SKILLS 111
The instruction during a stretching activity such as the one illustrated here could
be: ‘Keep your feet pointing forward. Lean forward and keep your heels on the
ground. Can you feel that “comfy stretch” and count to twenty? No bouncing!’
...feel the muscle

stretching here—
a comfortable stretch...
not an OUCH!
Figure 6.3 Preschoolers’ version of a jogger’s wall stretch
Source: Rang (1993:15).
Climbing games
Climbing gives children improved access to their environment and has an impor-
tant role in their musculoskeletal development: it can improve their strength,
motor planning, aerobic fitness, and control of movement involving rotation of
one body segment on another. As well, it teaches them to shift their weight in
various directions without falling and enables them to learn visuospatial rela-
tionships—that is, how much space their body requires to negotiate obstacles.
Thus, teaching horizontal or vertical climbing can be particularly beneficial
for children with weak muscles (e.g. those with cerebral palsy) and for those
with shortened muscle groups or immature lower limb bony alignment (e.g.
children who are ‘pigeon-toed’ beyond the age of 4 years). Whenever climbing
raises one knee past waist level, it causes rotation outwards of the raised leg. The
muscles that cause this outward rotation exert a cranking-out effect on the lower
limb bones and so with repetition may help to realign the limbs (Cusick 1990).
This is possible in young children as their bones are softer than those of adults.
While playing games such as follow-the-leader, animal walks or completing
an obstacle course, you can encourage horizontal climbing by having the child-
ren crawl over floor cushions, through tunnels or portholes, under or over rungs
of a climbing frame or in and out of supermarket cartons (turning hands and
body for descent; see next section). If necessary, offer extra help in the form of
manual or verbal prompts to duck their head, shift their weight, lean on their
palms not the backs of hands, and so on.
Vertical climbing can be up and down stairs or the ladder to a play fort or a
toddler’s slide, or on and off a rocking horse. From 4 years of age, you can help
children to descend a platform above waist height (e.g. trampoline, play fort)
using the following sequence: sit on edge, turn onto stomach, push back with
arms, feel with feet for rungs or the ground.
From 4 years of age, children can climb over a climbing trestle, turning to
face the equipment to descend. For children with motor planning or proprio-
ceptive problems, it helps to teach each stage of the trestle sequence separately.
For example, a simple rhythm of ‘hand, hand, foot, foot’ with verbal and manual
prompts can assist practice of limb placement for the ascent, reversing this order
for descent. Once this is established, show children how to swing one leg over
the top bar and turn to descend. Children with poor coordination or safety sense
may need to ‘sit on the bar, stop and think’. They should then ‘turn and swap’
their hands, thus initiating upper body rotation towards the trestle, then ‘keep
holding on, and stand up’. Help them to swing the trailing leg over the top bar,
then use that foot to ‘find the bar’ below to begin the descent.
For a strong handgrip, encourage preschoolers to wrap their thumbs around
each rung, to meet their fingertips ‘like a bird on a perch’. For children who are
afraid of heights, let them practise the ‘turn to descend’ while one foot remains
on the ground, perhaps climbing into a large supermarket carton, or over a low
fence.
Balance games
As discussed earlier, balance or postural adjustments accompany and under-
pin all movement. Young children can have poor balance or postural control for
one or a combination of reasons, and you may need to consult a paediatric
physiotherapist to work out where individual children’s main problem lies.
Nevertheless, there are many preschool games that you can use to help develop
postural control on a broad front, particularly the ability to shift weight for
single-leg stance activities, and the ability to make rapid postural adjustments
‘on the run’. Because balance accompanies all movement, children need to
practise their balance skills in a wide variety of task settings and under various
sensory conditions—for example with shoes on and off, indoors and outdoors,
and on the various types of terrain they are likely to meet in their everyday life.
To promote weight shift and single-leg stance, the following activities can be
useful:
• Kicking a ball softly.
• Marching to music, emphasising lifting knees.
• Simon says: ‘Stand on one leg and count to three.’
• Taking giant steps from island to island (hoops or paper circles).
• Stepping over shin-high bars without hand support in an obstacle course.
MOTOR SKILLS 113
• ‘Stomping’ toys and games (e.g. a foot catapult which throws beanbags for
the children to catch, or stomping on bubble wrap).
• Swaying activities in sitting, quadruped or standing on a trampoline (one
child at a time). You can stimulate the sway by gently applying pressure to
the trampoline mat, in various directions. The children can then sway them-
selves from foot to foot, being an elephant swinging its trunk.
• Side-stepping along a line, or between the rungs of a ladder laid flat on the
ground.
• Using low cup-type stilts.
To promote rapid postural adjustments ‘on the run’, you could encourage
the following activities either in the playground or during indoor music and
movement times:
• Walking, running or completing rapid turns on slopes and uneven terrain.
• Playing a ‘traffic game’, in which the children are cars that have to stop and
start rapidly on your traffic officer’s signal. Begin on level ground, then
progress to a gentle slope. A variation is ‘freeze’ on a verbal or musical
signal.
• Retrieving and returning a rolling ball without falling.
• Walking along a line, beam, or the brick edge of a garden bed. From 4 years
of age, try heel-to-toe walking (Burns 1992).
• Ball catching and throwing (seated or standing).
• Moving to music, later simple folk dance.
Jumping, hopping and running games

Jumping requires, and in turn promotes, children’s motor planning, visuospatial
perception and proprioceptive awareness. It also assists their ability to coordinate
in space and time their upper and lower body and left and right sides; and turning
muscles from hip to foot on and off quickly and repeatedly, in the correct order
and strength. It requires functional joint range and improves children’s propul-
sive strength and endurance, which in turn may assist running—and vice versa.
Soon after they learn to stand with support, infants enjoy bouncing (soften-
ing then straightening their knees) as a repetitive activity. Toddlers love to squat
to play. These activities are important for learning about switching from
controlled lowering (shock absorption, preparation) to controlled push-off
(propulsion), as preparation for jumping. Children with poor coordination may
have missed these stages. Thus, to encourage bouncing, you can use a mini-
trampoline or mattress, have the children complete five bounces and stop,
showing them how to bend their knees to stop (‘like riding a motor-bike’). You
can gradually progress from bouncing to assisted jumping. (An adult’s foot may
add rebound on a mini-trampoline.)
From the age of 3 years, children can practise controlled lowering and
push-off with activities such as squatting then jumping like a frog, or kangaroo
jumps forward with feet taking off and landing simultaneously. They can jump
off a low step (at ankle then knee height), with help from you if necessary by
drawing their hands forward. Walking on tiptoes and running improve the
propulsive strength needed to jump. Preschoolers benefit from opportunities to
run free on open ground with safe boundaries. From 3 or 4 years, children can
attempt hopping, although many 4-year-olds cannot hop (Shumway-Cook &
Woollacott 2001). Pushing down with their hands on a waist-high bench while
hopping may assist.
From 5 years of age, children can be challenged to jump zig-zag along a line,
sideways, or backwards. Many children of this age can be taught to use the balls
of their feet to help them in landing, although for some, this may require specific
training from a paediatric physiotherapist.
A useful strategy is to involve the children in jumping, hopping or tiptoe
relays (preferably not a race) in which three children move as a team together.
This avoids spotlighting individual children with difficulties.
Ball games
Basic proficiency with kicking, throwing and catching a ball is a great advantage
to children beginning school, as much of the socialisation that occurs in school
playgrounds involves ball games. Ball games advance children’s:
• eye–hand coordination;
• visual attention and pursuit;
• coordinated use of both sides of their bodies;
• ability to cross their body midline;
• strength, endurance and cardiovascular fitness;
• ability to stop and start quickly;
• rapid postural adjustments while manipulating or chasing the ball;
• rhythm and timing;
• group interaction.
This list implies that there are many possible reasons why young children might
be weak at ball skills. If children over 4 years of age have persistent problems
with ball-catch despite interest in and experience with the game, arrange for their
vision to be checked and look at these other potential sources of their difficulties,
including some of the physical disabilities already discussed.
Great variation exists in the sequence of ball skill development. For instance,
preschoolers with coordination difficulties may be at a 4-year level with kick, but
at a 2-year level with catch. Start at the children’s current functional level and
move them on in the general sequence that follows.
Catching
• Roll and stop. Start with a 20–24 cm ball. From the age of 2 years, sit on
the ground with your legs in a ‘V’, facing the child, and roll the ball back
and forwards between you. From 3 years, emphasise pushing through open
palms, with wrists cocked up. (This relates to pre-writing skills.)
MOTOR SKILLS 115
• Two-handed catch. For 3-year-olds or reluctant older children, toss a beach

ball, in midline, from 1–2 metres away. Progress to a firmer 20–24 cm ball. Ini-
tially, the children will scoop the ball to their chest, with unreliable eye-follow,
and from 4 years can trap the ball in their forearms or hands (Burns 1992).
• Clap-catch. From 4 years, teach children to ‘catch like a clap’ to encourage
eyes and hands to ball.
• Hanging ball in a net. From 3 years of age, suspend a 20 cm ball in a net
at their waist height, asking them to catch it as it swings. This is useful for
reluctant children or those with poor eye-follow. Older preschoolers could
bat the ball with a baton held two-handed, with wrists cocked up.
• Catching away from or above midline. From 5–6 years, children can learn
to catch a 20 cm ball tossed in line with their shoulder. The next stage is to
step to the side to catch, learning weight shift first, then adding catching.
Using a mitt to catch, and catching above their heads, are generally left until
school age.
Kicking
Infants enjoy crawling or running after a rolling ball and running into it in an
attempt to kick. Use a soft beach ball initially or have them chase balloons. Teach
youngsters who have poor balance or are impulsive to ‘kick softly’. If 4-year-
olds display excessive ‘pigeon-toeing’, show them how to contact the ball
with the inside edge of their foot, as in a ‘soccer pass’. From 4 years, teach leg
backswing.
Propulsion (toss, throw, bounce)

Begin with teaching an underarm toss two-handed, as this improves aim.
Children at this stage can also learn to bounce a large ball between themselves
and an adult then catch two-handed, and later bounce the ball in front of their
own feet at hip level and catch.
For 4-year-olds or those seeking more challenge, proceed to a chest pass or
two-handed overhand throw. Show the children how to position their elbows
‘like chicken wings’, with fingers cupped loosely around the ball. Have them
throw at a wall initially. Balloon volleyball can be played with a net improvised
from rope and paper streamers. Teach the children to throw the balloon straight
upwards, then reach up and bat it forwards to the child across the net, using both
hands initially. Another useful activity involves tossing small beanbags underarm
into hoops. Demonstrate a palm-forward position of the tossing arm, and hand-
opening for release. You can also try various-textured balls.
CONCLUSION
In this chapter, the focus has been on the more subtle problems in movement
control or avoidance of physical activity seen in preschoolers who are walking.
Because some sensory and movement difficulties are common across a range of
childhood conditions, many inclusive programming ideas can be modified to suit

various children. Nevertheless, the complexity of sensorimotor development
means that it is important to consult specialist allied health professionals if addi-
tional programming ideas are needed.
Box, J. and Lancaster, A. 1997 From cuddles to coordination Royal Blind

Society, Sydney
Finnie, N. 1997 Handling the young cerebral palsied child at home 3rd edn,
Butterworth-Heinemann, Oxford, UK
Klein, M.D. and Morris, S.E. 2000 Pre-feeding skills 2nd edn, Therapy Skill
Builders, Tucson, AZ
For information on other neurological or orthopaedic conditions, and orthotics

and mobility aids for children using wheelchairs, see:
Burns, Y. and MacDonald, J. (eds) 1996 Physiotherapy and the growing child
Saunders, London
Eckersley, P.M. (ed.) 1993 Elements of paediatric physiotherapy Churchill
Livingstone, Edinburgh
7
DAILY LIVING SKILLS
ZARA SODEN
KEY POINTS
• To perform everyday tasks, young children need to be able to organise the

information that they receive through their senses, use their hands effec-
tively, and perform basic self-care functions.
• Efficient hand use requires object grasp and release, grasp strength,
manipulation skills, tool (pencil and scissor) grip, use of two hands
together and established hand dominance.
• Self-care activities that are relevant for young children include dressing,
toilet learning, basic grooming and hygiene measures, and self-feeding.
• We can enhance children’s success in these areas through carefully
selected and directed activities and through influencing the environment.
• To assist children who are experiencing difficulties in basic play, pencil
and scissor work and self-help skills, it is essential to understand the role
of sensory processing in enabling them to attend, perform and self-correct
in order to achieve.
INTRODUCTION
To perform the tasks that are typical of their age, young children need to be able
to organise the information that they are receiving through their senses, use their
hands to carry out activities, and begin to take care of their physical needs. These
three areas are the typical domain of an occupational therapist and are the subject
of this chapter. Naturally, success in each of these areas rests on the successful
functioning of numerous other systems such as the visual and auditory senses
and motor skills (see chapters 5, 6 and 8). Furthermore, each is complex and can
be described only in overview in a text such as this; consultation with an occu-
pational therapist might be useful if a child in your care is experiencing
difficulties beyond those covered here.
117
SENSORY SKILLS
Young children learn about themselves through their senses. We are all familiar
with the five basic senses of touch, taste, smell, vision and hearing. Of these,
problems with seeing and hearing are the best recognised and understood (see
chapters 5 and 8). Less well understood is how children process and interpret
information from the other senses—known as ‘near-body’ senses because they
give us direct information about our bodies and what is happening to them.
These lesser-known senses comprise the three systems of touch, the vestibu-
lar (or movement) sense, and the proprioceptive or body position sense. These
last two are sometimes referred to as the combined vestibular-proprioceptive
sense because they work so closely together.
• Tactile (touch) receptors are located in the skin. The touch system is the first
part of the nervous system to begin functioning in utero and is the most
mature of the sensory systems at birth. Of any organ of the body, the skin
sends the most sensory information to the brain. It comprises two subsystems:
the protective system that warns of danger (the ‘flight’ or ‘fight’ response);
and the discriminative system that gives information about the properties of
objects so that children can recognise objects by feel. The discriminative
system develops more slowly and can override the protective system.
• Vestibular (or movement) receptors are located in our inner ear. From
these we receive information about how we are moving, the effect of gravity
on our bodies, and the position of our head in relation to the horizon.
Vestibular information helps us to regulate muscle tone so that we can
maintain posture, and coordinates with our visual system to allow us to
control eye and head movement.
• Proprioceptive receptors are located in our muscles and joints. These
receptors allow children to know where their body is in space and to perform
tasks automatically without looking. This takes some years to develop: most
under-4-year-olds, for instance, find it difficult to maintain standing balance
with their eyes closed, indicating that they are still relying on vision to
regulate their body position.
SENSORY PROCESSING
For infants and children to function effectively, information from the three near-
body senses must be integrated well together and with visual and auditory input.
Information from all these sources must be registered, sorted, combined and
related to past experiences. Doing so keeps children alert, safe and responding
correctly to their environment (Steer 1999). With successful sensory integration,
infants can develop eye movement (tracking), posture, balance, muscle tone,
gravitational security (so that they are comfortable with movement), sucking,
eating, and a sense of tactile comfort which can promote parent–child bonding
DAILY LIVING SKILLS 119
and attachment (Ayres 1981). These are all necessary foundation skills to
promote learning.
As illustrated in Figure 7.1, to achieve successful integration of sensory
input, children need to be able to moderate two processes: their level of arousal
or alertness, and their information processing. Although in reality these two
aspects occur almost simultaneously, to assist with conceptualising them they are
illustrated separately in Figure 7.1 and discussed individually here.
Alertness
Most children in a group can be calm when required, such as when listening to
a story or settling to their afternoon nap. Others seem to function in ‘overdrive’
and have great difficulty settling. These children are often in constant motion, yet
their activity levels seem to lack purpose, they might jiggle or rock constantly
during quiet activities such as group story time, flit from activity to activity so
often that it interferes with their play (Dunn & Westman 1997), need extensive
help to get to sleep, or seem to become anxious or stressed with little reason.
These problems can be exacerbated in summer, when the children are sleeping
under light covers, thus depriving them of the deep pressure of heavier bedding
that can help to settle them as they sleep.
Conversely, some children seem too calm or appear tired or disengaged even
when they have sufficient sleep. These youngsters might spend long periods in
sedentary activities, appear not to be tuned in to what is going on around them,
or are distracted by extraneous sights or sounds even during activities that you
would expect to hold their interest.
Children’s level of alertness is dynamic and so will vary throughout the day;
difficulties arise only when their alertness levels are not suitable for the activity at
hand. When these overactive or underactive behaviours occur often, they will inter-
fere with the children’s ability to engage in developmentally appropriate activities.
Although it can appear that these children are being disruptive, disengaged or have
behavioural difficulties, these patterns may be due to poor regulation of their state
of alertness. This means that the children themselves are not able to organise auto-
matically the sensory information that they are receiving. Because of this, they
require adults to structure their sensory experiences for them so that it is easier to
organise their bodies and achieve a state of calm alertness.
Those who are underaroused can require alerting activities that offer a high
level of stimulation, while those who are overwhelmed or overaroused can benefit
from activities that help them to calm. Both measures can help children achieve
optimal attention and alertness, thus assisting them to learn (Levine 1998)—see
Box 7.1.
An important sensory integration principle is that activities work best if they
are directed by the children themselves. When children enjoy the experiences and
are active in directing these, there is more potential to improve their brain organ-
isation and so to make them more successful in their interactions with their world.
A second key principle is that trial and careful observation are required to ensure
Age-appropriate attention Appropriate response to demands
and concentration span Organisation Successful
Flexibity to adjust Self-control
integration
arousal to suit the Accurate perception
type of activity Planned, controlled movement
Brain stem structures,

including Limbic system
and Reticular formation
SENSORY AROUSAL/ SENSORY OUTPUT

INPUT STATE OF PROCESSING
ALERTNESS
Experience
Emotional state
Too-high state of alertness Overreactions

• Purposeless motion • Tactile defensiveness
• Distractability • Gravitational insecurity
• Miss critical features of tasks Underreactions Poor
Too-low state of alertness • Poor tactile discrimination
integration
• Lack of responsivity • Purposeless movement
• Disengagement • Poor location of self in space
• Distracted by external
sights and sounds
Figure 7.1 Sequence of sensory processing

that the activities are enjoyable and of benefit to the children. The amount of extra
stimulation needed, its frequency, intensity and duration, will vary from child to
child and for the same child over time. As the children’s level of alertness
improves and they are better able to participate in activities, their intrinsic moti-
vation for the task will help reduce their need for additional sensory stimulation.
Sensory integration
Normally we receive so much sensory information all at once that we are unable
to pay attention to it all effectively. Consequently, we are forced to select out
some of it and focus only on what is important for us to function well. This selec-
tion process is called sensory modulation (Spitzer et al. 1996). When children’s
sensory systems appear not to be able to recognise and effectively screen
incoming sensory input, it can lead to what might simply be viewed as under- or
overreactions to sensory input (the latter being termed ‘sensory defensiveness’)
(Wilbarger & Wilbarger 1991).
These over- and underreactions can occur in any sensory modality and are
manifested by various unusual behaviours (see Figure 7.1) which, we can assume,
are an attempt by the children to organise and control the currently confusing
sensory input they are receiving. Although the resulting behaviours can seem
unusual, these have a physical basis and an adaptive function that reflect the
children’s efforts to meet their atypical sensory needs, or are simply an emotional
outburst in reaction to the distress caused by their unreliable nervous system.
Dysfunctional reactions to touch

You might observe that children who overreact to touch avoid hugs except on
their own terms; become disturbed by the feel of new clothing or rough textures;
are upset when touched unexpectedly, particularly by other children; avoid
messy activities such as playdough, sand, paint or glue; take extraordinary care
not to spill food on their face while eating; restrict themselves to particular food
textures; avoid having bare feet (or, conversely, are irritated by the feel of shoes
and socks); seem to require a larger than usual personal space; and are hesitant
around splashing water. These children are sometimes referred to as being
‘tactile defensive’, suggestions for assisting whom are given in Box 7.2. Subse-
quently, their avoidance of touch is likely to have led to impoverished experience
of exploratory play with their hands, so they can also require additional practice
at hand skills (see later in this chapter).
Meanwhile, some children underreact to touch. They might continually touch
objects, certain surfaces, textures or other people to the point of irritating others;
mouth objects beyond the usual age; show decreased awareness of pain or tempera-
ture; and be less aware of their clothing, perhaps leaving their clothes twisted
on their body when other children would notice that these needed adjusting. Activ-
ities to assist these children aim to enhance the touch input that they receive so that
they notice it more. If this can be done within a natural activity, it will prove most
meaningful to the children. Some strategies are included in Box 7.2.
Box 7.1 Activities to help children modulate their alertness

At various times, individual children might need a mixture of both alerting and
calming activities. Some of these require direct, hands-on assistance; others
comprise indirect ways of influencing the sensory environment.
Alerting activities
• Prior to commencing a task requiring more concentration, provide linear
movement with faster tempo, including stops and starts (e.g. giving
children a swing, jumping together on a trampoline, or rocking in a rocking
chair).
• Give the children a small ‘feely’ fidget item (e.g. putty or a ‘stress’ ball) to
hold during group time to aid sitting in the one spot.
• Give ice cubes or ice chips to crunch or snacks of crunchy and/or spicy
food (e.g. celery sticks, soya crisps).
• Use a focused light source such as a torchlight on an object on which you
wish the child to focus.
Calming activities
Clues about suitable calming experiences come from noting what sensory
activities help to calm young babies and adjusting these to make them
appropriate to individual children’s ages. Another clue to what might calm
children is to look at what input they seem to be seeking. For example, some
children like to squeeze into small gaps behind a sofa or a cupboard
(suggesting that they are seeking deep pressure), to rock when stressed
(indicating a need for rhythmic movement), or hum with their hands over their
ears (which can mean that they need quiet, blocking noise). The soothing
activities include:
• using rhythmic movement through rocking the child in your arms, a pusher,
hammock, or rocking chair; or jumping on a trampoline—at first quickly and
then more slowly to prepare for a quiet activity;
• giving firm proprioceptive input through swaddling, patting, massage and
use of a dummy (pacifier);
• providing deep pressure input through massage or a firm hug, by having
the children lie between heavy cushions, or roll up in a blanket pretending
to be a hot dog. You can then add ‘sauce’ and ‘mustard’ by stroking firmly
down their back;
• ‘chair push-ups’: having the children raise their bottom off the chair by
pushing their hands against the sides of the chair and straightening their
arms, keeping their feet off the floor. This is useful partway through a table
task when they are becoming restless;
• giving chewy food such as bread with thick crusts or thickened drinks to
provide deep pressure to the mouth. Keep flavours mild;
• place a weighted fabric bag filled with dried beans (or similar) on the child’s
lap when sitting (such as during meals or group time).
Box 7.2 Activities to help children integrate their sense of touch

Activities for children who overreact to touch
• Start by giving deep pressure touch, as firm touch tends to override tactile
irritation. If the children do not tolerate direct touch, give firm pressure
through another surface such as via a cushion squash, crashing off a swing
into soft cushions, wearing a vest weighted with beanbags, or additional
firm towelling after swimming.
• Have children perform ‘heavy work activities’ such as pushing or pulling a
trolley or wheelbarrow filled by them with blocks or sand; cutting through
playdough with a plastic or wooden knife; pulling velcro pieces apart; riding
a bike; swimming; or jumping on a trampoline.
• Gradually introduce more tactile play experiences to develop the hands’
ability to discriminate between different textures, shapes and sizes. Keep
these activities brief initially and have a face cloth handy during messy
activities for the children to wipe their hands clean if they desire.
• Allow children to sit on the edge of groups or be last or first in lines to avoid
unnecessary jostling.
• Ensure that there are quiet corners in play areas for them to withdraw to
when they are overwhelmed.
Activities to help children who underreact to touch
• Provide tactile activities as part of daily play, such as having a large box of
dried peas with scooping and pouring utensils available, and providing
manipulative play with textured objects.
• Have a collection of different and special textures in a feely bag for the
children to feel.
• Use massage.
• Employ messy play.
• For children who mouth objects past the usual age, provide mouth stimu-
lation via using straws or blowing on whistles or other musical instruments.
Dysfunctional reactions to movement

Some children overreact to movement. This is termed gravitational insecurity
and is seen when children become anxious or distressed when their feet leave
the ground or when they are held upside down; when they avoid climbing or
jumping; avoid uneven ground; seek sedentary play; and avoid playground
equipment or moving toys. You might notice these children holding their heads
upright, even when bending over or leaning, or turning their whole body to look
at you. These behaviours are aimed at avoiding movement because the children
misinterpret vestibular feedback and so movement scares them. Some sugges-
tions to help are given in Box 7.3.
Key principles of working with these children are to respect their fear of
movement as it is real to them, to prepare them for what they are being asked to
do by explaining the activity, and to give them control over their movements by
beginning with safe movements and introducing others only as the children
become more confident. To help children feel in control give them choices, be
predictable, and use equipment they can control. Keep close to the children to
give them security.
Rather than overreacting to movement, some children underreact. They
might seek out all sorts of movement to the point that their movement levels
interfere with daily routines; rock or spin constantly; spin objects; walk on their
toes; or take movement or climbing risks that compromise their safety (Dunn
& Westman 1997). Some ways to help these children integrate their sensory
reactions to movement are given in Box 7.3.
Box 7.3 Activities to help children’s reactions to movements

Activities for children who overreact to movement
• Start with linear movement, such as jumping backwards and forwards or
swinging. This is more focusing and calming than rotational movement.
• Start with low demands and work close to the ground, such as riding on a
scooterboard or walking along a plank on the ground.
• A fun and reassuring way to broaden movement experiences is to sit on a
trampoline together, bouncing gently. The children could initially sit on your
lap.
• Time in a warm swimming pool with a capable, understanding adult can
dramatically increase the children’s ability to cope with movement experi-
ences. In water they might tolerate more movement than on land.
Activities for children who underreact to movement
Aim to help the children become calm and alert by providing large doses of
the movement they are seeking. This is particularly effective when combined
with heavy muscle work (proprioceptive input).
• Provide a range of movement experiences during the children’s day, remem-
bering that linear movement (forwards and backwards and up and down) is
the most organising. These children can probably cope with strong, fast
movement and then the tempo can gradually be reduced to a calm pace.
• Supply activities that require hanging by the arm, such as swinging from a
trapeze swing.
• Offer trampolining.
• During table activities, have the children sit on a large ball or a cushion filled
with air, to give background movement as they work.
• Encourage hobbies such as swimming or walking.
Dysfunctional proprioceptive reactions

Children cannot have too much body position awareness (or proprioceptive
feedback); the only group of children mentioned clinically are those who under-
react to information from their muscles and joints about the position of their body.
This group of children will deliberately fall over or jump off heights without
regard to their personal safety; can seem to have weak muscles, including a weak
handgrasp; fidget excessively as they have trouble maintaining a steady position,
such as maintaining cross-legged sitting; lock their elbow or knee joints to achieve
stability; tire easily; or might use other people, furniture or objects as a physical
prop for support (Dunn & Westman 1997). Box 7.4 lists some suggestions for
assisting these children.
Box 7.4 Activities to help children who underreact to

proprioceptive feedback
• Use some calming strategies (as listed in Box 7.1).
• Provide extra opportunities for proprioceptive input throughout the child’s
day via heavy work activities.
• Many household chores offer strong proprioceptive input. These include
vacuuming, mopping, putting the wheely-bin out, using a tin opener, mixing
cake mixture and kneading bread dough.
• Use heavy quilts, layers of blankets or pillows over the children’s body at
nap times. (Make sure that the children do not overheat, however.)
• Provide ‘hidey holes’ in play areas with plenty of cushions for children to pile
on top of themselves.
Dysfunctional reactions of other sensory systems

Just as is the case with the near-sensory systems, children can experience
atypical under- or overreactions to taste, smell, visual or auditory sensations.
Some of the sensitivities in these domains (especially auditory sensitivity) can be
assisted by the activities recommended above, as calming one sensory modality
can help calm others as well. However, when individual children continue to
show extreme reactions that interfere with daily living (as commonly observed
in children who have moderate or severe disabilities), you will need to consult
specialists to advise you about designing individual programs for them.
HAND FUNCTION
Hand function is vital for many daily living skills throughout life. In terms of
adults’ focus on children’s development, with the understandable emphasis on
walking and talking in toddlers, hand function often takes a back seat until later
activities such as writing and using scissors are introduced. Yet for skilled ‘tool’
use such as using a writing implement, a toothbrush, scissors or a knife and fork,
much behind-the-scenes work needs to occur to ready the hand. Much prepar-
ation for manipulation occurs in babies’ early years as part of their gross motor
development—for example, while weight bearing on their hands during crawl-
ing. These large motor skills and ongoing refinement of grasps set the scene for
controlled hand use. Thereafter, to develop precision, toddlers and preschoolers
need to practise manipulative activities during quiet indoor time rather than
replacing these entirely with watching television or using a computer.
When looking at hand function and suspected difficulties, it is important to

look at not only what children can do but also how they perform an activity
(Exner 1997). While some children might be able to ‘get there in the end’ to
achieve a particular hand task, it can require considerably more effort and time
than would normally be expected. This can come about because of difficulties in
any of the following systems affecting hand function:
• Alertness. This affects persistence at, and thus practice with, tasks that
require the use of the hands.
• Sensory integration permits the use of two hands as a team, planning of
movement and accurate positioning of hands, all of which are essential to
children’s fine motor skills (Exner 1989).
• Gross motor development, particularly children’s ability to maintain stable
trunk, shoulder and neck control, affects their proficiency with fine motor
activities (see chapter 6).
• Vision. Vision is crucial for directing hand movements (see chapter 5).
Visual perception is the ability of the brain to interpret and use what is seen
(Levine 1998). It guides movement, particularly for developing pre-writing,
puzzle and scissor skills.
• Motor planning. This is our ability to plan and execute a sequence of steps
to complete a task successfully. As we become more proficient in a skill, our
movements can become less conscious and more automatic, leaving thinking
capacity available for higher-order problem solving.
• Intellectual development affects children’s interest in persisting with
complex tasks (Exner 1989).
• Social, cultural and emotional factors influence children’s exposure to and
interest in fine motor activities.
• Physical abnormalities such as an absent thumb, severe dermatitis or
juvenile arthritis, for instance, will affect children’s ability to use their hands
proficiently.
Grasp development
Hand skill development follows reasonably predictable trends, driven by nervous
system maturation and influenced by children’s experiences. Sequences for the
development of grasp and hand skills are outlined in Appendix II, with mature
grips illustrated in Figure 7.2. Behaviour that you might observe that suggests
difficulties with grasp development includes the following.
• You will observe grasp patterns that are immature for age, such as when
2-year-olds hold beads using the whole hand rather than fingertips when
attempting to put beads on a stick. A fisted grasp like this means that the
children cannot see the bead to line the hole up with the stick, which will
lead to failure at the task.
• You might also observe that individual children can use a mature grasp when
their hand is still, but not once they start to move their hand to manipulate
Superior pincer grasp 3 jaw chuck grasp
Radial palmar grasp Radial digital grasp
Figure 7.2 Mature grasp patterns
an object. This indicates that the mature grasp is not a well-established,

stable position.
• Some children could also be limited in the variety of grasps they are able to
use. This is a problem because everyday tasks require a wide range of grasp
positions (including those in Figure 7.2). Sometimes the awkward grasp is a
result of a problem ‘further up’ the arm such as poor control of the forearm.
Examples of this are when children hold their wrist in a bent-in (or flexed)
position when grasping, or hold their palm face down (pronated) instead of
the thumb pointing upwards (midpronation). Both these positions prevent
the children from being able to see the object and do not allow for a precise
placement.
• Other children might not be achieving age-expected functional independ-
ence because of their weak grasp, such as when they cannot pull their
trousers up.
Activities to encourage grasp and hand-use development are included in Box 7.5.
If individual children continue to experience difficulties, referral to an occu-
pational therapist is recommended.
Bilateral hand skills

The ability to use two hands as a team is important for many daily living tasks.
Activities which require children to use their two hands together can assist
those who are having difficulty with this aspect of hand use. It can help to present
toys on a slippery surface so that one hand has to stabilise the item, or to use toys
or objects that have a handle to encourage one hand to hold while the other
Box 7.5 Activities to encourage grasping and hand-use skills

To help children control their postural muscles, start them in a supportive
position, giving them a chair of correct height with armrests or sitting on the
floor with their back to the wall. Tables need to be at or slightly above elbow
height. This helps position the upper arm so that the thumb and the index and
middle fingers (the ‘skill fingers’) are more accessible. Different positions can
also be used to add variety: not all hand skill tasks need to happen at a
table—some can be done sitting on the floor, standing, side-lying and, for
activities that require a small range of movement only, lying on the stomach. It
is essential to give activities that engage the children, afford pleasure in their
accomplishment and fuel a drive to try more of the same activity.
As the wrist is a key control point for the hand, assist wrist stability with
weight-bearing activities such as animal walks, ‘wheelbarrows’, climbing and
handing from a trapeze swing.
Wrist supination (the ‘keep your thumb up position’) is necessary to facili-
tate fingertip grasps. To foster this, present objects to be grasped (e.g. pegs,
pencils or crayons) in a vertical orientation and to the side rather than in the
midline of the child’s body, with the object offered to the thumb side of their
hand (see Figure 7.3). Ask them also to carry the object in this position. An
example is grasping large birthday candles and inserting them into a play-
dough cake, with the wrist maintained in the thumb-up position.
• Start with large objects and gradually reduce size.
• Start with square objects then other shapes such as a cylindrical pegboard
peg (for three jaw chuck grasp), handbag handle (for hook grasp), holding
pieces of paper (to develop intrinsic muscles of the hand), perhaps posting
papers in a ‘letter box’ (with help if required).
• To improve stability, put objects to be grasped on a very firm surface such
as a table or hard floor.
• Hand objects to the thumb side of the children’s hands to encourage them
to use their thumbs in opposition to fingers.
• Expect a palmar grasp for objects that are unstable (e.g. are squishy, round
or lightweight).
• Initially place objects in the children’s hand rather than have them reach for
objects.
• For tools which require a power grasp, such as a toothbrush, hairbrush and
hammers, the handle size may need to be enlarged, or handles with finger
indentations might be useful. Practise this grip in activities that do not
require much power, such as hammering objects into playdough.
For release
Voluntary release can be a problem when children have involuntary movement
or tremors, abnormal tone or immature grasp patterns. To encourage release,
ensure that the children’s wrist is straight or slightly bent back (in extension).
• Have the children release objects into a container placed lower than their
seat. This position with the elbow straight makes it is easier to extend the
wrist and thus facilitates a good release pattern. Bring the container gradu-
ally higher and closer to the children.
• To release into a small space a good-quality grip is needed, in which case

you may need to position the children’s fingers on the object to be released.
• To help maintain the forearm in position and keep the object visible, remind
and/or manually guide children to keep their ‘thumb up’.
• Gradually reduce the size, weight and solidity of the object. For example,
go from a rubber to a paper ball.
• To increase interest, have the children use tweezers, or release balls or
marbles into a tin to enhance the noise effect; drop magnets into a tin,
upturn it and see if they hold; drop sultanas or currants into cake mixture.
manipulates—for instance, having children decorate with stickers a cup that has
a handle. Once children are comfortable using one hand to hold and the other to
manipulate, move on to activities that require both hands to manipulate, such as
easy threading tasks.
Grasp strength
Weakness in the hands, for whatever reason, interferes with children’s ability to
sustain good-quality grasp and to perform self-care tasks and engage in age-
appropriate play. Children with weak hands will have difficulty pulling up their
pants, fastenings snaps or pulling on their shoes (Case-Smith 1996); carrying
heavy objects; hanging from monkey bars or the ‘flying fox’; and opening lids.
Any activity that involves pushing and pulling with the arms and hands will
strengthen muscles. Examples include playdough, snaplock beads, and pulling a
partly loaded trolley or pushing a wheelbarrow.
Figure 7.3 Handing an object to be grasped to encourage forearm

supination and thumb opposition
Manipulation skills
Very young children use simple open-and-close patterns with their fingers.
However, as they get older, they need to be able to manipulate objects between and
within their hands. The latter is known as in-hand manipulation and comprises:
• translation of multiple or individual small objects from the fingertips to the
palm and retrieval of the objects back to the fingertips. When some objects
are retained within the hand during this manoeuvre, that is termed trans-
lation with stabilisation;
• simple rotation which involves rolling a small object between the pads of
the thumb and fingers;
• complex rotation, which involves using the thumb and fingers to turn an
object end over end (as when children pick up a pencil upside down and have
to rotate it so that the tip points down);
• shift, which comprises moving linearly on an object, as when children creep
their fingers down a pencil to be nearer its tip.
These skills are necessary for many daily tasks such as opening jars, replacing
lids on textas (felt pens), doing up buttons, and adjusting the position of a pencil
in the hand to permit comfortable use.
Checklists of fine motor development often overlook manipulation within
the hand (Case-Smith 1996; Pehoski et al. 1997). As a result of a lack of norms,
some children with significant manipulation difficulties are overlooked. These
children might avoid challenging hand skills or might drop objects while turning,
storing or positioning them in their hands.
To help develop in-hand manipulation skills (remembering to practise using
only one hand at a time), try handing children individual shiny stones or toy
coins with their fingertips to ‘store’ in their palm. They then can retrieve these
using the thumb of the same hand and insert the coin into a ‘treasure chest’. Start
with one coin at a time and gradually build up the number. (More than one is not
common prior to 3 years of age.)
Another idea to encourage object rotation: when replacing texta (felt pen)
lids have the children practise orienting the lid in their fingertips, again without
the assistance of the other hand. Place pencils or crayons in their hand so that
their fingers are well away from the tip; they then have to crawl their fingers
down to the tip. You will know that these activities have helped if the children’s
manipulative movements in daily activities become faster and more efficient.
Pencil grip
There are many reasons why children might use an awkward or inefficient pencil
grip. Before much time is spent with paper and pencils, it is important that the
muscles of the hand be ready. This is because prevention of awkward grips is better
than cure: it is hard to change a dysfunctional grip that is ‘locked in’. If the hand
is well prepared, many later difficulties experienced by learner writers—such as
poor grip and fatigue—could be prevented. When the muscles are overstressed,
children compensate for the discomfort and lack of stability by developing what is
in the long term an inefficient pencil grip.
Signs that children’s grip development is not progressing well include:
• deviation from the normal developmental progression of grips (see Fig-
ure 7.4 and Appendix II);
• an overly tight grasp, which often indicates the need for additional position
sense feedback (Schneck & Henderson 1990) but leads to fatigue and add-
itional strain on joints;
• poor position during pre-writing and drawing activities;
• excessive arm tension;
Primitive grasps: typical of a 3-year developmental level
Radial cross palmar Palmar supinate Digital pronate grasp

(only index finger
extended)
Transitional grasps: typical of a 41/2- year developmental level
Brush grasp Grasp with extended fingers
Cross thumb grasp Static tripod grasp Four finger grasp
Mature grasps: typical of a 6-year developmental level
Lateral tripod grasp Dynamic tripod grasp
Figure 7.4 Developmental progression of pencil grip

Source: adapted from Schneck & Henderson (1990). Reproduced with the permission of
the American Occupational Therapy Association.
• use of whole-arm movements rather than fine finger movements when

directing a pencil;
• no establishment of hand preference.
As to the last of these, children are less likely to have a mature grasp if their hand
preference is not well established by 4 years of age (Chapparo 1998; Schneck &
Henderson 1990), in which case it will be more useful to focus intervention on
establishing hand preference than on correcting their grip.
A skilled fine motor activity such as threading provides a good opportunity
to assess whether children’s hands have sufficient muscle control to begin
writing. While observing such an activity, you will need to note whether the
children are able to hold their hands in a cupped position (palmer arches are
developing); whether they can hold their wrist up; are able to use their thumb,
index and middle fingers separately from their other fingers (they have devel-
oped a ‘skill side’); the ‘skill fingers’ can move together at the end joints; and
the children have an open circular-shaped web space between their thumb and
index finger (Myers 1992). Children who lack these skills need to be given
opportunities to perform activities requiring manipulation. Such activities
include threading, lacing, using tweezers, tearing paper strips for use in art
projects and cutting with scissors. At the same time, use of vertical surfaces can
have a dramatic effect on preparing the hand. Vertical surface activities include
drawing or playing with magnets on a whiteboard, playing with felt pieces on a
vertically positioned felt board or painting at an easel. Pen grips can provide
comfort and anecdotally seem to help children’s grip, but they are treating
the symptom not the cause of the inefficient grip, whereas vertical surfaces
and manipulative activities address the cause and in my experience are more
effective.
When observing the progress of grip development in young children,
consider that grip is influenced by:
• the children’s age: most 4–6-year-olds use a dynamic tripod or a lateral
tripod grasp (see Figure 7.4);
• the children’s gender: girls tend to use more mature grasps earlier than boys
and more often use a lateral tripod grasp for colouring;
• type of task: the bigger the drawing, the less fine movement is required; when
colouring the middle of an object, a less mature grasp is used than when col-
ouring the edges; tracing elicits a more skilled grip than free drawing;
• time at the task: when a pencil grip is being used which is not yet firmly
established, children may revert to a less mature grasp because of fatigue
(Burton & Dancisak 2000; Schneck & Henderson 1990).
Once children are physically ready to practise pre-writing, it is important to vary
activities. Examples are duo drawing, which involves taking turns to add to a
drawing such as parts on a face; using stencils; writing with shaving or sorbolene
cream on a table or mirror; using chilled paints or warmed sorbolene cream;
adding essential oil to paints (peppermint to alert, lavender to calm); or copying
simple drawn designs such as a circle or cross using pipe cleaners, laces or even
bodies. (Other resources with more detail on prewriting activities are listed at the
end of this chapter.)
Children with advanced intellectual development can lack motivation for or
experience frustration with their fine hand skills, as these tend to be less
advanced than their intellectual abilities (Tannenbaum 1983). Their hands cannot
move as quickly as their ideas and so they experience frustration, particularly
with tasks involving writing. By school age, they might not be as interested as
others in getting the mechanics of hand writing and spelling correct, taking
greater interest instead in their ideas and concepts. If the discrepancy between
their fine motor and intellectual development bothers them, these children need
to know that this is just because their hands grow up at ‘body speed’ whereas
their brains are growing up faster (Porter, pers. comm.). Similarly, teachers need
to attend to the quality of these children’s ideas, rather than insisting on perfect
writing output.
Use of scissors
As well as offering an enjoyable constructive activity, scissor activities exercise
the same small muscles of the hand as are needed to manipulate pencils, and are
therefore useful for building muscle strength and control. The developmental
progression for the attainment of scissors skills is given in Appendix II.
Children who are experiencing difficulties with scissor control may ask for
adults to hold and direct the paper during cutting, might complain of fatigue,
and be unable to stabilise and control their wrist during cutting because of
muscle weakness.
Activities to prepare for scissor use include water pistols, squeeze toys, use
of a hole punch and play with tongs and tweezers. When introducing scissors,
ensure that you offer good-quality, clean-cutting scissors that fit the children’s
hand, with the lower loop being larger than the upper. Adapted scissors such as
Box 7.6 Correct scissor grip

