Notes on Knowledge of Child Development - Part 2

Emergent Literacy Theory

Emergent Literacy Versus Reading Readiness
Historically, early childhood educators viewed 'reading readiness' as a time during young children's literacy development when they were ready to start learning to read and write, and taught literacy accordingly. However, in the late 20th and early 20th centuries, research has found that children have innate learning capacities and that skills emerge under the proper conditions. Educational researchers came to view language as developing gradually within a child rather than a child's being ready to read at a certain time. Thus, the term 'emergent' came to replace 'readiness,' while 'literacy' replaced 'reading' as referring to all of language's interrelated aspects of listening, speaking, writing, and viewing, as well as reading.
Traditional views of literacy were based only on children's reading and writing in ways similar to those of adults. However, more recently, the theory of emergent literacy has evolved through the findings of research into the early preschool reading of young children and their and their families' associated characteristics.

Emergent Literacy Theory's Principles About How Young Children Learn to Read and Write
Through extensive research, emergent literacy theorists have found that: (1) Young children develop literacy through being actively involved in reading and rereading their favorite storybooks. When preschoolers 'reread' storybooks, they have not memorized them; rather, theorists find this activity to exemplify young children's reconstruction of a book's meaning. Similarly, young children's invented spellings are examples of their efforts to reconstruct what they know of written language; they can inform us about a child's familiarity with specific phonetic components. (2) Adults' reading to children, no matter how young, is crucial to literacy development. It helps children gain a 'feel' for the character, flow, and patterns of written/printed language, and an overall sense of what reading feels like and entails. It fosters positive attitudes toward reading in children, strongly motivating them to read when they begin school. Being read to also helps children develop print awareness and formulate concepts of books and reading. (3) Influenced by Piaget and Vygotsky, emergent literacy theory views reading and writing as developmental processes having successive stages.

Perspective Regarding Instructional Models
The emergent literacy theoretical perspective yields an instructional model for the learning and teaching of reading and writing in young children that is founded on building instruction from the child's knowledge. Emergent literacy theory's assumption is that young children already know a lot about language and literacy by the time they enter school. This theory furthermore regards even 2- and 3-year-olds as having information about how the reading and writing processes function, and as having already formed particular ideas about what written/printed language is. From this perspective, emergent literacy theory then dictates that teaching should build upon what a child already knows and should support the child's further literacy development. Researchers conclude that teachers should furnish open-ended activities allowing children to show what they already know about literacy; to apply that knowledge; and to build upon it. From the emergent literacy perspective, teachers take the role of creating a learning environment with conditions that are conducive to children's learning in ways that are ideally self-motivated, self-generated, and self-regulated.

How Babies and Young Children Learn to Read and Write
(1) According to the theory of emergent literacy, even infants encounter written language. Two- and three-year-old's commonly can identify logos, labels, and signs in their homes and communities. Also, young children's scribbles show features/appearances of their language's specific writing system even before they can write. For example, Egyptian children's scribbles look more like Egyptian writing; American children's scribbles look more like English writing. (2) Young children learn to read and write concurrently, not sequentially; the two abilities are closely interrelated.
Moreover, though with speech, receptive language comprehension seems easier/sooner to develop than expressive language production, this does not apply to reading and writing: first learning activities involving writing are found easier for preschoolers than those involving reading. (3) Research finds that form follows function, not the opposite: young children's literacy learning is mostly through meaningful, functional, purposeful/goal-directed real-life activities.
Literacy comprises not isolated, abstract skills learned for their own sake, but rather authentic skills applied to accomplish real-life purposes, the way children observe adults using literacy.

Developmentally Inappropriate Kindergarten and Preschool Literacy Practices
Research finds some preschools are like play centers, but not optimal for literacy because their curricula exclude natural reading and writing activities. Researchers have also identified a trend in many kindergartens to ensure children's 'reading readiness' by providing highly academic programs, influencing preschool curricula to get children 'ready' for such kindergartens. Influenced and even pressured by kindergarten programs' academic expectations, parents have also come to expect preschools to prepare their children for kindergarten. However, experts find applying elementary-school programs to kindergartens and preschools developmentally inappropriate. Formal instruction in reading and writing and worksheets are not suitable for younger children. Instead, research finds print-rich preschool environments both developmentally appropriate and more effective. For example, when researchers changed classrooms from having a 'book corner' to having a centrally located table with books plus paper, pencils, envelopes, and stamps, children spent 3 to 10 times more time on direct reading and writing activities.
Children are found to take naturally to these activities without prior formal reading and writing lessons.

Planning a Play-Based Curriculum
To plan a curriculum based on children's natural play with building blocks (Hoisington, 2008), a teacher can first arrange the environment to stimulate further such play. Then s/he can furnish materials for children to make plans/blueprints for and records and models of buildings they construct.
The teacher can make time during the day for children to reflect upon and discuss their individual and group building efforts. Teachers can also utilize teaching strategies that encourage children to reflect on and consider in more depth the scientific principles related to their results. A teacher can provide building materials of varied sizes, shapes, textures, and weights, and props to add realism, triggering more complex structures and creative, dramatic, emotional, and social development. Teachers can take photos of children's structures as documents for discussions, stimulating language and vocabulary development. Supplying additional materials to support and stick together blocks extends play-based learning. Active teacher participation by offering observations and asking open-ended questions promotes children's standards-based learning of scientific, mathematical, and linguistic concepts, processes, and patterns.

Supporting and Integrating Standards-Based Learning in Scientific, Mathematical, and Linguistic Domains
When children play at building with blocks, for example, they investigate material properties such as various block shapes, sizes, and weights and the stability of carpet vs. hard floor as bases. They explore cause-and-effect relationships; make conclusions regarding the results of their trial-and-error experiments; draw generalizations about observed patterns; and form theories about what does and does not work to build high towers.
Ultimately, they construct their knowledge of how reality functions. Teachers support this by introducing relevant learning standards in the play context meaningful to children. For example, math standards including spatial awareness, geometry, number, operations, patterns, and measurement can be supported through planning play. By encouraging and guiding children's discussion and documentation of their play constructions, and supplying nonfictional and fictional books about building, a teacher also integrates learning goals and objectives for language and literacy development. Teachers can plan activities specifically to extend learning in these domains, like counting blocks; comparison/contrast; matching; sorting; sequencing; phonological awareness; alphabetic awareness; print awareness; book appreciation; listening, comprehension, speech, and communication.

Using Thematic Teaching Units
To develop a thematic teaching unit, a teacher designs a collection of related activities around certain themes or topics that crosses several curriculum areas or domains. Thematic units create learning environments for young children that promote all children's active engagement, as well as their process learning. By studying topics children find relevant to their own lives, thematic units build upon children's preexisting knowledge and current interests, and also help them relate information to their own life experiences. Varied curriculum content can be more easily integrated through thematic units, in ways that young children can understand and apply meaningfully. Children's diverse individual learning styles are also accommodated through thematic units. Such units involve children physically in learning; teach them factual information in greater depth; teach them learning process-related skills, i.e. 'learning how to learn'; holistically integrate learning; encourage cohesion in groups; meet children's individual needs; and provide motivation to both children and their teachers.

Project Approach
The Project Approach (Katz and Chard, 1989) entails having young children choose a topic interesting to them, studying this topic, researching it, and solving problems and questions as they emerge. This gives children greater practice with creative thinking and problem-solving skills, which supports greater success in all academic and social areas. For example, if a class of preschoolers shows interest in the field of medicine, their teacher can plan a field trip to a local hospital to introduce a project studying medicine in depth. During the trip, the teacher can write down/record children's considerations and questions, and then use these as guidelines to plan and conduct relevant activities that will further stimulate the children's curiosity and imagination. Throughout this or any other in-depth project, the teacher can integrate specific skills for reading, writing, math, science, social studies, and creative thinking. This affords dual benefits: enabling both children's skills advancement, and their gaining knowledge they recognize is required and applies in their own lives. Children become life-long learners with this recognition.

Integrated Curriculum and Early Childhood Education A. integrated curriculum organizes early childhood education to transcend the boundaries between the various domains and subject content areas. It unites different curriculum elements through meaningful connections to allow study of wider areas of knowledge. It treats learning holistically and mirrors the interactive nature of reality. The principle that learning consists of series of interconnections is the foundation for teaching through use of an integrated curriculum. Benefits of integrated curricula include an organized planning mechanism; greater flexibility; and the ability to teach many skills and concepts effectively, include more varied content, and enable children to learn most naturally. By identifying themes children find most interesting, teachers can construct webs of assorted themes, which can provide the majority of their curriculum. Research has proven the effectiveness of integrated teaching units for both children and their teachers. Teachers can also integrate new content into existing teaching units they have identified as effective. Integrated units enable teachers to ensure children are learning pertinent knowledge and applying it to real-life situations.

Skills, Topics, Strategies, and Benefits Related to Creating Thematically-Based Teaching Units
EC teachers can incorporate many skills into units organized by theme. This includes state governments' educational standards/benchmarks for various skills. Teachers can base units on topics of interest to young children, e.g. building construction, space travel, movie-making, dinosaurs, vacations, nursery rhymes, fairy tales, pets, wildlife, camping, the ocean, and studies of particular authors and book themes. Beginning with a topic that motivates the children is best; related activities and skills will naturally follow. In planning units, teachers should establish connections among content areas like literacy, physical activity, dramatic play, art, music, math, science, and social studies. Making these connections permits children's learning through their strongest/favored modalities and supports learning through meaningful experiences, which is how they learn best. Theme-based approaches effectively address individual differences and modality-related strengths, as represented in Gardner's theory of Multiple Intelligences.
Thematic approaches facilitate creating motivational learning centers and hands-on learning activities, and are also compatible with creating portfolio assessments and performance-based assessments. Teachers can encompass skill and conceptual benchmarks for specific age/developmental levels within engaging themes.

Guidelines for Indoor and Outdoor Space Use
Indoor and outdoor EC learning environments should be safe, clean, and attractive. They should include at least 35' square indoors and 75' square outdoors of usable play space per child. Staff must have access to prepare spaces before children's arrival. Gyms/other larger indoor spaces can substitute if outdoor spaces are smaller. The youngest children should be given separate outdoor times/places. Outdoor scheduling should ensure enough room, plus prevent altercations/competition among different age groups. Teachers can assess if enough space exists by observing children's interactions and engagement in activities. Children's products and other visuals should be displayed at child's-eye level. Spaces should be arranged to allow individual, small-group, and large-group activity. Space organization should create clear pathways enabling children to move easily among activities without overly disturbing others, should promote positive social interactions and behaviors; and activities in each area should not distract children in other areas.

Arrangement of Learning Environments

Arranging Indoor Learning Environments According to Curricular Activities
EC experts indicate that rooms should be organized to enable various activities, but not necessarily to limit activities to certain areas.
For example, mathematical and scientific preschool activities may occur in multiple parts of a classroom, though the room should still be laid out to facilitate their occurrence. Sufficient space for infants to crawl and toddlers to toddle are necessary, as are both hard and carpeted floors.
Bolted-down/heavy, sturdy furniture is needed for infants and toddlers to use for pulling up, balancing, and cruising. Art and cooking activities should be positioned near sinks/water sources for cleanup. Designating separate areas for activities like block-building, book-reading, musical activities, and dramatic play facilitates engaging in each of these. To allow ongoing project work and other age-appropriate activities, school-aged children should have separate areas. Materials should be appropriate for each age group and varied.
Equipment/materials for sensory stimulation, manipulation, construction, active play, dramatic play, and books, recordings, and art supplies, all arranged for easy, independent child access and rotated for variety, are needed.

Arranging Learning Environments to Children's Personal, Privacy, and Sensory Needs
In any EC learning environment, the indoor space should include easily identifiable places where children and adults can store their personal belongings. Since EC involves children in groups for long time periods, they should be given indoor and outdoor areas allowing solitude and privacy while still easily permitting adult supervision. Playhouses and tunnels can be used outdoors, small interior rooms and partitions indoors. Environments should include softness in various forms like grass outdoors; carpet, pillows, and soft chairs indoors; adult laps to sit in and be cuddled; and soft play materials like clay, Play-Doh, finger paints, water, and sand. While noise is predictable, even desirable in EC environments, undue noise causing fatigue and stress should be controlled by noise-absorbing elements like rugs/carpets, drapes, acoustical ceilings and other building materials. Outdoor play areas supplied/arranged by school/community playgrounds should be separated from roadways and other hazards by fencing and/or natural barriers. Awnings can substitute for hills, and inclines/ramps for shade, when these are not naturally available. Surfaces and equipment should be varied.

Principles Related to Early Childhood Behavior Management
Repetition and consistency are two major elements for managing young children's behavior. Adults must always follow and enforce whichever rules they designate. They must also remember that they will need to repeat their rules over and over to make them effective. Behaviorism has shown it is more powerful to reward good behaviors than punish bad behaviors.
Consistently rewarding desired behaviors enables young children to make the association between behavior and reward. Functional behavior analysis can inform adults: knowing the function of a behavior is necessary to changing it.
For example, if a toddler throws a tantrum out of frustration, providing support/scaffolding for a difficult task, breaking it down to more manageable increments via task analysis, and giving encouragement would be appropriate strategies; but if the tantrum was a bid for attention, adults would only reinforce/strengthen tantrum recurrence by paying attention. Feeling valued and loved within a positive relationship greatly supports young children's compliance with rules. The '10:1 Rule' prescribes at least 10 positive comments per 1 negative comment/correction.

