From Early Intervention Practices Around the World, by Samuel L. Odom, Ph.D., Marci J. Hanson, Ph.D, James A. Blackman, M.D., M.P.H., & Sudha Kaul, Ph.D

Copyright © 2003 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Three-year-old Taly wandered around the room aimlessly, touching various objects or looking at them in a fleeting manner. Taly's father tried to play with her, as he was asked to do by the educational counselor. He pulled a book off the shelf, sat down on the carpet, and tried to seat Taly close to him, preparing to read to her. Taly had no intention of sitting, let alone listening to the story. Her father tried again to engage her, pulling out a basket with toys and dumping its contents on the floor. Taly moved closer to the objects, taking one toy after another and dropping them immediately. Her father offered a little ball; Taly took it but quickly lost interest. Taly kept looking around the room. She then came close to her father, pulled him toward the door, and mimed her wish to leave.

Her father said that this was typical of Taly's everyday behavior, except that at home she is hard to manage and has tantrums when she does not get what she wants. Taly's parents were primarily concerned about her poor language development. They were following the advice of Taly's pediatrician: Stimulate Taly by showing her many items such as concrete objects and toys or pictures in books.

The overall objective for Taly's intervention program was to help her develop a set of needs (i.e., the need to focus on things and perceive them clearly, to find the meaning of what is perceived, to link or associate between things, to plan before doing, to finish tasks, and to experience success). The concept of need is essential for understanding the intervention. The objective of the Mediational Intervention for Sensitizing Caregivers (MISC) intervention is to affect a child's need system. All other objectives, including development of understanding or skills, are only secondary to the effect on the need system that will enable Taly to

• Learn from new experiences (i.e., be driven by the need to focus on things and see, hear, smell, taste, and feel them clearly; to assign significance to things; and to relate or associate things and obtain more information about them beyond what is perceived through the senses)
  
  
• Seek approval and experience success in meaningful social contexts
  
  
• Plan ahead to regulate her behavior to experience success in meaningful social contexts
  

This multifaceted objective was met through improving the quality of Taly's interaction with others, specifically through the quality of teaching behavior (mediation) she received.

Taly was videotaped while interacting with her parents at home during play and during other caregiving situations. In a series of meetings with Taly's parents, practitioners analyzed these videotapes. Profiles of mediation were constructed and shared with her parents along with information regarding Taly's general development (language guage, cognitive, emotional, and motor), likes and dislikes in relation to her sensory integration dysfunction, and temperament.

At each meeting with Taly's parents, the practitioners used the videotaped interactions to identify one or more basic criteria of a quality interaction with very young children. The meetings with Taly's parents began with the practitioners providing encouragement (mediating competence) regarding some components of the taped interactions with Taly (e.g., the parents' concern about her development, their efforts to focus her attention). Based on the videotaped sessions, instances in which Taly attended to or looked at something — even briefly — were noted and discussed in relation to the parental behavior preceding or following it. In future meetings with Taly and her parents, the focus shifted to combining developmental landmarks, child-specific characteristics and difficulties, and criteria of quality interaction and mediation. The practitioners continued encouraging Taly's parents to invest in the process of quality mediation (as opposed to fragmented stimulation). The intervention was based on the ongoing interaction processes with Taly in her natural environment. All Adults interacting with Taly at home and at her child care program participated in the intervention.

Following eight meetings with Taly's parents and three meetings with the staff at Taly's child care program, significant changes were noted in Taly's interactions with her parents and with her child care providers and peers. Her parents and caregivers have learned to refrain from using fragmented stimulation and an over-didactic approach, which led to focusing Taly's attention repeatedly without actually making any use of the attention captured. Instead, they were following Taly's lead by choosing objects or activities that she selected, sustaining her attention, and prolonging episodes of joint attention by expressing affect and associating things with meaning (e.g., "Wow, what a beautiful bird"). Taly's social engagement, level of play, and interest in the world around her improved considerably, leading to significant developments in her communication and language skills. She is now on her way to having skills that match those of typically developing children.

(A volume in the International Issues in Early Intervention series.)