ACF OPRE: Early Head Start Research and Evaluation Project (EHSRE)

F. DISABILITIES AND DEVELOPMENTAL DELAYS AMONG EARLY HEAD START CHILDREN

The most commonly diagnosed problems that were reported by Early Head Start parents and could indicate potential functional disabilities were those involving speech (7 percent), hearing (3 percent), and vision (3 percent). Altogether, 12 percent of parents ever reported that a doctor had ever told them that their child had a vision, hearing, or speech problem by 28 months after enrollment (Table 3).

When asked to describe their child’s sight, hearing, and use of arms and legs and to compare their child’s communication abilities with those of other children about the same age, trouble with communication was the problem most often reported by Early Head Start parents. In the follow-up interviews completed an average of 16 and 28 months after enrollment, about 2 percent of parents reported that their child did not hear normally (Table 4). Similarly, at each point, 2 percent of parents reported that their child did not see normally. Only 1 percent of parents reported that their child did not have normal use of arms or hands, and the same proportion reported that their child did not have normal use of legs or feet. In contrast, 10 to 11 percent of parents reported in each follow-up interview that, compared with other children about the same age, their child had trouble communicating his or her needs to parents and others.

TABLE 4
FUNCTIONAL DISABILITIES AMONG EARLY HEAD START CHILDREN
	16 Months After Enrollment	28 Months After Enrollment	Ever by 28 Months After Enrollment (*or by Age 3)
Percentage of Children Reported by Their Primary Caregiver to Have:
Diagnosed or suspected hearing problem	2.1	2.2

Diagnosed or suspected sight problem	1.7	2.3
Eyeglasses prescribed	0.8	1.0

Trouble communicating	9.1	8.9	17.1
Lot of trouble communicating	1.4	0.8
No communication	0.5	0.4

Reached developmental milestone of talkinga	83.0	98.1
If child says words yet, he/she is:
Very easy for others to understand	32.5	47.8
Fairly easy for others to understand	40.2	33.5
Somewhat hard for others to understand	19.4	15.7	36.9
Very hard for others to understand	7.9	3.0	36.9

A little trouble using arms or hands	0.5	0.3	1.0
A lot of trouble using arms or hands	0.1	0.2
No use of arms or hands	0.3	0.1

A little trouble using legs or feet	0.9	0.6	1.8
A lot of trouble using legs or feet	0.5	0.5
No use of legs or feet	0	0.1

Uses equipment to get around	0.3	0.2

A physical condition or impairment that limits normal childhood activities	3.8	5.8	7.6

Percentage of Children Ever Diagnosed witha Cognitive Delay or Low Bayley Mental Development Index Scoreb	NA	NA	17.5*

Percentage of Children Ever Diagnosed witha Behavior Problem or High Score on Behavior Problems Checklistc	NA	NA	8.5*

Sample Sized	947-954	1,070-1,076	936-1,075

Source: Parent Services Follow-Up Interviews (PSIs) completed an average of 16 and 28 months after enrollment for families who completed the 28-month follow-upinterview.

NA = not available.

aOn average, children were 20 months old when the 16-month PSI was completed and 32 months old when the 28-month PSI was completed.
bDoctor told parent that child had a developmental delay or child received a score below 70 on the Bayley MDI conducted at 14, 24, or 36 months of age.
cDoctor told parent that child had an emotional disturbance or child received a score above 18 on the Child Behavior Checklist: Aggressive Behavior subscale at 14, 24, or 36 months of age.
dRange reflects minimum and maximum sample sizes for items in table.

Not all these problems interfered with children’s participation in normal childhood activities. In the follow-up interviews completed an average of 16 and 28 months after enrollment, 4 to 6 percent of parents reported that their child was limited in any way in any activities because of an impairment or health problem. Across the two interviews, approximately 8 percent of parents ever reported that their child had an impairment or health problem that limited his or her activities (Table 4). In the 1997 Panel Study of Income Dynamics, 2 to 3 percent of infants, toddlers, and preschoolers were reported to be limited in their activities (Hofferth 1998). The higher incidence of limitations among Early Head Start children probably reflects the programs’ efforts to recruit and serve children with disabilities.