Including Families in Children's Education
First, ECE personnel can make sure that communication between the school/program and family is reciprocal and regular. EC educators should promote and support the enhancement and application of parenting skills.
They should also acknowledge that parents have an integral part in supporting children's learning. All school personnel should make parents feel welcome in school, and moreover should seek parents' help and support. When school administrators, teachers, and other staff make educational decisions that affect the children and their families, they should always be sure that the children's parents are involved in these decisions. In addition, educational personnel should not just work on children's educational goals, learning objectives, and curricular and instructional planning and design on their own, keeping the school or program isolated; they should make use of all available community resources. Instead of trying to educate young children within a school bubble, educators who collaborate with their communities realize benefits of stronger families, schools, and child learning.

Managing the Normal Behavior of Young Children
Before reacting to young children's behaviors, adults should make sure children understand the situation. They should state rules simply and clearly; repeat them frequently for a long time for young children to remember and follow them; and state and enforce rules very consistently to avoid confusion. Adults should tell children clearly what they expect of them. They should never assume they need do nothing when children follow rules; they should consistently give rewards for compliance. Adults should also explain to young children why they are/are not receiving rewards by citing the rule they did/did not follow. Adults can arrange the environment to promote success. For example, if a child throws things that break windows, adults can remove such objects and substitute softer/more lightweight items. Organization is also important. Adults should begin with a simple, easy-to-implement plan and adhere to it. They should record children's progress; analyzing the records shows what does/does not work and why, enabling new/revised plans.

Effect of Maturational Factors on the Development and Learning
Many physiological factors affect the development of babies and young children. These dictate which kinds of learning activities are appropriate or ineffective for certain ages. For example, providing a newborn with visual stimuli from several feet away is wasted, as newborns cannot yet focus on distant objects. Adults cannot expect infants younger than about 5 months to sit up unsupported, as they have not yet developed the strength for it. Adults cannot expect toddlers who have not yet attained stable walking gaits to hop or balance upon one foot successfully. It is not coincidental that first grade begins at around 6 years: younger children cannot physically sit still for long periods and have not developed long enough attention spans to prevent distraction. This is also why kindergarten classes feature varieties of shorter term activities and more physical movement. Younger children also have not yet developed the self-regulation to keep from shouting out on impulse, getting up and running around, etc.—behaviors disruptive to formal schooling but developmentally normal.

Relationship of Sleep Quality to Blood Sugar Control in Children with Type 1 Diabetes
Researchers find blood sugar stability problematic for many children with Type 1 (juvenile) diabetes, despite all efforts by parents and children to follow diabetic health care rules, because of sleep differences. Diabetic children spend more time in lighter than deeper stages of sleep compared to nondiabetic children. This results in higher levels of blood sugar and poorer school performance. Lighter sleep and resulting daytime sleepiness tend to increase blood sugar levels.
Sleep apnea is a sleep disorder that causes a person's breathing to be interrupted often during sleeping. These breathing interruptions result in poorer sleep quality, fatigue, and daytime sleepiness. Sleep apnea has previously been associated with Type 2 diabetes—historically adult-onset, though now children are developing it, too. It is now known that apnea is also associated with Type 1 diabetes in children: roughly one-third of diabetic children studied have sleep apnea, regardless of their weight (being overweight can contribute to apnea). Sleep apnea is additionally associated with much higher blood sugars in diabetic children.

Considerations for Early Childhood Nutrition
Raw or lightly steamed vegetables are best because excess heat destroys nutrients and frying adds fat calories.
Fresh, in-season and flash-frozen fruits are more nutritious/less processed than canned. Adults should monitor young children's diets to limit highly processed produce, which can have excessive sugar, salt, or preservatives. Good protein sources include legumes, nuts, lean poultry, and fish. Adults should take care with young children to avoid choking hazards by cutting foods into bite-sized pieces. Serving nut butters instead of whole nuts is safer, but spread thinly on whole-grain breads/crackers or vegetable pieces, because young children can choke on large globs of nut butter as well. Omega-3 fatty acids from salmon, mackerel, herring, flaxseeds, and walnuts control inflammation, prevent heart arrhythmias, and lower blood pressure. Monounsaturated fats from avocados, olives, peanuts, their oils, and canola oil prevent heart disease, lower bad cholesterol, and raise good cholesterol. Polyunsaturated fats from nuts, seeds, and corn, soy, sesame, sunflower, and safflower oils lower cholesterol. These fats/oils should be served in moderation, avoiding saturated fats.

Nutritional Factors in Diet Affecting Early Childhood Development
Babies are typically nourished via mother's milk or infant formula, and then with baby food; however, young children mostly eat the same foods as adults by the age of 2 years. Though they eat smaller quantities, young children have similar nutritional needs to those of adults. Calcium can be more important in early childhood to support the rapid bone growth occurring during this period; young children should receive
2–3 servings of dairy products and/or other calcium-rich foods. For all ages, whole-grain foods are nutritionally superior for their fiber and nutrients than refined flours, which have had these removed. Refined flours provide 'empty calories' causing wider blood-sugar fluctuations and insulin resistance—Type 2 diabetes risks—than whole grains, which stabilize blood sugar and offer more naturally occurring vitamins and minerals. Darkly and brightly colored produce are most nutritious. Adults should cut foods into small, bite-sized pieces to prevent choking in young children, who have not yet perfected their biting, chewing, and swallowing skills.

Considerations for Feeding Young Children
Saturated fats from meats and full-fat dairy should be limited; they can cause health problems like high cholesterol, cardiovascular disease, obesity, and diabetes. Trans fats are produced chemically by hydrogenating normally liquid unsaturated fats and converting them to solid, saturated fats as in margarine and shortening used in many baked goods. These are considered even unhealthier than regular saturated fats and should be avoided. (The words 'partially hydrogenated' in the ingredients signal trans fats.) Infants derive enough water from mother's milk/formula, but young children should be given plenty of water and/or milk in
'sippy cups' to stay hydrated. The common practice of giving young children fruit juice should be avoided. Even without added sugars, fruit juices crowd out room in small stomachs for food nutrients and cause dental cavities and weaken permanent teeth before they erupt. Children can also gain weight, as juice calories do not replace food calories the way actual fruit does with its fiber and solids. Young children should eat two-thirds of adult-sized portions.

Characteristics of Young Children's Nutritional Needs
Young children have smaller stomachs than adults and cannot eat as much at one time as teens or adults. However, it is common practice for today's restaurants to provide oversized portions. The historical tradition of encouraging young children to 'clean their plates' is ill-advised considering these excessive portions and the abundance of food in
America today. Adults can help young children by teaching them instead to respond to their own bodies' signals and eat only until they are satisfied.
Adults can also place smaller portions of food on young children's plates and request to-go containers at restaurants to take leftovers home. Because young children cannot eat a lot at once, they must maintain their blood sugar and energy throughout the day by snacking between meals. However, 'snack foods' need not be high in sugar, salt, and unhealthy fats. Cut pieces of fresh fruits and vegetables, whole-grain crackers and low-fat cheeses, and portable yogurt tubes make good snacks for young children.

General Sleep Needs and Behaviors of Young Children
Sleep allows the body to become repaired and recharged for the day and is vital for young children's growth and development. Children aged 2–5 years generally need 10–12 hours of sleep daily.
Children 5–7 years old typically need 9–11 hours of sleep. Their sleep schedules should be fairly regular. While occasionally staying up later or missing naps for special events is not serious, overall inconsistent/disorganized schedules cause lost sleep and lethargic and/or cranky children. Some young children sleep fewer hours at night but need long daytime naps, while others need longer, uninterrupted nighttime sleep but seldom nap. Young children are busy exploring and discovering new things; they have a lot of energy and are often excited even when tired. Because they have not developed much self-regulation, they need adult guidance to calm down enough to go to sleep and will often resist bedtimes. Adults should plan bedtime routines. These can vary, but their most important aspect is consistency. Children then expect routines' familiar steps, and anticipating these comfort them.

Considerations in Children's Bedrooms and Family Beds
The majority of early childhood experts think young children should not have adults in their rooms every night while they fall asleep. They believe this can interfere with young children's capacity for 'self-soothing' and falling asleep on their own, making them dependent on an adult presence to fall asleep. Parents/caregivers are advised to help children relax until sleepy, and then leave, saying 'Good night' and 'I love you.' Young children frequently feel more comfortable going to bed with a favorite blanket or stuffed animal and/or a night light. Regardless, fears and nightmares are still fairly common in early childhood. 'Family beds,' i.e. children sleeping in the same bed or adjacent beds with parents, are subject to controversy. However, this is traditional in many developing countries and was historically so in America. Whatever the individual family choice, it should be consistent as young children will be frustrated by inconsistent practices and less likely to develop good sleeping habits.

Feeding Strategies Supporting Development of Nutritious Eating Habits and Attitudes
Early childhood is an age range often associated with 'finicky' eaters. Adults can experiment by substituting different foods that are similar sources of protein or other nutrients to foods young children dislike. Preparing meals to look like happy faces, animals, or have appealing designs can entice young children to eat varied foods. Engaging children age-appropriately in selecting and preparing meals with supervision can also motivate them to consume foods when they have participated in their preparation.  Adults should model healthy eating habits for young children, who imitate admired adults' behaviors. Early childhood is when children form basic food-related attitudes and habits and so is an important time for influencing these. Children are exposed to unhealthy foods in advertising, at school, in restaurants, and with friends, so adult modeling and guidance regarding healthy choices are important to counteract these influences. However, adults should also impart the message early that no foods are 'bad'/forbidden, allowing some occasional indulgences in small amounts, to prevent the development of eating disorders.

Components and Characteristics of Good Bedtime Routines
Bedtime routines serve as transitions from young children's exciting, adventurous daytime activities to the tranquility needed for healthful rest. Adults should begin routines by establishing and enforcing a rule that daytime activities like rough-and-tumble physical play or TV watching stop at a specific time. While preschoolers may be less interested in computer/video games than older children, establishing limits early will help parents enforce stopping these activities at bedtime when they are older, too. Bath time is one good way to begin bedtime routines.
Toys and games make baths fun, and bath washes with lavender and other soothing ingredients are now available to relax young children. Also, since young children eat smaller meals, healthy bedtime snacks are important. Too much/too little food will disrupt sleep, and too much liquid can cause bedwetting.
Adults should plan nighttime snacks appropriately for the individual child.
Bedtime reading promotes interest in books and learning, adult-child/family bonding, and calms children. Singing lullabies, hugging, and cuddling also support bonding, relax children, and make them feel safe and secure.

Helping Young Children Transition from Cribs to Regular Beds
One of young children's significant transitions from infancy is moving from a crib to a 'big bed.' Some become very motivated to escape cribs. For example, some bright, adventurous toddlers and even babies have untied padded crib bumpers, stacked them, and climbed out of the crib. For such children, injury is a greater danger from a crib than a bed. Others, whose cognitive and verbal skills are more developed than motor skills, may stand/jump up and down, repeatedly calling, 'Hey, I'm up!' until a parent comes. These children should be moved to regular beds, with guardrails and/or body pillows to prevent rolling/falling-out accidents. If a child is moved to a bed to free the crib for a new baby, this should be done weeks ahead of the infant's arrival if possible, to separate these two significant life events. Most young children are excited about 'grown-up' beds.
Some, if hesitant, can sleep in the crib and nap in the bed for a gradual transition until ready for the bed full-time.

Hygiene in Early Childhood

Importance of Hand-Washing
A major change during early childhood is that hygiene transforms from something adults do for children to something children learn to do themselves. Toddlers are typically learning toilet-training, getting many germs on their hands. Preschoolers today are also often exposed to germs in daycare or school settings. Adults must explain to young children using concrete, easily understood terms how germs spread; how hand-washing removes germs; and when and how to wash their hands. Adults also need to remind children frequently to wash their hands until it becomes a habit. Remind them hand-washing is required before eating, after toileting, after being outdoors, after sneezing/coughing, and after playing with pets.
Because young children have short attention spans and can be impatient, they are unlikely to wash long or thoroughly enough. Adults can encourage this by teaching children to sing 'Happy Birthday' or other 15- to 20-second songs/verses while washing, both assuring optimal hand-washing duration and making the process more fun.

Bathing
While infants are bathed by adults, by the time they are toddlers or preschoolers, they generally have learned to sit in a bathtub and wash themselves. However, regardless of their ability to bathe, young children should never be left unsupervised by adults in the bath. Young children can drown very quickly, even in an inch of water; an adult should always be in the bathroom. Also, adults should not let young children run bathwater: they are likely to make it too cold or hot. Adults can prevent scalding accidents by turning down the water heater temperature. The adult should adjust water temperature and test it on his/her own inner arm (an area with more sensitive skin). Parents/caregivers should choose baby shampoos, soaps, and washes that do not irritate young eyes or skin, and keep adult bath products out of children's reach and sight. Very active children may need to bathe daily; others suffering dry, itchy skin should bathe every other day and/or have parents/caregivers apply mild moisturizing lotion.