There is divided opinion about the best scissor grip. One version is when the
thumb occupies the top loop of the scissors and the third (middle) finger is
inserted into the bottom loop, with the index finger being used beneath it
to stabilise the grip. A second version employs two fingers in the bottom
loop (where the scissors permit) with, once again, the thumb in the upper loop.
Both grips are correct: it is safe to encourage whatever finger arrangement is
most comfortable and functional for a particular child. Meanwhile, it is impor-
tant that the hand holding the scissors is not bent forwards (flexed) at the wrist
but is in line with the forearm (except when cutting around curves), and that
the assisting hand can hold and guide the paper (or other object to be cut)
with accuracy.
squeeze or spring scissors can be used to build confidence initially. To encour-

age snipping, cut playdough sausages or soft sweets for variety. When cutting
paper, start with heavier paper to give greater stability. Next have the children
combine two snips by using wide strips. Then they can cut along lines of
reducing widths and finally cut around shapes. Remember to show them what to
do with their stabilising hand to support the cutting hand.
Hand preference
Hand preference is a complex area. Handedness is biologically determined, and
means that the arms and hands are asymmetrical in use and function so that indi-
viduals reliably favour one hand or the other for a range of tasks (Murray 1995).
Handedness refers not only to which hand is preferred but to the degree of
preference shown. Some research has indicated that hand preference is observed
from as early as 2–3 months of age, as displayed in infants’ favoured head orien-
tation. By the age of two-and-a-half to 3 years, handedness is well established
for the majority of children and remains consistent thereafter (Murray 1995).
Subsequently, the degree of handedness and proportion of activities performed
with the preferred hand increases over time.
If children are aged 3 years or older and have not yet established firm hand
preference, you might see that they use the hand closest to their activity; both
hands might look awkward during skilled activities such as writing, cutting or
drawing; or the children might swap hands during writing or drawing, often
accompanied by frustration or avoidance of skilled hand activities.
If children aged four years and over do not have a clearcut left-handed
preference, it is probably better to guide them gently towards right-handedness
(Chapparo 1998; Murray 1992). Alternatively, if the left hand is clearly the more
accurate during particular tasks such as drawing, then support the dominance of
that side. Keep in mind that some left-handers being taught activities by adult
right-handers can feel confused as they attempt to imitate the adults. If individ-
ual children use the left hand for drawing and other pre-writing activities but
choose the right hand for cutting, do not interfere unless their accuracy is clearly
better with the left (Levine 1998). It is beneficial if the same hand is consistently
used for the same tasks, but using different hands for different tasks is acceptable
(Chapparo 1998).
Activities that develop hand dominance include finger painting or reaching
tasks where the children are encouraged to cross the midline of their body, and
activities that encourage the hands to work together so that the children get into
the habit of using the same hand to manipulate and perform the most skilled
movements with the other hand holding and stabilising.
Left-handers make up 10% of the population, although this proportion is
slightly higher among people with learning or motor disabilities. This is thought
to be because of some interference with brain development on the left side
(remembering that the left side of the brain controls the right side of the body).
This causes a naturally right-handed child who has some brain impairment to
favour the left, in a pattern which has been termed ‘pathological left-handedness’
(Murray 1995). These children have to contend with living in a right-handers’
world as well as with their learning or motor difficulties.
Some left-handers develop an awkward grip to allow them to view their work
(Levine 1998). A common example is the hook grasp, where the wrist is bent
around and above the writing. To prevent maladaptive patterns becoming estab-
lished, ensure that children’s tables are not too high so that they can rest their
forearms on the table, position their hand to the left or below the writing line,
encourage tripod grasp of the pencil but with the thumb slightly further away from
the tip than is the case for right-handed children, and position paper to the left
of the children’s midline with the paper slanted left-side high at 45 degrees.
Because right-handed scissors, when used in the left, do not allow a view of
the line being cut, provide left-handed or either hand scissors.
SELF-CARE ACTIVITIES
Their ability to perform self-care tasks independently gives children some

control over their environment. Lack of ability in self-care skills compared with
others can be isolating and lead to frustration.
Children’s attainment of self-care skills will reflect cultural, class and family
expectations as well as their intrinsic abilities (Henderson 1995), and closely
reflects their acquisition of hand skills. With increased exposure at younger ages
in playgroups and child care to children of the same age, observation of others
performing independence tasks appears to motivate young children to learn the
same skill.
Self-care skills have varying degrees of manipulative, perceptual and cogni-
tive components (Henderson 1995). Encouraging development in self-care needs
to focus on functional outcomes that will make a difference for the children and
their families. Training is best achieved by direct practice of the desired skill,
rather than concentrating on components of the task (Case-Smith 1996).
It is beyond the scope of this text to detail the many self-care tasks with
which young children might have some difficulties. However, some general
guidelines follow.
Dressing
When teaching dressing, begin with undressing, as this precedes dressing as a
developmental skill. Meanwhile, remember that children learn one-handed skills
before two-handed and so teach such tasks as doing up buttons at a later age.
Another suggestion is to use the children’s favourite clothes, those with an
obvious front and back (e.g. those with designs or pictures on the front), and
clothing and footwear large enough for easy donning. Hand garments to the
children in such a way that they are already oriented to them, and allow children
with poor balance to sit down when pulling on pants.
Toileting
This is another important independence skill. Children with sensory processing
difficulties are unable to perceive correctly information from their touch and
pressure receptors, and so have reduced awareness of their need to empty their
bladder or bowel. Similarly, children with language difficulties often have dif-
ficulty gaining independence in toileting as some do not talk to themselves about
the sensations that signal the need to use the toilet.
For children with mild developmental difficulties, the general guidelines
suggested by and available from your local community health organisation for
introducing toileting are likely to be useful. These will comprise advice such as
ensuring that the children have ready access to a toilet and can remove their own
clothing quickly and easily; that their feet are able to reach the floor while sitting
on the toilet to maximise the use of muscles that assist with elimination; ensuring
that they can reach and use taps; and helping position their hand for wiping their
bottom. If children have suspected constipation, they will need to be assessed by
a paediatrician or a general practitioner interested in family health. If failure to
learn toileting has no physical or other developmental cause, psychologists or
occupational therapists can assist with toilet learning, such as with the ‘sneaky
poo’ program (White 1984).
Grooming and hygiene

Most preschoolers require assistance with the third area of self-care tasks—
namely, grooming and hygiene tasks such as bathing and cleaning their teeth,
hair and nails. When children have additional developmental needs, it often
seems easier for carers to perform these tasks for them, but the children’s ability
to perform even aspects of these tasks can build feelings of mastery and promote
later independence. Therefore it is useful to encourage the children’s active
involvement as soon as they show some interest. You can help by ensuring that
they can reach the sink, taps and mirror; that they can sit if balance, postural
control or stamina are problems for them; and that brushes have large handles
that are easy to hold.
Self-feeding
Self-feeding is a crucial self-care or independence skill. It requires the motor
skills of trunk stability, head and mouth control as well as eye–hand–mouth co-
ordination. Sensory information needs to be interpreted accurately to facilitate
an efficient eating process. Children with significant eating difficulties are likely
to be managed by a paediatrician aided by a ‘feeding team’—that is, a multi-
disciplinary team with expertise in feeding issues.
When children have feeding difficulties (see Box 7.7) you might observe the
following signs, with those with mild difficulties in this area exhibiting more
subtle expressions.
Box 7.7 General suggestions to assist children with feeding

difficulties
For detailed guidance, with parental permission refer children to your local
relevant health professional—such as a speech pathologist for mouth control
and swallowing difficulties, an occupational therapist for issues with sensory
awareness and utensils, a physiotherapist for positioning and problems of
muscle tone, and a dietitian for dietary requirements.
• Position children to maximise their function. To assist with postural security,
use a chair with arms and ensure that the children’s feet can be flat on the
floor. The table should be at elbow height when the children’s upper arms
are at the sides of their body.
• Use utensils with large handles and which are attractive and comfortable for
the children to hold. Some come with grip positions indicated by bumps on
the handle. To help guide movement, support the children at the upper arm
or elbow or, if required, have the children rest their elbows on the table to
give additional support. For part of the meal, give some finger food to ease
frustration.
• Remind children to close their mouth during eating. A visual cue could be
used to minimise embarrassment in front of peers.
• Have a damp face cloth handy for children to wipe their face clean as part
of their routine at the conclusion of mealtime.
• For children with hypersensitivity to textures, mouth preparation needs to
occur prior to the meal. You can do this by giving firm pressure around the
mouth by gently massaging the upper and lower lips using warm, clean or
gloved fingers. Older preschoolers might be able to do this for themselves.
Alternatively, to reduce sensitivity in the mouth, you can give deep pressure
through the use of thickened fluids requiring firm sucking, such as custard
through a thick straw. Crushed ice given prior to food can also reduce sen-
sitivity. Once desensitising has been achieved, a new texture could be
introduced to the child. Start with a small amount mixed with an already
accepted texture.
• For children who lack mouth awareness, try activities to get their mouth
ready such as imitation games with tongue, lips and cheeks, or have them
‘brush’ their teeth and lips with their finger covered by a face cloth.
• When low muscle tone is a difficulty, provide chewy food to develop mouth
muscles such as sugar-free bubblegum, dried fruit straps or bread with
thick crusts.
• Involve children in food preparation to assist their acceptance of food.
• New tastes take on average 10 presentations before they are accepted
(Birch et al. 1995)—so keep trying. Avoid mixing too many tastes at once,
and use the peer group to help encourage acceptance of new tastes.
• The children might drool excessively, and this is not better explained by
teething or a blocked nose. This can indicate poor sensory awareness around
the mouth so that the children are unaware that they do not have adequate lip
seal. Another explanation would be that the children have low muscle tone
in the facial muscles and so have trouble lifting their jaw against gravity.
• They might be very messy when eating, with food left around outside the
mouth. This can indicate poor sensory awareness of the face, poor handling
of utensils, poor hand-to-mouth control or a combination of all three.
• They could have excessive tongue movements, again suggesting poor sensory
feedback and awareness of the tongue, and poor planning and control of
tongue movement.
• Some children are hypersensitive to textures of food within their mouth and
manifest this by eating only a limited range of foods, being reluctant to try
new textures and gagging on food. Hypersensitivity to food textures is often
associated with hypersensitivity to taste and even temperature of food and,
predictably, to mealtime anxiety.
CONCLUSION
This chapter has explored children’s sensory needs and their development of
hand function and self-help skills and how these areas affect children’s daily
lives. The aim of programming for children in these domains is to assist them to
gain independence and thereby contribute to their sense of mastery and self-
worth. The suggestions offered provide starting points for helping children meet
their own needs and develop their skills and can all be integrated into ongoing
programming for routine activities in early childhood settings. By necessity, the
information offered is simplified: some children will present with more complex
difficulties about which it will be necessary to consult an occupational therapist
or other relevant health professional.
Occupational therapy is a profession that has a significant contribution to
make to children with atypical development. Nevertheless, not all gains must be
made in direct therapy sessions: many can be attained through collaboration
between therapists, educators and parents, whereby beneficial activities can be
incorporated naturally into children’s everyday activities in natural settings
(Washington et al. 1994). Ongoing links between therapy settings and the
children’s homes and education venues will enhance the benefits of each to
the children and their carers.
Henderson, A. and Pehoski, C. (eds) 1995 Hand function in the child: foun-
dations for remediation Mosby Year-Book, St Louis, MO
Klein, M.D. 1983 Pre-dressing skills rev. edn, Therapy Skill Builders, Tucson, AZ
——1990 Pre-writing skills rev. edn, Therapy Skill Builders, Tucson, AZ

——1999 Pre-scissor skills 3rd edn, Therapy Skill Builders, Tucson, AZ
Klein, M.D. and Morris, S.E. 2000 Pre-feeding skills 2nd edn, Therapy Skill
Shellenger S. and Williams, M.S. 1995 The Alert program with songs for self
regulation Therapy Works, Albuquerque, NM
The following internet site has a good home page with information about paedi-
atric occupational therapy: OTnetwork.com.au
8
HEARING
LINDSAY BURNIP
KEY POINTS
• Although hearing might seem to fall along a continuum from normal

hearing to total deafness, there is a point along this continuum when
vision replaces hearing as the main communication channel, in which case
quantitative differences in hearing produce qualitative differences in
learning style.
• Time is not a benign factor in childhood hearing impairment. The longer
an impairment remains undetected, the more affected will be children’s
language acquisition and the more likely it is that this will result in sec-
ondary difficulties such as behavioural or social problems as well.
• Early childhood practitioners can assist children whose hearing is
impaired by looking out for signs of impairment and recommending a
hearing test, creating a helpful communication environment, developing
an effective communication style, supporting the children and their
parents emotionally, and helping the children to manage their hearing aids.
INTRODUCTION
Hearing loss in childhood takes many forms, from the slight reduction in hearing
sensitivity that can occur during a heavy head cold through to the total inability
to hear spoken language experienced by a small number of children. On the
surface, it seems reasonable to assume that hearing ability forms a continuum,
with normal hearing at one end and total deafness at the other. However, this con-
tinuum view can be misleading when we consider the effects of hearing loss on
developing children. As McAnally and colleagues (1987:198) state:
somewhere along the . . . continuum . . . hearing ceases to be the major communi-
cation channel and is replaced by vision; the child becomes linked to the world of
communication by eye rather than by ear. This is the point at which a child can be
140
HEARING 141
considered to be deaf rather than hard of hearing. The impairment shifts from being
a difference in degree to being a difference in kind.
The management of severe and profound hearing loss in childhood is too

broad to deal with in any real depth here. Instead, this chapter considers some of
the common elements of childhood hearing loss and focuses on the more usual
forms of hearing loss that occur in the early years, particularly those that arise
from middle ear problems.
THE IMPORTANCE OF HEARING
Those of us with normal hearing can hear for some time before we are born, and
come into the world already familiar with the sounds of daily life and with the
sound of voices, particularly that of our own mother. These familiar sounds
remain the background music to our lives. Our ears are our connection to our
world and, unlike the sense of vision, our hearing sense is switched on at all times:
when we go to sleep, we close our eyes but not our ears. The unfamiliar creak of
a floor board or the all-too-familiar cry of a child can bring us instantly awake.
Even in deep sleep, some level of our consciousness is listening to the world.
As children, we hear the speech of those around us and, long before we can
understand the meanings of words, we learn to identify and draw meaning from
the patterns of speech. The many adaptations that adults make to their speech
when addressing babies and young children are well recorded and readily observ-
able. A major figure in the area of language development, Roger Brown (1973),
coined the rather delightful term ‘Baby talk’ to describe these adaptations which
include exaggerated pitch changes, frequent repetitions, short utterances, and con-
versational role-play in which the adults provide both their own and the children’s
conversational turns. Babies and infants are very attracted to these speech styles,
which most caregivers use instinctively and unselfconsciously. Researchers
believe that these early baby talk interactions provide the ‘scaffolding’ or support
structures within which young children learn how to produce the language of their
community and how to use that language in conversation. Almost all of this
learning—social, communicative and linguistic—occurs through hearing.
It is easy to appreciate the difficulties that a significant hearing loss might
cause when learning a spoken language, but some other effects on communi-
cative interactions are less straightforward. For example, when parents interact
with their normally hearing children they observe the child’s actions, predict the
likely object of their attention and offer appropriate commentary on that object,
while the child is engaged with it. That is, parents guess what their child is
thinking, then talk about it. This match between child attention and parental
language is referred to as ‘contingency’ (Bamford & Saunders 1991).
In contrast, for children with limited hearing it may not be possible for parent
and child to establish ‘mutual gaze’ and talk at the same time as they look. In such
cases the adult must attract the child’s attention, then communicate. When the
child’s attention must be gained before communicating, the conversation is no

longer contingent on—that is, related to—the child’s engagement: the probability
will be higher that the child is no longer thinking about the object or event when
it is being commented on. The linguistic interaction between parent and child
becomes sequential rather than occurring in parallel. Thus, children’s awareness
of contingency—of the connection between language and action—is believed to
be reduced by significant childhood hearing impairment (Wood et al. 1986).
The early communicative experiences of children with impaired hearing are
likely to be quantitatively and qualitatively different from those of normally
hearing children and, in general, less useful in helping them to develop social and
linguistic skills in a normal manner. It is possible to use visual rather than spoken
communication styles (e.g. a sign language) but this requires first that the child’s
hearing loss is identified very early, which it usually is not, and second that the
parents quickly learn a new set of unfamiliar skills, which is a very difficult task.
Hearing impairment does not in itself affect children’s acquisition of social
skills. However, where the development of communication skills is delayed,
regardless of whether speech or sign is used, interactions with parents and other
adults can become more difficult (Jamieson 1994), and the acquisition of some
social skills may be delayed (Sass-Lehrer 1999). Children with hearing impair-
ments with delayed language skills can also have difficulties in their interactions
with other children, and have been found to show a strong preference for play-
mates who also have impaired hearing, suggesting that even at 4 years of age
they have already established a sense of social-self which is distinctively differ-
ent from that of their normally hearing peers (Brown & Remine 1996).
THE NATURE OF HEARING LOSS
The mechanisms of the hearing apparatus are illustrated in Figure 8.1. In order
to hear a speaker or other sound source, the sound must:
• pass down the ear canal of the listener;
• vibrate the ear drum;
• pass through the middle ear;
• create a pressure wave inside the cochlea, causing a group of hair cells to ‘fire’.
The nerve impulse created by the hair cell firing must pass out of the cochlea and
through the various processing stages en route to the brain.
This can be thought of as the ‘hearing chain’, and hearing impairment occurs
when the transmission of sound is reduced or blocked at any point in this chain.
Three important parameters of hearing loss are its degree, type and age at onset.
Degree of hearing loss

The degree of loss is usually described as being mild, moderate, severe or
profound, and is plotted on a form called an audiogram. This plots intensity against
frequency, which is roughly the same as loudness against pitch. Interpreting an
HEARING 143
CONDUCTIVE SENSORINEURAL
Pinna (external ear)
Middle ear and ossicles
Ear canal
Ear drum
Eustachian tube Inner ear
Figure 8.1 The ear in cross-section showing regions of conductive and

sensorineural hearing loss
audiogram is not straightforward, as these graphs are intended to convey infor-

mation from one audiologist (hearing scientist) to another, not to indicate to lay
persons what a particular child can and cannot hear. To obtain this information you
should seek the assistance of an expert in the area, such as the child’s audiologist
or a specialist teacher of the deaf. However, it must be understood that the degree
of a hearing loss will not be, in itself, a reliable indicator of the impact of that
hearing loss on a child’s development. Numerous other factors must be considered.
Age of onset of hearing loss

Because childhood hearing impairment of any degree can affect language
development, the age at onset of the loss is most important. All else being equal,
a hearing impairment acquired after the development of normal language skills
will have a much less disabling effect than a loss present at birth or soon after.
The management of a prelingually deafened child (as the condition is known) is
significantly different from that of a later-deafened child.
Type of hearing loss

There are two types of hearing impairment: sensorineural and conductive.
Sensorineural impairments are caused in the inner ear or beyond; conductive loss
occurs when the transmission of sound is impeded by a blockage in the outer or

middle ear (see Figure 8.1). A problem in both is referred to as mixed.
The two forms of hearing loss are qualitatively different from each other.
With conductive hearing losses, sounds can be inaudible but, if made loud
enough, are understandable; whereas sensorineural hearing losses can cause both
inaudibility and sound distortion. Using a radio analogy, conductive hearing
impairment has an effect similar to turning down the radio’s volume, while a
sensorineural hearing impairment has an effect analogous to a radio with the
volume turned down and tuned off station.
Conductive hearing impairment is by far the commonest form of childhood
hearing impairment, generating around 24 million visits to the doctor in the USA
alone (Mitka 1999). Many different terms are used to describe this condition,
including ear infections, glue ear, middle ear disease/disorder and, more techni-
cally, otitis media. This last term is simply Latin for middle ear inflammation, so
they all mean much the same thing—problems in the middle ear that are likely
to affect hearing.
It is believed that most children experience one or two bouts of otitis media
in their early years (Bluestone & Klein 1988). Despite this high prevalence, in
general otitis media is seldom serious in terms of its impact on development,
Box 8.1 The effects of hearing impairment

Degree Likely effects
Mild Without a hearing aid, children with a mild hearing
impairment will probably hear quite normally when
close to a speaker and in quiet conditions. At a
distance or in noisy settings, that same child is likely to
be able to detect speech but might have some difficulty
in understanding it fully. (For further information, see
Bess et al. 1998; Tharpe & Bess 1999.)
Moderate A moderate hearing impairment will cause even greater
difficulties in hearing speech, and children with this
degree of impairment will be at a great disadvantage
without a hearing aid.
Severe/profound Attainment levels in language and academic skills are
typically low (Diefendorf 1996).
Unilateral hearing impairment
The erroneous view persists that unilateral hearing impairment—normal
hearing in one ear but a loss in the other—is relatively unimportant in young
children. (After all, they have two ears and can turn their head if necessary!)
But research tells us that this condition can cause difficulties in acquiring
language skills and, consequently, in language-based learning tasks
(Diefendorf 1996; English & Church 1999). Later difficulties with reading and
writing are not uncommon, even though affected children usually develop
age-appropriate spoken language skills.
HEARING 145
partly because it is usually transient in nature. However, some children have

more frequent and more severe bouts, and the hearing impairment that results
tends to be greater in degree and more long-lasting.
This more severe form causes a slight to mild hearing impairment which fluc-
tuates over time. The terms ‘slight’ and ‘mild’ can be misleading, however, as the
long-term effects of recurrent otitis media can be anything but slight (e.g. see
Clark & Jaindl 1996; also Roberts et al. 1997), with research linking this con-
dition to reduced language attainment and increased behavioural difficulties
(Wilks et al. 1999). Children who are otherwise in good health and with no other
impediment to learning may be able to compensate for the relatively small degree
of hearing difficulty that comes and goes from day to day, and may suffer no
longer-term ill-effects. Other children will be much less able to cope with their
fluctuating hearing if, for example, the language of their preschool is not the
language of home. This appears to be the case with Aboriginal children with a
history of otitis media who experience greater than usual difficulty in listening in
noisy environments, particularly when listening to English (Yonowitz et al. 1995).
CAUSES OF HEARING IMPAIRMENT
The hearing mechanisms contain the smallest bones in the body and some of the
most fragile structures. Permanent sensorineural hearing loss can result when
these vulnerable mechanisms fail to form correctly as a result of genetic or
developmental mishaps or are damaged by viral or bacterial infections (e.g.
rubella, CMV, syphilis, measles, mumps and meningitis), by ototoxic drugs
(e.g. some members of the group of antibiotics whose names end in ‘mycin’),
and by trauma (e.g. arising from car accidents). A strong risk factor for hearing
impairment in children is low birth weight (van Naarden & Decouflé 1999), and
admission to a neonatal intensive care unit for 48 hours or longer (Kennedy
2000). This latter risk factor has increased greatly in recent years (Bamiou et al.
1999), presumably as a result of improved medical technologies and procedures
helping very low weight and/or premature babies survive in greater numbers.
Very occasionally, children are born with one or both ear canals absent, often
with a malformed or absent outer ear. This is called congenital atresia, and gives
rise to a conductive hearing impairment that will remain until an artificial ear
canal is created surgically.
The commonest form of hearing loss—otitis media, which is of the conduc-
tive type of loss—is related in part to lifestyle; as such, its prevalence and
severity are considerably higher among some groups than among others. In Aus-
tralia, Aboriginal children are especially at risk (McPherson 1990), as are similar
indigenous groups elsewhere (e.g. McShane & Mitchell 1979). Children who
attend child care centres also appear to have higher rates of otitis media (Amarjit
& Scott 1999), and there is a suggestion that this might also be the case among
children who use pacifiers (CNN 2000) and those who are subjected to passive
smoking (Clark & Jaindl 1996). Nevertheless, although some of the risk factors
Figure 8.2 Comparison of the angle of the eustachian tube in children

and adults
for otitis media appear to be related to lifestyle, the condition is not wholly
preventable (Medley et al. 1995).
This is partly explained by considering the structure of the middle ear. It
consists of an eardrum over a cavity which contains a string of tiny bones (the
ossicles) joining the rear of the eardrum to the inner ear (see Figure 8.1). To
function properly, the air pressure inside the middle ear cavity must be the same
as the pressure outside. If it is not, the ear drum will not be free to move as it
should in response to incoming sound waves, thus reducing the ability to hear.
The tasks of equalising air pressure on each side of the eardrum and of
draining any middle ear secretions are performed by the eustachian tube. This
joins the middle ear to the back of the nose and throat and is normally closed, but
opens when we swallow or yawn, allowing air to flow in or out. In young children
the tube lies at a much flatter angle than in adults and as a result functions much
less efficiently (see Figure 8.2). Children typically acquire a more adult-like angle
of the eustachian tube at around the age of 7, but prior to that are very suscepti-
ble to blockage of the tube and thus to a build-up of pressure and fluid in the
middle ear. This may remain for a long time and become infected or glue-like,
resulting in various forms of otitis media with consequent effects on hearing.
INTERVENING WITH HEARING IMPAIRMENT
Early childhood practitioners can help children with hearing impairment in the
following ways:
HEARING 147
• Assist in the identification of children with impaired hearing.

• Create a helpful communication environment.
• Develop an effective communication style.
• Provide support to children and their families.
• Support children’s mode of communication.
• Assist in the management of hearing aids.
Identify children with impaired hearing

Given the impact that hearing impairment can have on the development of early
language, it is important to identify as early as possible children who have a
significant hearing loss (Downs & Yoshinaga-Itano 1999; Roizen 1998). The
prevalence of serious, permanent hearing impairment in young children is not
high: estimates vary depending on the criteria used but are typically around 1 or
2 per 1000 live births (Department of Human Services 1998; Steel 2000), so
large-scale screening is called for rather than the more expensive diagnostic
testing. Early childhood hearing screening procedures have been available for a
long time and, with recent advances in technology, have become cheaper, easier
and more accurate.
Expert opinion has it that screening should be performed around 3 months
of age and, where necessary, intervention begun before 6 months (Finitzo
2000). However, in most countries we are far from achieving these targets. In
1996 in Victoria in Australia, a state with a relatively good hearing screening
system, the median age of diagnosis was 10.43 months (Department of Human
Services 1998), but in Australia more generally some areas are poorly served by
hearing screening programs, and the majority of children are not tested until
after 2 years of age (Winton et al. 1998). In the UK, the average age at detec-
tion has been reported to be 26 months, with intervention not begun until
32 months (Abbasi 1997).
Because hearing screening programs are at present so incomplete, many
children with hearing impairment remain undetected through their early years.
This fact makes it essential for early childhood professionals to be vigilant in their
observations. Time is not a benign factor in childhood hearing impairment: the
longer the impairment remains undetected, the more developmental opportunities
children miss out on and the greater will be their resulting disability.
Thus, until effective universal hearing screening programs become available,
we should assume that a proportion of young children in early childhood settings
will have an undetected hearing impairment. Even when wide-scale screening is in
place, we will still have the continuing problem of recurrent otitis media. Box 8.2
lists some observable behaviours that can be indicative of a hearing difficulty. Of
course, some of these indicators are consistent with normal childhood behaviour
and thus a checklist such as this should not be used in a prescriptive manner, but if
a child exhibits several of these indicators a referral for a hearing test is in order.
If you find yourself or other adults saying of individual children, ‘They can
hear when they want to’, you should consider seriously the possibility of hearing
Box 8.2 Some indicators of possible hearing impairment

Children with hearing losses might:
• have frequent upper respiratory tract infections, coughs, colds or throat

infections;
• currently have an ear infection;
• turn their head towards a sound source;
• appear ‘blocked-up’, snore and breathe through their mouth;
• have some craniofacial abnormalities, including cleft palate;
• report or have a history of ear trouble;
• report earache, ‘popping ears’, or fullness in the ear;
• have periods of irritability or atypical aggression;
• appear to daydream, and be more ‘with it’ when close to a speaker;
• want to sit near to the TV, or have volume louder than usual;
• watch a speaker’s face intently;
• cup their ear with a hand;
• not turn when called;
• search for rather than locating a sound source quickly;
• ask for repetition of instructions or watch others;
• misunderstand or be slow in responding;
• give inappropriate answers;
• be inattentive and restless;
• show inconsistent listening behaviour, ‘switching off’ in noise;
• withdraw and not mix well;
• have poor concentration and become tired easily;
• have speech that is unusually soft or loud or indistinct;
• evidence a fluctuating pace of learning.
Source: adapted from Webster (1986).
difficulties. This is a classic comment made about children with fluctuating, con-
ductive hearing impairment. In reality, these children can hear on some occasions
and under some conditions but not others.
When a child appears to require a hearing test, staff can assist by encourag-
ing parents to make a referral and by helping them determine the best place to
go. In recommending to parents that their child have a hearing assessment, the
following information might be useful:
• In Australia, children are not charged for hearing tests.
• These tests are non-invasive and children usually find them fun.
• Parents may wish to involve their child’s general practitioner but a medical
referral is not required for a hearing test.
• Do not try to test a child’s hearing yourself: it is too easy to get it wrong.
• It is not appropriate for young children to have hearing tests at the commer-
cial vision and hearing agencies commonly found in shopping centres, as
the staff in these facilities will rarely have received specialised paediatric
training.
HEARING 149
• State health authorities are responsible for hearing testing of children and
should be approached first. The contact number for the relevant state health
agency will be in your local telephone directory, probably under ‘Health’ or
in the state government section.
Create a helpful communication environment

Children with impaired hearing often use vision to compensate for reduced
hearing. To make this easier, ensure that the room is adequately lit but without
harsh lighting and reflective glare.
Distance, noise and reverberation are all major hindrances to effective
communication for children with impaired hearing. Taking each of these impedi-
ments in turn, with distance sounds lose their intensity, and speech delivered
across a large room might be quite unintelligible through a hearing aid, espe-
cially if contaminated by noise and reverberation.
Noise creates particular difficulties for those with hearing impairment,
particularly young children. Normal conversation contains a great deal of
redundancy—that is, the same information is present in various forms. So, if one
piece is obscured by noise an alternative is often available, if one knows how
to interpret it. Young children with hearing impairments can have insufficient
knowledge of the structure of language and the rules governing conversation to
take advantage of this redundancy. In noise, they are at double jeopardy: the noise
hides some of the speech, and their limited linguistic skill reduces the benefit they
can derive from what is left.
Reverberation is a little more complex than echo but can be understood
in those terms. This occurs in most rooms—especially those with hard, shiny
surfaces—and can seriously reduce speech intelligibility for children with
hearing impairment, again at levels that might cause no discernible difficulty for
people with normal hearing. Reverberation often combines with noise and
distance to create a poor communication environment for children with impaired
hearing. Reducing noise and reverberation in rooms, although highly desirable,
may be beyond the resources and skills of most people. Choosing a less noisy
and/or reverberant room may be an option, but one can often compensate for
even a poor communication environment by getting close to a child with
impaired hearing and using the effective communication strategies suggested
below.
Develop an effective communication style

The way we communicate—our voice level, rate of speech, complexity of
language—and the strategies we employ can greatly affect how well we are
understood by children (and adults) who have impaired hearing. Becoming
aware of what we do when we communicate and changing these behaviours is
not easy, but becoming an effective and supportive communication partner might
be the greatest assistance we can provide to children in our care who have
hearing impairment. Some suggestions for effective communication strategies

include the following.
• Before conversing, direct the child’s attention on you and your face.
• Have the lighting on your face, not in the child’s eyes. Avoid having a
brightly lit window behind you.
• Identify the topic of conversation early. Use props and gestures as necessary.
• Face children when talking with them: in front and not too high and not too
low—and avoid unnecessary movement.
• Don’t exaggerate your speech or lip patterns: exaggerations make you look
silly and make understanding harder, not easier.
• Don’t obscure your mouth with pencils, hands, moustaches etc.
• Use visual aids to support your conversation.
• Speak at a strong normal voice level—that is, at the upper range of your
normal level. This should not cause vocal strain.
• Increase the intonation patterns in your voice—that is, the rise and fall in
pitch—in much the same manner as one does instinctively with very young
children.
• If your voice pitch is naturally very high, try to lower your pitch a little but
not so much that you suffer vocal strain.
• Emphasise the key words in your sentences a little.
• Provide non-verbal cues (e.g. meaningful facial expressions and natural
gestures).
Support children and their families

For many parents, the initial phases following the diagnosis of a disability in
their child are traumatic (see chapter 2). The great majority of children who have
impaired hearing are born to hearing parents, and those hearing parents typically
have as little knowledge of hearing impairment and its effects as the average lay
person. The years following diagnosis can be very stressful as parents acquire
new knowledge and attempt to understand and come to terms with the atypical
needs of their child. Effective counselling for this group requires skilled person-
nel who are also knowledgeable about the impact of childhood hearing
impairment, although early childhood staff can help by providing an empathic
and supportive ear.
Understand that communicating in a hearing-speaking world when one does
neither well can be a tiring and frustrating experience. Young children with
hearing impairment may expend energy faster and tire more readily than their
hearing peers. Where the hearing impairment has resulted in delayed language
and perhaps reduced speech intelligibility, children may have greater than
normal difficulty in interactions with adults and other children. Such difficulty
may result in displays of anger and aggression. These children can be assisted
with social skills interventions (see chapter 11).
HEARING 151
Support children’s mode of communication (speech or sign)

The great majority of children with hearing impairment develop spoken
language skills, although these may be delayed and voice quality (‘naturalness’)
may be affected if the hearing impairment is moderate or greater. A small
number of children need a visual mode of communication to supplement what
they can hear and lip-read. This is a complex field, and determining which
children require a visual mode of communication and which do not is difficult
and often controversial. To complicate matters further, there is a range of sign
languages and sign systems from which to select. There is an extensive literature
on this: a good starting point for further study would be Paul and Quigley (1990).
Assist in the management of hearing aids

If a child in your care has been fitted with hearing aids, find out as much about
the devices as you can. Information can usually be obtained from the child’s
parents or, with parental permission, from the audiologist who fitted the aids.
Modern hearing aids are sophisticated and expensive devices, but their effective
use with young children requires some knowledge and skill on the part of the
adults who care for and communicate with them. This is particularly important,
as hearing aid technology is advancing rapidly, quickly rendering textbook
descriptions obsolete. Nevertheless, the following key features are worth noting.
The primary task of a hearing aid is to pick up wanted sounds, make these
louder, and deliver them to the wearer’s ear. Secondary but important consider-
ations are that the aids be as uncomplicated and unobtrusive as possible. These
two features can be in opposition to each other, in that aids that fit right inside
the ear canal (in contrast to those conventional aids that sit behind the ear)
usually suffer a reduction in amplifying power and increased difficulty of man-
agement for little fingers, making these very small and unobtrusive hearing aids
often unsuitable for young children.
Ear moulds and hearing aids are fitted to each ear individually, so care must
be taken to ensure that these are replaced correctly. The left-ear hearing aid is
unlikely to work well if placed in the right ear, and the ear mould most certainly
will not! Also, hearing aids do not work well with ear moulds blocked with
cerumen (wax) or tubing that is partly filled with water. Moisture in the tubing
can result from perspiration or condensation. It filters out some of the higher fre-
quencies and can even flow into the hearing aid and cause corrosion.
Moisture should be removed using a puffer similar to that used to remove
dust from a camera lens. A caution: putting the end of the tubing into the mouth
and blowing may visibly remove the moisture in the tubing, but when the wet
and warm air from the lungs cools, moisture will be added.
Wax can be removed by washing the mould with warm, soapy water
(avoiding strong detergents), but sometimes the wax is rather hard and difficult
to dissolve. In such cases, it must be picked out without damaging the ear mould.
Scratching with a sharp object such as a piece of wire can create raised edges on
the ear mould which, in turn, can irritate the wearer’s ear. A device with a closed
loop of wire is preferable.
Flat batteries are a major cause of hearing aid malfunction and one that is
readily avoidable. Batteries should be checked regularly using a reliable battery
tester. To check that you know how to operate the tester correctly, test a battery
when it is new to ascertain exactly what the reading should be.
Hearing aids are sophisticated devices but can malfunction, especially if
subjected to rough handling. A regular listening test is highly recommended,
which is best done using a stethoclip, available from medical supply stores,
hearing aid dealers or through the child’s audiologist, who can also show you
how to carry out a listening test effectively and safely.
Conventional hearing aids amplify all sounds that reach the microphone and
work best when a speaker is nearby. However, real-world communication often
involves listening to speakers and other sound sources that are not close by.
Sounds drop in intensity as they travel through the air and may also get ‘mixed
up’ with other, unwanted sounds. This can be a major difficulty for children who
have hearing impairments and has led to the development of various types of FM
hearing aid systems. These typically use a microphone and transmitter worn by
an adult and a receiver unit linked to the child’s hearing aids. FM systems are
highly recommended as an addition to conventional hearing aids for young
children (ASHA 1991), and as stand-alone systems (i.e. without a conventional
hearing aid) for some children with mild hearing impairment (Edwards 1996).
The cochlear implant—sometimes called a bionic ear—is now used with
most children in the developed world who are born with a profound hearing
impairment or acquire such a loss during childhood. This device consists of a
thin wire implanted inside the cochlea (inner ear) and a speech processor worn
by the child. When used in conjunction with a high-quality and ongoing inter-
vention program, the cochlear implant can enable children to use auditory
means to learn and communicate, rather than relying on their vision as they
would if profoundly deaf. This is a rather technical and controversial field, but
Tye-Murray (1992) provides a good starting point to understand some of the
issues.
CONCLUSION
Hearing impairment in childhood can have a major impact on the development

of speech and language, often also affecting later academic and vocational attain-
ment. Time is not a benign factor for young children with impaired hearing and,
although early detection and intervention are widely agreed to be essential, they
are not as yet a reality for most children. Early childhood practitioners can play
an important role in detecting hearing impairment, in modifying the environment
to maximise the children’s hearing, and in making themselves more understand-
ing and skilled communication partners.
HEARING 153
Anonymous (no date) ‘Where do we go from hear?: support to parents of deaf,

hard of hearing children, infant, baby, and newborns’. Retrieved 8 February
2001 from the World Wide Web: http://www.gohear.org/
ASHA (no date) ‘Questions and answers about otitis media, hearing and
language development’. Retrieved 18 August 1999 from the World Wide
Web: http://www.kidsource.com/ASHA/otitis.html
Deslandes, S. and Burnip, L.G. 1995 ‘Choosing an early intervention program
for hearing impaired children’ Australasian Journal of Special Education
vol. 19, no. 2, pp. 54–61
Flexer, C. (ed.) 1994 Facilitating hearing and listening in young children
Singular Press, San Diego, CA
Health Pages 1998 ‘Easing your child’s ear infection’. Retrieved 20 February
2001 from the World Wide Web: http://my.webmd.com/content/dmk/
dmk_article_6462929
Lane, S., Bell, L. and Parson-Tylka, T. 1997 My turn to learn: a communication
guide for parents of deaf or hard of hearing children The Elks Family
Hearing Resource Center, Burnaby, BC, Canada
NIDCD 1997 ‘Otitis media fact sheet’ The National Institute on Deafness and
Other Communication Disorders. Retrieved 20 February 2001 from the
World Wide Web: http://my.webmd.com/content/dmk/dmk_article_4461625
Ross, M. 1991 ‘Hearing aids and systems’ in When your child is deaf: a guide for
parents D.M. Luterman & M. Ross (eds) (pp. 105–36) York, Parkton, MD
9
COMMUNICATION SKILLS
BERNICE BURNIP
KEY POINTS
• Communication refers to the act of exchanging information, ideas, needs

and desires. While speech and language are only part of the larger process
of communication, they do provide the most important and efficient
means for communication by human beings.
• In order to develop typical language skills, infants require a language-rich
environment, with caregivers who communicate often with them and
respond to their initiations of conversation.
• Difficulties with the acquisition of language affect children academically,
socially and personally.
• Intervention for children’s language learning difficulties must be based on
a sound knowledge of normal language development and a detailed
assessment of their language difficulties, with interventions ranging from
naturalistic methods to structured teaching of specific language skills.
INTRODUCTION
Communication plays a central role in human development and behaviour

throughout life. It allows us to express our needs and desires, to exchange infor-
mation and ideas, to learn about the world, and to become social beings. As most
children seem to learn to talk so quickly and effortlessly, the complexity of this
task tends to be taken for granted—that is, until difficulties emerge.
Communication disorders represent one of the most prevalent disabilities in
early childhood and are the single most common reason for special education
referral (Casby 1989, in Warren 2000). An estimated 7% of preschool children
and 2–3% of school-aged children have a specific language impairment that is
not related to another disability, while as many as 15% of school-aged children
154
COMMUNICATION SKILLS 155
have communication disorders with and without other disabilities (Heward 2000;
Shames et al. 1998; Vaughn et al. 2000).
Typically developing children have established a strong foundation in lang-
uage skills by the time they start school. Thus, the critical period for language
acquisition is considered to be before the age of 5 (Chomsky 1957); therefore,
if problems with the development of communication skills exist, it is vitally
important to identify and intervene with these during the preschool years.
Children who have difficulty making themselves understood or who cannot
understand what others say to them are likely to be disadvantaged academically,
socially and personally. Academically, language and/or communication dis-
orders are strongly linked to learning difficulties, particularly in the area of
reading and writing (Aram & Nation 1980). When children have a problem in the
development of language, school readiness will be delayed. Socially, children
with delayed language development have been found to be delayed in their
pretend play (Rescorla & Goossens 1992). Personally, their inability to commu-
nicate effectively may result in their developing alternative and disruptive
behaviours—such as pushing, hitting or yelling—to try to get their meaning
across. In fact, 50% of preschool children with language difficulties have been
observed to have behavioural difficulties (Cantwell & Baker 1987). Alterna-
tively, children with impaired language might seem shy and passive and make
little attempt to initiate conversation. Early identification and intervention are
crucial to preventing these associated difficulties.
THE COMPONENTS OF COMMUNICATION
Communication refers to the act of exchanging information, ideas, needs and

desires (Owens 2001). It involves the organisation and representation of a
thought in a mutually agreed form so that it can be shared with another being.
Communicative competence indicates an ability to convey a message effectively
and appropriately as well as determining how well the message was conveyed
(Dore 1986). Communication comprises many aspects, as depicted in Figure 9.1.
The two broadest categories are non-linguistic (non-verbal) and linguistic
(verbal) communication.
Non-verbal communication
Non-linguistic aspects that contribute to the effect of the spoken message include
facial expression, eye contact, gestures, body posture, head and body movement,
distance from the listener, manual sign, writing, drawing, or representational
symbols (Banbury & Hebert 1992). In face-to-face communication, it is estimated
that up to 60% of the information may be relayed in these non-linguistic ways
(Owens 2001). Given that there are cultural differences in the use of non-linguistic
features, when a signal from one culture is used within another language and
culture the intended meaning of a message may be altered (Cartwright et al. 1995).
Communication
Non-linguistic Language
(non-verbal) (verbal)
• facial expression • content (semantics)
• gestures • form (structure)
• body movement etc. • use (pragmatics)
Expressive language Receptive language

