김자경2002 학습장애 위험아동 조기진단 및 중재필요성 (1)

정서 학습장애연구
Journal of Emotional Disturbances & Learning Disabilities
2002, Vol. 18, No. 3, pp. 175∼191.
14)
Early Childhood Identification and
Intervention for At-Risk Children with
Learning Disabilities*
학습장애 위험아동을 위한 조기진단 및 중재의 필요성
Kim, Ja Kyoung**
<초 록>
최근 들어 특수교육의 전반에서는 조기진단과 중재의 필요성에 대해 강
조하고 있다. 그러나, 학습장애는 일생전반을 통해 나타나는 장애임에도 불
구하고 학습에서의 장애가 주된 특성인 관계로 학령기에서의 진단과 중재에
주로 치중하는 경향을 가진다. 본 논문에서는 학령기 이전 학습장애의 가능
성을 가진 아동을 ‘학습장애 위험아동’이라는 용어로 지칭하면서, 학습장애
조기진단의 필요성을 고찰하고 이를 위한 접근방안을 살펴보았다. 또한, 학
습장애 조기중재의 장점과 바람직한 중재 및 서비스에 대해 논의하였다. 마
지막으로 이 분야에 대한 향후 연구에 대해 언급하였다.
Key Words : At-risk Children, Learning Disabilities, Definition, Early Childhood.
During recent years, early childhood programs for children with disabilities
have grown. The early childhood years are crucial for all children; but the
years from infancy to entry into school are now considered critical time for
* 이 논문은 2001년도 조선대학교 학술연구비의 지원을 받아 연구되었음.
** 조선대학교 특수교육과 교수(E-mail; jkyoung@chosun.ac.kr).
Dept. of Special Education, Chosun University.
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정서·학습장애연구(제18권 제3호)
overall development, especially for youngsters with special needs. Existing
studies indicate that preschool intervention for exceptional youngsters leads
to significant improvement in development and learning (Guralnick, 1997;
McCormick et al., 1992; Rothenberg, 1990; Schmuel & Rubinroit, 1988).
However, most studies focus on short-term effects rather than look at
long-term impacts. There is a clear need for longitudinal studies to identify
risk factors and develop adaptive programs.
Surprisingly, first grade has one of highest retention rates (Slavin,
Karweit & Wasik, 1991). There is no doubt that many at-risk children with
learning disabilities(LD) are included in the rates. To prevent this early
failure, effective early intervention should be given to at-risk children with
LD. Nevertheless, the field of learning disabilities was seldom included to
early intervention because of its nature. As a matter of fact, U.S. Department
of Education (2000) indicates that most children with learning disabilities are
not identified until ages 9 through 14. For that reason, this paper applied
at-risk children for learning disability to early childhood intervention and
looked at perspective need of early childhood intervention on the future.
This paper presented a history of early childhood intervention, the
definitions of early childhood intervention, definitions of at-risk children for
learning disabilities, the advantages of early childhood intervention, the
services of early intervention, and implications for educators were discussed.
A Historical Study
The field of early childhood education has experienced the significant
growth in services and programs. The growth in early childhood intervention
has been strongly influenced by legislative acts and mandates to provide
services to children with disabilities and their parents (Bailey & Wolery,
1992; Mapes et al., 1988).
The first awareness of addressing the special needs for younger children
was with the initiation of Head Start in 1965. Head Start was established to
serve young children (age 3 to 5 years) from disadvantaged environments
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Early Childhood Identification and Intervention for At-Risk Children with Learning Disabilities
(Mapes, Mapes & Lian, 1988).
In 1974, the Economic Opportunity Act (P. L. 93-644) required that at
least 10% of the enrollment in Head Start programs should be provided to
children with disabilities (Bailey and Wolery, 1992; Mapes et alli, 1988).
According to Bailey and Wolery (1992), more than 13% of the children with
some types of disabilities were served in Head Start program. Sixty six
percent of those students were speech impaired. Very few other disabilities
were served.