Promoting and Teaching Dental Hygiene
Even while young children still have their deciduous/'baby' teeth, dental hygiene practices can affect their permanent/adult teeth before they erupt. For example, excessive sugar can weaken adult teeth before they even appear above the gumline. Adults should not only teach young children how important it is to brush their teeth twice and floss once daily at a minimum; moreover, they should model these behaviors.
Children are far more likely to imitate parents' dental hygiene practices than do what parents only tell them but do not do themselves. Integrating tooth brushing into morning and bedtime routines promotes the habit. Adults can help motivate resistant children with entertaining toothbrushes that play music, spin, light up, and/or have cartoon illustrations. Young children have not developed the fine motor skills sufficient for flossing independently and will need adult supervision until they are older. Individual flossers are easier for them to use with help than traditional string dental floss.

Exercise Benefits for Young Children
Young children need daily physical exercise to strengthen their bones, lungs, hearts, and other muscles. Throwing, catching, running, jumping, kicking, and swinging actions develop young children's gross motor skills. Children sleep better with regular physical activity and are at less risk for obesity. Playing actively with other children also develops social skills, including empathy, sharing, cooperation, and communication. Family playtimes strengthen bonding and let parents model positive exercise habits. Outdoor play is fun for youngsters; running and laughing lift children's moods. Pride at physical attainments moreover boosts children's self-images and self-esteem. At least 60 minutes of physical activity most days is recommended for children. This includes jungle gyms, slides, swings, and other playground equipment; family walks, bike-riding, playing backyard catch, baseball, football, or basketball; adult-supervised races or obstacle courses; and age-appropriate community sports activities/leagues. Adults should plan and supervise activities to prevent injuries. They should also provide repeated sunscreen applications for outdoor activities to prevent sunburn and long-term skin damage.

Exposure to TV/Other Media and Optimal Environmental Conditions for Leisure Activities
Preschool-aged children are not yet cognitively able to distinguish between reality and fantasy. Therefore, overly violent or intense content in TV or other media can frighten them.
Additionally, exposure to video violence has been proven to increase aggressive behaviors in young children. Moreover, using TV as a babysitter for long times excludes more cognitively stimulating and interactive pursuits. Parents/caregivers can provide young children with paints, crayons, and modeling clay. They can play board games and simple card games, do puzzles, sing songs, and read stories with young children. Pretend/make-believe play develops during early childhood, so adults can encourage their playing 'house,' 'dress-up,' or 'auto shop.' Park/playground trips afford outdoor play and physical activity/exercise. Visiting local museums, zoos, or planetariums combine education and entertainment with outings. In multiple-child families, it is important for each child to get some one on one time with parents regularly, even in unstructured activities like going to the hardware store with Daddy or keeping Mommy company while she washes dishes.

Disadvantages/Advantages and Risk/Protective Factors in Economically Deprived and Culturally Diverse Environments
Historically, disadvantages of poverty have been the focus of research; e.g. lack of toys, inadequate verbal interactions limiting visual discrimination and linguistic development or risk factors like less education, poorer nutrition, family stressors, medical illness, inadequate social stimulation, and insufficient social-service support leading to school dropouts, delinquency, unemployment, and perpetuated poverty.
However, more recent research also identifies poverty's advantages, including opportunities for young children to play with peers and older children with little adult intervention, promoting empathy, cooperation, self-control, self-reliance, and sense of belonging; experience with multiple teaching styles, especially modeling, observation, and imitation; and language acquisition within a culturally-specific context through rich cultural traditions of stories, songs, games, and toys. These findings illuminate the resiliency or stress resistance of some children. Recent research also identifies protective factors against risk factors. These protections contribute to child resiliency, including the child's personality traits; having stable, supportive, cohesive family units; and having external support systems promoting positive values and coping skills.

Influence of Cultures and Cultural Values on Early Childhood Development
The culture in a society influences, even determines, our individual values, as do both historical and current social and political occurrences. Our values then influence the ways in which children are valued and raised. As American educators, we can understand the 'American' perspective on early childhood better through understanding cultural diversity. We tend to fixate on our own culture's beliefs of truth as the only existing reality, but depending on our personal histories and values and current conditions, there can actually be multiple right ways of doing things. For example, Western cultures value children's early attainment of independence and individuality, but Eastern cultures value interdependence and group harmony more than individualism. In affluent societies, letting children explore the environment early and freely is valued, but in poor and/or developing societies, parents protect children, keeping them close and even carrying them while working, and thus do not value early freedom and exploration.

Effect of Age, Ethnicity, and Income on Health and School Outcomes
Research traces many variations in well-being and health to early childhood. These differences come from inequities in service access and treatment, congenital health problems, and early exposure to greater familial and community risk factors. Child groups at risk that are overrepresented in our population include young children, low-income children, and minority children. More young children than older children are likely to live in economically disadvantaged families. As of 2005, more than 10 million children aged 0–5 years lived in the U.S. 20 percent of these were in families classified as poor, i.e. with income below the federal poverty level (FPL), and 42 percent were in families designated low-income, i.e. with income below double the FPL. Of more than 2 million American children aged 0–5 living in families identified as extremely poor, i.e. with income less than half the FPL, minority groups were also overrepresented. The younger the children are, the greater the adverse effects of poverty are on their developmental outcomes.

Environment, Social and Emotional Support, Self-Image, and Success
Researchers have recently found that a child's sense of self is significant in predicting success in life. Even when a child's family environment involves multiple stressors, having a good relationship with one parent mitigates a child's psychosocial risks. As a child grows older, a close, supportive, lasting relationship with an adult outside the family can confer similar protection. Such relationships promote self-esteem in a child. Children with positive self-esteem are more able to develop feelings of control, mastery, and self-efficacy to achieve tasks, and they are more able to manage stressful life experiences. Such children demonstrate more initiative in forming relationships and accomplishing tasks.
They reciprocally derive more positive experiences from their environments.
Children with positive self-concepts pursue, develop, and sustain experiences and relationships that support success. Their positive self-images are further enhanced by these successes, generating additional supportive relationships and experiences. While we often hear about negative cycles of poverty, abuse, or failure, positive cycles of success can be equally as self-perpetuating.

Individualistic Versus Collectivistic Cultures
Anthropologists have classified various world cultures along a continuum of how individualistic or interdependent their structures and values are. Investigating these differences is found to afford much insight and application for early childhood education.
The predominant culture in America is considered very individualistic. Children are encouraged to assert themselves and make their own choices to realize their highest potentials, with the ultimate goal of individual self-fulfillment.
Collectivistic/sociocentric cultures, however, place the highest importance on group well-being; if collective harmony is disrupted by individual assertiveness, such self-assertion is devalued. Some educators characterize this contrast as the difference between standing out (individualist) and fitting in
(collectivist). Researchers note that when asked to finish 'I am…' statements, members of interdependent cultures tend to supply a family role, religion, or organization (e.g. 'a father/a Buddhist'); whereas members of individualistic cultures cite personal qualities (e.g. 'intelligent/hardworking'). Research finds American culture most individualistic, Latin American and Asian cultures most interdependent, and European cultures in the middle.

Health Risks and Results Related to Racial and Ethnic Origins
Children are at higher risk for inadequate development when they are born prematurely or with low birth weights. Recent research found racial and ethnic disparities in these birth conditions. For example, rates of low birth weights in 2004 were almost double for African-Americans as for whites (13.4 percent versus 7.1 percent). Latinos had similar but slightly lower risk than whites for low birth weight (6.9 percent versus 7.1 percent). Native American/Alaska Natives had slightly higher risk than white (7.5 percent versus 7.1 percent), as did Asian/Pacific
Islanders (7.9 percent versus 7.1 percent). In oral health, 28 percent of preschoolers have had tooth decay. Moreover, data show that in children aged 2–5 years, oral disease increased 15.2 percent from 1994–2002, equaling 600,000 more children. It was found 13.9 percent of children aged 2–5 years were overweight or obese. Risk for overweight/obesity is higher for low-income and minority children. These groups are also at higher risk for poorer quality and continuity in asthma treatment. Asthma's prevalence as well as asthma-related morbidity and deaths are higher in African-American children than white children.

Effect of Racial/Ethnic, Economic, Educational, and Mental Health Factors on the Emotional, Mental Health, and Social Outcomes
Proportionately more mothers in minority and low-income groups—up to 40 percent—suffer maternal depression than in other parts of the population. Maternal depression is associated with poor mother-child bonding; lower child scores in language and reading; and higher prevalence of depression and other mental health problems later in children.
Low-income and minority families are at higher risk for developmental difficulties and mental health issues. According to U.S. surveys, about one-third or over 3 million of young children have two or more health and developmental risk factors. These risk factors include maternal mental health, maternal education, family poverty, and race/ethnicity. Each added risk factor increases the probability of either greater developmental risk or worse health status. Risk increases exponentially with multiple factors. One risk factor doubles risk; two factors more than triple it; three causes almost five times the risk; and four risk factors represent 14 times the risk of developmental delay or poor health.

Effects of Racial, Ethnic, and Economic Disparities Upon Parenting, Home Safety, and School Readiness
According to the National Survey on Early Childhood Health, significant differences are reported in Latino and African-Americans' parenting practices, home routines, and home safety measures. These differences are associated with differing degrees of positive early childhood development.
Research studies have also revealed that American children in minority groups, on the average, demonstrate lower school readiness levels when they begin formal education than white American children do. The research furthermore shows that most of these differences in school readiness levels are associated with differences in family income. Researchers also comment that disparities among racial and ethnic groups in their school readiness and subsequent academic achievement in school may be additional contributors to discrimination against minority racial and ethnic groups by teachers and other educational personnel.

Effects of Income and Race/Ethnicity Upon Health Care Aspects
Although the disparity in childhood immunizations between white and minority infants and toddlers has decreased, still, fewer minority children are receiving standard immunizations than white children in America.
For example, the preschool rates for receiving each major vaccination from 2003–2004 in America were the lowest among non-Latino black, Native American, and Alaskan Native children. One sign of health service quality and continuity is having a regular health care provider. Recent national surveys have found that while more than 80 percent of children under the age of 5 in economically affluent families are seen at physicians' offices or HMOs for care when sick, not much more than 54 percent of children under age
5 in economically poor families are seen for sick care. The National Survey of Early Childhood Health has found African-American and Latino parents report more dissatisfaction with pediatricians and more unmet needs for early childhood development services than white parents. Twice as many Latino as white parents felt providers never or only occasionally understood their individual child's needs.

Socioeconomic and Racial Effects on Mental, Emotional, and Social Health
According to the National Survey of Child and Adolescent Well-Being, in recent years over 40 percent of toddlers and over 68 percent of preschoolers who were in contact with the child welfare system had high levels of need, developmentally and behaviorally. But overall, fewer than 23 percent of these children were getting services to address these needs. Thus, young children of socioeconomically disadvantaged families were found to have more developmental and behavioral problems than children in other socioeconomic groups, yet were also less likely to receive help with such problems. Another social and emotional difference related to racial group membership has been reflected by levels of violence in the family. 2003 data found that over 15 percent of African-American families experienced violent conflicts, compared to below 9 percent of white families and over 11 percent of Latino families. Racial groups classified as 'other' constituted over 12 percent. Experts concede that styles of disagreeing can be influenced by cultural and demographic variables. However, they find the strongest influence on conflicts becoming violent to be parental stress.

Inequity in Health Insurance Coverage for Children of Minority Groups
Research has demonstrated that after taking health insurance status into account, there are no significant socioeconomic differences in how family organization and doctor/health care practitioner visits are related.
Furthermore, research has shown that having health insurance coverage decreases differences in developmental and health outcomes for young children. However, despite these findings, children of minority groups are less likely than their nonminority peers to have either private or public health care coverage.
Regarding access to health care services, it has been found that parents whose first language was not English were only half as likely to get preventive health care for their infants as native English-speaking families. This inequity in service delivery was found to be constant across white, African-American, and Latino families that had infants, but not in Asian-American families having infants.
According to data collected by the National Survey of Early Childhood Health, minority families have less communication and guidance from pediatric health care providers than white families. For example, African-American parents were found to make significantly fewer phone calls than white parents to pediatric health care practices. Latino parents made fewer than half the calls that white parents did; African-American parents made fewer than three-fourths of the calls white parents did. This survey also found that pediatricians and other pediatric health care service providers were more likely to emphasize topics of household alcohol and drug use and community violence when they talked with minority patient families than they did in discussions with white patient families. African-American children are found far more likely to have special health care needs than white children; yet researchers find that even after controlling for health status, insurance, and other pertinent variables, health care providers are still nearly twice as likely not to refer minority children to specialists and consultants.

Early Childhood Comprehensive Systems

Decreasing Socioeconomically and Racially Influenced Health Care Inequities
According to the National Center for Children in Poverty, Early Childhood Comprehensive Systems (ECCS) initiatives in each U.S. state have the ability to further methods that can decrease socioeconomically related health care inequities in early childhood, which generates positive impacts for the rest of children's lives. To raise and shape consciousness of health care issues affected by income and race, experts recommend that ECCS establish connections between projects/programs designed to eradicate poverty and racism and efforts in developing early childhood systems. Another consciousness-raising strategy recommended for ECCS is to work at increasing the general public's awareness of racial, ethnic, and economic disparities in early childhood health care and to work at increasing such awareness in health professionals, educators, early care providers, and other significant stakeholders who regularly provide services to young children. ECCS can also include racial/ethnic data in performance monitoring; encourage state CHIP and Medicaid agencies to do the same; analyze state data for disparities in risk, access, and outcomes, including small-area analyses, geocoding, etc.; and identify and measure unequal treatment through data analysis.