(speech) (comprehension)
Articulation Voice quality Prosody

• Ability to produce • Resonance • Fluency (rate)
speech sounds (nasality) • Intonation (pitch)
(phonemes) • Breathiness • Volume (intensity)
Figure 9.1 The components of communication
Language
The second broad category of communication is verbal or language skills (see
Figure 9.1). Although these skills are only part of the larger process of communi-
cation, they are the most important and efficient means for communication by
human beings.
Language has been defined as ‘a code whereby ideas about the world are
represented through a conventional system of arbitrary signals for communi-
cation’ (Bloom & Lahey 1978). In order to understand atypical communication
skills, it will be useful to explain the complex rule systems of language in terms
of its components: content (meaning or semantics), form (syntax, morphology
and phonology), and use (pragmatics) (Bloom & Lahey 1978).
Content
The content of language is its meaning—what an utterance is referring to or is
about. This is called semantics. Words do not refer directly to an event, object or
relationship, but to a concept which is built up as individuals’ experiences and
perceptions are categorised, organised and related to one another. These concepts
are then stored in semantic memory, which contains word and symbol definitions
and is primarily verbal.
Language form
This refers to the order and form of words. It comprises syntax, morphology and
phonological structure. Taking each of these aspects in turn, syntax is the system
of rules that guides the way sentences are produced and understood. It specifies the
way words are organised or combined within different sentence types, which will
provide more information than the individual symbols themselves. For example,
the words ‘Dog the brown is’ make little sense compared with ‘The dog is brown’,
and their meaning is different again from ‘Is the dog brown?’. The rules for the
combination of words give language an order and allow creative use. An infinite
number of sentences can be created from the limited number of symbols and rules
for combining those symbols (Owens 2001): every day we create sentences that
have never before been produced in exactly the same way by anyone else.
Morphology is concerned with the internal organisation of words. A
morpheme is the smallest unit of meaning in language; it cannot be divided any
further and still remain a meaningful unit. Some morphemes are the content
words of a language (nouns, verbs, adjectives and adverbs) and some serve
grammatical functions in linking the content words (e.g. articles, prepositions
and conjunctions). Some morphemes are grammatical markers, such as ‘ed’ or
‘ing’, and cannot stand alone as words. As children learn morphological and syn-
tactical rules they often make errors in applying these, as in saying ‘I eated my
tea’. The fact that children make such errors suggests that they do not learn the
rules merely by imitating what they hear.
Phonology is the sound system of spoken language. Unlike morphemes,
phonemes do not carry meaning by themselves but are combined in specific
ways to form words. The English language has approximately 45 phonemes,
which are reduced to 26 written letters. For instance, the letter ‘a’ sounds differ-
ent in the words ‘car’, ‘cat’ and ‘caught’. As children acquire the individual
sounds (or phonemes), they must also learn the phonological rules that govern
the sequencing and distribution of phonemes within their language. In terms of
sequencing, they must be able to say ‘animal’ rather than ‘aminal’, for example.
In terms of distribution, English words do not start with /sd/ whereas /st/ is
common. These rules vary between languages, and it is only through experience
with a first language that a child learns which sounds may go with others.
Use (or pragmatics)

This third aspect of language refers to its purpose or function. It is concerned with
how language is used to communicate intent and to gain what is wanted from the
environment. In order to communicate effectively, as well as knowing about form
and content children need to know about social appropriateness, so that they can
use language appropriately in different contexts, depending on the specific topic
of conversation, the situation, the relation of speaker and listener, and so on.
Pragmatic rules relate to both verbal and non-verbal behaviours and include
turn-taking, establishing and maintaining a topic, implementing repair strategies
when the communication is not successful, and terminating a conversation. The
acquisition of these skills begins well before children produce their first words, as
seen in the prelinguistic acts of pointing combined with vocalisation and eye gaze
in attempts to communicate with adults. Children such as those with Asperger
syndrome (see Appendix I) who have not developed these pragmatic skills may
seem very different from other children in their preschool group (Rinaldi 2000).
In summary, these three aspects can be illustrated in a child’s request: ‘Can
we go to the park?’. The content of this utterance refers to a specific place for
recreational activity which, in this case, is likely to have children’s play equip-
ment; its form is a six-word interrogative sentence; and the use or purpose of the
utterance is to go to the park.
Linguistic competence refers to individuals’ underlying knowledge about
this complex system of rules. This knowledge is often intuitive in that users and
listeners might not be able to state the rules but can use them effectively. In
normal conversation this inability is not a problem, as the purpose of language is
to share the information. However, when the speaker is a child who consistently
produces utterances that do not fit the agreed rules, it becomes necessary for
adult listeners to identify the problem, which requires more than an intuitive
knowledge of the rules of language.
Comprehension (receptive language)

Children understand some of the language around them well before they produce
their first words. The repetitiveness of daily routines and their accompanying
verbal and non-verbal exchanges with caregivers allows children to develop an
understanding of some of the words that are used in those contexts. Before
producing their first word at around 10 months, infants typically understand
approximately 10 words heard in context and may understand 50 words by
13 months of age, even though they do not produce their first 50 words until about
18 months (Benedict 1977). Throughout life, receptive language skills continue
to exceed expressive language skills: even adults understand many more words
and language structures than we typically use in our spoken language.
Speech (expressive language)

Speech involves the use of an auditory-articulatory code to represent spoken
language. It is the actual mechanical act of producing phonemes (that is, sounds)
within a language. Unless the speaker and listener share the code, speech is a
series of meaningless sounds. The speakers of any language have agreed on the
symbols that will be used and the rules that will be followed when combining
those symbols. Languages are continually changing, with new words being
added and others falling into disuse.
Speech comprises three key aspects:
• Articulation. The production of the specific sounds (phonemes) and sound
combinations of a language is one of the more complex and difficult human
endeavours, requiring precise neuromuscular coordination. The unique
structure of the human vocal tract allows the production of a variety and
complexity of sounds that cannot be matched by any other species (Owens
2001). Box 9.1 details the typical sequence of the production of consonants.
• Voice quality (comprising resonance and breathiness).
• Prosody (comprising rate, intonation and volume).
The last two aspects are the ‘paralinguistic’ aspects of communication, and
enhance the meaning of a message by signalling the speaker’s attitude. For
example, a fast rate of production often indicates excitement, whereas slow,
hesitating speech may accompany a difficult or upsetting topic of conversation.
FACILITATORS OF LANGUAGE ACQUISITION
Children have a need to communicate long before they have the ability to use lan-
guage. They begin to communicate so that they can achieve something. This may
be to meet a need, such as to assuage hunger, reduce discomfort or gain attention.
Most importantly, language provides children with a means of controlling their
environment.
Although parents usually consider the appearance of their child’s first word
as the beginning of language, there has actually been much meaningful
communication between parent and child prior to that event. Children’s under-
standing or receptive language skills thus exceed their production or expressive
language skills.
For infants to develop typical language skills, they require a reasonably
stimulating environment, with reasonably verbal caregivers who provide a reason-
ably warm and caring atmosphere and who communicate reasonably often with
the infants. This will result in an internalised language system which will provide
the foundation of the children’s receptive and expressive language in early child-
hood as well as the base for subsequent literacy skills and academic achievement
(Quigley & Kretschmer 1982). Note that the word ‘reasonably’ is used to empha-
sise that, for typically developing children, some disruptions in the process can
take place without resulting in serious language delay.
In many cultures, including English-speaking ones, there is an expectation
that babies will communicate from the earliest age. In fact, many parents talk to
the fetus in-utero, as if their baby can understand. But such passive exposure
to communication is not sufficient for the development of language: meaningful
communicative interaction with a mature language user is essential.
Initially, the prosodic elements of language are more important than the
words as in the early stages words do not have meaning for infants. Rather it is
the aspects of speech such as pitch, intonation patterns and variation in intensity
that engage infants in a meaningful way.
Adult input is extremely important to children’s understanding of the
meaning of words—that is, their semantic development. An understanding of
words gradually develops as infants become able to attach meaning to often-
repeated phrases that occur in routine happenings. They learn the meanings of
Box 9.1 Typical sequence of the production of consonants in

Australian English
Consonants Typical age of Comments
accurate production
p, b, m, n By 21/2 years Infants’ suckling (moving their
tongue in and out of their mouth
while drinking milk) and later
sucking (moving the tongue
within the mouth during spoon
feeding) facilitate lip control.
Thus sounds made with the lips
are the earliest to be produced,
followed by those that rely on
tongue control. Munching and
chewing of solid foods teach jaw
control and stablisation, paving
the way for the production of the
remaining speech sounds.
h, w, t, d By 3 years By this age, children’s speech

should be easy to understand
around 80–90% of the time.
g, k, y By 31/2 years This group of sounds tend to

develop at a slightly earlier age
in girls compared with boys.
f, sh, ch, /dg/ (as By 4 years + The consonant blends and

in treasure), bl, fl, clusters may begin to appear
sl, sn, st, kr, gr, as early as 4 years of age but
sm, str the full range of clusters are not
acquired until the ages of 7 or
8 years.
l, z, v, s By 5 years + These fricatives and the liquid l

develop gradually. Although z
and v tend to be acquired a little
later, some children may
produce these sounds as early
as 3 years of age.
th (voiced as By 7 years Until this age, children typically

in ‘thumb’ and continue to use w instead of r
unvoiced as in (e.g. ‘wabbit’ instead of
‘father’), r ‘rabbit’).
Source: adapted from Kilminster and Laird (1978).

nouns by looking at or touching an object being named, while to learn the

meaning of verbs, activities must be described as these are happening. Having
thus acquired new words, children need subsequent opportunities to experiment
with their use (Cook et al. 2000).
The first 50 spoken words develop fairly slowly. When children often
interact with adults, these early words will usually comprise nouns (e.g. the
names of toys, clothes or food) with which the children can interact in some way,
in contrast with objects such as a tree or a house which they cannot manipulate
(see Box 9.2). When they interact often with other children, social words (‘hi’ or
‘bye’) can predominate (Nelson 1973). Nonetheless, children’s initial vocabu-
laries are very similar despite differences in environment and upbringing
(Gleason 1985; Slobin 1966).
Once children can produce 50 words the expansion of their expressive
vocabulary progresses at a much faster rate, with between two and four words
being added to their lexicon each day. By the age of 5 years, children will be able
to use at least 2000 words.
Similarly, once children have an expressive vocabulary of about 50 words,
the length of their utterances grows. The emergence of two-word utterances
marks the beginning of the interaction between semantics and syntax. By the age
of 5, typically developing children will have acquired a complex syntactic
system similar to that of an adult, combined with an extensive vocabulary that
will be further expanded and refined throughout life (see also Appendix II).
Communications between young children and their caregivers that focus
on the development of turn-taking, topicalisation and sustained reciprocal
Box 9.2 Children’s first 50 words

Nouns, or naming words, comprise at least 60% of the first 50 words, with
action words, or verbs, comprising perhaps 20%. Modifiers and personal-
social words make up the other 20%. As can be seen in the list below, the
same word can fit into different categories depending on the child’s purpose.
Naming words (nouns) Action words (verbs)
Mummy do
Daddy more
Nana up
Car all gone
Milk hi
Doggie no
Modifiers Personal-social
no please
yukkie bye-bye
hot yes
all gone no
nite-nite
want
conversational exchanges enable children to learn the underlying organisation of

conversation as used by adults for social purposes (Bruner 1975; Kretschmer &
Kretschmer 1999; McLean & Snyder-McLean 1999). Box 9.3 outlines the inter-
action styles that adults typically use to teach infants language. These early
social communicative interactions provide the foundations for the development
of socially appropriate discourse and language patterns: they help very young
children learn how to communicate.
Box 9.3 Communication styles that foster language acquisition

From birth, infants vocalise and move reflexively. Although these behaviours
are not under conscious control of babies, adults nevertheless interpret them
as meaningful communication and respond as if the infants were communi-
cating. They leave pauses between their utterances, giving children an
opportunity to take their turn in the conversation.
Adults will then behave as if infants had taken their turn and respond
accordingly. For instance, in response to an infant’s agitated movements and
hungry cry, the mother says ‘Oh! Are you hungry?’ (pause) ‘Okay, here’s your
bottle’.
Later, parents will focus more on their infants’ vocalisations so that by
the time infants are about 10 months old caregivers and infants engage in
what are termed ‘proto-conversations’. These occur when infants produce a
vocalisation to which the caregiver responds and which prompts interactions
that can last for many minutes. These exchanges are related to a topic—that
is, a task or object of interest to both infants and their caregiver. Although ini-
tially the topics are drawn from the immediate environment, these gradually
extend to events or objects that are less immediate. Even then, it is infants who
draw attention to the potential topic, as when attending to the other parent’s
voice in a nearby room. The caregiver will then talk about the ‘voice’ and
perhaps take the child to its source.
‘Motherese’ (also known as ‘parentese’ or ‘infant elicited behaviour’) is a
form of language which adults reserve for talking with young children. In this
pattern, adults’ speech is usually:
• enunciated clearly and slowly;
• with emphasis placed on important words;
• with varied pitch and intonation;
• with clear pauses between utterances.
Conversation with young children is usually about the ‘here and now’ and
involves objects that the children can see, so that they are able to interpret
what the words are referring to. A limited number of words is used and
adults will repeat the important words over and over again in subsequent
utterances, thus encouraging children to attach meaning to the words. For
example, an adult might draw an infant’s attention to a brightly coloured ball,
saying, ‘Oooh! I see the ball’ (pause) . . . ‘Can you see the ball?’ (pause) . . .
‘Roll the ball . . . Uh oh! Where’s the ball gone?’ (pause) . . . ‘Here it is! The ball
went under the chair.’
Finally, children need feedback about the effectiveness of their language use.
As infants begin to use gesture or voice in an intentional way, appropriate adult
response is vital. Children use language for a purpose, and therefore adults must
respond positively to children’s early attempts at communication so that they
continue to use and develop language.
CAUSES OF ATYPICAL LANGUAGE DEVELOPMENT
Children can be at risk of communication disorders as a result of environmental

events such as neglect, abuse or poor-quality interactions with caregivers, and from
biological causes such as genetically transmitted disabilities, trauma, toxins, infec-
tions, poor nutrition, drug exposure, anoxia or asphyxia at birth, and low birth
weight (Lerner et al. 1998; McCormick 1994; Wetherby 1998) (see Appendix I).
Such events may result in disability in the areas of hearing, vision or cognition, all
of which are associated with communication difficulties. These disabilities are
explained in other chapters of this text, and so will be discussed only briefly here.
Hearing impairment
Hearing is of greatest importance to the development of spoken language, and
therefore any degree of hearing loss in the early years can be detrimental to
language development (see chapter 8). In turn, as language development is so
intricately linked to academic achievement, critical thinking, and social and
emotional development, hearing impairment can detrimentally affect all these
other aspects of life (Greenberg & Kusche 1993).
Vision impairment
Although vision is not as important to language development as hearing, signifi-
cant vision impairment in early childhood can affect four key aspects of language
development. First, infants who cannot see cannot follow others’ gaze, and do not
appreciate that their parents can see, and so do not use gestures to draw adults’
attention to, and subsequently converse about, an object that interests either
partner. This lack of ‘joint referencing’ by parents and infants delays the children’s
ability to build vocabulary and to categorise and organise their concepts.
Second, children may repeat words or phrases in an ‘echolalic’ way because
they do not understand their meaning or because they are using language to
maintain a degree of social contact that, for normally sighted children, is
achieved by non-verbal means. Similarly, children with vision impairment can
make much use of questioning in an attempt to understand their environment as
well as to maintain social contact. However, their questions are not always
relevant to what is actually taking place (Palmer 1998; White & Telec 1998).
Third, vision impairment can restrict infants’ ability to imitate mouth move-
ments, resulting in some delays in their speech. Finally, vision impairment can
affect the development of pragmatic skills because the children cannot see the
non-verbal aspects of language use. Inappropriate use or lack of gesture by
children can make their communicative attempts harder to understand, which in
turn will affect the quality of their interactions with others. (For more detail on
vision impairment, see chapter 5.)
Intellectual skills
Children with intellectual delays usually develop language at a slower rate and
with less complexity than their peers. Impaired intellectual development is likely
to be associated with impaired memory, which in turn has a significant role in
language acquisition. Children with mild and moderate intellectual delays
require language stimulation based on their developmental level rather than their
chronological age so that they can develop language in the normal way, albeit at
a slower rate. Children with severe cognitive delays may require augmentative
communication systems, such as manual sign or visual symbols, to enable them
to develop functional language. Nevertheless, the decision to use signed com-
munication must be made on an individual basis as, for some children, having to
learn verbal communication and a signing system results in their learning neither
one; for others, having access to some signs takes the pressure off their produc-
tion of speech, allowing language to develop.
In contrast, intellectually gifted children may begin to say their first words at
an earlier age than usual. They are likely to develop a larger and more complex
vocabulary and use more complex sentence structures than their peers (Lewis &
Louis 1991; Perleth et al. 1993). Gifted children’s precocious comprehension of
language allows them to follow more complex instructions, modify their language
use to suit the listener, and use language to exchange and manipulate ideas and
information at a younger age than is typical (Porter 1999). They are able to use
language in a more abstract way, rather than being restricted to the ‘here and
now’. These advanced communication skills allow them to express their needs,
ask questions and understand adult explanations from an earlier age than usual.
Oral-motor skills
Children with feeding difficulties—perhaps associated with cerebral palsy,
Prader-Willi syndrome or other disabilities affecting their swallowing reflex or
tone and control of their oral muscles—can later have particular difficulties with
articulation skills, rendering their speech unclear to listeners. (This issue is
discussed in chapter 7.)
COMMUNICATION DISORDERS
Although there appears to be uniformity in the pattern of language development

for children learning the same language, there is actually much individual variation
in both the pattern and rate of development. Children do not always conform to
developmental norms, with some being advanced, some delayed, and some devel-
oping language in an unusual sequence (Heward 2000). However, when the
deviation from the norm is too extreme, children will experience difficulty under-
standing language, making themselves understood, or both, with resulting social
and educational problems.
A difference in communication is considered to be a communication
disorder when the ability to receive, send or process information is impaired
and/or when the ability to comprehend concepts or verbal, non-verbal or graphic
systems is impaired (American Speech-Language-Hearing Association 1982).
Communication disorder is categorised further into speech disorders and
language disorders.
Speech is considered to be disordered when it is so unusual that it draws
attention to itself, interferes with communication, or causes discomfort for the
listener. Speech disorders can occur in articulation, voice quality and prosody
(fluency, intonation and volume) (see Figure 9.1), with articulation problems
being the most prevalent type in preschool children (Heward 2000). The
common articulation errors include:
• substitution of one sound for another (e.g. ‘dat’ for ‘that’);
• distortion of certain speech sounds (e.g ‘shame’ for ‘same’, or a lisp);
• omission of certain sounds (e.g. ‘kool’ for ‘school’);
• addition of sounds (e.g. ‘hamber’ for ‘hammer’).
It is quite normal for preschool children to exhibit these types of speech errors,
and in most cases they disappear as the children get older. However, if articu-
lation problems do not improve or are causing difficulties in interactions with
others, the children should be referred to a speech-language pathologist.
Voice disorders may take the form of a breathy, hoarse, husky or strained
voice. There may also be a problem with resonance, where sounds either come out
through the nose (hypernasality) or not enough sound comes through the nose, as
if the speaker has a cold (hyponasality). Voice disorders are much more common
in adults than children, although they can result in children from organic con-
ditions—such as hearing impairment, cleft palate or swollen nasal tissues.
Fluency disorders occur when the normal rhythm and timing of speech are
disrupted. Stuttering is an example of a fluency problem and occurs when sounds
are repeated over and over again, usually at the beginning of words. In the course
of developing normal speech patterns, most young children stutter at some stage
and in certain situations. When adults accept these dysfluencies (repetitions and
interruptions) in a patient manner and focus on the content of the children’s
message rather than the delivery, the children are unlikely to develop a fluency
problem. However, as with any speech disorder, if their ability to communicate
with others is impaired, early referral to a speech-language pathologist is crucial.
Language is considered to be disordered when children have difficulty in
comprehending and/or using spoken, written and/or other symbol systems. The
disorder can involve the content, form or use of language (ASHA 1982). Where
children have difficulty understanding an aspect of language—such as being

unable follow a sequence of commands—they have a receptive language
disorder. Children with expressive language disorders may have difficulty with,
among other things, the sequencing of sounds in words (e.g. ‘aminal’ for ‘animal’,
‘psgetti’ for ‘spaghetti’); may have a limited vocabulary for their age; or they may
have difficulty in applying the morphological rules correctly (e.g. ‘I wented out’).
The terms specific language impairment (SLI) or specific developmental
language disorder (SDLD) are used when there are no other apparent causes for
children’s language difficulties, such as sensory or intellectual disability
(Leonard 1990).
LANGUAGE DELAY
Whereas a language disorder is characterised by a problem in one or more aspect

of language (i.e. content, form or use), children with language delays show delay
in the acquisition of all aspects of language. They seem to be following the normal
progression but at a slower rate, and the expectation may be that they will eventu-
ally ‘catch up’ without specialist intervention. However, as children get older this
distinction between language disorder and language delay becomes less relevant,
because any children using language that is appropriate for much younger ages will
need specialist intervention if they are to catch up to their peers (Rinaldi 2000).
When children aged under 3 acquire two languages simultaneously, their rate
and manner of development is similar to those who are learning only one language
(Owens 2001). Commonly, however, many bilingual children develop their first
language in the home and their second language after the age of 3 in early child-
hood settings. If they are exposed to their second language before they have
developed some maturity in their first language, temporary delays in both may
occur, which will be overcome naturally through the provision of rich opportuni-
ties to learn language during sensory activities and in meaningful contexts.
However, when children with certain intellectual or language disabilities are
required to learn more than one language simultaneously, they might have great
difficulty becoming proficient in any. In these exceptional cases, it may be nec-
essary to limit them to one language at a time. This can involve negotiating with
the family to use the language of the educational setting at home when com-
municating with the child. Although initially at least this can limit the child’s use
of the family’s native language, it can help the child to access education. Sub-
sequently, if the child is able to become reasonably proficient in the language of
the educational setting, he or she can then learn the language of home in the same
way as other children who are bilingual.
ASSESSMENT
All development progresses in uneven steps, which is one of the reasons that
assessment of language problems in the preschool years is so challenging.
Another reason is that it is difficult to distinguish whether communication is

children’s only affected domain, or whether their language difficulties are just
one feature of another condition such as autism or intellectual disability.
The indicators of speech or language impairments given in Box 9.4 can alert
you to the need to discuss with parents their child’s language skills; if there is
still concern, recommend an assessment by a speech-language pathologist.
Speech-language pathology assessments

Intervention should be based on a comprehensive assessment of children’s
language and other skills, based on a sound understanding of the typical develop-
mental sequences in content, form and use of language. An interdisciplinary
assessment is required to discriminate whether children’s language difficulties
stand alone or are part of more generalised developmental difficulties such as
the autism spectrum disorders or developmental delay or disability. With this
in mind, children are often referred to a psychologist for a generalised test of
development, while those whose language difficulties are associated with
sensory or other disabilities will be referred to specialists in these domains. A
comprehensive evaluation will normally include tests of hearing, auditory dis-
crimination, articulation and vocabulary development, as well as samples of the
children’s communication behaviour in various settings.
INTERVENTION
When an assessment of children’s language abilities indicates delays in some

areas, some form of language intervention must be implemented. The assessment
information should indicate the children’s strengths, emerging language skills
and areas of difficulty. Following from this, as mentioned in chapter 4, priorities
for intervention will be selected in light of the normal developmental sequence,
tempered with ecological information about which skills will be most functional
for the children in their present and future environments and which will make the
most difference to the quality of life for them and their families.
All adults involved with children’s language programs should be aware of
the current priorities and strategies to be used to elicit the language, and be
able to use everyday occurrences to encourage the use of the language skills
that the children need to acquire. To that end, it is extremely important that
adults who are assisting children with language difficulties have a good under-
standing of the normal sequence of development (see Appendix II), the
components of language, and a shared ‘language to talk about language diffi-
culties’ (Martin 2000:28). Effective intervention should be implemented early
and carefully monitored so that strategies can be adjusted according to the
children’s progress.
Box 9.4 Indicators of speech or language impairments

• The most obvious signs of language acquisition problems are delays in the
number and type of words in children’s vocabulary. At an age when you
would expect more sophisticated vocabulary, children with language
impairments might use only a few nouns and social greetings, with few
other word forms. (This is an impairment of content.)
• Children’s speech might be echolalic—that is, they repeat part or all of what
has just been said to them. Although when communicating together
children and adults commonly repeat what they have heard to signal their
understanding, children’s echolalia can occur because they have learned
that it satisfies their communication partner and so will end an uncomfort-
able communication, or as an attempt to disguise the fact that they have not
understood. (This indicates a problem with pragmatics.)
• Children might repeat questions over and over again, not appreciating that
these have been answered. (This signals a problem with pragmatics and
semantics.)
• Some children fixate on one particular topic of conversation, introducing it
even when others are already conversing about another. Others change
topic within a conversation, perhaps using a key word uttered by an adult
to spark a flight into an unrelated topic. For instance, an adult might
comment that one of the building blocks is light and the child might use this
as a trigger to introduce his or her favourite topic of Superman, saying
‘Superman is light. He can fly’. (This suggests a problem with pragmatics.)
• Some children cannot detect that communication has broken down and so
do not use language to repair it or to solve social problems. (This is charac-
teristic of difficulties with pragmatics.)
• Children might say the same thing in the same circumstance, such as asking
‘Where we going?’ when in a car, without understanding the meaning of what
they are saying. The relevance of the utterance to that particular context can
deceive adults into thinking that the children understand, when instead the
children simply know that this is the thing to say in these circumstances.
(This indicates a problem with semantics—or meaning—of language.)
• Children might often make physical contact with other children because
they do not have ready access to their words to greet others, make requests
or negotiate. This can result in antisocial touching, snatching at items over
which they are competing, and aggression. (This suggests a problem with
semantics and pragmatics.)
• Children can be inattentive during language-based sessions such as song or
story time, particularly when the content is relatively advanced for their
language age. (This suggests a problem with language form and semantics.)
• They might attempt to participate in song sessions, but have to watch the
other children’s gestures to know what they are supposed to be doing, and
might sing very few of the words. (This suggests a problem with phonol-
ogy, syntax and semantics.)
• Some children might have difficulty following instructions that contain many
parts. For example, when asked to put their car on the bookshelf and come
back with a book and sit down, they might move over to the bookshelf and
• apparently forget what they were there for. This can appear to be a lack of
cooperation and so is seen to be a behavioural issue, but results instead
from their inability to remember the instructions. (This indicates a problem
with syntax and semantics.)
• Some children have difficulty finding the words to express their ideas when
age mates are doing so more automatically. (This relates to difficulties with
semantics.)
• In comparison to their age mates, some children might have difficulty
forming grammatical sentences, such as being unable to form questions
or use pronouns accurately, as when continuing the use of ‘Me do it’ past
toddlerhood. (This indicates a problem with syntax.)
• Some children can use language to communicate about the ‘here and now’
but cannot use it for a variety of purposes—such as to tell about an event,
to gain attention or to make a request. (This relates to difficulties of both
semantics and pragmatics.)
• Some children continue to use immature word endings: as in, ‘He wented
out’ or ‘I breaked it’. (This indicates a problem with morphology.)
• Some children have difficulty producing speech sounds well beyond the
age at which they are normally produced. This can result in ‘babyish’-
sounding speech, for example ‘I fought we were doing out’ instead of
‘I thought we were going out’. (This indicates a problem with phonology.)
• Some children have difficulties acquiring independence skills, such as toilet-
ing, because they do not have the language to talk to themselves about the
need to go to the toilet; they can have difficulty putting away toys as they
cannot categorise them and plan where they belong; they can be impulsive,
as their lack of self-talk means that they do not guide (think about) their
actions in advance. All of these can surface as behavioural difficulties but
can have a general expressive language problem as their basis.
Provide a language-rich environment

An environment that is rich in language experiences will give children repeated
exposure to a range of language forms in multiple natural settings and ensure that
children’s communication is purposeful (McCormick & Schiefelbusch 1990).
Early childhood settings can provide children with many natural reasons to com-
municate, thus allowing them to associate language with the context to which it
relates.
Incorporate play into language learning

Keep in mind that children learn to communicate because they have a need to and
because they want to, not because someone makes them. This means that play must
be an integral feature of children’s language programs. Peer interaction through
play allows children to use the various types of language according to the roles
assumed during play. Adults can assist children to engage in and elaborate on play
in the ways suggested in chapter 4, keeping in mind that high levels of adult direc-
tiveness can reduce the complexity of children’s pretend play (Fiese 1990).
Be a responsive communication partner

Language learning normally occurs in the pleasant, caring interactions between
caregivers and children. Thus, any attempt to teach language is likely to fail unless
the children enjoy the interaction in which the teaching is embedded. Communi-
cation will be enhanced when adults accept and respond to children’s
communication attempts, including paying attention to their initiations of conver-
sation and verbally and non-verbally expressing acceptance of their attempts.
Through this acceptance children learn that communication is reciprocal. Adults can
also initiate and elaborate conversations with children using the following means.
• Talk with children about objects and events to which you are both attending.
• Model, imitate and expand children’s intended or actual communicative
attempts.
• Repeat and clarify any aspect of the language that individual children do not
seem to understand.
• Use higher pitch and stress—typical of ‘parentese’—to highlight important
sentence elements for listening children (McCormick 1994).
However, although frequent interaction with responsive communication partners
is a necessary condition for language development, it does not ensure develop-
ment in all cases. This fact necessitates some more deliberate interventions.
Adjust the complexity of language

When children’s comprehension of language is delayed, the language content of
stories and song sessions may need to be simplified so that children are able to par-
ticipate at their level. If the language is too advanced for their comprehension, they
will become bored and frustrated and will not benefit from the language activities.
In contrast, when children have advanced language skills, they will seek
sophisticated language experiences. Verbally gifted children may come to rely on
adults as their communication partners if their age mates are not able to converse
with them about sophisticated concepts. Placing these children with older play-
mates for at least some of their day can allow them to converse and play with
intellectually matched peers, so that they do not become reliant on adults and can
learn to accept peers as potentially rewarding companions.
Use naturalistic interventions

The least intrusive form of naturalistic intervention is to respond to children’s
spontaneous language use. Giving their communication your attention and fol-
lowing it with a response or action that reflects their communicative intent is vital
(McCormick 1994). Nevertheless, it is not sufficient just to wait for naturally
occurring opportunities; thus, at the next level of naturalistic intervention, edu-

cators can structure situations so that specific language is elicited and practised.
At the last, most formal level of naturalistic teaching, educators can focus on
children’s specific language difficulties. For instance, if individual children’s
morphological development is found to be delayed with ‘ed’ or ‘s’ endings being
omitted, educators could ensure that many examples of these morphemes are
provided in a salient way throughout their program, as well as prompting and
modelling their use.
Nevertheless, as children with language difficulties have not developed typical
skills under normal language learning conditions, many will also require some
specific, targeted intervention as well as this more general naturalistic approach.
Provide structured teaching as necessary

While intervention strategies are best placed in children’s natural settings, the
importance of one-on-one direct instruction in a setting conducive to learning
cannot be overlooked. The provision of specific, targeted interventions is justi-
fied on the grounds that children have already experienced a normal language
environment during their early years but nevertheless have not managed to
acquire language as expected. In that case, providing more of the same experi-
ence is unlikely to be sufficient to develop their skills.
Thus, in order to progress, some young children—and particularly those
who have sensory or intellectual disabilities accompanying their language diffi-
culties—may need specific language elicitation techniques (Yoder et al. 1998).
These may include the use of prompts and feedback, quick repetition of target
skills, ongoing diagnostic assessment of learning, and daily one-on-one sessions
so that they receive intervention of sufficient intensity to ensure optimal progress
(Warren 2000).
Chapter 10 mentions that, when teaching children new thinking processes, it
helps to apply these to content with which the children are already familiar. The
same applies to teaching new language skills: children need to develop new
information in the context of known information. For instance, a new sentence
structure should be introduced using known vocabulary and experiences so that
the children are able to understand and classify this new piece of knowledge.
Similarly, new words are best introduced in relation to known words so that these
can also be categorised on the basis of known information. Other general strate-
gies are listed in Box 9.5.
Provide early literacy experiences

The ability to identify and manipulate the sounds (phonemes) in words is called
phonological awareness. When activities that emphasise the sounds of language
are integrated into the preschool program, there is a greater likelihood of children
becoming successful readers in their second year of schooling (Bryant & Bradley
1990). Furthermore, children who are good readers become even better readers,
Box 9.5 Strategies for teaching language skills

• Give priority to skills that are relevant to children’s everyday communicative
needs.
• Give children with language difficulties extra opportunities to practise newly
acquired skills across meaningful settings, including home, care or edu-
cation settings, and the community.
• Before giving an instruction, ensure that the children are attending.
• Check that they have understood by requiring a verbal or behavioural
response.
• Allow extra time for the children to respond as it may take them longer to
process information.
• Keep directives short and simple.
• When children have not understood, repeat a directive but modify it by sim-
plifying its vocabulary, sentence structure or number of parts or elements.
• Be alert to naturally occurring events that provide opportunities to introduce
a new concept or to consolidate a skill being acquired.
• Accept and acknowledge children’s attempts at initiations or responding.
Model, expand or extend these as appropriate.
• Aim for productivity rather than perfect mastery. It is enough that children
can produce the target skill on 60% of occasions, as they will continue
to improve in natural interactions without the need for continued direct
intervention.
whereas those who are poor readers are likely to fall even further behind
(Stanovich 1986).
A language-rich environment promotes children’s phonological awareness
and thus their reading skills through, among other things, their participation in
nursery rhymes, finger plays and stories that are read aloud, developing picture
charts and books that describe children’s first-hand experiences, and encourag-
ing story telling. Such activities can include identifying rhyme patterns and
alliteration (as in ‘There’s a mouse in my house’ or ‘Peter Piper picked a peck of
pickled peppers’), recognising isolated sounds (as in the ‘ssss’ for a snake
sound), and counting or clapping syllables (e.g. Pe - ter) or sounds in words (e.g.
d-o-g ). (See the Additional resources section.)
This naturalistic teaching might seem insufficiently formalised, but literacy
learning can be likened to an iceberg: most of the learning occurs in hidden or
natural ways, with formalised learning, although more observable, being respon-
sible for the smallest proportion of children’s literacy skills (Miller 2000). Even
those verbally gifted children who are interested early in literacy—and only a
minority of these children are (Perleth et al. 1993)—require early reading and
writing to be introduced in naturalistic rather than formalised ways so that their
disposition to keep learning is not impaired by finding literacy activities mean-
ingless, too abstract, or too challenging.
CONCLUSION
Language does not develop in a linear way: children progress unevenly within
and across developmental domains—and at times seem to plateau. Intervention
must take this variability into account and be sensitive to children’s individual-
ity. At the same time, we cannot fail to provide support when children clearly are
not acquiring the language skills that they need to function in everyday life.
Caregivers must be aware of the vital role that they have in facilitating the
language development of all young children and referring these children for spe-
cialist help if naturalistic methods are not progressing their skills as expected.
Owens, R.E. 1999 Language disorders: a functional approach to assessment and

intervention 3rd edn, Allyn & Bacon, Boston, MA
——2001 Language development: an introduction Allyn & Bacon, Needham
Heights, MA
The following internet sites might also prove useful:

