Question 1

The primary purpose of early intervention (EI) is to:

Accepted Answer

The primary purpose of EI services is to identify infants and toddlers who may be eligible for services and to provide the necessary services to promote the family's ability to meet the infant's or toddler's special needs. The aim is to improve the physical, cognitive, communication, adaptive, sensory, and emotional capabilities of these infants and toddlers. The required components of the EI system are detailed in Part C of the IDEIA. Improvements in the legislation have occurred over time. Services for infants and toddlers were first included in the 1986 amendment to the legislation. Subsequent reauthorizations mandated more inclusive environments for the infants and toddlers with disabilities.

Question 2

Professionals must seek verbal approval from which of the following stakeholders to make a referral to the EI system for an evaluation?

Accepted Answer

Each state must establish a system to identify children who may be eligible for services and refer them to the EI system. Children with suspected developmental delays or a disability are identified through a variety of sources, including parents, occupational therapists, physicians, other health providers, and community agencies. Professionals must seek verbal approval from the parents to make a referral to the EI system for an evaluation. A central phone number (usually a toll-free number) is typically available for referrals. Occupational therapy practitioners often participate with other team members in community screenings to identify infants and toddlers who may be behind in their development and who can then receive further evaluation and interventions if needed from EI.

Question 3

To be eligible to receive EI services, a child must meet which of the following criteria?

Accepted Answer

Eligibility refers to whether or not the child qualifies, under the state's criteria, to receive EI services. States must serve children "who are experiencing developmental delays" in accordance with the state's definition of developmental delay and children with "a diagnosed physical or mental condition that has a high probability of resulting in developmental delay" (IDEIA, 2004, p. 100). States are also given the option to serve infants and toddlers at risk for developmental delay. Once written parental consent is obtained, the evaluation process is initiated. A variety of trained professionals can perform the evaluation. The evaluation scores and other information are used to determine eligibility for services. A specific level of developmental delay (such as 25%) in one or more developmental domains, or two standard deviations below the mean in any two domains, may serve to qualify the infant or toddler for services. Likewise, a diagnosis of a mental or physical condition associated with developmental delays may be used to establish eligibility. In some states, professional opinions of high risk may qualify the child.

Question 4

Which of the following individuals should be included in any early intervention evaluation?

Accepted Answer

Assessment instruments must not be culturally biased. Many states indicate a specific instrument as the assessment tool of choice and allow other informed clinical opinions to be expressed in writing to support the findings. Parents should be included in the evaluation process to provide information about the abilities of their child. Structured interviews and other informal assessments are used to understand family strengths, needs, and resources.

Question 5

The occupational therapist in early intervention plays which role?

Accepted Answer

Occupational therapy practitioners assume many roles in the EI system. They can be part of the evaluation team, conduct screenings in the community, provide direct services, provide consultation to other team members in a transdisciplinary model, or fulfill any combination of these roles (American Occupational Therapy Association [AOTA], 2015c). The occupational therapist working in EI needs to have good background knowledge of assessment tools for very young children and common therapeutic interventions. Occupational therapy practitioners support and promote the development and engagement of infants, toddlers, and their families or other caregivers in everyday routines that include play, rest and sleep, activities of daily living, education, and social participation.

Question 6

The individual on the early intervention team who acts as a consultant to the parents and service providers is known as the:

Accepted Answer

The service coordinator functions as a consultant to the parents and service providers. The service coordinator may be involved in training parents and other family members and professionals, coordinating appointments with professionals, participating in the team IFSP process, and establishing links with service providers. In addition, the service coordinator assists the family in planning for the transition to public school or other settings when the child is 3 years of age. The service coordinator is responsible for implementing the IFSP. An occupational therapy practitioner could also serve in the role of the service coordinator, which would decrease the number of professionals involved.

Question 7

This example demonstrates what type of question in a parent interview? "I have noticed how carefully you position your child's head and arms when you place him in the infant seat. This is great. Do you do this in any other tasks as well?"