Improving and Equalizing Health Care for All American Demographic Groups

Enhancing Community Support
Experts in early childhood development find that state ECCS should target their support toward communities with larger populations of minority and low-income families. Inasmuch as local systems have limited resources, some state ECCS might need to allocate more of these resources to communities having higher risks of adverse outcomes for children. ECCS can also provide assistance to communities by helping them assess their local assets, strengths, needs, and risk factors. Early childhood development experts emphasize that state ECCS should focus their efforts on improving the quality of health care services that are available within communities where all or the majority of residents are members of minority groups and/or have low socioeconomic status. Another way in which state ECCS can strengthen the supports available in communities for citizens who are subject to unequal health care treatment according to their demographic groups is to offer and provide incentives for community development projects that are designed to decrease health care treatment disparities based on racial/ethnic and economic differences.

Reducing Unequal Treatment of Cultural/Linguistic Minorities
Early childhood experts advise that each U.S. state's ECCS should implement strategies designed to monitor health care providers and services for cultural and linguistic competency, and to improve these competencies. One example of such improvement is ensuring that specific training in cultural and linguistic competency and cross-cultural competency is integrated into the training of both health care providers and early childhood educators. ECCS can also be responsible for seeing that parent education materials and resources in health care are translated into the native languages of local families who are not native English speakers, and supporting interpreter and translator services for communities having families needing these. Experts find that ECCS can additionally improve child and family health services by supporting various early childhood service settings in employing nonprofessional/community health workers. Moreover, ECCS can help further equality and consistency of health care across varied demographic groups by applying research evidence-based guidelines regarding health care, family support, early learning, and related services and programs.

Benefits of Leveling Inequalities in Care, Health, and Education
Eliminating unequal treatment in early childhood has significant benefits, including lowering overall national rates of poverty; improving overall health and education measures; saving long-term health care costs; decreasing disabilities; and lengthening lives by decreasing mortality rates. The effects of low income and racism on young children and their families are complex, and these influences interact with one another. Therefore it is impossible or extremely difficult to solve problems generated by one of these social factors without including the other associated influencing factors. Because of the interrelationships of variables, strategies on a system level have the most potential for effectiveness. For example, job training and placement programs that could help parents economically are limited in effectiveness if quality child care is not also available to those parents.
Enhancing educational programs could improve academic performance, but not if young students are too hungry to benefit from instruction. And the measurement and monitoring of developmental, health, and educational outcomes will not change their disparity unless treatment inequities are resolved.

Involving Families in Their Children's Education
Flexibility and variety are key elements for involving diverse families, with changing situations and needs, in ECE. Adaptable approaches include these: Educators include families in designing children's
Individual Family Service Plans (IFSPs) for preschoolers. They ask families to develop their own goals for educational participation. They create volunteer calendars, encouraging parents to collaborate when able. They communicate with families regularly, using speech if written/printed language presents barriers.
They establish media libraries for parents/families to browse and check out resources. They facilitate parental meeting attendance and school visits by providing transportation and child care. They adapt to parental work schedules by convening meetings at alternative times of day. They often send families communications about both their children and class content, including information regarding important developmental milestones and methods for nurturing growth and development. They offer families individualized, specific strategies for home use. They recruit interested family members to help in preschool. They also function as clearinghouses to facilitate family access to community supports like local health care agencies, businesses, and universities.

Causes of Intellectual Disabilities in Babies and Young Children

Infections
Congenital cytomegalovirus (CMV) is passed to fetuses from mothers, who may be asymptomatic. About 90% of newborns are also asymptomatic;
5% to 10% of these have later problems. Of the 10% born with symptoms, 90% will have later neurological abnormalities, including intellectual disabilities.
Congenital rubella, or German measles, is also passed to fetuses from unvaccinated and exposed mothers, causing neurological damage including blindness or other eye disorders, deafness, heart defects, and intellectual disabilities. Congenital toxoplasmosis is passed to fetuses by infected mothers, who can be asymptomatic, with a parasite from raw or undercooked meat that causes intellectual disabilities, vision or hearing loss, and other conditions. Encephalitis is brain inflammation caused by infection, most often viral. Meningitis is inflammation of the meninges, or membranes, covering the brain and is caused by viral or bacterial infection; the bacterial form is more serious. Both encephalitis and meningitis can cause intellectual disabilities.
Maternal human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) can be passed to fetuses, destroying immunity to infections, which can cause intellectual disabilities. Maternal listeriosis, a bacterial infection from contaminated food, animals, soil, or water, can cause meningitis and intellectual disabilities in surviving fetuses and infants.

Environmental, Nutritional, and Metabolic Influences
Environmental deprivation syndrome results when developing children are deprived of necessary environmental elements—physical, including adequate nourishment (malnutrition); climate or temperature control (extremes of heat or cold); hygiene, like changing and bathing; and so on. It also includes lack of adequate cognitive stimulation, which can stunt a child's intellectual development, and neglect in general. Malnutrition results from starvation; vitamin, mineral, or nutrient deficiency; deficiencies in digesting or absorbing foods; and some other medical conditions. Environmental radiation, depending on dosage and time of exposure, can cause intellectual disabilities.
Congenital hypothyroidism (underactive thyroid) can cause intellectual disabilities, as can hypoglycemia (low blood sugar) from inadequately controlled diabetes or occurring independently and infant hyperbilirubinemia.
Bilirubin, a waste product of old red blood cells, is found in bile made by the liver and is normally removed by the liver; excessive bilirubin buildup in babies can cause intellectual disabilities. Reye syndrome, caused by aspirin given children with flu or chicken pox, or following these viruses or other upper respiratory infections, or from unknown causes, produces sudden liver and brain damage and can result in intellectual disabilities.

Genetic Abnormalities and Syndromes Affecting the Nervous System
Rett syndrome is a nervous system disorder causing developmental regression, particularly severe in expressive language and hand function. It is associated with a defective protein gene on an X chromosome.
Having two X chromosomes, females with the defect on one of them can survive; with only one X chromosome, males are either miscarried, stillborn, or die early in infancy. Rett syndrome produces many symptoms, including intellectual disabilities. Tay-Sachs disease, an autosomal recessive disorder, is a nervous system disease caused by a defective gene on chromosome 15 resulting in a missing protein for breaking down gangliosides, chemicals in nerve tissues that build up in cells, particularly brain neurons, causing damage. Tay-Sachs is more prevalent in Ashkenazi Jews. The adult form is rare; the infantile form is commonest, with nerve damage starting in utero. Many symptoms, including intellectual disabilities, appear at 3 to 6 months and death occurs by 4 to 5 years. Tuberous sclerosis, caused by genetic mutations, produces tumors damaging the kidneys, heart, skin, brain, and central nervous system. Symptoms include intellectual disabilities, seizures, and developmental delays.

Genetic or Inherited Metabolic Disorders
Adrenoleukodystrophy is an X-linked genetic trait. Some female carriers have mild forms, but it affects more males more seriously. It impairs metabolism of very long-chain fatty acids, which build up in the nervous system (as well as adrenal glands and male testes). The childhood cerebral form, manifesting at ages 4 to 8, causes seizures, visual and hearing impairments, receptive aphasia, dysgraphia, dysphagia, intellectual disabilities, and other effects. Galactosemia is an inability to process galactose, a simple sugar in lactose, or milk sugar. By-product buildup damages the liver, kidneys, eyes, and brain. Hunter syndrome, Hurler syndrome, and Sanfilippo syndrome each cause the lack of different enzymes; all cause an inability to process mucopolysaccharides or glycosaminoglycans (long sugar-molecule chains). Hurler and Sanfilippo (but not Hunter) syndromes are autosomal recessive traits, meaning both parents must pass on the defect. All cause progressive intellectual disabilities. Lesch-Nyhan syndrome, affecting males, is a metabolic deficiency in processing purines. It causes hemiplegia, varying degrees of intellectual disabilities, and self-injurious behaviors.
Phenylketonuria (PKU), an autosomal recessive trait, causes lack of the enzyme to process dietary phenylalanine, resulting in intellectual disabilities.

Prescription Drugs, Substances of Abuse, Social Drugs, and Diseases
Warfarin, a prescription anticoagulant drug to thin the blood and prevent excessive clotting, can cause microcephaly (undersized head) and intellectual disabilities in an infant when the mother has taken it during pregnancy. The prescription antiseizure drug Trimethadione can cause developmental delays in babies when it has been taken by pregnant mothers.
Maternal abuse of solvent chemicals during pregnancy can also cause microcephaly and intellectual disabilities. Maternal crack cocaine abuse during pregnancy can cause severe and profound intellectual disabilities and many other developmental defects in fetuses, which become evident when they are newborns. Maternal alcohol abuse can cause fetal alcohol syndrome, which often includes intellectual disabilities, among many other symptoms. Maternal rubella
(German measles) virus can cause intellectual disabilities as well as visual and hearing impairments and heart defects. Maternal herpes simplex virus can cause microcephaly, intellectual disabilities, and microophthalmia (small or no eyes). The varicella (chicken pox) virus in pregnant mothers can also cause intellectual disabilities as well as muscle atrophy in babies.

Characteristics of Infants and Young Children with Intellectual Disabilities
Newborns with intellectual disabilities, especially of greater severity, may not demonstrate normal reflexes, such as rooting and sucking reflexes, necessary for nursing. They may not show other temporary infant reflexes such as the Moro, Babinski, swimming, stepping, or labyrinthine reflexes, or they may demonstrate weaker versions of some of these. In some babies, these reflexes will exist but persist past the age when they normally disappear. Babies with intellectual disabilities are likely to display developmental milestones at later-than-typical ages. The ages when they do display milestones vary according to the severity of the disability and by individual. Young children with intellectual disabilities are likely to walk, self-feed, and speak later than normally developing children. Those who learn to read and write do so at later ages. Children with mild intellectual disabilities may lack curiosity and have quiet demeanors; those with profound intellectual disabilities are likely to remain infantile in abilities and behaviors throughout life. Intellectually disabled children will score below normal on standardized IQ tests and adaptive behavior rating scales.

Potential Variables Causing Learning Disabilities
LDs are basically neurological disorders. Though they are more specific to particular areas of learning than global disorders like intellectual disabilities, scientific research has found correlations between
LDs and many of the same factors that cause intellectual disabilities, including prenatal influences like excessive alcohol or other drug consumption, diseases, and so on. Once babies are born, glandular disorders, brain injuries, exposure to secondhand smoke or other toxins, infections of the central nervous system, physical trauma, or malnutrition can cause neurological damage resulting in LDs. Hypoxia and anoxia (oxygen loss) before, during, or after birth is a cause, as are radiation and chemotherapy. These same influences often cause behavioral disorders as well as LDs. Another factor is genetic:
Both LDs and behavior disorders have been observed to run in families. While research has not yet identified specific genetic factors, heritability does appear to be a component in influencing learning and behavioral disorders.

Types of Neurological Damage Found in Children with LDs and ADHD
Various neurological research studies have revealed that children diagnosed with LDs and ADHD have at least one of several kinds of structural damage to their brains. Scientists have found smaller numbers of cells in certain important regions of the brains of some children with learning and behavioral disorders. Some of these children are found to have brain cells of smaller than normal size. In some cases, dysplasia is discovered; that is, some brain cells migrate into the wrong area of the brain. In some children with learning and behavioral disorders, blood flow is found to be lower than normal to certain regions in the brain. Also, the brain cells of some children with learning and behavioral disabilities show lower levels of glucose metabolism; glucose (blood sugar) is the brain's main source of fuel, so inadequate utilization of glucose can affect the brain's ability to perform some functions related to cognitive processing, as in LDs, and to attention and impulse control, as in ADHD.

Attachment Styles Identified in Toddlers by Mary Ainsworth
Mary Ainsworth worked with John Bowlby, discovering the first empirical evidence supporting his attachment theory. From her Strange
Situation experiments, she identified secure, insecure and avoidant, insecure and resistant, and insecure and disorganized attachment styles. Securely attached children show normal separation anxiety when mother leaves and happiness when she returns, avoid strangers when alone but are friendly with mother present, and use mother as a safe base for environmental exploring.
Insecure and resistant children show exaggerated separation anxiety, ambivalence and resistance to mother upon reuniting, fear strangers, cry more, and explore less than secure or avoidant babies. Insecure and avoidant children show no separation anxiety or stranger anxiety and little interest on reunions with mother and are comforted equally by mother or strangers. Insecure and disorganized types seem dazed and confused, respond inconsistently, and may mix resistant and ambivalent and avoidant behaviors. Secure styles are associated with sensitive, responsive caregiving and children's positive self-images and other images, resistant and ambivalent styles with inconsistent caregiving, and avoidant with unresponsive caregivers. Avoidant, resistant, and disorganized styles, associated with negative self-images and low self-esteem, are most predictive of emotional disturbances.