How Now Brown Cow: Phoneme Awareness Activities for Collaborative Class-
rooms
http://www.ldonline.org/ld_indepth/teaching_techniques/cld_hownow.html
www.asha.org/speech/development/Parent-Stim-Activities.cfm
www.asha.org/speech/development/Pragmatic-Language-Tips.cfm
www.ldonline.org/bulletin_boards/index.html
members.tripod.com/Caroline_Bowen/acquisition.html
members.tripod.com/Caroline_Bowen/encourage.html
members.tripod.com/Caroline_Bowen/wordretrieval.html
www.angelfire.com/nj/speechlanguage/Articles.html
www.speechteach.co.uk
10
COGNITIVE SKILLS
LOUISE PORTER
KEY POINTS
• As well as acquiring information as they develop, children need to acquire

skills for managing how they learn.
• As children near school entry age, their main intellectual task is the acqui-
sition of learning skills. It is principally their facility with these that
distinguishes advanced, average and delayed learners from each other.
• These skills comprise the knowledge acquisition skills of attending and
recalling information; metacognitive knowledge to plan, check and solve
problems; the metacognitive controlling skills of self-monitoring, self-
instructing and self-evaluation; and aspects of learning style or dispositions
such as motivation and self-efficacy.
INTRODUCTION
Cognitive development entails acquiring understanding about the world in which

we live (Lutz & Sternberg 1999). The processes involved in achieving such
understanding comprise mental activities such as conceiving, reasoning, storing
and retrieving information from memory, and attending to stimuli (Wolery &
Wolery 1992). These abilities are known as knowledge acquisition and meta-
cognitive abilities, the latter having to do with managing thinking.
In this chapter I review what information processing theory can tell us about
young children’s learning processes. This focus is selected because it has specific
implications for intervention. The measures described for promoting intellectual
development of children with additional needs is built on the concept that, for
this group in particular, learning cannot be left to chance (Umansky 1998).
Although early childhood programs can supply the materials that provide curricu-
lar content, children with disabilities are best served by structured teaching of the
processes involved in learning that content.
174
COGNITIVE SKILLS 175
EARLY COGNITIVE ATTAINMENTS
Acquiring the following cognitive skills is important during the first five years
(Chen & Siegler 2000; Cook et al. 2000). Achievement of these relies on
accurate perception—that is, the ability to assign meaning to sensations—plus
intact sensory and motor systems and language skills (Umansky 1998).
Intentionality
Around the age of 8–10 months, infants are able to do things intentionally rather
than by chance. Infants learn that they can act voluntarily, and that their actions
will have an effect. This is a prerequisite for almost every other skill (Cook et al.
2000). Babies who have an intention—for example, to reach for an object—but
cannot achieve this will find it difficult to learn intentionality. This could explain
the passive learning style of some children born with physical disabilities. These
children might learn that there is little point being curious when they cannot
move themselves to explore the item that has engaged their interest.
This potential for acquiring a passive learning style makes it doubly impor-
tant to facilitate children’s development of intentionality. Some means of doing
so are suggested by Cook et al. (2000):
• Increase motivation by making objects and activities interesting to the
children.
• Create a need to act: by placing an object within sight but where the infant
must reach for it; by stopping an enjoyable activity and waiting for the child
to indicate a wish for it to start again; by interpreting even accidental move-
ments as signals of intent; and by ensuring that children can activate
favourite toys.
• Allow ample time for children to act and let them do things for themselves
when they are able.
Systematic exploration
Young infants’ exploration is based on trial and error, but once they are able to
manipulate objects and their own actions systematically they become capable of
self-directed learning and of discovering new ideas for themselves (Cook et al.
2000). To assist in this process, you can guide them to explore solutions and
persist at activities until they are successful.
Cause–effect understanding
The ability to explain why an event has happened or will happen is crucial to the
subsequent development of problem-solving skills and intentionality. To learn
this, children must be allowed to experiment safely so that their explorations
teach them the effect of their actions. As well as offering opportunities for them
to discover information for themselves, some ways to enhance this learning are
to copy their actions in the typical mimicking game which involves your turn, my
turn, and by responding to their social cues. This may be difficult when their cues
are atypical, such as a blind child’s not looking in your direction to gain social
contact.
Object permanence
Learning about object permanence is crucial to the development of memory and
to being able to predict not only the presence of objects and people but also their
behaviour (Wolery & Wolery 1992). This in turn promotes exploration. Games
that demonstrate that an object is present even if unseen can teach this concept.
Deferred imitation
While young children may be able to imitate an activity simultaneously or
immediately after it has been carried out, their later ability to defer imitation is
necessary for pretend play and language development.
Means–end analysis
Means–end analysis involves being able to assess the present situation, envisage
a goal, and plan an appropriate strategy to move from the first to the second
(Chen & Siegler 2000). This ability is present by the end of the first year of life
and is crucial to the subsequent development of more sophisticated problem-
solving skills.
Symbolic representation
Symbolic play reflects children’s understanding of the world and (as discussed
in chapter 1) is important for social and emotional development. The first stage
of symbolic play is where the children are the actors in very familiar activities,
such as shopping or going to bed. Children with disabilities may need to be
assisted to engage in these activities, although this will help their development
of symbolic play only if the chosen activities are very familiar to them.
The above represent the earliest intellectual attainments of infants. Sub-
sequently, children develop logical thought, which entails the abilities to use
previous experience to make decisions and solve problems, and to transfer solu-
tions from one problem to another (Chen & Siegler 2000; Umansky 1998). To
achieve this, children need sophisticated skills for acquiring and retaining new
knowledge and to control their thinking processes (termed metacognitive skills),
and a set of dispositions or style of learning that will enable them to learn. The
remainder of this chapter describes these three processes, which dictate how
children learn.
KNOWLEDGE ACQUISITION SKILLS
Knowledge acquisition is an active process. Children who have intellectual dis-

abilities tend to be more passive than typically developing children in learning
situations, and are more dependent on others for guidance (Whitman et al. 1991).
In comparison, children who are developmentally advanced play an active role
in eliciting stimulation from their physical and social environments (Damiani
1997; Morelock & Morrison 1996). They can deal with abstract and complex
material earlier and gain knowledge in greater depth and breadth than is usual for
their age (Morelock & Morrison 1996).
Young children’s ability to move around and converse with others shape the
opportunities that they have to acquire new information; therefore, their skills in
these other domains have a significant impact on their intellectual development.
Two cognitive skills that also affect their acquisition of skills and information are
their abilities to attend to and remember their experiences.
Attention skills
One of the necessary skills for acquiring knowledge is the ability to pay atten-
tion to relevant input. Attention follows a developmental trend (see Appendix II),
and comprises five quite separate processes (Zentall 1989).
1. Maintaining a level of arousal necessary to attend. As described by Soden
(chapter 7), some children with disabilities have difficulty moderating their
levels of alertness to suit the task at hand, while gifted children are
commonly highly alert and demand constantly changing stimulation
(Morelock & Morrison 1996).
2. Focus is the second aspect of attention. It requires, first, awareness or detec-
tion of an event (Umansky 1998) and, second, ability and interest in
attending to it.
3. Maintaining attention over time is termed the attention span, sustained atten-
tion, or concentration. Having been made aware of a stimulus, the individual
must compare it with others that have been experienced previously (Umansky
1998). Children with intellectual disabilities show impairment of both aware-
ness and comparison; gifted children are alert and make ready comparisons
with prior experience, and so can quickly lose interest in (habituate to)
repeated stimuli (Perleth et al. 2000). For opposite reasons, then, both groups
can experience difficulties sustaining their attention.
4. Scanning the field of possible stimuli allows children to select those aspects
relevant to the task at hand and ignore those that are not relevant. It requires
focus and inhibition of distracting or incidental stimuli. It also involves being
able to shift attention rapidly to deal with changes in stimuli or in response to
directives from an adult. This form of attention is called selective attention,
and is impaired in children with intellectual disabilities in that they are less
able to screen out distractions in their environment, resulting, for example, in
less sophisticated play in group versus individual settings (Malone &

Stoneman 1990).
5. Divided attention allows us to manage more than one task at a time, pru-
dently shifting our focus as the tasks require (Sternberg 1999). Children with
intellectual disabilities appear to have difficulty attending to many environ-
mental features at once, and if not distracted and disorganised by competing
events instead fixedly focus on one activity, screening out all competing
information in the wider environment, with the result that their play can
become inflexible and repetitive (Krakow & Kopp 1983).
When planning attention training, you will need to distinguish between dis-
tractability, whereby children cannot focus on any activity, versus those occasions
when they are simply attending to something other than the adults intend
(McWilliam & Bailey 1992). If the former, attention training can be useful; if the
latter, engagement could be an issue (see below).
Box 10.1 lists some general guidelines relevant to all forms of cognitive and
metacognitive training. In addition to using those measures, there are some
specific recommendations for helping children learn attention skills:
• Respond to the object or event that has attracted children’s interest, rather
than directing children to attend to features that you have selected (Jones &
Warren 1991).
• In the initial stages of an intervention program, cut down on extraneous
stimuli so that it is easier for children to attend to relevant information.
However, to aid generalisation, these distractions will need to be reintro-
duced gradually, requiring the children to exercise selective attention skills
and thus to be able to function in natural environments.
• To make children more willing to attend, use attractive, moderately novel
materials of varying complexity.
• Control the pace. Rather than speeding up when the children’s attention
appears to be waning, slow down to reduce the amount of input to which
they have to attend.
• Ensure that children are seated in a position that facilitates their interaction
with materials. Many children with physical disabilities need specific
seating in order to be able to control their arms and hands (see chapter 7); all
children need table and chair height to match, and for toys to be below eye
level.
One everyday activity that can enhance attention skills is cooking, as this encour-
ages children to look and listen to instructions (Cook et al. 2000).
Memory function
A second knowledge acquisition skill is use of memory. It can be distinguished by
three features: first is the amount of stored knowledge; second is how is it organ-
ised; and third is how accessible the information is (Rabinowitz & Glaser 1985).
Box 10.1 General guidelines for teaching cognitive and

metacognitive skills
There are two tasks in facilitating children’s skill acquisition: first, to help them
to be willing to put in the effort to learn; second, to structure tasks to be easier
to learn.
Make tasks relevant
Children will be willing to put in the effort to learn thinking skills when there is
a reason to do so—that is, when tasks reflect their interests (Wolery & Wolery
1992). They must be able to see that the task is helping them in obvious ways
to make a success of their lives. Although the rationale for a task might seem
apparent to you, it might not be as obvious to young children, so it can help
to explain it to them.
Give children control of their learning
Where educationally viable, give children choices about what they want to
learn; if you deem an activity to be necessary for educational reasons (and
there is thus no choice whether to attempt it), you can still give children the
choice of how to do it.
Provide sufficient challenge
The degree of challenge must not be so high that the children do not feel con-
fident that they can meet demands, while not being so low that success on the
task is meaningless: work that is too easy will not raise children’s opinion of
their abilities (Bandura 1986).
Use the children’s favoured learning mode
Offer a range of auditory, visual or kinaesthetic, or multisensory experiences that
allow children to access information via their favourite mode. At young ages,
physical activity is likely to be children’s favourite mode of learning.
Teach knowledge acquisition and metacognitive strategies
These comprise the knowledge acquisition skills of selective attention,
rehearsing and recalling; the metacognitive knowledge of how to plan,
check and solve problems; and the metacognitive controlling skills of self-
monitoring, self-instructing and self-evaluation.
Simplify the content
When asking children to use processes that are difficult for them, you will need
to simplify the content so that the children are applying the new skill to some-
thing they already know and understand well. Gardner (1983) argues that
individuals have differing abilities at problem solving across various content
areas (e.g. mathematics versus language). It could be useful, then, to begin
teaching problem solving in each child’s strongest content domain and only
afterwards attempt to transfer the skills to other domains.
Give informative feedback
Children who are discouraged about their skills are in most need of feedback,
although in giving feedback you do not have to judge or evaluate what the
children achieve but instead give them information about what they are doing.
This must be specific and precise, but also genuine, so that children learn to
discriminate success from failure.
Furthermore, rather than commenting on the content of the activities
or what the children produce, informative feedback should focus on the
processes that the children are using to achieve success—such as paying
attention, planning what to do, checking whether it is working, and applying
what they have learned elsewhere to this present task.
Encourage risk taking
To encourage children to learn new skills, you must avoid implying that they
should not make mistakes. Mistakes merely signal that it is time to try another
approach. You can guide the children to turn failure into success by changing
their strategy, or you can adapt the processes or materials to enable success.
Give repeated practice
One study showed that children with intellectual disabilities required 40
training sessions to teach problem-solving skills (Ross & Ross 1978, in
Whitman et al. 1991). It is clear, therefore, that children will need extensive
opportunities to practise new skills.
Taking each aspect in turn, there is some evidence that children with an intellec-
tual disability have limited knowledge, presumably because they have difficulties
both storing information in and subsequently retrieving information from memory
(Umansky 1998). Meanwhile, gifted children acquire more knowledge because
they are faster (more efficient) at storing information in their memory and sub-
sequently at retrieving it (Borkowski & Peck 1986; Haensly & Reynolds 1989;
Rabinowitz & Glaser 1985). This probably arises because their brain cells transmit
information with few errors (Eysenck 1986), allowing them to master a new skill
with unusual speed and accumulate deeper knowledge than other children of the
same age.
To explain organisation in the memory store, it might help to think of
memory as being like an office filing cabinet. If over time you toss documents
into a filing cabinet until they fill the drawer, you are going to have difficulty
locating the document you want when you need it. If, instead, you put each
document in a hanging file devoted to that topic, retrieving it is simply a matter
of locating the topic and finding the document that relates to it. So it is with
memory: when we rehearse information or elaborate on it, we are ensuring that
we ‘park’ that memory near other related information, which makes it easier to
locate when we need to retrieve it later.
The third feature of memory is accessibility. Here, the analogy of dropping a
stone into a pond might be useful. When a stone is thrown with force into the water,
it disturbs or sends out ripples to nearby parts of the pond in ever-increasing
circles; when the stone lands gently in the water, the ripples are smaller and they
spread less far. In the same way, one memory can trigger or activate another,
related concept. A person with a superior memory will have strong links between
concepts and will activate a large number of related ideas (the ‘ripples’ will go out
strongly from the original idea to a wide range of related memories). If the associ-
ative links in memory are weak, then the activation (ripples) does not spread far
enough or with enough strength to call up related ideas. In short, related memories
are not activated automatically. Thus, individuals with learning difficulties can
retrieve information that has been stored in their memory, but only with effort; in
contrast, the ability of advanced learners to access a wide range of relevant infor-
mation easily and quickly permits complex problem solving (Rabinowitz & Glaser
1985; Perleth et al. 2000).
In summary, as individuals become more competent in a given domain, their
knowledge of that domain grows, they organise their knowledge in memory in
more sophisticated ways, and much of it can be accessed automatically (Perleth
et al. 2000; Rabinowitz & Glaser 1985; Shore & Kanevsky 1993). This leaves pro-
cessing capacity available for carrying out higher-order tasks (Perleth et al. 2000).
Children with intellectual disabilities appear to have both memory storage
and memory retrieval difficulties compared with children both of the same age
and younger children with the same developmental level (McDade & Adler
1980). This is likely to be due to their language difficulties, which limit their
ability to rehearse information (Ellis 1970) and to store information according
to its category membership. Both these aspects will mean that information is
stored randomly rather than near related concepts, making it more difficult
to retrieve. In turn, memory deficiencies limit problem-solving capacity as
the children cannot recall information that is relevant to solving the problem
(Ellis 1970).
To enhance children’s recall, the most crucial dual strategies are to engage
them actively in learning (rather than passively receiving information) and to
ensure that the information is meaningful and relevant to them. For instance,
children may be least motivated to learn by rote the names of colours or to learn
letters of the alphabet if they have not yet developed an interest in the written
word. General teaching strategies are listed in Box 10.1; some other specific
strategies for memory enhancement include:
• asking conversational questions about topics of interest to the children, such
as ‘What is your new baby sister’s name?’, ‘Where does your puppy sleep?’
and, in a story, ‘What was Spot looking for?’;
• playing games at group time in which the children are asked to recall each
other’s names;
• having the children report what objects have been removed from an array of
three toys;
• asking children where an item they are seeking is stored;
• checking that the children have understood an instruction that has just been
given, for example, ‘Put your plate on the side table . . . Where do you have
to put your plate?’ (Allen & Schwartz 2001).
Not carrying out directives can have many causes, one of which is children’s
inability to remember what they were asked to do. If individuals frequently
carry out only part of a task, it can help to simplify what you say and to reduce
instructions to fewer parts—perhaps instructing just one step at a time (Allen &
Schwartz 2001).
METACOGNITIVE SKILLS
The second cluster of intellectual skills which children need for learning are the
metacognitive abilities. Metacognition refers to our knowledge about our cog-
nitive processes. It involves monitoring and regulation of our thinking processes
and has three aspects (Schraw & Graham 1997):
• Self-awareness. This comprises individuals’ knowledge about how their mind
works, which is crucial for selecting suitable strategies to assist their learning
(Borkowski & Peck 1986).
• Metacognitive knowledge is information about how to use learning strate-
gies, and when and why to use them.
• Metacognitive control comprises planning, monitoring and evaluation to
regulate our thinking.
The main task of the year immediately prior to school entry is the acquisition of
metacognitive thinking. As can be expected, children with intellectual disabil-
ities are typically less proficient at all three aspects: first, they are less aware of
how their mind works; second, they have less knowledge about learning strate-
gies; third, although they can be taught strategies, they are less able efficiently
and independently to initiate, regulate and monitor (i.e. control) their use of these
(Cole & Chan 1990; Whitman et al. 1991).
In contrast, gifted children demonstrate more knowledge about how their
mind works (Borkowski & Peck 1986; Carr et al. 1996) and how to use strategies,
and they show early use of metacognitive control (Horowitz 1992; Schwanen-
flugel et al. 1997). In turn, their early acquisition of these skills might be due
to the structure of their brains which permits, among other skills, advanced
language abilities and early understanding of cause-and-effect relationships
(Borkowski & Peck 1986; Moss 1990, 1992).
Self-regulation (-control) skills

To be effective and independent managers of their own learning, children need
to be able to monitor what they are doing, have the verbal skills to give them-
selves useful instructions, and set appropriate standards or criteria by which to
judge their performance.
Self-monitoring
To be successful, individuals have to keep track of or monitor what they are
doing so that, if necessary, they can adjust their approach to tasks (Bandura 1986;
Lutz & Sternberg 1999). However, few young children are aware of the strate-
gies they can use to acquire new information (e.g. rehearsal to promote recall)
and, if aware, do not always employ these when needed (Lutz & Sternberg
1999). This means that all children—even those with advanced development—
will need feedback about how they are approaching tasks (see Box 10.1) and,
ultimately, instruction in how to monitor their task approach independently.
Self-instruction
This is the use of ‘personal verbal prompts’ (Zirpoli & Melloy 1997: 187) to guide
our actions. When a task is new or challenging to us, we talk about it out loud
to ourselves; then our self-talk becomes covert; finally, we no longer need to self-
instruct as the task has become automatic for us. When teaching children to
self-instruct, you can use the following steps:
• As you complete an activity, talk out loud about what you are doing and how
successful you are being.
• Next, have target children perform the same activity alongside you, while
you comment on your own and their performances as you go.
• Next, if necessary, children can complete the task while giving themselves
out loud the same instructions that you were using, until eventually they can
self-instruct quietly in their heads (Meichenbaum 1977).
Throughout, you will need to teach strategies for dealing with failures and ensure
that once the children have become competent at a task, they have enough time
to practise and consolidate their new skills.
Self-evaluation (self-assessment)
In this phase of self-regulation, children need to assess whether their perform-
ance has been successful or not. Only when they can recognise their
accomplishments will this information add to their pool of knowledge that can
be drawn on during future tasks (Whitman et al. 1991). Setting appropriate
performance standards may be the most crucial phase of the self-management
process (Whitman et al. 1991). Some children might set themselves very lenient
standards, while others are too demanding of themselves (Alberto & Troutman
1999; Kaplan & Carter 1995). To assist them in judging their own efforts, you
will need to give clear and specific feedback (see Box 10.1).
Problem solving
Problem solving is a key metacognitive skill. It requires developing a plan to bring
about a desired result (Ashman & Conway 1993). In order to achieve this,
children need to realise that a problem exists, examine what has to be done, scan
a range of options, and select one that they think will be most successful (Ashman
& Conway 1989; Kaplan & Carter 1995; Zirpoli & Melloy 1997). This decision
will be based on their judgment about whether the chosen strategy is feasible and
will meet their goal without generating new problems for them. Next, they need
to devise a plan for implementing their chosen solution. This step requires conse-
quential thinking, which is the ability to consider the potential outcomes or
consequences of a proposed behaviour, and means–end thinking. This refers to the

ability to plan the steps needed to achieve a goal.
Problem-solving training involves teaching children how to deal with the
structure of problems and provides practice in the skills involved. Once again,
general teaching strategies are listed in Box 10.1, with additional strategies for
teaching problem solving being the following.
Present clearly structured problems

Children with few learning difficulties make the transition readily from well- to
poorly structured (novel) problems, generalising the skills across content areas
(Ashman & Conway 1989). In contrast, children with learning difficulties cannot
apply structure as readily to ill-structured problems. Thus, they will need you to
structure tasks well. This requires you to:
• present the task clearly;

• give all the information that is necessary for successful completion;
• teach strategies for solving the problem;
• provide extensive practice.
Teach the problem-solving steps

The formal steps of problem solving comprise the following:
1. Pause.
2. Ask: ‘What is the problem?’
3. Ask: ‘What do I want?’
4. Ask: ‘Is what I’m doing working?’
5. If not, plan solutions: ‘What else could I do?’
6. Choose what to do and do it.
7. Evaluate the results. (Go back to step 4).
8. Self-reinforce.
Older children or those with advanced development ultimately can learn and
direct the steps independently, but very young children or those with learning
difficulties are likely to need you to prompt them at each stage. To be successful,
children need to be capable of paying attention, pacing themselves, persisting,
and noting feedback, some or all of which might need specific training as well.
Give multiple and varied prompts

To teach them to solve problems, children with mild intellectual disabilities will
require repeated instruction and prompts. It may not be enough simply to repeat
the original instruction; instead you will need to augment that with active demon-
strations and perhaps manual guidance to ensure that they understand how to go
about solving a problem (Rynders et al. 1979).
Generalisation skills
As has already been mentioned, children with intellectual disabilities can be
taught learning strategies, but have difficulty applying these in new situations
and with knowing when and how to change strategies (Whitman et al. 1991).
The ability to transfer skills from one task or setting to similar ones is termed
generalisation. It requires the ability to scan memory efficiently, knowledge
of strategies and, above all, metacognitive control (Borkowski & Peck 1986;
Carr et al. 1996; Risemberg & Zimmerman 1992).
The single most effective way to promote maintenance and generalisation of
new skills is to teach children self-management skills, rather than having
programs under adult direction (Martin et al. 1988, in Whitman et al. 1991). Skill
transfer can be programmed for using the same general teaching strategies as the
other cognitive skills and which are outlined in Box 10.1. In addition, you can
encourage generalisation by specifically teaching for it. This can involve the
following measures:
• Make sure that tasks are not too difficult and that they are similar to real-life
activities—both to make them more meaningful and to reduce the discrep-
ancy between the skill as it is taught and as it is enacted in real life.
• Highlight similarities between tasks by asking ‘How is this similar to what
you’ve done before?’ and then teach children to analyse what they already
know about solving the problem at hand (Whitman et al. 1991).
• Where their verbal skills permit, teach children strategies such as rehearsal,
repetition, labelling, classification, association and imagery. Also teach how
the strategy can be used so that ultimately the children can work independ-
ently. This is the essence of generalisation.
• Give children numerous opportunities to practise using the strategies in the
one context before requiring them to transfer these to other situations
(Zirpoli & Melloy 1997).
• Offer a series of similar (not exactly the same) tasks working up to the
generalisation task.
EMOTIONAL LEARNING STYLE
The third aspect of intellectual abilities is children’s learning style or dispos-

itions. Children’s dispositions involve first, an awareness that a particular skill
would be useful and, second, an inclination to employ it (Perkins et al. 1993).
Metacognitive skills dictate how children go about achieving success; style
refers to how they feel about learning and about themselves as learners. Although
discussed last in this chapter, this emotional aspect actually makes the greatest
contribution to success, because even if children have the ability to do a task,
they will not be successful at it unless they are motivated to use their skills. This
may be especially so for young children, as they rely more than older children,
on their emotional interpretations of events (Meyers et al. 1989).
Many dispositions or aspects of learning style could be nurtured within early

childhood programs—some are listed in chapter 4; the discussion in this section
will focus on the key processes of engagement, motivation, fostering an internal
locus of control in children and encouraging independent learning.
Engagement
Engagement refers to the amount of time children spend intellectually or
emotionally involved with materials, peers or adults in developmentally and con-
textually appropriate ways (McWilliam 1991). It also relates to how they use
their time (i.e. to the quality of their involvement rather than its duration) and can
span five levels (McWilliam & Bailey 1992):
• non-engagement, where children are not involved in their surroundings;
• transient engagement, in which they pay attention for short durations but do
not become involved in any particular activity;
• undifferentiated engagement, in which they play in one given way with
objects or people;
• elaborative engagement, when the children use a range of different behav-
iours in their interactions with materials and other people;
• sustained engagement, when they display persistent, goal-directed
interactions.
High levels of engagement are necessary—but not sufficient—for learning to
take place, and are assumed to result in fewer behavioural disruptions; further-
more, engagement is important simply because children have a right to
involvement in an attractive and interesting program (McWilliam 1991).
The level of children’s engagement reflects the quality of the environment,
the level of educators’ support for children to engage and maintain their partici-
pation, and children’s personal characteristics such as developmental level. Young
children with developmental delays (aged 2 years) have been found to be less
engaged with toys and in overall learning than their age mates, but this difference
disappears by age 4 (McWilliam & Bailey 1995).
In terms of program planning and delivery, the following measures could
prove useful for engaging children in learning (McCormick et al. 1998; McGee
et al. 1991; McWilliam & Bailey 1992; Whaley & Bennett 1991).
Modify the environment

Ensure that the children have independent access to materials that are develop-
mentally appropriate, which encourage a variety of independent, constructive,
social and creative play, and are in good supply. You could systematically rotate
some of the available toys to renew children’s interest in familiar play materials
and demonstrate at group time the potential uses of those toys that seldom
engage the children.
Having supplied activities within clearly delineated zones but between
which transitions are easy, assign individual staff members a particular zone so
that they can observe and alter those activities that are not inviting the children’s
participation and can assist children to manipulate the activities on offer.
Modify processes
Choice over their activities will engage children, as will using naturalistic
instruction that provides activities which closely match the children’s under-
standing and interests, is non-directive and facilitates children’s achievements
rather than providing direct assistance. Small-group rather than large-group
activities promote engagement also (Burstein 1986).
However, there will also be a need on occasion to intervene actively when
your observations reveal that individuals are disengaged. To assist them to par-
ticipate, you will need to mediate these children’s learning or social play (see
chapters 4 and 11). On the other hand, allow children some passive time in which
to recharge their batteries and select their next activity (Linn et al. 2000). This
breathing space could be particularly useful for those children with delays who
focus exclusively on the activity to hand and so do not use surrounding events as
a clue about a next possible activity. Within reason, giving them time to plan will
allow them to exercise some initiative rather than being under adult control (Linn
et al. 2000).
Another process issue is the management of transitions between activities
to minimise waiting time so that children do not become disengaged. Yet another
is observing routines, as these signal to children to change their style of engage-
ment; on the other hand, you will need to be responsive so that, where appropriate,
routines can follow rather than direct children’s engagement.
Modify social interactions

Social engagement with adults will be fostered by ensuring that you relate
warmly with children, and use authoritative rather than controlling discipline
(see chapter 12) so that the children want to be involved with you. The children’s
engagement will also be affected by the nature of their peers: some will be more
engaged with same-ability peers and others with same-aged peers. Furthermore,
in my research I observed that in order to engage there needed to be a minimum
number of children, maximising the chances that one would generate an idea for
an activity in which the others could participate: groups can be too small to
occasion engagement (Porter 1999).
Motivation
Motivation refers to children’s willingness to invest time, effort and skills in the
tasks that we set for them (Ben Ari & Rich 1992; Cole & Chan 1994). Glasser
(1998) believes that all individuals are motivated to meet their emotional needs
(see chapter 11) and their need to survive. Therefore, Glasser contends, when we
say that children are not motivated, what we are actually saying is that they are
not motivated to do the particular task they are being given. In turn, this will be
because it is not meeting their needs. Motivation, or a lack of it, then, is not an
inherent part of children’s personality: if some children are choosing to invest

their energies elsewhere, this will have at least as much to do with the way edu-
cational activities are structured as with the children’s personal make-up (Ben
Ari & Rich 1992).
Thus, motivation has the following aspects (Cole & Chan 1994; DiCintio &
Gee 1999; Glasser 1998; Jones & Jones 1998):
• children’s expectation that they can be successful. They will not be motivated
to invest energy in tasks that are not intellectually demanding or in tasks
where they do not expect to be successful (Chan 1996; Vallerand et al. 1994);
• their assessment of the benefits that success will bring in terms of the fulfil-
ment of their personal needs. This assessment will cause children to place a
value on being successful;
• the extent to which the environmental climate meets their physical, emotion-
al and social needs. The notion that relationships are crucial to children’s
social and emotional development is mentioned in chapter 11; in chapter 12
the quality of relationships is discussed with respect to its impact on
children’s willingness to cooperate with others; in the present context, warm
relationships are crucial to motivation as they inspire children to put in the
effort to achieve (Hauser-Cram 1996).
Jones and Jones (1998) regard these elements as multiplicative, which implies
that all three components are necessary for motivation. Thus, their formula
(Jones & Jones 1998: 179) is:
Motivation = Expectation of success expected benefits of success emotional climate
The general measures for enhancing children’s motivation are given in Box 10.1.
These can distil down to a three-pronged approach suggested by the above
formula: make realistic demands which the children are confident of meeting,
ensure that tasks are relevant for the children, and develop a supportive relation-
ship with the children so that they are emboldened to face challenges.
Locus of control
An important belief that children gain through experience is whether they them-
selves can control outcomes (which is termed having an internal locus of control,
or self-efficacy), or whether luck, fate or other people control what happens to
them. Individuals are said to have an external locus of control or, in its extreme
form, to display ‘learned helplessness’ (Seligman 1975) when they believe that
events outside their control are responsible for what happens to them.
When children believe that they can control the outcomes of their actions—
that is, when they locate their control internally—they are more motivated to
invest effort in learning, are more likely to learn from their mistakes, are more
persistent and are more reflective learners (Knight 1995). In contrast, children
with intellectual disabilities can be unmotivated because they are not aware that
the way they go about tasks will affect the outcome. Because of a history of
failure, these children might not apply themselves to a task because they do not
expect to succeed. They are more likely to attribute success or failure to uncon-
trollable outside events such as luck, help from the teacher, or the difficulty or
ease of the task (Cole & Chan 1990).
Meanwhile, the picture of the locus of control of gifted children is mixed.
Although they tend to achieve an internal locus of control earlier than usual
(Brody & Benbow 1986), some take too much responsibility for their mistakes,
which can lead to perfectionism, while attributing their successes to the ease of
the task (Bogie & Buckhalt 1987); although this pattern is by no mean universal.
Self-efficacy is vulnerable to repeated failures and to criticism (Bandura
1986). Unfortunately, it is not responsive to positive persuasion. Thus, in
addition to the general measures given in Box 10.1, the following strategies will
be necessary to teach children that they can be successful:
• Children will need to experience success, rather than simply be told that they
are successful. Therefore, feedback needs to be specific and genuine. That
is, you should not tell children that they have been successful when they
have not, and should give feedback that is specific enough for them to be
able to act on the information and correct their errors.
• Give children experience of both success and failure, so that they can form a
link between their actions and the outcome (Seligman 1975). If they are
always successful, no matter what they do, they will feel just as helpless as if
they always fail, no matter what they do. In either case, they will show low
tolerance of frustration, poor persistence at tasks, and avoidance of challenge.
• To encourage them to persist in the face of setbacks, you will need to teach
children to attribute their achievements to their own effort, rather than to
uncontrollable factors such as inability or luck. This is called attribution
training. You will need to guide them to: define the failure as temporary
rather than permanent; see failure as specific to the event rather than a sign
of a general or all-pervasive failing on their part; and explain the failure in
terms of their behaviour, not personality—they need to take personal
responsibility without taking blame (Seligman 1995). Without confronting
them with their mistakes, you should not allow them to make excuses or
teach them to do so, for example by blaming a ‘naughty’ step for tripping
them over, but instead comment that they forgot to watch out for the step.
Independence
Children who have intellectual disabilities can be reliant on adults to present
information to them and to help them to make sense of it. They might not spon-
taneously generate their own play ideas. In contrast, although they can generate
their own play ideas, gifted children might learn to rely on adults to give them the
stimulation which they seek, partly because adults’ ideas are more sophisticated
and fascinating than their own or those of age mates. Others prefer to work inde-
pendently—perhaps because of the discrepancies between their skill levels and
those of their age mates. Still others might fiercely insist on doing things
independently (e.g. getting dressed) but, once they have mastered the task
intellectually and it holds no further interest for them, might then refuse to do it
at all. They can be impatient with repetition of activities that they already under-
stand (Clark 1997; Kitano 1990).
Various cultures place differing values on and expectations of independence
in children: some encourage early autonomy while others value interdependence
of individuals. Furthermore, it is appropriate that children learn to perform both
independently and in cooperation with others. Therefore, although it can be
valuable to encourage children to attempt age-appropriate tasks independently, it
can also be important to allow them to give and receive help.
Even though you might be seeking to foster independent learning skills in
individual children, at times they will need adult guidance to learn, particularly
when they are acquiring new skills or extending or challenging themselves. This
can involve scaffolding or mediation of their learning, as described in chapter 4.
CONCLUSION
When assisting children to ‘learn how to learn’, the strategies you teach must
match their abilities (Cole & Chan 1990). For example, children who have
impaired language skills will find it difficult to use self-instruction to guide their
completion of tasks, in which case their receptive and expressive skills would be
a more fruitful focus of teaching (Whitman et al. 1991). It is also important that
you correctly identify whether they most need knowledge acquisition skills
(attention or memory training), metacognitive knowledge and control, or adjust-
ments to their learning style. Otherwise, a mistargeted program could frustrate
both you and the children.
Some of the measures for teaching thinking processes will involve a behav-
ioural element as well as cognitive training. I refer you to chapter 12 for a review
of behavioural approaches.
Ashman, A. and Conway, R.N.F. 1997 An introduction to cognitive education:

theory and applications Routledge, London
11
EMOTIONAL AND SOCIAL NEEDS
LOUISE PORTER
KEY POINTS
• After satisfying the need to survive, children require security, self-esteem,

autonomy and a sense of belonging.
• Security entails more than physical safety: children need to feel nurtured
and confident that they can meet adults’ expectations of them.
• A healthy self-esteem is achieved by being competent at worthwhile skills,
having a realistic picture of oneself and striving for attainable ideals.
• Satisfaction of the need to be self-determining is central to individuals’
emotional wellbeing and to their constructive approach to learning.
• Children cannot thrive in isolation; when for whatever reason they are not
socially engaged, their social inclusion cannot be left to chance but
requires some specific intervention.
INTRODUCTION
Rather than focusing on children with recognisable emotional difficulties, this

chapter examines the everyday emotional and social needs of all young children,
with particular attention to those whose atypical development makes them espe-
cially vulnerable to difficulties.
After the need for physical survival, children’s other emotional needs can be
categorised as the needs for:
• security—an assurance of protection and safety;
• self-esteem—the need to value oneself;
• autonomy—the need to be self-determining, to have some freedom;
• belonging—the need to love and be loved and accepted.
Two additional needs have been suggested. The first is the need of all crea-
tures—and the young in particular—to have fun, which Glasser (1998:30)
191
defines as the ‘intangible joy’ that arises from satisfaction of the above needs.
The second was posited by Maslow: namely, the need for self-actualisation,
which refers to the drive to develop our abilities fully (Peterson 1996). Both of
these are probably outcomes of meeting the above needs, so only that list is
focused on here.
THE NEED FOR PROTECTION AND SAFETY
Adults can choose to take part in activities and to associate with people who
bolster our self-esteem, but children are at the mercy of the contexts in which we
place them (Katz 1995). This means that they rely on you to create an accepting
environment in which they can feel emotionally safe and confident about their
ability to meet the demands being placed on them.
Require considerate behaviour

To safeguard miscreants, victims and onlookers, it is important to require con-
siderate behaviour of all children and adults. The advantage for perpetrators of
learning self-control is that doing so will protect them from being shunned by
others and will give them a skill to feel proud about. At the same time, teaching
individuals self-control will protect surrounding children from being the recipi-
ents of thoughtless behaviour. Nevertheless, the means used must themselves
protect all parties (see chapter 12).
Supervision of children is essential to oversee their physical and emotional
safety. In addition, some of the following measures could prove useful.
• Prohibit discriminatory comments and actions. There are few occasions
when an outright ban on particular behaviours is warranted, but discrimin-
ation is one of these times. So establish a general rule that children cannot
use words that hurt other people or unfairly exclude others from their play
(Derman-Sparks 1992).
• Encourage assertiveness. You can cue children when to be assertive and
perhaps teach them diplomatic strategies for rejecting domineering
commands of their peers—for example, by offering a reason for not follow-
ing a peer’s suggestion (Trawick-Smith 1988). Explain that if being assertive
does not work, they can ask you for help.
• Follow up. If any children report that they cannot resolve a conflict, help them
to sort it out: do not tell them to go back and be assertive if they have already
done so. You might return with them to the other child and solve the problem
collaboratively. If one child has been hurt physically or emotionally, in the
hearing of the perpetrator, you can tell the victim you understand that it hurt
and that the perpetrator might remember next time to use words to solve
problems or to speak more kindly (as the case may be). This validates hurt
children’s feelings without confronting perpetrators with their mistakes and in
EMOTIONAL AND SOCIAL NEEDS 193
so doing avoids a repetition of an aggressive incident. If particular children are

repeatedly aggressive or unkind to their playmates, social skills interventions
could be useful (see later in this chapter).
Respond to and prevent child abuse

Child maltreatment takes a number of forms: neglect of children’s physical or
emotional needs, and physical, emotional and sexual abuse. Of these types, neglect
constitutes more reported cases than the other forms combined.
Families who are isolated and lacking in support are more prone to child
abuse, while parents’ substance abuse is an increasing cause of the neglect of
children. Although the use of illicit drugs occurs across all sectors of the
community, it is likely to have most impact on those families that are already
economically disadvantaged (Hanson & Carta 1995). Meanwhile, additional
caretaking demands that arise when children have certain disabilities appear not
to lead to the documented higher rate of abuse of these children: instead, the
children’s dependence is the factor that places them at increased risk.
The effects of child abuse differ depending on its severity, chronicity, the
child’s age when it occurs, the relationship between the child and the per-
petrator, and the fact that in most cases many types of abuse are co-occurring.
Abuse produces developmental and social-emotional impairments, with children
under the age of 5 years being at more serious risk than older children of injury
from physical abuse (Bonner et al. 1992). Despite this, the effects of neglect are
thought to be more severely damaging (Bonner et al. 1992). When the parents are
the perpetrators, the effects of abuse are compounded by the fact that it is
happening within dysfunctioning family relationships that are characterised by
neglect, indifference, violence, humiliation and terrorisation of children, isol-
ation, corruption of children (as they are encouraged into antisocial behaviours),
and unreliable parenting (Harter 1998).
This context leads to insecure attachments between children and their
parents, as the children must continue to rely on their parents for survival but are
under threat from those same caregivers (Cole-Detke & Kobak 1998; Harter
1998). In this respect, neglected children might be most disadvantaged, in that
they are less likely to learn how to form attachments to others; alternatively,
while abused children develop attachments, these are often damaging to them
(Steele 1986).
Disturbed attachment to parents can cause these children to withdraw from
the friendly overtures of caring adults or peers, and to assault or threaten adults,
as they have learned that adults can be dangerous (George & Main 1979).
Abused children often have difficulty regulating their anger and aggression,
which probably arises from copying their parents’ lack of inhibition; while neg-
lected children can be withdrawn as a result of learning to avoid relationships:
they have few social problem-solving and coping strategies, limited interaction
with peers, and lack empathy for others (Hoffman-Plotkin & Twentyman 1984;
Klimes-Dougan & Kistner 1990).
The result of such behaviours is that the children tend to be ignored in care
and preschool settings—unless behaving disruptively, when their interactions
with caregivers often comprise disciplinary measures (Hoffman-Plotkin &
Twentyman 1984). This emotional neglect compounds the problems these
children experience at home and leads to worsening social difficulties through-
out childhood (Cole-Detke & Kobak 1998; George & Main 1979; Trickett 1998).
Emotionally, depression and anxiety are common outcomes (Trickett 1998).
In terms of children’s self-esteem, child abuse causes children to see themselves
in negative terms and to try to be perfect in an attempt to halt the abuse (Harter
1998). Thus, in the terms discussed below, the children develop a devalued self-
concept and unattainably high ideals for themselves. Their development is
impaired by not believing themselves capable of solving problems.
The signs that abuse is occurring include the above social and emotional
behaviours, plus physical signs such as burns or bruises; sudden changes in the
children’s behaviour (coinciding with the onset of abuse); refusal to accompany
a particular adult; declining development or regression to less mature behav-
iours; and, for sexually abused children, frequent discussion about secrets or
about sexual practices, knowledge of which is in advance of the children’s years
or developmental level.
The above litany of serious effects of abuse make it essential to report any
signs that children might be being abused. You cannot wait until you have
gathered all necessary evidence. Instead it will be the welfare agency’s job to
investigate your suspicions, which they will aim to do without further victimis-
ing the child or those wrongly suspected of being perpetrators.
If the welfare agency decides on the basis of your information to investigate
the family, you will need its advice on whether you should tell the parents that
you have reported your concerns and about how to support the family during
the investigation process so that the child is not subjected to further violence or
emotional abuse as a result of the disclosure.
Meanwhile, you will need to support the children by respecting their feelings
but also requiring them to use prosocial means for dealing with their anger and
regaining some power (Gootman 1993). They need empathic responses from
educators so that they learn to recognise their own and others’ pain; they need
attention; and they need to know that they will be safe if they make a mistake
(Gootman 1993). Predictable reactions and a safe emotional climate will help
children who are hypervigilant to signs of danger to know what is required of
them and to realise that they will be safe.
Personal safety programs are often recommended for preventing children
from becoming victims of abuse, although there is little research evidence of
their effectiveness at empowering children to enact the protective skills imparted
in the programs (Bevill & Gast 1998; Ko & Cosden 2001), little advice about
necessary modifications to ensure age-appropriateness, and few guidelines to
avoid side-effects such as increased fears in children (Bonner et al. 1992; Jordan
1993). Nevertheless, incidental or more formal instruction involving modelling,
role-play and feedback can teach children to be assertive and seek help in unsafe
situations (Bevill & Gast 1998). Meanwhile, raising the topic of abuse with your
parent group can highlight how they can keep their children safe, recognise the
signs of abuse, and acquaint them with reporting procedures, while using behav-
iour management strategies that permit children to exercise self-control and do
not demand obedience to adults (see chapter 12) will empower children and thus
make them less vulnerable to abuse.
SELF-ESTEEM
The second fundamental emotional need is for a healthy self-esteem. In their first
two years or so, when young children are learning to trust their caregivers, their
self-esteem relies almost entirely on whether they feel loved and accepted. After
that age, their self-esteem begins to be fed by how much control they can
exercise over their lives. Subsequently, adults’ reactions to their choices allow
them to feel proud of or guilty about wanting to act independently, and they
begin to define themselves as competent or as failures (Curry & Johnson 1990).
So, from the earliest years of their lives, children gain impressions about
the type of people they are and how others want them to be. By comparing
themselves to their ideals, they learn to feel pleased or disappointed in them-
selves. In short, then, self-esteem has the following three parts (Burns 1982;
Pope et al. 1988):
1. The self-concept. This is our picture or description of ourselves. Young
children’s self-concept is fairly basic and becomes more comprehensive as
they get older and learn more about themselves. At young ages, they tend to
describe themselves according to how they look, what they wear, their state
of health and their possessions. As they get older, they begin to define them-
selves on aspects comprising their relationships within and outside the
family (which includes ancestors as well as living people), abilities and
talents at sport and academic work, temperament, religious ideas, and ability
to manage their own lives.
2. The ideal self. This is our beliefs about how we should be. This set of beliefs
comes about from actual or implied critical judgments by significant people
in our lives or by a process called social comparison, in which we compare
ourselves to other people and set our ideals accordingly (Adler et al. 2001).
3. Our self-esteem. This is how much we value our characteristics. It is a
judgment about whether our abilities and qualities meet or fall short of the
standards we believe are ideal. In other words, self-esteem is a comparison
between the self-concept and ideal self (Burns 1982), as shown in Figure 11.1.
No-one’s self-concept and self-esteem ever overlap completely: most emotion-
ally healthy individuals believe that they have around three-quarters of the
characteristics they would like to have. If the two overlapped entirely, individuals
would have no ambitions or goals to strive for.
Self- Self- Ideal

concept esteem self
Figure 11.1 Diagram of self-esteem as the overlap between the self-

concept and ideal self
Signs of low self-esteem

In contrast with the attributes of a healthy self-esteem as listed in Box 11.1,
children who have low self-esteem can display a wide range of less adaptive
behaviours. Emotionally, they might seek constant reassurance about your
affection for them, might be overly helpful as if they must earn your approval,
might be devastated if chastised, and could be highly reliant on parents, as seen
with separation difficulties. Socially, they might not be able to have any fun,
might be withdrawn, or not be able to enter a group without becoming either too
self-conscious (‘shy’) or too boisterous. Finding and keeping friends can be a
problem, and negotiating conflict can be difficult because they do not have
enough confidence to assert themselves. They might be bullied on the one hand,
or easily led on the other. Their development can be compromised as they avoid
trying something new, refuse to take risks or be adventurous, or give up easily.
Instead, they might play the same game over and over—such as playing only in
the sandpit—because they are afraid to fail at other activities.
Such behaviours can be an effect of low self-esteem but also cause future
underachievement. As time goes on, their earlier unsuccessful experiences cause
them to approach tasks without confidence and fail at these as a result, thus re-
affirming their low opinion of their abilities.
Routes to low self-esteem

