BACKGROUND INFORMATION
Rationale
In infancy and early childhood, providing interventions that promote healthy social and emotional functioning results in behaviors that have a strong correlation with future mental health and school success. Early Interventionists, however, often lack preparation, experience, and knowledge about social emotional development and their potential roles, boundaries and partners. This section will offer guidance and resources to assist practitioners in meeting the challenges of evaluating the complexities of social and emotional development as the foundation for early intervention eligibility and intervention.
History
Until recently, the prevailing view of children’s development focused on discrete skill areas. We looked at social abilities such as cooperating, playing with peers, or reaching out for hugs; cognitive skills such as searching under a blanket for a hidden toy; language skills such as saying ‘baba’ or ‘dada’; and motor skills such as drawing a circle. We identified the ages at which the skills occurred and judged a child’s developmental progress based on whether she fit age expectations. As interest in infants and young children grew, the importance of social and emotional skills in development became apparent and more of these skills were added to the list of skills charted. A baby’s first smile, the first time he balks at being held by a stranger, his first turn taking; we now look for these skills, too, on a young child’s path of development (Greenspan & Weider, 1998).
The study of differences in the social and emotional development of children has only occurred recently. What is known is that there is wide variability in this area of development. Developmental specialists have just begun to understand the relationship between biological and environmental factors that influence a child and family’s ability to navigate reciprocity, shared experiences and emotional well being. Recent work in the field of brain development is beginning to look closely at the role of emotion in all areas of development.
Throughout history we have believed that emotions were subservient to thought or reason. Freud likened the emotions to a wayward horse, controlled by the rational ego. But our recent clinical work with infants and young children, as well as an emerging body of observational and neuroscientific research, suggests this view is inaccurate. Rather than being separate and subservient to thought, emotions seem to be responsible for our thoughts. Because emotions give direction to our actions and meaning to our experiences, they enable us to control our behavior, store and organize experiences, construct new experiences, solve problems, and think (Greenspan & Wieder, 1998).
Individuals with Disabilities Education Act (IDEA)
The need for prevention or minimization of social or emotional problems in young children is an international concern, addressed in the United States the Individuals with Disabilities Education Act (IDEA) Amendments of 1997 (Squires, Bricker & Twombly, 2003). This was accomplished by identifying social and emotional development as one of the five developmental domains for which an infant or toddler may be found eligible for early intervention service from a state’s Part C Early Intervention Program. This meant that early intervention programs have an obligation to identify and serve children who demonstrate developmental delays in social or emotional development. The reauthorization of IDEA in 2004 increased attention to social emotional and other areas of development relative to the impact of child abuse and neglect. The Child Abuse and Treatment Act (CAPTA) requires child protective services agencies to refer all infants and toddlers (birth to three) with substantiated cases of abuse and neglect to early intervention for screening. In response to CAPTA, IDEA 2004 requires early intervention programs to screen all infants and toddlers (birth to 3) who are referred to Birth to 3 Programs by child protective services with a substantiated case of abuse or neglect.
In reviewing data collected by the State of Wisconsin’s Birth to 3 Program, (April 2003), no children were found eligible due to a documented developmental delay solely in the area of social and emotional development. This finding reinforces the need for early intervention providers to have information, education and experience in evaluating social and emotional development as part of a comprehensive approach to determining children eligible for the Wisconsin Birth to 3 Program.
The administrative rules that govern The Birth to 3 Program and early intervention services in Wisconsin, HFS 90, define social and emotional development as a domain to be considered for evaluation, assessment, eligibility determination, and intervention. The rules define social and emotional development as evidenced by "temperament, mood, attachment, self-soothing behaviors, adaptability, activity level, awareness of others and interpersonal development" (HFS 90.08). These broad terms need to be understood if effective evaluation, assessment, and intervention are to take place. Furthermore, it is important to understand social and emotional development when it is the only area of documented delay, and when social and emotional delays are present alongside other developmental delays. When a young child experiences social and emotional delays concurrent with other developmental challenges or diagnosed conditions, the impact of a primary disability may be exacerbated (Vygotsky, 2004). See Cognitive Section for additional information about Vygotsky’s theories of development. However, ‘comprehensive’ definitions of social and emotional competence and disability are not included in either federal or state statutes or regulation (Squires, et al.2002, p.5).