In 1975, P. L. 94-142, the Education for All Handicapped Children Act,
mandated free and appropriate public education for children with disabilities
age 3 to 5 years unless the states' laws prohibited or made such services
permissive (Bailey & Wolery, 1992; Lerner et al., 1987; Mapes et al., 1988).
P. L. 94-142 brought major force in providing educational services to young
children with disabilities and in extending the services to all ages three
through twenty-one in states with supporting legislation (Lerner, Czudnowski
& Goldenberg, 1987).
In 1986, P. L. 99-457 was passed and this legislation extended all of the
right and protection of P. L. 94-142. However, there was still no legal
support for age extensions to the infants and toddlers until P. L. 99-457.
Since the passage of P. L. 94-142, under the influence of the age extension
of the law to mandate services for three to five year olds, the infants and
toddlers became one of major interest to special education advocates (Mapes,
Mapes & Lian, 1988). In response to the public interest, P. L. 99-457
provided incentives to states for the development of programs for educating
toddlers age birth through two (Lerner, Czudnowski & Goldenberg, 1987;
Mapes, Mapes & Lian, 1988).
In 1990, P. L. 94-142 was amended by P. L. 101-476, which renamed the
law to the Individuals with Disabilities Education Act (IDEA) and one of the
amendments emphasized "identifying and serving infants and toddlers in
need, facilitating the transition from medical to early intervention services,
promoting the use of assisting technology, and serving children exposed
prenatally to maternal substance abuse" (Bailey & Wolery, 1992; Haring et al
., 1992).
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Public Law 102-119, passed in 1991, reauthorized an extended Part H (the
infant component) of P. L. 99-457, and made some features regarding how
services are to be provided. Also, the role of family was recognized as
important in the child's development (Lerner, 1993). Although it has been a
relatively short period of time that federal and state governments has
accepted the mandate to provide early childhood education for children with
disabilities, there has been remarkable efforts in developing services and
programs for toddlers and preschool age children.
Definition and Benefits of Early Childhood Intervention
The term “ early childhood intervention” has been used to describe
various services provided to families and their young children with special
needs. The term carries many meanings depending on the purpose of the
intervention. Because of the unique characteristics and needs of each child
and family, there is no one service could meet the needs of all children.
Early childhood intervention includes not only education, but also health care
and social services (Hanson & Lynch, 1989). Thus, close connections among
medical specialists, psychologists, educators and other professionals are
essential to provide best intervention to young children with disabilities.
Lerner, Czudnowski & Goldenberg (1987) defined early childhood
intervention as a individually developed instruction for children, who have
been identified as disabled. It recognizes the importance of planning
individualized intervention for each young child and his/her family. An
individualized family services plan (IFSP) is required for infants and toddlers
with disabilities and their families. For preschooler with disabilities, either an
individualized education program (IEP) or an individualized family services
plan (IFSP) is needed.
To be an effective program, as the first step, a program provider (a
teacher) should consider an individual's strengths and weaknesses in
choosing and appropriate program (Hagin, 1983; Pickering, 1978; Ramey,
1988). There is no single approach as a panacea for the different needs
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presented by young children. Therefore alternative and modified methods of
intervention should be available (NJCLD, 1985). As the one of most effective
strategies, Slavin, Karweit & Wasik (1991) indicate that one-to-one tutoring
with well-trained certified teachers as tutors. There is no doubt that
one-to-one tutoring should be performed on the basis of individual
differences. For pre-kindergarten children at risk, programs through
child-directed and play-like activities are effective rather than teacher
directed and specific practice (McCormick et al., 1992). Early experiences
through high interest and positive activities help young at-risk children to
develop motivation and self-esteem which impact their learning.
There are several reasons why early childhood intervention is important
for children with disabilities. Research supports the benefits of early
childhood intervention for young children with disabilities. First, The effects
of the disabled condition can be reduced more easily with early intervention
(National Information Center for Children and Youth with Handicaps, 1988).
