DOCUMENT RESUME

ED 305 788 EC 212 588

AUTHOR Wetherby, Catherine, Ed. TITLE Early Intervention for Children Birth Througn 2 Years. INSTITUTION Interstate Research Associates, Inc., Washington, D.C.; National Information Center for Handicapped Children and Youth, Washington, DC. SPONS AGENCY Special Education Programs (ED/OSERS), Washington, DC. PUB DATE 88 GRANT G0087C3051 NOTE 14p. PUB TYPE Collected Works - Serials (022) Guides - Non- Classroom Use (055) JOURNAL CIT NICHCY News Digest; n10 1988

EDRS PRICE MFO1 /PCO1 Plus Postage. DESCRIPTORS *Child Development; *Child Rearing; Developmental Stages; *Disabilities; Identification; *Infants; Intervention; *Parent Participation; Parent Role; Preschool Education; Stimulation; *Toddlers IDENTIFIERS *Early Intervention

ABSTRACT Information is provided for parents of handicapped children, aged 0-2 years, on the uniqueness of each infant's learning processes and the valuable role that parents and others can play in helping their infants with special needs to make the most of their abilities. The digest examines parents' concerns during the infant's hospital stay and early days at home, emphasizing the stresses on not only the parents but other family members. It notes the availability of early intervention programs, and describes methods of identifying infants who need early intervention services. Principles of infant development are discussed, along with the sequence of development of motor skills, language or communication, cognition, and socialization. Throughout, the digest stresses the uniqueness of each child's skills and personality and the parents' roles in stimulating their infant's development. The digest concludes with a bibliography and list of organizations that can provide information and assistance. (JDD)

*********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. **********************************************************************ft U.S. DEPARTMENT Of EDUCATION Office of Educe!. Onal Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) VAdocument has been reproduced as received from the person or draansZahOn Onginahng Minor changes have been made to improve CX) reproduction Quality

rft Points of view or opinions stated in this doctr Ll1 ment do not necessarily represent official O OERI position or policy reN O LU

Early Intervention for Children Birth

Through 2 Years

News Digest, Number 10, 1988 National Information Center for Childre and Youth with Handicaps

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NUMBER 10 1988 National Information Center for Children and Youth with Handicaps

EARLY INTERVENTION FOR CHILDREN BIRTHTHROUGH 2 YEARS

The National Information Center for and support groups that can help. This infants with special needs. Most of all, Children and Youth with Handicaps issue of News Digest is written to provide this issue of News Digest is intended to (NICHCY) regularly receives re- parents with information on (1) how help parents deal confidently with the quests from parents and others for in- each infant learns in his or her unique challenges of helping their child make formation on raising infants with spe- way, and (2) the valuable role that par- the most of his or her abilities. cial needs and on programs, resources, ents and others can play in helping their

ry about their newborn, most parents of In the Hospital vulnerable infants find it more difficult Many infants are born with handi- to put aside their fears. The stress and caps that may appear serious but do not emotions of the first days and weeks of the baby's life will take time to fade, nfants are active learners necessarily pose an immediate threat to their health. Parents of these infants of- and anxiety about the future is very from birth. Having a handicap or seri- ten experience a range of emotions dur- real. ous illness doesn't change this fact; how- ing the hospital stay that may or may not When parents bring their baby ever, these infants may need extra help be offset by a caring and understanding home, they often find that they haveex- in developing the skills needed to learn hospital staff and by the support and changed one anxiety-provoking situation and grow. This help may come from for another. In some cases, they are structured early intervention programs ercouragement from family and friends. The sense of lightheartedness bringing home an infant who has been as well as from normal, everyday inter- cared for by a large staff of well- actions with parents and other family that often accompanies the birth ofa child can be displaced by the thoughts trained professionals in a carefully con- members. Parents need to become and concerns about the unexpected and trolled and highly specialized environ- aware of the importance of their role in ment. If the infant had been connected facilitating, guiding, and supporting unknown, turning this into a time of stress and uncertainty for parents. to intravenous (IV) tubes and monitor- their baby's development. With time When a baby is born with complex ing equipment from the first days of and understanding, parents can become life, he may be leaving the hospital still their baby's best ally in interpreting medical problems or is at risk for de- veloping serious handicaps through requiring special equipment, complicat- needs. Also, with time and understand- prematurity, illness, disease, malfor- ed feeding procedures, and frequent, ing, they will be able to develop the mations, arrested development, or otherprecisely administered medications. coping skills they'll need to face the complications, the hospital experience Suddenly the parents alone are respon- day-to-day realities of the handicap or can be particularly unsettling for par- sible for that same care at home. And illness. ents. The fast - paced, high-tech atmos- although they may have received thor- The majority of new parents start out phere of the neonatal intensive ough, but accelerated, eon-the-job" with little preparation or special train- care unit (NICU) can be frightening and training from the NICU staff at the hos- ing in meeting the unique, ongoing chal- may contribute to the stress and confusion pital, parents still may not feel confi- lenges and demands of a newborn. parents already feel with the child's dent in providing that same care at home Even experienced parents must readjust birth. Often, parents are faced with to their new, and often fragile, baby. their lives whenever another child is making life-or-death decisions about Even in the safety of their home, parents added to the family. Yet, parents of in- may be afraid to leave their baby un- fants who have handicaps or serious ill- situations unfamiliar to them at a time when they are most vulnerable. In addi-watched even for a moment, andmay be ness, or who are at risk of developing tion, they may be exhausted from travel-easily upset by any unusual noises or handicaps as the result of prematurity ing back and forth to the hospital sever- movements their baby makes. Exhaus- or other birth complications, must deal al times daily and disappointed at not tion from sleepless nights, responsibili- not only with the normal challenges of being able ,D take their baby home. ty for continuous monitoring of the parenthood, but with additionalstresses baby's vital signs, and intricate, round- and concerns for which they are typical- At Home the-clock feeding and medication sched- ly not prepared. Regardless of the seri- ules can cause even the most conscien- ousness of the handicap or illness, each Even when it has been determined tious and self-assured parent to become change in their baby's condition that an infant is well enough to leave thestressed and distracted. These circum- presents a new set of questions, con- hospital, parents' fears do not immedi- stances may cause parents to remain cerns, and challenges that parents must ately dissipate, in fact, they are i'cry of- anxious long after the baby looks -- and confront. ten intensified. While all parents wor- is -- less fragile.