Social and Emotional Competencies
It is clearly understood that social and emotional aspects of development are connected. It is important to understand the relationships and distinct differences between social and emotional competencies. " Social competence can be defined as an array of behaviors that permits one to develop and engage in positive interaction with peers, siblings, parents, and other adults," (Raver & Zigler, 1997). "… Emotional competence can be defined as the ability to effectively regulate emotions to accomplish one’s goals," (Campos, et al., 1994). The following diagram illustrates the interconnected relationship between social and emotional competencies:
Social Competence
An array of behaviors that permits one to develop and engage in positive interactions with peers, siblings, parents, and other adults (Raver & Zigler, 1997)
Emotional Competence
The ability to effectively regulate emotions to accomplish one’s goals (Campos, Mumme, Kermoina, & Campos, 1994)
"The early identification of social and emotional problems in infants, toddlers, and young children is
essential if we are to assist them in building their emotional and social competence and reduce the
likelihood of placement in special education programs, residential treatment, or later incarceration."
(Squires et. al., 2002, p.3).
"The assessment of an infant’s or young child’s core emotional and social capacities provides
families and clinicians with a rich, nuanced profile of how a very young child experiences his or her
physical and human environment, the ways in which the child uses his or her own resources and the
support of caregivers to engage with the world, and the challenges that confront the child"
(Greenspan, 1996).
UNDERSTANDING SOCIAL AND EMOTIONAL DEVELOPMENT
For early intervention providers to gain confidence in their ability to make informed team decisions about a child’s social and emotional functioning, it is helpful to have knowledge of areas of functioning that contribute to a child’s social and emotional development. It is also important for early intervention providers to understand their roles and boundaries in evaluating, diagnosing, and providing intervention for complex social emotional disorders.
The system of infant and early childhood mental health services proposed by Constantine Lillas (2003) encompasses an array of professional services across multiple types of caregivers and programs. Appendix A includes a description of the proposed services and interventions for early intervention providers within Levels I (developmental, relational practices for daily care across all caregivers) and II (developmental, relationship-based early intervention services). When interventions that fall into Level III (developmental, relationship-based mental health services) are required, a licensed mental health professional is needed to address the more complex situations for a child diagnosed with or suspected of having an emotional disorder, serve mental health problems or been exposed to abuse, neglect or violence.
This section includes information about various frameworks for describing critical areas of social emotional functioning to help early intervention practitioners better understand the work of Level III practitioners and develop their roles as Level I and II partners with licensed mental health professionals. Important partnership roles for early interventionists may include: screening, observing, assessing, identifying, listening, reporting, referring, coaching, consulting, supporting, and interacting with children and families within relationship-based early intervention services.
Attachment
Accepting that early relationships the basis for a child’s development, D.W. Winnicott tells us "There is no such thing as a baby; there is a baby and someone else". To begin understanding a child’s social and emotional functioning, it is important to understand the child’s behavior in relation to the significant caregivers in her life. Early attachments shape the development of a child’s "internal working model" of their world and have a long-term influence on early relationships. Attachment is a special enduring form of an emotional relationship with another, and if secure creates trust that allows a baby to explore, learn and reach out to a bigger world. When these attachments are disrupted, a baby often experiences a great sense of loss. (Noddings- Eichinger, 2005).
Types of Attachments
"….the balance between attachment and exploration in the child is mirrored by the balance between protectiveness and encouragement of exploration in the parent. When things go well enough, the parent serves as a secure base from which the child sets forth to explore and to which he can trustingly return for solace before moving off yet again." (Alicia Liebermann, Zero to Three)
Assessing Parent-Child Interactions: The Parent-Child Early Relational Assessment (PCERA) (1985), developed by Roseanne Clark, Ph.D., UW-Madison, Department of Psychiatry, is one way to learn more about the quality of parent-child interactions (Clark, Tluczek, & Gallagaher, 2005).
The assessment process includes parent interviews and observations of parent and child interactions in four different situations- feeding/snack, free play, structured task, and parent-child separation and reunion. The results are used to develop a profile based on the ratings and provide feedback for discussion with the parent/caregiver. The information gathered from the PCERA would help early intervention professionals develop an affective vocabulary to describe parent-child interactions and a child’s performance, and to formulate ideas to focus intervention. Professionals often describe specific motor or communication actions, but don’t typically include comments about a child’s enjoyment or motivation to perform a task such as playing with dolls or building a bridge. One caution, specific training in the tool is required to use it for an initial diagnostic evaluation to formulate relationship issues and to assess outcomes in treatment efficacy studies.
