Professional papers presented at the conference are 

being published in book form under the title "Intervention Strategies for High Risk Infants and Young 

Children." University Park Press, Baltimore, Md. 
THE 

PROBLEM 

IS GROWING 

What 

Are 

We 

Waiting 

For? 

A Report of a Conference on Early Intervention 

With High-Risk Infants and Young Children 

Sponsors: 

The President's Committee on Mental Retardation 

Washington, D.C. 20201 

The University of North Carolina 

Chapel Hill 

May 5-8, 1974 

Association for Childhood Education International 

3615 Wisconsin Avenue, N.W. 

Washington, D.C. 20016 

The President's Committee on Mental Retardation 

Washington, D.C. 20201 

1975 
we 

gratefully 

acknowledge...

. . . the cooperation and support of the 

conference by the following agencies of the 

U.S. Department of Health, Education, and 

Welfare: 

National Institute of Child Health and Human 

Development 

Bureau of Education for the Handicapped 

Developmental Disabilities Division 

National Institute of Mental Health 

Office of Child Development 

We also appreciate the assistance of Dr. 

James Gallagher, Dr. Don Woods, Joe Sanders, 

and other members of the faculty and 

concerned staff of the University of North 

Carolina at Chapel Hill, whose efforts in 

planning, public relations and logistics made 

the conference a success and a pleasure. 

Each successful conference is dependent on a 

special group of leaders. Appreciation for their 

leadership is extended to Alberta L. Meyer of 

the Association for Childhood Education 

International; the co-chairpersons, Dr. Will 

Beth Stephens, PCMR Member, and Dr. 

Theodore Tjossem of NICHD; and the PCMR 

staff coordinator for the conference, A. D. 

Buchmueller. 

FRED J. KRAUSE 

PCMR Executive Director 

MARY Z. GRAY, PCMR 

EDITOR 

Library of Congress Catalogue No. 75-600085 

DHEW PUBLICATION NO. (OHD) 75-21011 
The Conference 

Children are ready to learn from the time they 

are born. Parents are ready to teach them. 

Teaching tools are available. Professionals 

know how to use these tools to help parents help 

their children. But here the links of the chain 

often fail to connect. 

What are we waiting for? 

The time lag between a child's readiness to 

learn and the start of appropriate mental 

stimulation can often determine the extent of 

ability—or disability—for life. This concept 

was a major theme of the Conference on Early 

Intervention With High-Risk Infants and Young 

Children held at the University of North 

Carolina at Chapel Hill, May 5-8, 1974. 

The conference was called by the President's 

Committee on Mental Retardation and the 

Association for Childhood Education 

International. The University of North 

Carolina's Child Development Institute was the 

host. 

The first presentations were on basic research. 

Discussions then proceeded to applied research, 

followed by demonstration, and, finally, 

application of current knowledge. 

Participants included educators, physicians, 

biological and behavioral researchers, nurses, 

social workers, federal officials, parents, 

professionals from Canada and South America, 

and others concerned with children at risk from 

either biological or environmental causes. 

There was a recurring call for full partnership 

among parents, educators, physicians and community leaders to share their knowledge and 

experience to help all children—especially highrisk children—to develop as normally as possible. 

"We do not have all the answers," said Dr. 

George Tarjan, in summarizing the conference, 

"but we do know enough to promise to the next 

generation of high-risk infants that there will be 

progress rather than regression." 

1 
REVIEW OF RELEVANT RESEARCH 

The conference topics ranged from a 

microscopic view of very early 

development of neural connections in the 

infant brain to parental involvement in 

treatment programs. 

As the discussions progressed, these 

disparate subjects came together in an 

interrelationship that pointed up the 

necessity for interaction of all disciplines 

in order to achieve the highest quality of 

life possible for each child who is retarded 

or is in danger of retardation from 

biomedical or other causes. 

Dr. Morris Lipton gave participants a 

basic example of such interaction within 

each individual. There is now good 

evidence, he said, that "the structure and 

functional organization of parts of the 

central nervous system may be modified 

by changes in the internal and external 

environment. The chemical capacity to 

connect between neurons," he said, 

"appears to be altered by experience, and 

represents, in a sense, a type of learning." 

In order to learn, however, the computerlike brain requires a programmer, as Dr. 

Victor Dennenberg explained. In most

cases this programmer is the mother. There 

are now indications that the mother/infant 

(or care-giver/infant) interaction, in the 

earliest days, shapes not only the initial 

behavior pattern, but also the electrochemical circuits of the thinking process in 

the brain. 

The question then arises: Is too much 

stimulation as damaging as too little? 

Research indicates that there can, indeed, 

be too much. 

Sometimes incubators, for example, can 

bombard the premature infant with noise. 

"We are keeping alive 28-, 29-week old 

fetuses," said Dr. Dominick Purpura. 

"From 22 to 32 fetal weeks is a major period of dendridic differentiation in the 

cerebral cortex," he said. At this period of 

extraordinary extra development, he said, 

inappropriate stimulation or the absence of 

appropriate stimulation, may contribute to 

the retardation and other handicaps often 

seen in premature infants. 

2 
Dr. Felix de la Cruz reported that a group 

of Swedish investigators had measured the 

noise levels inside five different kinds of 

incubators used for intensive care of 

newborn babies. The study revealed 70 to 

80 decibels of sound pressure. 

Human adults, he pointed out, can 

tolerate only about 80 decibels of sound. 

Anything above that intensity results in 

sensory neural loss, regardless of duration. 

The recommended standard acceptable 

noise level on a hospital ward in Sweden is 

30 decibels. 

Discussions then moved on to mother/child 

interaction. This interaction is "like a dance 

between mother and baby," said Dr. Evelyn 

Thoman. She and others stressed the individuality 

of each child and parent, and dispelled the longheld belief that the child's mind is a "tabula rasa" 

or blank slate. 

"Mother may control the interaction," she said, 

"or she may yield to a diaper-dictator, or they 

may each in a synchronous way, perceive the 

cues given by each other and respond 

appropriately." 

(Infants are not "passive, reflexive recipients of 

environmental stimulation," according to Dr. Earl 

Butterfield, in a later presentation, "Rather, they 

actively process the sensory experiences and they 

act instrumentally to change them from the day 

they are born.") 

Dr. Thoman described research on "organized" 

babies who send out clear signals that are easy to 

recognize and respond to, in contrast to 

"disorganized" babies whose behavior changes 

erratically and rapidly. 

She illustrated these behavioral states with 

several actual cases. The mother of one of the 

"disorganized" babies eventually reacted by 

withdrawing, because her efforts to communicate 

were increasingly futile. The baby died of sudden 

infant death. The mother, quite naturally, felt 

guilty because she thought she had rejected the 

child. The truth was, said Dr. Thoman, "the 

disruptive role was played by the baby." The 

child had rejected the mother. 

Another baby in the study did not like to be 

held, and reacted by becoming drowsy or fussy. 

When left alone, she was alert. 

"This is the kind of behavior," Dr. Thoman said, 

"that mothers of autistic children describe." 

She then introduced into the conference the importance of mother/child/professional interaction, 

especially in such cases. 

"If someone can perceive, and help parents perceive that there are certain stimulus conditions 

under which this baby can be alert, and that she is 

very easily stimulated, then she may be brought 

around to the point where she can accept social 

stimulation," she said. 

Dr. Harriette Rheingold concurred with the 

findings on mother/child interaction but also 

warned against "deifying the mother/infant 

relationship to the exclusion of the effects of 

father, siblings and culture on the child's 

development." 

A warning of another kind was sounded by Dr. 

Leonard E. Ross and others: Despite the fact that 

intensive and comprehensive intervention can 

produce dramatic changes in children's behavior, 

the measures used to assess the changes are often 

sensitive to many other factors that influence the 

child's performance in other situations and over 

extended periods of time. 

He saw improved school performance 

following intervention as possibly reflecting 

"student conformity or teacher expectations rather 

than changes in basic intellectual capacity." 

Hence, he stressed research on the process of 

learning. He asked: "Are there differences in the 

way in which information is initially processed, 

transformed, rehearsed, stored and retrieved by 

the retarded child or the child at risk for mental 

retardation?" 