Individuals can develop low self-esteem when they actually are not competent at
skills which they value; when their self-concept is impoverished such that they
possess many of their ideal qualities, but do not realise it; and when their stan-
dards are just too high. These pathways suggest three routes for improving their
self-esteem.
Promote competence
The first route to a healthier self-esteem is to help children become competent at
skills they value, because success breeds confidence. However, success must be
personally meaningful. Thus, Curry and Johnson (1990:153) argue that:
Box 11.1 Characteristic behaviours of children with a healthy

self-esteem
When children have a healthy self-esteem, they:
• make transitions easily;

• approach new and challenging tasks with confidence;
• set goals independently;
• have a strong sense of self-control;
• assert their own point of view when opposed;
• trust their own ideas;
• initiate activities confidently;
• show pride in their work and accomplishments;
• cope with (occasional) criticism and teasing;
• tolerate frustration caused by mistakes;
• describe themselves positively;
• make friends easily;
• lead others spontaneously;
• accept the opinions of other people;
• cooperate and follow rules, remaining largely in control of their own
behaviour;
• make good eye contact (although this can vary across cultures);
• are realistic about their shortcomings but not harshly critical of them.
Sources: Adler et al. (2001); Curry & Johnson (1990); Pope et al. (1988).
Self-esteem is not a trivial pursuit that can be built by pepping children up with empty
praise, extra pats, and cheers of support. Such efforts are temporary at best, and decep-
tive at worst. Our children need coaches, not cheerleaders (emphasis mine).
In line with this assertion, coaching children to learn skills that they value could
entail the following measures:
• Break tasks down into achievable steps and then teach each step until the
children can successfully complete the task independently. It might help to
keep a record of the children’s improvement, using audiotapes, videotapes,
photographs or other natural means so that in the course of learning a skill
the children can appreciate their progress.
• Give positive instructions. We might accidentally set children up to fail by
telling them what not to do (‘Don’t run’) instead of what they could do:
‘Take small steps on the wet floor.’
• Encourage children to be independent about performing age-appropriate
skills, to give them something to feel proud of.
• Teach self-instruction skills. Success at tasks involves not only being able
to perform the skill but also being able to organise oneself to do it profi-
ciently. Therefore, teach children how to concentrate, plan each step of a
task, check that their approach is working, persist, change approaches if
necessary, and so on (see chapter 10).
• Provide authentic and specific feedback so that children know precisely

what they have to do to be successful.
Embellish children’s self-concept

For children to know themselves, they need information or feedback about their
attributes:
• Use acknowledgment. In my view, the single most powerful way that you
can help children develop a healthy self-esteem is to acknowledge and cele-
brate their successes, without praising these. Children need information
about their attainments but not judgmental feedback in the form of praise or
other rewards, as these imply ideal standards and might threaten children’s
faith in their ability to continue to meet adults’ expectations.
• Focus on processes. Children’s self-esteem will depend on the extent to
which they make the most of their potential: if you praise them for inherited
characteristics, their self-esteem is not likely to improve, as they had no
control over those characteristics. This means that you will need to acknowl-
edge effort rather than cleverness, personality rather than appearance,
learning style rather than outcome.
• Introduce activities that acquaint children with their attributes. If you
would like to supplement your everyday feedback with a formal activity,
you could help children make a list of all the many things they can do.
• Do not use—and do not permit surrounding children to use—put-downs or
nicknames that demean individual children.
Encourage realistic ideals

It is important for children to have realistic standards for themselves; otherwise
they can develop a dysfunctional form of perfectionism in which they are
dissatisfied with their achievements, no matter how well they perform. A more
functional type of perfectionism entails striving for high standards because you
know you are capable of meeting your goals. Gifted children in particular can
fall into this category. In that case, you do not want to teach them to lower their
standards as their perfectionism is the engine that drives them to achieve, but you
do need to give them confidence that they can reach their ideals:
• Accept yourself. Show children how to talk positively about themselves by
occasionally doing so about yourself in their hearing and treat your own
mistakes kindly so that children will learn to handle their own errors similarly.
• Respect children and their feelings, even when you do not understand why
they feel as they do. Respect also requires you to value children’s diverse
cultural backgrounds. This requires doing more than discussing the exotic
customs and dress of other cultures but demonstrating acceptance in your
day-to-day interactions with all the children.
• Encourage risk taking. If children are told when they are successful that they
are ‘good’ boys and girls, they will assume that making a mistake renders them
‘bad’, and so will restrict themselves to only the safest of activities. Therefore,
you need to give children permission to be adventurous and risk getting things
wrong. If they are not making mistakes, that means they already knew how to
do a task—and that is not called learning: it is practising.
• Teach children to evaluate negative feedback. When children are dis-
appointed in themselves, your first response must be to listen and accept
what they feel. They will think that you do not understand them if you insist
on reassuring them that things aren’t that bad, or if you tell them to cheer up.
Moreover, their disappointment might be a realistic reaction to a failure and
might spur them on to becoming more skilled.
• But if they are expecting too much of themselves, you might gently
question whether they are being realistic, without giving advice or telling
them off for feeling what they feel. You could, for example, ask gently, ‘You
seem disappointed that you didn’t finish that. But do you think that 4-year-
olds can normally do it all by themselves or do they need help? Perhaps
you’re expecting too much of yourself to be able to do it alone.’
AUTONOMY
A third emotional need is for self-determination or autonomy. When children

feel out of control of what happens to them, they become stressed. Thus, giving
children autonomy is fundamental to satisfaction of these other needs.
Give children control

Children need repeated opportunities to exercise choices, initiative and autonomy,
so involve them in making decisions that affect them. Asking for their suggestions
and listening to their ideas tells them that you value them and believe in their abil-
ities to take responsibility for themselves. This is especially important for children
whose disabilities limit their learning of intentionality (see chapter 10) as, without
experience of being able to act on their intentions, they can develop a helpless
learning style which in turn compromises their development (Seligman 1975).
It is important not to ask for children’s participation when there is no choice
whether to perform a particular activity, but you can still give them a choice of
how to go about it. For example, at pack-up time you will not ordinarily ask
whether children want to help pack away, but could ask if they want to pack away
the blocks or the paints.
Provide attribution training

This is described in chapter 10, so it is enough to repeat here only that you must
teach children to connect an outcome with their own actions (Seligman 1975), so
that they realise they are in command of their decisions and actions.
Minimise stress
Stress is a physical reaction to feeling out of control, particularly of negative
events in life. Children whose families are stressed can become overwrought
themselves, while children who have emotional or behavioural difficulties can

themselves create stress in those around them, which then rebounds on them
(Luthar & Zigler 1991).
You can support stressed children, first, by noticing the signs such as behav-
ioural acting out or withdrawal and allowing children to discuss their feelings.
Second, you can assist children to solve challenges in a way that enhances their
self-confidence, promotes mastery and encourages them to take appropriate
responsibility for themselves (Rutter 1985).
To prevent provoking stress in reaction to your program, you must give child-
ren activities that they feel able to master. It is important not to overwhelm children
who have learning difficulties with remedial programs in many developmental
domains at once or to focus only on what they find difficult, but instead allow
them also to experience success and pleasure in other skills, even when these are
outside the traditional focus of education (Sapon-Shevin 1999).
SOCIAL NEEDS
In order to satisfy children’s fourth emotional need—correctedness with others—

they need warm relationships with their adult carers and peers.
Educators’ relationships with children

In chapter 4, the quality of educators’ relationship with children is highlighted as
being crucial to the children’s willingness to learn; here it must be emphasised
that children’s attachment to their caregivers will meet many of their fundamen-
tal social and emotional needs. To that end, your relationship with children needs
to involve the five As of attention, acceptance, appreciation, affirmation and affec-
tion (Albert 1989, in Rodd 1996).
With respect to the first of these qualities, it has been found that although
educators spend the vast majority of their time interacting with children, nearly
one third of the children actually receive no individual attention on a given day
(Kontos & Wilcox-Herzog 1997). This signals the need for adults deliberately
to make contact with individual children who could otherwise be overlooked.
Meanwhile, the other listed qualities do not mean that you should indulge
children’s emotions or behaviours if these will be detrimental to them in the long
run (Katz & McClellan 1997), but simply that you respect children for who they
are and respond to them in ways that will make it more rather than less likely that
they will continue to cherish relating with you (see also chapter 12).
Children’s relationships with each other

Friendship is an ongoing, voluntary bond between individuals who see themselves
as roughly equal, have a mutual preference for each other, share emotional warmth
and interact reciprocally (Hartup 1989; Howes 1983). It usually requires that the
children are at a similar developmental level and behave predictably so that others
feel safe in their company.
Peers can make unique contributions to children’s development in many
domains (see Hartup 1989; Hartup & Moore 1990). This tells us that when
children’s peer relationships are disrupted, their development as well as their
emotional wellbeing can suffer.
Three groups of children are more likely than most to be socially isolated in
early childhood centres. First are children with significant intellectual delays:
around 30% are actively rejected, which is often related to their behavioural dif-
ficulties, while a greater number still are ignored (or neglected) by peers, which
is often related to their social reticence (Odom et al. 1999). This social isolation
comes about because, even compared with younger children of an equivalent
developmental level, those with intellectual disabilities lack the cognitive and
metacognitive skills necessary to read social cues and to instigate and maintain
peer relationships. As a result, they (Brown et al. 1999; Guralnick & Groom
1987; Hanline 1993; Odom et al. 1999):
• interact less often and so spend proportionately more time either unoccupied
or engaged in solitary play;
• initiate fewer interactions with peers (Reynolds & Holdgrafer 1998);
• are less successful in their social initiations—and this can deteriorate over
time;
• respond less to approaches from others;
• take the lead less often in social play.
The same is not necessarily true of all disability categories, however. For
example, children with physical disabilities appear to be well understood,
accepted and included (at least at the level of parallel play) in the play of typi-
cally developing children (Okagaki et al. 1998).
A second group of potentially isolated children are those with advanced
development. Gifted youngsters are often popular with others but do not experi-
ence these relationships as deeply companionable: in short, many are not as
attached to peers as their peers are to them. They might develop deep attach-
ments to a best friend at a similar developmental level to themselves or to their
parents, but lack a breadth of attachments, making them vulnerable to separation
problems and loneliness within groups of age mates. Thus, despite the fact that
their advanced problem-solving skills contribute to social finesse, it can seem at
times that they lack the ability to form friendships. The main intervention for
these children is to give them access to others at their developmental level, as
usually their social success improves and they feel less lonely when they have
playmates who can share their sophisticated interests.
A third group of children commonly experiencing social isolation are
those who often behave aggressively. Although these children initially
approach others often, their overtures are commonly rejected because their
approaches are boisterous or aggressive, they disrupt others’ play and are less
cooperative—with the result that over time they initiate less often and become
increasingly isolated (Dodge 1983). As a result of their behaviour, these

children are disliked by many peers but are liked by and gravitate towards other
aggressive children (Arnold et al. 1999; Dodge 1983; Farver 1996; Hartup
1989; Hartup & Moore 1990).
SOCIAL SKILLS INTERVENTIONS
Once isolated, children’s social inclusion is unlikely to improve without deliber-

ate intervention: it is not enough simply to place children together and hope they
will relate to each other positively (Guralnick et al. 1995). One approach is to
conduct formal social skills training programs. However, across a range of
learning and behavioural difficulties, such programs have produced improved
rates of interaction at the time but little evidence that these gains are maintained.
Given that the studies involve intensive and prolonged training—as many as 37
(Antia et al. 1993), 56 (McConnell et al. 1991) and 60 (Odom et al. 1999) daily
training sessions, for example—and given that most studies utilise highly trained
behaviour specialists and still attain very modest results, it seems that formal
social skills training programs are unlikely to be practicable (Odom et al. 1999).
More comprehensive, multifaceted approaches focusing on the environment,
children’s everyday interactions and their developmental skills are more likely to
produce lasting results (Strain & Hoyson 2000).
Promote acceptance
When children have a history of being in the same group and have observed
adults interacting positively with isolated peers, they are similarly likely to
accept and involve these children in their play (Hughes et al. 2001; Okagaki et
al. 1998). Your acceptance can also be communicated by talking openly with the
children about the many differences and similarities between people (Crary
1992). This can allow you to dispel some of their myths about disabilities, such
as that a peer’s disability in one domain affects all his or her developmental skills
simultaneously, or that it is contagious.
Ensure that the children know each other

Children are more willing to play with someone they know. This requires that,
where possible, you maintain a stable group membership and on a daily basis
incorporate the likes of name songs in your group story and song sessions so that
the children become familiar with each other.
Furthermore, it pays to limit individual children’s withdrawal or absences
for specialist appointments and the like, so that they have continuity in their
contact with potential playmates (Freeman & Kasari 1998). Also, dividing the
children regularly into groups composed of the same members for particular
activities is likely to highlight their differences, and could make members of the
other group seem unsuitable as playmates (Hestenes & Carroll 2000).
Consider placement
Because children choose playmates who are at their own developmental level, it
behoves us to provide individual children with potential matches by, where
possible, placing children with disabilities with at least one other child with a
similar disability (Freeman & Kasari 1998)—and gifted children with older play-
mates—so that the children have access to peers at similar developmental levels
to themselves (see also chapter 4).
Use toys that invite social play

Ensure that the activities on offer invite social play and are more attractive than
being alone. Toys that tend to invite isolated or parallel play include small
building blocks, playdough, books, sand play, and craft activities; while those
that promote social cooperative play include dress-up clothes, dolls and doll
houses, large blocks, housekeeping materials and vehicles (Ivory & McCollum
1999). This list is not prescriptive, as most of the latter group can be used in
solitary play as well, while the provision of dramatic play equipment will allow
children to engage cooperatively with otherwise solitary materials, such as
playdough and sand play (Sainato & Carta 1992).
Initiate cooperative activities

You can actively foster cooperative play between children by instigating activi-
ties and games that require joint effort and cooperation. Cooperative games aim
to involve isolated children and to pair up children who ordinarily do not play
with each other. In this way, they expand each child’s pool of potential friends;
help children form a cohesive group; teach cooperation skills, turn-taking and
sharing; decrease aggressiveness; and provide a non-threatening context for
modelling and rehearsing social skills (Bay-Hinitz et al. 1994; Hill & Reed 1989;
Orlick 1982; Sapon-Shevin 1986; Swetnam et al. 1983).
Examples of cooperative games include non-elimination musical chairs,
which involves removing a chair—not a player—whenever the music stops, so
that all the children end up having to fit on the one remaining chair. Another
example is the frozen beanbag game, which requires children to move around
with a small beanbag on their heads, freezing when it falls off, and remaining
still until another child helps by replacing the beanbag on their head (Sapon-
Shevin 1986).
At the same time you must curb competitive activities, as these increase
aggressive behaviours and reduce cooperation (Bay-Hinitz et al. 1994). Com-
petitive games involve taunting or teasing (e.g. ‘King of the castle’), grabbing or
snatching at scarce toys (e.g. musical chairs), monopolising or excluding other
children (e.g. the piggy-in-the-middle game), or the use of physical force (e.g.
tag ball) (Orlick 1982; Sapon-Shevin 1986).
Some children are reluctant at first to engage in cooperative games but still
benefit from even low participation rates, and can be persuaded to participate by
watching the other children enjoying themselves (Bay-Hinitz et al. 1994; Hill &
Reed 1989).
Mediate children’s use of social skills

When you observe that particular children have no stable friendships, are
rejected because of their aggressive behaviour, have disabilities that impair their
social skilfulness, or play predominantly alone or in parallel beyond the usual
age, you can take active steps to support their social engagement.
Mediate social play

In most instances, it is important to allow children to direct their own play and
resolve their non-violent conflicts independently (Harrison & Tegel 1999).
However, when children are often isolated, you can be more directive by:
• selecting socially competent children to play alongside the reticent child;
• introducing an activity that will attract that child and others;
• if necessary, prompting their play until the children can direct it themselves
(Odom et al. 1999).
Some writers advise educators to structure all elements of play involving children
with intellectual disabilities: determining the game, allocating roles and assigning
tasks, as negotiating these exceeds the children’s cognitive skills and so limits their
involvement in dramatic play (DeKlyen & Odom 1989). However, as this denies
children without disabilities the metacognitive exercise that negotiation provides,
and the imposed structure might not result in generalisation of disabled children’s
play to less structured settings, this procedure should be used judiciously.
Teach specific behaviours that make up social skilfulness

The first social skill is surveillance: to enter a group, children need to take time to
survey the group’s activities and members’ non-verbal behaviours. This allows
hopeful entrants to make their behaviour relevant to the group’s, which in turn
makes it more likely that their bids to gain entry will be positively received (Asher
1983; Brown et al. 2000). A hopeful entrant can approach the other children and
quietly observe their game, wait for a natural break to occur, and then begin to do
what the other children are doing (Putallaz & Wasserman 1990). This has been
called the wait-and-hover technique and is extremely useful—as long as it is
followed by bids to enter; otherwise children remain on the periphery for extended
periods (Brown et al. 2000). Moreover, as groupings become more firmly
entrenched over time, entry bids have to be increasingly sophisticated, which will
disadvantage children with developmental delays (Guralnick & Groom 1987).
This entry process can be facilitated by the use of some social behaviours,
as listed in Box 11.2. You can naturalistically prompt and assist isolated children
to use any of these behaviours. Once children have located some playmates, they
need to know how to maintain the relationship. This too requires a range of skills
(see Box 11.2).
Assist children’s development

Children need to be competent at talking so that they understand the play themes
of others and can sustain and elaborate on their social play (Rose 1983;
Box 11.2 Prosocial behavours

Although social skills differ at various ages and for various ethnic and cultural
groups, some skills are universal. These universal skills comprise being
positive and agreeable; being able to use relevant contextual and social cues
to guide one’s own behaviour; and being sensitive and responsive to the inter-
ests and behaviour of playmates (Mize 1995).
Entry skills
• Observe the group before attempting entry.
• Initiate contact by approaching, touching, gaining eye contact, vocalising
or using another child’s name.
• Responding positively to others’ invitations is a second way to gain
entry to others’ play.
• Avoid disruptive actions, such as calling attention to oneself, asking
questions, criticising the way the other children are playing, or introduc-
ing new topics of conversation or new games, being too boisterous and
thus out of keeping with the group, acting aggressively or destroying
others’ play materials (Putallaz & Gottman 1981; Putallaz & Wasserman
1990).
Supportive actions
Supportive behaviours tell others that potential playmates are keen to
cooperate and can be trusted. Such actions comprise:
• complimenting;
• smiling at;
• cooperating;
• imitating;
• sharing;
• taking turns;
• assisting others;
• leading diplomatically (i.e. making positive play suggestions) to enlist other
children in their play, but without being bossy.
To be supportive, children also need to pay attention to relevant social cues

so that they are sensitive to the needs of their playmates. In response to
feedback from their peers, they need to:
• moderate their behaviour to suit their friends;
• respond positively when others are trying to make friends.
Finally, children need to be aware of how their behaviour will influence how
other people respond to them.
Conflict management skills
To resolve conflict peaceably with playmates, such as when their requests to
enter a group are being rebuffed, children need to:
• be persuasive and assertive rather than bossy;
• negotiate play activities;
• obey social rules about sharing and taking turns as leader;

• suggest compromises when someone’s actions have been disputed;
• avoid acceding to unreasonable demands from playmates but nevertheless
decline tactfully by presenting a rationale for not accepting a playmate’s idea
or by offering an alternative suggestion (Trawick-Smith 1988).
Rubin 1980; Trawick-Smith 1988). Similarly, they need the requisite motor skills
to participate in peers’ physical play and to move about the centre, seeking activ-
ities and peers to engage them. Therefore, if children speak a language other than
English or have delayed skills in any developmental domain, secure them pro-
fessional assistance to enhance their skills and thus their social inclusion.
Ensure access for children with disabilities

If children are to play together, you will need to ensure that those with disabili-
ties have access to the same activities as their peers. Suggestions given in
previous chapters can help here. Nevertheless, being alongside each other is
necessary but not sufficient for children to play together and so you will need to
enact the following additional measures that allow them to find mutual interests.
Assist peers to engage excluded children

When children are neglected or ignored by their peers, you might deliberately
structure an activity that you know will appeal to two children who do not ordi-
narily play together, or you could await a natural opportunity to point out to a
competent child that an isolated child appears interested in what he or she is
doing and might want to take part. You could say something like: ‘James seems
interested in your game. Do you think he could help you with the baby’s bed?’
Some social skills programs that train peers to lead the play of less able
children (e.g. Odom et al. 1999) generally increase the rate of children’s inter-
actions. Even then, educators must continue to structure activities and materials
and seek opportunities to facilitate the children’s natural social exchanges
(Kohler & Strain 1999). Moreover, such programs have disadvantages that
suggest caution in their use: first, the children’s friendships may not flourish
(English et al. 1997), partly because the ‘buddy’ role must be shared between the
able children so that they do not feel burdened by it; second, it is important that
time involved in training their less able peers not encroach on opportunities for
the able children to extend their own development.
Another instance where you can support individual children is when they are
refused entry to other children’s play, which is common even when children
request entry in socially graceful ways. At times, a rebuff will occur because the
children just want to be alone or because they cannot think of a way of involv-
ing a new player. In the latter case, you can inquire about their game and ask
whether there is room for one more child. You could meet such complaints as
‘Matthew wants to be the baby and we already have a baby’ with suggestions that
this family could have twins, or that Matthew could adopt some other role.
If the children reject these suggestions, you could limit the duration of the
exclusion. You could begin by explaining to the excluded child, ‘Well, it looks
like there isn’t room for you in this game just now, Matthew. Children, how long
do you think you’ll be playing this game before you can let Matthew join in?
How long will Matthew have to wait?’ This gives a certain end to their exclusion
of Matthew and lets him know that his exclusion has to do with the demands of
the game, rather than himself.
Assist aggressive children

Troubled and isolated children have troubled and isolated families (Hartup &
Moore 1990; Kelly 1996). Furthermore, the behaviour of aggressive children
can provoke rejection by their parents, educators and peers, exacerbating their
original difficulties. Thus, it is crucial that you do not allow the children’s
behaviour to provoke the same reaction in you (Kelly 1996). Instead, you will
need to:
• build a close relationship with these children, to compensate for their lack of
attachments to peers and other adults;
• teach them to manage their emotions so that they can behave prosocially
with peers, without using coercive means that invite further rejection
(Arnold et al. 1999) (see chapter 12);
• teach the children how to enter a group without disrupting its ongoing
activity (Kelly 1996);
• as aggressive children are more likely to interpret their peers’ accidental
behaviours as intentionally hostile and to respond aggressively, guide them
to make more accurate interpretations of others’ intent and to overlook
occasional mistakes by playmates (Asher 1983; Katsurada & Sugawara
1998);
• teach recipients of aggression how to negotiate with rather than to reject the
aggressor, so that rejection does not provoke further instances of aggression
(Arnold et al. 1999);
• allow recipients of aggression some time to be assertive independently to
establish their own place in the group hierarchy (Farver 1996);
• if safety becomes an issue or resolution is not speedy, step in to protect
recipients from intimidation (Arnold et al. 1999);
• give aggressors alternative opportunities to lead and exercise autonomy so
that they do not need to exert control in destructive ways;
• consider social skills coaching for all members of an aggressive child’s
clique, as all group members are likely to display similar levels of aggres-
sion, even when individuals have differing popularity (Farver 1996);
• foster cohesion within the peer group in general, as aggression is less
common within stable, cooperative groups (Farver 1996);
• where possible, support parents to improve their bond with their children
without using controlling disciplinary methods, so that the children experi-
ence and acquire an attitude of nurturance and empathy towards others;
• encourage parents to provide additional opportunities for the children to

practise prosocial skills in relationships with family acquaintances or other
children from the centre (Hartup & Moore 1990).
CONCLUSION
A crucial part of any early childhood program is safeguarding the emotional

wellbeing of the children. All children have emotional needs that deserve con-
sideration, while children with atypical development can experience additional
emotional and social challenges.
If young children are having difficulty learning social skills naturally, early
childhood is an ideal time to intervene: children of this age are motivated to play
socially so they are willing to be guided by adults, and there are many natural
opportunities every day to be taught social skills. Nevertheless, antisocial behav-
iour might arise not because children do not know the prosocial alternative but
because their aggression works for them. In that case, the issue is behavioural
rather than a skill deficit, which leads in to the topic of chapter 12.
Child protection
Briggs, F. and McVeity, M. 2000 Teaching children to protect themselves Allen
& Unwin, Sydney
Self-esteem
Curry, N.E. and Johnson, C.N. 1990 Beyond self-esteem: developing a genuine
sense of human value National Association for the Education of Young
Children, Washington, DC
Seligman, M.E.P. 1995 The optimistic child Random House, Sydney
Social skills
Cartledge, G. and Milburn, J.F. (eds) 1995 Teaching social skills to children:
innovative approaches 3rd edn, Allyn & Bacon, Boston, MA
Katz, L.G. and McClellan, D.E. 1997 Fostering children’s social competence:
the teacher’s role National Association for the Education of Young Children,
Washington, DC
Kostelnick, M.J., Stein, L.C., Whiren, A.P. and Soderman, A.K. 1998 Guiding
children’s social development 3rd edn, Delmar, Albany, NY
McGrath, H. 1997 Dirty tricks: classroom games for teaching social skills
Longman, Melbourne
McGrath, H. and Francey, S. 1991 Friendly kids; friendly classrooms Longman
Cheshire, Melbourne
Odom, S.L., McConnell, S.R. and McEvoy, M.A. (eds) 1992 Social competence
of young children with disabilities: issues and strategies for intervention
Paul H. Brookes, Baltimore, MD
Sapon-Shevin, M. 1999 Because we can change the world: a practical guide to
building cooperative, inclusive classroom communities Allyn & Bacon,
Boston, MA
12
GUIDING CHILDREN’S
BEHAVIOUR
LOUISE PORTER
KEY POINTS
• Behaviour management or disciplinary practices reflect an imbalance of

power between adults and children, which is often justified on the grounds
of the children’s immaturity (Johnson et al. 1994).
• There is a contradiction between teaching children to explore so that they
will learn and teaching them to do as they are told so that they obey behav-
ioural limits.
• This tension can be resolved by aiming not for compliance but for
thoughtful and considerate behaviour, using means that increase the
children’s self-control rather than imposing controls on them externally.
INTRODUCTION
Although more common in those who have significant developmental disabil-

ities, clinical behavioural difficulties in very young children are rare—perhaps as
low as 2% (Smith et al. 1987). Nevertheless, many practitioners experience
significant behavioural difficulties in children who have no recognised behav-
ioural disorder and display otherwise typical development. Such difficulties
comprise the following:
• behaviours that are normal but occur excessively—past the usual age or at a
higher rate than usual (Herbert 1987);
• behaviours (e.g. head-banging and biting oneself) that are abnormal at any
age (Smith et al. 1987);
• a constellation of behavioural difficulties, any one of which on its own
would not be a major challenge but when combined pose some management
difficulties;
210
GUIDING CHILDREN’S BEHAVIOUR 211
• behaviours that are suitable in one time and place (e.g. moving about) but
which disrupt the present context, such as group story time (Apter 1982, in
Conway 1998).
These scenarios have been termed primary behaviours (Rogers 1998), and are
generally thought to be a problem because they violate the rights of the children
performing them or interfere with the rights or needs of surrounding children or
adults. Secondary behaviours, however, are probably more common and there-
fore of greater importance: these are said to occur in reaction to adults’ corrective
responses to the primary behaviours (Rogers 1998). In my research I found that
the disciplinary methods described in this chapter avoided provoking such
reactions, thus reducing considerably the number of disruptions (Porter 1999b).
DEBATES ABOUT DISCIPLINE OF YOUNG CHILDREN
The language about behaviour ‘management’ is problematic, having overtones of

controlling others: of doing something to them, rather than working with them
(Kohn 1996). It implies a reward-and-punishment system of behaviour modifi-
cation: even the alternative term ‘discipline’, which might seem preferable, has
connotations of punishment because our society has such a long tradition of
using controlling forms of discipline that the two terms are wrongly thought to
mean the same thing.
Locus of control
Some theories—most notably applied behaviour analysis (ABA), which was
earlier termed ‘behaviour modification’—believe that individuals’ behaviour can
be manipulated by changing the rewards and punishments that follow it. Guided
by this belief, adults give children rewards for ‘good’ behaviour and punish
undesirable actions.
Taking rewards first, these can be social (e.g. praise, hugs or a smile); the
opportunity to do a favourite activity (e.g. being allowed to play outside for extra
time); a sticker or some other tangible reward that the children value for itself;
or food rewards (although these are not recommended; see Birch et al. 1995).
Meanwhile, punishment is of two types: withdrawing a positive consequence
that children want (e.g. withdrawing access to a privilege, or withdrawing atten-
tion through the use of time out), and administering negative consequences such
as verbal reprimands and physical aversives such as spanking. In some countries,
physical aversives, particularly in professional settings, are illegal; even where
this is not the case, experts agree that they should never be used for ethical
reasons and because of their ineffectiveness.
A contrasting view of where control is located comes from a group of theor-
ists known as humanists. These writers believe that external events only ever
give us information about what might happen to us if we engage in a particular
Box 12.1 Side-effects of rewards

Rewards imply that adults know everything in all domains and so have a right
and are able to judge whether children’s achievements are adequate. Other
disadvantages include the following.
Effects on children’s self-esteem
• Children will not feel accepted because they know that they are being
judged.
• When ideal behaviours are rewarded, children might expect themselves to
be ‘good’ all the time, lowering their self-esteem when this is impossible.
• Rewards teach children that other people’s opinions of them are more
important than their own. This can stifle self-reliance.
Rewards can impede learning
• Rewards can cause children to develop external rather than intrinsic
motivation.
• Children who strive for rewards might engage in ‘adult watching’ to assess
whether you approve of them. This will distract them from their own
learning.
• Rewards cause children’s performance to deteriorate: they may do more
work but it is of lower quality.
• Rewarded children might strive to please and fear making mistakes, and so
avoid being creative and adventurous.
Rewards can provoke disruptive behaviour
• Discouragement about being unable to meet unrealistic expectations can
cause some children to behave disruptively.
• Rewards do not teach children to monitor their own successful behaviour
and so do not give them the skills to regulate their unsuccessful actions
either.
• Rewards might teach children how to manipulate their peers.
Rewards can be ineffective
• Rewards are often delivered to the children who achieve least well (as
adults are aware that these children need encouragement) and so, if they
work, will reinforce low-quality output.
• Adults and their praise lose credibility if the children’s evaluations of their
work do not match those of the adults.
Rewards can be unfair
• Adults need a high level of technical expertise to use rewards well.
• While some children can ‘pull’ praise from adults, others cannot and so
receive less praise than they deserve.
• Rewards increase competition between children.
• Their experience that praise is unfair causes some children to reject the
adults who administer it.
• Many children come to resent being manipulated by rewards.
behaviour, but that we decide for ourselves whether we will abide by or defy a
system of rewards and punishments (Glasser 1998). This decision is based on
whether a behaviour we are contemplating is likely to meet our needs (as listed
in chapter 11). In short, humanists say that all individuals are controlled inter-
nally, not externally.
The debate is difficult to settle through research, but cognitive theory (see
chapter 10) highlights the need to promote an internal locus of control for all
children and particularly for those who have disabilities—and disciplinary
methods are no exception to this edict. Furthermore, even if individuals can be
manipulated externally, the humanists contend that it is risky to do so. They cite
many disadvantages of rewards and punishments, respectively listed in Boxes
12.1 and 12.2. Many (but not all) of these have been verified by research: for
instance, studies have shown that when mothers exercise restrictive control over
their children, the children become defiant, uncooperative, withdrawn, anxious,
unhappy, hostile when frustrated, and unwilling to persist at tasks (Baumrind
1967, 1971; Crockenberg & Litman 1990).
In contrast, Gordon (1991) believes that adults must achieve authority by
virtue of their expertise, rather than through their power to make children
uncomfortable for non-compliance. Glasser (1998) describes the first style as
leadership and the second as bossing. This authoritative discipline style tends to
produce children who are more cooperative, self-controlled, self-confident,
independent and social. This is probably because children are more likely to
cooperate with adults who have previously cooperated with them (Atwater &
Morris 1988; Parpal & Maccoby 1985; Porter 1999b).
In light of such studies with parents and educators, the humanist writers
conclude that there are alternative disciplinary measures that are as effective as
rewards and punishments, but which do not incur their risks.
View of children
The humanist writers accuse the authoritarian theories of having a sour view of
children, namely that they will not behave thoughtfully unless they are manipu-
lated into doing so (Kohn 1996). Humanism believes instead that when adults do
not threaten children with punishment or bribe them with incentives for behav-
iour of which we approve, young people are motivated, will make constructive
choices, and are likely to behave thoughtfully (Kohn 1996; Rogers 1951; Rogers
& Freiberg 1994).
Goals of discipline
Some theories aim to teach children to comply with adult directives, and indeed
use terms such as ‘non-compliance’ or ‘naughty’ to describe behavioural dif-
ficulties. Most claim that their intent is to use this external control to teach
children self-discipline. However, ‘self-discipline’ means different things to the
various authors: in some cases, it simply means getting children to comply
Box 12.2 Summary of disadvantages of punishments

Limited effectiveness
• Children must infringe someone’s rights before action is taken.
• Aversive consequences can increase undesirable behaviour.
• Children learn to behave well only to avoid punishment, rather than devel-
oping a ‘conscience’.
• Adults must be constantly vigilant to detect misbehaviour, and cannot.
Failure to identify the full circumstances leads to errors in administering
punishment.
• Its effects may not be permanent.
• Punishment may not replace the undesired behaviour with a more desirable
one.
• Punishment works only for those who do not need it.
Effects on recipients
• Punishment can produce negative emotional side-effects, including low
self-esteem.
• It can teach children to imitate exercising control over others.
• Children might avoid punishing situations either by withdrawing or by
becoming submissive.
• Punishment can provoke undesirable behaviours such as resistance, rebel-
lion and retaliation, which in turn attract more punishment.
• Punishment can intimidate onlookers even when they themselves are never
punished.
• Punishment can cause onlookers to define a punished child as ‘naughty’
and, as a result, exclude him or her from their friendship group.
Effects on administrators and society
• Punishment can become addictive and can escalate into abuse.
• It can teach children to ignore adults who threaten but do not deliver
punishment.
• Children might push adults who threaten punishment, to see how far they
will go or to force them to back down from an empty threat.
• Violence damages relationships.
• Violence in homes, care settings, preschools or schools leads to a violent
society.
whether or not they are being supervised. But this might come about simply
because the children are not sure when the adult will return and detect any
misdeeds. This, then, is simply internalised compliance. Instead, humanism aims
to teach thoughtful behaviour, which comprises:
• developing in children a sense of right and wrong so that they act consider-
ately, not because they might be punished for doing otherwise but because it
is the right thing to do;
• teaching children to manage their emotions so that their outbursts do not
disturb those around them, but more importantly so that they themselves
learn to cope with setbacks in life;
• teaching children to cooperate so that all can have their needs met;
• giving children a sense of potency—that is, a sense that they can make a
difference to themselves and their world and can act on their values
(Porter 2001).
In the vein of Calvin Coolidge’s declaration that ‘There is no right way to do the
wrong thing’ (Sapon-Shevin 1996: 196), the humanists reject the authoritarian
goal of teaching obedience, as it runs counter to the educational goals of teaching
democratic values, problem-solving skills and critical thinking (McCaslin &
Good 1992). As McCaslin and Good (1992: 13) observe, ‘We cannot expect that
[children] will profit from the incongruous messages we send when we manage
for obedience and teach for exploration and risk taking.’
Furthermore, training children to be obedient is dangerous in three respects.
First, it endangers individual children because they might not resist abuse—and
here I’m thinking mainly of sexual abuse—because they have been taught to do
what adults say (Briggs & McVeity 2000). Second, it is dangerous for surround-
ing children, as those who have been trained to follow others might collude with
schoolyard bullying when directed to do so by a powerful peer. Finally, whole
societies would be safer if people did not follow the commands of a sociopathic
leader who told them to harm members of a surrounding community whose race
or religion differed from their own.
Definition of disruptiveness
The pluralistic perspective introduced in chapter 1 flows into acceptance of
diverse behaviours of children as well as other differences among them. Lieber
et al. (1998) observed that teachers who seek conformity accept only a narrow
range of behaviours in their young charges. This provokes the recognition that
‘misbehaviours’ or ‘inappropriate behaviours’ are mostly defined by adults and
are in the eye of the beholder (Kohn 1996). Instead, you need to keep in mind
your goals of discipline and define only those behaviours that violate these or
interfere with someone’s rights as being in need of intervention.
Externally oriented theories such as ABA believe that children’s disruptive
behaviour is caused when it is inadvertently rewarded or not punished. The
humanist view, in contrast, is that disruptions occur:
• as a natural result of children’s inability always to anticipate the effects of
their actions;
• when children explore their social environment and, not having the skills to
predict the outcome in advance, at times do not realise that their actions
could negatively affect someone else (Gartrell 1987, 1998);
• when children lose control of themselves because they are temporarily over-
whelmed emotionally;
• in reaction to the methods adults commonly use to control children’s behaviour
(Gordon 1974; Porter 1999b).
All of these reasons, then, are natural childhood events—in which case we
should not punish children for such mistakes, because to do so would be to
punish them for being children. Instead, we should teach them how to act
thoughtfully, just as we teach any other functional skills.
SELECTING DISCIPLINARY METHODS
With these debates about the discipline of children as a background, practitioners

must choose which approaches they will use when children act thoughtlessly.
When selecting these, the issue of justice or ethics is fundamental. As discussed in
chapter 1, there are two key ethical guidelines: first, that practitioners must do good
and, second, that they must avoid doing harm. The first of these principles implies
that when trying to correct disruptive behaviour, any measures used must be effec-
tive. That is, they must improve the behaviour so that surrounding children or
adults are protected from ongoing disruptions. Second, miscreants must likewise
be protected: children who are acting inconsiderately must learn self-control so
that they can cope with emotional setbacks without becoming overwhelmed and
can become proud of their ability to manage themselves, and so that they do not
become ostracised by others because of their inconsiderate actions.
The second principle—of avoiding harm—implies that while attaining a
good outcome in terms of the reduction of thoughtless behaviour, the means of
achieving this must not harm miscreants or onlookers in any way: the measures
used must not scapegoat, disempower or intimidate any individuals.
Thus, the merit of any proposed disciplinary measures should be assessed on
the following dimensions:
• the child returns to considerate behaviour—the disruption ceases;
• the miscreant learns something positive through the process of correction—
such as how to solve problems;
• there are no unintended side-effects that could disadvantage the miscreant—
such as increased fear of adults, feelings of intimidation, or rejection by
peers;
• there are no spillover effects for onlookers—such as intimidation about how
they would be treated if they too made a mistake;
• there are no spillover effects for adults—such as a loss of their humanity or
violation of their own principles;
• there are no deleterious effects on the adult–child relationship as a result of
how a misdemeanour is handled.
Although the theories that use rewards and punishments can cite a considerable
body of research demonstrating that these methods often reduce subsequent
undesired behaviours and increase desired ones (e.g. see Alberto & Troutman
1999; Kaplan & Carter 1995), such studies typically do not investigate whether
there were side-effects on individual and surrounding children. When examining
such spillover effects, my research (Porter 1999b) found that the humanist
approaches both were more effective at ending disruptions and avoided the
negative emotional side-effects of the rewards and punishments used by
the authoritarian approaches (as summarised in Boxes 12.1 and 12.2). This
suggests that educators should guide—rather than control—children.
SKILLS FOR GUIDING CHILDREN
Based on the research and ethical issues just described, the following methods
adhere to a humanist approach to discipline, in which adults guide children and
coach considerate behaviour rather than controlling children through the use of
rewards and punishments.
Enact preventive measures