Functional Emotions
Stanley Greenspan M.D. has developed The Functional Emotional Assessment Scale (1994, 1996) through his work with young children and their families as a way to help practitioners systematically organize and interpret observations of the child with his or her parents as well as the clinician. The Functional Emotional Assessment Scale (Greenspan, DeGangi, & Wieder, 2001) addresses six areas:
Phases of Emotional Development
Greenspan further defines phases of development as described in his book, Infancy and Early Childhood (1992):
Greenspan and Wieder (2001) have clarified the understanding of social and emotional "functioning" in children. They define what is necessary for the child to interact with his environment and others successfully:
Emotional Response/Temperament
Stella Chess and Alexander Thomas (1996) have defined nine elements that are widely regarded as markers of a child’s emotional response or temperament. Each dimension defines the child’s personality and personal traits. The understanding of individual temperament can lend predictability and insight into the child’s social and emotional development and the "goodness of fit" between the child and parent’s interaction styles. It is helpful to recognize the influence of a child’s temperament on the reciprocal interactions between the child and the environmental expectations or demands of the parents/caregivers. When demands and expectations of the parent match with the child’s capacities, style of behaving, and motivations "goodness of fit" is achieved. The elements of temperament are as follows.
Temperamental Attributes:
A ‘core set’ of five temperamental attributes that are characteristic of typical development has emerged from research in this area and includes:
Self-Regulation:
Self-regulation pertains to a child’s ability to organize and react adaptively to sensory or sensorymotor stimuli in daily interactions and relationships. Researchers have found that a young child’s failure to develop "executive brain functions" to inhibit or delay behavioral actions is strongly related to difficulties in self-regulation. Impairments in this neurodevelopmentally rooted processes are often associated with various problems in thinking and behavioral organization and result in challenging behaviors. (Neisworth, Bagnato, Salvia, & Hunt, 1999). These behaviors are often the ones that draw attention to a child’s problems in developing appropriate social skills and result in referrals to early intervention and other services.
Other Social and Emotional Development Resources
Wisconsin Think Big Start Small: Relationships Matter: This brochure, developed in collaboration with the Wisconsin Infant Mental Health Initiative, identifies a number of social and emotional development markers in young children. Visit: http://www.thinkbigstartsmall.com/docs/Relationships_Matter.pdf
Wisconsin Model Early Learning Standards: The standards are a listing of developmental expectations for children upon kindergarten completion supported by practice-based evidence and scientific research. Visit: http://www.collaboratingpartners.com/EarlyLS.htm
Healthy Minds: Nurturing Your Child’s Development: This free product of ZERO TO THREE and The American Academy of Pediatrics is based on findings from a report from the National Academy of Sciences that examined the research on early childhood and brain development. Visit: http://www.zerotothree.org/healthyminds/
UNDERSTANDING DEVELOPMENTAL DISORDERS
Recent work in the field of children’s mental health has yielded an increase in classification systems and strategies designed for diagnosing and treating difficulties in social and emotional development. One such tool is the Diagnostic Classification: Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3). The diagnostic framework presented in Diagnostic Classification: 0-3 seeks to address the need for a systematic, developmentally based approach to the classification of mental health and developmental difficulties in the first four years of life. The Diagnostic Classification: 0-3 categorizes emotional and behavioral patterns that represent significant deviations from normative development in the earliest years of life. Some of the categories presented represent new formulations of mental health and developmental difficulties. Other categories describe the earliest manifestations of mental health problems, which have been identified among older children and adults but have not been fully described in infants and young children. In infancy and early childhood, these problems may have different characteristics, and prognosis may be more optimistic if effective early intervention can occur (Zeenah, 2000).This approach to classification complements The Diagnostic and Statistical Manual –IV (DSM-IV) and offers alternative to avoid prematurely or inappropriately labeling a child with a psychiatric disorder. Additionally, the DC: 0-3 includes descriptive information that is developmentally appropriate for infants and toddlers and helpful both for classification and intervention. See Appendix B for additional information about some of the most common early childhood disorders described in both the DSM-IV and the DC: 0-3.