3 current technology have made it possi- ble for an increasing number of low ...the emotional and physical demands that birthweight and other at-risk babies to survive. accompany the birth of achild with special Another reason for expansion in this area is that since the 1960's there has needs should never be underestimated. been an increased awareness of the val- ue of early :ntervention for young chil- dren in general and particularly for in- fants and toddlers who have handicaps Other Concerns do the best job they can. They especially or who are at risk for developing handi- need to know that other parents of chil- caps. Research suggests that early inter- In addition, the birth of an infant dren with special needs have had simi- with an illness, handicap, or condition vention with infants, in which problems lar problems and feelings and that are identified and treated as early as that can lead to later delays can put un- help and support are available. due stress on family finances and fami- possible, can make a significant differ- Professionals, family members, and ence later in their physical, cognitive, ly life. Most new parents have not had friends also must recognize that parents time to cope with the stresses and emo- and social abilities, and can minimize do not always find involvement with the effects of present or potential handi- tions of the early days of their baby's their infant's development and progress life or accept the fact of the handicap or caps (Weiner & Koppelman, 1987). to be a satisfying or rewarding experi- The impact of studies and 7esearch illness, before they must also cope with ence. Some parents may always have present realities. on the -ffectiveness of providing special difficulty coping with a child with education to very young children has re- Parents may have to negotiate with handicaps. insurance companies over hospital bills; sulted in a federal law, passed in 1986. There are many ways that parents known as Public Law 99-457. This law arrange for and coordinate home care, can obtain help and emotional support. nursing services, and special equipment; They can join therapy or parent support requires that early interventiop and spe- and schedule follow-up visits with med- groups made up of parents of children cial education services be provided t3 ical professionals. Conspquently, the with handicaps. In these groups, partici- children (ages birth through 5 years) needs of other children in the house- pants can offer support and encourage- who have handicaps or who are at risk hold, although important, may be inad- ment to each other and exchange infor- for developing handicaps. Under the vertently overlooked or neglected in the mation about helpful resources. provisions of the law, these services he..tic pace of caring for the new baby. Parents can also seek help through indi- must be provided no later than senool Parents may be unable to set aside the vidual and group counseling sessions of year 1990-91. (For more information on necessary time to talk with their other fered by counselors, social workers, children about their new sibling's Public Law 99-457 and accessing ser- psychiatrists, and psychologists in pri- vices for your infant with specia; needs, problems and needs. vate practice or in public agencies. Oth- Parents' own needs may be neglect- write to NICHCY and ask for a free er parents of children with handicaps, copy of "A Parents' Guide to Aczessing ed, as well. Finding adequate childcare as well as family members and close and getting social and moral support Programs for Infants, Toddlers, and friends, can offer much-needed under- Preschoolers with Handicaps.") from others may be particularly diffi- standing and support. In addition, the cult. Friends, neighbors, and family physicians and nurses at the hospital or members -- especially grandparents -- clinic, as well as the family's pastor, Early Intervention may want to help, but may feel afraid, priest, or rabbi, may be good sources of Programs and Parent confused, or overwhelmed themselves. advice and help in obtaining resources. They may not know how they can help However, it is important to remember Involvement and may feel inadequate in offering any that the emotional and physical de- Public Law 99-457 should increase help at all, for fear of harming the mands that accompany the birth of a parents' access to early intervention pro- baby, especially one that is fragile. As child with special needs should never a result, parents may miss out on sorely be underestimated. Life as these par- grams. Such programs can make a dif- needed respite and privacy at a time ents have known it has changed! ference for infants born prematurely, or when they need it most. Single parents with handicaps or illness -- and their may feel these stresses even more in- families. Through these programs, par- tensely and may need help in finding The Future ents can understand more about their and developing support systems within Once parents have had time to con- baby's abilities, make decisions about the family and the community. sider the future, they may find some of the goals they have for their baby, ar .1 All of these concerns and pressures the recent research about infants as discover ways to stimulate their baby's can cause many parents of infants with learners reassuring. In the last 5 to 10 growth and development. In many cases, handicaps or serious illness to feel iso- years, the areas of infant development, parents can get support in adjusting to lated and singularly responsible for infant education, early intervention, and and meeting the needs of an infant with raising and caring for their infant. As infant mental health have become ever- handicaps or delays. But probably the parents struggle to come to terms with expanding fields of study ai1d research. most important function of such pro- the problems they face, they need infor-One reason for this increased attention grams is to help parents develop a close mation, support, and encouragement to to infants is that medical science and and satisfying relationship with their

- 2 - child. When parents find ways to enjoy their baby and are able to give the needed support, they very likely will Parents need to be regarded.. .as prime increase the prospect that their child will have a happier and more produc- contributors in decisions made about their tive life within the family and the community. child's program andprogress. Traditionally, the approach to deliv- ering services to very young children has focused on identifying strengths and Babies with serious handicaps can m: Ke weaknesses, then remediating deficits How Infants are remarkable progress when they are and "teaching" the child the needed Identified as Needing provided appropriate opportunities to skills. In recent years, however, the lo- learn within a caring and nurturing cus in many early intervention programs Early Intervention environment. offers a more positive approach for When parents first suspect that children, their families, and the profes- Services there may be a problem, it is important sionals who work with them. This ap- Some babies are identified at birth to have a physician check for physical proach, often referred to as prevention- as having genetic/congenital conditions problems. The infant may have a intervention, recognizes that not all such as Down syndrome or spina bifida health, vision, or hearing problem that is problems or deficits can be "fixed" that cause, or are likely to cause, delays interfering with appropriate develop- through many of the medical or educa- in development. Other babies are iden- ment. When physical concerns have ei- tional therapies available, and that par- tified as being at risk for developing ther been ruled out or identified and ents and professionals cannot change handicaps as the result of prematurity addressed, the infant's developmental the long-term problems that occur at or other birth complications. In both level can be better assessed. birth, such as brain damage or severe cases, infants are generally monitored An important step in determining hearing loss.Parents and professionals by physicians and/or other health care whether an infant needs early interven- can, however, minimize or prevent im- professionals for early signs of devel- tion is the assessment -- the process of pairments from causing secondary han- opmental problems, such as a delay in gathering information about an infant's dicaps, such as emotional problems, or one or more of the areas of develop- development to make decisions about problems with thinking or communicat- ment (cognition, motor skills, communi- the kind of help the infant might need. ing. They can work with the child's cation, or socialization). In some cases, Parents may first want to discuss their strengths and help their child develop parents (or other family members) concerns with their child's pediatrician, alternative or compensatory learning identify their baby as not developing in or with someone at a nearby children's strategies. (Campbell, 1986). expected ways. Alerting someone who hospital or the pediatric department of While many programs focus on par- can help is an important and necessary their local hospital or health clinic who ents being given advice and educational step for anyone to take if they have con- is a qualified specialist in infant and therapeutic tasks to do at home, oth- cerns about how their baby is develop- development ers are beginning to develop systems ing. In addition, many states have estab- that recognize parents and profession- The period in which parents await lished programs to identify children als as equal partners. In such programs, Lesults from medical (or other) tests ages birth through 2 years who may have professionals serve as consultants to that will provide additional informa- developmental delaysSomeo le: in families, helping them determine the tion on how their baby is developing canyour local school district or in ycur goals and activities they want for their be a stressful one. Balancing the possi- state's Department of Education can child. The changes in the approaches bility of "good" news against the threat give you information about whom to con- taken and attitudes adopted by profes- of "had" news creates uncertainty and tact to arrange for an assessment. Typi- sionals working with parents reflect a anxiety that can last long after parents' cally, the contact person may be located focus on family needs, with an emphasis suspicions are confirmed or denied. within the education dedartment, the on enhancing the child's growth, devel- Even though parents need to have infor- health department, or the local Child opment, and sense of well-being, rather mation about their child's condition, Find office. than a singular fetus on correcting a they may not always be ready or able to In an assessment, a team of profes- problem.Parents need to be regarded "hear" the information. They may need sionals, which includes an infant spe- as full partners in this effort, and val- to have it repeated many times and may cialist, observes and evaluates the infant ued as prime contributors in decisions need to talk about it at length. Profes- to determine his or her eligibility for made about their child's program and sionals' awareness of and sensitivity to early intervention services. If the child progress. parents' vulnerability during this time is is found eligible for services, the family vital to creating a climate in which dis- may be assigned a case manager who co- cussion about the baby's condition is ordinates the set-ices and consults with welcomed and encouraged. the family about their needs and con- Often, babies will appear to be at cerns for their baby. The case manager risk for developing a handicap when, in can also offer families the support and fact, they are only taking a little longer information they need about how their than others to develop certain skills. baby is developing.