Early childhood intervention shows the best possible developmental progress
in young children. For example, if the environment is modified during the
critical early years, intellectual capacity will increase later on. Early childhood
intervention can not only increase intellectual capacity, but also provide
emotional and physical development (Baily & Wolery, 1992; Lerner, 1993;
Piazza & Rothman, 1979).
Second, early childhood intervention promotes actual gains in all
developmental areas. It helps young children to develop basic skills, such as
cognitive thinking, speech, language, motor skills and self-help (Kirk, 1987).
If these skills remain underdeveloped, failure in academic performance is
likely. Research done by Shulman & Rubinroit (1988) examined the effects of
early intervention adjusted three years olds. Children were give social
emotional treatment and cognitive enrichment over a certain period. As the
result, it was found that all the children improved on cognitive and social
emotional functioning.
Third, many researchers suggest that inclusive environments can provide
for successful performances for children with disabilities (Guralnick, 1990;
Safford, 1989; Salisbury, 1991). When children with disabilities are in
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inclusive environments, they usually display better social behavior and play
more constructively. While, children with learning disabilities typically have
difficulty in social interaction and exhibit immature behavior (Lerner, 1989;
Smith, 1989). It is not easy for those children to cope in inclusive
environments during their school age years. Early childhood is the time of
readiness for inclusion into regular school (Salisbury, 1991). Thus,
improvement in disabled conditions as well as working with inclusive
programs during this time will be helpful with inclusion in regular school
later. Salisbury (1991) indicated the importance of effective inclusive
programs for a preschooler. Inclusion during the early childhood years will
produce positive child outcomes in both academic and social skills later on.
Fourth, early childhood intervention helps to prevent secondary or related
disability. Children with learning disabilities suffer from academic deficits, as
well as social and emotional difficulties. Because they encounter so much
daily frustration, they usually develop a complexity of problems (Lerner,
1989). So, failure to remediate the primary problems may produce other
problems later.
Fifth, early childhood intervention also addresses the parent training need
of the family. Intervention programs helps parents to cope with the reality of
having a child with disability and to reduce possible stress in the family.
Also, the parents are provided information, knowledge and skills to enhance
the development of their special child. Casto & Mastropieri (1986) found that
positive parental involvement improves the effectiveness of early intervention.
Because parents could be effective teachers, parents must first learn before
they can teach. Then they are expected to work with their son or daughter.
Abbott & Sabatino (1975) also identified the effectiveness of having mothers
function as teachers through interaction with preschool teachers for their own
preschool academic-risk children. Early childhood intervention reduces the
burden to the family of caring for the special needs of child and children
who receive early intervention require fewer special education services during
the elementary school (Lerner, 1989).
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Defining At-Risk Children for Learning Disabilities
In the area of learning disability, early detection has been known as quite
difficult (Vaughn, Bos, Schumm, 1997). Although the effectiveness of early
childhood intervention for children with disabilities has been emphasized
during recent years, learning disabilities were seldom included because of
lack of definition and understanding of the disability (Kelly, 199). At the
school-age level, academic problems are the main factors in deciding and
labeling of a learning disability. Consequently, many people think that a
learning disability is a problem faced only school-age children and adults
(Lerner et al., 1987; Thurman & Widerstrom, 1990). In the field of early
childhood intervention, initial research has concentrated on severe and
sensory disabled conditions. Thus, learning disabilities were not seen as
urgent as other disabilities for rededication during early childhood.
There has been a lack of long-term studies in the field of early
intervention, particularly those in which adequate comparison groups have
been used (Rothenberg, 1990). Nevertheless a few researchers attempted to
approach a long-term study to examine effectiveness of early childhood
intervention for at-risk children with LD. Hagin (1983) examined the impact
of an early intervention for prevention of learning disabilities. The result
showed that early intervention reduces the number of nonpromotions and
improve academic performance during early school years. Keogh (2000)
demonstrated that early childhood intervention help at risk children improve
cognitive and behavioral function. Rothenberg (1990) also reports that most of
the students who participated in an early intervention program performed at
average or higher levels of academic achievement for eight years after the
intervention.