He cited new insights into the cognitive control 

of eye movements and the perceptual unit 

processes in reading that have profound 

implications for the understanding of intellectual 

deficit. Another promising area for intervention 

that he pointed to is research on the processes and 

strategies used in the acquisition of language. 

Dr. L. A. Leavitt described the collaborative research on learning processes that he and Dr. Ross 

are conducting. 

In a related discussion, Dr. Earl Butterfield 

spoke of the necessity of cognitive and perceptual 

structures to be present before language can be 

acquired. "It is these structures which give 

meaning to the spoken form of a child's language, 

which he presumably learns through his 

experience with the auditory environment," said 

Dr. Butterfield. 

He reported that studies indicate that babies can 

distinguish speech from nonspeech—from birth. 

And the more nonspeech auditory stimuli 

resemble speech, the more the infant responds. 

The implication, he concluded, is that infants 

should benefit from being talked to very early in 

life. (But not bombarded with speech, another 

participant cautioned.) 

The theme of individual differences was again 

emphasized by Dr. James Gallagher. In embarking 

on a longitudinal study on intervention for high-risk 

children, the researchers became aware of the fact

3 
that most longitudinal studies included two or more 

measures taken on the same sample of individuals 

one year apart. The purpose of the study was to try 

to understand child development. 

"But development is not necessarily linear or predictable, we realize, when we study individual children over time and cross-sectional collections of 

large numbers of children," he said. 

He confessed that behavioral scientists have tried 

to be like the physical scientists, with their laboratory control situations, "at the expense of observing 

what is going on in the child's interaction with his 

environment." 

If the interaction between each individual and his 

environment were unchanging and predictable over 

time, he said, intervention could be done at any 

point of the developmental sequence, presumably 

with predictable results. 

"But is this really so?" Dr. Gallagher questioned. 

"What about nurturance and independence? Does 

that relationship hold the same at age 2? 5? 15? 

How about peer values and the relationship of 

social behavior to the presence of the opposite sex? 

Does the interaction between these variables differ 

according to the age of the children and the 

developmental sequence? And don't all of these 

variables vary according to earlier events that have 

occurred? And is this series of interactions 

complementing the innate constitutional 

characteristics of the individual?" 

Despite the fact that these realistic questions cannot be answered by unsolicited, short-term, massive 

cross-sectional studies, he said, we still believe the 

half-truth that their aggregate findings make up the 

wisdom of the scientific community. 

In summary, he recommended careful and longterm financial support of longitudinal studies of 

three to five years that would cut across key developmental areas (language development, for example). He suggested that research organizations do 

the studies—"not just because individual investigators tend to die or move away, but because the 

range of talent that is needed to comprehend the full 

development of the child defeats any single investigator." 

Dr. Todd Risley followed by speaking on the importance of a working language for the child—

which is not always the same as classroom 

vocabulary—and the related importance of childinitiated learning episodes. 

In classroom studies, Dr. Risley found that in 

working with disadvantaged, high-risk children, 

there was a rapid rise in the use of labels in their 

working language when conversation centered on 

things and normal activities that the children were 

required to describe. A child, for example, wants to 

play with a truck. Does he want the red truck? The 

blue truck? Big truck? Little truck? He has to describe the properties of the one he wants. 

Then comes the reason for things. What are you 

going to do with it? Why do you need it? Thoughts 

grow into complex sentences. 

A child's working language, said Dr. Risley, "is 

an indication of the way he approaches his environment, and it's probably a determinant of how the 

environment responds to him." If he doesn't use 

language concepts, he said, no matter how many 

language concepts he knows, other people do not 

tend to respond to him 

One of the keys to teaching children who are retarded in language skills, he said, is to engineer an 

environment which captivates them and engages 

them in ongoing activities which thereby increase 

the frequency of incidental teaching episodes. 
Dr. Donald Baer reported on a research 

project with children with more serious 

problems than a lack of language skills—

hyperactive children with short attention spans, 

aged four to about eight. 

The first requirement, he said, is a potent 

reinforcement system used all day, day after 

day, but one not requiring special techniques 

or materials. Although motivational, the 

program can gradually be discontinued. 

He described how these hyperactive 

children are taught to work at length and to 

completion of each task assigned. 

In addition to teaching the elemental skills 

and content needed for school entry, Dr. Baer's 

program also works on behavioral quirks, such 

as a strange gait that one child had, that was 

changed to normal by a daily half hour of 

roller skating for an extended time. 

The home program reinforces the classroom 

procedures. Parents are taught how to react 

constructively to the child's desirable and 

undesirable behavior, and how to diminish 

token reinforcement until correct social 

behavior itself is the sustaining reinforcer, said 

Dr. Baer. 

In his discussion, Dr. Earl Schaefer 

suggested that professionals can be far more 

cost-effective if they try to change the parents' 

behavior toward the child, than if they try to 

change the child's behavior through direct 

intervention. There needs to be a working triad 

of mother/child/professional, he said. 

The mother's attitude toward the child can 

be a strong force in positive or negative 

reinforcement, Dr. Schaefer said, adding, 

however, a note on the unpredictability of 

human nature. He recalled a situation in a 

longitudinal research project that illustrated 

diametrically opposite maternal attitudes. One 

mother rejected and ignored the child; the 

other was very accepting and loving. "Then 

we broke the research code," he said, "and 

found it was the same mother." 

"I think it's the early environment, plus the 

continuing environment that influences the 

child," he said, in pointing out the need for 

more intervention research that examines the 

effect of a variety of environmental influences. 

He also called for a close look at what 

professionals and institutions are doing that 

may be harmful or, at best, ineffective. 

In our hospitals today, said Dr. Schaefer, 

illustrating his point, we are separating the 

mother from the infant in the first days and 

weeks of life—a practice that may do more 

damage to the infant than we can 

counterbalance by later corrective intervention. 

Dr. Lyle Lloyd also questioned professional 

practices. "Why don't we find out how the 

child's auditory system is working before we 

start training procedures that frequently 

involve auditory signals?" he asked. 

About one out of 15 or 20 premature infants 

have a hearing loss, he said, which seriously 

affects the incidental learning that comes 

naturally to others without handicaps. 

He repeated the concern of other speakers 

for the effects of incubator noises, especially 

on hearing and communication ability. 

DEMONSTRATION PROJECTS 

OVERVIEW 

In giving an overview of demonstration 

projects presented at the conference, Dr. Ernest Gotts asked the participants to consider 

the consequences of a physical disability, 

confinement to a crib and/or sensory loss. "A 

child who is tremendously impaired is 

restricted in his ability to create a world that 

has overlap with anyone else's," he explained. 

"As a result, he doesn't develop a very 

effective communication system. He doesn't 

share much world with anyone else to 

communicate about. Communication means 

sharing. Development of an abstract language 

system enables us to be flexible in what we 

share." 

Dr. Gotts described the restrictions of that 

child's world, with nothing to stimulate 

motivation and curiosity or socialization and 

self-concept. 

The young children who are confined 

because of handicaps do not explore, he said, 

do not initiate activities, do not imitate, or 

respond to adults or other children. They don't 

converse, can't sit still for even five minutes. 

"I regard this behavior as the personal and 

social consequences of specific limitations of 

environmental stimulation—particularly the 

limitation in human contacts," he said. 

He explained that the demonstration projects 

presented at the conference deal with behavior 

problems, lack of attachment, failure to 

develop sound human relationships. And the 

implications, he said, are twofold: "One, a 

direct intervention with the child; and two, a 

direct intervention with the child's immediate 

environment—his home and family." 

5 
DEMONSTRATION PROJECTS 

EDUCATIONAL INTERVENTION WITH 

HIGH-RISK INFANTS 

PRESENTORS: ARTHUR H. PARMELEE, M.D. 

 ETHEL R. KASS, M.A. 

Department of Pediatrics, School of Medicine 

and Mental Retardation Center 

Neuropsychiatric Institute 

University of California, Los Angeles 90024 

This program is part of the Infant Studies 

Project at UCLA. The dual aims are to

develop methods of identification of high-risk 

infants and techniques of intervention with 

such infants. 