SCREENING FOR DEVELOPMENTAL CONCERNS
Whether families themselves raise concerns, or they are identified through exploration and observation, any child for whom you have concerns about their social and emotional development should be screened and receive further evaluation if needed.
Recommendations for Screening:
There are a growing number of instruments that have been developed for the purpose to screen for social and emotional concerns. These three instruments are readily available and widely used:
Any child who demonstrates the need for further evaluation in the area of Social and Emotional Development should receive a thorough and comprehensive look across all areas of development. See Appendix B for additional information about these screening tools.
EVALUATION OF SOCIAL AND EMOTIONAL DEVELOPMENT
Once a child has been identified to be in need of further evaluation in the areas of social and emotional development, it is important for practitioners to have access to the tools and strategies that can accurately and reliably identify children eligible for early intervention. Because of the mounting evidence for attending to early social and emotional development, along with requirements to evaluate in programs such as early intervention and Early/Head Start, new and better tools, instruments and strategies are becoming available on the market. However, at the present time, there are few instruments that would stand alone in indicating that a child has social and/or emotional development delays that would lead an early intervention team to determining eligibility. As indicated by HFS90 and other best practices guidelines, a comprehensive approach is needed. Ultimately, this approach should be based on the informed judgments of early intervention team members. See Overview Section for additional information on "informed clinical opinion".
Components of Evaluation Consistent with best practices promoted by the Zero to Three organization and other infant mental health initiatives, the following areas have been identified as critical components in the evaluation of social and emotional development:
"Classification schemes in infancy are in the process of rapid evolution, reflecting changing perspectives from clinical experience, advancing knowledge, and new directions in research," (Zeenah, 2002, p. 225)
These processes and strategies should be invaluable to a team in making an informed clinical opinion about whether a child would quality for Wisconsin’s Birth to 3 Program with a delay in social and/or emotional development. The information may also help a team determine if a child demonstrates atypical behaviors that would warrant consideration for eligibility beyond the numerical data available from testing instruments.
Instruments for Evaluating Social and Emotional Development
The following section provides an overview of a few instruments. A single domain instrument, the Temperament and Atypical Behavior Scale (TABS) is included as an example of a tool that is normreferenced, and therefore, appropriate for using as one data source for determining eligibility. The Functional Emotional Assessment Scale (Greenspan, DeGangi, & Wieder, 2001), described above on page 5 could also be used to help determine eligibility for Wisconsin’s Birth to 3 Program. The Hawaii Early Learning Profile (1992) is included as an example of a multi-domain curriculumbased, criterion-referenced instrument that has a comprehensive social and emotional development component. With growing developments in the field of infant and early childhood mental health, it will be important to watch for the availability of new and better instruments. For example The Bayley Scales of Infant Development, Third Edition (2005), a norm-referenced instrument now includes a social and emotional domain developed by Stanley I. Greenspan. See Appendix C for a list of other instruments for measuring social emotional development.
Temperament and Atypical Behavior Scale (TABS)
The Temperament and Atypical Behavior Scale (TABS) was developed to provide a reliable and valid, norm-referenced, individually administered measure of dysfunctional behavior appropriately used with infants and young children between the ages of 11 and 71 months.
As a norm-referenced scale, TABS is intended to identify children who are either developing atypically or are at risk for atypical development. In addition, when used for clinical purposed, TABS data can indicate specific areas of concern and can be the basis for planning early intervention programs for children and support programs for parents.
Content Summary: On the TABS Assessment Tool, atypical self-regulatory behavior is assessed by 55 items in areas such as temperament, attention, attachment, social behavior, play, vocal and oral behavior, senses and movement, self-stimulation and self-injury, and neurobehavioral state. Four psychometric factors underlie the 55 items and are arranged into four subtests on the Assessment Tool. These four factors define a construct of atypical temperament and self-regulation.
Factor 1: Detached
For infants and young children, a detached style of temperament and self-regulation is exemplified by behavior that is withdrawn, aloof, self-absorbed, difficult to engage, and disconnected from everyday routines involving adults or other children. This behavior can be manifested in a variety of activities and contexts. Infants and young children with a detached style may look through or past people, turn out, lose contact with what is going on, often just start into space, or act like others are not there. Behavior assessed by Subtest 1 is commonly associated with autism spectrum disorder (ASD).
