Symposium
Chair: Rebecca R. Fewell
Discussant: Cordelia Robinson
This symposium will examine the developmental outcomes attained in four intervention research studies in relationship to parent-child interaction. During the past 30 years, numerous researchers have reported significant correlations between the manner in which parents interact with their children and the rate of development children attain during the early years of life. Consistent findings have been cited for a wide range of dyads, including children from low socio-economic status families (Bradley, 1989), those born prematurely (Beckwith & Cohen, 1989), and those with moderate to severe developmental disabilities (Brooks-Gunn & Lewis, 1984; Mahoney, Finger & Powell, 1985). Since the early 1980s several early intervention programs for children with disabilities or who are at risk for developmental problems have incorporated parent-child interaction information (i.e., relationship-focused intervention) directly into the intervention design. Despite the fact that a number of studies have reported that relationship focused procedures have been effective both at enhancing the quality of relationships between mothers and children and in promoting children's development (McCullom & Hemmeter, 1997), the early intervention community has been slow to adapt this model (McBride & Petersen, 1997). This issue is related partly to professionals lacking the training necessary to carry out this model. Yet, there are two other issues related to the resistance of this model. One is the incompatibility relationship focused procedures and rationale with traditional child-focused, didactic models of intervention. The other is the fear that relationship-focused procedures might devalue parents' cultural, religious and individual values and beliefs. Despite the legitimacy of these factors, it is critical to determine the extent to which the quality of parent-child relationships influence early intervention outcomes. If a transactional model of development (Sameroff & Friese, 1990) is a valid characterization of the factors that contribute to children's development, then it is possible that early intervention efforts might only be effective at enhancing children's development if they encourage parents to adopt interactive qualities that research suggests are associated with children's development. Each of the studies discussed in this symposium have been reported as independent intervention studies for children with developmental problems. They employed a variety of intervention content and procedures. Although, only one of the studies involved intervention procedures explicitly designed to change patterns of interaction, these studies shared a common interest in evaluating parent-child interaction. As a result a comparison of results from across these studies enable us to examine the contribution of parent-child interaction to early intervention effectiveness when this was both an intended and incidental focus of intervention.
Details of individual items:
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The Infant Health and Development Program (IHDP, 1990) was an eight-site, three year comprehensive early intervention program for low birthweight, premature at risk for developmental delay and interactional disturbances. The major finding reported for the IHDP was that children in the intervention group showed significantly higher cognitive scores than children in the follow-up group both at 24 and 36 months. The purpose of this study was to identify factors that may have contributed to these intervention effects. Analyses were undertaken to determine the mediating influences of mother-child interaction on children's outcomes at 24 and 36 months. Subjects were 298 mother-child dyads from 3 of the 8 IHDP sites. The sample included intervention (n 3D 116) and follow-up (n 3D 182) groups. There were no significant group differences on initial status variables. Videotapes, made when the children were 30 months, permitted an opportunity to assess mother-child interaction on four maternal interactive style factors of the Maternal Behavior Rating Scale. Results indicated that mothers in the intervention group had higher ratings on 3 of the 4 style factors than did follow-up mothers. Post-hoc analyses of items indicated that intervention mothers had higher levels of expressiveness, enjoyment, warmth, sensitivity,responsiveness, achievement orientation, inventiveness, effectiveness, and acceptance. Stepwise regressions were used to examine the relationship of maternal style factors and intervention to children's developmental outcomes, as measured by the Stanford-Binet at 36 months and the Bayley at 24 months. Results indicated that Responsiveness accounted for 25% of the variance in children's Binet scores, intervention accounted for 4%,and Directiveness was negatively related to the Binet outcomes, accounting for 1.6% of the variance. Similarly. Responsiveness accounted for 13% of the variance in children's Bayley scores, intervention accounted for 4% and Directiveness was negatively related to Bayley scores, accounting, for 1.5% . Even though the IHDP curriculum did not intend to modify mothers' style of interaction, intervention effects on maternal style were highly significant. The contribution of mothers' interactive style to children's development was high, six times greater than membership in the intervention group itself. This study points to the possibility that some of the intensive child directed services of this program may not have been the major contributor to the child outcomes reported for this project.