The Infant Studies Project uses a cumulative 

risk system to score the infant's performance 

from birth through nine months of age. 

Selected infants determined to be high risk 

receive both clinical support services and a 

concentrated program of educational 

intervention for the following 14 months. 

Rather than working either directly with 

only the infant or with the mother's emotional 

adjustment to the child, this program 

concentrates on improving the infant and 

mother interaction by training the mother to 

respond to the child's specific cognitive and 

developmental strengths and weaknesses. 

The hope is that a mutually satisfying 

interaction of mother and child will produce 

both short-term and long-term results.

6 
THE PORTAGE PROJECT: A MODEL FOR 

EARLY CHILDHOOD EDUCATION 

PRESENTERS: DAVID E. SHEARER, M.S. 

MARSHA SHEARER, M.A. 

Cooperative Educational Service Agency #12 

412 East Slifer Street 

Portage, Wisconsin 53901 

The project serves any child, from birth to age 6 

(or until ready for school) with any type or degree 

of handicapping condition, who lives within the 

23 school districts of rural south-central 

Wisconsin. 

All instruction takes place in each child's home, 

with the parents as teachers. The parents are 

trained by a Portage Project home teacher, who 

may be either a professional or trained 

paraprofessional, using a precision teaching model. 

At least three prescribed behaviors are targeted 

for learning each week. At the end of the week, 

the home teacher records data on achievement of 

the goals. 

Parents are taught what to teach, how to teach, 

what to reinforce, and how to observe and record 

behavior. 

7 
PROGRAMS FOR DOWN'S SYNDROME 

CHILDREN 

PRESENTORS: ALICE G. HAYDEN, PH.D 

 VALENTINE DMITRIED, M.A. 

Experimental Education Unit 

Child Development and Mental Retardation Center 

University of Washington 

Seattle, Washington 98105 

The purpose of the program is: To develop and 

use sequential programs for increasing the 

children's rate of developing motor, 

communication, social, cognitive and self-help 

skills. The primary program emphasis is on 

bringing the children's developmental patterns as 

close as possible to "normal" children's 

performance. 

The individualized curriculum is based on each 

child's observed and measured performance. He 

is not expected to acquire a new skill until he has 

mastered its prerequisite skills. Behavioral 

objectives are established for the child by 

teachers, parents, and consultants. 

9 
THE INFANT, TODDLER AND PRESCHOOL 

RESEARCH AND INTERVENTION PROJECT 

PRESENTORS: WILLIAM A. BRICKER, PH.D. 

 DIANE D. BRICKER, PH.D. 

George Peabody College for Teachers, 

The John F. Kennedy Center for Research 

on Mental Retardation and Human Development 

Nashville, Tennessee 37203 

The program, based on Piaget's concepts of 

human development, is designed for children 

from infancy to school age who are moderately 

to severely retarded or disturbed. An equal 

number of children who are developing normally 

take part in the program. Participants are from a 

wide range of socio-economic backgrounds. 

The center provides individual education for 

each child, geared to his own developmental 

level, in language, motor, sensorimotor, and 

social skills. Parents are trained in behavior 

management of children prior to their training in 

the core classroom curriculum so that the center's 

program can be continued in the home. 

Parents with special needs are given assistance 

in budgeting, using community agencies and 

obtaining needed medical and dental services. 

9 
MEETING STREET SCHOOL PROJECT 

PRESENTORS: ERIC DENHOFF, M.D. 

IRMA HYMAN, M.S.S. 

333 Grotto Avenue 

Providence, R. I. 02906 

The Meeting Street School Parent Program for 

Developmental Management is a comprehensive, 

therapeutic-educational program designed to meet 

the developmental needs of children from birth to 

three years of age. Disabilities vary from the severely disabled, multiply handicapped baby to the 

relatively normal child with mild behavioral problems. The program has provided service to over 

1,000 infants since its inception 15 years ago. 

Its goals are: 

(1) To provide a community resource to evaluate atypical and "at-risk" infants. 

(2) To provide a comprehensive developmental 

management program for infants and their parents 

through various service models. 

(3) To offer service to the infant's parents that 

will enable them to understand their child's

disability, and to participate in a program designed to help achieve the child's highest potential. 

(4) To involve the agency in an advocacy role 

with various other voluntary and official health, 

education, and social agencies in order to plan and 

provide for a continuity of appropriate services; 

and to foster the concept of the "rights of infants." 

10 
EARLY INTERVENTION FOR HEARING 

IMPAIRED INFANTS AND YOUNG CHILDREN 

PRESENTOR: KATHRYN B. HORTON 

Bill Wilkerson Hearing and Speech Center 

Vanderbilt University School of Medicine 

Nashville, Tennessee 37212 

The program emphasizes the detection of hearing 

impairment in infancy, followed by immediate intervention in the form of an intensive parent teaching 

program which stresses the maximization of residual 

hearing in order to enhance natural language acquisition. 

There are two major components: (1) the Mama 

Lere Parent Teaching Home for infants and children 

under age 3 years, and (2) the acoustic preschool for 

children from 3-6. 

The first program concentrates on parent instruction involving demonstration teaching in the child's 

natural environment, intensive audiologic 

monitoring of the child's hearing, and use of hearing 

aids. 

In order to provide peer stimulation of language 

and communication skills, classes for the younger 

children include an equal number of children with 

normal hearing. Classes for older children emphasize individual and small group instruction supplemented by placement for one half day in a regular 

kindergarten.

11 
THE READ PROJECT 

PRESENTOR: BRUCE L. BAKER, Ph.D.

Read House 

Harvard University 

Cambridge, Massachusetts 02138 

The Read Project Series consists of an Assessment Booklet and ten self-instructional manuals for 

parents of retarded children. Subjects covered are 

those for which parents expressed the greatest need 

for guidance: managing behavior problems, toilet 

training and other self-help skills, developing 

speech and language skills, and teaching 

constructive play. 

The manuals are addressed directly to parents, 

with instructions presented clearly and humorously. 

Cartoons illustrate the material. 

One hundred and sixty families, each with a retarded child ranging in age from 3 to 14, and living 

within a 30-mile radius of Boston formed the initial 

participants in the Read Project. The manuals are 

designed to be used by any parent of a retarded 

child within this age span. Special training is not required for the utilization of the manuals. 

12
NATIONAL COLLABORATIVE INFANT 

PROJECT 

PRESENTOR: UNA HAYNES, R.N., M.P.H. 

United Cerebral Palsy Inc. 

66 East 34th Street 

New York, N.Y. 10016 

This nationally organized collaborative 

project is designed to provide comprehensive 

services to handicapped infants and their 

families. Directed and coordinated by United 

Cerebral Palsy Associations Inc., it involves a 

consortium of centers already serving 

handicapped infants under age two, and their 

families. The project attempts to identify and 

use unique aspects of exemplary services 

provided by the centers, and incorporate them 

into service models. 

Among the goals are the pooling of 

knowledge, skills and experience; the 

strengthening of the role of the family as the 

primary teacher and care-giver for children 

under age two; promoting team effectiveness in the design and implementation of services, 

especially where there are both medical and educational needs; informing both the scientific and 

lay communities about early intervention programs for atypical infants and their families. 

13
CASE FINDING, SCREENING, DIAGNOSIS 

AND TRACKING 

As the conference moved on to further discussions, 

Dr. John Meier addressed the group on case finding, 

diagnosis and tracking. "Intelligence is a relative 

thing," he said. "As our society becomes increasingly 

complex, there are more and more people who 

cannot cope effectively. Medical science has enabled 

more infants at risk to survive. Also there are large 

numbers of very young mothers who are not able to 

deal with child rearing intelligently. They are 

contributing to the fact that a number of children do 

not flourish, either through abuse or neglect or both." 

Prevention of disability is more necessary than it 

has ever been before, he said. He added that the state 

of the art and science now makes it possible to 

identify at an early age at least some of the precursors 

of handicaps. 

Dr. Meier reported that a cost-benefit analysis had 

revealed that not only laboratory screening for 

diseases but also screening for behavioral and other 

incipient disabilities can now be done for 1

/2 of 1% 

of the average cost of raising a child. 