Factor 2: Hyper-sensitive/active For infants and young children, a hyper-sensitive/active style of temperament and selfregulation is exemplified by behavior that is overreactive to even slight environmental stimulation, impulsive, highly active, negative, and defiant. This behavior can be manifested in a variety of activities and contexts. Infants and young children with a hyper-sensitive/active style may be difficult to soothe when upset and crying, frequently irritable, touchy, or fussy, mostly on the go, too grabby, impulsive, or destructive. Behavior assessed by Subtest 2 is commonly associated with attention-deficit/hyperactivity disorder (ADHD).
Factor 3: Underreactive
For infants and young children, an underreactive style of behavior is truly unresponsive and requires intense environmental stimulation to elicit a response. An underreactive style is associated with limited awareness, low alertness, passivity, and lethargy – it differs from a detached style that actively avoids engagement. Infants and young children with an underreactive style may show no surprise to new events, not be upset when a favorite toy is taken away, not react to new sounds, or rarely smile, giggle, or laugh at funny things. Behavior assessed by Subtest 3 is commonly associated with a variety of severe neurodevelopmental problems (i.e., problems presumed to have primarily a neural basis, such as problems related to brain injury and more subtle neurological impairment).
Factor 4: Dysregulated
For infants and young children, a dysregulated style of temperament and self-regulation is exemplified by difficulty controlling or modulating neurophysiological behavior (e.g., sleeping, crying, self-comforting) and oral-motor control (e.g., jitteriness and hypersensitivity to physical contact). Infants and young children with problems in regulation may cry too long, need help falling asleep too often, scream in their sleep, or be inconsolable.
The Hawaii Early Learning Profile (HELP) (1992) authored by Stephanie Parks and published by VORT Corporation is a widely regarded curriculum-based, criterion-referenced developmental assessment (http://www.vort.com/products/help_overview.html). The HELP identifies the following milestones in the social and emotional development of young children:
Attachment/Separation/Autonomy
| Age (months) | Milestone |
|---|---|
| 0-3.1 | Enjoys and needs a great deal of physical contact and tactile stimulation |
| 0-2 | Establishes eye contact |
| 0-3 | Draws attention to self when in distress |
| 3-6 | Awakens or quiets to parent’s voice |
| 3-5 | Socializes with strangers/anyone |
| 3-5.1 | Discriminates strangers |
| 4-8 | Recognizes parents visually |
| 5-9 | Lifts arms to parents |
| 5-7 | Explores adult features |
| 5-8 | Displays stranger anxiety |
| 6-10 | Shows anxiety over separation from parent |
| 8-12 | Lets only parents meet his needs |
| 9-12 | Explores environment enthusiastically |
| 12-13 | Likes to be in constant sight and hearing of any adult |
| 12-14 | Attempts self-direction: resists adult control |
| 24-30 | Displays dependent behavior; clings/whines |
| 24-36 | Feels strongly possessive of loved ones |
| 30-36 | Separates easily in familiar surroundings |
| 30-36 | Shows independence |
| 30+ | Insists on doing things independently |
Development of Self
| Age (months) | Milestone |
|---|---|
| 2-3 | Inspects own hands |
| 3-5 | Plays with own hands, feet, fingers, toes |
| 3-5.5 | Makes approach movements to mirror |
| 5-7 | Looks and vocalizes to own name |
| 5.5-8.5 | Smiles at mirror image |
| 6-9 | Distinguishes self as separate from parent |
| 6-9 | Responds playfully to mirror |
| 7-12 | Shows like/dislike for certain people, objects, places |
| 12-15 | Displays independent behavior; is difficult to discipline – the "no" stage |
| 12-18 | Shows toy preferences |
| 12-18 | Enjoys being center of attention |
| 12-18 | Recognizes several people in addition to immediate family |
| 15-16.1 | Identifies self in mirror |
| 18-24 | Uses own name to refer to self |
| 18-24.1 | Experiences a strong sense of self-importance |
| 19-24 | Recognizes self in photograph |
| 24-30 | Uses "self-centered" pronouns |
| 24-30 | Takes pride in clothing |