Although prevention is by far the most crucial aspect of behaviour management,
previous chapters have discussed how to adjust the curriculum for children with
atypical needs, so that information will not be expanded on here. In addition,
other preventive principles can only be summarised here for reasons of space.
These include the following.
• Provide a child-friendly environment in which all children feel emotionally
safe and confident that they can meet expectations.
• Give children choices: on compulsory activities you cannot give them a
choice whether to participate, but you can give choices about how they carry
out the activity.
• Expect considerate behaviour—even from children with conditions that
make this difficult, as to expect less of them would be to gain less for them
and would disable them doubly with the original disability and rejection by
their peers. However, when individual children have more than the usual
difficulties learning thoughtful behaviour, balance this with the provision of
increased support.
• Use routines where appropriate so that children understand what they have
to do and do not need you to supervise their performance.
• Give instructions on what you want the children to do, rather than what you
want them to stop doing. For instance, the positive instruction to ‘Take small
steps’ can replace the negative injunction ‘Don’t run’ on wet tiles.
• Be sensitive to what is troubling children and respond suitably so that they
can regain emotional balance.
It cannot be emphasised enough that, when individual children are often acting
thoughtlessly, you must examine the context in which they are currently func-
tioning and make adjustments to the wider curriculum (including group size,
teacher–child ratios and developmental demands) to enable more considerate
behaviour, and you must develop caring relationships with troublesome children
in order to make them more willing to cooperate with you. No intervention—no
matter how skilfully employed—can compensate for a program that does not
meet children’s academic, social and emotional needs.
Establish guidelines, not rules

In collaboration with the children (once they have the verbal skills), you can
jointly determine the behavioural guidelines that will help everyone to enjoy their
time at the centre. Guidelines define considerate behaviour—that is, what you
want children to do (Gartrell 1998). They are reference points that help make your
responses predictable across time and different situations, but they leave you free
to decide how to respond in each instance, depending on the circumstances.
In contrast, rules tell children what you do not want them to do and usually
have predetermined penalties: ‘If you do that, this will happen.’ Consequences
leave you either having to enforce something that does not make sense in the
circumstances, or appearing to be inconsistent, which under the controlling
forms of discipline is ineffective.
Acknowledge considerate behaviour

The humanists have generated many criticisms of using rewards (including
praise) to encourage children’s achievements and thoughtful behaviour, as listed
in Box 12.1 (Kohn 1996, 1999; Ryan & Deci 1996). Nevertheless, these writers
do recognise that children, especially those who are discouraged about their
skills, need feedback about their successes and considerate behaviour, so that
they will remain motivated to strive to achieve.
This dilemma is resolved by giving children information about what they
have achieved (which elsewhere I have termed ‘acknowledgment’), rather than
praising or evaluating them—that is, judging children positively for their
achievements. The risk with evaluative feedback is that it can inflate children’s
ideals, with the result that they become discouraged at their ability to meet
expectations (see chapter 11). Acknowledgment instead aims to feed children’s
self-concept, and so gives them information about what they can achieve, not
what they must achieve to gain adult approval. The humanists contend that
children will be equally motivated by informative feedback, with fewer risks to
their self-esteem and motivation to act thoughtfully (Brophy 1981).
Acknowledgment differs from praise in the following ways:
1. Acknowledgment teaches children to evaluate their own efforts, whereas
praise gives your evaluation of these. You can invite children’s self-
evaluations with feedback such as: ‘What do you think of that? . . . Was that
fun? . . . Are you pleased with yourself? . . .You seem pleased that you did
that so well.’
2. Unlike praise, acknowledgment does not judge children or their behaviour or
achievements. When you acknowledge, you might tell them how what they
have done affects you, but this is only an opinion, not an evaluation: ‘Thanks
for being quiet while I explained what we all have to do’, or ‘I appreciate that
you all helped pack away: it meant we could all go outside a little earlier.’
3. Acknowledgment is a private event that, unlike praise, does not show
children up in public or try to manipulate others into copying someone who
is behaving to expectations.
We do not reward our adult friends or tell them that they are ‘good people’ when
they help us out: all we do is thank them. So we can do the same for children: it
is not up to us to judge or label them, but we can say when we appreciate their
considerate behaviour. This is a natural outcome (consequence) of their actions,
not an attempt to bribe them into repeating the behaviour again.
Nevertheless, on rare occasions I have had to contrive some feedback so that
children who find learning very difficult have some physical evidence that they
are achieving the many small steps towards success. This is particularly so when
using cognitive training approaches (see chapter 10). In these cases I have used
stars, placing them inside an outline of a child’s favourite cartoon character—not
as a reward for listening, attending or whatever, but as a form of evidence of that
achievement. Placing the sticker on the drawing ‘punctuates’ the training session,
as it were, allowing us to pause and highlight the children’s efforts. At the end of
the session, when the character is filled with stickers, the children have some
physical evidence to remind themselves of their achievements. Meanwhile, the
feedback is still informative, not judgmental. It comprises such comments as,
‘Congratulations! You did it!’ or ‘Wow. Did you know you could listen so care-
fully?’ or ‘How did you do that?’ or ‘I think you can be proud of that. Here’s
another star to remind you that you did it.’ This practice might seem similar to
delivering rewards but the intent is to help the children recognise their own
achievements by giving them visual information when verbal feedback is not
meaningful enough to them.
Modify your demands

It is important to ‘listen with your eyes’ to children’s disruptiveness and interpret
it as a message that they cannot cope with the present circumstances. Here you
have two options: try to help them to regain self-control (see below), or change
what you expect (you can change your demands, not the child). For example,
when a child is disrupting others’ play, you could invite him or her to come with
you to help cut up the fruit. To those steeped in the controlling style of discipline,
this seems like a ‘reward’ for poor behaviour, but under a guidance approach it
is a recognition that the child is experiencing difficulties and is an attempt to
offer support for regaining control.
Let children save face

Because their self-esteem can be tenuous, it is important to give children a way
to save face after they have made a mistake. You could comment that sometimes
people forget to think before acting, that it was probably an accident, or that now
that the children know what can happen when they act in that way they will
probably decide not to do it again. Because children cannot always anticipate the
effects of what they do, the result can startle them enough to teach them not to
do it again, and you will only humiliate them if you preach about something they
have already realised.
Similarly, do not force children to apologise when they have hurt another
child and do not deliver a lecture about what they have done. They will already
know that their actions were hurtful but, in the heat of the moment, could not
overcome their emotions and act on this knowledge. Therefore, there is no point
explaining this to them again: the issue is not a lack of information but a lack of
self-control.
So take the perpetrator and victim aside and soothe the child who has been
hurt, responding to his or her feelings, as well as the physical pain. With the
perpetrator listening, reflect the victim’s feelings: ‘That hurt you, didn’t it? Yes,
Shelley forgot to use her words … She might be feeling frustrated or angry, do
you think?’You could add, ‘I think that she is sorry that she hurt you. She might
be able to say so later.’ If you let perpetrators save face in this way, they are likely
to choose to say sorry; if they are not ready to, forcing them will not help.
Be assertive about inconsiderate behaviour

The types of behaviour for which intervention is necessary are those which
violate someone’s rights. Disruptive behaviour can interfere with children’s own
participation, with meeting the needs of surrounding children or adults, or both.
When children’s behaviour is violating your needs or those of other children in
your care, you will have to be assertive about the effect their behaviour is having
on others—without, however, blaming or criticising them, as that would be
aggressive. The difference between assertiveness and aggression is that assertive-
ness tells children about your needs (using the word ‘I’) whereas aggression tells
them about themselves (using the word ‘you’).
The first principle of assertiveness is to speak up early so that you do not
force yourself to be too patient, do not require surrounding children to suffer
repeated disruptions, and do not allow the miscreant to develop a habit of acting
thoughtlessly.
A second principle is that, if you expect children to listen to your needs, you
must first be willing to listen to theirs. This makes the method of ‘empathic
assertion’ particularly valuable (Jakubowski & Lange 1978). In this approach,
you deliver a three-part statement which:
• reflects the children’s positive motives for the behaviour;
• states what you require;
• asks for a resolution.
For example, when some children are being noisy outside, you could say: ‘I
know that it’s fun to run around and be noisy, but the babies are still asleep
inside, so I need you to be a little quieter or move away from the babies’ window.
What would you like to do?’
Resolve conflict collaboratively

Instead of punishing children for what it regards as natural childhood mistakes,
humanism uses collaborative problem solving to resolve disruptive behaviour
that is negatively affecting both children and adults. When there is a conflict,
leaders look for a solution, not a culprit. Nevertheless, children will need
guidance to solve a dispute collaboratively. When disputes have arisen between
children, this comprises the following steps:
1. Ask and listen to what each child needs.
2. Explain each child’s need to the others involved.
3. Ask the children how they can solve the dispute so that they all get what they
need.
4. Guide them to select one of the strategies they have suggested.
5. Gain their agreement to try the chosen solution and thank the children for
their cooperation.
6. Once the solution is in place, check that it is working.
Similar steps can be used when you are in a dispute with children over their
behaviour, whereby you listen to what they require, are assertive about what you
need, and ask how the two of you can resolve the issue.
Teach self-control
Mostly, we assume that when children are not able to behave in a certain way,
this is because they do not know the correct form of behaviour. Instead, in my
observations, most children know how they should be acting but are temporarily
overwhelmed by their feelings and cannot act on that information.
A brief adult example might help to explain this: let’s say that at a social
gathering you are offered some potato crisps. Despite not feeling hungry, you
reach out your hand to take some. At that point, do you need someone to tell you
about the nutritional value of potato crisps—or do you already know that and
instead need more self-control? The answer is clear: it is not a lack of information
that causes us to behave in ways we would prefer not to, but a lack of self-control.
In my experience, children show that they have lost self-control in one of the
following four ways (Porter 2001).
1. Protesting tantrums occur when children are angry about not getting what
they want. This type of tantrum involves crying, screaming, hitting or
kicking, and is very active. (This is different from preverbal children’s
attempt to communicate that they are disappointed. That is not a tantrum: it
is legitimate communication. A tantrum is where children who can usually
say what they need, instead get so worked up that they cannot use words.)
2. Social tantrums involve one or more children exchanging verbal abuse,

refusing to share or take turns, bullying, name calling, and generally not
being friendly.
3. Whingeing, sulking or nagging are the passive version of a protesting
tantrum and tell us that children feel dissatisfied with something, and cannot
get past that feeling to get on with what needs to be done.
4. Uncooperative behaviour is the commonest expression of lost self-control,
and occurs when children cannot do as they are asked because they do not
want to—and cannot overcome their feelings about having to do it.
That young children lack emotional self-control is natural, given that as babies
their survival demanded that they communicate every emotion to their care-
givers. But this does not mean that we have to wait passively in the hope that
somehow they will learn to manage their emotions: we can teach this skill to
them by explaining the process of growing up and lending our warm support as
they regain command of themselves.
Explain growing up
Growing up is a process of learning how to be boss of our feelings. Adults
(mostly) have learned that we cannot act on every impulse. In contrast, infants
believe that if they feel something, it is okay to act on it. This is part of normal
development. However, as they are approaching school age, they need to be
beginning the lifelong process of learning how to be in charge of what they do.
So I tell children that while their body—their outside—is getting taller,
bigger, stronger and so on, their insides may have forgotten to grow up. Their
feelings boss them around and get them into trouble or get them upset (as the
case may be). As they are growing up to be a kindy or school person shortly—
or will be this old at their next birthday—now is the right time to start thinking
about growing up on the inside as well.
You cannot talk children into growing up, or they would not want to do it.
Also, you cannot give them suggestions of how they can achieve it. But it can
help to warn them that it will take them a long time to think about, but you are
sure that part of them knows how to do it. After all, they have grown up on the
outside so successfully that this shows they know how!
While they are thinking about how to teach their feelings to grow up, you
will help them at the times when they get out of control.
Bring children in close

When babies get upset, we bring them in close to us and soothe them. But often
our first impulse with older children is to send them away to sort themselves out
alone. That, to my mind, is unfair and is too big a task for young children. (It’s
even too big a task for many adults.)
So instead of sending them away from you, bring upset children in close.
Cuddle them, soothe them, let them cry—for as long as it takes for them to feel
better. This is meant to be nurturing. The children’s behaviour tells you that they
are feeling stressed and out of control. There is no point punishing them for
feeling like this, but they do need help to learn how to manage their feelings so
that, with repeated practice, these do not need to get out of control in future.
Meanwhile, on the grounds that you cannot reason with people while they
are being unreasonable, say very little: do not try to hurry them into feeling better
or explain yourself or the problem. That can come later, if at all. All you need to
repeat is something like, ‘I understand that you’re upset and I’ll sit with you until
you feel happier/better.’ In this process, children usually go through a range of
feelings from anger, sadness, to bargaining, before becoming calm and back in
control.
Staying with children in this way tells them that you are willing to help them
and teaches them the very skill that you are wanting them to learn—namely, how
to get back in control of their emotions. Cuddling them does not do that task for
them, but it does give them the support they need to achieve it.
Being with them will work best if you can begin before they get really upset
and if you can comfort children often so that they get repeated practice. The early
signs that they are losing control could comprise one of the passive tantrums
(whingeing or uncooperativeness), which will be easier to manage than the sub-
sequent active versions (protesting or social tantrums).
Sometimes, however, children are too out of control to accept your company
or a warm cuddle as they calm down. When there is a risk of injury or the
children’s distress escalates, you might instead need to use time away.
Use time away

Sometimes you cannot or do not want to accompany children while they calm
down, in which case time out might seem an attractive option. This usually
involves isolating a child on a chair that is somewhat separate from others and
asking him or her to think about a transgression. The child is typically allowed
to leave when able to state what he or she did ‘wrong’ or should have done
instead, or when adults judge that the child has calmed down sufficiently; less
commonly, a predetermined time limit is imposed. However, time out in this
form has many disadvantages:
• It isolates hysterical children.
• It unfairly expects children to regain control by themselves.
• They might damage the area where they have been isolated.
• They can create so much noise that the disruption is unabated.
• They might forget that they are being punished.
• You might forget that a child has been isolated and leave him or her there for
too long.
• You cannot teach children more considerate behaviour when you are not
together.
Therefore, time out will not work to discourage inconsiderate behaviour. However,
when everyone needs a breather you can use time away instead. This involves
inviting upset children to go off by themselves to a quiet and pleasant corner, until
they feel better. This is not a punishment: they should find their solitude enjoyable
and refreshing. If you use it as a punishment, like time out, it will not work.
Reframe your explanation of the behaviour

Your response to children’s behaviour will depend on what you think the behav-
iour means. When your approach is not working, maybe that is because your
explanation of the behaviour is not helping.
Unhelpful explanations usually incorporate one of two ideas: first, that the
children are ‘doing it deliberately’ (perhaps even ‘to get at you’), which will have
led to a range of responses that were all designed to make the children stop it;
second, that the children cannot help it (because of their personality, disability,
events in the past, or their home circumstances). This idea will have led to unasser-
tive discipline methods, where no demands are made on children to act thoughtfully,
usually alternated with exasperation—neither of which have much effect.
To find a new solution, you will need to find a new way of looking at the
problem. A new view of the problem is called a reframe. This will look at what
is maintaining the behaviour now, rather than what might have triggered it
originally. It will identify the effect of the children’s behaviour rather than
seeking a cause. For instance, when children appear to be ‘attention-seeking’, it
might be because they are simply not sure that even when you are busy you will
nevertheless insist that they behave considerately.
The new view of the problem will enable you to let go of an ineffective
solution so that you can try another instead (Fisch et al. 1982). (Reframing is
more complex than this brief overview; see Porter 2000a, 2000b or Durrant 1995
for more detail.)
Interrupt the pattern

Let’s say that you cannot figure out a new view or a reframe of a recurring
problem. In that case, you could simply use ‘pattern interruption’ (Durrant 1995).
With this approach you allow the behaviour to continue, on the understanding
that it is helping the children in some way, even if you do not understand how.
In line with the principles of guidance, you cannot frustrate children’s legitimate
needs; but you can insist that the resulting behaviour is less disruptive to others
(Molnar & Lindquist 1989).
There is an old saying that a chain is only as strong as its weakest link. With
this in mind, you can break up the chain or sequence of events that occur
whenever the children’s behaviour is disruptive, producing in its place a new
pattern. To disrupt the old, dysfunctioning pattern you could (Durrant 1995):
• change the location of the behaviour;
• change who is involved;
• change the sequence of the steps involved;
• add a new element;

• introduce random starting and stopping;
• increase the frequency of the behaviour.
So when individual children throw themselves down on the floor in a tantrum,
you could move them to the sofa so that they are more comfortable (changing the
location); you could invite children who often fight over sharing toys to fight
now before they enter the sandpit, so that they do not miss out once they start to
play (changing the sequence or introducing random starting); you could let
children know that it is okay to cry when their parent leaves and that you will
stay with them for as long as it takes for them to feel better (increasing the
frequency of the crying), and so on.
Even when you do not understand why the children persist with their behav-
iours, changing the sequence of events will alter the behaviour to a form that is
less disruptive.
Try a reversal
If all else has failed, try doing the opposite of what you have been doing so far
(Amatea 1989), even if you do not understand in advance how that could help.
If you have been:
• ignoring the behaviour, give it your attention;
• sending children away to sort themselves out, bring them in close to you and
give them your support to get back in control of themselves;
• trying to talk them out of a behaviour, give them permission to continue with
it—perhaps using pattern interruption to ensure that it does not bother
anyone;
• thinking that they cannot help themselves, notice the times when the behav-
iour does not occur, and expect them to do more of what causes those
exceptions;
• getting earnest about the problem, have some fun—for example, by pre-
tending to throw a tantrum yourself whenever the child does;
• working on a difficult behaviour, choose an easier one so that you can have
some success on which to build.
This suggestion to do something different is based on the advice: ‘Always
change a losing game’ (Fisch et al. 1982:88). Or, put another way: ‘If something
isn’t working, don’t do it again’ (de Shazer et al. 1986:212).
Provide repeated practice

In order to work at all, rewards and punishments have to be administered con-
sistently. But in the real world things happen that get in the way of consistency,
making it unwise or just impossible to apply the same disciplinary methods on
every occasion.
Luckily, however, a consistent response to repeated disruptions is unneces-

sary. An analogy might be useful to explain this: if you give children swimming
lessons every day for a fortnight, they might learn to swim in two weeks; if you
give them lessons once a month, they might take a year to become competent
swimmers. This tells us that the more practice children can get at learning a new
skill, the more quickly they will learn it—but either way, they do achieve it. So
if you cannot respond in your usual way to a disruption, the children will still be
learning how to control their feelings at other times. Consistency is unnecessary,
but repeated practice helps.
Support parents
It is inefficient (and inhumane) to undermine the skills and confidence of parents,
particularly those whose children often behave inconsiderately. Just as consis-
tency within your setting is unnecessary, so too are common approaches between
home and educational settings not a prerequisite to teaching children how to
manage their feelings—although it is clearly preferable if children can get
practice in both locations. Nevertheless, you would create resistance in parents if
you tried to convince them of your approach. Instead, allow your success to be
persuasion enough.
CONCLUSION
Discipline will only ever safeguard individual children from abuse and protect
society from the behavioural excesses of its members when individuals accept
responsibility for themselves and can seek to satisfy their own needs without vio-
lating the needs of other people. In the preschool years, the goal of discipline,
then, is to give children the confidence to take increasing responsibility for their
own actions and for their effect on other people. In this chapter, I have argued
that the most effective means to this end is a guidance rather than a controlling
approach to discipline.
The guiding skills described here can be very similar to their controlling
counterparts. For example, a natural positive consequence can involve virtually
the same action as a reward, but the intent is just to acknowledge children, not
manipulate them into repeating a desirable behaviour. The difference has to do
with flavour or style, with how you communicate your respect for children. In
their turn, children can detect the difference and will respond distinctly to the
two methods. Nevertheless, because the methods are similar, you do not have to
learn a completely new set of skills but can apply the skills you already have,
with just a change of purpose and flavour.
If you would like to read more about the ideas introduced in this chapter,
I suggest the following titles:
Fields, M.V. and Boesser, C. 2002 Constructive guidance and discipline:
preschool and primary education 3rd edn, Merrill Prentice Hall, Upper
Saddle River, NJ
Gordon, T. 1991 Teaching children self-discipline at home and at school
Random House, Sydney
Kohn, A. 1996 Beyond discipline: from compliance to community Association for
Supervision and Curriculum Development, Alexandria, VA
——1999 Punished by rewards: the trouble with gold stars, incentive plans, A’s,
praise, and other bribes 2nd edn, Houghton Mifflin, Boston, MA
Porter, L. 1999 Young children’s behaviour: practical approaches for caregivers
and teachers MacLennan & Petty, Sydney
——2000a Student behaviour: theory and practice for teachers 2nd edn, Allen
& Unwin, Sydney
——2000b Behaviour in schools: theory and practice for teachers Open
University Press, Buckingham, UK
——2001 Children are people too: a parent’s guide to young children’s behav-
iour 3rd edn, Small Poppies SA, Adelaide
Appendix I
COMMON CAUSES OF
ATYPICAL DEVELOPMENT
LOUISE PORTER
Awareness of the primary and secondary characteristics of various disabilities

allows you to look out for associated difficulties in children with a known dis-
ability. Such knowledge can also alert you to patterns of atypical development
that might signal the presence of an as yet unrecognised disability.
Naturally, you cannot diagnose disabilities merely by observing atypical
development—nor without a comprehensive assessment can you raise with
parents the possibility of a particular diagnosis—but you can encourage parents
to seek a relevant assessment and discuss with that specialist your observations
of the child (Mazzocco & O’Connor 1993). Once a diagnosis is attained,
knowledge of the child’s associated needs can allow parents and educators to
anticipate and plan for these with more detailed understanding (Hatton et al.
2000; Mazzocco & O’Connor 1993).
Three facts must be borne in mind, however. First, for the majority of
children with disabilities, the condition has no recognisable biological cause, in
which case detailed observation of their developmental pattern will be more
useful than diagnostic categories (Ashman 1998). Second, children who share
the same diagnosis can vary considerably in its severity and manifestation. This
implies that educational interventions must be planned on the basis of knowledge
of individuals rather than their diagnostic label. Third, for all but those with
severe disabilities, children’s environments are better predictors of develop-
mental outcomes than is the existence of disabling conditions (Sameroff 1990).
This means that children can suffer mild impairments (as defined in chapter 1),
but in a responsive environment these do not necessarily result in a disability. For
example, the link between low birth weight and poor developmental outcome is
most pronounced in impoverished families: it is the families’ limited resources
that cause the risk posed by low birth weight to be realised (Sameroff 1982).
PRENATAL DRUG EXPOSURE

Some of the developmental effects of alcohol and other drugs can be due not
only to the damage to the developing brain of the baby but also to the chaotic
APPENDIX I 229
home circumstances prevailing when a parent is an addict—not least of which is

a lack of supervision and stimulation of the baby, poor prenatal and postnatal
care and nutrition, impoverished living circumstances, multiple drug use, and
diminished social supports for the family.
Alcohol
Fetal alcohol syndrome is now the single biggest cause of intellectual disability
in the world, accounting for 10–20% of all instances (Batshaw & Conlon 1997;
Howard et al. 2001). Developmentally, delays are mainly in speech, language,
cognitive and motor skills, with some behavioural difficulties also being associ-
ated with the condition (Batshaw & Conlon 1997). The physical signs of fetal
alcohol syndrome are listed in Table AI.1. The degree of intellectual disability
and the extent of facial abnormalities are both related to the amount of the
mother’s alcohol intake during the first trimester of pregnancy in particular, but
also subsequently through the pregnancy and during breastfeeding (Batshaw &
Conlon 1997). The mean IQ of affected children falls around 70 IQ points,
although variation is considerable (Shonkoff & Marshall 2000). Lesser effects on
development and physical appearance are experienced at lower doses, when the
child’s difficulties are usually referred to as ‘fetal alcohol effects’.
Other drugs
Exposure to tobacco, marijuana, cocaine and other illicit drugs in utero results in
decreased blood and oxygen reaching the fetus, causing stunted growth and
increased risk of miscarriage, premature birth, stillbirth and sudden infant death
(Batshaw & Conlon 1997; Howard et al. 2001). In the long term, babies whose
mothers smoked during pregnancy or subsequently, achieve at below-average
levels in cognitive and language skills, and may be more prone to the attention
deficit disorders and learning disabilities (Howard et al. 2001).
CHROMOSOMAL ANOMALIES
Most chromosomal anomalies are incompatible with life: the fetus does not
survive; a few key anomalies, however, are sustainable while resulting in dis-
abilities in children.
Fragile X syndrome
This condition is now considered to be the leading hereditary cause of intellec-
tual disability, being transmitted from generation to generation in a complex
fashion (Batshaw 1997; Howard et al. 2001). It occurs when a long arm of the
X-chromosome becomes detached or connected to the rest of the chromosome
by only a thin strand.
230 APPENDIX I
Boys are more seriously affected by this condition, with 80% of boys and
30% of girls having intellectual disabilities (Howard et al. 2001). Physical signs
of the condition (as listed in Table AI.1) are too variable in girls to be of any use
in diagnosis; in boys, most signs show up only in adolescence. However,
developmental delays are apparent from infancy, showing first as late walking
and talking (Batshaw 1997). The main signs of the condition are autistic-like
social behaviours, impaired (or disordered) speech and language, hyperactivity,
attention deficits and emotional difficulties. The behavioural difficulties appear
to relate to sensory processing impairments (Hatton et al. 2000), while the infor-
mation processing deficits might account for the deterioration in the children’s
intellectual functioning as they age, which in turn partly accounts for the later
identification of this syndrome.
Down syndrome
This is the second-largest genetic (but not inherited) cause of intellectual dis-
ability (Howard et al. 2001; Mazzocco & O’Connor 1993). Since the 1970s its
incidence has declined from 1.33 per 1000 to 0.92 per 1000, partly as a result of
prenatal screening of older mothers, some of whom subsequently choose to abort
(Roizen 1997).
It is caused mainly by the existence of a third 21st chromosome (termed
trisomy-21) or, in 5–10% of cases, by translocation of extra chromosomal
material to another chromosome (Howard et al. 2001). Less obvious is mosaic
Down syndrome, in which only 10–12% of the individual’s cells have the extra
genetic material. Children with this condition will share only some of the charac-
teristics of those with the full syndrome, and as a result might not be recognised
unless genetic screening is instigated.
The majority of children with this syndrome have an intellectual disability,
ranging in degree from mild to severe (Howard et al. 2001), with the milder
degrees of disability usually typical of mosacism (Fishler & Koch 1991). Low
muscle tone leads to delayed motor skills, and significant speech and language
delays are the norm. Down syndrome is also associated with many medical dif-
ficulties, as listed in Table AI.1. After the first year, the children are commonly
overweight and, combined with orthopaedic problems associated with ligament
abnormalities, are less likely to exercise. Nevertheless, with adequate exercise
and diets and treatment of the associated medical problems, life expectancy can
be near the norm (Howard et al. 2001).
As to their temperament, some studies find that children with Down
syndrome are more positive in their interaction with peers than children with
similar levels of intellectual disability (Hauser-Cram et al. 1993), while others
have shown them to have similar personalities to non-disabled children (Roizen
1997). Furthermore, these children experience resistance to rules, ADHD,
aggressive or uncooperative behaviour, eating disorders and other psychiatric
complaints at slightly elevated rates compared to the general population (Hauser-
Cram et al. 1993; Roizen 1997).
APPENDIX I 231
Other chromosomal abnormalities

Other chromosomal abnormalities lead to a myriad of syndromes. Prader-Willi
and Angelman syndromes result from a deletion of genetic material from
chromosome 15: Prader-Willi occurring when the affected chromosome is
supplied by the child’s father; Angelman occurring when the mother’s chromo-
some 15 mutates (Shonkoff & Marshall 2000). Children with Prader-Willi
syndrome have similarities of appearance to those with Down syndrome, and
have small hands and feet. Their low tone at birth leads to feeding difficulties and
thus failure to thrive, but subsequently they develop an insatiable appetite that
leads to obesity. Children with Angelman syndrome have low muscle tone,
seizures, severe intellectual disabilities, a tendency to smile and laugh often and
a walk that resembles a marionette (Shonkoff & Marshall 2000).
Rett syndrome occurs only in girls and is characterised by normal early
development followed by decelerated developmental progress and head growth
(Shonkoff & Marshall 2000). Children with this progressive condition have
seizures, develop hyperventilation, lose purposeful hand movement and develop
instead wringing of the hands, develop spasticity and often lose the ability to
walk independently (Shonkoff & Marshall 2000).
Muscular dystrophy is a term representing many genetic conditions that
cause progressive loss of muscle tissue and subsequent muscle weakness, which
first shows in the early childhood years following normal motor development
during infancy. Progressive physical disability occurs during childhood and, with
the commonest form (Duchenne muscular dystrophy), death usually occurs
in the late teens as a result of heart or respiratory failure, although other forms
of the disease have a longer life expectancy (Howard et al. 2001). Being
X-linked, the condition affects mainly boys.
Phenylketonuria (PKU) is an error in metabolism that causes affected indi-
viduals to be unable to use the essential amino acid, phenylalanine (which is
found in high-protein foods), whose consequent build-up causes brain damage
and profound intellectual disability. All babies born in hospitals are screened for
the condition, which if detected can be avoided by dietary restrictions.
NEUROLOGICAL CONDITIONS
Many disabilities relate to the integrity of children’s nervous system.
Cerebral palsy
Cerebral palsy (CP) is one of the commonest disabilities, and the commonest
cause of physical disability in children, with a rate of 1.5–2.7 per 1000 live births
in the developed world and higher rates in developing countries (Howard et al.
2001). CP causes disturbances of muscle tone, movement, reflex integration and
posture. Prematurity combined with low birth weight (below 2500 grams) is a
232 APPENDIX I
leading cause, accounting for 36% of cases, as is damage to the brain occurring
during gestation (in approximately 30–50% of all cases) or resulting from birth
complications (predominantly asphyxia, in 14% of cases) (Howard et al. 2001;
Pellegrino 1997). However, many children with these risk factors do not have
cerebral palsy and many children without those events do. Therefore, many ad-
ditional causes are implicated, including infections before or soon after birth and
exposure to toxins. Furthermore, the figures just cited may be speculative, and in
many instances no cause can be found.
With the hypotonic and ataxic forms of cerebral palsy, babies will have
reduced reflexes whereby, for instance, their gag reflex is weak, thus making
feeding risky (Sullivan, pers. comm.) Another diagnostic sign is the persistence
beyond 12 months of age of babies’ early reflexes, whose continued presence
affects muscle tone and movement (Pellegrino 1997). One of these reflexes is the
asymmetrical tonic neck reflex (ATNR), which is seen when the head is turned
to one side. It causes the arm and leg on the chin side to extend, with the other
arm and leg becoming more flexed (bent), with related alterations in the trunk
muscle tone (Pellegrino 1997). In normally developing children, independent
movement of head, trunk and limbs is progressively possible by 3 months of age,
but children with CP often cannot achieve this integration.
Another sign is delayed walking, although this is characteristic of many con-
ditions. Treatment involves active movement training and strengthening where
possible, positioning to minimise abnormalities in tone and maximise
movement, prevention of contractures of muscles through the use of braces and
splints, and correction of contractures where necessary through surgery. (For
more details, see chapter 6.)
Epilepsy
A second neurological condition which can result from and cause disabilities is
recurrent seizures—that is, epilepsy. When epilepsy is combined with neuro-
logical damage, intellectual disabilities and young onset, the prognosis is less
favourable than when it occurs alone (Howard et al. 2001). Most children with
epilepsy have diminished concentration and information processing skills,
with a higher than usual rate of behavioural difficulties (Howard et al. 2001).
Some of these difficulties can also be the result of medications needed to control
the seizures (Tyler & Colson 1994).
Traumatic brain injury

A third neurological cause of disabilities is traumatic brain injury, 90% of which
is caused in infants by child abuse, with the remainder being caused by the likes
of falls and motor vehicular crashes (Howard et al. 2001). The severity of result-
ing impairments, of course, depends on the extent and location of the damage to
the brain (Howard et al. 2001). As well as intellectual effects and impaired motor
functioning, following a traumatic brain injury children can have reduced
APPENDIX I 233
stamina, seizures and sensory impairments (Tyler & Colson 1994). The progno-
sis for children who are injured non-accidentally is less positive than for those
who experience single traumas, as child abuse can lead to repeated and multiple
injuries, and where a parent or parents were the perpetrators of the abuse subse-
quent treatment must also involve rehabilitating both the injured child and the
dysfunctioning family.
NEURAL TUBE DEFECTS
Neural tube defects result from malformation during the third to fifth week of ges-
tation of the neural groove which houses the spinal cord. Spina bifida is the most
common of these and only one form of that, myelomeningocoele, causes physical
disability. It is the second most prevalent cause of motor disabilities in childhood,
after cerebral palsy (Shepherd 1995). In this condition, both the spinal cord and
its covering, the meninges, push through the defective vertebrae to the skin
surface, most commonly in the lumbar region of the spine. This causes flaccid
paralysis and reduced sensation below the lesion, whose extent and associated
difficulties depend on the location of the lesion along the spine (Liptak 1997).
In the USA the present rate of myelomeningocoele is around 0.3–0.9 live births
per 1000 births, with a three to four times higher rate in Wales and Ireland and a
much lower rate in Africa (Garber 1991). The prevalence is decreasing in developed
countries, partly as a result of prenatal screening (following which 40% of mothers
elect to abort), partly because folic acid intake by women prior to and in the first
trimester of pregnancy reduces the risk of spina bifida, and partly through a natural
decrease in prevalence which might be due to improved nutrition (Liptak 1997).
Three-quarters of children with myelomeningocoele have measured intelli-
gence within the low–normal range, but still experience some learning
difficulties as a result of mild impairments of perception, organisation, attention,
memory, speed of motor response and hand use; the remaining quarter have an
intellectual disability (Liptak 1997).
Of those infants with myelomeningocoele, 80% have associated hydro-
cephalus, which is a build-up inside the head of cerebrospinal fluid caused by
obstruction of its drainage system (Shepherd 1995). Untreated, this causes the
head to grow in size, placing pressure on the brain and leading to brain damage.
When treated soon after birth with the surgical closure of the vertebral defect and
insertion of a shunt to drain off excess cerebrospinal fluid, subsequent impair-
ment to intellectual functioning is minimised.
It is crucial to be aware that sometimes the shunt diverting the fluid from the
brain becomes blocked, resulting in lethargy, headache, vomiting and irritability
as pressure builds up inside the child’s skull, while an infected shunt will cause
similar signs plus fever and an elevated white blood cell count (Liptak 1997).
A blocked or infected shunt can be life-threatening or lead to intellectual dis-
ability (Shepherd 1995). It is important to look out for these signs in children
with this condition, therefore, so that an early shunt repair can be performed.
234 APPENDIX I
As they have reduced sensation of pain, care must be taken that children with
spina bifida do not sustain injuries, particularly to their feet and buttocks (e.g.
from walking on hot outdoor surfaces).
CONDITIONS OF PREGNANCY
Illnesses of the mother or baby during pregnancy and exposure to toxins can also
lead to disabilities in the baby. Still more numerous (accounting for 50% of all
disabilities) is extreme prematurity (those babies born at less than 32 weeks’
gestation). Nevertheless, birth weight combined with gestational age is more pre-
dictive of outcome than degree of prematurity alone, with around 20% of those
born at less than 2500 grams being later diagnosed with disabilities, and babies
of even lower birth weights being at still higher risk (Bernbaum & Batshaw
1997; Howard et al. 2001).
SYNDROMES WITH UNKNOWN CAUSES
Despite advances in genetic and medical understanding, the exact cause of some
syndromes is still unknown, although many run in families and thus appear to
have a genetic and biological basis.
Autism spectrum disorders

The autism spectrum disorders are one of a category known as pervasive develop-
mental disorders. In this context, the term ‘pervasive’ means that the disorders
affect all domains of children’s functioning and are experienced across various
settings. For children to receive the diagnosis of autism, the following three
domains must be affected, with irregularities first becoming evident prior to 3 years
of age and being present across a range of settings (Mauk et al. 1997; Quill 1995).
• Impaired communication. Around half of all children with autism do not
develop functional speech; those who do show severely disordered or
impaired speech which lacks diversity and is echolalic (i.e. immediate
or delayed repetition of something they have heard), and thus their speech
is unspontaneous and uncreative. Verbal children also use strange rhythms
and intonation patterns in their speech, and use speech to indicate their needs
rather than to interact with others.
• Impaired social understanding is shown in extreme aloofness and indif-
ference to others and an inability to copy others, including an inability to
imitate peers’ play. This leads to isolated and stereotypical play with objects
(e.g. lining up vehicles or spinning the wheels of a toy vehicle rather than
using these toys in pretend road play), with the result that the children lack
representational or pretend (dramatic) play.
APPENDIX I 235
• Behavioural abnormalities. The children have narrow play interests and

obsessive adherence to routines, to the point of severe tantrums if routines
are disturbed or preoccupations interrupted. The children often display
repetitive movements such as hand-flapping or waving, toe-walking, rocking
and, particularly in those with severe intellectual disabilities, self-injurious
behaviour such as head-banging or biting their arms.
Around 75% of children with autism also have an intellectual disability, with
40% recording IQs below 50, which signifies a profound disability (Howard
et al. 2001). These children also have a higher than usual rate of ADHD and
perhaps epilepsy (Mauk et al. 1997). Their intellectual disabilities appear to
relate to perceptual problems, one of which (termed ‘overselectivity’) entails
perceiving only one aspect of a multifaceted problem, resulting in impaired
problem solving and social perception (Quill 1995). These difficulties might
arise from problems with coding and categorising information which, in turn,
causes information processing difficulties (Quill 1995). Rote memory seems
unimpaired (Quill 1995).
Asperger syndrome involves the last two impairments listed above.
Children with this condition acquire language at around the usual age, although
as a result of the children’s impaired social functioning their language use can be
unduly formal and non-verbal behaviours such as eye contact can be disturbed
(Mauk et al. 1997). Children with Asperger syndrome might simply have rigid
thinking which does not disturb them unduly, while others experience anxiety
and sensory sensitivity problems (Quill 1995). Some of the latter respond to
medications that reduce anxiety, either taken singly or in a ‘cocktail’ of various
drugs, designed specifically for their particular constellation of disturbed per-
ception and thinking.
About two-thirds of parents report that their children who are later diag-
nosed as autistic were aloof during infancy (Howard et al. 2001), with the other
characteristics of the condition subsequently appearing in place of the usual
developmental milestones. However, some children have a normal develop-
mental pattern until 12–24 months, following which their skills regress (Quill
1995). This subgroup of children are more likely than others with autism to have
seizures (Howard et al. 2001; Quill 1995).
Attention deficit disorders