He suggested using existing systems as the initial 

nucleus for a massive screening effort, and cited as a 

possible model the U.S. Department of Agriculture's 

County Extension Service. Their child development 

specialists make regular visits to large numbers of 

people in sparsely settled areas. The agents can be 

trained in the use of screening instruments, he said. 

He also mentioned the network of University Affiliated Facilities and training centers which provide 

"the kind of clustering for identifying and screening 

and intervention" that has great promise. 

"If you can get a responsive environment for an 

infant, including a mother and other physical accoutrements in the environment, it's incredible how 

this little computer is able to program itself," said Dr. 

Meier. 

In comparing the brain to a computer, he asked: 

"Where else can you find a computer that has over 

ten billion flip-flop circuits, occupies less than a cubic 

foot of space, will operate on the energy of a peanut 

for up to four hours, is completely mobile, and is 

produced with unskilled labor?" 

Dr. Arthur Parmelee's subject was diagnosis of 

high risk, and he outlined what a useful risk scoring 

system might encompass. 

The system would (1) score pregnancy and neonatal biological advance and behavioral performance 

in additive fashion; (2) assess the infant in the first.

14 
months of life to sort out those with transient 

brain insult from those with brain injury or those 

who remain deviant; and (3) reassess the infant, 

primarily on a behavior basis, later in the first 

year of life. 

The fact that there is no single predictor test 

supports the merit of a cumulative risk score, he 

said. 

Following Dr. Parmelee's presentation, May 

Aaronson discussed the "enormous potential" for 

impact on early intervention of the Early and 

Periodic Screening, Diagnosis and Treatment 

Program (EPSDT), which is part of the FederalState Medicaid Program. 

She said that the EPSDT program necessitates 

major communication and collaboration among 

health and welfare professionals and parents, and 

provides "an extraordinary opportunity for 

upgrading the quality of parenting through 

parent-oriented education." 

Dr. Theodore Scurletis described North 

Carolina's Comprehensive Developmental 

Health Services. He stressed the need for 

individualized, longitudinal and accessible 

services, in order to transfer scientific information into practical realization. 

The North Carolina array of community 

services, he said, emphasizes case finding and 

educating the community; early and periodic 

screening; ongoing personal contact to teach the 

families what services can do for their children; 

and monitoring and assisting them in obtaining 

those services that are necessary. 

Our health care in this country is failing, he 

said, "not because of lack of services, but 

because of lack of educating the population who 

are at greatest risk in the use of these services." 

Dr. Scurletis listed five characteristics of 

mothers at risk: (1) under 18, over 34; (2) three 

or more children; (3) education less than ninth 

grade; (4) pregnant out of wedlock; (5) delivered 

a previous child born dead or a child born alive 

who is now dead. "We are trying to educate the 

population to the fact that if you have even one 

of these characteristics, you are definitely at risk, 

so seek service," he said. 

Dr. T. Berry Brazelton presented overview 

comments of the previous discussions, and 

added some further insights. 

"We should look for coping strengths," he 

stated, "and put the labels on them, not on the 

pathology." He suggested that professionals 

approach a mother/child interaction with an 

entirely new nonmedical model that emphasizes 

the positives. 

Expressing great empathy with the mother, Dr. 

Brazelton said that mothers of handicapped 

children often feel responsible for the problem. "They feel guilty, helpless, hopeless." They feel 

that anybody who would take the baby over 

would do a better job than they could, he said. 

Professionals should interact with these 

mothers, he said, let them know that "we care, we 

see what they're going through, and we 

understand." 

Give her an image of herself as an effective 

parent, he advised, and then get into the 

intervention program. Our goal, he said, should 

be not just the target child and his I.Q., but also 

the quality of a family's life. 

U.N.C. CHAPEL HILL DEMONSTRATION 

PROJECTS 

The conference participants then fanned out 

into Chapel Hill to make site visits to the 

University of North Carolina's intervention 

programs. 

The first stop was a program of early 

intervention for biologically handicapped infants 

and young children, which combined research 

with training and service. The program also 

demonstrated the ways in which a University 

Affiliated Facility and a Mental Retardation 

Research Center can interact successfully. Dr. 

Donald Routh was the presentor. 

Drs. David L. Lillie and Ronald Wiegerink 

presented information on the Frank Porter 

Graham's Developmental Disabilities Technical 

Assistance System (DD/TAS). The central staff 

of 20 works directly with the Developmental 

Disabilities Councils in all the States and 

Territories of the U.S. to help identify problems 

and develop solutions relevant to the Councils' 

planning and coordination of programs for 

developmentally disabled persons. When the 

central staff is unable to assist directly, they draw 

upon the DD/TAS's 500 consultants in a human 

services network. 

Next on the itinerary was the Frank Porter 

Graham Child Development Center, for the 

Carolina Abecedarian Project, with Drs. Craig T. 

Ramey and A. M. Collier making the 

presentations. This project demonstrated a 

longitudinal and multidisciplinary approach to the 

prevention of developmental retardation. 

Researchers, from a number of disciplines, are 

attempting to demonstrate that developmental retardation can be prevented. They also will attempt 

to explain how psychological and biological 

processes were affected by these preventive 

efforts. 

The participating high-risk families receive: (1) 

Family support social work services, guidance 

with legal help, counseling in family planning, 

plus assistance in obtaining necessities; (2) 

nutritional supplements for each child in the 

center program; (3) medical care; (4) 

transportation to and from the,

15 
center; (5) payment for participation in psychological evaluations. 

A matched group of families receive the same 

benefits, but their children do not participate in the 

day center's program. 

Over 2,000 pieces of information are collected 

on each child in the project each year, ranging 

from the identification of microbes in the child's 

respiratory tract to the number of social agencies 

with which the families have contact. 

The Center is establishing a comprehensive, 

open-ended, magnetic tape computer system 

which will allow access to any portion of the data 

from a remote terminal. 

The hope is that such a breadth of information 

will help in the understanding of the high-risk 

child's development, and will aid him in 

developing normally. 

LUNCHEON ADDRESS 

"We have been attacking the problem of 

children at risk at too late a stage," HEW's 

Assistant Secretary for Human Development 

Stanley B. Thomas, Jr. told the luncheon guests 

during the conference. 

He deplored the lag between the first suspected 

symptoms of retardation and intervention, and the 

fact that diagnosis frequently does not lead to 

treatment. 

He cited a survey done by the National Easter 

Seal Society showing that after diagnosis, only 

81% of the agencies assumed responsibility for 

placement of the child in needed programs. Only 

42% of the agencies, he said, followed up to 

determine whether placements had been 

successful. 

State clear objectives for clients, he advised, 

not only for the good of the client, but also as a 

means of measuring results. He also strongly 

endorsed parent participation in treatment 

programs, and a more effective use of 

paraprofessionals. 

The greatest emphasis, however, was on 

environmental influences. "We need to spread the 

word," he said, "that it is possible to influence the 

child's intellectual growth by changing his 

environmental experience. At the same time, we 

must pursue research that will refine the 

techniques of such intervention." 
"If you want to make [early intervention 

programs] widely available," he advised, "you must 

convince your State legislatures, your State Health 

departments, your State education departments, 

your county councils, your city councils . . . that 

your program is so cost-effective that the citizens 

and their representatives cannot afford to do 

without it." 

STATE OF THE ART OF EARLY INTERVENTION 

In introducing the State of the Art papers, Esther 

Morgan asked the questions she said she hoped 

would be answered by the papers to follow: Who 

has the responsibility for high-risk infants? Is it educators? Nurses? Psychologists? Doctors? 

Dr. Paul Ackerman spoke on educational manpower. He estimated that 50,000 teachers of preschool handicapped children are needed. 

The first problem, however, is to find these 

children, he stated. 

Among other needs he referred to: Curricula 

demonstration models; research projects on 

preschool handicapped children and targeted 

dissemination and analysis of the research findings; 

a better defined State role; quality control; more 

inservice training of teachers, rather than just 

preservice training; more paraeducators. 

In his report on pediatrics, Dr. Felix de la Cruz 

stated that the official goal of the American Academy of Pediatrics is the attainment by all children of 

the Americas of their full potential for physical, 

emotional, and social health. 

