HANDBOOK OF EARLY CHILDHOOD INTERVENTION LAL ATE! SECOND EDITION Edited by JACK P. SHONKOFF Brandes University SAMUEL J. MEISELS The Unversity of Michigan (§3§ CAMBRIDGE fp UNIVERSITY PRESSCHAPTER SEVEN ‘Transactional Regulation The Developmental Ecology of Early Intervention ARNOLD J. SAMEROFE AND BARBARA H. FIESE ‘The prevention of children’s psychosocial disorders has not been an easily accomplished task, Dut ing the years since we wrote this last sentence in our chapter for the frst edition of this book (Sameroff & Fies, 1990), the lives of children in the United States have not improved. The Children's Defense Fund (1995) estimates that between 3 and 10 million children experience domestic violence yearly, with more than a million confirmed child abuse or neglect cases in 1993. Mental health aso Continues to bea major problem, with approximate- ly 20% of children having diagnosable disorders (US. Department of Health and Human Services, 1990). Surveys of child health found that 13.4% fof children in the United States have emotional of behavioral disorders, 6.59% have learning disabili- ties, and 49 have developmental delays (Zill & Schoenborn, 1990), Decreasing these numbers re- Quizes @ clear understanding of the causes of these childhood problems. One of the cleat coreates of ‘Increases in child problemsis the decline in the qual ty of cildeen’s environments. Concurtent with the high level of problems among children, family resources for coping with these problems have diminished. In 1991, 22% of children lived in families with incomes below the poverty line, the highest rate since the early 1960 (Children’s Defense Fund, 1992), During the same period, the percentage of female-headed single parent homes increased from 794 to more than 21% (MeLanahan, Astone, & Marks, 1991). Moreove 75% of mothers of school-age children are in the ‘workforce now compared to about $0% in 1970(US. Department of Health and Human Services, 1993) Declines in family resources for supporting child evelopment have often been offset by social pro rams that offer compensatory professional or eco- hnomie support. Unfortunately, we ate living in a historical period in which these resources ate also in decline. Forall these easons, if we are toute bene: fcially the intervention resources that ae still avall- able, Its of the utmost importance to have a clear understanding of the sources of problems in child evelopment. The fist edition of this handbook ‘made a major contribution in emphasizing that the context of development is as important asthe char acteristics ofthe child in determining successful de velopment. We shall continue this theme by delin: cating an ecological model of development and the ddynamic processes by which children and their en- vironments interact. Through this presentation we ‘dentty a number of requirements necessary for suc- ‘cessful intervention to support child development. The fis sto recognize that child development has ‘multiple contributors at multiple levels ofthe child's ecology. The second is that at each of these levels, multiple processes are represented in family hought and cultural symbols and are enacted in family in- teractions and social services. The tied requirement Is that intervention processes be targeted at a pat- ticular problem for a particular child ina particular family in a particular culture. Unfortunately, there are no universal teatments forall children Im this chapter, we use an ecological model (Gronfenbrenner, 1977; Garbarino, 1990) to enu- ‘erate a variety of factors that affect child compe- tence, ranging from parent practices that have direct Influence on the child to community and economicfactors that impinge on the child through the action of others. Depending on disciplinary background, tiferent factors have been proposed to explain chil ‘en's problems, Economists focus on poverty and deprivation a5 the roots of social maladjustment; sociologists implicate problems in the community and family structure as the valables that promote deviancy; educators seek to repair problems in the school system; and psychologists focus on processes ‘within the family and its members asthe environ- ‘mental influences that most profoundly affect suc- ‘cessful development, We have accepted all of these proposals but, rather than viewing them as compet ing, we se them as additive contributors to a post tive or negative trajectory through lif. ‘No ingle factors damaging o facilitating for cil- fren, Rather, the power of an individual factor or Set of factors lies in thelr accumulation in the life fof any one child. Children reared in families with f large numberof negative influences will do worse ‘than children in familes with few risk factors. Such ‘view militates against any simplistic proposal that by changing one thing in society, we will change the fate of our children. Competence isthe result of ‘a complex interplay of children with a range of per Sonalities in different kinds of famille in commu- nities with varying economic and social resources. (Only by attending tosuch complexity will the devel- ‘opment of competence be understood and perhaps altered for the better. ‘Unfortunately, intervention programs are sekdom equipped to deal with the full range of factors that influence sucessful development. To the extent that there is a range of options within a program, deci sions must be made as to which families need which ‘options. To the extent that appropriate options are ‘not available, decisions have to be made concer. ing where families can obtain needed resources. In either event, there is a need to understand the so ‘al influences on development and, in tur, which of them can be improved upon. Its the purpose of this chapter to provide a perspective on socal infla- fences that can help with such decisions. ‘We begin with an overview of traditional con- cepts of intervention and prevention, When these ideas are used to interpret eausl factors in disease, 4 variety of paradoxes emerge that require a con- textual systems analysis of developmental processes for their understanding, 4 transactional model Is a ARNOLD J. SAMEROFF AND BARBARA H. FIESE described that explains behavioral outcomes asthe ‘mutual effects of context on child and chil on con- text. The transactional model is shown as embed- ded in a regulatory system that Is characteristic of, all developmental processes. Based on the regula- tory system, a numberof intervention strategies are described that are theoretically driven and that en- hhance the possibility of providing optimal outcomes for children, Several of these Ideas have been pre- sented at greater length in the fist edition of this handbook. In portions of the text where we have abbreviated the presentation, the reader is refered to the earlier reference (Samerof & Fese, 1990), DEFINING PREVENTION Intervention efforts are typleally divided into pri ‘mary, secondary, and tertiary categories (Leavell & Clark, 1968). Primary prevention is practiced prior to the origin of the disease. Secondary prevention Is practiced after the disease has been identified but before it has caused disability. Tertiary prevention ‘occurs after disability has been experienced with the goal of reducing further deterioration. However, these distinctions among prevention categories are less clear when one turns from the pri- ‘mary prevention