| 24-30 | Becomes aware of sex differences |
| 24-36.1 | Distinguishes self as separate person; contrasts self with others |
| 26-33 | Knows own sex or sex of others |
| 30-36 | Takes pride in achievement; resists help |
Expression of Emotions and Feelings
| Age (months) | Milestone |
|---|---|
| 0-1 | Cries when hungry or uncomfortable |
| 0-1.5 | Smiles reflexively |
| 1.5-4 | Responds with smile when socially approached |
| 1.5-4 | Laughs |
| 2.5-5.5 | Squeals |
| 3-6 | Vocalizes attitudes – pleasure and displeasure |
| 6-7 | Responds to facial expressions |
| 6-18 | May show fear and insecurity with previously accepted situations |
| 12-18 | Displays frequent tantrum behaviors |
| 14-15.5 | Hugs and kisses parents |
| 18-24 | Expresses affection |
| 18-24 | Shows jealousy at attention given to others, especially other family members |
| 18-24 | Feels easily frustrated |
| 22-24 | Attempts to comfort others in distress |
| 24-30 | Frustration tantrums peak |
| 24-30 | Dramatizes using a doll |
| 24-30 | Fatigues easily |
| 24-30 | May develop sudden fears, especially of large animals |
| 30-36 | Demonstrates extreme emotional shifts and paradoxical responses |
Learning Rules and Expectations
| Age (months) | Milestone |
|---|---|
| 1.5-4 | Shows anticipatory excitement |
| 3-6 | Becomes aware of strange situations |
| 5-6.5 | Distinguishes between friendly and angry voices |
| 9-12 | Tests parental reactions during feeding |
| 9-12 | Tests parental reactions at bedtime |
| 9-12 | Knows what "no no" means and reacts |
| 12-16 | Acts impulsively, unable to recognize rules |
| 12-15 | Hands toy back to adult |
| 12-18 | Needs and expects rituals and routines |
| 12-18 | Begins to show a sense of humor |
| 12-15 | Displays distractible behavior |
| 12-18 | Tends to be quite messy |
| 18-24 | Desires control of others-orders, fights, resists |
| 21-24 | Remembers where objects belong |
| 24-27 | Demonstrates awareness of class routines |
| 24-30.1 | Holds parent’s hand outdoors |
| 24-30.1 | Says no but submits anyway |
| 24-30 | Dawdles and procrastinates |
| 30+ | Begins to obey and respect simple rules |
| 30-36.1 | Resists change; is extremely ritualistic |
| 30-36 | Experiences difficulty with transitions |
Social Interactions and Play
| Age (months) | Milestones |
|---|---|
| 0-1 | Regards face |
| 0-2 | Establishes eye contact |
| 0-3 | Molds and relaxes body when held; cuddles |
| 1.5-4.1 | Responds with smile when socially approached |
| 3-5 | Vocalizes in response to adult talk and smile |
| 3.5-4.5 | Laughs when head is covered with a cloth |
| 3-8 | Demands social attention |
| 3-6 | Enjoys social play |
| 5-6 | Hand regard no longer present |
| 4-8 | Repeats enjoyable activities |
| 6-10 | Plays "Peek-a-boo" |
| 6-10.1 | Cooperates in games |
| 9-12 | Extends toy to show others, not for release |
| 11-12.5 | Repeats sounds or gestures if laughed at |
| 12-15 | Plays ball cooperatively |
| 18-24 | Interacts with peers using gestures |
| 18-24 | Engages in parallel play |
| 23-34 | Defends possessions |
| 24-30 | Displays shyness with stranger and in outside situations |
| 24-30 | Tends to be physically aggressive |
| 24-36 | Enjoys a wide range of relationships; meets more people |
| 24-36 | Relates best to one familiar adult at a time |
| 24-36 | Engages best in peer interaction with just one older child, not a sibling |
| 24-36 | Initiates own play, but requires supervision to carry out ideas |
| 30-36 | Tends to be dictatorial and demanding |
| 30-36 | Talks in a loud, urgent voice |
| 30+ | Participates in circle games; plays interactively |
MAKING A DIFFERENCE…ONE CHILD AT A TIME
Vignette #1
A child has been referred to your program by her parent. The mother reports great difficulty in managing her child’s behavior. The child has been asked to leave 2-day care centers due to destructive and aggressive behavior. The mother reports difficulty in getting her child to "listen to her." She says her child won’t "do what she is told." The developmental screening tool that you administered does not identify concern. Your observation of the child in her home environment revealed a compliant and engaging child with appropriate play and learning skills.