Emotional Disturbances in Young Children Classified as Anxiety Disorders
Anxiety disorders include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder
(PTSD), panic disorder, social phobia, and specific phobias. All share a common characteristic of overwhelming, irrational, and unrealistic fears. GAD involves excessive worrying about anything or everything and free-floating anxiety.
Anxiety may be about real issues but is nonetheless exaggerated and spreads, overtaking the child's life. OCD involves obsessive and preoccupied thoughts and compulsive or irresistible actions, including often bizarre rituals. Germ phobia, constant hand washing, repeatedly checking whether tasks are done or undone, and collecting things excessively are common. PTSD follows traumatic experiences/events. Children have frequent, extreme nightmares, crying, flashbacks wherein they vividly perceive or believe they are experiencing the traumatic event again, insomnia, depression, anxiety, and social withdrawal. Symptoms of panic disorder are panic attacks involving extreme fear and physical symptoms like a racing heart, cold hands and feet, pallor, hyperventilation, and feeling unable to move. Children with social phobia develop fear and avoidance of day care, preschool, or other social settings. Specific phobias are associated with specific objects, animals, or persons and are often triggered by traumatic experiences involving these.

Types and Characteristics of Learning Disabilities
Dyslexia, the most common LD, means deficiency or inability in reading. It primarily affects reading but can also interfere with writing and speaking. Characteristics include reversing letters and words, for example, confusing b and d in reading and writing; reading won as now, confusing similar speech sounds like /p/ and /b/, and perceiving spaces between words in the wrong places when reading. Dyscalculia is difficulty doing mathematical calculations; it can also affect using money and telling time. Dysgraphia means difficulties specifically with writing, including omitting words in writing sentences or leaving sentences unfinished, difficulty putting one's thoughts into writing, and poor handwriting. Central auditory processing disorder causes difficulty perceiving small differences in words despite normal hearing acuity; for example, couch and chair may be perceived as cow and hair. Background noise and information overloads exacerbate the effects. Visual processing disorders affect visual perception despite normal visual acuity, causing difficulty finding information in printed text or from maps, charts, pictures, graphs, and so on; synthesizing information from various sources into one place; and remembering directions to locations.

Factors Contributing to Emotional Disturbances
Researchers have investigated emotional disturbances but have not yet established known causes for any. Some disturbances, for example the major mental illness schizophrenia, seem to run in families and hence include a genetic component; childhood schizophrenia exists as a specific diagnosis. Factors contributing to emotional disturbances can be biological or environmental but more often are likely a combination of both. Dysfunctional family dynamics can often contribute to child emotional disorders. Physical and psychological stressors on children can also contribute to the development of emotional problems. Some people have attributed emotional disturbances to diet, and scientists have also researched this but have not discovered proof of cause and effect. Bipolar disorder is often successfully treated with the chemical lithium, which affects sodium flow through nerve cells, so chemical imbalance may be implicated as an etiology. Pediatric bipolar disorder, which has different symptoms than adult bipolar disorder, correlates highly with histories of bipolar and other mood disorders or alcoholism in both parents.

Symptoms of Pediatric Bipolar Disorder
Bipolar, formerly called manic-depressive disorder, has similar depressive symptoms in children as adults. However, children's mood swings often occur much faster, and children show more symptoms of anger and irritability than other adult manic symptoms. Bipolar children's most common symptoms include frequent mood swings; extreme irritability; protracted (up to several hours) tantrums or rages; separation anxiety; oppositional behavior; hyperactivity, impulsivity, and distractibility; restlessness and fidgetiness; silly, giddy, or goofy behavior; aggression; racing thoughts; grandiose beliefs or behaviors; risk-taking; depressed moods; lethargy; low self-esteem; social anxiety; hypersensitivity to environmental or emotional triggers; carbohydrate
(sugar or starch) cravings; and trouble getting up in the morning. Other common symptoms include bed-wetting (especially in boys), night terrors, pressured or fast speech, obsessive or compulsive behaviors, motor and vocal tics, excessive daydreaming, poor short-term memory, poor organization, learning disabilities, morbid fascinations, hypersexuality, bossiness and manipulative behavior, lying, property destruction, paranoia, hallucinations, delusions, and suicidal ideations. Less common symptoms include migraines, bingeing, self-injurious behaviors, and animal cruelty.

Conduct Disorder in Children
Factors contributing to conduct disorders in children include genetic predispositions, neurological damage, child abuse, and other traumatic experiences. Children with conduct disorders display characteristic emotional and behavioral patterns. These include aggression: They bully or intimidate others, often start physical fights, will use dangerous objects as weapons, exhibit physical cruelty to animals or humans, and assault and steal from others. Deliberate property destruction is another characteristic—breaking things or setting fires. Young children are limited in some of these activities by their smaller size, lesser strength, and lack of access; however, they show the same types of behaviors against smaller, younger, weaker, or more vulnerable children and animals, along with oppositional and defiant behaviors against adults. Also, while truancy is impossible or unlikely in preschoolers, and running away from home is less likely, young children with conduct disorders are likely to demonstrate some forms of seriously violating rules, another symptom of this disorder.

Symptoms of Childhood-Onset Schizophrenia
The incidence of childhood-onset schizophrenia is rare, but it does exist. One example of differential diagnosis involves distinguishing qualitatively between true auditory hallucinations and young children's
'hearing voices' otherwise: In the latter case, a child hears his or her own or a familiar adult's voice in his or her head and does not seem upset by it, while in the former, a child may hear other voices, seemingly in his or her ears, and is frightened and confused by them. Tantrums, defiance, aggression, and other acting-out, externalized behaviors are less frequent in childhood-onset schizophrenia than internalized developmental differences, for example, isolation, shyness, awkwardness, fickleness, strange facial expressions, mistrust, paranoia, anxiety, and depression. Children demonstrate nonpsychotic symptoms earlier than psychotic ones. However, it is difficult to use prepsychotic symptoms as predictors due to variance among developmental peculiarities. While psychiatrists find the course of childhood-onset schizophrenia somewhat more variable than in adults, child symptoms resemble adult symptoms. Childhood-onset schizophrenia is typically chronic and severe, responds less to medication, and has a more guarded prognosis than adolescent- or adult-onset schizophrenia.

Diagnosing the Emotional Disturbances in Children Classified as Psychotic Disorders
Psychosis is a general psychiatric category referring to thought disturbances or disorders. The most common symptoms are delusions that is, believing things that are not true, and hallucinations, that is, seeing, hearing, feeling, tasting, or smelling things that are not there. While early childhood psychosis is rarer than at later ages, psychiatrists confirm it does occur. Moreover, prognosis is poorer for psychosis with onset in early childhood than in adolescence or adulthood. Causes can be from known metabolic or brain disorders or unknown. Younger children are more vulnerable to environmental stressors. Also, in young children, thoughts distorted by fantasy can be from normal cognitive immaturity, due to lack of experience and a larger range of normal functioning, or pathology; where they lie on this continuum must be determined by clinicians. Believing one is a superhero who can fly can be vivid imagination or delusional; having imaginary friends can be pretend play or hallucinatory. Other developmental disorders can also cloud differential diagnosis.

Visual Impairments

Developmental Characteristics of Infants and Young Children with Visual Impairments
Historically, it was thought that VI children developed more slowly than normal; however, it is now known that ages for reaching developmental milestones are equally variable in VI babies as in others and that they acquire milestones within equal age ranges. One developmental difference is in sequence: VI children tend to utter their first words or subject-verb 2-word sentences earlier than other children. Some VI children also demonstrate higher levels of language development at younger-than-typical ages. For example, they may sing songs from memory or recall events from the past at earlier ages than other children. This is a logical development in children who must rely more on input to their hearing and other senses than to their vision when the latter is impaired. Totally blind babies reach for objects later, hence explore the environment later; hand use, eye-hand coordination, and gross and fine motor skills are delayed. Blind infants' posture control develops normally (rolling, sitting, all-fours, and standing), but mobility (raising on arms, pulling up, and walking) are delayed.

Causes of Visual Impairments in Babies and Young Children
Syndrome-related and other malformations like cleft iris or lens dislocation causing VI can have prenatal origins. Cataracts clouding the eye's lens can be congenital, traumatic, or due to maternal rubella. Eyes can be normal, but impairment in the brain's visual cortex can cause VI. Infantile glaucoma, like adult glaucoma, causes intraocular fluid buildup pressure and VI. Conjunctivitis and other infections cause VI. Strabismus and nystagmus are ocular-muscle conditions, respectively causing eye misalignments and involuntary eye movements. Trauma damaging the eyeball(s) is another VI cause.
The optic nerve can suffer from atrophy (dysfunction) or hypoplasia, that is, developmental regression, usually prenatally due to neurological trauma; acuity cannot be corrected. Refractive errors like nearsightedness, farsightedness, and astigmatism are correctable. Retinoblastoma, or behind-the-eye tumors, can cause blindness and fatality; surgical or chemotherapeutic treatment is usually required before age 2. Premature infants can have retinopathy of prematurity or retrolental fibroplasia. Cryotherapeutic treatment seems to stop disease progression. Its effects range from none to severe VI (approximately 25% of children) to complete blindness.

Impacts of Blindness Upon Cognitive Development
Blind children have more difficulty determining and confirming characteristics of things, hence defining concepts and organizing them into more abstract levels; their problem-solving is active but harder, and they construct different realities than sighted children. Blind babies typically acquire object permanence (the understanding that unseen objects still exists) a year later than normal; they learn to reach for objects only by hearing. Understanding cause-and-effect relationships is difficult without visual evidence. Blind babies and toddlers take longer to understand and object's constancy regardless of their orientation in space, affecting their ability to orient toys and their own hands. Blind children can identify object size differences and similarities, but classifying object differences and similarities in other attributes requires longer times and more exposures to various similar objects. Blind children's development of the abilities to conserve object properties like material or substance, weight, amount and volume, length, and liquid volume is later than normal.

Effects of Blindness on Emotional and Social Development
Blind babies and children are more dependent than others on adults, affecting development. With control of their inner realities but not of their outer environments, blind children may withdraw, seeking and responding less to social interaction. They may not readily develop concepts of the external world or self-concepts as beings separate from the world and the understanding that they can be both agents and recipients of actions relative to the environment. Mother-infant smiling initiates recognition, attachment, and communication in sighted babies; blind infants smile on hearing mother's voice at 2 months. Only tactile stimuli like tickling and nuzzling evoke regular smiling in blind babies. Missing facial expressions and other visual cues, blind children have more complicated social interactions. They often do not understand the basics of playing with others and seem emotionally ambivalent or uninterested and uncommunicative. Peers may reject or avoid them; adults often overprotect them. Self-help skills like chewing, scooping, self-feeding, teeth brushing, grooming, and toilet training are delayed in blind children.

Hearing Impairments

Prevalence and Etiologies of Hearing Impairments
Half or more (50% to 60%) of infant hearing losses have genetic origins—Down and other genetically based syndromes or the existence of parental hearing loss. About 25% or more of infant hearing losses are caused by maternal infections during pregnancy, such as cytomegalovirus (CMV), postnatal complications like blood transfusions or infection with meningitis, or traumatic head injuries. Included in this 25% or more are babies having nongenetic neurological disorders or conditions that affect their hearing.
Malformations of the ears, head, or face can cause hearing loss in babies.
Babies spending 5 days or longer in neonatal intensive care units (NICUs) or having complications while in the NICU are also more likely to suffer hearing loss. Around 25% of babies are diagnosed with hearing loss whose etiology is unknown.

Signs of Hearing Impairments
If an infant does not display a startle response at loud noises, this is a potential sign of hearing loss. This can also indicate other developmental disabilities, but because hearing loss is the most prevalent disability among newborns, hearing screening is a priority. Between birth and 3 or 4 months old, babies should turn toward the source of a sound; if they do not, it could indicate hearing loss. A child who does not utter first words like mama or dada by age 1 could have hearing impairment. When babies or young children do not turn their heads when their names are called, adults may mistake this for inattention or ignoring; however, children turning upon seeing adults, but not upon hearing their names, can indicate hearing loss. Babies and children who seem to hear certain sounds but not others may have partial hearing losses. Delayed speech-language development or unclear speech, not following directions, saying 'Huh?' often, and wanting higher TV or music volumes can indicate hearing loss in children.

Speech and Language Impairments

Factors Contributing to Speech and Language Impairments
Some speech and language disorders in children have unknown causes. Others have known causes such as hearing loss: Speech and language are normally acquired primarily through the auditory sense, so children with impaired hearing have delayed and impaired development of speech and language.
Brain injuries, neurological disorders, viral diseases, and some medications can also cause problems with developing language or speech. Children with intellectual disabilities are more likely to have delayed language development, and their speech is also more likely to develop more slowly and to be distorted. Cerebral palsy causes neuromuscular weakness and incoordination of speech. When severe, it can cause inability to produce recognizable speech sounds; some children without speech can still vocalize, and some cannot. A cleft palate or lip and other physical impairments affect speech. Inadequate speech-language modeling at home inhibits speech-language development. Vocal abuse in children (screaming, coughing, throat clearing, or excessive talking) can cause vocal nodules or polyps, causing voice disorders. Stuttering can be related to maturation, anxiety or stress, auditory feedback defects, or unknown causes.