of biological disease, the source of ‘the formulation ofthese definitions to the primary prevention of psychological disease, the source of, the increasing complexity of the problem. Although ‘lear linkages have been found between some germs land specific blological disorders (eg, diplococct and diptheria), this is not true for behavioral disorders ‘Much promises emanating rom progress in genetic research, However, translations into effective inter ‘vention programs are yet to be achieved. Primary prevention of psychological disorders, in the sense of deterring a single biological factor, may hhave meaning in a small percentage of instances, Dut these are usually the most severe and profound cases, In the vast majority of cases, behavioral or ‘developmental disturbances are the result of com- bined factors tha are more strongly assoclated with the environment than with any intrinsic charac- teristics ofthe affected individuals, The one major ‘genetic success story is the prevention of the ef fects of phenylketonuria (PKU). However, the pre- vention strategy isan environmental one, changing the child's diet rather than changing the child. ~~ ‘Traditionally, ealy intervention programs have been based on stable models of development in Which children who were identified as doing pooriy cay in life were expected to continue to do poorly, Early childhood education, as exemplified in Head Start, was designed to improve the leaning and so- ‘lal competence of children during the preschool years with the expectation that these improve- ments would be maintained later in life, Unforta- nately, follow-up research of Head Start children hhas shown only moderate gains in measurable inte lectual competence being maintained through ado- lescence Zigler, Styfeo, & Gilman, 1983), although there were reduced rates of school failure and need for special education in other ealy intervention pro grams (Lazar, Darlington, Murray, Royce, & Snippet, 1982; Schwieinhart & Welkart, 1980) From a different perspective, children who were Identified early in ifeas being at risk because of such biological crcumstancesas birth complications were thought to have generally negative developmental ‘outcomes, But longitudinal research inthis area has ‘demonstrated thatthe majority of children who ex- Perlenced such biological conditions did not have Intellectual or socal problems ater in life Samerot, 1986; Samerotf & Chandler, 1975) ‘We ean drave two conclusions that have majorim- plications for intervention programs. The fst is that the child's level of competency at any point in early development, whether reached through normal de vvelopmental processes or some special intervention efforts, isnot linearly related to the child's compe- tence later in life. The second point is that in order ‘to complete an equation predictive of later develop- rent, one needs to add the effects ofthe child's so- al and family envionment that act to foster or im- pede the continuing positive developmental course ‘ofthe child. In shor, intervention programs cannot be successful if changes are made only inthe indi- vidual child, Corollary changes inthe environment -must occur that willenhance the existing competen- ‘les ofthe child and buffer the child from steesful life events inthe futue, Lets turn fora moment to research aimed at identi- {ying representative risk factors inthe development ‘of cognitive and social-emotional competence. Such ‘competencies of young children have been found to be strongly related to family mental health and es- pecially social class (Broman, Nichols, & Kennedy, 1975; Werner & Smith, 1982). However, social lasses difer in many of the characteristics that fs- ter of impede psychological development in their children, These factors range from such proximal variables as the mother’ interaction with the child, to-such intermediate variables asthe mothers men. tal health, to distal variables such a5 the financial resources ofthe family. ‘An ecological model emphasizes the complexity of development and the large numberof environmen- tal inflaences on children, Although causal mod- ls have been sought in which singular variables uniquely determine aspects of child behavior, a se- Hes of studies in variety of domains has found that, ‘except at the extremes of biological dysfunction, iis thenumberrather than the nature of isk factors that is the best determinant of outcome, For example, Parmelee and Haber (1973) found this tobe true for neurological factors in samples of infants with many perinatal problems, and Rutter (1979) for family fac- tors in samples of children with many psyehosoctal problems. We have followed this theme In a series ‘of developmental studies of children and found that attention to the fll array of contextual factors pro- vides a better picture of each chile’ development as wells identifying those children in greatest need of {Intervention efforts, ‘The Rochester Study Im a longitudinal study of children in Rochester, New York, Sameroff, Seifer, Barocas, Zax, and Greenspan (1987) assessed a set of 10 environmen- fal variables when the children were 4 years old They tested whether poor development was a func tion of low SES or the compounding of environmen- tal risk factors found more frequently in lower SES groups. The ten environmental risk variables were chronicity of maternal mental illnes; maternal anx- lety; a parental perspectives score derived from a combination of measures that reflected rigidity or Aexbilty in the attitudes, beliefs, and values that ‘mothers had in regard to their childs development; spontaneous positive maternal interactions withthe child during infancy; occupation of head of house hold; maternal education; disadvantaged minoritynas ARNOLD J. SAMEROFF AND BARARA H. status; family support; stressful life events; and fam- y size. ‘When these risk factors were related to social- ‘emotional and cognitive competence score, major differences were found between those children with low multiple risk scores and those with high scores. In tezms of intelligence, children with no environ- ‘mental risks scored more than thirty points higher than children with eight or nine risk factors. Sim- Hany, the range in scores on an assessment of the social and emotional competencies ofthe children showed a similar spread (Samerot,Seifer, Zax, & Barocas, 1987) Several conciusions from this study are relevant to intervention efforts, One conclusion fs that the rhumber of risk factors was the prime determinant of ‘outcome within each socioeconomic level, not the socioeconomic level self. The second and more i portant conclusion for intervention strategies sthat the same outcomes were the result of different com binations of risk factors. Preschool cognitive devel ‘opment was not different fr groupsof children with the same numberof risks. No single factor was regu- larly related to either poor or good outcomes. I this isthe case, its unlikely that universal interventions can be found for the problems of children. For ev- ry family situation, a unique analysis of isk factors will requite @ unique set of intervention strategies embedded within a developmental model ‘The Philadelphia Study ‘The Rochester Study Samerof a, 1987) was somewhat exploratory in tat isk factors were cho: sen from thor aleay avilable the dat set and svete not fll representative of he many’ contents