"Are pediatricians properly trained to meet this 

challenge?" he asked. 

He cited a 1964 study that attempted to ascertain 

the adequacy of pediatric residency training requirements. In this study, 60% of the pediatricians surveyed reported that management of disorders of 

mental and emotional development were frequently 

encountered in their practice; 35% of those surveyed felt they possessed a low level of 

competence to manage these problems. 

In continuing care of chronic cerebral dysfunctions, such as mental retardation and cerebral palsy, 

57% of the medical practitioners reported insufficient training opportunities were available. Almost 

three of every four practitioners reported 

insufficient training opportunity in child care 

activities in the community—the schools, courts, 

etc. 

Dr. de la Cruz compared the results of studies 

done in 1934, 1959, and 1971, showing the relative 

frequency of diseases and conditions seen by pediatricians, as an index to the type of preparation 

needed. 

In 1934, approximately 50% of the practice of 

one pediatrician was devoted to the care of infectious diseases; 35% involved routine care; .5% dealt 

with so-called psychological problems and/or those 

involving the central nervous system. (The pediatrician indicated that the .5% figure did not reflect the true prevalence of psychological 

problems.) 

In 1959, a survey of 2,000 pediatricians showed 

that on a typical day, over 5% of the children seen 

had emotional or behavioral problems. 

In a 1971 analysis of all 277,000,000 contacts 

between private practitioners and patients 0-15 

years old, 30% of the contacts were for routine care 

of infants and children; approximately 27% for 

infectious diseases, and almost 10% for diseases of 

the central nervous system, sense organs and 

behavioral problems. 

Of the patient contacts reported in the 1971 survey, 71% were in the doctor's office; 9% in the 

hospital, Dr. de la Cruz said. 

Since the financial support of interns and residents comes primarily from hospital funds, he indicated, the nature of their training is determined 

largely by hospital needs—"not national or regional 

needs for pediatricians, nor educational needs of the 

graduate students themselves." Nor, he implied, is 

the type of training determined by patients' needs. 

"With the extension of health care to encompass 

behavioral, developmental and cognitive 

problems," Dr. de la Cruz said, "it is evident that the 

medical model of care may not only limit but may 

even prevent professional intervention in these 

multifactoral problems." 

Dr. Kathryn Barnard described a similar situation 

in the nursing field. The majority of nurses are 

trained in hospitals, she said, and consequently they 

lack a good base in preventive care or child growth 

and development. She encouraged consumers "to 

rebel" since the decision-makers respond more to 

them than they do to professionals in the field. 

She cited several nursing programs that offer follow-up support to the infant through the first few 

years, or to parents of handicapped infants under 

stress. 

The nursing department at the Eunice Kennedy 

Shriver Center of Fernald School in Massachusetts 

sees all referred newborns who are severely damaged, or infants whom the parents have decided to 

place outside the home, she said. The nurses help 

parents cope with the grief of having a child who is 

not normal, or a child they are giving up, or one 

who has died. 

"We have a real obligation here," said Dr. Barnard. 

Western Reserve, she reported, is now following

17 
for six months all parents of infants who have died in 

the hospital. She said that Denver General Hospital 

has public health nurses follow 95% of the infants 

born there, and 100% of all the high-risk infants. 

She echoed the concern that several participants 

had expressed for the premature infant in an incubator. She cited the possibly damaging effects of 

such an environment, and the difficulty of family 

and infant to attach to one another after such prolonged separation. She strongly recommended 

parental involvement with the infant while he is in an 

incubator. 

Another suggestion Dr. Barnard offered was the 

installation in each newborn nursery of a nurse 

whose special job it is to provide developmental care 

and supportive work with parents. And she also 

advocates more masters level nurses who are trained 

in predictive infant and family care. 

Following a discussion of the Developmental Disabilities Division by its director, Francis X. Lynch, 

there were presented some perspectives on the "state 

of the art" of early intervention. 

"The best way I can describe the parent's 

perspective," said PCMR Member Louise Ravenel, 

"is to go back 15 years when I was a very scared, 

broken-hearted mother of a brand new retarded baby 

boy." 

She recounted her feelings of grief, rejection and 

guilt. Although her family physician advised taking 

the baby home, "and love him just like the rest," 

several other physicians and other professionals later 

recommended putting him in an institution. The 

family took him home—"the best thing that ever 

happened to my other five children." 

"New parents going through this crisis vitally need 

the emotional support and professional intervention 

that I did not receive 15 years ago," she said. "When 

it is the informed opinion of professionals that your 

child has true value and worth, and has potential for 

growth, then the child begins to have value and 

worth in the eyes of the parents. And parents can 

become partners with the professionals in helping 

this child to grow to the highest level possible for 

him." 

As he presented the educator's perspective, Dr. 

Godfrey Stevens noted that when compulsory

education legislation was introduced, about 100 

years ago, the Governor of Wisconsin was one of the 

Governors who vetoed the bill, announcing that 

compulsory education was un-American. 

"Whoever made the elegant statement that it is the 

responsibility of the State to educate all of the 

children of all the people started a massive system of 

education, probably for the first time in history," he 

said. 

The starting age of six was chosen, he explained, 

because in rural America at that period a child of that 

age could be expected to get from home to school 

and back without too much difficulty. 

Age became a rather critical notion, he continued, 

because ultimately, when we use tests which deal 

with chronological age and mental age, those numbers become magical predictors of success or failure. 

"Whole systems of instruction were built on the 

notion that you can't teach a child anything until he 

has a mental age of six," he said, adding that in 

Scotland, the system of instruction is based on a 

starting age of five. 

He noted one often repeated concept of the conference: the very young child is probably as viable 

and ready for education as he ever will be the rest of 

his life. 

It is critical for educators to realize this fact, Dr. 

Stevens said. He warned that there will probably 

have to be a major shake-up in the structure of 

American education, requiring new kinds of legislation to accommodate to this truth. 

In addition, he predicted that the days of rejecting 

defective children from the educational system are 

over. 

He deplored the rigidity of such "instructional 

configurations" as the perpetuation of the German 

grade school system, in which children who are six 

years old are in first grade, seven years old in second 

grade, and so on in chronological sequence, regardless of ability. The same kinds of instructional 

configurations exist in the universities, he said, as he 

pointed out the difficulties of obtaining a comprehensive, cohesive view of early childhood development in a systematic way at the university level. 

"If we're going to start educating children from 

birth on," he concluded, "we'll probably have to 

change the habits and value systems of people in 

order to realize these new educational concepts." 

Dr. Pamela Coughlin based her presentation on 

handicapped children in Headstart programs. 

Headstart has gone beyond its mandate to fill 10% 

of the slots with handicapped children, she reported. The largest group of handicapped children enrolled in full year Headstart programs—35%—are 

speech impaired, while health impaired or developmentally impaired children account for over 20%, 

according to Dr. Coughlin. 

She told the group that about one-third of the 

handicapped children in Headstart were diagnosed 

before entry, while two-thirds were diagnosed as 

handicapped in some way, after entering the program. 

In general, she said, Headstart program staff and 

parents believe the integration of handicapped and

18 
non-handicapped children is beneficial to both 

groups of children. 

Dr. G. Allan Roeher, remarking, tongue in cheek, 

on earlier comments made at the conference, said it 

was interesting to note some 50 years after the industrial revolution and Sigmund Freud, and around 

$700,000,000 spent on social, behavioral and educational research, that we've discovered that children 

do, indeed, have parents. And, he said, we have to 

listen to them if we want to realize optimal results. 

"We have at times taken ourselves a bit too seriously in some of our efforts that we call research," he 

said, "and sometimes have overlooked what the 

elders would call good common sense." 

One of the major obstacles that became apparent 

in the conference, as he saw it, was the inability of 

professional people to agree on a common 

approach—a necessity if the agents for change are 

going to implement progress on a large scale. 

He envisioned two continuing streams of effort

moving in parallel lines in the future: 

(1) Continued emphasis on stimulation of 

basic research efforts (in contrast to what is often 

good clinical service under the guise of research). 