Characteristics
In speech, most phonological disorders are articulatory; that is, children fail to pronounce specific speech sounds or phonemes correctly beyond the normal developmental age for achieving accuracy.
Stuttering, disfluency, and rate and rhythm disorders cause children to repeat phonemes, especially initial word sounds; to repeat words; to prolong vowels or consonants; or to block, that is, straining so hard to produce a sound that, pressure builds, but no sound issues. Their speech rates may also speed and slow irregularly. Children with voice disorders can have voices that sound hoarse, raspy, overly nasal, higher- or lower-pitched than normal, overly weak or strident, and whispery or harsh. Hoarseness is common with vocal nodules and polyps. Cleft palate commonly causes hypernasality. In language, one of the most common impairments is delayed language development due to environmental deprivation, intellectual disabilities, neurological damage or defects, hearing loss, visual impairment, and so on. Children with neurological damage or disorders may exhibit aphasias, language disorders characterized by receptive difficulty with understanding spoken or written language, or expressive difficulty constructing spoken or written language.

Physical and Health Impairments

Examples of Physical and Health Impairments
In the special education field of early childhood education, other health impairment is a term referring to health and physical conditions that rob a child of strength, vitality, or alertness or that cause excessive alertness to environmental stimuli, all having the end result of impeding the child's ability to attend or respond to the educational environment. Health problems can be acute, that is short-term or temporary but serious, or chronic, that is, long-term, persistent, or recurrent. Some examples of such health and physical impairments include: cerebral palsy, spina bifida, amputations or missing limbs, muscular dystrophy, cystic fibrosis, asthma, rheumatic fever, sickle-cell anemia, nephritis or kidney disease, leukemia, Tourette syndrome, hemophilia, diabetes, heart disease, AIDS, and lead poisoning. All these conditions and others can interfere with a child's development and ability to attend and learn. In addition to seizure disorders, which often cause neurological damage, seizure-controlling medications also frequently cause drowsiness, interfering with attention and cognition. Attention deficit and attention deficit hyperactivity disorders (ADD and ADHD) limit attention span, focus, and concentration and thus are sometimes classified as health impairments requiring special education services.

Characteristics of Babies and Children with Physical and Health Impairments
The characteristics of children having various physical or health impairments can range from having no limitations to severe limitations in their activities. Children with cerebral palsy, for example, usually have deficiencies in gross and fine motor development and deficits in speech-language development. Physical and health conditions causing severe debilitation in some children not only seriously limit their daily activities but also cause multiple primary disabilities and impair their intellectual functioning.
Other children with physical or health impairments function at average, above-average, or gifted intellectual and academic levels. An important consideration when working with babies and young children having physical or health impairments is handling and positioning them physically. Correctly picking up, holding, carrying, giving assistance, and physically supporting younger children and arranging play materials for them based on their impairment is not only important for preventing injury, pain, and discomfort; it also enables them to receive instruction better and to manipulate materials and perform most efficiently. Preschoolers with physical impairments also tend to have difficulty with communication skills, so educators should give particular attention to facilitating and developing these.

Developmental Delays

Factors Leading to Developmental Delays
Developmental delays can come from genetic or environmental causes or both. Infants and young children with intellectual disabilities are most likely to exhibit developmental delays. Their development generally proceeds similarly to that of normal children but at slower rates; milestones are manifested at later-than-typical ages. Sensory impairments such as with hearing and vision can also delay many aspects of children's development.
Children with physical and health impairments are likely to exhibit delays in their motor development and performance of physical activities. Another factor is environmental: Children deprived of adequate environmental stimulation commonly show delays in cognitive, speech-language, and emotional and social development. Children with autism spectrum disorders often have markedly delayed language and speech development; many are nonverbal. Autistic children also typically have impaired social development, caused by and inability or difficulty with understanding others' emotional and social nonverbal communications. When they cannot interpret these, they do not know how to respond and also cannot imitate them; however, they can often learn these skills with special instruction.

Characteristics Indicating Developmental Delays
Developmental delays mean that a child does not reach developmental milestones at the expected ages. For example, if most babies normally learn to walk between 12 and 15 months of age, a 20-month-old who is not beginning to walk is considered as having a developmental delay. Delays can occur in cognitive, speech-language, social-emotional, gross motor skill, or fine motor skill development. Signs of delayed motor development include stiff or rigid limbs, floppy or limp body posture for the child's age, using one side of the body more than the other, and clumsiness unusual for the child's age.
Behavioral signs of children's developmental delays include inattention, or shorter than normal attention span for the age; avoiding or infrequent eye contact; focusing on unusual objects for long times or preferring objects over social interaction; excessive frustration when attempting tasks normally simple for children their age; unusual stubbornness; aggressive and acting-out behaviors; daily violent behaviors; rocking; excessive talking to oneself; and not soliciting love or approval from parents.

Traumatic Brain Injury (TBI)

IDEA's Legal Definition of Traumatic Brain Injury
TBI is defined by the IDEA law (the Individuals with Disabilities Education Act) as 'an acquired injury to the brain from external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affect a child's educational performance.' This definition excludes injuries from birth trauma, congenital injuries, and degenerative conditions. TBI is the foremost cause of death and disability in children (and teens) in the USA. The most common causes of TBI in children include falls, motor vehicle accidents, and physical abuse. In spite of the IDEA's definition, aneurysms and strokes are three examples of internal traumas that can also cause TBI in babies and young children. External head injuries that can result in TBI include both open and closed head injuries.
Shaken baby syndrome is caused by forcibly shaking an infant. This causes the brain literally to bounce against the insides of the skull, causing rebound injuries, resulting in TBI and even death.
TBI can impair a child's cognitive development and processing. It can impede the language development of children, which is dependent upon cognitive development. Children who have sustained TBI often have difficulties with attention, retention and memory; reasoning, judgment, understanding abstract concepts and thinking abstractly, and problem-solving abilities. TBIs can also impair a child's motor functions and physical abilities. The sensory and perceptual functions of children with TBI can be abnormal. Their ability to process information is often compromised. Their speech can also be affected. In addition, TBIs can impair a child's psychosocial behaviors. Memory deficits are commonest, tend to be more long lasting, and are often area specific; for example, a child may recall personal experiences but not factual information. Other common characteristics of TBI include cognitive inflexibility or rigidity, damaged conceptualization and reasoning, language loss or poor verbal fluency, problems with paying attention and concentrating, inadequate problem solving, and problems with reading and writing.

Etiologies and Characteristics of Multiple Disabilities
The term multiple disabilities refers to any combination of more than one disabling condition. For example, a child may be both blind and deaf due to causes such as having rheumatic fever in infancy or early childhood. Anything causing neurological damage before, during, or shortly after birth can result in multiple disabilities, particularly if it is widespread rather than localized. For example, infants deprived of oxygen or suffering traumatic brain injuries in utero, during labor or delivery, or postnatally can sustain severe brain damage. So can babies having encephalitis or meningitis and those whose mothers abused drugs prenatally. Infants with this type of extensive damage can often present with multiple disabilities, including intellectual disabilities, cerebral palsy, physical paralysis, mobility impairment, visual impairment, hearing impairment, and speech-language disorders. They may have any combination of or all of these disabilities as well as others. In addition to a difficulty or inability with normal physical performance, multiply disabled children often have difficulty acquiring and retaining cognitive skills and transferring or generalizing skills among settings and situations.

Prematurity or Preterm Birth
Babies born before 37 weeks' gestation are classified as premature or preterm. Premature infants can have difficulty with breathing, as their lungs are not fully developed, and with regulating their body temperatures. Premature infants may be born with pneumonia, respiratory distress, extra air or bleeding in the lungs, jaundice, sepsis or infection, hypoglycemia (low blood sugar), severe intestinal inflammation, bleeding into the brain or white-matter brain damage, or anemia. They have lower-than-normal birth weights, body fat, muscle tone, and activity. Additional typical characteristics of premature infants include apnea (interrupted breathing); lanugo (a coating of body hair that full-term infants no longer have); thin, smooth, shiny, translucent skin through which veins are visible; soft, flexible ear cartilage; cryptorchidism (undescended testicles) and small, non-ridged scrotums in males; enlarged clitorises in females; and feeding difficulties caused by weak or defective sucking reflexes or incoordination of swallowing with breathing.

Disabling Conditions Resulting from Premature Births
Physicians find it impossible to predict the long-term results of prematurity for any individual baby based on an infant's gestational age and birth weight. However, some related immediate and long-term effects can be identified. Generally, the lower the birth weight and the more prematurely a child is born, the greater the risk is for complications. Infants born at less than 34 weeks of gestation typically cannot coordinate their sucking and swallowing and may temporarily need feeding or breathing tubes or oxygen. They also need special nursery care until able to maintain their body temperatures and weights. Long-term complications of prematurity can include bronchopulmonary dysplasia, a chronic lung condition; delayed physical growth and development; delayed cognitive development; mental or physical delays or disabilities; and blindness, vision loss, or retinopathy of prematurity
(formerly called retrolental fibroplasia). While some premature infants sustain long-term disabilities, some severe, other babies born prematurely grow up to show no effects at all; and any results within this range can also occur.

Required and Recommended Information in Screening for Developmental Disorders
If a young child has been screened for developmental disorders or delays within the past 6 months and no changes have been observed or reported, repeat screening may be waived. Initial screenings are required.
Hearing and vision screenings are mandatory in screening young children. Formal developmental measures are also required, which may include screening tests of motor skills development, cognitive development, social-emotional development, and self-help skills development. Formal screening tests of speech-language development are also required. Additional tests recommended during screening include informal measures. For example, checklists, rating scales, and inventories may be used to screen a child's behavior, mood, and performance of motor skills, cognitive skills, self-help skills, and social and emotional skills. On checklists, parents or caregivers check whether the child does or does not demonstrate listed behaviors, or assessors may complete them via parent or caregiver interviews or interviewing and observing the child. Rating scales ask parents, caregivers, and assessors to rate a child's behaviors, affect, mood, and so on, within a range of numbered and labeled descriptions.
Inventories list demonstrated skills and needs. Behavioral observations and existing records and information are also used.

Features of Developmental Screenings and Evaluations
If a child's development is suspected of being delayed—for example, the child is not reaching developmental milestones during expected age ranges—a developmental screening may be administered. Screening tests are quickly performed and yield more general results. The hospital or doctor's office may give a questionnaire to the parent or caregiver to complete for a screening. Alternatively, a health or education professional may administer a screening test to the child. Screening tests are not intended to diagnose specific conditions or give details; they are meant to identify children who may have some problem. Screenings can overidentify or under-identify developmental delays in children. Hence, if the screening identifies a child as having developmental delay(s), the child is then referred for a developmental evaluation—a much longer, more thorough, comprehensive, in-depth assessment using multiple tests, administered by a psychologist or other highly-trained professional. Evaluation provides a profile of a child's strengths and weaknesses in all developmental domains. Determination of needs for early intervention services or treatment plans is based on evaluation results.

Developmental Evaluation Data Types
The child's social history should be obtained. This is typically done by a social worker. Details of the child's developmental progress heretofore; the family's composition, socioeconomic status, and situation; and the child's and family's health and medical histories and status should be emphasized. A physician's or nurse's medical assessment is required, including a physical examination, and if indicated, a specialist's examination.
A psychologist typically assesses intellectual and cognitive development; at least one such test is generally required. At least one test of adaptive behavior is also required to assess emotional-social development. Self-help skills are evaluated; this may be included within cognitive, adaptive behavior, or programming assessments. Communication skills are typically evaluated by a speech-language pathologist. Both receptive and expressive language must be tested and comprehensively rather than simply by single-word vocabulary tests. A. indicated, speech articulation is also tested. At least one test of motor skills, typically administered by a physical or occupational therapist, is required. Programming evaluation requires at least one criterion-referenced or curriculum-based measure, typically administered by an educator.

Behavioral Variations and Characteristics of ADHD
While the chief symptoms associated with ADHD are inattentiveness, impulsive behavior, distractibility, and excessive physical activity, there is considerable variation among individual children having ADHD. For example, the degree of severity of this condition can vary widely from one child to the next. In addition, each child can vary in how much he or she exhibits each of these primary characteristics. Some children might not appear to behave very impulsively but show severe deficits in attention. Some may focus better, but only for short periods, and are very easily distracted.
Some display very disruptive behavior, while others do not but may daydream excessively, not attending to programming. In general, children who have ADHD can show deficits in following rules and directions. Also, when their developmental skills are evaluated or observed, they are likely to demonstrate inconsistencies in performance over time. To identify or select specific intervention methods and strategies, professionals should use a comprehensive evaluation to obtain information about the child's specific behaviors in his or her natural environment that need remediation.

Child Find
Child Find is an ongoing process with the aim of locating, identifying, and referring young children with disabilities and their families as early as possible for service programs. This process consists of activities designed to raise public awareness and screenings and evaluations to identify and diagnose disabilities. The federal IDEA law mandates under Part B that disabled children are guaranteed early childhood special education services and under Part C that infants and toddlers at risk for developmental delays are guaranteed early intervention programs. (Eligibility guidelines vary by U.S. states.) The IDEA requires school districts to find, identify, and evaluate children with disabilities in their attendance areas. School districts have facilitated this Child Find process by establishing community informed referral networks whose members refer children who may have exceptional educational needs (EENs). Network members typically include parents, doctors, birth-to-3 programs, child care programs, Head Start programs, public health agencies, social service agencies, and any other community members with whom the young children come into contact.

