Module 1: Interaction: Plan

Cultural context has everything to do with responsive interaction intervention, since family members are often central to this approach to intervention. Values, expectations, and norms of interaction vary across cultures for children at different ages, and may also vary when children have disabilities.

Different views of what is appropriate and valued in children in general and in children with disabilities in particular will influence how we interpret what family members do with children, and will guide our own approaches to interaction and intervention. For example, how family members perceive their children's current and future abilities and roles may determine when, where, and with whom responsive interaction intervention should occur.

Cultural perspectives of intervention itself may influence how interventionists go about planning and implementing the intervention. For example, they may form the context for whether and how we use intervention strategies such as demonstrating, coaching, or modeling.

The whole idea of being sensitive and responsive can be a useful intervention guide here as well.

One tip is to learn about, through observation or discussion, with whom, when, and where the target child is most likely to engage in interactions with adults and with siblings or peers. With whom is the child most likely to engage in pleasurable interactions that have the qualities of turn-taking, whether verbal or non-verbal? Are there adult-child or child-child interactive games or other high-interest activities that are common in that family's cultural context that might provide the basis for responsive interaction intervention?

Many high-interest activities may already incorporate aspects of responsive interaction such as imitation and turn-taking, and can become the basis for intervention. In what other contexts do interactions naturally occur? Are there adult-child routines into which communicative opportunities can be embedded through using strategies such as waiting for attempts by the child?

A second tip is to observe the child during different types of interpersonal interactions, with the adult as an observation partner. When the child is engaged in activities in which s/he is interested, in adult-child games, or with another child, how does she respond? What is she feeling and communicating, and how do we know? How and when does she initiate or try to maintain interactions? Might some of these ways of initiating and responding be reflective of cultural norms, as well as of the child's individual differences?

Sharing observations with the adult can lead to better understanding of the child's interactions for both the family member and the practitioner, and can provide a better foundation for planning appropriate opportunities and interventions that respond to and support cultural context.

Before we talk about interactions to support young children with low incidence disabilities, let us first understand what low incidence disabilities mean. Low incidence disabilities include visual impairments, hearing impairments, deaf-blindness, orthopedic impairments, multiple disabilities, and traumatic brain injuries which account for 2 percent or less of those served under Individuals with Disabilities Education Act.

Children with low incidence disabilities learn and develop at varying rates and appear to follow different developmental sequence than their typical peers.

When working with or teaching young children with low incidence disabilities, it is important to note that their sensory inputs are altered—especially for children with visual impairments, hearing impairments, and deaf-blindness. Their sensory inputs may be:

• discrete — that is, they happen once
• fragmented — that is, not connected to each other, and/or
• intermittent — that is, they happen without being predictable

Children with low incidence disabilities often rely on Inductive learning. For example, children with visual impairment rely on tactual input, which means you can only feel so much as your little hands will allow at one time. Then they have to somehow put all these little pieces into a whole. This is the opposite of how other children learn—they see the entire object before breaking it down into pieces. It's a higher level skill to reason inductively.

In order to support learning of young children with low incidence disabilities professionals may provide concrete objects to teach a child different concepts. For example, in order to promote cognitive development, the visual impairment specialist may use a real dog to teach the child what a dog is by helping them touch its face, legs, nose, body, paws, etc. while making comparisons and talking about relationships. Then, she may use a stuff dog to tell the child about a whole dog.

Another challenge is that incidental learning is limited and cannot be relied upon for children with visual impairments or deaf blindness as they may be unable to copy or imitate others' visual gestures because they cannot see it. Similar difficulties arise for children with hearing impairments when imitating verbal sounds or with children with multiple disabilities when imitating motor movements.

To review another example, a speech language pathologist working with a child with multiple disabilities may use a communication device to assess a child's preferences and interests and use this knowledge to increase the child's engagement and promote interaction with peers during meal time.

The DEC Interaction Recommended Practices are the foundation for promoting the development of a child's language, as well as their cognitive and emotional competence. Interactional practices are the basis for fostering all children's learning. However, for children who have or at-risk for developmental delays or disabilities, these practices represent a critical set of strategies for fosteing social-emotional competence, communication, cognitive development, problem-solving, autonomy, and persistence.

We consider the first six years of a child's life as critical to his/her growth and development. However, we don't often recognize that this same period is also the most vulnerable period for young children. Young children are the most frequent victims of child maltreatment. Child maltreatment falls into a number of categories:

• There is Physical abuse, which refers to a non-accidental physical injury by a parent or another caregiver. This can include hitting, kicking, or burning.
• Another category is neglect. This refers to the failure of a parent or caregiver to provide for the child's basic needs, for example, food, shelter, supervision, medical care, and/or emotional nurturing.
• Another category is sexual abuse. This refers to not only forcing or coercing a child to engage in sexual activity, but also includes the exploitation of a child through pornography.
• Another category is emotional abuse. This usually is a pattern of behavior that hurts a child's emotional development. This can include constant criticism, threats, or withholding love.

There is a strong connection between disability and abuse. Meaning, if a young child experiences abuse, they have a higher likelihood of developing a disability or developmental delay. If a young child has a disability or developmental delay, they are at a higher risk for experiencing abuse and neglect. This connection is important when we think about supporting young children with disabilities.