P- - 3 - 111111 whether a baby is at risk for develop- mental delays and whether heor she Test results alone shouldnot be considered should be referred for further evalua- tion. (Bailey & Wolery, 1984). Like the the final predictors ofa child's later Bayley, it is a norm-referenced test, in- dicating how a child compares witha functioning. group of ocher children of the same age group. It is used to screen or detect problems in children from birth toap- Bailey and Wolery (1984) propose more commonly used scales. These proximately 6 years in four areas of de- certain guidelines for givi.ig an assess- include: velopment: personal/social, fine motor/ ment adaptive, language, and gross motor. It The Brazelton Neonatal Behavioralis important to remember that the Den- o It should be administered in d re- Assessment Scale - This scale provides laxed, comfortable manner, with ver is a screening test and not an in-depth measures of the behaviors of newborns assessment test (Wodrich, 1984). Its parents present whenever appro- (ages birth to 4 weeks). It also provides priate; and primary advantage is that it is relatively estimates of an infant's neurological short, easy to use, economical, andaccu- o It should be conducted in as many functioning and assesses the infant'sca- rate (Bailey & Wolery, 1984). sessions as are needed for an accu pacity to respond to and interact with While the above-mentioned screen- rate assessment. "events in the environment" (such as ing and assessment tests are very useful light, sound, and touch). It is typically, They also identify three methods that in detecting lags in development, it is though not exclusively, given to at-risk important to be aware of the limitations are recommended for obtaining this in- babies or to those who show formation: some de- of such tests. In general, testsor scales lays in development. This scale pro- used with infants 18 months or younger o Naturalistic observations -- in vides estimates of developmental are less able to predict later IQ (intel- which children are observed ina progress and indicates signs of delay. ligence quotient) than tests given to chil- variety of settings that allow for The Gesell Developmental dren older than 18 months. Infants with typical behaviors to occur; Schedules- This measures the devel- low scores on tests may be more at risk for developmental delays in later o Interviews with parents which opmental status of infants (bets '.en the are conducted either formally, us- childhood than infants who score higher, ages of 1 to 36 months) in terms of fine but making a developmental diagnosis ing questionnaires and other as- and gross motor behavior; language be- sessment procedures, or informal -. is more limited in infancy than at later havior; adaptive behavior, including stages. ly, with parents supplying eye-hand coordination and imitation; anecdotal information; Parents should keep in mind that in and personal-social behavior, includingall assessment situations, it is important o Testing -- which involves giving an reactions to persons, initiative and inde- for the process to be carried out in pendence, and play response. a infant a variety of screening tests nondiscriminatory manner. The admin- and assessment scales to help gain The Bayley Scales of Infant istration of tests and the interpretation more information about his or her Development - This well-known and of the results to gain information about present level of development. widely used infant scale providesa di- a child must be done carefully and ac- Regardless of how a baby isas- agnostic measure of an infant's mental cording to guidelines specified by such sessed, it is important to remember that abilities, including memory, learning, professional organizations as the Amer- tests often do not accurately predict the and problem-solving behavior; rates ican Psychol3gical Association. By be.. long-range outlook for a child. Each test motor skills, such as body control, large coming more informed about psycho- is only a "snapshot" of an infant's devel- muscle coordination, and control of the logical testing, parents can make opment at a particular point in time, andhands and fingers; andassesses behav- clearer decisions about whether or not often, several different tests are needed iors such as social orientation, fearful- test results and the test interpreter's to get a more complete picture of how a ness, and cooperation. The Bayley is a comments and observations are accepta- baby is functioning. The interaction ofa norm-referenced test or scale that ble or unacceptable. Above all, testre- number of factors, including the baby's cates a child's developmental level in sults need to be worded in such a way temperament, the supportiveness of his relation to other children, specifically that they are useful to families seeking or her environment, and the child's over- to a group of other children in the same information and assistance (Wodrich, all progress all help to determine how age group. As a diagnostic tool, the pur- 1984). the child develops over time. pose of the Bayley is to verify the nature Test results alone should not be con- Physicians, nurses, psychologists, and extent of a child's developmental sidered the final predictors of a child's child development specialists, and oth- delay.It is a fairly lengthy test and later functioning. Parents' observations ers who work with infants use a number must be administered by a well-trainedand knowledge of their child's of different scales or screening tests to examiner. (Bailey & Wolery,1984). strengths, weaknesses, and needs also should be considered when a child is answer questions about an infant's de- The Denver Developmental velopment. Wodrich (1984) and Bailey evaluated. Because of the importance of & Wolery (1984) review some of the Screening Test - This test is a screen- the family environment for the develop- ing instrument designed to determine ment of young children, evaluations can include observations of the child at home. Some families might find this process helpful; others might consider it Research data from the last 20years... intrusive, feeling as though they were being evaluated as parents. Each fami- reveal that infants learn, respond, and ly needs to decide whether home obser- vations would meet their specific needs, interact from the moment theyare born. and members of the early intervention team should respect that decision. How Infants Develop 2. Infants learn through social taught specialists that lust as the par- contact. ent's attention, affection, requests, physi- Over the past 20 years, developmen- Infants begin their social contact by cal interactions, and warmth trigger a tal specialists have changed their views engaging in soothing bodily contact and response by the infant, so also, do the of infants. It once was believed that an eye contact with their parents, and later child's responses affect the parent. For infant's capacity to learn emerged slow- by smiling and making sounds. Infants example, when a baby smiles, the par- ly after birth. Infants were viewed like to look at faces and can understand ents smile in return and often talk to the largely as being passive recipients of facial expressions and tone of voice. A baby. The baby, in response, may coo or care. Some specialists believed that de-social smile and cooing are part of an gurgle and thrash around, which, in turn, velopment took place primarily as a re- infant's way of communicating and have causes the parents to continue the inter- sult of the unfolding of the child's in- an important role in social interaction action. What is important is that each born capacities; others believed that between the parent and child. A large partner in the parent-child interaction development was influenced primarily part of early learning takes place influences the other and sets up a re- by the experiences the child encoun- through play and other interactions be- sponse to the reaction for the other. tered in the environment. Now it is tween the parent and child (Anastasiow, When interactions between infant widely believed that infants develop 1986). and parent are strained and seemingly through a continuing interaction between unrewarding, parents' feelings of self- their inborn abilities and the stimula- 3. Infants are active learners. esteem may be threatened, And a cycle tion they receive from their environment Infants like to have an influence on of rejection may result. In Handicapped (Anastasiow, 1986). the people and objects in their environ- Infants and Children A Handbook for The following principles summarizement. Several researchers (Watson, Parents and Professionals, (1983), Carol contemporary thinking about infant de- 1966; Siqueland and De Lucia, 1969; in Tingey-Michaelis emphasizes that even velopment, according to Lewis (1984), Lewis, 1984), have demonstrated this though parents may feel like playing Hanson (1984), and Anastasiow (1986). principle by giving a group of infants and talking less with their non- While these principles are based on control over what they see while other responsive infant, it is very important studies of infants without handicaps, we infants observe the same thing without that they play and talk even more than have included them to provide a basis having that control. they would if the infant were respon- for an understanding of normal devel- In the Watson study, the infants who sive. Although an infant may have some opment. had control were able to move a mobile difficulty interacting with others, he or 1. An infant's capacity to learn is which was attached to their arms by a she may very much want to play and re- present from birth. string. In the Siqueland and De Lucia spond, but may not know how or be able study, infants could change the bright- to "sigral" others to do this. The impor- Research data from the last 20 years ness of a projected picture by sucking a tant point is to "listen to and watch your on early childhood development reveal pacifier.In these and similar studies, infant to find out the unique signals or that infants learn, respond, and interact the infants whose actions made a differ- cues he or she uses to indicate a willing- from the moment they are born. Their ence in what they saw were interested ness or readiness to play and respond. capabilities and their sensory and cog- for longer periods of time and smiled There arc various ways parents can nitive skills are greater and more com- more than those who could not affect interact with an infant who is slow to re- plex than researchers had thought possi- what they saw (Lewis, 1984). Similarly, spond that are mutually pleasurable ble (Hanson, 1984). infants like to produce an effect on the and rewarding. Siblings, grandparents, Even very young infants can process people around them. When they make and other adults who are comfortable information and respond to it based on faces, they like someone to make faces with the baby can initiate and partici- their experiences. For example, re- in return; when they make sociable pate in these activities, as well, and search and studies by Robert Fantz in sounds, they like responses from those should be encouraged to do so. Some of the 1960s demonstrated that newborns around them. these activities include simple, sponta- could see and process information and neous interactions, such as stroking or showed signs of visual preferences. 4. Infants affect their parents, just as parents affect infants-. gently touching the baby; talking or When newborns were given a choice be- singing in a quiet, soothing voice; or tween simple and complex visual pat- We think of parents as having the holding and rocking or swaying the terns, they preferred the more complex primary influence in the parent-infant baby. These activities can occur during (Lewis, 1984). interaction. More careful observation day-t -lay interactions, when your baby of play and other social interaction has is beir.g fed, dressed, or bathed.