(2) The mass application of agreed-upon 

knowledge. To move from isolated "Islands of 

Excellence" to broad programming, professionals 

must agree on the use of only those approaches 

which work well, even though they may not be 

perfect. 

"We will have to strip off the jargon and the 

many research variables," he said, "and build a kind 

of basic curriculum for manpower preparation and 

inservice models to realize mass application of techniques." 

He reported that it would cost $9,000,000 to institutionalize 20 mentally retarded persons an average of 60 years. However, using the techniques 

described in the conference and creating a comprehensive community services model, the cost of caring for these same 20 people would be $3,200,000—

a savings of almost $6,000,000. More importantly, 

the 20 would have a far higher quality of life. 

We need leaders who can translate these kinds of 

things into organizational systems, Dr. Roeher concluded. 

Eloisa Garcia de Lorenzo offered an overview of 

some early childhood programs in South America. 

She described the practice of sending premature babies home with the incubator in Caracas, Venezuela. 

A trained nurse makes frequent visits to the home to 

teach the mother how to interact effectively with the 

baby, as well as teaching basic care. Despite low 

economic standards the infection and mortality rate 

of the babies taken home in the incubator is far lower 

than that for babies kept in the hospital. 

She discussed other innovative programs, including mobile clinics with team specialists in Panama; 

day-care demonstration centers in Brazil; laws making breast feeding compulsory in Uruguay and Chile. 

Mrs. de Lorenzo gave a graphic picture of conditions around Lima, Peru, in the new paper shack 

villages inhabited by people who have migrated 

from the jungles and mountains, and have found no 

place to live. There are massive problems in these 

"pueblos," she said, including extremely poor nutrition and no child-care programs. "Babies are often 

left in the care of children four or five years old for 

the whole day," she said. 

With the participation of the people, the educators 

and doctors have started education programs and 

intensive day-care centers in these villages. The 

main point is to help these families handle what they 

have, as the first step in making basic changes in the 

environment. The youngsters who take care of the 

babies are being trained to get better nutritional value 

even from the minimal food that they have, and to 

talk to and otherwise stimulate the babies in their 

care. 

She spoke of "how good it is for people to work 

together from different countries. Then we have a

19 
different image of what an American is, because the 

image at the beginning is United Fruit and capital 

investment . . . machines and cold technology. We 

develop defenses," she said. 

"And then [through such meetings as this] we see

another type of American. Absolutely different. This is 

a people-to-people relationship through professional 

people . . . who talk to us to help us or to discuss with us 

the way we care for our minorities." 

Those who have come to South America "to see the 

work there are never the same afterwards," she said. 

"And we were never the same after they were there." 

She pleaded for more international cooperation. "One 

of the best things I will take from here is the knowledge 

that you really care and understand." 

CONFERENCE COMMITTEE REPORTS AND 

R

tation, 

co

development, cognitive deve

most of the 

st

looke as. 

l intervention in the lives of 

vances and professional efforts directed at 

plinary, in spite of the 

als, and improved models of professional 

development and the perceptual basis of 

(6)

r. Paul Pearson, University of Nebraska 

at 

nitive, emotional and 

social

infant and the infant with a disabil20 

ECOMMENDATIONS 

On Tuesday evening, participants had met in separate groups to discuss and make recommendations on 

education, pediatrics, nursing and habili

mmunity development, parents, and research. 

Prefacing his report on the education committee's 

recommendations, the chairman of that group, Dr. 

Willard H. Hartup, commented that early childhood 

classes and programs are concerned with the basic 

processes of perceptual 

lopment, and learning. 

The developmental status of the individual child is 

the cardinal principle. "This contrasts sharply with the 

emphasis on graded subject matter transference which 

has been the basis of the development of 

rategies in the rest of education," he said. 

Consequently, he said, more and more educators of a 

variety of sorts—not only special educators—have 

d to early childhood education for plans and ide

The education committee's recommendations: 

(1) Expand at a rapid rate the capabilities of our 

society for educationa

young children at risk; 

(2) Plan the intervention within the context of 

theoretical ad

all children; 

(3) Predicate these efforts on the thesis that effective 

intervention efforts are multidisci

difficulties in achieving that end; 

(4) Attempt to solve the manpower needs in 

intervention in at least two respects: Increased number 

of profession

preparation; 

(5) Continue and expand research in the processes of 

acquiring language, the pure attachment system, 

memory 

reading; 

Hold further conferences of this sort. 

The pediatrics committee was represented by its 

chairman, D

Omaha. 

The pediatrics committee recommendations: 

(1) The goal of the pediatrician must be to do 

everything within his professional competence to 

insure the optimal physical, cog

 development of the child. 

a. He must play a vital role—but not in 

professional isolation—in all aspects of child care: 

Prevention (conditions which place the child at 

high risk and early identification of the high-risk 
ity); assessment and definition of the problem; 

development of the management plan. 

(2) Evaluate as soon as possible, the state of the art 

of child development programs within departments 

of pediatrics and medical centers. 

a. Identify available models of training to 

determine factors that make a program successful or unsuccessful; 

b. Include in the study team a pediatrician 

knowledgeable in developmental pediatrics 

from an academic background, a pediatrician 

familiar with primary care, and a social scientist; 

c. Visit all departments of pediatrics, and, in 

addition, do a sample of practicing pediatricians 

to determine their perception of needs for 

training; 

d. Hold a conference to deal with results of 

the study and make recommendations; 

e. Get the information to the pediatric power 

structure. 

Results of the nursing and rehabilitation meeting 

were reported by Barbara Bishop, who chaired the 

group. 

The nursing and habilitation committee recommendations: 

The Family: 

(1) Focus programs for infants at risk on the 

family; 

(2) Identify positive support systems to provide 

help for mothers; 

(3) Involve parents and the family in the education, 

evaluation and decision-making process regarding 

themselves and their child. 

Education: 

(1) Initiate family life courses from kindergarten 

through grade 12, with emphasis on parenting; 

(2) Include courses on the exceptional child in the 

public education of children and adults; 

(3) Plan common learning experiences, both 

didactic and clinical, for all disciplines relating to 

infants at risk and their families; 

(4) Introduce continuing education for all

professions and disciplines relating to the child at 

risk. 

Professionals: 

(1) Encourage interdisciplinary work; 

(2) Validate, through research, what interventions 

work, and who can deliver the services; 

(3) Encourage dialogue among researchers and 

clinicians; 

(4) Pro-rate the cost factor in any health care 

delivery system. 

The community development committee 

presented its report through its chairman, Dr. 

Ronald Wiegerink, who stated that the group 

focused primarily on community services. 

The general recommendations of the community 

development committee: 

(1) Get the existing knowledge and expertise into 

delivery systems now, and design them to maintain 

high quality while serving much larger numbers of 

high-risk children and their families; 

(2) Develop improved community services for the 

rural and urban poor who have received so little. 

Specific recommendations: 

(1) Develop a public information campaign to 

promote community and neighborhood service 

systems; 

(2) Design public policy to make resources 

available to provide comprehensive community 

services, and promote laws and appropriations 

which lead to services such as mandatory early 

screening and assessment of all children; 

(3) Establish networks of coordinated community 

services in all regions of the country, to include at a 

minimum: Crisis support, transportation, respite 

care, foster care, adoptive support services, family 

planning, and parent education; 

(4) Insure that someone or a group take 

responsibility for every high-risk child and family to 

coordinate many of the existing but uncoordinated 

services. 

H. Rutherford Turnbull, III spoke for the group 

he chaired, the parents of handicapped children. 

"We are families at risk," he said. Rather than presenting recommendations, he listed some of the 

needs of parents, as expressed by the group. 

Among the needs of the parents group: 

Training on the need for early intervention 

and means of getting into the early intervention 

system; 

Training on the nature and causes of mental 

retardation; 

Parent survival skills; 

Expansion of the parent/child/professional 

triad to include the total family, with parents participating in training programs; 

The parents' need to listen and the need to be 

listened to; 

Parent-to-parent referral systems for support 

and information; 

Longitudinal follow-along services—not just 

for the child from 0 to 5; 

More research to help prevent and ameliorate 

mental retardation; 

21 
Increased professional sensitivity to parents' 

opinions of child's condition and behavior; 

Less professional jargon—"We ask you not to 

speak in tongues;" 

Keep parents involved. 