Inwhich chilren are infisenced. Ina newer std of Adolescents in Philadephia, Pennsylvania, Fustn- berg, Cook, Eels ler and amert (1999) were rote planful and incladed factors in six dif nt ecologial domains, They examined variables ‘tin stems that affected the adolescent, ranging from those microsjtems (Bronfenbrenner, 1977) in tvhich the child was an active patpant, such 2s Patent interactions, to those systems more di {alto the child such s community characterises, "went variables were selected fom sx groupings reflecting ferent ecological reatonsto te ado Cent Gee Table-1),twiceas many asin the Rochester ‘TABLE 7.1. Ecological Risk Varlables in Philadelphia Study Doman Variables Family process ‘Support for autonomy, lscpline effectiveness, parental investment and cation, efcacy, ‘resourcefulness, and Marta status, household ‘crowding and welfare recipe tnsttational volvement, Family structure Management of community Informal networks, se resorts, an economic Peers Prosocial and antisocial community Neighborhood SES, ‘neighborhood problems, tn school eiate Study. The intention was to have multiple factors in each of the six ecological levels. Family Process was the fst grouping and included variables in the family mierosystem that were directly experienced by the child, These included suppor for autonomy, behavior control, parental involvement, and family climate, The second grouping was Parent Character {stes, which included the mother’s mental health, sense of efficacy, resourcefulness, and level of ed- uation. This group included variables that nflu- fenced the child but, generally speaking, were less Influenced by the child. The thied grouping. as Family Seucture, which included the parents’ mari tal status, and socioeconomic indicators of house- hhold crowding and receiving welfare payments ‘The fourth grouping was Family Management ofthe Community and comprised variables that charac {ged the family’s management ofits relationship to the lager community as reflected in variables of in- stitutional involvement, {nformal network, social resources, and adjustments to economic pressure ‘The ith grouping, Pers, included indicators of an- ‘other microsystem of the chil the extent to which ‘the youth was associated with prosocial and antiso- al peers, Community was the sixth grouping repre senting the ecological level most distal to the youth and the family. It included a census 4 > tract variable reflecting the average Income and educational level of the og neighborhood the family lived in, 2 parental report of the number of problems in the neighborhood, and the climate ofthe adolescent's school In the Philadelphia study (Furstenberg et al, 1999), in addition to the larger number of ecological variables, we had a wider array of assessments available for interpreting developmental competence. The five outcomes that were thought to 02 characterize successful adolescence were parent reports of adolescent _o4 Psychological Adjustment on a num- ber of mental health scales; youth reports of SelfCompetence measures and Problem Behavior with drugs, delinquency, and sexual behavior: combined youth and parent reports Cf Activity Involvement in sports, reli- ious, extracurricular, and community Drojects; and Academic Performance 38 reflected in grade reports submitted by the parent and adolescent Inthe Philadelphia data there were risk at every ecological level assocated with child outcomes. It wasnotonly the parent or the family that had an in- AAyenceon child competence but also the pees group, neighborhood, and community, together with their Interactions with the family. Some of the variables were risks for each of our five outcomes. These Included lack of support for autonomy, a negative family climate, and few prosocial peers. At the other extreme were variables that affected only a few out- ‘comes such as having parents who lacked education and resourcefulness, single marital status and signit- leant economic adjustment, a lack of informal net works, and low census tract socioeconomic status, ‘The important question was whether there would be the same effect of multiplersk factorsin Philadel- Dhia as was seen in Rochester. When the five no malized adolescent outcome scores were plotted against the number of risk factors, a large decline Jn outcome was found with increasing isk. As can be seen in Figure 7.1, the maximum effect of cu- _mulative risk was on Psychological Adjustment and + Prpetogea sma Savy neem Figure 7.1 Hoaton of fve youth outcomes to multiple "Sk Scores in Philadephia study, ‘Academic Performance with smaller relations to the {youth's report of Self Competence and Activity In- volvement, ‘0pDs.RATIO ANALYSIS. Whether the cumla- tive risk score meaningfully increases the predic: tive efficiency of risk variables can be demonstrated by an odds-ratio analysis. The odds of having a bad outcome in a high-risk neighborhood could bbe compared with the odds in a low-risk environ- ment. To simplify the report, we examined the re- lation between the negative outcomes and adoles- ‘ent environmental risk cores in four multipe-risk groups: a low-risk group defined as three or fewer, ‘two moderate risk groups of four-to-ive and sixto- seven risks anda high-risk group with eight or more (Gee Figure 72), ‘The relative risk in the high-risk group foreach of the negative outcomes was ubstantilly higher than In the low-risk group. The strongest effects were for ‘Academic Performance, in which the relative risk for140 ARNOLD J. SAMEROFF AND BARBARA H. FIESE Percent of Adolescents with Poor Outcomes {In Differing Rsk Groups. 072, Percentage of out in lowes quate fo ve Jour otcomes nthe Pilate study sparated io {our malt isk groups. Odds are calculated a the rato between percent youth in helomestquarein the high ‘lead owes rouge ‘bad outcome increased from 796 in the low-risk {r0up to 45% in the high-risk group ~an odds ratio fof 6.7 to 1. The weakest effect was for Activity In- volvement, in which the relative risk only increased from 12 to 33% ~ an odds ratio of 7 to 1. In some sense ths Is not unexpected because, although ev- eryone would agre that academic failure and poor ‘mental health are bad outcomes, there might be some dispute whether an adoleséent’s desire not to participate in scouts, religious activities, or sports = fects a lack of competence, n any case, forthe im- portant cognitive and social-emotional outcomes of Youth, there seem to be powerful negative effects of the accumulation of envizonmental risk factors PROMOTIVE FACTORS ‘The concern with preventing developmental fail tures has often clouded the fact that the majority fof children in every social class and ethnic group fare not failures. They get jobs, have successful so- ial relationships, and ralse a new generation of aoae 5 near 56-7 noe la ron ‘cildzen. The concern with the source of such suc cess has fostered an increasing concem with the ‘development of competence and the identification of protective factors (Garmezy, Masten, & Tellegen, 1984), However, the differentiation between rskand protective factors i far from clear (Sefer & Samero, 1987), and there continue to be many theoretical and methodological limitations in their identifca- tlon (Luthar & Zigler, 1991), ‘Although some have argued that protective fac- tors can only have meaning in the face of adver sity (Rutter, 1987), in most