- 5 - A child with a handicap is first Infants as Individuals Today, we know that every infant is a of all a child; the handicap is unique being with an equally unique temperament. One infant may be plac- secondary. id and easygoing from birth; another may be constantly restless. Each grows and learns at his own pace and accord- ing to his own style. The growth and de- Remember that an infant who is slow to experiencing joy, love, and the security velopment of infants born with handi- respond may need to interact more often of the closeness of his family and those caps or chronic or life-threatening and continue the activity longer than otheraround him. It is also important to keep illness may be as erratic as their first infants. It is also important to remem- in mind that you are a valuable and im- days or weeks after birth. As these in- ber that the activities suggested here portant asset to your child, and that your fants grow, they may be on and off' the may not be appropriate or advisable child's sense of identity originates with chart of developmental milestones: they for infants who are considered high risk you. Your attitude toward your child may seem to follow normal patterns of or sick. Parents should always consult a and yourself is vital to your ability to development in some areas but not in pediatrician or infant specialist about put the situation in perspective. others. The ways in which skills and activities that are appropriate for their It is important that parents confront personalities unfold and develop make baby. and manage any negative feelings they each child a unique individual. Whenever possible,(and with a phy-may have about themselves and try to Regardless of how fast or slow sician's approval), keep your baby rid themselves of any guilt they might growth and development are, all infants where the action is in your household, feel over their baby's problems. Par- possess a set of skills and abilities rather than secluded in a separate room.ents who are able to let themselves ex- which change with development. In ad- Take your baby on as many outings as perience their infant as a separate beingdition, all infants progress through simi- possible, and with other people, for rather than a negative extension of them-lar stages of development. The growth added stimulation. Try to maintain con- selves, and who can recognize the unique may be slower and the needs at each tact with others r, expose yourself and qualities that make their infant an indi- stage may be more pronounced, but your baby to common, everyday experi- vidual, have begun to take the first steps there is an overall sequence to the stages. ences. For example, if others are taking toward growth and survival as a family. Some infants may take longer than oth- their infants to the park, take your infant The needs of an infant with handi- ers to reach a goal, but what is important out as well, even if doing so seems dis- caps are the same as every child's needs, to remember is that it is not a matter of couraging at first. Although your baby but there may be more of them. The in- how much time it takes to reach a goal, may not be able to participate in the fant with special needs may require but that there is progress towards reach- same way the other infants do, try to help and attention more often and in ing that goal. By understanding the make his or her everyday experiences asdifferent ways than do other infants. steps or sequence of normal develop- normal as possible. Parents need to re- Meeting these demands is often diffi- ment. parents are better prepared to spond to a baby with special needs the cult for parents to handle alone, and help guide their infant with handicaps same way they would to any baby, and they may need more support and en- or delays from one stage to the next. should encourage others to do the same. couragement than those around them can The following section includes gen- While it may seem that your child is notgive. Parent support groups can be an eral information about the predictable progressing in certain areas of develop-excellent source of needed assistance, sequences of normal infant develop- ment (for example, walking or talking),practical advice, and understanding. ment in the areas of motor skills, lan- it is important to remember that there is Through such groups, parents can share guage or communication, cognition, and a wide range of abilities that all indi- their experiences and feelings with oth- socialization. Also included are sugges- viduals possess. Some of those abilitieser parents who can empathize, rather tions on how parents can stimulate de- may include (but not be limited to) than sympathize. Quite often, parents velopment in each of these four areas. good listening skills, good short- or maintain close personal contact with Much of this information is based on the long-term memory, and socialization each other through phone conversations. Parent Helper series from the Maryland skills. Many inborn abilities may not Other support may be in the form of in- State Department of Education and is be seen in the first few years of life, but formational meetings, informal get- consistent with many of Hanson's (and may unfold as time goes on. togethers, or structured discussion others') points, with additional sugges- As a parent, you can help your child groups. (For more information on par- tions from interviews with parents. mature and grow by focusing on your ent groups, contact NICHCY and ask Generally speaking, infants devel- child's strengths and worth as a human for our "Parent Pack.") op in a predictable sequence in each of being and, more importantly, by giving Even if your baby isn't developing the following areas: your child what every child needs: ac- normally in every aspect, you will want ceptance and a sense of belonging to a to strive to make his or her everyday ex- Motor Skills - This area includes family and being valued and loved. As periences as normal as possible. A gross and fine motor development. much as possible, try to focus on your child with a handicap is first of all a Gross motor activities involve the use of baby's positive qualities, and concen- child; the handicap is secondary. large muscles for sitting, crawling, and trate on the potential your child has for walking. Fine motor activities involve the use of small muscles, such as those in the hands and fingers used in the pincer grasp for picking up small ob- The rate, pattern, and quality of motor jects. Initially, gross motor develop- ment occurs in a head-to-foot direction, development varies from child to child. so that facial, oral, and upper limb movements develop before many move- ments involving the leg muscles. At the same time, as motor control continues, (Hanson, 1984). This can occur as soon ashim or her in the main room, around oth- muscle groups that are close to the trunk an infant is discharged from a neonatal er members of the family, if possible. of the body develop before those that intensive care unit. are further away.For example, an in- If you are concerned about your in- Language or Communication - fant will learn how to use the arm and fant's motor developm. ent, ask your pe- This area involves the development of hand together before being able to pick diatrician, a pediatric nurse, your baby'sreceptive language -- the ability to re- up a small object with the fingers. case manager (if you are enrolled in an ceive information and process and un- Gross motor skills generally follow early intervention program), or another derstand its meaning -- and expressive a sequential pattern, with each new skill parent for information (books, pamph- language -- the ability to transmit infor- providing a basis for later skills. lets, or charts) on the steps in normal in- mation, through tb.: use of various forms While infants are mastering one type offant and toddler motor development. If of language, including making gestures activity, they are experimenting with the you have concerns about how your in- and signs, babbling, head shaking, and next kind of activity in the develenmen- fant'; motor skills are developing, ex- speech. Facial expressions, body move- tal sequence. In general, when babies press your concerns to a professional, ments, gestures, and changes in tone and begin to experiment with a new activity, such as your baby's pediatrician or your volume of voice are all examples of their movements are quite awkward; baby's case manager (if applicable). early forms of normal communication. over time, the movements will become They can refer you to a pediatric devel- Research studies into mother-infant in- better coordinated. With infants who opmental specialist, a physical thera teractions have shown that a continuous, have handicaps, motor skills develop- pist, or an occupational therapist. (Occu-two-way process in which each partner ment is often varied. Parents and others pational and physical therapist modifies the other's interactive behavior working with the infant need to keep this organizations are listed under "Organi- can develop early in an infant's life. In in mind. zations" at the end of this News Digest.) this process, the intant's behavior (such Variation in the patterns of motor Another good source for information as opening its eyes or making gurgling development is common; some variation and referrals are parent support sounds) is reinforced by the mother's re- is normal, some is abnormal. The rate, groups. Often, these groups have lists ofsponses, such as making face-to-face pattern, and quality of motor develop- names of professionals, and will give contact, touching, or vocalizations. The ment varies from child to child. With parents the names of several profes- evidence of how this reinforcement af- infants havine abnormal variation, it is sionals from whic i they c an (noose. fects different aspects of an infant's de- often difficult to tell if the problems You can help your baby develop velopment, including language and are temporary or long-lasting. In cases gross motor skills by providing experi- communication, is significant for infants where abnormal variation is due to poor ences that stimulate the movement of born at risk or with special needs. muscle tone or delays in motor abilities, eyes, head, body, arms, and legs. For Studies of infants with handicaps an intervention p agram might be rec- example, dressing your baby in bright- have revealed that many of their interac- ommended, even without a specific di- ly colored mittens and booties with tive behaviors, such as frequent and loud agnosis. Parents need to be aware that bells attached can help your baby be- crying, difficulty in being comforted, intervention therapies may be short- come more aware of his or her hands and infrequent eye contact, did little to