Accepted Answer

During the interview with the parent, the message that families are competent and in control of their child's life must be conveyed. One way to do this is to ask solution-focused questions (Andrews & Andrews, 1993). Solution-focused questions are worded such that they assume the family is already working toward improving the situation, giving the family credit for their efforts. For example, "I have noticed how carefully you position your child's head and arms when you place him in the infant seat. This is great. Do you do this in any other tasks as well?" Another example is "Turning off the TV during feeding really seemed to help your daughter concentrate on feeding. Have you noticed other things you do that help her pay attention?" Important information, as well as trust building, can be gained from this approach.

Question 8

During observation, which of the following is an example of amplification?

Accepted Answer

The concept of amplification may be a useful strategy for occupational therapy practitioners. Amplification is a process of "noticing, describing, and discussing an interactive event between family member and child that is likely to promote child change" (Andrews & Andrews, 1993, p. 42). This means that the occupational therapy practitioners discuss observations with the family regarding any communication attempts the child makes and the responses of the parents that reinforce the child's behavior. This encourages the parents to notice and respond to nonverbal communication attempts. For example, during lunch, the occupational therapy practitioners might comment, "I just saw your child look to you and move his head toward the spoon. Try placing the spoon just in front of his mouth again this time, and see if he moves that way again." This encourages the parent to attend to nonverbal communication and reinforces the child's efforts. This may be the first recognition of interaction, which can facilitate bonding between the child and parent.

Question 9

Which of the following early intervention assessments is helpful to practitioners who work with infants up to the age of 4 months?

Accepted Answer

The Newborn Behavioral Observations (NBO) assessment is helpful to practitioners who work with newborn infants up to the age of 4 months (Nugent, Keefer, Minear, Johnson, & Blanchard, 2007). This is an individualized, infant-focused, family-centered assessment for use in examining communication and interactions between infants and parents. This assessment consists of 18 neurobehavioral observations that describe the infant's capacities and behavioral adaptations. It is designed to help parents identify the infant's unique capabilities and vulnerabilities. Occupational therapy practitioners can help parents learn to understand and interpret the infant's behaviors so parents can in turn respond in ways to meet their child's developmental needs.

Question 10

An example of a family-centered approach when supporting children with difficulties in sensory processing is to:

Accepted Answer

A family-centered philosophy is based on the assumption that the parents know best. This philosophy is consistent with occupational therapy practice to promote meaningful family engagement (Stoffel et al., 2017). The parents, viewed as partners with the service providers, are expected to be advocates for their child. The role of service providers is to meet the needs of the family by providing the information and instruction designated as important by the parents. Accepting parental reports as reliable information, allowing parents to help define goals, letting parents lead the discussions, and allowing parents to have questions ready for the team to problem- solve together are all aspects of family-centered care. Reynolds and Andelin (2018) discuss caregiver-focused interventions, including coaching, developing home programs, and home modifications, as an integral part of supporting children with difficulties in sensory processing.

Question 11

Which level in the hierarchy of parental involvement, representing a continuum from passive to active participation, is described here: The family views themselves in a reciprocal interaction and decision-making process with the health-care providers.

Accepted Answer

Simeonsson and Bailey (1990) identified a hierarchy of parental involvement, representing a continuum from passive to active participation, for EI. Families will fluctuate in the levels, depending on the environmental demands and their coping abilities at the time. At the lowest level is elective noninvolvement, in which the family chooses not to be involved in the child's care. Information seeking is another level of involvement, in which the family focuses on gathering information and developing skills. Partnership is when the family views themselves in a reciprocal interaction and decision-making process with the health-care providers. At the highest level, the family assumes the role of advocacy for their child. Some families may need the help of the occupational therapy practitioner or other professional to teach them how to be advocates for their own needs and empower them to make decisions for themselves and their child. Identifying the level at which the family is functioning at a given time will assist the occupational therapy practitioner in determining appropriate caregiving roles within the family. Research has indicated that families consistently reported positive perceptions of family-centered and routine-based approaches in EI (Kingsley & Mailloux, 2013).