cases protective factors simply appear to be the positive pole of tsk factors (Stouthamer-Loeber et al, 1993) In this sense, a bet- ter term for the postive end ofthe tsk dimension ‘would be promotverather than protective factors. To test this simplification, we created a set of promo- tive factors by subdividing each of our risk dimen- sions atthe top quartile (Sameroft,Batko, Baldwin, Baldvsin, & Seifer, 1998), For example, when a neg” ative family climate had been a risk factor, a posi tive family climate now became a promotive factor, fr when a pazent’s poor mental health was 2 risk factor, her good mental health became promotive. ‘Wethen summed these promotive factorsand exam- {ned thei elation to our five outcomes. The results ‘mirrored our analysis of the effects of multiple risks. A similar range of promotive factors was found from families with none to families with 15 out ofa pos: sible 20 and a similar elation to outcomes; fami- lies with many promotve factors did substantially better than those from contexts with few promotive factors. For the youths in the Philadelphia sample, there does not seem to be much difference between the influence of risk and promotive variables. The {greater the rsk factors, the worse the outcomes; the ote promotive factors, the better the outcomes, In shor, when taken as patt ofa constellation of env ronmental influences on child development, most contextual variables inthe parents, the family, the nelghbothood, and the cultuee a large seem to be ‘dimensional, aiding in general child development at one end and inhibiting it atthe other. IDENTIFYING INTERVENTION TARGETS ‘Mulirisk analyses emphasize the many factors that Influence child development, yet most political pol ley devoted to changing single factors in children’s lives. Two factors that have received great attention are the effets of poverty and the efecto living in a single parent home. Although one would think that these factors should have powerful effectson the fate ‘of children, we did not find such differences when these ingle varlables were put into a broader mult- tisk ecological framework. Differences in effets on ‘child competence disappeared when we controlled for the number of other environmental rsk factors in each family. To test the effects of different amounts of nancial resources, we spit ou sample of familiesinto those with higher, middle, and lower Income levels. For the family structure comparison, we divided the sample into groups of children liv- Ing in two-parent versus single-parent families. To simplify the analysis further, we combined the five ‘youth outcomes into one overall adolescent compe- tence score reflecting general adaptation across per- sonal, academic, and social domains. In each ease, there were no differences in the relation to child competence when we compared groups of children with the same numberof risk factors raised in ich ‘r poor families or families with one o two parents. The reason that income and matital status seem to make major differences in child development is rot because they are overarching variables in them- selves but because they are strongly associated with a combination of other risk or promotive factors. For example, we found that although 39% of poorer children lived in high-risk families with more than Seven risk factors, only 7% of more afiuent children did. Similarly, although 29% of single-parent fami- lies lived in high-esk social conditions, only 15% of ‘two-parent families di (ur analyses of the data reveal that single envi- ronmental factors rarely make a major diference by themselves; rather, the constellation of rsks in each family’s life does make a difference. In the Philadelphia study, the effects of income level or marital status taken alone were small or nonexis- tent in comparison with the effects ofthe accumu lation of multiple negative influences that charac- terize our high-risk groups. The overlap in outcomes for youths in high- and low-income families, and In single- and two-parent families, is substantial for any and al psychological outcomes, There are many successful adults who were raised in poverty and un- successful ones who were raised in affluence. There are many healthy and happy adults who come from broken homes, and there are many unhappy ones who were ralsed by two parents ‘What these analyses tell us Is that income level and marital status taken alone may have some et- fects on adolescent behavior but that these ditfer: fences pale in comparison with the accumulation ‘of multiple negative influences that characterize ‘our high-risk groups. The overlap In outcomes for youths in low-income versus high-income fariies and families with one or two parents is substantial for most psychological outcomes, but the overlap is far less in comparisons of groups of children reared In conditions of high versus low multiple risk, in ‘Which income and number of parents in the home are only single factors. The important implication of this research is that a focus on individual character- Istes of families can never explain more than a tiny proportion of variance in behavioral development ‘To truly appreciate the determinants of successful development requires that attention be pald to @ broad constellation of ecological factors in which ‘these individuals and families are embedded ‘TRANSACTIONAL MODEL mn our ecological analyses, we have emphasized the role of the envionment In affecting child devel- ‘opment and have argued that planning effective2 ARNOLD J. SAMEROFF AND BARBARA HL. FIESE fof uch a transactional outcomecan beseen in Figure 73. women ane scones In Figure 7.3, the childs outcome is nei ther a function of the initial state of the ZN\2Z\ child nor the inital state of the environ- ‘ment but is a complex function ofthe in ra orrcuLt crm | couticanon | | renpenaient terplay of child and environment overtime. For example, complicated childbirth may have madean otherwise calm mother some- ™ hoo ek Figure 7.3. Example of transactional process leading to developmental problem interventions requites a sophisticated view of environmental action that includes attention to ‘many factors. Within this contextual emphasis, we cannot lose sight of the important role individual dlfferences in the child play in terms of what the child eicts from the environment and what the child is able to take from the environment. ‘One such developmental model that appears to apply na number of scientific domains is the trans actional model (Sameroff, 1983, 1993; Samerott & ‘Chandler, 1975). In this approach, developmental ‘outcomes are neither a function of the individual alone nor of the experiential context alone, Out ‘comes are a product of the combination of an in- dividual and his or her experience, To predict out ‘come, a singular focus on the characterstes of the individual, in this ease the child, fequently will be misleading. An analysis and assessment of the expe- riences available tothe child need fo be added. ‘Within this transactional model, the development of the child is seen as a product of the continu ‘ous dynamic interactions of the child and the ex perience provided by his or her family and social ‘context. What is innovative about the transactional ‘model i the «qual emphasis placed on the eects of ‘the child and the envionment so that the exper ‘ences provided by the environment