4 term and that many problems may not and feet. Remember that your child encourage or reinforce the caretaker's affect the overall developmental out- needs to touch and handle objects in or- behaviors. From these and similar stud- come of their child. Many children who der to learn. It should be noted, howev- ies, it is thought that an infant's earliest are born prematurely, with handicaps, er, that some babies cannot tolerate stim- interactions with its environment can sig- or with serious illnesses that put them at uli and are negatively affected by nificantly, although not totally, affect risk for developing handicaps may not tight colors and even by being touched.future language and communication de- have any problems later on. However, You can stimulate movement by giv- velopment (Hanson, 1984). other infants, such as those with Down ing your child simple, safe objects such You can help your baby develop the syndrome or cerebral palsy, often have as empty boxes or plastic containers to ability to communicate by talking to her problems in motor development that stack and build with and by providing while you are performing daily activi- are more easily identifiable and which push/pull toys. In addition to having ties.For example, while dressing your may remain with them. Such problems safe toys available for your child, make baby, you can talk or sing about what often can be greatly modified or les- sure that your home is "baby-proofed" you are doing, using simple action and sened with early intervention. Today, so that your child can move about with- descriptive words as you go through infants who have motor development out getting hurt. If your baby cannot each step. By reading to your baby problems may be referred for interven- move around, find a safe location for while she sits on your lap, you can help tion therapy once a diagnosis is made in the development of attending, listen-