Question 12

Typically, food neophobia resolves around the age of:

Accepted Answer

Food neophobia is a fear of new foods. Many children between the ages of 2 and 3 years exhibit this behavior, but it diminishes by age 5 (Ernsperger & Stegen-Hanson, 2004). Howe and Wang (2013) reported that behavioral interventions were effective at leading to the acceptance of a variety of foods, improving mealtime behaviors, increasing weight gain, improving caloric intake, promoting self-feeding skills, and decreasing caregivers' stress. Children with food selectivity accept a very limited number of foods; may avoid entire food groups; may avoid specific textures, temperatures, or flavors; or may refuse to eat foods that are not presented in the same manner, such as the size, shape, or type of plate. Complete evaluation of the sensory system and sensory preferences is warranted to determine if hyper- or hyposensitivities are part of this problem.

Question 13

Once a young infant is comfortable with a soft baby toothbrush that fits over the adult's finger, what tool should the OT transition parents to using to help with oral care?

Accepted Answer

Young infants can be introduced to a soft baby toothbrush that fits over the adult's finger. This is used for sensory stimulation of the gums and cleaning of the gums and emerging teeth. Next, a NUK brush set is introduced to get the infant used to longer, brush-like instruments being placed in the mouth. This includes a set of three instruments that start out larger and round and end with one resembling a toothbrush. Once this is tolerated well, the child can be transitioned to a regular, soft child-sized toothbrush. Most children under the age of 6 do not have the dexterity to adequately brush their teeth. Children should be encouraged to participate by holding and moving the toothbrush; however, an adult needs to go over the entire mouth area to provide adequate cleaning. A child who is willing to use a battery-operated toothbrush may do a more thorough job. Children need to establish dental hygiene routines as part of their daily self-care skills.

Question 14

Which of the following assessment tools focuses on assessing the ADL of dressing in young children?

Accepted Answer

A thorough evaluation and an understanding of the dressing routines will help the occupational therapy practitioner provide the appropriate interventions and expectations for parents. Many evaluations for children under age 3 include adaptive skills as components, such as the Hawaii Early Learning Profile-Revised (Furuno, O'Reilly, Hosaka, Zeisloft, & Allman, 1997), the Early Learning Accomplishment Profile (Glover, Preminger, & Sanford, 1988), and the Carolina Curriculum for Infants and Toddlers (Johnson-Martin, Attermeier, & Hacker, 2004). The Pediatric Evaluation of Disability Inventory is useful for children 6 months up to age 7 and evaluates self-care, social, and mobility skills (Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992). The Wee-Fim includes two versions that evaluate self-care, mobility, and cognition (Hamilton & Granger, 2000).

Question 15

What is a key consideration with promoting toilet training?

Accepted Answer

Positioning is a key component of potty training. The youngest children are often placed on small, stable floor-sitting potty chairs, as the standard in-home toilets are too high. Children with motor delays and abnormal tone will need the occupational therapy practitioner to evaluate positioning needs for the potty chair. Adaptations may need to be made to a commercially available chair, or a customized potty chair will be required to promote the correct sitting alignment. Often a tray is helpful to provide some arm stability, which can assist with sitting up, and is useful to place communication cards or devices on to indicate when "all done." At times, trays are helpful to restrict the child's access to touching the feces.

Question 16

Identify a key component of the Greenspan Floortime Approach.

Accepted Answer

The Greenspan Floortime Approach is an intervention method to improve reciprocal social interactions between parents and children, with emphasis on children with autism (Greenspan, 2018). Floortime is an evidence-based intervention that has been shown to strengthen fundamental communication and relationship abilities for children with autism and other special needs (Casenhiser, Binns, McGill, Morderer, & Shanker, 2015). Key components include getting down on the floor to the child's level and meeting the child at his or her developmental level. Parents receive coaching and learn to include three principles: (a) follow the child's lead so you enter his or her world, (b) challenge the child to be creative and spontaneous, and (c) expand the actions and interactions using multisensory preferred toys. Over 100 articles, several books, and web-based resources are available to train professionals and parents in the Greenspan Floortime Approach. Many occupational therapy practitioners working in EI have been trained in this relationship-building approach and incorporate these strategies into play sessions.

Quiz 9: Early Intervention Programs Introduction