If parents and preschool teachers observed their young children carefully,
they may have found that young children at-risk for LD had difficulty in
performing some basic developmental skills and showed immature behaviors.
Pickering (1978) described development of an at-risk child for learning
disabilities, contrasted to development of an average child:
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1. Attention - An average child begins to develop inhibition control at 2
1/2 to 3 years of age and works with activities for period of 10 minutes or
longer. But, the at-risk child may have attention deficit and inhibition
control does not develop in a normal manner.
2. Coordination, gross motor - An average child walks, runs, hops, skips,
throws and catches ball by approximately 5 years of age. But, the at-risk
child often is clumsy in body movement and shows below normal limits on
specific skills such as skipping and learning to jump rope.
3. Fine motor - An average child cuts on a line, cuts out shapes, holds
pencil, maintains line and pressure, makes corners by 5 years of age, while
the at-risk child has difficulty maintaining a pattern of cutting. The motion
results in jerky, jagged cutting. Also the at-risk child has difficulty
maintaining a line, pressure and round corners.
4. Organization - An average child learns order and sequence by
imitation. But, the at-risk child has difficulty in ordering work tasks and
working in a sequential way.
5. Perception - An average child matches and discriminates sensory
information. Also an average child perceives patterns in shape, color and
numbers. But, the at-risk child has difficulty with discrimination of sensory
information noted.
6. Work Choices - An average child chooses a variety of work, and
proceeds to more difficult concepts. Whereas, the at-risk child chooses
simple work, avoiding work that is perceived as "harder".
7. Habits - An average child chooses his work, a procedure with
purpose, and replaces the work on the shelf, while, the at-risk child avoids
work. When the at-risk child chooses his work, he replaces it without using
the item, or leaves the work and wanders the room.
8. Cycle - An average child chooses one activity after another varying
the difficulty of choices. Yet, the at-risk child does not establish a true
cycle without the teacher's support.
9. Language Oral - An average child has a vocabulary of approximately
2,500 to 5,000 words and usage of this vocabulary or basic communication
with appropriate sentence structure. Whereas, the at-risk child has
vocabulary deficiencies seen in labeling, sentence formation and usage in
running speech.
10. Written language - If presented, an average child has mastered most
of the letters and basic sounds of the language. Often an average child
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begins to read by 5 years of age. The at-risk child shows inconsistency in
performance seen in learning letter symbols and sounds, and has difficulty in
perceiving the patterns of words.
11. Math - An average child gains number to quantity concepts, math
symbols, math concepts, and begins computation by 5. The at-risk child has
difficulty with number to quantity concepts, and difficulty with immediate
recall of facts.
12. Co-operative Behaviors - An average child cooperates with a teacher
and peers in a learning environment. But, the at-risk child is often seen as
stubborn, willful, immature or withdrawn in a learning environment.
According to Kirk (1987), a learning disability can be divided into two
categories: developmental learning disability and academic learning disability.
Developmental LD is regarded as difficulty in developing prerequisite skills
that a child needs to learn: attention, visual and auditory perception, memory,
thinking, language and motor skills. In general, it includes preschool children.
If children with developmental LD are not rededicated at an early age, they
will exhibit difficulty in learning the academic subjects later on.
Since 1962, with Samuel Kirk's effort to define the term “ learning
disability” , many educators, parents, and governmental agents have tried to
develop an appropriate definition of learning disability. Regardless of various
definitions, no one is sure of its exact meaning. Some people think that there
is lack of definition in LD (Kelly, 1990; Lerner, 1989). The federal definition
is considered as the most widely used one:
“ Specific learning disability” means a disorder in one or more of the
basic psychological processes involved in understanding or in using language
spoken or written, which may manifest itself in and imperfect ability to
listen, think, speak, read, write, spell, or to do mathematical calculations. The
term includes such conditions as perceptual handicaps, brain injury, minimal
brain dysfunction, dyslexia, and developmental aphasia. The term does not
include children who have learning problems which are primarily the result
of visual, hearing, or motor handicaps, of mental retardation, of emotional
disturbance, of environmental, cultural, or economic disadvantage (cited in
Lerner, 1989, p.7).