- 7 - seeing, hearing, touching, moving, and Infants learn about their world primarily tasting. The first social interaction an in- fant experiences is usually with the through the experiences they havewith those mother. As these interactions continue, they develop into mother-childgames, who takecare of them, beginning at birth. such as "this little piggy went to market" or "peek-a-boo." The social behaviors of infants who ing, and memory skills. If you are other- can do this by providing your child with have handicaps may not follow thesame wise occupied, you can also use the ra- different sensations as part of his or her patterns. The give-and-take interactions dio and the television to stimulate your everyday routine. For instance, you can between the parent and infant may be baby's communication skills. Remem- attach a homemade mobile with two or disrupted due to a number of factors. ber, however, that these devices provide three safe, sturdy objects to your baby's The infant with a physical,sensory, or one-way communication only and arc crib to stimulate awareness of differ- cognitive disability may not be able to not interactive in nature. Encouraging ences in shape, color, and texture. You send clear social messages to thepar- your baby to use her voice to make new can renew your baby's interest by chang- ent. The inability of an infant with a sounds; increasing your baby's aware- ing the objects in the mobile as often as handicap to smile or gaze in ways that ness of voice, lip, tongue, and jaw move- you like. Similarly, you can give your encourage social responses from par- ment; and prompting your baby .:o imi- baby lessons in listening by speaking ents and others may negatively affect tate your gestures all add to the and singing in different tones. If you their overall patterns of social interac- development of communication skills. are too busy to do this, you can sing into tions. In such cases, parents may need a tape recorder and play it back when- help in finding alternative waysto inter- Cognition - This includes an infant's ever your baby is ready for a listening act with their infant. One way parents processing of information in the environ- activity. You can use a traditional game can receive help is to participate with ment and constructing knowledge based of peek -a -boo to develop your infant's their infant in an early interventionor on his or her experiences and percep- memory (usually successful with babies infant stimulation program, where they tions. In order for infants to function at least 3 to 4 months old, or older). Af- can learn ways to encourage social re- and adapt in their environment, they ter playing the game many times, your sponses in their infant. need to be able to receive information infant learns to look forward to special Other factors that may play a part in from their surroundings, understand words or actions, repeated in sequence, the altered patterns of sock,: interaction what it means, and act on it. Seeing, that act as cues for what will come next. between mother and infant are the ;n- hearing, touching, smelling, anu tasting In addition, infants can learn a great fanes temperament, appearance, and are the starting points for the infant's ex-deal from toys that are attractive,versa- habits. Parents may find it more diffi- panding understanding of the world. tile, durable, and easy to pick up and cult to react positively to an infant who Memory is also a part of the process of hold. If your baby's ability to grasp and is unloving, who rarely sleeps, or who cognition. As an infant's capacity to re- hold is delayed or impaired,try toys elicits negative feelings from family member grows, he or she is able to that hang or roll. In choosing toys, be- members and others. Both handicapped make decisions based on experience. In-come your own expert. Make a list of infants and their parents may needspe- fants learn about their world primarily your baby's strengths and weaknesses cific support in learning how to develop through the experiences they have with and choose those toys which meetyour reciprocal social skills that promote those who take care of them, beginning child's requirements. Other parents of greater social interaction. at birth. According to the late Swiss children with special needs, suchas Early intervention groups and par- psychologist and leading infant dev:1- those in parent support groups, can be ent support groups can help parents opment theorist, Jean Piaget, an infant excellent sources of information about learn how to interact with their infant. must be given certain "environmental what toys work with children havingcer- Many parents in these groups have had experiences" if basic cognitive skills aretain types of handicaps. Physical and oc-difficulty relating positively toward to develop. Infants with handicaps needcupational therapists can also provide their own special needs infant andcan to be given alternative ways to develop advice on techniques and materials that offer encouragement and support for their cognitive abilities. For example, will encourage use of hands throughma- other parents. most infants use reaching behavior to nipulation of toys and objects. Many lo- You can help your infant develop learn about their world. An infant who cal libraries have toy-lending services self-awareness and an ability tore., is blind, however, does not attain eye- or can refer you to libraries or other fa- spond to other people by getting Into hand coordination, and needs to be cilities that do. (Additional information the habit of taking your baby withyou as taught "ear-hand" coordination-- that is, on toys and ideas for play can be found you move through your daily routines. locating an object by sound and reach- under "Developmental Toys and Play Infants who frequently are left alone ing for it -- to make possible future ex- Therapy" at the end of this News Digest.) get bored and lonely just the way older plorations of his or her world (Garwood people sometimes do. Encourage other and Fewell, 1983). Socialization- This area involves the family members to become involved You can help your child develop development of a child's self-awareness with the baby's activities. This willen- abilities in knowing, understanding, and and ability to respond to others. An in- rich the baby's life, expose him to others remembering by making your home a fant's self-awareness and interest in oth- in his life at an early stage, and aid in stimulating learning environment. You ers begins with early experiences in the development of his social skills.

- 8 - Parents' Roles in Stimulating their There is no prescribed wayor time to Infant's Develop- teachyourinfant; it should be natural ment and unaffected. For any child, the parent is the first and often the most important teacher, and a major influence on how the child Z. Teach your baby through social him time to show you how he is doing develops. Long before child develop- experiences, with an activity. Most important, be ment specialists id killed the impor- Most infants enjoy and are motivat- flexible and try to relax and enjoy the tant factors in infant learning. parents ed by learning activities that are made time together. were playing with their children, talk- into games and other kinds of social ac- 4. Be consistent with your baby. ing to them, and providing a variety of tivities. Play activities and social experi- stimulating experiences. Although your ences are learning experiences. They Try to be as consistent as possible in child may be receiving help from spe- should be planned according to the your responses to your ch:!d's signals. cialists, these speci.lists cannot take baby's tolerance level for stimulation For example, if you smile and clap your place because they do not have the and should occur at a time when both when your baby pats his or her hands to- relationship that you have with your parents are relaxed. A baby's attention gether, respond the same way each time child, and they will never know your span may vary according to activity as your baby does that. Consistent re- baby as well as you do. well as mood. Some infants can spend sponses make your child's environment Parents can play a major role in en- no more than a few minutes on an activi, more predictable and help your child couraging and shaping the development ty; others can remain involved for half learn. of their child with special needs. The an hour at a time. There is no pre- reciprocal teaching and leamirg can be-scribed way or time to teach your infant; 5. Give your baby varied experiences. gin during the infant's first weeks of it should be natural and unaffected. As part of a natural routine, you can life. The process used by parents in However, parents must learn about theiroffer your child a variety of experiences stimulating their infant's early learning child's unique way of absorbing infor- in different locations and situations. For is described below. This information mation. has been taken from material written by example, take your child on walks or Parents need to learn what their outings and point out things that increase Marci Hanson (1987), from pamphlets baby's activity limits are. The limit is piblishcd by the Maryland State De- awareness of and familiarity with the the point at which an activity becomes a environment. Your home can provide partment of Education (1980.84), and strair to the parent or the child. If par- your child with a variety of sensory ex- from interviews with mothers who have ents need to spend 15 minutes on an ac- perience-, such as feeling different lived the experiences. Helping an in- tivity, it does not have to be 15 consecu- fant learn involves certain basic steps. textured materials, smelling and tasting tive minutes in 3 row; it may be three 5- different foods, and seeing and hearing Hanson suggests that parents begin by minute sessions. If the infant is ex- different shapes and sounds. The chii- becoming aware of how their baby re- tremely act, fe and does not sit down dren's television show "Sesame Street' sponds to various situations in daily life. and attend to a task well, parents an was designed around the idea of a In addition, Hanson points to six strate- think about activities that their child can child's surroundings as a natural learn- gies that have proven effective in help- do standing up or moving around. They ing place. Such places as the kitchen, the ing babies learn: need to choose activities and settings stairway, or the backyard can be as ex- 1. Be responsive to your baby. that are relaxing to both of them. Such citing to atr infant as a shopping mall is aetivities may offer the child the great- to some adults. Stacking pans or empty It is important to learn how your est oppoitunities for learning. One food cartons or playing with water can child signals his or her needs, All in- mother reported that when her baby be- be as sti-iulating (and often, less frus- fants, including those with disabilities, came tense or overactive, she placed himtrating) to an infat.t d3 playing with the develop "signalling systems."For ex- in a tub of warm water, where he playedmost sophisticated toy on the market. ample, parents should think about what happily. Depending on your baby's handicap their infant does to signal feelings of or unique style of learning, determining hunger, sleepiness, or the need for a di- 3. Take turns rhen interacting what is interesting and stimulating may aper change. Are the clues subtle or with your baby. take a lot of creativity en your part. For very obvious? Once it has been deur- Imitation is one of the basic ways we example, if you can't get to a play mined what some of the s;gr.als are, par-all learn. After demonstrating to your ground or to the city or town easily, a ents will be able to recogn;ze when and infant how to do sot-nettling, give km xery store may be the best museum' how their infant is communicating his or time to absorb the lesson. Wait cc; him for your baby. her needs. Many parents can tell what a ro try the activity before demonstrating Parents should be discriminating in baby wants by the subtle tone:, of the it a second time. Remember, it's not !tow the types of toys they introduce to their cry they hear. long he does something that is impor- infant: most have been designed with no tant, but rather that he responds. Give thought of their use by children with

