Published for the British Institute of Learning Disabilities Journal of Applied Research in Intellectual Disabilities 2017, 30, 211–229 REVIEW Early Intervention for Children with Intellectual Disabilities: An Update Michael J. Guralnick Center on Human Development and Disability, University of Washington, Seattle, WA, USA Accepted for publication 26 November 2015 This article provides an update on advances in both improving children’s cognitive and social outcomes in developmental and intervention science that have inclusive preschool settings. Merging policy initiati- occurred in the field of early intervention for children ves with our knowledge of developmental processes with developmental delays in the past decade. From is discussed as the key to accelerating progress in the perspective of developmental science, findings the development of comprehensive early intervention related to multiple and reciprocal pathways of influence systems. on the development of children with delays that can inform early intervention practice are discussed. This is Keywords: children with delays, developmental followed by a review of two prominent lines of early framework, early intervention, policy initiatives intervention research: promoting children’s developm- ent by enhancing parent-sensitive responsiveness and their child’s development, working with professionals Introduction and advocating for their child. This latter study also The provision of comprehensive early intervention noted that there appears to be greater optimism about services and supports for children with established the future as well as increased parental confidence developmental delays continues to be a high priority in their ability to carry out their roles and respon- in the United States and in virtually all other high sibilities with respect to their child with a develop- resource countries throughout the world. Moreover, mental delay. despite the unique challenges posed by lower- and These encouraging reports by parents are consistent middle-resource countries, the potential contributions with the long-established intervention science indicating of early intervention to children’s development and to that comprehensive early intervention programmes can, family well-being for vulnerable children in general are at minimum, help prevent the substantial decline in well-recognized by the international community (World intellectual development that generally occurs across the Health Organization & UNICEF, 2012). Surveys of early childhood period for children with developmental parents have indicated that, in general, high levels of delays (Guralnick 2005). Moreover, both developmental support exist in various countries for early intervention and intervention science have suggested that benefits to services (Lanners & Mombaerts 2000; Peterander 2000; children’s social and cognitive competence are the direct Bailey et al. 2005). Despite variability related to ethnic result of enhancing developmental influences on minority and socio-economic status, parental income, children’s outcomes related to various components duration of involvement in early intervention, specific associated with parent–child transactions (e.g. child disabilities and other factors (Raspa et al. 2010), socioemotional connectedness), family-orchestrated child perceived parental benefits of participation in early experiences (e.g. community participation; inclusive intervention are considerable including assisting in preschool) and children’s health and safety (e.g. © 2016 John Wiley & Sons Ltd 10.1111/jar.12233 212 Journal of Applied Research in Intellectual Disabilities preventive health) (Guralnick 2011). Collectively ngs are considered in a developmental context. Emphasis referred to as family patterns of interaction, these three will be given to work promoting relationships, generally major areas of influence on child competencies are also indexed by sensitive–responsive interactions between influenced by a family’s resources including the parents and children with delays. Additional research personal characteristics of the parents (e.g. coping style, on inclusion will also be considered addressing both mental and physical health) and material resources (e.g. children’s social and pre-academic skill development. In financial resources, social support). Consequently within the final section, challenges facing the field of early this framework, comprehensive early intervention intervention from a practice/systems perspective for requires attention to all components at the level of children with delays will be discussed along with family patterns of interaction as well as influences on suggestions to address these challenges and move the these family patterns from the level of family resources. field forward. In particular, it will be suggested that by These components at both levels constitute well- merging policy initiatives with developmental and established developmental pathways directly and intervention science, including our knowledge of indirectly affecting children’s development. As will be disability characteristics and patterns, it is possible to described, the developmental science of normative establish a framework for optimizing early intervention development, our knowledge of the developmental practices for children with delays and incorporate patterns and processes associated with children with emerging findings. established delays, intervention science and early intervention practice continues to converge with the Developmental Science potential to ultimately coalesce into a system capable of maximizing children’s development. Understanding the patterns of cognitive abilities and The purpose of this article is to update my prior adaptive skills of children with delays and influences on review in this journal (Guralnick 2005) and discuss those skills and abilities has continued to be pursued advances and future directions in the field of early within a developmental framework in numerous intervention for children with developmental delays. investigations. Broader assessments of children’s More specifically, this article focuses on young children problem-solving abilities including social components with identified delays in the cognitive domain, the vast provide important perspectives with respect to majority of whom, including children with mild delays, children’s goals and their involvement in daily will receive a classification of intellectual disability by activities. Information about the components that are the school age (Vig et al. 1987; Bernheimer & Keogh 1988; underpinnings of more general cognitive and social Keogh et al. 1997). Not considered in this review are competencies including children’s developmental preventive interventions for children at environmental resources (e.g. cognition, language) and organizational or biological risk or children with a primary autism processes (e.g. executive function, social cognition, diagnosis. emotion regulation) has been of increasing interest in Emphasized in this update are conceptual and recent years. This assessment effort has been facilitated empirical efforts conducted within a developmental by the development and conceptual refinement of framework to refine and enhance our existing measures representing key aspects of cognition. As knowledge base for children with identified delays. An noted below, although only recently applied to children examination of children’s behaviour problems is beyond with delays, and recognizing that a full understanding the scope of this review although recent research in this of what constitutes intellectual development remains to area is consistent with the developmental framework be achieved, the National Institutes of Health Toolbox presented here (Ciciolla et al. 2014; Pedersen et al. 2015). (Zelazo & Bauer 2013) provides an example of easily Discussion of the major themes that have emerged in administered measures that include executive function the past decade is divided into three major sections. In and attention, episodic memory, language, working the first section, advances in developmental science memory, and processing speed (Bauer & Zelazo 2014). related to children with delays are discussed, including By observing how these various aspects of children’s aetiology-specific information and research addressing cognition develop over time as a consequence of a developmental pathways that influence family patterns diverse array of biological constraints in the context of of interaction. In the second section, recent intervention environmental influences, we are obtaining a better approaches, mainly superimposed on existing early understanding of how children adjust their devel- intervention services, and their conceptual underpinni- opmental resources and organizational processes to © 2016 John Wiley & Sons Ltd, 30, 211–229 Journal of Applied Research in Intellectual Disabilities 213 accommodate to these circumstances (Guralnick 2002; respect to emotion regulation, gaze aversion, early Karmiloff-Smith 2011; Elsabbagh & Karmiloff-Smith visual attention, working memory and social anxiety are 2012). Evaluating these cognitive features, especially among the issues that many families must contend with over time, provides insight into how constraints as they seek to establish optimal family patterns of influence downstream developmental processes interaction (Murphy & Abbeduto 2005; Skinner et al. resulting in specific child competencies, including 2005; Abbeduto et al. 2007a; Cornish et al. 2008; unusual and often