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On the other hand, Hammill (1990) recommended the definition proposed
by the National Joint Committee on Learning Disabilities (NJCLD) through
reviewing eleven representative definitions over the country:
Learning disabilities is a general term that refers to heterogeneous group
of disorders manifested by significant difficulties in the acquisition and use
of listening, speaking, reading, writing, reasoning, or mathematical abilities.
Theses disorders are intrinsic to the individual, presumed to be due to
central nervous system dysfunction, and may occur across the life span.
Problems in self-regulatory behaviors, social perception, and social interaction
may exist with learning disabilities but do not by themselves constitute a
learning disability. Although learning disabilities may occur concomitantly
with other handicapping conditions (for example, sensory, impairment, mental
retardation, serious emotional disturbance) or with extrinsic influences (such
as cultural differences, insufficient or inappropriate instruction), they are not
the result of those conditions or influences.
Both the federal and NJCLD's definition concerned about the young
at-risk children for learning disabilities broadened the definition because these
disorders are developmental in nature and occur during the life span of and
individual. While the first programs in special education concentrated on the
children in the elementary schools, the field is now expanding the ages at
both ends of the continuum.
Namely, learning disabilities are disorders not only found during the
school years, but also during the years of early development, the preschool
years, and adult life. Thus, at-risk children for LD are defined as youngsters
with deficits in speech and language development, reasoning abilities, and
other behaviors which are prerequisites for academic achievement later
(NJCLD, 1985). As noted earlier, learning disabilities may occur in individuals
of all ages. This fact supports the possibility of identifying at-risk infants
and toddlers for LD in the first two years.
Infants and toddlers from birth to three are influenced by the effects of
internal dysfunction predicted by biological risk such as low birthweight and
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prematurity (Turner & Wade, 1982). Babies with low birthweight and
prematurity are that some (but not all) have developmental delays, and many
are classified as high risk (Bailey & Wolery, 1992). According to the
longitudinal study by Carren et al. (1989), the data that indicates the
relationship between birthweight and exceptionalities showed many
lower-birthweight children (those weighing less than 2,500 grams) were
included in mild exceptionalities when they experience problems in school.
Moreover, large numbers of mild exceptionalities were identified as having
learning disabilities compared to other mild exceptionalities. Therefore, to give
better early childhood intervention to learning disabled children, birthweight
might be an important variable for determining learning disabilities. Above
all, the role of parents is the most valuable to identify and treat their babies
with special needs as earlier as possible.
However, labeling disabled conditions and children who have these
conditions has been controversial for a long time. It is especially problematic
for young children. Labeling of young children has the positive aspects of
helping the disabled children and their family to design appropriate services
and obtain needed legislation (Safford, 1989). However, the negative aspect
also cannot be ignored. Early labeling of children may contribute to the
development of prejudice toward them (Thurman & Thurman, 1990).
An accurate diagnosis of young children is extremely difficult because of
the uncertainty of one's developmental rate. A learning disability is not a
condition that can be reliably diagnosed in early childhood because it is the
most prevalent diagnosis of school-age children. Haring et al. (1992)
indicated that there is very little to gain and a great deal to lose from
labeling young children as having learning disabilities. Although we use
labeling the disabled condition to get legislative benefits, it is important to
look at individual problems that need to be addressed, rather than to look at
the labels. That is why young children who appear to have problems are
simply viewed as "at-risk" children (Lerner, 1989).
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Services of Early Childhood Special Education
When public Law 99-457 amended the special education laws to mandate
early childhood special education services in 1986, the extension of services
to be made available were in two categories: infants and toddlers and 3-5
year olds. Consequently, early childhood intervention programs fall in two
categories: age birth to two (infants and toddlers) and age three to six
(preschooler) (Lerner, 1989).