- 9 handicaps. Infants who are not able to handicaps feel additional pressures. pick up or manipulate objects will not While keeping a positive attitude will A Final Word.... benefit from the newest or latest toy be-have rewards not only for your baby, Babies born with handicaps often ing advertised as 'educadonal.* Discov- but for you, this may be difficult, de- may nccd more help and require more er what works with your baby and put pending on the nature and ;evcrity of planning from their parents and others away the other toys that frustrate or con- your child's handicap. You as weal as to get the skills they need :o be able to fuse. the other members of your 'amity, need progress.Parents of special needs in- Also be careful not to overstimulate to be aware of your child's s Tengths as fants also may nccd extra help andsup- your baby or introduce new experiences well as weaknesses. Try tor laintain a port. With it, they can accomplish a lot. when she is tired or ill. Be aware of the sense of humor and your per. pective on Even though a child's growth and devel- signs or signals your infant gives when what you arc trying to accomplish with opment may be delayed in certain areas, ovcrsti nulatal, frustrated, or just tired your baby. Others, especially parents the most important goals for children oldie activity. Pia a time of day to in- of children with handicaps, &ten are with sp. ;al needs arc the sameas they troduce new places or experiences whenable to help you with this. Re amber arc for children without special needs: it is best 21,4 easiest for bath you and that playing with your child is not a job: to develop feelings of self-worth and your baby. This might be when you are it is a part of the life you have with luur self-trust, to become as independentas driving in the car, making meals in the child. The most important thingsyou possible, to develop trust in others, and kitchen, or changing diapers in your can give are the feelings of by:, enjoy- to develop to the fullest his or her abili- baby's room. The timing of introducing ment, and a sense of belonging to the ties. learning experiences should be part of world. In doing these things,Du will One of the most important goals to the natural rhythm of your baby's day, naturally be helping your chit I devel- strive for is to help build your child's and the experiences should be fun and op self-esteem. self-esteem and to plan for and antici- relaxing for both of you. You needn't Of course, parents do not Zr dcannot pate. future successes for four child. feel compelled to teach at every oppor- always maintain a positive attit jdc. If Even if you cannot cure the problemsor tunity. you are having a bad day with 1Dur speed up development, you are capable baby, change what you are doin and do of raising a child who has a sense of 6. Maintain a positive attitude ac- something else. Take a break uhenever complishment and feelings of self- about teaching your child. possible; it is important that you main- worth. As one parent cautioned: *Don't Sometimes this won't be easy. You tain your sense of equilibrium. Like all sell your child(ren)'s capabilities short. may feel guilty that you don't always -Arents of young children, you reed to Encourage them every step of the way enjoy teaching your child. All parents take time for yourself to renew /our and help them to believe in them- feel stressed, but parents of infants withstrength and spirit. selves.' (Thompson, 1986).

This document was developed by Interstate Re- Education Programs, Office of Special Education and search Associates, Inc. pursuant to Cooperative Rehabilitative Services, U.S. Department of Educa- Agreement #00087C3051 with the Office of Special tion, for their time in reading and reviewing this docu- Education Programs of the U.S. Department of Educa-ment. We also want to thank Dr. Maxine Freund, Dr. tion. The contents of this document do not necessarilyBud Fredericks, Diane Crutcher. Patricia Place,Dr. reflect the views or policies of the Department of Edu- Robert Greenstein, and Dr. Pascal Trohanis for their cation, nor does mention of trade names, commercial valuable comments and suggestions. products, or organizations imply endorsement by the Government. PROJECT STAFF ibis information is in the public domain unless Project Director Carol Valdivicso otherwise indicated. Readers are encouragedto copy Acting Deputy Director Suz.inne Ripley and share it, but plea.ae credit the National Informa- Editor Catherine Wethcrby tion Center for Children and Youth with Handicaps. Contributing Authors Barbara Hobbs, Suzanne Ripley, NICHCY would like to thank our Project Officer, Catherine Wethcrby Helene Corradino, and others at the Office of Special REFERENCES