Current Collaborative Approaches and Models of Screening
Historically, the tradition was to conduct kindergarten screenings of children entering schools around age 5. However, in recent years, school districts have developed community referral networks to assist in the processes of Child Find, screening, evaluation, and referral for early intervention and early childhood special education and related services.
Current models are more informal, proactive, and collaborative. Cooperative educational interagency service efforts give parents information about normal early childhood development and available community resources and offer opportunities for developmental screenings of their young children. Specific procedures are governed by individual U.S. state laws. Generally, district networks implementing current models send developmental review forms to parents to complete in advance, and then they attend a developmental screening at a community site. Parents discuss normal early childhood growth and development with program staff, while in the same room, trained professionals observe their children as they play. Children's vision and hearing are also screened. Parents can discuss their children's current development with psychologists, early childhood educators, or counselors. Thereafter, they can learn about community resources.

Defining Developmental Delays in Infants and Toddlers
The IDEA Part C specifies the areas of development that states must include in defining developmental delays. However, individual states must identify the criteria they use to determine eligibility, including pertinent diagnostic instruments, procedures, and functional levels. States currently use quantitative and qualitative measures. Quantitative criteria for developmental delay include: difference between chronological age and performance level, expressed as a percentage of chronological age; performance at a given number of months below chronological age; or number of standard deviations (SDs) below mean of performance on a norm-referenced test.
Qualitative criteria include: development considered atypical or delayed for established norms or observed behaviors considered atypical. At least one state differentially defines delay according to a child's age in months, with the rationale that a 25% delay, for example, is very different for a 1-year-old than a 3-year-old. Quantitative criteria for defining delay and determining eligibility vary widely among states. A 25% or 20% delay; 2 SDs below mean in 1+ areas or 1.5 SD below mean in 2+ areas are some common state criteria.

Single and Multiple Risk Factors in Infants and Toddlers for Developmental Delays
Scientists find that developmental outcomes for children are not reliably predicted by any one risk factor or event. Developmental risk increases with increased biological, medical, or environmental risk factors.
However, researchers have found some variables that afford resiliency in children to offset risk factors. These can include the child's basic temperament, the child having high self-esteem, the child having a good emotional relationship with at least one parent; and the child having experiences of successful learning. These findings indicate that assessments should include criteria for multiple biological and environmental risk factors, for cumulative biological and environmental risk factors, and for protective or resilience factors, considering all of these in the context of change occurring over time. Under the IDEA (the Individuals with Disabilities Education Act), U.S. states have the option to provide early intervention services to children considered at risk for adverse developmental outcomes as well as those already identified with them. Some states apply multiple-risk models, requiring three to five risk factors for service eligibility. Some states also determine eligibility with less DD when biological, medical, or environmental risk factors also exist.

Information Sources on Early Intervention and Preschool Special Education Services
Military families stationed both in the United States and overseas who have young special needs children can seek information and assistance from the federally funded organization Specialized Training of Military Families (STOMP). The staff of STOMP is composed of parents having special needs children themselves, who also have been trained to work with other parents of special needs children. STOMP staff members are spouses of military personnel who thus understand the unique, specialized circumstances and needs of military families. Another government agency, the U.S. Department of Defense, includes the office of the Department of Defense Education Activity
(DoDEA) and provides comprehensive guidance to military families with special needs children who are eligible to receive, or are receiving, free appropriate public education (FAPE) as mandated by the IDEA law (the Individuals with Disabilities Education Act), whether that education is located in the United States or in other countries.

Providing Special Education Services for Preschoolers
If parents observe that their preschooler is not attaining developmental milestones within the expected age ranges or does not seem to be developing in the same way as most other children, they should seek evaluation for possible developmental delay or disability. Although 3- to-5-year-olds are likely not in elementary school yet, the elementary school in a family's school district is still the best first contact because the IDEA law (the Individuals with Disabilities Education Act) specifies that school districts must provide special education services at no family cost to eligible children, including preschoolers. Another excellent source of more information about special education is the National Dissemination Center for Children with Disabilities (NICHCY) of the U.S. Department of Education's Office of Special Education Programs. They partner with nonprofit organizations like the Academy for Educational
Development (AED) to produce useful documents for families with special needs children. NICHCY supplies state resource sheets listing main contacts regarding special education services in each U.S. state. Families can obtain these sheets at NICHCY's website or by telephone.

Information Sources for Evaluation to Determine Developmental Disability
Under the IDEA (the Individuals with Disabilities Education Act), evaluation information sources include: physicians' reports, the child's medical history, developmental test results, current classroom observations and assessments (when applicable), completed developmental and behavioral checklists, feedback and observations from parents and all other members of the evaluation team, and any other significant records, reports, and observations regarding the child. Under the IDEA, involved in the evaluation are parents, at least one regular education teacher and special education teacher if the child has these, and any special education service provider working with the child—for children receiving early intervention services from birth through age
2 and transitioning to preschool special education, it may be an early intervention service provider; a school administrator knowledgeable about children with disabilities, special education policies, regular education curriculum, and resources available; a psychologist or educator who can interpret evaluation results and discuss indicated instruction; individuals with special expertise or knowledge regarding the child (recruited by school or parents); when appropriate, the child; and other professionals, for example, physical or occupational therapists, speech therapists, medical specialists, and so on.

Special Education Services for Preschool Children
Special education for preschoolers is education specifically designed to meet the individual needs of a child aged 3 to 5 years with a disability or developmental delay. The specialized design of this instruction can include adaptations to the content, to the teaching methods, and the way instruction is delivered to meet a disabled child's unique needs. Special education for preschoolers includes various settings, such as in the home, in classrooms, hospitals, institutions, and others. It also includes a range of related services, such as speech-language pathology services, specialized physical education instruction, early vocational training, and training in travel skills. The school district's special education system provides evaluation and services to eligible preschoolers free of charge. Evaluation's purposes are to determine whether a child has a disability under the IDEA's (the Individuals with Disabilities Education Act) definitions and determine that child's present educational needs.

Post-Evaluation and the Individualized Education Program
After a preschool child is evaluated, the parents and involved school personnel meet to discuss the evaluation results. Parents are included in the group that decides whether the child is eligible for special education services based on those results. For eligible children, the parents and school personnel will develop an IEP. Every child who will receive special education services must have an IEP. The main purposes of the IEP are (1) to establish reasonable educational goals for the individual child and (2) to indicate what services the school district will provide to the child. The IEP includes a statement of the child's present levels of functioning and performance. It also includes a list of more general instructional goals for the child to achieve through school and parental support along with more specific learning objectives reflecting those goals and specifying exactly what the child will be able to demonstrate, under what circumstances, how much of the time—for example, a percentage of recorded instances—and within what time period (e.g., 1 year).

Individualized Education Program Goals and Objectives
In an IEP, the goals are more global, describing a skill for the child to acquire or a task to master. The objectives are more specific articulations of achievements that will demonstrate the child's mastery of the goal. For example, if a goal is for the child to increase his or her functional communicative vocabulary, a related objective might be for the child to acquire
X number of new words in X length of time; another related objective could be for the child to use the words acquired in 90% of recorded relevant situations.
If the goal is for the child to demonstrate knowledge and discrimination of colors, one objective might be for the child to identify correctly a red, yellow, and blue block 95% of the time when asked to point out each color within a group of blocks. Progress toward or achievement of some objectives may be measured via formal tests; with preschoolers, many others are measured via observational data collection.

Progress Monitoring, Updating, and Revising IEPs
Once a child has been identified with a disability, determined eligible for special education and related services under the IDEA
(the Individuals with Disabilities Education Act), and had an IEP developed and implemented, the child's progress must be monitored. Monitoring methods may be related to evaluation methods. For example, if a child identified with problem behaviors was initially evaluated using a behavioral checklist, school personnel can use the same checklist periodically, comparing its results to the baseline levels of frequency and severity originally obtained. If an affective disorder or disturbance was identified and instruments like the Beck Depression
Inventory or Anxiety Inventory were used, these can be used again periodically; reduced symptoms would indicate progress. If progress with IEP goals and objectives is less or greater than expected, the IEP team meets and may revise the program. This can include specifying shorter or longer times to achieve some goals and objectives; lowering or raising requirements proving too difficult or easy; resetting successive objective criteria in smaller or larger increments; changing teaching methods, content, or materials used, and so on.

Informal Assessment Instruments
EC teachers assess pre-K children's performance in individual, small-group, and whole-class activities throughout the day using informal tools that are teacher-made, school/program/district-furnished, or procured by school systems from commercial educational resources. For classroom observations, teachers might complete a form based on their observations during class story or circle time, organized using three themes per day, each targeting different skills—social-emotional, math, alphabet knowledge, oral language, or emergent writing. They note the names of children demonstrating the specified skill and those who might need follow-up, and provide needed one on one interventions daily. For individual observations, teachers might fill out a chart divided into domains like physical development; oral language development; math; emergent reading; emergent writing; science and health; fine arts; technology and media; social studies; social-emotional development; and approaches to learning, noting one child's strengths and needs in each area per chart. In addition to guided observation records, teachers complete checklists; keep anecdotal and running records; and assemble portfolio assessments of children's work. Tracking children's progress informs responsive instructional planning.

Screening Versus Assessment Instruments
A variety of screening and assessment instruments exist for EC measurement. Some key areas where they differ include which developmental domains are measured by an instrument; for which applications an instrument is meant to be used; to which age ranges an instrument applies; the methods by which a test or tool is administered; the requirements for scoring and interpreting a test, scale, or checklist; whether an instrument is appropriate for use with ethnically diverse populations; and whether a tool is statistically found to have good validity and reliability. EC program administrators should choose instruments that can measure the developmental areas pertinent to their program; support their program's established goals; and include all EC ages served in their program. Instruments' administration, scoring, and interpretation methods should be congruent with program personnel's skills. Test/measure administration should involve realistic time durations. Instruments/tools should be appropriate to use with ethnically diverse and non-English-speaking children and families. Tests should also be proven psychometrically accurate and dependable enough.

Typical Applications of Screening and Assessment Instruments
The ways in which screening and assessment instruments applicable to ECE are used include a wide range of variations. For example, ECE programs typically need to identify children who might have developmental disorders or delays. Screening instruments are used to identify those children showing signs of possible problems who need assessments, not to diagnose problems. Assessment instruments are used to develop and/or confirm diagnoses of developmental disorders or delays. Assessment tools are also used to help educators and therapists plan curricular and treatment programs. Another important function of assessment instruments is to determine a child's eligibility for a given program. In addition, once children are placed in ECE programs, assessment tools can be used to monitor their progress and other changes occurring through time. Moreover, program administrators can use assessment instruments to evaluate children's achievement of the learning outcomes that define their program goals—and by extension, the teachers' effectiveness in furthering children's achievement of those outcomes.

Formal Assessment Instruments
Formal assessment instruments are typically standardized tests, administered to groups. They give norms for age groups/developmental levels for comparison. They are designed to avoid administrator bias and capture children's responses only. Their data can be scaled and be reported in aggregate to school/program administrators and policymakers. The Scholastic Early Childhood Inventory (SECI) is a formal one on one instrument to assess children's progress in four domains found to predict kindergarten readiness: phonological awareness, oral language development, alphabet knowledge, and mathematics. Other instruments measuring multiple developmental domains include the Assessment, Evaluation and Programming System (0–6 years) for planning intervention; the Bayley Scale for Infant Development (1–42 months) for assessing developmental delays; the Brigance Diagnostic Inventory of Early Development (0–7 years) for planning instruction; the Developmental Profile II (0–6 years) to assess special needs and support IEP development; the Early Coping Inventory (4–36 months) and Early Learning Accomplishment Profile (0–36 months), both for planning interventions; and the Infant-Toddler Developmental Assessment (0–42 months) to screen for developmental delays.

Screening and Assessment Instruments Measuring Development
The available screening and assessment instruments for EC development cover a wide range in scope and areas of focus. Some measures are comprehensive, assessing young children's progress in many developmental domains including sensory, motor, physical, cognitive, linguistic, emotional, and social. Some other instruments focus exclusively on only one domain, such as language development or emotional-social development. Some instruments even focus within a domain upon only one of its facets, e.g. upon attachment or temperament within the domain of emotional-social development. In addition, some tools measure risk and resiliency factors influencing developmental delays and disorders. Programs like Head Start that promote general EC development should select comprehensive assessment instruments. Outreach programs targeting better identification of children having untreated and/or undetected mental health problems should choose instruments assessing social-emotional development. Clinics treating children with regulatory disorders might select an instrument measuring temperament. Prevention programs helping multiple-needs families access supports and services could use a measure for risk and resiliency factors. Multifaceted EC programs often benefit most from using several instruments in combination.