Services for young children with special needs are classified into three
groups: home-based, center-based, and combination home-and center-based
services (Lerner, 2003; Odom et al., 1988; Odom & Karnes, 1988).
Home-based programs are basically provided in the home as opposed to a
center. A professional child-care provider visits the home a number of times
per week or month, collects information about a child's skills. Then, the
professional either works directly with the child or trains the parent(s) how
to teach the skills.
In this type of program, the parents become the child's main teacher and
the professionals help the parents work with their child with special needs.
The home-based program promote teaching the child in a natural setting and
generalize the child's learning to the home environment (Lerner, 1993).
However, it may limit assess to therapists and other specialists. Also, it may
limit opportunities for social and communicative interactions with peers and
limit assess to various toys and specialized equipments (Odom & Iarnes,
1988). According to Odom & Karnes (1988), most states have chosen
home-based services for infants and toddlers.
In center-based programs, children attend a center for three to five hours
a day, two to five times per week. These programs provide comprehensive
curriculum in centers with experts in many related fields. In addition, they
may provide parent training and offer parent support group meeting. A
frequent consultation between parents and preschool teachers helps the
parents to function more effectively within educational systems (Hanson &
Lynch, 1989; Mccormick et al., 1992).
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Ramey (1988) examined the relationship between the parents and
preschool teachers, and found that the relationship between the two
influences on transition and adaptation of intervention content from preschool
to home environment. Center-based program has equipments, instructional
materials and toys that the child does not have in the home. Moreover, the
child can develop social skills by playing with peers (Lerner, 1993). However,
it may not generalize the child's learning to the home. Most children over 24
months are served in center-based programs, while very few infants involved
in these programs.
Programs may combine home-and center-based services depending on the
needs of the child and parents. For example, the child comes to the center
twice a week and a professional visits the child at home twice monthly. This
type of program is flexible, so it is useful for the child and parents with
unique need (Lerner, 1993).
Although there is research to show how early intervention was
approached to the child with special needs and the family, there is a need for
research in describing content of services and result of implementation. Also,
research needs to design new intervention programs to meet the needs of
parents in today society.
Based on the foregoing parts, the following recommendations in early
intervention are provided to help young children with special needs.
1. Systematic identification of individual strengths and weaknesses should
proceed before choosing an appropriate program.
2. Qualified personnel are necessary to implement a variety of
intervention strategies.
3. Families should be assisted in participating fully in intervention.
Teachers should develop strong relationships with parents and explain the
child's needs and details of the intervention.
4. Effective intervention should be provided to children based on
individual needs.
Above all, development of various programs and services are of ultimate
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importance. According to Odom & Karnes (1988), existing programs do not
have enough intensity to help development of young children with disabilities
effectively. Thus, intensive programs need to be developed.
Conclusion
As the focus on early childhood special education has been growing,
current research continues to show the effectiveness of early intervention.
Nevertheless, learning disabilities are not considered as much important as
other disabilities in the field of early intervention because of lack of
definition and understanding. After analyzing the research related to learning
disabilities, it is clear that at-risk children for LD can be identified through
the following: low birthweight, prematurity, and developmental discrepancies
of basic skills. To be effective programs, for each child and the family, the
program should be provided on the basis of the child's strengths and
weaknesses.
Services for young children are classified into three groups: home-based,
center-based, combination services. Home-based services are particularly
provided to infants and toddlers, while, center-based services are provided to
three-to six-year-olds. However, there are few longitudinal data that
describe any comparison among these services. It was found that ongoing
research needs to develop various intervention programs to meet the needs of
children with special needs and their families. Also, a professional should
assist the families, especially parents, to help them cope their situation and
work with their child. Moreover, it is important for researchers to continue
to concentrate on investigating at-risk factors and the effectiveness of early
intervention for at-risk children for LD and their families.
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【논문 접수: 2002. 10. 25. / 수정본 접수: 2002. 11. 27. / 게재 승인: 2002. 12. 7.】
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김자경2002 학습장애 위험아동 조기진단 및 중재필요성 (1)

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