You can obtain many of these documents throughyour lo- Pa H Brookes.(Available from Paul H. Brooke, Pub- cal public library.Wherever possible, we have included lishing Co., P.O. Box 10624, Baltimore, MD 21285-0624 ) the publisher's address or some othersource in case the publication is not available in your area. Bailey, Donald B. Jr., 6i. Wolery, Mark. (1984). Teaching infants and preschoolers with handicaps. Columbus, Ohio: Merrill Publishing Co. (Available from Charles E. Mer- Anastasiow, N. (1986). Development and disability: A r--- rill Publishing Co., Columbus, OH 43216.) chobiological analysis for special educators.Baltimore, Iv: : 10 Campbell, P.H. & Wilcox, M.J. (1986). In Special needs Resource manual: Handicapped children birth to five. (1980). report - a newsletter from the Akron Medical Center, Akron, Baltimore, MD: Maryland State Department of Educa- OH. tion, (Author). Garwood, S. Gray, ewell, Rebecca, R. (1983). Educat- Thompson, Charlotte E,, M.D. (1986). Raising a handi- ing handicapped infantsIssues in development and interven- capped child - A helpful guide for parents of the physically tion.Rockville, MD: Aspen Publications. (Available disabled. New York: Ballantine Books. from Aspen Publications, 7201 McKinney Circle, Frede- Tingey-Michaelis, Carol. (1983). Handicapped infants and rick, MD 21701.) children: A handbook for parents and professionals. Austin, Hanson, Marci J., (1984). Atypical infant development. Bal- TX: Pro-Ed, Inc. (Available from Pro-Ed, Inc., 5341 Indus- timore, MD: University Park Press. (Available from Uni- trial Oaks Blvd., Austin, TX 78735.) versity Park Press, 300 North Charles Street, Baltimore, Weiner, Roberta, & Koppelman, Jane. (1987). From birth MD 21201.) to five: serving the youngest handicapped children. Alexan- Lewis, M. (1984).Developmental principles and their dria, VA: Capitol Publications, Inc.(Available from Ed- implications for at-risk and handicapped infants.In ucation Research Group, 1101 King St., Alexandria, VA Marci J.Hanson (Ed.), Atypical Infant Development. Ba 22314.) more, MD: University Park Press.(Available from Uni- Wodrich, David L., (1984). Children's psychological testing: versity Park Press, 300 North Charles Street, Baltimore, A guide for nonpsychologists. Baltimore, MD: Paul H. MD 21201.) Brookes. (Available from Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624.)

BIBLIOGRAPHY

You can obtain many of these documents through your Parent helper: Handicapped children birth to five. (1980-84). cal library. Whenever possible, we have included the Baltimore, MD: Maryland State Department of Educa- publisher's address in case the publication is not availa- tion, (Author). (Series includes five pamphlets covering ble in your area. general information on development, socialization, com- munication, motor development, and cognition. Copies are General Interest: available from the National Information Cen zr for Chil- dren and Youth with Handicaps, Box 1492, Washington, Bromwich, R.M. (1981). Working with rzits and infants: D.C. 20013.) An interactional approach. Baltimore: University Powell, Thomas H., & Ogle, Peggy Ahrenhold, (1985). Park Press.(Available from University Park Press, 300 North Charles Street, Baltimore, MD 21201.) Brothers and sisters: A special part of exceptional families. Baltimore, MD: Paul H. Brookes Publishing Co. (Avail- Featherstone, Helen, (1980). A difference in the family: able from Paul H. Brookes Publishing Co., P.O. Box Life with a disabled child. New York: Basic Books, Inc. 10624, Baltimore, MD 21285-0624.) Fewell, Rebecca, & Vadasy, Patricia (1986).Families of Simons, Robin (1984). After the tears - Parents talk about handicapped children: Needs and supports across the life span. raising a child with a disability.San Diego, CA: Harcourt Austin, TX: Pro-Ed.(Available from Pro-Ed, 5341 Indus- Brace Jovanovich, Inc.(Available from Harcourt Brace Jo- trial Oaks Blvd., Austin, TX 78735.) vanovich, Inc., 1250 Sixth Ave., San Diego, CA 92101.) Goldfarb, T-ori A.;' Brotherson, Mary Jane; Summers, Jean Turnbull, Ann & Turnbull, Rutherford (1986). Families, Ann; & Turnbull, Ann P. (1986). Meeting the challenge of professionals and exceptionality: A special partnership. Co- disability or chronic illness: A family guide.Baltimore MD: lumbus, OH: Charles E. Merrill. Paul H. Brookes Publishing Co. (Available from Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD Magazines and Newsletters: 21285-0624.) Exceptional Parent. A magazine for parents of children Lindemann, James E., & Lindemann, Sally J., (1988). with disabilities published eight times a year.(Write: Growing up proud: A parent's guide to the psychological care Exceptional Parent, 605 Commonwealth Ave., Boston, MA of children with disabilities. New York: Warner Books. 02215.) (Available from Warner Books, 666 Fifth Ave., New York, NY 10103.) Raising Kids. A newsletter published monthly that focus- es on the many aspects of normal development in young Arling- Mather, June (1981). Make the most of your baby. children, and often includes articles on disabilities and ton, TX: Association for Retarded Citizens.(Available health problems. (Available from Raising Kids, P.O. Box from Association for Retarded Citizens, National Head- 273, Braintree, MA 02184.) quarters, 2501 Ave. J., Arlington, TX 76006.) Developmental Toys and Play Therapy: McConkey, Roy, & Jaffree, Dororhy (1983). Makingtoys for handicapped children: A guide for parents and teachers. Fewell, Rebecca R., & Vadasy, Patricia F., (1983). Learn- (Revised edition). Englewood Cliffs, NJ: Prentice-Hall. ing through play: A resource manual for teachers and parents Rappaport, Lisa (1986).Recipes for fun: Play activities and (birth to three years). Allen, TX: DLM Teaching Resources. games for young children with disabilities and their families. Hanson, Marci J., (1987). Teaching the infant with Down Washington, DC: Let's Play to Grow. (Available from syndrome: A guide for parents and professionals.(2nd ed.). Lets Play to Grow, 1350 New York Ave., NW, Washing- Austin, TX: Pro-Ed, Inc. ton, DC 20005. Phone: (202) 393-1250.) Learning to play: Common concerns for the visually impaired For Grandparents: preschool child. (1987). (Available at nocost from Blind Childrens Center, P.O. Box 29159, Los Angeles, CA Especially grandparents: A newsletter for and about grandpar- 90020-0159. Phone: (213) 664-2153.) ents of children with special needs.(Write to ESPECIALLY GRANDPARENTS, 2230 Eighth Ave., Seattle, WA 98121.) ORGANIZATIONS Association for the Care of Children's Health [ACCH]. of Education to provide technical assistanceto states in An association of professionals and parents promoting pro "iding services for children with special needs, birth health care for children and their families.Publishes a through 8 years, and their families. Also provides limited quarterly newsletter. (Contact: ACCH, 3615 Wisconsin technical assistance and information to professionals and Ave., N.W., Washington, DC 20016. Phone (202) 244- parents. (Contact NEC*TAS, CB* 8040, 500 NCBN Plaza, 1801.) The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599. Phone (919) 962-2001.) The National Center for Education in Maternal and Child Health/ National Maternal and Child Health Clearinghouse [ NCEMCH]. Has information for organi- Therapy Organizations: zations, agencies, and individuals who have an interest in American Physical Therapy Association- Section on ?e- maternal and child health.Produces publications on top- cle.,tics, 1111 North Fairfax St., Alexandria, VA 22314. ics related to maternal and child health. Provides infor- mation on request. (Contact: NCEMCH, 38th & R Streets, The American Occupational Therapy Association, Inc., NW, Washington, DC 20057. Phone: (202) 625-8400.) 1383 Piccard Drive, P.O. Box 1725, Rockville, MD 20850. National Early Childhood Technical Assistance System Neuro-Developmental Treatment Association, P.O. Box [NEC*TAS]. A project funded by the U.S. Department 70, Oak Park, IL 60303.

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