are not viewed as independent of the child. The child may have ‘been a strong determinant of curtent experiences, ‘but developmental outcomes cannot be systema cally described without an analysis of the effects of the environment on the child. A concrete example ‘what anxious, The mother’s anxiety during ‘the fist months ofthe chiles life may have ‘caused her to be uncertain and inappropei- ‘ate im her interactions with the child, In response to such inconsistency, the infant may have developed some iregulartes in feeding and sleeping patterns that give the appearance of 4a difficult temperament. This dificult temperament decreases the pleasure thatthe mother obtains from the child, so she tends to spend less time with her child, If adults are not actively interacting with the child, and especially speaking to the chil, the child ‘may not meet the norms for language development and may score poorly on preschool language tess ‘What determined the poor outcome in this ex ample? Was the poor lingulstle performance caused by the complicated childbirth, the mother's anxiety, the chile’s dificult temperament, or the mother’s avoidance of verbal and social interaction? If one ‘were to design an intervention program for this family, where would it be directed? If one were to select the most proximal cause, it would be the mother’ avoldance ofthe child, yet one can see that such a view would oversimplify a complex devel ‘opmental sequence. Would primary prevention be ltected at eliminating the child's difficult temper ment, changing the mother’s reaction, or provid- ing alternative sources of verbal stimulation for the child? Each ofthese would eliminate potential dys- function at some contemporary point in the devel ‘opmental system. But would any ofthese efforts en- ‘sure the verbal competence of the child of, pethaps ‘more important, ensure the continued progress of ‘the child after the intervention was completed? ‘The series of transactions described caller Is an ‘example of how developmental achievements are rarely sole consequences of immediate antecedents dnd even more rarely sole consequences of distal antecedents. Not only i the causal chain extended ‘overtime but itis also embedded in an interpretive framework, The mother’s anxiety is based on an interpretation of the meaning of a complicated childbirth, and her avoidance is based on an in- terpretation of the meaning of the child's iregu: lar feeding and sleeping pattems. To understand the effects of interventions on the way parents be hhave toward their infants, there isa need to under stand this interpretive framework, What follows is 4 description of the organization and operation of this interpretive scheme that offers the possibility ‘of a richer understanding of why past intervention strategies were more of ess successful, The ultimate ‘goal of this description is to provide a theoretical basis fr the design of future Intervention strategies that can be targeted ata level of developmental re. ulation appropriate tothe desired change ina chia’s development. ‘THE ENVIRONTYPE Just as there i a biological oganlzation, the geno- type, which regulates the physical outcome of each individual, there isa social organization that regu- lates the way human beings fit into their society, This organization operates through family and cul- tural socialization patterns and has been postulated to.compose an environtype analogous to the biolog- al genotype (Sameroff, 1995). The importance of Identifying the sources of regulation of human de- velopment is obvious if one is interested in manip. tulating that development, as inthe case of preven: tion orintervention programs. Itisbeyond the scope of even the most ambitious intervention progr to manipulate all of the parameters that influence child development. The alternative i to understand ‘determinants of development in suficient degree to ‘choose evel of complexity appropriate tothe prob- lem to be solved, the developmental stages of the child ane family, and available supports. The failures fof intervention efforts can only be understood in terms ofa allure to understand these regulatory ys- tems. Each individuals environtype contains these regulatory patterns. For our purposes, we restrict the discussion to lev- ls of environmental factors contained within the culture, the family and the individual parent. These subsystems not only transact with the child but also transact with one another. Developmental regula- tions at each of thes levels are carried within codes: ‘the cultural code, the family code, andthe individ- ual code of the parent. These codes regulate cogni- tive and social-emotional development so that the child ultimately wil be abl to fila role defined by society. They ae hierarchically related in ther evo- Ition and in thelr curtent influence on the child ‘The experience of the developing child Is partially determined by the beliefs, values, and personality of the parents; partially by the family’s Interaction patterns and transgenerational history; and partially by the socialization beliefs, controls, and supports of the culture, However, there is a distinction between codes and behaviors, The environtype is no more a description ofthe experiential environment than the genotype i a description of the biological phe notype. In each case, the code must be actualized ‘through behavior. The codes have an organizational and regulatory influence on parent behavior, but the behavior isnot the same asthe codes. ‘Most behavioral research on the eects of the en- ‘vironment has been limited to the study of mother- ‘child interaction patterns, which is only one com- Ponent of the environtype. Another component is parental belief systems (Sigel, MeGillicuddy-De-Lis, & Goodnow, 1992). These beliefs include parent “understanding of child behavior, the sources of de- velopmental change (Samerotf & Fell, 1983), and child-rearing values (Kohn, 1969). To summarize the overall model of developmen- tal regulation, the child's behavior sa product ofthe ‘wansactions between the phenotype tLe, the child), the environtype (Le, the source of external exper fence) and the genotype (Le, the source of biological ‘organization; see Figure 74). Traditional research on child development has emphasized the child's uti lization of biological capacities to gain experience and the role of experience in shaping child compe- tencies, but there has been far less attention to how Figure 7-4. Regulation model of development with rane actions amang gentype, phenotype, and enirotype eWAONTYPE. Ee Em 00.0 Q.0_0 enor ame Commeat ARNOLD J. SAMEROFE AND BARBARA M. FIESE that experience is organized. Indeed, the organiza- tion of experience Is explicit in the great amount of attention given to curriculum development and behavior modification plans, but far les attention is given to the implicit organization of experience found in the envitontype to be described later. Cultural Code ‘The ingredients ofthe cultural code ae the com- plex characteristics that organize a society's child- fearing system and that incorporate elements of Socialization and education. These processes are em besed in sets of social controls and social supports. They are based on beliefs that difer in the amount of community consensus ranging from mores and hnorms to fads and fashions. It would be beyond the scope of this chapter