Early Head Start and Developmental Disabilities Craig T. Ramey, Ph.D. Georgetown Distinguished Professor of Health Studi

1. Early Head Start and Developmental Disabilities Craig T. Ramey, Ph.D. Georgetown Distinguished Professor of Health Studies Director, Georgetown Center on Health and Education EHS Disabilities Summit Washington, D.C. February 5, 2004

2. Eager to learn Ask lots of questions Work hard and know effort matters Have good social-emotional skills Can assess their own skills well Parents are role models for learning Parents promote learning at home Family routines support doing well in school Parents set and maintain limits Schools have high student expectations, support teacher development, and communicate frequently with parents 10 Hallmarks of Children WhoSucceed in School Ramey & Ramey, Going to School, 1999

3. Good health is the foundation for learning, development and school success.

4. The developmental domains of health, cognition, social and emotional development are closely linked by neurobiological connections and personal experiences.

5. WHO Definition of Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

6. Health Promotion and Disease Prevention Promotion of mental health mentoring in cognitive, social and emotional basics responsive language experiences stable and caring adults good role models

7. Health Promotion and Disease Prevention Promotion of social well-being Safe environments Enjoyable play and learning activities Supportive, informative and frequent interactions with parents and other adults

8. Some Facts about Developmental Disabilities Majority of children with intellectual, social and emotional disabilities are born healthy Biological risk conditions(e.g., LBW, prematurity) result in different outcomes, depending on cognitive, social and emotional support About 11% of children are in special education Ethnic and regional differences in developmental disabilities are poorly understood

10. Seven Essential Transactions ForCaregivers with Young Children Encourage exploration Mentor in basic skills Celebrate developmental advances Rehearse and extend new skills Protect from inappropriate disapproval, teasing, and punishment Communicate richly and responsively Guide and limit behavior Ramey & Ramey, 1999 Right from Birth

11. Sources of Available Support for Early Intervention Funding • Elementary and Secondary Education Act: Title I: Disadvantaged Children Title V: Innovative Block Grant • Early Head Start • Head Start • Child Care Development Fund (CCDF) • Temporary Assistance for Needy Families (TANF) • Early Reading First • Social Services Block Grant • Even Start • Early Intervention (0-2 yrs; 3-5 yrs)

12. Psychosocial Developmental Priming Mechanisms • Encouragement to explore the environment • Mentoring in basic cognitive and social skills • Celebrating new skills • Rehearsing and expanding new skills • Protection from inappropriate punishment or ridicule for developmental advances • Stimulation in language and symbolic communication

13. Potential Levels of Early Intervention Developmental of Biomedical affordances Prenatal and perinatal services Children’s direct learning opportunities Development of family skills Development of professionals’ knowledge and skills Development of community and cultural norms concerning inclusion

14. Statement of the problem • For a variety of reasons, the early years are believed to be the most efficacious period to intervene in the lives of poor children. • Development appears to be more malleable in the early years. • Children who arrive at kindergarten lacking basic readiness skills tend to fall further behind in later years. • Massive attempts to prepare poor children for school success, such as Head Start, were initially disappointing. • Research was needed to learn whether intensive early intervention that began in the infancy period could make more lasting difference for poor children.

15. Stages for the Development of a Scientific Knowledge-Base Proof of concept studies Efficacy studies Effectiveness studies Efficiency studies

16. Hierarchy of Criteria for Evidence-based Practices Multi-site randomized controlled trial Single site randomized controlled trial Single site randomized trial (not controlled) Case/control study Observational study Opinions of best practices

17. Key Research Question for Abecedarian (ABC) Project Can the cumulative developmental toll experienced by high-risk children be prevented or reduced significantly by providing systematic, high-quality, early childhood education from birth through kindergarten entry?

18. The Abecedarian (ABC) Project is a randomized controlled trial (RCT) that tests the efficacy of early childhood education for high-risk children and their families.

19. ABC Eligibility • Recruitment in community agencies serving poor women • High Risk Index • Other criteria • Healthy newborn child • Living within commuting distance of FPG • Likely to remain in area

20. Who was invited to take part? • 120 families invited to enroll • 8 refused random assignment • 2 infants reassigned at insistence of authorities • 1 ineligible due to biological condition (seizure disorder with moderate MR)

21. Participants • 4 cohorts of children born between 1972 and 1977 • Half randomly assigned to preschool education program, half were controls • Original Sample N Males Females • Treated 57 29 28 • Control 54 23 31 • Total 111 52 59

22. Study Design EE E EC 29 Males 28 Females R 23 Males 31 Females CE N=111 C CC Follow-up Assessments Preschool Treatment Ages 0-5 Preschool Treatment Ages 0-5 School-age Treatment Ages 5-8 Age 12 Age 15 Age 21

23. Educational Intervention • Very intense • Full day childcare program • 5 days/week • Year round • Began in infancy (mean entry age: 4.4 months, range: 6 weeks to 6 months) • 5 years, until kindergarten entry • University-based setting • Medical care on site • Stable staff • Low adult : child ratios • 1 : 3 infants • 1 : 4–5 toddlers • 1 : 7 preschoolers