The reported incidence of several potential disabilities increased over time as children got older and staff and parents had more opportunity to observe and conduct assessments with children and determine whether potential delays were temporary (Table 4). The proportion of parents who reported that their child had a condition or impairment that limited normal childhood activities increased from about 4 percent when children were 20 months old, on average, to about 6 percent a year later. Parents were also more likely to report diagnosed speech problems as children got older (3.4 percent 28 months after enrollment, when children were 20 months old, on average, compared with 2.2 percent a year earlier). This increase in diagnosed speech problems may not reflect an increase in the incidence of problems, however. In the last follow-up interview, parents were slightly less likely to report that their child had trouble communicating and more likely to report that their child was very easy for others who did not know the child to understand, which reflects children’s normal language development (or decreased concern about language after the child started talking at all).

The child assessments conducted for the national Early Head Start Research and Evaluation study suggest that a substantial proportion of Early Head Start children may have had potential developmental or behavioral problems. Nine percent of the Early Head Start children had potential behavior problems by age 3, as indicated by a score above 18 on the Child Behavior Checklist (Table 4).5 Eighteen percent of Early Head Start children had a potential cognitive delay by age 3, as indicated by Bayley MDI scores below 70 at any of the assessments. Children in mixed-approach programs were more likely than children in center- or home-based programs to have potential cognitive delays (22 compared with 15 percent).

Potential developmental and behavioral problems were much less likely to be identified by physicians (as reported by parents). Less than 1 percent of parents reported that a doctor had advised them that their child had a behavior problem. Similarly, less than 1 percent of parents reported that a doctor had advised them that their child had a developmental delay.

The revised Head Start Program Performance Standards stipulate that at least 10 percent of programs’ enrollment opportunities must be made available to children with identified disabilities. Nearly 8 percent of families in the research sample ever reported that their child was eligible for early intervention services during the combined follow-up period (Table 5).6 About 5 percent of families in the research sample reported receiving early intervention services. Parents may have underreported their children’s eligibility for and receipt of early intervention services (they may have been unaware of their child’s eligibility or may not have recognized the name of the local Part C program). According to reports by program staff in summer 2000, 13 percent of children in the research sample had been identified as eligible for Part C.

TABLE 5
ELIGIBILITY FOR AND RECEIPT OF EARLY INTERVENTION SERVICES BY EARLY HEAD START CHILDREN
	16 Months After Enrollment	28 Months After Enrollment	Ever by 28 Months After Enrollment

Percentage of Children Reported by Primary Caregivers to:
Be eligible for early intervention services	3.9	6.1	7.5
Have received early intervention services since last interview	2.7	4.1	4.9
Have received Part C services coordinated with Early Head Start services	2.0	2.5	3.6

Percentage of Children Reported by
Program Staff to be Eligible for Part C Early Intervention Services by Summer 2000	NA	NA	13.0

Sample Sizea	935-951	1,064-1,075	1,050-1,073

Source: Parent Services Follow-Up Interviews completed an average of 16 and 28 months after enrollment and program records for families who completed the 28-month follow-up interview.

NA = not available.

a Range reflects minimum and maximum sample sizes for items in table.

The extent to which Early Head Start families in the research reported eligibility for and receipt of early intervention services varied widely among programs. The proportion of children ever reported by parents to be eligible for early intervention services ranged from 2 to 22 percent across programs (not shown). According to parents, the proportion of children who received early intervention services ranged from 0 to 16 percent across programs (not shown). These variations may reflect varying efforts to reach out to and recruit families with children with disabilities, differences in state Part C eligibility criteria, or differences in the emergence of disabilities as children got older.

Not all families who reported that their child was eligible for early intervention services reported that they had received early intervention services. This may reflect, in part, the time required to set up services after identification (or parents’ decision to seek additional services similar to early intervention but called something different). Four percent also reported that their child’s early intervention services were being coordinated with the Early Head Start program. Some parents with children who had been identified as eligible for Part C may not have recognized that their child was receiving early intervention services because the services were well-coordinated with Early Head Start services.

5 A score of 18 is the clinical cut-off indicating the need for referral (Achenbach and Rescorla 2000). (back)

6 The percentages reported here do not necessarily reflect the percentage of children with identified disabilities served by the programs at any given point in time. Follow-up interviews occurred over a 28-month period, on average, during which programs also served other families who were not in the research sample but who may have had children with identified disabilities. (back)

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