Attention deficit hyperactivity disorder (ADHD) comprises predominantly vocal
or motoric hyperactivity; ADD involves inattentiveness; and a combined form
comprises both. The terms are relatively new labels for a condition that was first
identified almost 100 years ago and has variously been described as hyperactiv-
ity, minimal brain dysfunction and hyperkinesis (Anastopoulos & Barkley 1992).
Most estimates say that around 3–5% of children and adolescents have
ADHD (Wodrich 1994), with little variation across socioeconomic groups and
with more boys than girls being recognised. Most children show their first signs
236 APPENDIX I
of the condition between 3 and 4 years of age, and to be diagnosed must have evi-
denced the condition prior to the age of 7 years (Anastopoulos & Barkley 1992).
In the early childhood years in particular, it is difficult to distinguish normal
childhood exuberance from ADD and ADHD, making accurate diagnosis dif-
ficult. Diagnosis is also complicated by the fact that the children’s behaviour
varies according to the circumstances and that their attention skills can be
deficient in different ways (see chapter 10).
Some writers believe that impulsivity is at the heart of the attention deficit
disorders. Although not yet certain, a possible neurological explanation for the
behaviours is that arousal pathways in the brain fail to activate brain regions
involved in decision making, while inhibitory pathways fail to suppress impul-
sivity and distractability—and that these mechanisms are differently affected in
different children (Riccio et al. 1993).
As well as the cluster of primary symptoms, children with ADD or ADHD
often show other, secondary symptoms that can complicate management. These
include behavioural problems, emotional outbursts, relationship difficulties,
learning disabilities (despite having average intellectual abilities overall), and
a higher than normal rate of health problems such as incoordination, sleep
disturbances, middle ear and upper respiratory infections, asthma and allergies
(Anastopoulos & Barkley 1992).
Whereas negative parental discipline was earlier accused of causing ADHD,
most practitioners now believe that such parenting styles are instead the result of
having a child with ADHD in the family. This view is supported by research
showing that parents’ style becomes more positive when the children’s behaviour
improves—say, in response to medication (Anastopoulos & Barkley 1992;
Wodrich 1994). It also stands to reason that the parents are not the cause in
families where one child has the condition and the siblings do not.
Many children outgrow the condition within a year of its diagnosis. For
those who do not, the longer-term outcome is still mostly unknown, although the
severity of childhood symptoms is probably unrelated to adult outcome (Hart
et al. 1995). Throughout childhood and adolescence, the inattentive symptoms
remain relatively stable but then improve substantially during early adulthood,
while the hyperactive-impulsive behaviour progressively improves throughout
childhood (Barkley 1988; Hart et al. 1995).
CHRONIC ILLNESS
With the exception of certain metabolic disorders and AIDS which can cause
sensory impairment, changes in muscle tone and central nervous system distur-
bances (Bruder 1995), most chronic childhood illnesses do not have a direct
effect on the brain’s capacity to learn. Nevertheless, some medical treatments
such as radiotherapy or chemotherapy can themselves cause disabilities in
children such as growth retardation, neurocognitive deficits and immune system
suppression (Tyler & Colson 1994).
APPENDIX I 237
Even without these treatment side-effects, long-term health problems can

compromise children’s development through interruptions to their education and
relationships with parents and peers. The children’s early exploration can be
restricted by the reduced stimulation that is available to them in hospital, by a
lack of energy caused by their illness, and by the children’s need to be protected
from infection (McCarthy 1987). If the illness is terminal and the children are
aware of this, their motivation to explore and learn can be reduced.
Socially, children’s misunderstandings of their condition and its treatment,
their early encounters with pain and the prospect of death can lead to fears that
surpass those of healthy children (McCarthy 1987). Ongoing relationships with
medical personnel can cause children to direct their social interactions to adults
rather than peers. Meanwhile, the requirements of their management can
increase children’s dependency on adults. Their family circumstances are likely
to be stressed, particularly with conditions such as AIDS, which were transmitted
from the mother and which impair the mothers’ own health and impede their
ability to oversee their children’s treatment (Bruder 1995).
Thus, while children with disabilities in general do not require medical
interventions, those with chronic health problems obviously require treatment
that not only improves their health but also optimises their participation in edu-
cation. To promote continuity, any medication and dietary regimens will need to
be integrated into the children’s education program, while centre activities can
be supplied for children to complete during absences.
After an absence, children’s re-entry to their education program needs to be
planned carefully, with opportunities for them to debrief about their experiences
and chances for their peers to be informed about the reason for their absence
and present needs (McCarthy 1987; Tyler & Colson 1994). The children’s and
families’ privacy must be preserved, however, and disclosure cannot result in
stigmatising the child or family; at the same time, others must be protected from
cross-infection (Bruder 1995). So that you do not confuse the children them-
selves or undermine their parents, you will also need to find out what they have
been told about their condition, particularly if they are dying (McCarthy 1987).
In such circumstances you will need also to take care of yourself, allow yourself
to grieve, and channel your grief into responding positively to the children’s
present needs (Bruder 1995).
GIFTEDNESS
Children can have the potential for significantly advanced development in a

single or many developmental domains. Gardner (1983) lists the following skill
domains: verbal, logical/mathematical, visual/spatial, music, body/movement,
interpersonal relationships, and intrapersonal skills (that is, self-knowledge). The
neurological basis of high ability in any of these domains is not entirely under-
stood. Some researchers have gathered evidence that accurate transmission and
storage of information in the brain account for gifted children’s advanced abilities
238 APPENDIX I
Table AI.1 Summary of common disabilities

Condition Prevalence Characteristics
Fetal alcohol syndrome 1–2 per 1000 Delayed speech, language and
Fetal alcohol effects 3–5 per 1000 motor skills.
Behavioural difficulties.
Below-average height but normal
weight.
Abnormal facial features: small
head, short, upturned nose, thin
upper lips and flattened philtrum,
wide-set eyes, flat mid face
epicanthic folds over the eyes.
Malformations of outer and
middle ear.
Cardiac, vision and hearing
problems.
Fragile X syndrome 1/1500 (males) 80% of boys and 30% of girls

1/2500 (females) have intellectual disabilities.
Autistic-like social behaviours.
Impaired/disordered speech and
language: echolalia, cluttered
and perseverative speech and
word-finding problems.
Hyperactivity.
Attention deficits.
Emotional difficulties.
Information processing
weaknesses: especially in
mathematics, grammar,
sequential processing,
short-term memory and problem
solving.
Strengths in daily living and
visual skills.
Some physical malformations:
long face, protruding ears,
prominent jaw and forehead,
high-arched palate, short stature,
hyperextensible joints, flat feet
and enlarged testicles in males
(from adolescence).
Down syndrome 1/700–1/1000 Physical signs: small head,

recessed nose, eyes slanted
upwards with epicanthal folds at
inner corners, small ears, mouth,
hands and feet, short fingers,
broad neck.
APPENDIX I 239
Condition Prevalence Characteristics

Mild to severe intellectual disability.
Delayed motor skills.
Speech and language delays.
Medical problems: cardiac,
respiratory, depressed immunity,
hypothyroidism, orthopedic
abnormalities, premature ageing.
Hearing impairments.
Vision impairments.
Behavioural difficulties.
Duchenne muscular 1/3500 (males) Muscle wasting leading to

dystrophy deteriorating physical skills and
death (usually in late
adolescence or early adulthood).
PKU 1/14 000 Profound intellectual disability

and death if untreated.
Cerebral palsy 1.5–2.7 Movement and posture

per 1000 disturbances (100%).
Intellectual disabilities (75%).
Epilepsy (approximately 30%).
Brain injury Emotional and family difficulties if

injuries caused by child abuse.
Developmental disabilities,
depending on location and
severity of injury.
Myelomeningocoele 0.6 in US Paralysis and impaired sensation

1.8–2.4 in Wales in lower limbs.
and Ireland Incontinence, constipation for
< 0.6 in Africa lumbar lesions.
per 1000 Hydrocephalus (80%).
Learning difficulties (75%).
Intellectual disability (25%).
Epilepsy (15–25%).
Strabismus (20%).
Spinal cord compression.
Prematurity and 72 (low birth weight) Vision impairment.

low birth weight 13 (very low birth Cerebral palsy (spastic).
weight) Intellectual disability.
per 1000 Hearing impairment.
Epilepsy.
Autism 1 per 1000 Communication impairments.

spectrum disorders Social impairments.
Behavioural disorders.
240 APPENDIX I
(Eysenck 1986; Jausovec 1997). Others speculate that, in addition, gifted children
have more efficient links between the limbic system (the seat of emotions in the
brain) and the prefrontal lobes, which are responsible for overseeing learning
(Geake 1997). The first of these explanations accounts for an increase in the
quantity of knowledge gifted children can acquire; the second relates to a quali-
tatively different learning style whereby, compared with average learners, gifted
children are said to be more sensitive, intense and responsive emotionally, and
more invested in learning (Miller et al. 1994). Thus, some regard gifted children’s
learning as quantitatively different from average learners’, some see it as quali-
tatively different and others believe it to be both (see Porter 1999).
Although still debated, it seems evident that giftedness runs in families,
although the exact genetic mechanism is not yet determined. Meanwhile, an optimal
environment—and one that responds to children’s changing needs throughout
childhood—is required for this potential to be translated into sophisticated (i.e.
talented) performances (Horowitz 1987). This does not mean that children require
a perfect environment, however, as action is stimulated by some experience with
overcoming challenges and some awareness of a wrong to be righted.
This brief discussion of giftedness cannot overlook the fact that children
might have advanced abilities in one domain and at the same time experience a
disability in another. Clearly, children can have physical or sensory impairments
and still possess extraordinary information processing skills; less intuitively
obvious, perhaps, are those gifted children who also have learning disabilities
such as dyslexia. The disability will result in restricted input in the affected mode,
but when information is given in a different channel, children who are also gifted
can manipulate it in sophisticated ways. Similarly, children from educationally
disadvantaging backgrounds might not display talents compared to advantaged
children but are nevertheless learning more efficiently than those who are simi-
larly disadvantaged. These children with dual exceptionalities are a challenge to
identify and generally require a two-pronged program: one that offers remediation
of their disability, alongside the equally important promotion of their gifted skills
(Porter 1999).
If you would like detailed information on various disabilities, I recommend:

Batshaw, M.L. (ed) 1997 Children with disabilities 4th edn, MacLennan & Petty,
Sydney
Howard, V.F., Williams, B.F., Port, P.D. and Lepper, C. 2001 Very young children
with special needs: a formative approach for the 21st century 2nd edn,
Merrill Prentice Hall, Upper Saddle River, NJ
For information on giftedness, see:

Porter, L. 1999 Gifted young children: a guide for teachers and parents Allen &
Unwin, Sydney (also Open University Press, Buckingham, UK)
Appendix II
TYPICAL DEVELOPMENTAL
MILESTONES
LOUISE PORTER, BERNICE BURNIP,
ZARA SODEN, MARGARET SULLIVAN
Children’s skills are generally acquired in a predictable order. To follow are some
commonly cited milestones for development during the early years. It is impor-
tant to keep in mind, however, that children naturally differ in the rate at which
they acquire the skills listed, with their pattern of skills reflecting the values of
their culture and their opportunities to gain particular experiences and skills.
Furthermore, although the skills listed below are separated into the various
developmental domains, it is essential to realise that all are actually interwoven
and that apparent delays in one developmental domain do not necessarily signal
a difficulty in that skill area but can be a secondary outcome of impairments in
another—for example, when children’s vision or physical disabilities affect their
environmental exploration and thus their development of cognitive concepts.
Qualitative aspects of skills Typical behaviours
Birth to 3 months
Gross motor
The neonate has little control against Holds head up momentarily while in prone
gravity. position.
Movements and postures appear Lifts head when supported at adult’s
lopsided or asymmetrical. shoulder.
Reflexes (which are innate responses Kicks reciprocally.
to stimulation) become integrated in these Rolls or falls from side to supine position.
early months, permitting subsequent Repeats satisfying actions.
development of purposeful movement.
Fine motor
Grasp and release are dominated by Grasps with hand tightly fisted.
reflexes. Release starts as an avoiding reaction
Arm movements are random. in response to touch on the back of the
hand.
By 3 months, arms move to midline
spontaneously and simultaneously.
242 APPENDIX II

Language (comprehension)
Baby listens to pitch, intonation, and Responds to voices.
intensity of others’ language. Locates sounds by moving eyes.

Baby vocalises reflexively but adults Cries when uncomfortable or hungry.
respond as if speech were deliberate. Uses different types of cries to signal
By the end of this period, babies’ sounds different needs.
become social, in that they are made in Coos and gurgles with pleasure.
response to adults’ speech and they Uses some vowels and consonants.
capture adult attention. Repeats satisfying sounds.
Cognitive
Exploration of the environment is Inspects surroundings.
unplanned. Inspects own hands.
Self-help
Feeding skills are initially reflexive but Opens mouth in response to food.
come under voluntary control Coordinates sucking, swallowing and
throughout this stage. breathing.
Clutches and pulls clothing.
Social-emotional
Object permanence has not yet developed Regards caregivers’ face.
and so infants are equally contented with Enjoys physical contact, snuggles in.
various caregivers. Conversational Makes eye contact.
turn-taking builds attachment. Communicates distress.
Experiences joy (from 6 weeks) and At 4–10 weeks, begins social smiling—that
distress. is, smiles spontaneously to caregiver’s
Will cry contagiously when peers are upset. face, voice or smile.
4–6 months
Gross motor
Control against gravity of head and upper Head, eyes, hands and feet can be
trunk and some limb movement is aligned with body midline in lying and
emerging in lying. while sitting with support.
Control of side-to-side and supported Able to still self in lying and sitting.
rotational movement is beginning. Bears weight on hands in prone position.
At 4 months, rolls from supine to side and
prone to side.
Bears some weight in supported standing.
Fine motor
Increasing voluntary control of grasp. Scratches surfaces.
Grasp becomes more functional and can Clutches at bedclothes and caregivers’
accommodate different sized objects. clothing.
Release is still accidental. Reaches towards objects with both hands.
There is more control over arm movements Rakes objects towards self.
and posture. Grasps feet.
Forearm has voluntary supination (the Holds out objects but does not release.
thumb side of the forearm faces up), Transfers object from hand to hand.
allowing objects to be viewed more easily. Uses ulnar grasp (fingers closed against
At this age, infants use vision to guide palm).
APPENDIX II 243

their reaching. Holds an object in each hand at same
Play is predominantly tactile and time.
increasingly visual. Pokes fingers into holes and at objects.
Reaches objects on opposite side of body.
Uses both hands in coordinated
exploration.
Comprehension is developing at a Responds to own name.
faster rate than speech.

Begins to respond to opportunities at turn Babbles using vowel sounds such as ‘ee’
taking in ‘conversation’ with caregivers. and ‘uh’ which are produced before
consonants such as /m/ and /b/.
Imitates vocalisations that are within
repertoire.
Cognitive
Object permanence will develop during Explores objects through mouthing.
this stage. Looks for partially hidden objects.
Attachment to others is facilitated by Anticipates trajectory of an object.
memory advances. Shows anticipatory excitement.
Infants’ ability to point, grasp, explore and Begins rattle play.
exchange socially with carers promotes Repeats a familiar activity.
cognitive mastery of the environment. Shakes or bangs toys to make different
They learn that actions and sounds.
manipulations affect objects.
Self-help
Feeding is no longer driven by reflexes. Feeds self a biscuit.
Infants can now inhibit the rooting reflex. Swallows pureed foods.
Early reaching signals the beginning of Uses tongue to move food.
eye–hand coordination. Drinks from an adapted cup.
Passive during dressing. Reaches for an object that attracts interest.
By 6 months, pulls off hat.
Social-emotional
Infants are learning to trust their primary Shows a preference for familiar others.
caregiver and to feel safe that their needs Smiles at people, objects and own
will be responded to sensitively and in a actions.
timely fashion. Cries, smiles, kicks, coos and laughs to
Experiences anger (at 4 months) and attract attention.
sadness (at around 5–7 months). Is soothed by being picked up.
Responds gaily to social play.
Lifts arms to primary caregiver.
Cries if another child cries.
6–9 months
Gross motor
Control of rotational body movements is Rolls over and over.
strengthening (that is, movements around Sits solo.
the body’s long axis), allowing one body Moves in and out of sitting.
244 APPENDIX II

segment to twist on another (e.g. trunk Creeps, crawls—backwards first.
over pelvis). Pulls to stand.
Uses movement for locomotor exploration. Stands while holding on.
The use of baby walkers may delay
development of transitional movement
sequences.
Fine motor
Reach is more accurate, aided by Uses a radial palmar grasp: an object is
increasing forearm supination. held in the palm with the thumb and
Development of hand control is facilitated radial fingers pressing the object into
by gains in postural control, particularly the palm.
being able to sit. Release begins during mouthing or
Mouthing reduces and tactile exploration bimanual play when one hand pulls an
through fingering increases. object from the other hand.
By the end of this stage release is Release can occur against a surface.
voluntary. Extends arms protectively.
By this age, infants listen to the Looks at pictures briefly.
vocalisations of others. They recognise Recognises names of family members
some words and different tones of voice. or pets.
Already they respond to a few words. Understands some words such as
‘bye-bye’, ‘no’ or own name.
Responds to simple requests with gesture.

Infants practise sound production and Speech sounds start to be limited to those
will play sound games with parents, of the infant’s own language.
repeating some sounds, simple words Babbling incorporates reduplicated
such as ‘da-da’ or an emphasised sounds such as /bababa/ and contains
syllable. phonemes that will be heard later in first
They produce intonation patterns. word approximations.
They use social gestures. Demands by pointing and vocalising.
Imitates coughs and other sounds.
Vocalises loudly to get attention.
Cognitive
Intentionality is being developed in Finds object after watching it being
response to infants’ ability to explore hidden.
physically and visually. Works to reach objects.
Curiosity develops. Plays for 2–3 minutes with a single toy.
Attention is drawn to a dominant stimulus Repeats actions in order to repeat a
and infants are easily distracted by another. consequence.
Self-help
Infants are developing increasing Holds and drinks from bottles or spout
awareness of their clothing as separate cups with lids.
from themselves. Mouths and gums solid food.
Bites voluntarily.
Feeds self finger foods with whole hand
grasp.
Pulls off booties.
APPENDIX II 245

Social-emotional
Separation anxiety will appear in this Shows anxiety when separated from
phase as a result of infants’ attainment of primary caregiver.
object permanence, which is now applied Smiles at self in mirror.
to familiar adults as well as objects. Infant-to-infant interactions increase.
Experiences enjoyment, fear, humour Enjoys teasing.
and shyness. Will protest when dissatisfied.
Fights for disputed toy.
9–12 months
Gross motor
When first walking solo, toddlers have a Climbs horizontally over low obstacles
wide base, short stride and no arm swing. in crawling.
Cruises furniture.
Stands solo briefly at 10–11 months.
Walks solo briefly at 11–14 months.
Arms held in ‘high guard’ for trunk control.
At 11–14 months, stoops and recovers.
Fine motor
Movement about on all fours supplies Can pick up increasingly small objects.
sensory input to the hands and arms. At 9 months, uses an inferior pincer grasp.
Arm strength is enhanced. By 12 months, uses a superior grasp.
Infants can grasp using fingertips and Uses both hands freely.
distal (end) portions of fingers. Tries to imitate scribble.
The thumb side of the hand is developing Puts objects into and out of containers.
as the skill side.
Cognitive development and improved
accuracy of reach encourage
experimentation with new objects.
Vision is less necessary to guide
reaching and grasping.
Recognises words as symbols for objects. Understands ‘no’.
Understands simple directives or Listens selectively to familiar words.
commands. Enjoys looking at books.
Responds to simple verbal requests.

May produce one or more word Babbles single vowel-consonant
utterances. syllables (e.g. ‘ba’).
Imitates familiar words. Uses behaviours and vocalisations to
express desires.
Imitates sounds gestures not previously in
repertoire.
Cognitive
Intentionality is now established. Begins to see the connection between
Cause-and-effect understanding is actions and consequences (e.g. putting
developing. lids on).
246 APPENDIX II

Cognitive development is highly dependent Performs an action to attain a desired
at this stage on early physical exploration result.
and thus on infants’ motor skills.
Self-help
Infants understand the Insists on doing things independently.
functional use of objects. Finger feeds a variety of foods using a
They increasingly cooperate with dressing. pincer grasp.
Grasps spoon in fist.
Chews by munching.
Holds arm out to assist with dressing
upper body.
Pulls off socks.
Social-emotional
Children are beginning to be able to use Enjoys turn-taking games.
imitation in play. Shows preferences for people, objects
They like to be in constant sight and and situations.
hearing of an adult. Demonstrates affection to adults.
They are learning to cooperate and will Shows but does not yield toys to others.
show guilt at misdeeds. Displays separation anxiety.
They recognise that they are separate Will attempt to change adults’ intent using
individuals from parent. persuasion or protest.
They are developing a sense of humour.
Emotional repertoire now includes anxiety,
fear, affection, protest, elation, surprise,
frustration, shame, wariness and negativism.
12–18 months
Gross motor
Walking continues with ‘bow legs’. Pulls toy while walking.
Will throw large balls underarm (with a At 15 months, crawls up stairs.
two-handed toss) unless taught otherwise. Crawls down stairs or goes down on
Vertical climbing is beginning, first onto bottom.
parents’ lap and, later still, up playground At 15–18 months, trots (walks quickly with
equipment. no airborne phase).
At 13–16 months, throws a ball
underarm in sitting position (with no aim).
At 15–18 months, throws a ball
forward while standing (with no aim).
Walks into a large ball while trying to kick it.
Picks up toy from floor without falling.
Carries large toy while walking.
Moves to music.
Fine motor
Precision grips on small objects is Holds two objects in the hand at once.
established. Builds a three-block tower.
The toddler refines learned manipulation Holds a crayon and scribbles.
patterns to combine them into more Rotates and examines three-
complex and longer play sequences. dimensional objects.
There is further differentiation of the two Turns pages two or three at a time.
APPENDIX II 247

sides of the hand. Paints with whole arm movement,
Has controlled release. changing hands.
Is interested in ‘tool’ use. Deliberately throws or drops objects to
The grip is static, with movement coming watch them fall.
from the shoulder, elbow and wrist.
In play, the toddler increasingly acquires
bilateral (two-hand) skills with one hand
stabilising and the other manipulating.
Multiword comprehension is beginning, Can respond to simple and often-repeated
whereby children can understand three commands such as ‘Give me your bottle’.
or more words out of context. Understands 50 words (nouns, verbs and
They can point to some objects when adjectives).
named. Understands ‘where’ questions when
these are accompanied by gesture.
Enjoys looking at a book.
Identifies at least one body part.

Children aged 12–18 months are Will repeat familiar words on request and
beginning to use words purposefully, in imitation of a model.
expressing a variety of communicative By 18 months, can use a few words
functions. appropriately.
They have a vocabulary of about Words are approximations of their adult
20 words. equivalent (e.g. ‘bobo’ for ‘bottle’).
They sing spontaneously. Communicates by pointing accompanied
with a word (e.g. ‘Wassat?’).
Uses exclamations: ‘Oh-oh!’.
Says ‘no’ meaningfully.
Refers to self by name.
Cognitive
Cause-and-effect and object permanence Toys with hinges, switches, push buttons
are now well established. and pop-ups are increasingly enjoyed.
Learns primarily through exploration. Matches similar objects.
Trial-and-error learning is beginning to Simple pretend play directed towards self
be informed by insight. (e.g. eating, sleeping).
Shows some understanding of categories. Immediate imitation of a model.
Shows pleasure at achievement of Uses a ‘tool’ to obtain a desired object.
self-selected goal. Can place round, and later, square
Can concentrate for some time on a task pieces in formboard puzzles.
of their choosing but attention span is May become angry if interrupted.
limited on adult-directed activities.
Focus is rigid as competing stimuli must
be ignored, resulting in apparently
obstinate behaviour.
Self-help
At this age, children can anticipate Finger feeds part of a meal.
self-help activities. Can use a spoon to self-feed, with some
Their developing trunk stability allows for spilling.
248 APPENDIX II

more participation in dressing. Takes bite-sized pieces from plate.
Grasp is now delicate, with ability to use Independently drinks with cup, with some
appropriate force. tipping.
Release now deliberate and purposeful. Indicates when wet or soiled.
Tries to push off soiled pants.
Takes off shoes, socks, hat, mittens, coat.
Puts on hat.
Tries to put on shoes.
Undoes bows and snap fasteners.
Holds head in position for hair brushing.
Brings brush to head.
Social-emotional
The use of routines supplies toddlers Pulls adult to show or help.
with some predictability. Hugs and kisses adults.
They use their primary caregiver for Can play in parallel with two other
‘emotional refuelling’ while moving away children.
briefly but repeatedly. Plays simple object-centred games.
Begin to prefer interactions with peers. Recognises difference between ‘you’
They display extremes of emotions. and ‘me’.
Play is becoming more experimental Laughs at incongruous events.
but still ritualised.
18–24 months
Gross motor
Legs are now straight in walking (i.e. Climbs onto an adult chair, holds on for
no longer bow legged). support, turns and sits.
Rotational changes in alignment of lower Walks up then down stairs with hand held,
limb bones continue. two feet per step.
The development of ball skills depends Brief airborne phase begins in running.
heavily on exposure to ball play. Rises on tip-toes with hand support.
Squats.
Moves on ride-on toys without pedals.
Fine motor
Significant changes in hand skills occur Can use isolated finger movements.
during this period. Builds a six-block tower.
Cognitive gains allow more complex Uses a fingertip grasp for precision tasks.
movement patterns to be used. Uses a palmar grasp for power tasks.
Pencil grasp becomes more controlled. Can hold objects with appropriate
Eye–hand coordination is beginning in pressure (e.g. so that a biscuit is not
ball play. crushed).
Development of perceptual-motor ability Can place and release accurately.
allows for refinements of earlier hand skills. Imitates vertical and circular strokes.
Manipulates objects into small openings.
Receptive vocabulary growth continues By 2 years, understands more than
to be much more rapid than expressive 1000 words.
vocabulary. Begins to understand temporal words
APPENDIX II 249

Children can now understand some words such as ‘soon’ and ‘later’.
out of context. Begins to distinguish between common
Comprehension of personal pronouns objects, such as cat and dog; milk and
begins to develop. juice.
Follows a series of two simple but related
directives.
Identifies three to six body parts.
Enjoys nursery rhymes.

This is a normal echolalic stage, when Uses speech to gain attention.
young children repeat part of what they Uses words with, or instead of, gestures.
hear. Most grow out of this by Once 50 words are acquired, can combine
approximately 21/2 years of age. these into two-word sentences (e.g. ‘Want
Turn taking is beginning to occur in bikky’).
primitive conversations. May use jargon (syllable strings that
sound like language).
Attempts to sing songs with words.
Imitates three to four word phrases.
Makes sounds to animals.
Cognitive
Cause-and-effect understanding is Completes simple puzzles.
developing. Varies creatively own imitation of a
Attention span is lengthening but is not model.
discretionary: children cannot give equally Finds object not observed being hidden.
long concentration to adult-selected Sorts and matches objects.
activities. Recalls recent events.
Deferred imitation is now made possible Remembers where things belong.
by memory storage and representational Constructive play emerges.
thought. Play becomes symbolic, first directed at
Children can now use some foresight the self and then at objects (e.g. putting
before acting. a doll to bed).
Increased use of non-realistic objects in
pretend play.
Activates mechanical toys.
Self-help
Can integrate sensory experiences and Unwraps food.
make accurate motor responses to allow Rotary chews solid foods.
for tasks such as dressing and threading. Scoops food, feeds self with spoon.
Has distinct food preferences. Indicates wet pants.
Lifts foot for shoes or pants when dressing.
Removes loose shoes, pushes down
shorts, removes socks on request.
Opens mouth for teeth to be brushed.
Holds toothbrush and approximates
brushing.
Allows wiping of nose.
Washes and dries hands partially.
Tries to wash body.
Helps with simple household tasks.
250 APPENDIX II

Social-emotional
Children are learning that they can Reveals sense of ownership: defends
exercise some autonomy. possessions.
This, plus their fixed attention skills can Shows affection to other children.
make it difficult to redirect them once they Imitates adult behaviours in play.
are fixed on an idea or action. Plays by self, initiating own games.
Their egocentrism at this age is Plays in parallel and associatively.
characterised by their assumption that Attempts to comfort others in distress.
what upsets them is the cause of Laughs at incongruous events and play
another’s distress. with words.
They may show fear at departure of Plays house.
primary caregiver and cry in relief at his Imitates adult behaviours in play.
or her return.
They now experience guilt, pride, affection,
jealousy and defiance.
Symbolic play begins to emerge.
Children are beginning to initiate their
own play.
24–36 months (2–3 years)

Gross motor
Walks with arms at sides, with a narrower Can stand on one leg for 1–2 seconds.
base, longer stride, but little push off At 2 years, walks up and down stairs
with toes. alone, still two feet per step.
Is flat-footed. At 21/2 years, walks up with support, one
Has little body rotation in walking. foot per step.
Airborne phase in running lengthens. May begin climbing heights, with reduced
Legs develop ‘knock knees’, peaking at sense of danger.
around 31/2 years of age. This corresponds Climbs over, in/out with help for hand
with in-toeing (or ‘pigeon toes’) if very placement and weight shift.
flat-footed. Begins to jump, usually with one foot
leading.
Can jump from a bottom step.
Kicks a ball and retains balance.
Needs to be shown how to position arms
to catch.
Fine motor
Ability to make manipulative movements Strings four large beads.
within the hand improves. Turns book pages singly.
For the majority of children, handedness Imitates a drawing of a face.
is present. Imitates directional movements for
writing tasks: vertical, horizontal and
circular strokes.
Uses scissors to snip paper.
Manipulates play dough.
Turns knobs.
Has a 2500-word receptive vocabulary Understands two or three prepositions
comprising nouns, verbs, prepositions (e.g. under, in, on).
and adjectives. Responds correctly to common multiword
APPENDIX II 251

Can follow two-step commands. sentences (e.g. ‘Put your cup on the
Understand simple time concepts such table’).
as ‘tomorrow’. Cannot understand compound commands
Enjoys hearing stories repeated. (e.g. ‘Take your coat off and put your
slippers on’).
Understands negatives: no, don’t, can’t.
Understands ‘what’ and ‘where’ questions.
Points to pictures of common objects when
these are named.
Begins to understand ‘long’ and ‘short’.
Enjoys simple stories and requests
repetition.

Can now participate in conversations Expressive vocabulary of 1000 words.
and sustain these for two to three turns. An average of three to four words per
Around 70% of speech is intelligible sentence.
but children express frustration at Asks for wants.
not being understood. Uses pronouns ‘I’, ‘me’, ‘you’, ‘mine’.
Will ask ‘what’ and ‘where’ questions
(e.g. ‘Where’s Mummy?’).
Uses plurals of nouns.
Tells simple stories about recent
experiences.
Identifies some colours.
Can use most vowel and consonant
sounds correctly.
Makes negative statements (e.g. ‘Can’t
do it’).
Cognitive
One-to-one number Can plan actions mentally without acting
correspondence is developing. them out.
Children are now able to amuse Can relate an experience to another using
themselves for extended periods. ‘if . . . then’ logic.
Can transfer their attention when bid, Matches and uses associated objects
unless engrossed already. (e.g. sock and shoe).
Learning is through exploration and Can sort objects by size.
adult mediation. Can count by rote from 1 to 5.
Can self-correct to meet adult standards. Can count two or three objects.
Can follow adults’ directives to attend to Can complete three to four piece puzzles.
particular stimuli. Identifies body parts with function.
Knows two to three primary colours.
Self-help
Children of this age take particular Holds cup or glass with one hand, with
pride in their own achievements, the other poised to help.
particularly in the self-help domain, Pours liquids.
and they resist assistance. Uses spoon well with minimal spilling.
They understand and stay away from Spears food with fork.
common dangers. Opens jars.
Unzips clothes.
Pulls pants down.
252 APPENDIX II

Pulls pants up from ankles.
Removes coat, jumpers, T-shirts.
Puts on coat with assistance.
Puts on socks and shoes.
Unties and removes shoes.
Is interested in lacing.
Identifies clothing appropriate to different
occasions.
Combs and brushes hair.
Washes and brushes teeth (not
thoroughly).
Wipes nose on request.
Independent daytime toileting control when
adult regulates toilet trips.
Can anticipate the need to urinate.
Social-emotional
Children at this stage are distinguishing Plays near other children.
themselves as separate individuals. Joins in briefly with other children’s play.
Frustration tantrums peak. Defends possessions, using ‘mine’.
Sometimes shy with strangers. Begins to play house.
Make constant demands for parents’ Participates in simple group activities
attention. (e.g. sings, claps, dances).
Cooperation is facilitated by language Knows own gender.
development which assists reasoning skills. Acts to help others in distress.
By the end of the third year, some children
make a special friend.
They are easily roused to anger when
frustrated.
Numbers of emotions and finer
discriminations between them continue
to increase with age but at this age
children experience emotions one at
a time and completely (for the moment).

Gross motor
By this age, motor skill depends largely Can run around obstacles.
on practice. Stands on one leg for 3–5 seconds.
Stop-start and turning are more efficient Some can hop on one foot.
while walking and running. Can walk on toes.
There is a longer airborne phase during Can walk on heels.
running, with arm swing, longer stride, Jumps with two feet together,
increased speed, stop-start and 4–5 jumps in a sequence.
cornering abilities. Can walk up stairs alone, one foot per
Is more aware of danger during step.
climbing but still needs supervision. Walks or jumps down stairs, two feet per
step.
Scoops ball to chest when catching.
May catch a bounced ball more easily than
one that has been thrown.
Rides a tricycle.
APPENDIX II 253

Fine motor
Precision grasps of tools are established Uses a fingertip grasp on pencil.
but will be refined over the next 3–5 years Able to hold a small object in the
with practice. fingertips while storing one or more in palm.
In-hand manipulation skill of moving small Draws a circle.
objects from the fingertips and thumb to Draws face of a person.
the palm and back again (translation) Imitates a cross.
is developing. After 36 months this Draws a somewhat recognisable
movement can occur even when other picture that is meaningful to self.
small objects remain in the hand. (This Cuts along a line and around a circle.
is called stabilisation.) Can roll a ball and mould a biscuit shape
with playdough.
At this age, children display a relatively Understands children’s stories.
large growth in vocabulary. Understands concepts such as smaller,
more, less, same.
Can state some opposites (e.g. ‘Hot
and. . .?’).
Can carry out a series of two to four
related directives.
Understands when told ‘Let’s pretend’.

Talks a lot and rapidly. Sentences are Will make requests, tell jokes, protest and
longer and more varied. agree.
Children may repeat the initial sound Asks many questions for
in words (e.g. ‘b-b-b-baby’). information: why and how questions.
This is a normal developmental stage and May substitute some sound for others
does not mean that they are beginning to (e.g. ‘baf’ for ‘bath’).
stutter. They have many ideas to get Tells about past experiences.
across with language that does not yet Uses ‘ed’ on some verbs to indicate
come automatically to them, so they past tense.
build in pauses as they find the words Refers to self using pronouns ‘I’ or ‘me’.
to express themselves. Speech is understandable to strangers,
They use new words meaningfully. although there are still some articulation
errors.
Cognitive
Concentration span is now longer on Plans out pretend play in advance.
self-selected activities but it cannot Acts out sequences with toys.
alternate its focus. Can put graduated sizes in order.
Learns through observing and imitation Recognises and matches six colours.
by testing predictions and via adult Names basic shapes and colours.
explanations. Counts up to five objects, touching each
Has increased understanding of concepts, one (rational counting).
functions and grouping of objects. Completes simple picture puzzles.
Knows the sequence of routine events.
Self-help
3–4 year olds are now able to perform Can hold a cup by its handle.
many self-care tasks with diminishing Drinks securely, with one hand holding
supervision. vessel.
254 APPENDIX II

Pours well from small pitcher.
Wipes up spills.
Can dress and undress without help,
except for difficult fastenings and shoe
laces.
Buttons and unbuttons large buttons.
Uses toilet independently, except for
thorough wiping.
Washes hands unassisted.
Washes body well in bath.
Wipes nose without request.
Social-emotional
Children are beginning to show clear Joins in play with other children in an
preferences for particular playmates. associative fashion, commenting on each
Many children of this age enjoy imaginary other’s actions and exchanging toys.
companions. Takes turns with assistance.
They are interested in others’ emotions. Shares with assistance.
They begin to express their own emotions Begins acting out whole scenes in
verbally. dramatic play.
They are eager to please, although often Has one or two preferred friends.
self-willed and uncooperative.
They can accept the absence of their
primary caregiver if in a supportive
environment.
Beginning to tolerate frustration as
emotions begin to come under
self-control, albeit inconsistently.

Gross motor
When walking, legs are almost straight Runs on toes.
again at knee, ankle and mid-foot Can walk a straight line, but still with
(knock-knees have corrected). some wobbles at 48 months.
Physical growth slows, so food Can take a standing jump over a rope
requirements reduce. held stationary at 15 cm height, with feet
parallel on take-off and landing and
synchronised (30 cm height by 5 years).
Jumps up to 20 sequential jumps forward.
Walks up and down stairs with no hands,
one foot per step (although may use a
handrail in crowds).
Catches a 20–24 cm ball with an efficient
and secure catch in forearms with elbows
bent.
Can kick a basketball into a box 1 metre
away.
Turns somersaults.
Fine motor
Two sides of the hand—the skill (thumb) Draws stick figure.
side and stability (little finger) side—are Copies square (4 years).
well established. Prints a few capital letters.
APPENDIX II 255

In the majority of children, the arches of Cuts around a circle.
their hand are well established, giving Draws, names and describes a
greater control and endurance with recognisable picture.
hand use. Able to fold paper with reasonable
The two hands are able to perform accuracy.
different movements simultaneously and Can place paper clips on paper.
proficiently to carry out an activity.
Their preferred hand becomes increasingly
specialised.
At this stage, children can listen for Can follow three unrelated commands
extended periods to stories although in correct sequence.
they might misinterpret the events. Understands comparatives (e.g. big,
Their vocabulary and concept knowledge bigger, biggest).
continue to grow. Understands concept of zero.
They can now use these skills to express Can put three pictures in a sequence to
ideas, solve problems and plan ahead. tell a story.
Understands first, middle, last.
Understands sequences of events when
these are explained to them.

Children’s more extensive vocabulary Expressive vocabulary of 1500 words.
allows them more routinely to use words Average sentence length of five words.
in social play to solve problems rather Asks questions using ‘who’ and ‘how’.
than being aggressive. Can define words such as ‘carrot’ and
They can use language to describe ‘fire fighter’.
imaginary situations. Adapts language use for listeners:
They use language to find out about their uses more complex sentences when
world. talking to an adult compared with a baby.
Swearing and chanting emerge as Now uses other conjunctions in addition
children play with the rhythms and to ‘and’ (e.g. ‘because’, ‘when’, ‘if’).
patterns (and prohibitions) of language. Can sing songs and recite poems from
memory.
May still have some difficulty with
consonants such as /s/ and /t/ and
consonant blends such as ‘str’ and ‘gl’.
Cognitive
Can now integrate spatial, cause-and-effect Counts objects in sequence with
and representational thinking into one-to-one correspondence.
problem solving. Matches pictures of familiar object pairs.
Close to their fifth birthday, can divide Can describe what will happen next.
attention and pay selective attention Understands sophisticated time concepts
reasonably automatically. such as yesterday and last week.
Increased understanding of concepts.
Self-help
Children of this age are able to perform Cuts easy foods with a knife.
many self-care tasks independently with Uses spoon and fork competently.
256 APPENDIX II

verbal prompts only, although they Serves self and helps set table.
commonly prevaricate. Dresses with supervision.
Places shoes on correct feet.
Night-time toileting reliable.
Knows front from back of clothing.
Social-emotional
Children are now able to negotiate Plays cooperatively: children engage
during social play and conform to together to achieve a common goal.
group decisions. Dramatic play more closely mirrors
Family membership is a strong source reality, with attention to detail.
of self-esteem. Shows interest in exploring gender
They can share and take turns more reliably differences.
(although this occurs sooner in children Shows concerns and sympathy for
with early experience of group care settings). others.

Gross motor
Running and jumping are now more Reciprocal arm-swing when walking.
rhythmical and efficient, with help from Uses an adult pattern for climbing and
arm movements. descending stairs.
By 6 years, hops on the spot 10 or more
times.
Can run and kick a ball.
By 5 years can catch in hands a 20–24 cm
ball thrown in midline.
Hits a ball with a bat or stick.
Skips with alternating feet.
Fine motor
Hand movements continue to improve Can hold several small objects in the hand
in efficiency and control. while picking up or releasing one in thumb
and fingertips.
Draws triangle, diamond.
Adds trunk and arms to drawing of a
person.
Draws identifiable objects without a model.
Copies own name in large, irregular letters.
Copies numbers unevenly.
Cuts around objects.
Language continues to develop after the Demonstrates preacademic skills:
age of five, although at a slower rate letter word, and number recognition.
than previously. Laughs at multiple meanings of words.
They now have a receptive vocabulary
of at least 20 000 words.