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The Longitudinal Studies of the Effects and Costs of Alternative Types of Early Intervention was a controlled, multi-site investigation of early intervention effectiveness directed by the Early Intervention Research Institute at Utah State University. In this investigation, researchers re-examined data from 6 sites that included observations of parent-child interaction using the Maternal Behavior Rating Scale. To limit variability in the sample, only children between the ages of two and four years were included, resulting in a sample of 238 dyads. At each site children were randomly assigned to the ongoing intervention program (Typical) or an enhanced (Expanded) program. In the Typical model, the group received primarily child-focused, instructional services. The focus of parent involvement typically was on demonstrations of intervention strategies. In the Expanded model children and parents received the same services as in the typical model except that they received either more intervention each week, started at an earlier age, or parents were provided parenting classes. Videotapes were analyzed at the first or second reassessment of the children while they played with their mothers. Child development was assessed concurrently and one year later. A MANOVA was used to examine site intervention effects on the interactional behavior of mothers and the developmental status of children. Since no significant intervention by site interaction effects was observed, data from all sites were collapsed into two groups. No group differences on demographic characteristics were found except for mother's age and child gender. Analyses of covariance were used with mother's age as a covariate. Results indicated mothers in the Expanded group were significantly less Achievement Oriented and Directive than mothers in the Typical Group. Correlational analyses revealed that Responsiveness was associated with positive child outcomes while Directiveness was associated with negative outcomes. However, when variables were examined in regression analyses, Responsiveness and child age were significant predictors of child outcomes, but neither Directiveness nor intervention was a significant predictor of child development in the current year or a year later. These results replicate the original findings of this project that indicate the expanded intervention services had no measurable impact on children's development. However, this study adds to our understanding two issues: mothers who received the expanded interventions showed lower levels of Achievement Orientation and Directiveness; and Responsiveness, a feature of interactive style not affected by the Expanded intervention procedures, related consistently to children's development.
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The PALS (Play and Learn Strategies) Program was a 3 month (24 sessions of 30 minutes each) designed to help adolescent mothers improve their interactions with their children and acquire information on the early developmental skills including play, language and cognition. A total of 100 mothers were randomly assigned to intervention or contrast groups. At the beginning and end of the program, mothers were videotaped interacting with their children in a free-play situation. In addition, the children were administered the Developmental Activities Screening Inventory-ll to estimate children's developmental functioning. The Maternal Behavior Rating Scale was used to measure mothers' interactions. Classes were limited to eight mothers and children with children attending 25% of the classes. For purposes of this investigation children less than 4 months of age and their mothers were excluded due to questionable reliability due to young age. This resumed in an intervention group of 21 dyads. A matched pairs procedure was used to compose a contrast group. Consistent with the emphasis of the PALS curriculum, intervention mothers had a less Directive, more Responsive style of interacting with their children then did mothers in the contrast group. While the difference on the Responsiveness factor score did not reach significance, the difference as measured by the responsiveness item was statistically significant (p.3D.018). A stepwise multiple regression was used to examine the contributions of children's development at the beginning of the program and mothers' interactive style of interaction at the end of the program. Only maternal Responsiveness entered as a significant predictor in this analysis, accounting for 10% of the variance in children's DASI-II scores. These results indicate that the PALS program was effective both at modifying the manner mothers interacted with their children and at enhancing children's developmental functioning. In addition, mothers' Responsiveness was more predictive of children's developmental functioning at the end of the program than was children's level of developmental functioning at the beginning of the project. These results suggest that changes in mothers' responsiveness were a major contributor to the enhanced rates of child development promoted through PALS.
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The Family-Centered Outcomes study was a 12 month longitudinal investigation designed to test some of the assumptions underlying the impact of family centered intervention services on parents and their children. Specifically, this study attempted to determine whether services that reflected two of the key components of family-centered practice, comprehensive scope of family support services and services that corresponded to the desire or needs of families, would enable parents to interact more effectively with their children, and thus be more effective at promoting children's developmental growth. Subjects were 47 mother-child dyads from 36 programs in 5 states. The majority of the sample likely received developmental activities individually tailored to the unique characteristics of their child and which were designed to accelerate all domains of child functioning. Mothers completed the Family Focused Intervention Scale, which assesses the frequency of services that families receive in several domains. Cluster analyses were used to sort the sample into two differentiated samples, high and low service groups on two clusters, comprehensiveness of services that mothers received and responsiveness of the program to family needs. Assessment of parent-child interaction on the Maternal Behavior Rating Scale and family functioning were collected at the beginning and end of the 12-month period. There were no changes, pre to post in children's rate of development. Analyses of these data as function of the family-centered orientation of services indicated that neither of the components of family-centered service assessed in this study had a significant impact on encouraging mothers to modify their style of interacting with their children and on enhancing children's rate of developmental growth. This study provides an example of an intervention evaluation where there was no observable acceleration of children's development over a 12-month period. Even though it was thought that parents would become more engaged or more effective in interacting when provided a wide array of supports, there was no evidence to support this assumption. Over the study period, parents' style of interacting with their children remained unchanged regardless of the intensity of family-centered services received.