Sidney W. Bijou, Ph.D., chaired the research 

committee and presented their recommendations as 

follows: 

(1) Design a new federal mechanism that is 

concerned with research on delivery systems 

and utilization of findings; 

(2) Ease the access to both normal and retarded children for research purposes where no 

danger or deception is involved; 

(3) Make the universities more aware of the 

needs for research on risks to children, make 

them aware of current information so that they 

can provide adequately trained people; 

(4) Devise improved methods of 

communications between researchers and 

parents, with parents' groups systematically and 

continuously reviewing federal research policy 

and programming; 

(5) Clarify the fact that research for high-risk 

children applies to any child that is in a sense 

deviate in development; the labeling and specific 

diagnosis mean very little at that stage. 

PCMR Member William B. Robertson commented on minority problems, saying that when 

we talk about children at risk, we are talking 

mostly about black, Chicano, Puerto Rican, Indian, 

and white Appalachian children. And when we 

speak of bringing people with physical and mental 

handicaps into the mainstream of American life, he 

said, we must resolve to bring all segments of the 

population into the mainstream. 

Dr. Louis Z. Cooper, who had chaired the session, took the chairman's prerogative to make the 

final statement of that session. "It is my bias," he 

said, "that the concept of high risk is useful only as 

a step toward development of full service programs 

for children. In fact, those children whom we currently label 'high risk' or 'at risk' are the ones who 

most easily fall through the cracks, who are always 

going to be the last to be served. Until full service 

programs for all children are in place and operational, we never will adequately reach the 'high-risk 

child' with the quality of care to which they are 

entitled." 

SUMMARY 

In a review of the proceedings, Dr. George 

Tarjan, commented that an "Ideal" preventive program would assure that every child be born with a 

healthy central nervous system, that he will have a 

set of early experiences that encourage intellectual, 

emotional and social growth, and that he will be 

protected from physical and psychological damage. 

Since no child can escape from all harm, he said, 

the program must also strive to strengthen the 

child's ability to cope with what befalls him. 

"Unfortunately," said Dr. Tarjan, "we are far 

from even an approximation of this Utopian state." 

Information brought out in the conference, however, promises significant progress, he said, citing, 

for example, indications of interdisciplinary 

collaboration, especially in major research 

strategies involving broad attacks on interrelated 

issues. 

In the real world of clinical practice, he said, the 

physical and behavioral dimensions are fully interlinked. In general, one cannot observe the physical 

organization of the brain except through its behavioral expressions, and, he continued, one cannot 

adequately assess behavioral impairments without 

taking into proper account the presence and nature 

of possible organic disorder. 

Interventions, even when conceptually restricted 

to one domain, unquestionably influence the other, 

he said, using as an example the fact that drugs 

modify behavior, and learning in some fashion 

alters the biochemistry and physiology of the brain. 

"Behavioral interventions, particularly during 

very young ages when the central nervous system 

is still undergoing development, could positively 

influence the quality of the brain's somatic 

organization," he said. 

Moving on to other areas, he sounded a warning 

on the inherent dangers of mislabeling to those 

doing any broad scale early screening and intervention program, and suggested that in the borderline 

areas where diagnosis can be difficult, he would 

prefer to miss a few children who are retarded 

rather than risk false labeling of children who are 

not retarded. 

Dr. Tarjan stressed individual differences and 

the limited scientific understanding of these 

differences, especially among high-risk children. 

An understanding of the child's immediate 

environment is equally essential, he said. "Early 

intervention programs are composed of a series of 

external stimuli to which the infant is expected to 

respond," he said. "His responses in turn evoke 

modifications in his environment, resulting in new 

stimuli; and the cycle continues in this fashion."

22 
He pointed out that in many respects, the 

process is very similar to the ordinary 

mother/infant interaction—and she, too, is as 

variable as the infant. The behavior of each is 

constantly modified by the responses of the 

other, said Dr. Tarjan. 

After defining the difficulties of adequate 

evaluation of early intervention programs, he 

still held that continued evaluation is 

essential to lead us to more effective 

solutions. He called for more data on natural 

growth and development, since infants or 

young children change over a period of time 

with or without intervention, and simply as a 

consequence of growth. 

"We do not have all the answers," he said. 

"But we do know enough to promise to the 

next generation of high-risk infants that there 

will be progress rather than regression," he 

said. "We can and we must assure each child 

the best opportunities for maximal 

development and for a better quality of life." 

PARTICIPANTS 

MAY AARONSON 

Program Specialist 

Early Child Care Research Program 

Center for Studies of Child and Family 

Mental Health 

National Institute of Mental Health 

Parklawn Building 

Rockville, Maryland 20852 

PAUL ACKERMAN, Ph.D. 

Chief, Program Development Branch 

Bureau of Education for the Handicapped 

U.S. Office of Education 

400 Maryland Avenue, S.W., ROB 3 

Washington, D.C. 20202 

DONALD M. BAER, Ph.D. 

Professor of Human Development 

University of Kansas 

Room 130 Haworth Hall 

Lawrence, Kansas 66044 

BRUCE BAKER, Ph.D. 

Director, Read Project 

Read House 

Harvard University 

Cambridge, Massachusetts 02138 

KATHRYN BARNARD, Ph.D. 

Child Development and Mental 

Retardation Center 

University of Washington 

Seattle, Washington 98105 

LEILA BECKWITH, Ph.D. 

Infant Studies Project 

Department of Pediatrics 

UCLA Medical School 

Los Angeles, California 90024 

SIDNEY W. BIJOU, Ph.D. 

Professor of Psychology and Special 

Education 

Psychology Building 

University of Illinois 

Champaign, Illinois 61820 

23
BARBARA E. BISHOP, R.N., M.N. 

Program Coordinator 

Division of Maternal & Child Health Nursing 

Practice 

American Nursing Association 

2420 Pershing Road 

Kansas City, Missouri 64108 

T. BERRY BRAZELTON, M.D. 

Associate Professor of Pediatrics 

Harvard Medical School 

23 Hawthorne Street 

Cambridge, Massachusetts 02138 

DIANE D. BRICKER, Ph.D. 

Director, Infant and Toddler Project 

The John F. Kennedy Center for Research on 

Mental Retardation and Human Development 

Nashville, Tennessee 37203 

WILLIAM BRICKER, Ph.D. 

Kennedy Professor of Psychology and Special 

Education 

Box 88 

George Peabody College for Teachers 

Nashville, Tennessee 37203 

HONORABLE CLAIR W. BURGENER 

U.S. House of Representatives 

Washington, D.C. 20515 

EARL C. BUTTERFIELD, Ph.D. 

Kansas Center for Mental Retardation and Human 

Development 

The University of Kansas Medical Center 

Kansas City, Kansas 66103 

ANNIE BUTLER, Ed.D. 

President, Association for Childhood Education 

International 

3615 Wisconsin Avenue, N.W. 

Washington, D.C. 20016 

HARRIE R. CHAMBERLIN, M.D. 

Director 

Division of Disorders of Development and Learning 

Box 523, North Carolina Memorial Hospital 

Chapel Hill, North Carolina 27514 

ALBERT M. COLLIER, M.D. 

Frank Porter Graham Child Development Center 

University of North Carolina 

Chapel Hill, North Carolina 27514 

LOUIS Z. COOPER, M.D. 

Professor of Pediatrics, Columbia University 

Director, Pediatric Service, Roosevelt Hospital 

428 W. 59th Street 

New York, New York 10019 

PAMELA COUGHLIN, Ph.D. 

Director, Special Projects 

Office of Child Development 

Office of Human Development, DHEW 

P.O. Box 1182 

Washington, D.C. 20013 

FELIX DE LA CRUZ, M.D. 

Special Assistant for Pediatrics 

Mental Retardation Branch 

National Institute of Child Health and Human 

Development 

7910 Woodmont Avenue 

Bethesda, Maryland 20014 

ELOISA DE LORENZO 

Instituto Interamericano del Niños 

Avenue 8 de Octubre 2904 

Montevideo, Uruguay 

ERIC DENHOFF, M.D. 