By this age, most children use Expressive vocabulary of over 2000 words.
complex forms of the language. A few consonant sounds (e.g. ‘ch and ‘j’)
There are few obvious differences will not be fully mastered until age 7 or 8.
between their grammar and that of adults. Gives and receives information.
APPENDIX II 257

They still need to learn subject–verb
agreement and irregular forms of past tense
verbs.
They can take appropriate turns in
conversation.
They communicate well with family, friends
or strangers.
Cognitive
Attention span has increased; children Can retell a story from a book with
can direct their attention at adult command; reasonable accuracy.
they can select what to pay attention to, Names some letters and numerals.
and divide their attention between tasks. Is beginning to use time concepts
accurately (e.g. tomorrow).
Self-help
Efficiency of performance improves. Spreads soft sandwich toppings with a
Dawdling over self-care tasks lessens with knife.
the children’s increased awareness of time Dresses self completely (except for shoe
and the consequences of being late. laces).
Level of supervision needed for self-care Brushes teeth unassisted.
tasks continues to decrease. Carries liquid in open container without
spilling.
Washes hands at appropriate times
(e.g. before meals).
Independent grooming.
Social-emotional
Children are able to delay Chooses own friends.
gratification—that is, sacrifice an Plays simple competitive games that
immediate outcome for a longer term are not too highly organised.
outcome—and so can withdraw from Can negotiate and direct roles, rules and
disputes. tasks during social play.
They can now accurately interpret the Comforts playmates in distress.
source of a friend’s distress. Protects other children and animals.
They generally have one or two close Offers help to others voluntarily.
friends of the same sex. Judges behaviour as right or wrong.
Quarrels are frequent but of short duration
and soon forgotten.
They can feel more than one emotion at
a time, as long as it is of the same category.
Their ability to understand others’ emotions
has a direct effect on their social
competence.
72 months + (6–7 years +)

Gross motor
By 6 to 7 years, children display a mature Anticipates and prepares to catch.
running pattern. Catches 15–24 cm ball in hands easily
Further refinement throughout childhood and repetitively, with elbows bending to
depends on training and practice with absorb impact.
new movement challenges. Catches to the side of body space.
258 APPENDIX II

By 7 years, leg and foot alignment is Catches 5 cm (tennis) ball.
similar to adults’ (i.e. there is slight Throws a ball in the air and catches it.
out-toeing).
Fine motor
As dynamic eye skills (e.g. tracking) Uses a dynamic tripod pencil grip, with
have developed, children’s eye–hand pencil moved by moving fingertips.
coordination continues to improve. Copies rectangle.
The majority have a well established Writes letters and numbers with some
dynamic tripod pencil grip. accuracy, but still has errors.
They have proficient in-hand manipulation Letter size decreases, with letter formation
skills and use gravity to assist. more consistent.
Vocabulary continues to grow. Understands jokes, word puns and
figurative language.
Can understand more complex stories.

Pragmatic skills improve. Most English speech sounds acquired
Conversational skills are refined. including thin and treasure.
Sentence structure becomes more
complex.
Cognitive
Children now have the ability to focus on Accepts that matter is conserved, even
several attributes of an object though the container shape alters.
simultaneously (termed decentration). Loves exploration.
They begin to use logic to solve
problems, reverse steps in a
problem-solving sequence. They are able
to discern differences between
appearance and reality.
They are lively intellectually.
Self-help
Children are able independently to Cuts and spreads with knife.
perform most necessary self-care tasks Grooming independent.
although will continue at times to seek Selects appropriate clothing.
adult support. Turns clothing right side out.
Buttons back buttons.
Ties shoe laces.
Blows and wipes nose independently.
Social-emotional
Play continues to be the main vehicle Plays games with rules increasingly.
driving development in all domains. Sensitive to criticism.
Around the age of seven years, sex Wants to be best and first at everything.
discrimination emerges.
Sources: Allen and Schwartz 2001; Burns 1992; Case-Smith 1995; Cook et al. 2000;
Furuno et al. 1985; Henderson 1995; Howard et al. 2001; Jones 1992; Kostelnik et al. 1998;
APPENDIX II 259
Lerner et al. 1998; Linder 1990; Nixon and Aldwinckle 1997; Nixon and Gould 1999;
Owens 2001; Raver 1999; Sheridan et al. 1999; Tachdjian 1997; Talay-Ongan 2000.
Berk, L. 2000 Child development 5th edn, Allyn & Bacon, Boston, MA
Nixon, D. and Aldwinckle, M. 1997 Exploring: child development from three to
six years Social Science Press, Katoomba, NSW
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Appendix III
INDICATORS OF ADVANCED
DEVELOPMENT IN YOUNG
CHILDREN
LOUISE PORTER
The following characteristics and behaviours can indicate advances in children’s

development during the early childhood years. However, it must be said that
some of these signs can be due to reasons other than giftedness—and that no
gifted child will display all of the signs. Furthermore, it is not clear which behav-
iours are essential for giftedness and which are unnecessary, and we have
insufficient knowledge to allow us to give extra weight to the most important
features (Perleth et al. 2000).
Nevertheless, the fundamental criterion for defining giftedness is that the
children’s development (in at least one developmental domain) is proceeding
around one-third faster than expected at that age—such that a 3-year-old more
closely resembles at least a 4-year-old’s development and a 6-year-old behaves
and achieves more like an 8-year-old (or older).
Cognitive (thinking) skills

Children who are developing significantly ahead of age in their intellectual abil-
ities may show an array of the following behaviours. They:
• achieve developmental milestones early (around one-third sooner than

expected);
• learn quickly;
• observe the environment keenly;
• are active in eliciting stimulation from the environment—sometimes leading
to reliance on parents to act as ‘input’ for them;
• may read, write or use numbers in advanced ways (although this is not very
common: if the children are reading during the preschool years, they are likely
to be highly gifted; if they are not reading early, that may not be significant);
• show advanced preferences for books and films, unless too sensitive to older
themes;
APPENDIX III 261
• have quick and accurate recall (although this is necessary, having a good
memory is not sufficient on its own to indicate giftedness);
• can recall skills and information introduced some time ago;
• possess deeper knowledge than other children (have information on more
topics, and know more about those topics);
• have an ability to teach other children (although they might become irritated
if others appear not to be learning, and may have difficulty describing the
steps of tasks as they themselves did not need to learn them in a stepwise
fashion but were competent almost immediately);
• understand abstract concepts (e.g. death or time) early;
• are imaginative or creative (not just with artistic pursuits but in their problem
solving as well);
• have an advanced sense of humour (because they understand incongruity,
which is the basis of humour).
Learning style
As well as what they are able to achieve, young children who are learning at a
faster pace than usual typically go about tasks in sophisticated ways—that is,
how they achieve is exceptional. They:
• are motivated, curious and seek to understand;
• will focus intensely on an area of interest, as long as there is sufficient
challenge;
• have wide-ranging interests;
• are alert (sometimes resulting in poor sleeping patterns and sometimes in
sound sleep as a result of expending their energy all day);
• respond to novel stimuli and get used quickly to repetitive activities;
• have a longer than usual concentration span on challenging topics of interest
(but may ‘flit’ from one activity to another if activities are not challenging
enough);
• use metacognitive skills early to manage their own thinking processes;
• have a clear understanding of cause and effect;
• possess good planning skills;
• have an internal locus of control;
• are less impulsive than usual for their age (and so have fewer injuries than
usual);
• can be independent when working at challenging, non-routine tasks but
highly dependent when bored;
• can think logically.
Speech and language skills

Children whose advances fall within the verbal domain tend to show the follow-
ing characteristics. They:
262 APPENDIX III
• comprehend language early;

• use advanced speech, in terms of vocabulary, grammar and clear articulation;
• will use metaphors and analogies (e.g. when hanging upside-down on a
jungle gym will announce that they are a bat);
• will make up songs or stories spontaneously;
• can modify their language to suit less mature children;
• use language for a real exchange of ideas and information at an early age;
• can carry out instructions to do several things in succession.
Motor abilities
Children with advanced physical skills may display the following characteristics.
They:
• have early motor development, particularly in skills that are under cognitive
control (e.g. balance), in contrast with those (e.g. stamina) which are purely
physical;
• can locate themselves within the environment;
• have an early awareness of left and right (without necessarily being able to
name these accurately);
• may have average fine motor skills, which means that these lag behind their
other developmental skills, leading to some children’s reluctance to draw or
write and later to untidy handwriting through lack of practice and reduced
motivation;
• can put together new or difficult puzzles (particularly if visually advanced,
in contrast with children who prefer to learn auditorally);
• can take apart and reassemble objects with unusual skill;
• can make interesting shapes or patterns with objects;
• have high levels of physical energy (sometimes leading to queries about
motoric or vocal ADHD).
Social skills
Some gifted children are particularly adept at relationships and are tuned in to
other people and their feelings. These children often:
• have highly developed empathy for others;
• are less egocentric than usual—that is, can interpret accurately what is both-
ering others;
• have advanced play interests;
• can play games with rules earlier than usual;
• may form close, reciprocal friendships from a young age (as long as intel-
lectual peers are available);
• seek out older children or adults for companionship if intellectual peers are
not available;
• might withdraw to solitary play if intellectual peers are not available;
APPENDIX III 263
• are often sought out by other children—that is, others feel drawn to them
although the gifted children themselves might not feel so warmly disposed
to others who are not ‘soulmates’;
• can display leadership skills, although in their early years they might not
have the maturity to exercise tact with those whom they are leading;
• develop moral reasoning and judgment early (although might not act accord-
ingly unless circumstances facilitate this);
• take an early interest in social issues involving injustices (sometimes leading
to the need for media blackouts in times of wars and other world crises).
Emotional and behavioural characteristics

Finally, some children whose development is advanced have been described as
showing the following emotional features. They:
• can be emotionally sensitive, intense and responsive. (As this can be a
response to frustration at their uneven developmental levels across a range
of skill domains, any children with atypical development may be similarly
emotional.);
• develop fears early;
• develop their self-concept early and so are aware from a young age of being
different from others (from perhaps as young as 2 years old);
• are self-confident in their strong domains but less confident in their less
advanced domains;
• might be perfectionist, in the sense of seeking to achieve at high levels;
• can be oversensitive to criticism;
• may become frustrated at their lesser skills, which can lead to emotional or
behavioural outbursts;
• may accept responsibility usually given only to older children (which is
important not to exploit, as the children may not be free to develop fully
while taking care of others’ business);
• are non-conformist, and so do not take kindly to authoritarian forms of
discipline whereby they are expected to do as they are told without an
explanation.
Source: adapted from Porter (1999:74–6).

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Appendix II: Typical developmental milestones

Allen, K.E. and Schwartz, I.S. 2001 The exceptional child: inclusion in early childhood education
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at-risk, children with disabilities Allyn & Bacon, Boston, MA
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approach 2nd edn, Merrill, Upper Saddle River, NJ
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Appendix III: Indicators of advanced development

Perleth, C., Schatz, T. and Mönks, F.J. 2000 ‘Early identification of high ability’ in International
handbook of giftedness and talent 2nd edn, eds K.A. Heller, F.J. Mönks, R.J. Sternberg &
R.F. Subotnik (pp. 297–316) Pergamon, Oxford, UK
INDEX
Aboriginal children 145 articulation 158–9, 164, 165, 167
absences 74, 202, 237 Asperger syndrome 158, 235
abstract learning 5, 71, 164, 172, 177 aspirations, of parents 20, 25
abuse of children 8, 14, 163, 193–5, 214, 215, assertiveness 32, 192, 207, 220–1
226, 232–3 assessment 1, 28, 36–55
academics 57, 64, 163 of hearing impairment 147–9
acceleration 64 of language skills 166–7
acceptance 16, 191, 195, 198, 200, 202 principles of 38–40
access 11, 13, 22, 31, 97, 206 purposes of 37–8
accessibility of information 26 asthma 108, 236
accountability 20, 22, 38 astigmatism 87, 92
acknowledgment 198, 218–9 at risk 41, 52
acquisition of skills 58 ataxia 92, 100, 232
see also knowledge acquisition athetoid 100
activity-based instruction 67 atlantoaxial instability 103
see also naturalistic instruction see also neck instability
ADD/ADHD 54, 101, 229, 230, 235–6 attachment 119, 192, 200, 201, 207
adult-directed teaching 8, 13, 68 see also bonding
see also direct instruction attention deficit disorders 54, 101, 229, 230,
adults-in-waiting 8 235–6
advocacy 7, 24, 29–30, 31, 38–9 attention seeking 224
aggression 102, 148, 150, 168, 193, 201–2, attentiveness 47, 54, 68, 102, 121, 148, 174,
207–8, 220, 230 177–8, 184
AIDS 236–7 see also concentration span
aids, hearing 151–2 attitude 16, 20
aims of programs 58–9 attribution training 189, 199
alcohol 228 audiogram 142–3
see also fetal alcohol effects/syndrome audiologist 143, 151, 152
alerting activities 122 auditory sense 102, 117, 125
alertness 98, 118, 119–21, 124, 126 see also hearing
see also arousal augmentive communication systems 69, 164
alignment of joints/bones 99, 104 see also sign languages
altruism 12 autism spectrum disorders 103, 104, 167,
amblyopia 85, 86 234–5, 239
Angelman syndrome 231 see also Asperger syndrome
anxiety 48, 119, 123, 194, 213, 235 autonomy 15, 191, 199–200, 207
Apgar scale 41 average 51–2
apologies 220
applied behaviour analysis (ABA) 211, 215 baby talk 141
apprenticeship 15 see also motherese, parentese
Achilles tendon 104, 110 background movement 104, 106, 109
arousal 47, 103, 106, 119, 177 balance 99, 102, 103, 104, 106–7, 109, 110,
arthritis 107, 126 112–3, 115, 118, 135, 136
INDEX 297
ball skills 86, 109, 110, 114–5 cerebral palsy 92, 97–101, 103,
see also milestones 104, 107, 109, 110, 164, 231–2, 239
bathing 99, 136 classification of 100
behavioural chain
difficulties 13, 31, 47, 90, 102, 119, 145, of events 224–5
155, 169, 186, 194, 200, 201, 210–27, 232, of hearing 142
235 checklists 43
causes of 215–6 chemotherapy 236
behavioural optometrists 91, 94, 95 cheerleaders 197
behaviourist methods 8, 211 child abuse see abuse
see also applied behaviour analysis child-oriented approach 13
belonging 191 choice 7, 8, 27, 31, 62, 123, 179, 199, 217
bias of assessment 40, 43, 45 of school 30
bilateral hand skills 127, 129 classification 38, 40
bilingualism 39, 145, 166 cleft palate 148, 165
binocular vision 85, 89, 91, 92 climate 60, 188, 194
bionic ear 152 climbing 99, 108, 109, 110, 111–2, 123, 124,
birth weight, low 145, 163, 228, 231–2, 234, 128
239 see also milestones
biting 210, 235 clothing 161
bladder control 101, 136 see also dressing, milestones
see also toileting clowning 102
blindness 63, 83, 91–2 clumsiness 89, 98
definition 81 coaches 197
body language 34 cochlea 142, 152
see also nonverbal communication see also ear, inner
body speed 93, 133 cochlear implant 152
boisterous 105, 196, 201 cognitive skills 15, 174–90, 218
bonding 113–9 see also milestones
see also attachment collaboration 59
bottom–up model 57, 70–1 with parents see parents
bottom shuffle 99 collaborative problem solving 32, 33, 192,
bowel control 101, 136 221
see also toileting colour
Braille 94 naming 44–5
brain injury 83, 98, 232–3, 239 perception 85, 88
breathiness 156, 159 communication 32–5, 74, 142, 154–73
bright children 52 components of 155–9
see also gifted disorders 164–6
brushes 128 see also language
bullying 196, 215 community 59
see also exclusion compassion fatigue 25
bunny hopping 100 competitiveness 105, 203
burnout 25 comprehension 47
see also language
calm, state of 119, 124, 125 comprehensive assessment 40, 51
calming activities 122 computers 69, 125
cancer 104 concentration span 49, 62, 92, 122, 148, 177,
cardiac 54, 92, 108, 114 232
case manager 31–2 see also attentiveness
casting 110 concept development 82
castor carts 101, 108 concrete learning 5, 71
cause-effect understanding 175–6, 182 conductive hearing loss 143–4, 148
298 INDEX
cones 88 developmental
confidence 15, 59, 62, 63, 96, 103, 108, 123, coordination disorder (DCD) 101–3, 104,
179, 188, 192, 196, 200, 213, 217 105, 109, 110
of parents 23, 24, 33 emergency 82
confidentiality 8 model 8–9, 69–70
conformity 9 developmentally appropriate practice 13–14
consent 7–8 diagnosis 37, 48, 51, 54, 228
consequences 218 see also labels
see also rewards, punishment dietitian 137
consequential thinking 183 differentiation of programs 59–74
consistency 218, 225–6 diplegia 99–101, 109, 110
consonants 159, 160 direct instruction 14, 171
see also milestones see also adult-directed teaching
constipation 136 directives 66
consumers 22, 56 disability, defined 5
content discipline 211
differentiation 69–73 discrimination 7, 33, 192
of language 156, 158, 165, 168 skills 82, 84, 94, 167
of programs 13, 59, 60, 73, 171, 174 disease
continence 101 of joints 104
of ear 144
see also toileting
of eye 87, 90–1, 93
contingency 141, 142
disengagement 119
see also joint referencing
of parents 33–4
cooperation 34, 59, 197, 201, 213, 215
see also engagement
cooperative efforts/play 42, 73, 203
dispositions 10, 15, 57, 58–9, 65, 66, 70, 73,
coordination
172, 176, 185–90
motor 102
distance, from speaker 148
of services 13, 31–2
distractability 90, 178
cortical vision impairment 83
see also attentiveness
counselling 31, 150
diversity 9, 11, 59, 65
courtesy 33
doctor see medical practitioner
crawling 100, 125 double vision 86
creativity 15, 59, 62 Down syndrome 54, 92–3, 103, 108, 230, 231,
creeping 100 238–9
critical period 155 drawing 90
cross-eyed 85 dressing 90, 99, 135, 190
culture 9, 10, 13, 33–5, 39, 45, 59, 98, 126, see also milestones
135, 155, 159, 190, 197 drinking 97, 103, 105
see also feeding
daily living skills 117–39 drugs
deafness 140–1, 143, 152 illicit 163, 193, 228, 229
decision making (by parents) 21 treatment see medication
defensibility 39, 45 dual exceptionalities 240
defensiveness 121 Duchenne muscular dystrophy 104, 231, 239
demand-based model 22 dummy see pacifier
dependence 25 dyslexia 4, 240
see also independence dyspraxia 102
depression 194
depth perception 89, 90, 92 ear
dermatitis 126 drum 146
developmental delay 4, 103, 167 canal 151
see also intellectual disability inner 107, 118, 143, 152
INDEX 299
middle 141, 144, 146, 236 eye

outer 144 contact/gaze 34, 83, 158, 197, 235
wax 151 dominance/preference 90, 91
early intervention 4, 70 exercises 86, 94
effects of 6, 19, 30 movements 84–5, 91, 105, 118
for hearing impairment 147, 152 sight 57
for language impairments 167
timing of 6 factory model of education 8
eating 97, 103, 105, 118, 121, 138, 230 failure 189
see also feeding falls 96, 99, 124, 232
echolalia 163, 168, 234 false negatives 40
ecological perspective 8–9, 16 family-centred style 22–6
effectiveness 216 fatigue 130, 131, 132, 133
efficacy 15, 188–9 see also exhaustion, tiredness
efficiency of assessment 51 fears 194
eligibility 30, 31, 32, 45, 48 feedback 66, 68, 163, 171, 179–80, 183, 184,
emmetropia 84, 87 189, 194, 198, 199, 218–9
empathy 25, 150, 193, 207 physical 97, 107, 110
emotional blackmail 8 proprioceptive 124
emotional needs 15, 191–200 sensory 138
employers, parents as 22 vestibular 123
empowerment 20, 23, 51, 65, 68 feedforward 97, 107
empty vessels 8 feeding 97, 136–8, 164, 231, 232
endurance 102, 104, 109, 113, 114 see also eating, drinking, food, milestones
engagement 11, 58, 67, 68, 70, 72, 142, 178, fetal alcohol effects/syndrome 229, 238
186–7 fidgeting 90
English as a second language 39, 145, 206 fine motor 64, 101
enlargement of text 86 see also eye-hand coordination
enrichment 64 first words 159, 161
entry skills 204–5, 207 fitness 58, 96, 98, 103, 105, 108, 111, 114
environment 12, 13, 59 flexor muscles 106, 110
differentiation 60–5, 93–4 floor of tests 48
epilepsy 92, 97, 232, 235 fluency
see also seizures of skill use 58
equity 39, 46 of speech 156, 165
esotropia 85 follow up 192–3
ethics 7–8, 36, 211, 216 food 122, 138, 160, 161, 211
eustachian tube 146 see also eating, feeding
evaluation 37, 75–6 form of language 156, 157, 158, 165, 168
exclusion 192, 206–7 fragile bones 101
exhaustion 90 fragile-X syndrome 229–30, 238
see also fatigue friendliness 23, 25–6
exotropia 86 friendships 12, 26, 28, 196. 197, 200–2
experts 21, 34, 213 frustration 33, 102, 150, 170, 189
exploration 14, 59, 65, 67, 68, 69, 108, 121, fun 191–2, 196, 225
175, 176, 237 functions of families 23–4
expressive language 156, 158–9, 166, 190
see also milestones, speech gaps in services 31
extended family 34 generalisation 13, 29, 58, 67, 70, 75, 103, 106,
extensor muscles 106 107, 178, 184, 185, 204
extracurricular activities 105 gifted children 1, 4, 5, 16, 24–5, 42, 45, 48, 52,
see also leisure activities 54 60, 63, 237, 240
eye-hand coordination 82–3, 86, 90, 92, 95 behaviour of 263
300 INDEX
characteristics of 260–3 health 58, 97, 145, 236

cognitive skills of 177, 180, 181, 182–3, see also illness
260–61 hearing 118
emotional characteristics of 263 impairments 83, 92, 97, 140–53, 165, 167
hand skills of 133 effects of 144, 163
independence of 189 heart see cardiac
language skills of 164, 170, 172, 182, helplessness 188, 199
261–2 hemiplegia 92, 99–100, 108–9
learning style of 261 heterogeneous grouping 63, 65
locus of control 189 higher-order skills 58, 67, 68
motor skills of 104–5, 262 highly able see gifted
perfectionism 189, 198 hopping 110, 113–4
social skills of 201, 262–3 see also milestones
vision skills of 93 horizontal relevance 75
glare 89, 149 hospitalisation 47
glasses see lenses humanism 211, 213, 215, 221
glue ear 144 humiliation 220
goal-directed movement 97, 107, 110 hydrocephalus 233–4
goals of discipline 213–5 hygiene 136
God’s will 34 see also milestones
goodness of fit 9, 11 hypertonia 100
Gower’s sign 104 hyperopia 84, 87, 89, 92
grammar 157, 169 hypotonia 100, 232
grasp
development 126–7 ideal self 195, 198–9
pencil 91, 130–3 identification see assessment
strength 129 ignoring behaviour 225
gravity 103, 105, 118, 123, 138 illness 74, 106, 234, 236–7
grief 24 illumination see lighting
grip see grasp imagination 15
grooming 136 imitation, deferred 176
see also milestones impairments 5, 228
group impulsivity 54, 90, 102, 109, 115, 169, 222,
composition 63, 65 236
size 62, 187, 217 inclusion 10, 11–13, 17
story time 62, 63, 75, 109, 119, 168, 170, inclusive settings 28–9
202 independence 7, 62, 68, 74, 127, 169, 189–90,
gross motor see motor 197, 213
guidelines 218 individualisation of programs 28, 29, 56–77
individualised education plan (IEP) 21, 60
hand-eye coordination 82–3 individualised family service plan (IFSP) 60
see also eye-hand coordination individually appropriate practice 13–14
hand infections 82, 83, 91, 97, 144, 145, 148, 163,
dominance/preference 90, 132, 134–5 232, 236, 237
grasp/grip 112, 124 information, parents’ need for 26–7, 31
skills 99, 125–35 information processing 174, 232, 240
handicap, defined 5 initiative 15
handling techniques 101, 108, 110 integration 10
harm 7, 8 intellectual delay/disability
head and blindness 92
aches 89 and cognitive skills 177, 180, 182
banging 210, 235 and generalisaiton 185
control 97, 118 and independence 189
INDEX 301
and language skills 164, 166, 171 learned helplessness 188

and locus of control 188 learning difficulty/disability 4–5, 101, 155,
and physical disabilities 103, 106, 109, 110 181, 184
and social skills 12, 201, 204 see also intellectual disability
causes of 228–235 learning style 13, 190, 199, 261
definition 4, 26 see also dispositions
see also learning difficulty/disability legislation 3
intellectual development 126 leisure activities 32
intelligence tests 43–5 lenses, corrective 81, 82, 86, 92
intentionality 175 ligaments 103, 230
interaction 12 lighting 63, 93, 149, 150
interdisciplinary 16–17, 32, 97, 101–2, 167 limits on professional relationship 26
see also multidisciplinary limps 99, 104
interests 60, 67, 70, 179, 187 lip reading 151
integration 71 listening 22, 32, 66, 220
intelligibility 150 training 94
intensity of voice 156, 159 with eyes 219
interpreters 27 literacy 58, 94, 104, 159, 171–2
see also translators locus of control 188–9, 211, 213
interrelated development 10, 71 loneliness 12, 201
intimacy 10, 66 long-sightedness 57, 84, 87, 92
intimidation 33, 216 low vision clinic 91
intonation 34, 150, 156, 159, 165, 234
irritability 102, 109 macula 84, 86, 93
isolated children 12, 201–2 magnification 86
parents 29 mainstreaming 10
IQ tests 43–5 maintenance of skills 58
see also generalisation
jargon 27, 34 manipulation skills 130
jaw lifting 138 marionette 231
opening 109 massage 122, 123
see also mouth opening mean 51–2
joint means–end analysis 176, 184
alignment 104 mediation of
movement 107 learning 14, 17, 67–8, 187, 190
referencing 163 social skills 204–6
see also contingency medical 97, 104
judgment–based assessment 43 practitioner 91, 101, 108, 136, 148
jumping 109, 110, 113–4, 123 see also health, illness
justice 7, 38, 45, 216 medication 47, 97, 110, 232, 235, 236
meetings 21, 27, 29–30
knowledge acquisition skills 174, 176, melting pot 9
177–82 memory 68, 102, 156, 164, 174, 178 180–2,
185, 190
labels 26, 39, 54–5, 228 mental retardation 5
language 156 see also intellectual disability
delay 166 metacognitive skills 14, 15, 174, 176, 179,
disability/impairment 74, 83, 101, 141, 182–5, 190
154–5, 166 methods of teaching 13
signs of 168–9 see also process
skills 15, 47, 58, 94, 190 midline 109, 114, 134
see also comprehension milestones 16, 39, 41, 43, 52, 70
lazy eye 85–6 in each developmental domain 241–58
302 INDEX
mistakes 180, 188, 189, 192–3, 194, 197, non-verbal communication 150, 155, 156, 157,
198–9, 216, 219–20 158, 163, 164, 204, 235
mobility training 94, 101 see also body language
mode of learning 179 normalisation 10, 11
monitoring 38, 52, 75–6 normed tests 38, 43–6
morphemes 157, 171 numeracy 58
morphology 156, 157, 169 nystagmus 85, 86, 92
motherese 162
see also baby talk, parentese obedience 195, 215
motivation 77, 83, 103, 106, 135, 175, 187–8 obesity 231
motor see also weight
control 85 object permanence 176
development 126 observation 41–2, 88
learning 97–8, 107–16 occipital lobe 83
planning 102, 103, 112, 126 occupational therapy 29, 43, 117, 136, 137
skills 89, 96–116 one size fits all 13
mouth–opening 104 optic nerve 83
see also jaw opening optometrists 90–1, 92, 94, 95
mouthing objects 63, 121, 123 opthalmologists 91, 92
movement options 11, 30
dysfunctional reactions to 123–4 opposite response 225
sequencing 106 oral-motor skills 164
speed 99 orientation 105
strength 99 training 94
see also motor orthoptists 91
multidisciplinary team 16, 29–30, 136 orthotics 104, 110
see also interdisciplinary team oscillation of eyes 86
muscle osteoporotic bones 101
length/balance 97, 103, 106, 110 otitis media 144, 146, 147
strength 97, 103, 104, 107, 110, 124 outsourcing 31
tone 97, 98, 100, 102, 103, 107, 118, 128, overtesting 49
137, 138, 164, 231
muscular dystrophy 104, 231, 239 pace 59, 68, 124, 178, 184
musculoskeletal 97, 107, 108, 111 pacifier 122, 145
mutual gaze 141–2 pain, awareness of 121, 234
myelomeningocoele 101, 233–4, 239 parent-professional relationship 21–2
myopia 87, 89, 92, 94 parentese 162, 170
see also baby talk
nasality 156, 165 parents 13, 226
natural consequences 67, 219, 226 as teachers 19, 21, 24
naturalistic learning/teaching 14, 29, 66–8, collaboration with 1, 16, 19–35, 41–2
170–1, 187 involvement in assessment 50–1
near body senses 118 with a disability 23
neck instability 108 parents’ reactions to
see also atlantoaxial instability disability 24, 150
needs of families 26–32 giftedness 24–5
neglect 163, 193–5, 201, 206 partner, communication 149–50, 170
negotiated curriculum plan (NCP) 60 passivity 13–14, 66, 155, 175
nervous system 83, 97, 107, 118, 121, 236 patching of eyes 86
neural pathways 57 pattern interruption 224
neural tube defects 233–4 percentile rank 52–3
see also spina bifida perception 175, 235
noise 145, 148 perfectionism 189, 194, 198
INDEX 303
peripheral vision 85, 90 privatisation 31

permanence, of objects 176 problem solving 183–4
persistence 15, 59, 66, 67, 188, 189, 213 skills 58, 66, 67, 175, 181
phenlyketonuria (PKU) 4, 231, 239 with parents 33
phonemes 156, 158 see also collaborative problem solving
phonological awareness 171, 172 processes, learning 10, 59, 60, 73, 74, 171,
phonology 156, 157, 168–9 174, 187, 198
photophobia 89, 94 differentiation 65–9
physical disabilities 47, 82, 96–116, 178, 240 products 59, 60
and social inclusion 201 differentiation 73–4
physical skills 15, 58 prognosis 54
see also motor skills program
physiotherapy 14, 29, 97, 101, 104, 109, 112, aims 58
137 differentiation 59–74
Piaget 14 individualisation 28, 29, 56–77
pigeon–toed 111, 115 projects 73
see also milestones prompts 67, 68, 109, 112, 171, 184, 204
pitch of voice see intonation proprioception 102, 107, 112, 113, 118, 122,
pity 25 124
PKU (phenlyketonuria) 4, 231, 239 dysfunctional reactions 124–5
placement 10, 28, 38, 40, 41, 48, 63, 64, 170, propulsion 113, 115
202, 203 prosody 159, 165
planning, by parents 27 protection 191, 192–5
plateaus of development 49–50, 173 protectiveness training 194–5
play 12, 14–15, 57, 68–9, 155, 169–70, 201 pseudohypertrophy 104
stereotypical 234 psychologist 136, 167
themes of 71 punishment 211, 215, 216, 217, 225
pluralism 9–10, 25, 215 disadvantages of 214
policy 3 pupil size 89
popularity 12 purposes
portfolios 41, 73 of assessment 37–8
positioning 108, 137, 178 of early childhood education 56–7
positiveness 23 pushy (parents) 24
postmodern perspective 8–9, 16 put-downs 198
posture 89, 231
postural control 98, 103, 106–7 quadriplegia 100
see also balance quality
potency 15, 215 of learning 59, 240
poverty 23, 33, 228, 229 of life 54, 167
practice effects 49 of voice 151, 159, 165
Prader-Willi syndrome 164, 231 questions 67
pragmatics 156, 157, 158, 168–9
pragmatism 40 racial differences 47
praise 198, 218–9 see also culture, discrimination
see also rewards radio 144
pregnancy 234 rapport 23, 47
prematurity 92, 145, 229, 231–2, 234, 239 ratios of adults to children 12, 62, 217
see also birth weight readiness 69–70, 155
prevention 4 reading 64, 86, 89, 93, 95, 144, 155, 171–2
primary realism 23
behaviours 211 receptive language 156, 158, 166, 190
service provider 17 see also comprehension, milestones
priorities 21, 33, 34, 53–4 recreation 23, 96
304 INDEX
referral 32, 90, 91, 148 behaviours 211

reflexes 85, 100, 164, 231, 232 disabling conditions 69, 94
refractive errors 82, 85, 86, 87, 89, 91, 92 prevention 4
reframing 224 second opinion 51
rehearsal 182, 185 segregated settings 28–9
reinforcement see rewards seizures 83, 97, 231, 232, 233
relationships 10, 15, 59, 217 see also epilepsy
see also friendships self-actualisation 192
release 128 self-care tasks 129, 135–8
relevance 75, 188 see also self-help skills, milestones
reliability of tests 44–5, 48 self-concept 194, 195, 218
remedial training 14 self-control 59, 182–3, 195, 197, 213, 219,
reports, assessment 36, 40 221–3
resonance 156, 159 self-discipline 213–4
respect 198, 200 self-efficacy see efficacy, locus of control
respiratory problems 108, 231, 236 self-esteem 59, 95, 101, 102, 191, 194, 195–9
respite care 31 self-help skills 94
responsiveness 23, 25 self-instruction 183, 190, 197
retardation 5 self-regulation see self–control
see also intellectual disability self-talk 169
reticence 201, 204 see also self–instruction
retina 83, 84, 88 semantics 156, 159, 161, 168–9
retinitis pigmentosa 93–4 sensitivity 10, 23–5, 217
retinopathy 92 sensorineural hearing loss 143, 145
Rett syndrome 231 sensory
reverberation 148 defensiveness 121
reversal 225 disabilities/impairments 47, 63, 96, 106,
rewards 8, 211, 215, 216, 217, 219, 225, 226 166, 167, 171, 233, 240
disadvantages of 212 integration 118–25, 126
rhythm 109, 114, 165 modulation 121
rights 13, 211, 215, 221 processing 104, 109, 118–25
of parents 20, 21 sensitivity 235
risk taking 124, 180, 196, 198–9 separation
rods 88 difficulties 196
rotation 105–6, 109, 111, 130 marital 23
rote learning 70, 235 sequencing
Rousseau 8 movements 106, 109
routines 75, 187, 217, 235 sounds 166
rules 218 short-sightedness 87, 89, 92, 94
running 100, 113–4 shunt 233–4
see also milestones sign languages 142, 151, 155, 164
see also augmentive communication
saccadic eye movements 85, 91 systems
safety 28–9, 62, 83, 96, 109, 112, 118, 123, size of groups 62, 187, 217
124, 191, 192–5, 199, 207, 217 skill fingers/side 128, 132
safety programs 194–5 smell 118, 125
saving face 219–20 smoking 145
scaffolding 14, 67, 141, 190 social
see also mediation of learning justice 38, 45
school, choice of 30 play 68–9
scissors 125, 126, 132, 133–4 skill interventions 150, 193, 202–8
screening 37, 40, 88, 230, 233 skills 83, 94, 142
secondary socialisation 15, 23, 59, 114
INDEX 305
sole parents 23 talented children see gifted

somatosensation see proprioception tantrums 221–3, 225, 235
space 34, 60 taste 118, 125
spanking 211 teacher-directed instruction see adult-directed
spastic 99, 100, 231 teaching
spatial awareness/perception 82, 102 team 16–17
see also visuospatial technological adaptations 69
specialists 13, 16, 69, 73, 97, 173 television 125
specific tendons 104, 110
developmental language disorder 166 tertiary prevention 4
language impairment 166 testing 36–55
learning disabilities defined 37
see also learning disabilities themes of play 71
speech 83, 103, 156, 158–9 therapy 29, 74
disorders 165 tiered
see also milestones activities 72
speech/language pathologists 14, 29, 43, 137, products 74
165, 167 time away 223–4
spina bifida 101, 233–4 time out 211, 223
see also myelomeningocoele tiptoes 114
splinter skills 75 tiredness 102, 109, 119, 150
spurts of growth/development 49–50, 101 see also fatigue
squint 89 toe
see also strabismus standing 99, 100, 109
stamina 136, 233 walking 100, 102, 103–4, 110, 235
see also endurance toileting 136
standard deviation 52, 53 see also bladder, bowel
standing frame 101, 108 tone see muscle tone
statistics 51–3 tongue movements 138, 160
status 8, 21 top-down model 57, 70
stepfamilies 23 topic 58, 150, 157, 161, 168
stigma 5, 54, 237 touch 34, 102, 118, 168
story time 62, 63, 75, 109, 119, 168, 170, 172, activities to integrate 123
202 reactions to 121
strabismus 85–6, 92 sensitivity 103
strength 113 toys 67, 72, 82, 161, 203
see also muscle strength tracking (of eyes) 57, 93, 118
stress 74, 119, 199, 200, 223 traffic 62
stretching of muscles 104, 110, 111 training of staff 13
stuttering 165 trampoline 103, 112, 113, 123, 124
style of learning 13, 190, 261 transdisciplinary team 17
see also dispositions transitions 24, 30–1, 35, 43, 68, 74–5, 186–7,
sucking 118, 160 197
surgery 86, 97, 103, 110, 232, 233 translators 34
survival 23, 187, 191, 193, 222 trauma 145, 163, 232–3
sway back 104 see also brain injury
symbolic play 176 tunnel vision 81, 94
sympathy 25
syntax 156, 157, 161, 168–9 underachievement 54, 196
undressing 135
tactile see touch see also dressing, milestones
tactile defensive 121 unilateral hearing impairment 144
tailored activities 71 use of language 156, 157, 158, 165
306 INDEX
validity of tests 44–5, 48 waiting time 62, 187

values 1, 6, 7–10, 11, 25, 35, 59 walking 97
vehicular crashes 145, 232 see also motor skills
vertical web space 132
relevance 75 weight 230
surfaces 89, 132 bearing 99, 103, 108–9, 125, 128
vestibular sense 107, 118, 123 birth, low 145, 163, 228, 231–2, 234,
views of childhood 8, 56, 213 239
vision 101, 117, 118, 125, 126, 140, 141, 148, shift 105–6, 108–9, 112
152 see also prematurity
vision impairment 81–95, 97, 98, 107, 114, wheelchairs 63, 101, 108
163–4 withdrawal 102, 148, 193, 200, 213
signs of 88–90 World Health Organisation 6
visuospatial 111, 113 wrist 128
see spatial perception writing 114, 125, 126, 131, 132, 133, 144, 155
vocabulary 167, 168, 171, 172
see also first words, milestones X–chromosome 88, 229–30, 238
volume 144, 156, 159, 165
Vygotsky 14 zone of proximal development 14

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Educating Children - TEXT copy 6/12/02 12:41 PM Page i

EDUCATING YOUNG CHILDREN

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EDUCATING YOUNG CHILDREN

First published in 2002

Copyright © this collection Louise Porter 2002

All rights reserved. No part of this book may be reproduced or

Allen & Unwin

National Library of Australia

Educating young children with additional needs.

1. Special education. 2. Handicapped children—Education.

Typeset in 10/12pt Times by Midland Typesetters, Maryborough, Victoria

PART I—FOUNDATIONS OF EARLY YEARS EDUCATION 1

PART II—PROGRAMMING FOR ATYPICAL DEVELOPMENTAL

11 EMOTIONAL AND SOCIAL NEEDS 191

Appendix I—Common causes of atypical development 228

FIGURES AND TABLES

3.1 A proposed process for the identification of atypical needs

4.1 Common and differentiated features of programs for young children 61

ABOUT THE CONTRIBUTORS

James D. Kenefick, BOpt, is the author of chapter 5. He is a behavioural

Louise Porter, PhD, MA(Hons), MGiftedEd, DipEd, is the author of seven

x ABOUT THE CONTRIBUTORS

Zara Soden, BAppSci (OT), is the author of chapter 7 and contributed to

Margaret Sullivan, BPthy, MAppSci (Pthy), is the author of chapter 6, co-author

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4 FOUNDATIONS OF EARLY YEARS EDUCATION

This rationale applies equally to children with compromised and with

Internationally, the early childhood period is considered to span from birth to

FUNDAMENTALS OF EARLY EDUCATION 5

Another cluster of terms comprises the triumvirate of impairment, disability

6 FOUNDATIONS OF EARLY YEARS EDUCATION

EFFECTS OF EARLY CARE AND EDUCATION

FUNDAMENTALS OF EARLY EDUCATION 7

CORE VALUES OF EARLY YEARS EDUCATION

Ethical service delivery

8 FOUNDATIONS OF EARLY YEARS EDUCATION

& Troutman 1999). Furthermore, professionals cannot use emotional blackmail to

An ecological perspective of childhood and development

FUNDAMENTALS OF EARLY EDUCATION 9

10 FOUNDATIONS OF EARLY YEARS EDUCATION

The importance of process

RECOMMENDED EARLY EDUCATION PRACTICES

The difficulty of researching the effectiveness of programs for children with

FUNDAMENTALS OF EARLY EDUCATION 11

Box 1.1 Values and recommended practices in early childhood

12 FOUNDATIONS OF EARLY YEARS EDUCATION

children opportunities to practise altruism through supporting their peers who

FUNDAMENTALS OF EARLY EDUCATION 13

• Staff require adequate training and support, including planning time

Individually appropriate practices

14 FOUNDATIONS OF EARLY YEARS EDUCATION

exploratory play is inhibited and self-initiation is reduced. In turn, this creates

FUNDAMENTALS OF EARLY EDUCATION 15

Box 1.2 Benefits of play