What would you do?
Vignette #2
A 5-month-old child has been referred to your program by his pediatrician due to concerns for extreme irritability. The mother reports the child to be difficult to soothe when upset. And, although there really isn’t any difficulty with feeding, the mother reports that the child never "feels satisfied" after a feeding. The mother has attempted to get her child on a schedule but reports that her baby isn’t cooperating.
Which factors will be important to explore in working with this family? Should this child be evaluated to determine eligibility? Who should be on the evaluation team? What information will need to be gathered?
What resources or supports would be helpful to consider when working with this family?
Vignette #3
A family doctor has been treating a mother for depression, (with limited success), following the birth of her third child. The children are ages 3, 1-1/2, and 2 months. The physician has referred the family to your Birth to 3 Program due to concerns for the effects of depression on the children.
What would you do?
OTHER THOUGHTS
As a state, we need to better serve children and families with concerns for social and emotional development. There is a ground swell being created through the Wisconsin Infant Mental Health Initiative. Many people, from many diverse professions throughout the state, have been meeting to create a system capable of responding to the social and emotional needs of young children and families. Conversations have led to discussions, which have led to a Statewide Summit addressing the mental health needs of young children. A plan is beginning to take shape. People in Wisconsin are thinking about promoting young children’s mental health and intervening when concerns are identified.
Things to Do
Things Can Only Get Better
Hopefully this document will inspire you to sharpen your skills and expand your resources to include services that will enhance the social and emotional well being of children in Wisconsin. Developed for the Wisconsin Birth to 3 Program Eligibility Work Group (2001-2003) by Diane Fett, M.Ed., Fond du Lac County, Birth to 3 Program, Director, Fond du Lac County Department of Community Programs. Edited by Linda Tuchman, Ph.D. Waisman Center, University of Wisconsin-Madison with guidance and input from Carol Noddings Eichinger, MS, LPC, LLP ., University of Wisconsin-Milwaukee and consultant.
A System of Infant Mental Health Services for Infants and Young Children and Their Families: WORKING DRAFT – 4/03
Interdisciplinary Training Institute
Revised and adapted from Florida’s Strategic Plan: The Florida State University Center for Prevention and Early
Intervention Policy
SENSORY - MOTOR - AFFECT - MEMORY - SPEECH & LANGUAGE - COGNITION
The Array of Infant Mental Health Services
| _ | Level One: Developmental, Relational Principles for Daily Care Across All Caregivers | Level Two: Developmental, Relationship-Based Early Intervention Services | Level Three: Developmental, Relationship-Based Mental Health Services | Priority Population | Expectant families and families of all children birth to age five; may include level 2 & 3 children and families in service delivery | Families of children with delays, disabilities, health problems or multiple risk factors | Families with children or primary caregivers diagnosed with emotional disorders, severe mental health problems, or have experienced abuse, neglect, or violence |
|---|---|---|---|
| Description of Services/Interventions |
Strengthening the caregiver/child bond by:
|
Strengthening the caregiver/child dyad through:
|
Strengthening the caregiver/child dyad through:
|
| Range of Responsibilities for Infant Mental Health Services |
Front Line caregivers including:
|
Developmental Professionals such as:
|
All licensed mental health therapists, psychiatrists
and psychologists, with additional training in
interdisciplinary mental health for infants and their
families including:
|
The following information is adapted with permission from a lecture given by Carol Noddings- Eichinger, MS, LPC, LLP, at the Summer 2005 Wisconsin Videoconference: Social and Emotional Development in Children Birth to Age 6: Nurturing Relationships and Recognizing Concerns and Boundaries.
To help early intervention providers understand some of the most frequently considered social and emotional disorders, Carol has provided a cross referenced list of disorders from the two major classification systems - The Diagnostic and Statistical Manual – IV (DSM-IV) and the Diagnostic Classification: Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3). Pervasive Developmental Disorders are the only diagnostic classifications included in Chart 1 of the Wisconsin Birth to 3 Program list of diagnosed conditions with 50% or higher probability of resulting in a developmental delay. The other classifications would be considered under Chart 2, and would require documentation of development delays or atypical development. See Overview Section for Diagnosed Conditions information.