Governor Medical Center 

293 Governor Street 

Providence, Rhode Island 02906 

VICTOR H. DENNENBERG, Ph.D. 

Professor of Biobehavioral Sciences and Psychology 

The University of Connecticut 

Storrs, Connecticut 06268 

VAL DMITRIED, M.A. 

Experimental Education Unit 

Child Development and Mental Retardation Center 

University of Washington 

Seattle, Washington 98105 

JAMES J. GALLAGHER, Ph.D. 

Director 

Frank Porter Graham Child Development Center 

University of North Carolina 

Chapel Hill, North Carolina 27514 

ERNEST A. GOTTS, Ph.D. 

Assistant Professor of Special Education 

College of Education 

University of Texas at Austin 

2611 Wichita Street 

Austin, Texas 78712

24 
DR. WILLARD W. HARTUP 

Institute of Child Development 

University of Minnesota 

Minneapolis, Minnesota 55455 

ALICE HAYDEN, Ph.D. 

Experimental Education Unit 

Child Development and Mental 

Retardation Center 

University of Washington 

Seattle, Washington 98105 

UNA HAYNES, R.N., M.P.H. 

Associate Director, Program Services 

United Cerebral Palsy 

66 East 34th Street 

New York, New York 10016 

MRS. KATHRYN B. HORTON 

Chief, Language Development Program 

Vanderbilt University 

Bill Wilkerson Hearing and Speech Center 

1114 19th Street, South 

Nashville, Tennessee 37212 

MRS. IRMA HYMAN, M.S.S. 

Parent Programs for Developmental 

Management 

Meeting Street School 

333 Grotto Avenue 

Providence, Rhode Island 02906 

ROBERT L. ISAACSON, Ph.D. 

Department of Psychology 

University of Florida 

Gainesville, Florida 32601 

ETHEL KASS, M.A. 

Infant Studies Project 

Department of Pediatrics 

UCLA Medical School 

Los Angeles, California 90024 

FRED J. KRAUSE 

Executive Director, PCMR 

Washington, D.C. 20201 

LEWIS A. LEAVITT, M.D. 

Assistant Professor, Pediatrics 

Center for Health Sciences 

2605 Marsh Lane 

University of Wisconsin 

Madison, Wisconsin 53706 

DAVID L. LILLIE, Ed.D. 

Director 

Technical Assistance Development System 

136 East Rosemary Street 

Chapel Hill, North Carolina 27514 

MORRIS A. LIPTON, M.D., Ph.D. 

Director 

Biological Sciences Research Center 

University of North Carolina 

Chapel Hill, North Carolina 27514 

LYLE L. LLOYD, Ph.D. 

Health Scientist Administrator for 

Communication Disorders 

National Institute of Child Health and Human 

Development 

7900 Woodmont Building 

Bethesda, Maryland 20014 

FRANCIS X. LYNCH 

Director 

Division of Developmental Disabilities 

DHEW, Mary Switzer Building 

Washington, D.C. 20201 

JOHN H. MEIER, Ph.D. 

Director 

John F. Kennedy Children's Diagnostic Center 

University of Colorado Medical Center 

4200 East 9th Avenue 

Denver, Colorado 80220 

A. ESTHER MORGAN, M.Ed. 

Past President, Association for Childhood 

Education International 

Professor of Education 

Department of Education 

University of Florida 

Gainesville, Florida 32611 

DR. ARTHUR H. PARMELEE, JR. 

Associate Professor of Pediatrics 

Department of Pediatrics 

UCLA Medical School 

Los Angeles, California 90024 

PAUL PEARSON, M.D. 

Director, Meyer Children's Rehabilitation 

Institute 

University of Nebraska Medical Center 

444 South 44th 

Omaha, Nebraska 68131 

DOMINICK PURPURA, M.D. 

Rose F. Kennedy Center 

Albert Einstein College of Medicine 

1410 Pelham Parkway 

Bronx, New York 10461

25 
CRAIG T. RAMEY, Ph.D. 

Frank Porter Graham Child Development 

Center 

University of North Carolina 

Chapel Hill, North Carolina 27514 

LOUISE R. RAVENEL 

Member, PCMR 

1 Farmfield Avenue 

Charleston, South Carolina 29407 

HARRIETTE L. RHEINGOLD, Ph.D. 

Department of Psychology 

University of North Carolina 

Chapel Hill, North Carolina 27514 

TODD R. RISLEY, Ph.D. 

Professor of Human Development 

University of Kansas 

AA-313 Bristol Terrace 

Lawrence, Kansas 66044 

WILLIAM B. ROBERTSON 

Member, PCMR 

Director, D.C. Office of Consumer Affairs 

1409 L Street, N.W. 

Washington, D.C. 20006 

G. ALLAN ROEHER, Ph.D. 

Director 

National Institute on Mental Retardation 

Kinsmen NIMR Building, York University 

4700 Keele Street 

Downsview, (Toronto) Ontario 

Canada M3J1P3 

LEONARD E. Ross, Ph.D. 

Waisman Center of Mental Retardation and 

Human Development 

2605 Marsh Lane 

Madison, Wisconsin 53706 

DONALD K. ROUTH, Ph.D. 

Biomedical Sciences Center 

North Carolina Memorial Hospital 

Chapel Hill, North Carolina 27514 

EARL S. SCHAEFER, Ph.D. 

Frank Porter Graham Child Development 

Center 

University of North Carolina 

Chapel Hill, North Carolina 27514 

THEODORE D. SCURLETIS, M.D., M.P.H. 

Chief, Section of Personal Health 

Division of Health Service 

Department of Human Resources 

Raleigh, North Carolina 27602 

DAVID SHEARER, M.S. 

Director 

Portage Project 

Cooperative Educational Service Agency 12 

P.O. Box 564 

412 East Slifer 

Portage, Wisconsin 53901 

MARSHA SHEARER 

Portage Project 

Cooperative Educational Service Agency 12 

P.O. Box 564 

412 East Slifer 

Portage, Wisconsin 53901 

CECIL G. SHEPS, M.D. 

Vice-Chancellor of Health Sciences 

University of North Carolina 

Chapel Hill, North Carolina 27514 

WILL BETH STEPHENS, Ph.D. 

Member, PCMR 

Professor, Special Education College of 

Education 

Temple University 

Philadelphia, Pennsylvania 19122 

GODFREY STEVENS, Ed.D. 

Department of Special Education and 

Rehabilitation 

School of Education 

University of Pittsburgh 

Pittsburgh, Pennsylvania 12513 

GEORGE TARJAN, M.D. 

Director, Mental Retardation Program 

Center for the Health Sciences 

University of California at Los Angeles 

760 Westwood Plaza 

Los Angeles, California 90024 

26 
EVELYN B. THOMAN, Ph.D. 

Associate Professor of Biobehavioral Sciences 

The University of Connecticut 

Storrs, Connecticut 06268 

HONORABLE STANLEY B. THOMAS, JR. 

Assistant Secretary for Human Development 

U.S. Department of Health, Education, and 

Welfare 

Washington, D.C. 20201 

THEODORE TJOSSEM, Ph.D. 

Director 

Mental Retardation Program 

National Institute of Child Health and Human 

Development 

7910 Woodmont Avenue 

Bethesda, Maryland 20014 

H. RUTHERFORD TURNBULL, III 

Associate Professor of Law 

Institute of Government 

University of North Carolina 

Chapel Hill, North Carolina 27514 

RONALD WIEGERINK, Ph.D. 

Director, Developmental Disabilities 

Technical Assistance System 

136 East Rosemary Street 

Chapel Hill, North Carolina 27514

PCMR Staff for the Conference 

ALFRED D. BUCHMUELLER 

MARY Z. GRAY 

FRED J. KRAUSE 

RUTH A. METZGER 

PIERRETTE A. SPIEGLER 

LINDA E. WALDER 

WILLIAM WILSNACK 

27 

President's Committee on Mental Retardation POSTAGE AND FEES PAID

Washington, D.C. 20201 U.S. DEPARTMENT OF H.E.W.

HEW-391 

OFFICIAL BUSINESS