to elucidate the full range of Cultural regulatory processes that are potentially re! evant to intervention efforts. Asa consequence, only a few points are highlighted to clarify the dimen- ‘Sons of the cultural code ‘Many common biological characteristics of the hhuman species ave acted to produce similar ‘developmental agendas in most cultures. For ex ample, in most cultures formal education begins between the ages of 6 and 8 when most chil ‘ren have developed the cognitive ability to lea from such structured experiences (Rogoff, 1981). However, there ate historical and cross-cultural dit ferences in which changes in child behavior are emphasized or ignored. For example, informal ed- lucation can begin at many different ages, depend- Ing on the culture's attributions to the child. For ‘example, some middle-class parents have been con- Yinced that prenatal experienced will enhance the cognitive development of thelr children and com- sequently begin stimulation programs during preg hhancy, whereas other believe best to walt until the fist grade before beginning formal learning expeti- fences Such examples demonstrate the variability of hhuman developmental contexts and the openness ‘of the regulatory system to modification. Family Code “The family code regulates child development through combinations of factors that extend across {generations include the coordinated efforts of more than two people, and provide a sense of belonging to a group. Traditional approaches to regulation in the family system have focused on the directly ‘observable interaction patterns that are associated with such individual adaptations as_ sensitive, intrusive, oF neglectful behaviors directed toward the child (eg, Clarke Stewart, 1973) In these cases, repetitive patterns of neglect or intrusiveness are proposed to lead to maladaptive development. Re ent extensions to family management and dyadic Interaction have also been proposed (Grych & Fin- cham, 1990; Parke & Bhavnage, 1989). Regulation {nthe family system has also been approached from the perspective that family beliefs affect behavior di- rectly through working models that guide behavior tnd impart expectations to children. This approach Is evident in the attachment terature as wel as in generational influences on development (Bowen 1976; Main & Goldwyn, 1984). Both approaches may account for variability in child development and need not be considered incompatible heuristics. In tervention with families of young children demands attention to both the direct effects of interaction patterns that are proximal tothe child's experience land famlly beliefs that may be more distal to the child Toapprecate the effects of family interactions and beliefs on child development, itisimportant to iden- tify the central tasks of the family, Family life ex- tends across a variety of domains, and families are responsible for multiple aspects of their members ‘development, Landesman, Jacard, and Gunderson (1991) proposed six domains of family functioning: 1) physical development and health, 2) emotional evelopment and well-being, 3) socal development, ‘4 cognitive development, § moral and spiritual de- velopment, and 6) cultural and aesthetic develop- tment. Families organize thet behavior around these foals, and adaptation fs linked to whether they are Feached successfully. Families also change over the life span with shifts in membership through mar- riage, divorce, birth, and death that are often accom- panied by changes in roles and responsibilities that affect individual adaptation (McGoldrick, Heiman, '& Carter, 1993). We propose that the family code regulates development so thatthe tasks ofthe fam- ity may be fulfilled, Families organize experience through the belils ‘that they hold and the ways in which they interact ‘with each other. Ress (1989) has theorized that fam- ily regulation can be detected and observed through the study of family practices and representations ‘The represented family highlights the internal rep- resentation of relationships and how working mem- ries provide a sense of stability. Working models of relationships develop within the context of the family, are retained in memory, and guide the ind- Vidal's behavior overtime. To study the represented family, we must explore how families impart values and make sense of personal experiences, The practic ing family, in contrast, stabilizes and regulates fam- lly members through observable interactions. The interaction patterns are repetitive and serve to pro- videa sense of family coherence and identity. Family life resides not only in the minds of individuals but also comes to life in the observed coordinated prac- tices of the group (Grych & Fincham, 1990; Reis, 1981) Representations are timelinked recollections of past experiences that are often reconstructed to ‘luce future expectations (Stern, 1989). Forexample, «parent's recollection of past childhood experiences ‘may benluenced by the age of children inthe fam- lly and current chil-rasing demands Fiese, Hooker, Kotary, Schwager, & Rimmer, 1995; Miller & Moore, 1988). Family practices are momentary exchanges that are repeated over time. They may serve as the foundation for some representations as interac: tion patterns become predictable, expectable, and a source of comment. For example, repetitive inter actions among family members at the dinner table "may become the source ofa family story for the next generation (Byng-Hall, 1995), ‘The family code Isa cause and a consequence of what families do on a regula basis and how family values and beliefs are directly imparted to children, One way to access the family code, while consis Ing family ecology, isto examine family stories as Dart of the represented family and family rituals as Dart ofthe practicing family. Family stores and ritu- als ae integrated into the developmental demands of raising young children and reflect transactional processes over time. FAMILY STORIES. Family stories deal with how ‘the family makessense of its worl, expresses rules of Interaction, and creates beliefs about relationships ‘When family membersare called upon to recount an experience, they set an interpretive frame reflecting how individuals grapple with understanding events, hhow the family works together, and how the ascip. tion of meaning is linked to beliefs about relation- ships in the family and social world, The storie that families tell about thete personal experiences aid in constructing a meaningful picture of the familys theory of how the world works and their expecta- tions for family members’ behavior (Bruner, 1990). Family stories may be examined by their thematic contenton the one hand and by the process of tory telling itself on the other ‘The formation of close interpersonal relationships and striving for success are two central themes in adult and child development (Erikson, 1980; Gili 4gan, 1982; McAdams & dest. Aubin, 1992), How the family goes about imparting values of relationships and achievement will be tempered by the develop- ‘mental stage ofthe family and personal values held by the family. Family stories about one’s own child- hhood may aid in integrating generational factors withthe current demands of parenting. In addition, these themes ae sensitive to the developmental life yee ofthe tamil. In a study of parents whose ol ‘st child was eltheran infant or