When caregivers and parents foster protective factors, it can lessen the negative effects of maltreatment. Early childhood professionals can play a large role in this work by promoting a strong and secure emotional bond between children and their caregivers. This is critical for children's physical, social, and emotional development, including their ability to form trusting relationships, exhibit positive behaviors, and heal from past traumas. The healing process is not always a clear, straight path, and it does take time. Note many of these practices are good early childhood practices we recommend for all children—regardless if they have experienced abuse, neglect or trauma.

• Build strong connections with friends, families, and teachers that can support children during challenges, and teach them to think about and consider other people's feelings.
• Allow children to feel their feelings. Teach them how to describe those feelings, wether they be happy or difficult feelings.
• Be consistent. This will help you teach your child that people can be trusted.
• Be patient. Children's reactions to trauma vary as widely as the types of traumas one can experience. There isn't always one solution.

In lots of ways! Below, we'll talk about two case examples.

Let's consider Interaction Practice 1: Practitioners promote the child's social-emotional development by observing, interpreting, and responding contingently to the range of the child's emotional expressions. I'll give you the example of Oscar.

Oscar is a 5-year-old with Down syndrome who was removed from his biological family because of neglect, and recently was placed in a foster home. Oscar's preschool teacher called his foster home to explain that Oscar is regularly coming to school upset. For the past two weeks, Oscar enters the classroom in the morning crying, and doesn't actively participate in the classroom activities. Oscar's teachers decided to create a morning routine where she and Oscar have special one-on-one time reading a book in a quiet place to ease him into the morning routine, and to make him feel safe and secure. If Oscar's teacher just wanted to ignore this "needy" or "attention-seeking" behavior, she would not be meeting Oscar's needs. In this instance, Oscar's teacher needed not only to understand behavior, but she also needed to understand the context of Oscar's life in order to appropriately support him and his emotions in her classroom.

Let's consider Instructional [sic] Practice 2: Practitioners promote the child's social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support. I'll give you the example of Marina.

Marina was a typically developing 13-month-old living with her mother. While under the supervision of a babysitter one evening, Marina was scalded in a bathtub. Immediately after the incident, Marina was cared for in the emergency room. Shortly after that, Marina began receiving early intervention services. Marina's OT not only needed to understand child development and interaction, she also needed to understand the complex relationship Marina and her mother had because of this incident. After the incident, Marina's mother was extremely depressed and upset. Marina's mother felt any time Marina cried, it was her fault for "not taking better care of her". While Marina's mother had good intentions, Marina's OT had to delicately explain why it was a good thing Marina would cry to express her emotions. In this instance, supporting interactions required knowledge of child development, as well as understanding the emotionally taxing situation the parent was going through. If the OT ignored this, her interactions and approaches could have been, at best, ineffective, and at worst, inappropriate for Marina and her mother.

No two cases of child abuse and neglect are alike. Every child and family will require flexibility, responsivity, and astuteness.

We have included some resources that will support your work with young children with disabilities who have experienced abuse and neglect.

The role that typical peers played in my daughter's early education program made a huge impact on the growth we were able to see in my daughter's development. I was not able to anticipate the impact beforehand. But taking that leap of faith, coupled with a great early educator, our daughter had a wonderful experience.

Peers provided my daughter with an example of what a child her age might be doing. The goal wasn't for that peer to be an example, or even set the standard for how my daughter should be, but it was a person with whom my daughter had something in common—their age. It is important to note that while peers serve a wonderful benefit for children with disabilities, there is also a benefit for children without disabilities, as well.

The kids just had welcoming, and accepting heart! They genuinely wanted to just play with my daughter. And my daughter could check out what kinds of things they were doing. And her natural desire to connect and remain connected was a natural motivator for her to do some of the things we wanted to see her do.

The teacher made all of the difference! While a special educator, the teacher was simply a good, open-hearted person who valued all of the children equally. It was so obvious! While she valued them all equally, she was also able to recognize and gladly meet each of their unique needs.

My daughter's teacher convinced me that we should embark on the journey of potty training my daughter, and we succeeded! The teacher led the way. She would provide cues when other students asked to go to the bathroom. She said things like "Look at Katie. She has to use the bathroom. Do you need to use the bathroom?" This pointed out action, and also an opportunity to enhance communication.

Over the course of the school year, things we wanted to see happen began happening, and equally important, my daughter was making friends.

At those young ages, play is the great equalizer. All kids want to play, and that is how essential skills and social interactions are fostered. All kids can be shy. Adults have to keep an eye out for any child—whether they have a disability or not—who seems to be excluded. That exclusion could be resulting from their own withdrawal, or the exclusion could be happening because the students need help with how to connect with an individual child. But the most important ingredient is for the culture of the classroom to already be established as one that is welcoming, accepting, respectful, and kind.

We were able to see our daughter help cultivate even greater empathy, compassion, and confidence in the children who had no disabilities. Our daughter always had great manners. She was able to model things like saying please and thank you for other kids!

One thing that I can see now is that early childhood settings and schools are the starting place for connections to happen. For those benefits to be long-lasting, those connections have to be cultivated outside of the school setting into other areas of life. Birthday parties, playdates, and other community activities should be encouraged, so that there is a long term benefit that can be realized.

But even if the relationships with the people she met early didn't last, the skill of making friends and being in new settings has remained. I can see my daughter's willingness to meet new people, to not shy away from a new experience, and to make connections. She is very empathetic, so she is able to bring a positive energy to people and experiences.