Age Ranges Included in Various Screening and Assessment Instruments

An important consideration for screening and assessment in early childhood is that EC development is very dynamic and occurs rapidly.
Hence screening and assessment instruments must be sensitive to such frequent and pronounced developmental changes. Some instruments target specific age ranges like 0–36 months. Others cover wider ranges, e.g. children aged 2–16 years. The latter may have internal means of application to smaller age ranges; for example, sections respectively for 3–6-month-old babies, 7–12-month-olds, and 12–18-month-olds. Or they indicate different scoring and interpretation criteria by age; for example, some screening tools specify different numbers of test items depending on the child's age to indicate a need for assessment.
Choosing screening and assessment instruments covering the entire age range served in an ECE program is advantageous—not only because they can be used with all child ages in the program, but also because they can be administered and readministered at the beginning and end of programs and/or in between, to compare and monitor changes, which is difficult with separate, age-specific tests.

Features of Paper-and-Pencil Reports
The most common form of paper-and-pencil report about infants and young children are questionnaires. Parents, caregivers, and teachers read printed questions or statements and respond by selecting Yes or
No to a question or a number/level on a Likert-type scale showing the degree to which they agree with a statement. For self-administration, instruments must contain questions/statements written on reading levels accessible to the respondents and in their native languages. Alternatively, some questionnaires or surveys can be read to the respondent by an interviewer trained in or familiar with administration of the chosen instrument. Such self-reporting instruments usually take fewer than 20 minutes to finish, and ECE program personnel need comparatively little training to administer them. However, employees may need further training to score and/or interpret responses, or already-trained specialists may score and interpret them in some cases. ECE schools/programs/agencies can obtain some self-reporting instruments free of charge; other tools' publishers charge for response forms; and others charge only for initially obtaining their materials, allowing purchasers to reproduce them thereafter.

Features of Formal and Informal Observations
Some instruments require EC staff to watch a child's behavior and/or interactions with parents/caregivers and/or peers. Formal observations involve watching activities structured for the screening/assessment instrument. Informal observations involve watching a child's activities in natural settings like at home or in preschool during play times. Formal observation tools typically require staff to be trained to administer them. The trained observers' findings can include records of which developmentally normal behaviors a child has attained, incidences of problem behaviors noted, descriptions and evaluations of the quality of a child's social interactions with other people, and other observations of the child's behaviors that can inform screening and assessment. Observational screening and assessment instruments usually take more than 20 minutes for administration.
Publishers of observational tests typically charge EC programs to order single-use recording forms; some allow them to purchase templates and then reproduce the forms.

Scoring and Interpretation of Various Screening and Assessment Instruments
Some instruments are fairly simple to score and interpret, needing little training of EC personnel. For example, paper-and-pencil questionnaires/surveys often only need the numbers/points for each item response added up for a total score; or a group of scores is obtained by summing values within sections. Interpreting some screening scores can be as simple as noting whether a child's score surpasses a designated cut-off value that signals assessment is needed. Such screenings can be scored and interpreted right after administration, and readily shared with parents and other stakeholders. Assessment instruments using more complicated scoring and interpretation include such procedures as weighting item values; reversing point values for certain items; converting raw scores into standardized scores or percentages; and referring to tables giving national norms for comparison.
Standardized tests, including preschool IQ scales, commonly involve such methods. Assessors often need considerable training; advanced psychometric education and experience; thorough knowledge of EC development; and additional time to score and interpret these tests. Results may be discussed in separately scheduled meetings.

Interview Features
In EC programs conducting assessments, personnel usually conduct interviews with a child's parents, teachers, and/or caregivers.
Interviews can be made in structured formats, i.e. the administrator reads prescribed questions as written to the interviewee, or semi-structured formats, wherein the administrator uses his/her judgment to add more questions to the written ones until s/he determines that the information provided is complete enough. Interview questions vary, covering subjects of parental concern, the child's identified areas of strengths and accomplishments, the child's identified areas of deficits or needs, the interactions between parents and child, and the child's behavior. Interviews can be brief, but usually they are longer than paper-and-pencil self-reporting questionnaires, surveys, or checklists. EC personnel frequently need to be trained to administer published interview-based instruments. Publishers typically charge schools/programs/agencies for ordering multiple, single-use response forms, or they may require a one-time order and allow them to reproduce the forms from their initial purchase to use for multiple administrations.

Features of Screening and Assessment Tools Using Structured Tasks
Screening and assessment instruments that use structured tasks involve a list of behaviors and/or skills that a child is expected to attain by a certain age range or developmental level. The administrators must present various activities or tasks to a child, and then record the details of the child's performance of each activity or task. Instruments using structured tasks require EC staff training for administration. They take over 20 minutes to complete. EC programs/schools/agencies must buy testing equipment/materials and single-use recording forms. Because paper-and-pencil questionnaires/surveys are easy to administer; apply across various settings, e.g. preschools, pediatricians' waiting rooms, homes, etc.; cost comparatively little; require minimal administrator training; and are frequently short, they are appropriate for screening use. While formal/informal observational tools, structured/semistructured interview tools, and structured-task tools take more training, time, and expense, they also provide more detailed information, making them useful for determining diagnoses and/or developing individualized care/instruction plans. Instruments using multiple methods, e.g. collecting data from various settings and respondents, yield the most comprehensive

Test-Retest Reliability
Test-retest reliability is how consistent/stable an instrument's results are across administrations. An instrument with good test-retest reliability yields the same results when administered twice or more to the same child within a short time. For example, the same assessor gives a child the same test twice within a few days or weeks, comparing the results. The more similar the results between/among administrations, the higher the test-retest reliability. This implies the instrument measures an attribute/construct that is stable over a short time. Due to the inherent rapidity and dynamism of EC development, we expect significant developmental changes over years and months; but over only weeks or days, we expect little or no substantial change.
Therefore, instruments whose results are not stable over a short time are less utile for EC screening/assessment. For example, a child's scoring with 'typical development' on one administration but 'possible delay/disorder' a week later means the instrument does not define the child's developmental needs, and thus is not reliable.

Inter-Rater Reliability of Screening and Assessment Instruments
Inter-rater reliability is how consistent/stable an instrument's results are across different individual administrators/raters.
Good inter-rater reliability means the instrument will give the same/similar results for the same child, at the same time, in the same setting, when administered by different people. This shows that the instrument measures a quality/construct that remains stable regardless of who administers the test.
Significant differences among different raters' results present problems, especially with instruments using unstructured interviews, observations, or structured tasks. For example, if one rater scores a child as possibly having a developmental delay or disorder while another rater using the same test scores the same child as within the range of normal development, the instrument does not identify the child's true developmental needs and is unreliable. When different assessors (like parent vs. teacher) observe a child in different settings, though, like home vs. preschool, and/or at different times, varying results are expected and not necessarily indicative of inter-rater unreliability because children's behaviors can vary by setting.

Internal Consistency Regarding Test Instruments
A testing instrument is said to have internal consistency when its individual items correlate strongly with each other and with the total test score. This means that all of the individual items (questions, stimuli, tasks, etc.) measure parts of the same construct that the test is intended to measure.
A test with low internal consistency could be measuring additional attributes that the authors did not define or mean for the test to measure. Children with disparate developmental needs could thus receive similar scores, based on different test items. With comprehensive screening and assessment instruments that cover multiple domains of development, EC educators should look for internal consistency within each subscale of the test or within each domain tested. However, they should not necessarily expect internal consistency among the different domains or at the level of the test's full-scale/overall score.
For example, they should not expect high correlation between a test's subscale measuring a child's language skills development and its subscale measuring a child's gross motor skills development.

Internal Consistency and Screening and Assessment Instruments
Whether a test's individual items contribute to measuring the construct the test is supposed to measure is internal consistency. It is determined by how much the test's individual items correlate with one another and with the overall score. A test with high internal consistency more accurately measures the specific content area/developmental domain/construct it means to measure. A test with low internal consistency poses problems when children who might have very different needs get the same score. For example, if a test meant to measure aggression has low internal consistency, its individual items are not correlated with one another or the overall score, implying it tests more than one construct. Two children given this test could score beyond the cutoff level indicating diagnosis or assessment need, but their scores could be due to completely different individual test items. Since individual test items do not correlate, the two children might have markedly different needs. Furthermore, those needs may not be related to aggression, since the test probably unintentionally measures additional constructs.

Concurrent Validity Regarding Screening and Assessment Instruments
When a screening or assessment instrument yields results comparable to those of another instrument whose validity has been previously established, it has good concurrent validity. Since the test used for comparison was already found valid, users have confidence in its results. Therefore, their confidence is warranted in another test showing high concurrent validity with the established test. For example, the Stanford-Binet Intelligence Scales and the Wechsler Preschool and Primary Scales of Intelligence (WPPSI) are both well-established IQ tests with demonstrated statistical validity and reliability. So if EC educators have found or been given a new instrument for measuring intelligence, they are likely to find that its authors have compared the test's results to the results obtained by the Stanford-Binet and/or WPPSI.
Educators who have confidence in the Stanford-Binet and/or the WPPSI are then justified in having comparable confidence in the new test if its results were found similar to those of the established tests, indicating its high concurrent validity.

Content Validity Regarding Screening and Assessment Instruments
Whether a test instrument measures the entire content area it purports to measure is known as content validity. It determines whether a test can yield accurate and fair measures of the totality of the construct that the assessor wants to test. For example, if a screening instrument is intended to measure social-emotional development in a young child, it should include individual test items covering the range of this domain's important components.
A screening test that covers a child's interactions with caregivers but not with peers; screens attention but not initiation of play; or screens for social skills but not communication skills would not address all elements of social-emotional development and thus not have good content validity. EC educators can use instruments with high content validity to generalize with more confidence about how a child's test performance predicts his/her levels of functioning in real life. By contrast, if a test has low content validity, generalizations about the tested child's development can exceed the test's scope and be inaccurate and/or unrealistic.

Predictive Validity in Screening and Assessment Instruments
A screening/assessment instrument's prediction of a child's behavior in real life is predictive validity. For example, an instrument screening for social-emotional disorders in preschool children might predict tantrum and/or oppositional behaviors in kindergarten. In another example, you would expect a screening instrument for social-emotional disorders to differentiate between children with normal/typical social-emotional development and those with mental health disorders. If a screening tool identifies a child with a potential mental health disorder and has high predictive validity, a complete clinical diagnostic evaluation of the screened child would diagnose a mental health disorder. Sensitivity is the instrument's accuracy—here, in identifying developmental disorders/delays, if it correctly identifies 9 of 10 children really having disorders/delays, it has 90 percent sensitivity. Specificity conversely would be accuracy in identifying children without disorders/delays.
Despite high sensitivity and specificity, screeners yield some errors.
False-positives over-identify delays/disorders where none exist; false-negatives under-identify existing delays/disorders. Unnecessary concern is a consequence of false-positives; lack of prevention/early intervention/treatment is a more serious consequence of false-negatives.

Norm-Referenced Versus Criterion-Referenced Tests
Norm-referenced tests compare a child's test results to those of a comparison group of other children in the same age group, grade, or developmental level. This comparison group is called a normative or standardization sample. Norm-referenced tests show how an individual child's performance compares to that of the general population of children.
Criterion-referenced tests compare a child's test results to a predetermined standard of performance for the child's age group/grade/level. They show how an individual child's performance compares to standards established by educational experts. Norm-referenced tests are useful for determining whether a child is similar to the 'average' child and identifying children performing significantly above or below average. Criterion-referenced tests are good for measuring the extent to which an individual child has mastered areas or domains of development and for monitoring changes over time in the child's levels of mastery.

Establishing and Maintaining Good Communication with Parents
When teachers send home a letter to parents explaining classroom practices and giving contact information at the beginning of the school year, parents perceive them as approachable and available. When a teacher calls each parent/guardian during school's first two weeks, parents appreciate and enjoy conversations. Calls also make it easier for teachers to contact parents later in the year regarding child issues if needed. Experts find it effective to mail postcards home, addressed to children or parents.
Establishing simple class websites including teacher contact information facilitates parental access. Teachers' printing business cards and attaching them to their first parent letters conveys professionalism. Teachers using
Internet/e-mail/print to publish weekly/monthly class newsletters informally keep parents apprised of children's instruction and teach parents to expect communication. Teachers can send parents invitations to visit prior to school/program Open Houses: teachers are perceived as more approachable when more parents are comfortable in classrooms. Having children write appreciation letters to parents for Open Houses encourages children to invite parents; parents also perceive teacher appreciation by association.

Applying Assessment Results to Planning Instruction for Individuals and Groups
ECE settings should provide organized outlines of developmentally appropriate guidelines for their children, including when and how to introduce and reinforce guidelines at each learning stage. These outlines are foundations for anecdotal observations and authentic assessments tracking developmental progress. ECE programs supply opportunities and activities to develop each discrete skill, including copious review and practice young children require for retention. Teachers should plan learning experiences meaningfully promoting developing identified guidelines and addressing children's interests. ECE settings should have organized progress-tracking systems following developmental sequences. These help teachers determine whether a child can move to the next level or prior skills that need additional reinforcement. Tracking systems should be easy to maintain and immediately give teachers basic information regarding each child's level of functioning for planning activities and discussions. Teachers should then create 'ready reference' charts/graphs of assessment and monitoring results, giving an idea of the class/group's general functioning level, to inform activity/lesson planning and additional support needed for individual children—one on one for those below class/group level, enriched for those above it.