preschooler, several ‘developmental and parent gender diferences were {foundin the thematic content of family stores (Fiese etal, 1995). Fathers tended te talk about their child- hhood experiences with an emphasis on achievement themes and mothers tended to talk about childhood ‘experiences with an emphasis on affliation themes, Furthermore, parents of infants were more likely to tell family stories with stong afliation themes, and parents of preschoolers were more likely to tell fm- lly stories with achievement themes. Parents may us stories asa means o highlight ex: pected developmental tasks of family members. Dur ‘ng theeaely stages parenting, mothers and fathers both told stories of an aflative nature, focusing fn the needs of others and being close, Consistent with the demands of raising an Infant, parents re ‘all experiences that incorporate themes of belong: ing. However, when the oldest child is of preschool age and js gaining a sense of autonomy, parents’ stories begin to include themes f personal success and achievement, perhaps preparing the child for roles as a student and achiever. In adation to the thematic content of family stories, the relative co hherence of famlly narratives may impart to children thatthe world can be understood and mastered, The Importance of family stories for ealy interventionm6 ARNOLD J. SAMEROFF AND WARBARA H. FIESE amansucrionan wrovtarn Is highlighted by the kinds of stories imparted by from marital dissatisfaction during the early tages =] hhigh1sk parents. Ina study of psychiatrically ill paz- of parenthood. Couples who are able to practice parent |e” Safran tents, Dickstein and colleagues found that depressed! meaningful family rituals in the context of raising nme * ‘mothers told stories that provided a less coherent children are more satisfied in their marriage than. iso red {mage of family ife (Dickstein et al, 1999). in this ‘regard, the child ina depressed family may not only be at fsk because of inconsistent interaction pat- terns but also because ofthe transmission of family ‘messages that ae inconsistent and poorly organized and that demonstrate a mismatch between affect and content. One only has to speculate what itis Tike fora child to be raised in an environment that is marked by difficulties in creating coherent images ‘of personal experiences, FAMILY RITUALS, Family tual are powerful oF ‘ganizers of family life and are associated with both the practicing and represented aspect ofthe family cose, Family rituals range from highly stylized reli tious observances, such as ist communion, to less articulated daly interaction patterns, such as din- hertime, to problem-solving routines such as anger ‘management. Family rituals appear to affect family lite by pairing meaning and affect with patterned interactions (Fese, 1992, 1995). During the child- rearing years, creating and maintaining rituals on a ‘ally basi are an integral pat of family life Bennet, olin, & McAvity, 1988). The organized experience ofthe family in its dally practices is sensitive to de- Yelopmental changes in the family and! may aid in the preservation of close relationships during peri- ‘ods of transition, In families with young children, it ‘was found that families of preschool-age children - tablish more dinnertime, weekend, and annual cele bration rituals than parents of infants. Furthermore, families of preschool-age childfen also report the oc: currence of more family rituals a greater attachment fof affect and symbolic significance to family rituals, land more deliberate planning around ritual events, ‘with a stated commitment to continue the family it uals into the future (Fese, Hooker, Kotary & Schwa- ler, 1993), As children are able to take on a more factive role In the family, dally activities appear to be reorganlzed to incorporate the child’ partici tion (Goodnow & Delaney, 1989). Over time, these practices have meaning forthe family and aid in the creation of a family identity, amily rituals may also preserve relationships dur- ing times of transition and may protect couples couples who find thelr family practices hollow and Jacking in meaning (Fiese etal, 1993), Families who are faced with the care of a family member with a chronic illness may also find that rituals provide @ sense of stability and meaning asociated with fam- ity adaptation, Bush and Pargament (1997) reported ‘that for adults with chronic pain, the regularity of, family routines provided a sense of predictability as sociated with postive adaptation, For the spouse of the patient, the meaning ofthe ritual was linked to feelings of family competence, suggesting a sense of bbelongingness and preservation of family rlation- ships in the fae of caring for someone with chronic pain, Whether a similar pattern thos for families ‘with children with chronic conditions has yet to be ‘determined. However, taken together, these findings suggest that the stability of family rituals as well as the meaning associated with family practices is e- lated to family adaptation IRESENTATIONS. From a transactional perspective, both the practicing and the epresented family code behavior across time and affect one another. Fam- ily practices come to have meaning overtime and become translated into the symbolic aspect of the represented family. The represented family, n tur, ‘may affect how the family regulates and interprets its practices. As an example, consider negative a- fect at the dinner table in the context of a pi ent with generational paterns of abuse and neglect. ‘The parent does not expect relationships toe re ‘warding and has created a representation of family as unfublling and disappointing (Cicchet & Toth, 1995). Negative affect at the dinner table confirms the parents expectation of unrewarding family in- teractions, Direct exposure to negative affect may then lead to acting-out behaviors (Katz & Gottman, 1993). The acting-out behaviors may serve to rein- force the parent in the belief that he or she cannot expect his or her offspring to behave in a postive manner, and a family story is then created labeling the child as “bad” and uncontrollable. This trans- actional proces results in escalation of problem be- havior and an entrenchment of beliefs that mak It chi | tl Init ‘Sate rocco alter maladaptive ates ofinter Acton. Thestoedrepresetation of ally behavior Becomes tainted with expectations for unfailing family reationships confirmed in the dcely ob servale interaction among family members (Fese & Matjinky 1999). This tasactional proces ik Tusa in igure 78 ‘As wth other tansactona systems, there no direct aus nk between parental expectation for “unrewardngelatonshipsand child eocee behav. ioe The ration mediated by a chan of rere Cal events that could lead to many other outcomes with appropriate interventions Changing parental behavior at dinnertime, negative expectations of the cid or family toes may signe er the outcome forthe child. A transactional unde standing of uch processes hips in tenting both pyoblematc developmental processes and potent Interventions Individual Parental Code "Tht cl edence that prea eave Inuenced bythe aly content When operat 2 par of a ally the Behavior ofeach member atered (Parke & Tinsley, 198), tequently witout fvarenss ofthe behavioral change ets 198) However, thereisno dst that individuals socom. tribute to family interactions. The