24. PreschoolCurriculum • Eclectic in nature • Stressed contingently responsive early environment for infants • Learningames for the First Three Years(Sparling & Lewis, 1979, recently reissued) • Natural part of infant’s or toddler’s day • Learningames for Threes and Fours: A Guide to Adult and Child Play(Sparling & Lewis, 1984)

25. Key Abecedarian (ABC) Program Components Health and Mental Health Nutrition Family Support Parent Involvement Early Childhood Education

26. Preschool Results • Tests of cognitive development constituted major outcome during early years • Infants equivalent at outset (3 month Bayley MDI scores) • Cognitive measures • Bayley Scales of Infant Development • 3–18 months • Stanford-Binet Intelligence Scale (Form LM, 1972 norms) • 2–4 years • Wechsler Preschool & Primary Scale of Intelligence • 5 years

27. Preschool Test Scores

28. Percent of Abecedarian Sample in Normal IQ Range (>84) by Age (longitudinal analysis) Martin, Ramey, & Ramey, 1990 American Journal of Public Health

29. Positive Effects on: IQ Performance Learning & cognitive performance Social responsiveness Language development Decreased Effects: Incidence of intellectual disability Resilience to biological risk conditions Maternal education Maternal employment Ramey & Ramey, 1999 Brief Summary of Abecedarian ResultsDuring Preschool Period

30. School-Age Program EE E EC R CE C CC Follow-up Assessments Preschool Treatment Ages 0-5 Preschool Treatment Ages 0-5 School-age Treatment Ages 5-8 Age 12 Age 15 Age 21

31. School-Age Program • Home-School Resource teacher (first three years of school) • Consultation with classroom teacher • Individualized curriculum items based on needs • Encouragement of parental involvement with home activities • Liaison between home & school • Family support as needed

32. School-Age Results • Reading Scores: • Strong preschool effect on reading scores at age 8 (p<.01) • Significant trend for EE>EC>CE>CC (p<.05) • No effect for school-aged treatment alone

34. School-Age Results • Trend for preschool effect on mathematics scores (p<.10) • Linear trend in mathematics scores not significant • No effect for school-age treatment alone

36. Long-Term Effects EE E EC R CE C CC Follow-up Assessments Preschool Treatment Ages 0-5 Preschool Treatment Ages 0-5 School-age Treatment Ages 5-8 Age 12 Age 15 Age 21

37. Long-Term Effects • Intellectual measures in the follow-up • Age-appropriate Wechsler scales administered • Full Scale IQ used in plots • Examiners unaware of earlier treatment/control status • Because school-age treatment had no effect, reverted to two-group model

38. Long-Term Effects on intellectual development

39. Long-Term Effects,continued • Treated children earned higher scores across time • Treatment/control group difference was greater during the early, treatment years • Slopes differ in treatment/post-treatment phases • Treated children differed from control children in rates of change during treatment years but not during post-treatment years • Both groups showed upward trends during the early years and declines in post-treatment years • Up to young adulthood, the group with early treatment maintained an advantage over controls.

40. Can we identify mediators of long-term treatment effects on cognitive development? • Early task orientation mediated effects of early treatment on test scores but effect size did not show much change when this factor was entered into the model. • Early verbal development accounted for much of the treatment effect on test performance, and in later years, wholly accounts for it.

41. Long-Term Effects,continued • Adding child and family characteristics to the prediction model • No significant effect for child gender • No significant treatment x gender interaction • Gender x time2 interaction reflects complex pattern of change in intellectual test performance of males and females over time

42. Long-Term Effects,continued • Females change more rapidly in early childhood • Females decline more sharply than males in early adolescence • Males decline more sharply than females in later adolescence

43. Long-Term Effects,continued • There is also a main effect for the HOME score • Main effect is moderated by a HOME x age interaction • Effect of HOME is stronger in the early years • Parental attitudes in early life did not have a significant effect on intellectual test performance. • No significant effects of mother’s marital status.

44. Long-Term Effects,continued Does a modest effect on IQ test performance matter? • The evidence indicates that the significant long-term effect of treatment on academic performance was mediated by its effect on early cognitive performance.

45. Long-Term Effects,continued Does a modest effect on IQ performance really matter? • Early treatment was associated with significantly higher scores on reading from age 8 to age 21

46. Long-Term Effects,continued Does a modest effect on IQ matter? • Early treatment was associated with significantly higher scores on math from age 8 to age 21

47. Long-Term Effects,continued Real-life benefits in young adulthood • Treated group attained more years of education • Treatment associated with increased likelihood of attending a 4-year college or university

48. Long-Term Effects,continued • Teenaged parenthood was less likely for those having preschool treatment.

49. Whatwas the early intervention worth? • Cost-benefit study was carried out at the National Institute of Early Education Research (NIEER) at Rutgers University • Leonard Masse and Steven Barnett

50. Cost of Abecedarian Program Compared with Others (1999 Dollars)