PERVASIVE DEVELOPMENTAL DISORDERS
Pervasive Developmental Disorders (DSM-IV)
Multisystem Developmental Disorder (DC: 0-3)
REGULATORY DISORDERS
Regulation Disorders (DC: 0-3)
A distinct behavioral pattern coupled with a sensory, sensory-motor, or organizational processing
difficulty which affects the child’s daily adaptations and interaction and relationships
ATTENTION DISORDERS
Attention Deficit/Hyperactivity Disorder (DSM-IV)
OPPOSITIONAL DEFIANT DISORDER (DSM-IV)
Negativistic, hostile and defiant behavior lasting at least six months:
Four or more of the following are present---
REACTIVE ATTACHMENT DISORDERS
Reactive Attachment/Maltreatment Disorder of Infancy (DC: 0-3)
Reactive Attachment Disorder (DSM-IV)
Markedly disturbed and developmentally inappropriate social relatedness inmost contexts, beginning before age five:
POST TRAUMATIC STRESS DISORDER
Traumatic Stress Disorder (DC: 0-3)
Post Traumatic Stress Disorder (DSM-IV)
Anxiety Disorders (DC: 0-3)
Separation Anxiety Disorder (DSM-IV)
Generalized Anxiety Disorder (DSM-IV)
Mood Disorder (DC: 0-3)
Bereavement/Grief
Depression (DSM-IV)
Social Emotional--Screening
| Instrument | Author(s) | Age Group | Method(s) | Type | Publisher | Temperament and Atypical Behavior Scale Screener (1999) | Bagnato, S., Neisworth, J., Salvia, J., and Hunt, F. | 11 through 71 months | Report or Observation | Normed | Paul H Brookes, www.pbrookes.com |
|---|---|---|---|---|---|
| Infant/Toddler Symptom Checklist (1995) | De Gangi, G., Poisson, S., Sickel, R., and Santman Weiner, A. | 7 to 30 months | Checklist | Criterion | Harcourt Assessment, Inc., www.harcourtassessment.com/ |
| Ages and Stages Questionnaire- Social Emotional (2002) | Squires, J., Bricker, D., and Twombly, E. | 6-60 months | Parent completion; rating scale | Normed | Paul H Brookes www.pbrookes.com/ |
| Brief Infant Toddler Social Emotional Assessment (BITSEA) (2000, Spring 2006) | Alice Carter and Margaret Briggs- Gowan | 12-36 months | Parent and Child Care Provider Rating Form | Normed, Spanish & English | Harcort Assessment, Inc. www.harcourtassessment.com/ |
Social Emotional--Evaluation
| Instrument | Author(s) | Age Group | Method(s) | Type | Publisher |
|---|---|---|---|---|---|
| Temperament and Atypical Behavior Scale (1999) | Bagnato, S., Neisworth, J., Salvia, J., and Hunt, F. | 11 through 71 months | Report or Observation | Normed | Paul H Brookes, www.pbrookes.com/ |
| Functional Emotional Assessment Scale (2001) | Greenspan, S., De Gangi, G., Wieder, S. | 7-48 months | Observation | Normed | ICDL, www.icdl.com |
| Child Behavior Checklist (2002) | Achenbach, T.M. | 18-60 months | Checklist; rating scale. Psychologist administered | Normed |
ASEBA Room 6436 1 S. Prospect St Burlington VT 05401 |
| Vineland SEEC: Vineland Social- Emotional Early Childhood Scales (1998) | Sparrow, S., Balla, D., & Chicchetti,D. | Birth – 5-11 | Interview Ph.D. in psychology/ certified or licensed school psych./ social worker | Normed | AGS Publishing, http://www.agsnet.com/ |
| Bayley Scales of Infant and Toddler Development, Third Edition (2005) | Bayley, N. (social emotional by Greenspan, S.I.) | 1-42 months | EI, EC, assessment, and cross disciplinary specialists; school psychologist | Normed (includes new social emot. dev. Domain) | Harcourt Assessment, www.harcourtassessment.com/ |
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