Contbuton of Parents has much more complex ns tan that {young children, given the malpe eves hat or fanize tele behavior We have cseased the so ling regulation embodied in he catalan fa ly codes We have nt dace the indeed =) © © ree End State Figure 7. Transactional proces ding rom patent x pesto unrevadgatonship ch conc Interpretations that each parenting igure imposes fon these codes To age extent, thes interpret tons ar condoned by ach parents post pe ination tn his of er own familys coded nea: tons, but they ae captred uniquely by each mem ber of the family. These inividual nfuenees ther condition each parents sponses ois or het on child. Main and Goldner (1984) have Iden. tied adult atachiment categories that ree par 8 econ ofthe interpret ft a tachment wo thelr own parents, What i comp about these adult atachment categories that they ‘operate acros generations and ac predicte ofthe Sachment xtegoes ofthe nant The rchnes of bot health and pathology em boule in these parental responses is wel dese in the clin Hteratre in tems of early devel opment, Faberg (980) and her colleagues peo. vided many deseriptons of theattabution thet pr ents ring to thet parenting. These “ghosts” of um resolved childhood conics have been shown to *othermischietaccording ois rope agenda, depending upon the vanities of the Parental past alberg, Adlon, & Shap, oie 80,1975, "eee of parental deviance has long been ognized 5» contort the poo dercopmes tlsatusof eden Samerof Sey & Za, 982) ‘ne ofthe major sep formar neuen eal in tervenion programs the efor to fattate the8 ARNOLD J. SAMEROFF AND BARBARA H. FIESE parent's caregiving behavior because ofits impor tance forthe development ofthe child. Although we acknowledge that influence, we must also be care- ful to ada the importance of the contexts in hich parental behavior is rooted - the family and cul- tural codes. To ignore these contexts that organize parental behavior would permit only limited add tional success when parent involvement is added to Intervention efforts that foundered when the child was the sole target of treatment. Its important to ‘understand the parent as a major regulating agent, Dut tis equally important to recognize that parental bbchavior is itself embedded in regulatory contexts that may require additional intervention strategies Regulations ‘The description of the contexts of development Js a necessary prologue to the understanding of de- velopmental problems and to the eventual design of intervention programs. Once an overview of the complexity of systems isobtained, we can turn tothe search for nodal points at which intervention state- ales can be directed. These points will be found in the interfaces among the child, the family, and the cultural systems, especially when regulations are oc courting Despite a tendency to see infants as objects exist ‘ng in a material world where thei talents unfold Jn some maturational sequence, the reality is that from conception the infantis embedded in relation- ships with others who provide the nutrients for both physical and psychological growth. n Figure7.6, the developmental changes in this relationship between Individual and context ae represented.as an expand- ing cone. The balance between otker-cegulation and self-regulation shifts asthe child Is able to take on Figure 7.6. Changing balance betneen ter requlation sd seleregulation as child develops into ad. REGULATION MODEL. Increasing responsiblity for his or her own well being. At bith the infant could not survive without the environment providing nutrition and warmth, Later the child is able to put on a jacket and find the refrigerator, although someone else stil has 0 ‘buy the clothing and food forthe family. The child ‘eventually reaches adulthood and becomes part of the other-regulation ofa new infant, beginning the next generation, ‘To complete the picture ofthe developmental ys tem, one must appreciate the complexity of regu latory processes reflected in thelr time span, pur posiveness, level of representation, and the nature Of the child's contribution. We have divided de- velopmental regulations into three categories on the bass ofthese considerations: macroregulations, ‘minieegulations, and microregulations Samerof, 1987; Sameroff & Fese, 1990). Macroregulations are predominantly purposive major changes in experi ence that continue for long periods of time ~ such a5 weaning or entry into school. Miniregulations are predominantly caregiving activities that occur ‘on a dally basis and include dressing, feeding, or ‘isciplining, Microtegulations ae almost automatic pattens of momentary interactions. Examples in ‘lude attunement (Stern, 1977) on the positive side ‘or coercion (Patterson, 1986) on the negative. The three sources of regulation are organized at ferent levels of the environtype. Macroregulations ae the modal form of egulation within the cultural code. Many cultural codesare written down or mem- rized and may be passed on to individual members of society through customs, beliefs, and mytholo- ‘ies, in adalition to actual laws that ae almed at reg Ulating child health and education, Miniegulations ‘are modal within the family code in which less fo. mal interactions condition the caregiving behavior of family members. Micorgulations come into play at the individval level in which diferences in per sonality and temperament balance with commonal- ities in human species-specific behavior in regulat- {ng reactions to the child. ‘The operation of the family code is characterized by a series of regulated transactions. Parents may hold particular concepts of development that influ- ence their caretaking practices. As children are ex- posed to different role expectations and listen tothe family stores, they make thei own contribution by thelr particular styles. The child’ acting out of rolas. within the family s incorporated into family stories, rituals, and myths. By becomingan active transactor Jn the family code, the child ultimately may affect the child rearing practices of the parents and even influence the code to be passed down to the next gener ‘TARGETING INTERVENTION EFZORTS. A sensitivity to the complexities of child develop- ment has encouraged the implementation of in- tervention strategies to include multiple members Of the child's family (Turnbull, Summers, & Broth- erson, 1983), as well as multiple disciplines con- ‘cerned with early childhood (Bagnato & Neiswort, 1985; Bricker, 1986; Bricker & Dow, 1980). Increas- Ingly, early intervention programs designed today ate based on a team approach that addresses the ‘many facets of childhood problems. As it becomes less acceptable to focus on isolated aspects of devel ‘opmental disorders, the total environmental con- text of the child is considered (Sameroff, 1982) ‘Once multiple determinants have been recognized as being associated with childhood problems, a more targeted approach to implementing intervention is Inorder, which isbased on the specific determinants Identified in a specific situation ‘A frequent problem in planning Intervention strategies is deciding where to concentrate therapeu- tic efforts. As outlined earlier, developmental regu- latory systems may include individual, family, and cultural codes. Not only do economicand personnel limitations preclude global interventions across sys- tems, but al these regulatory codes also incorporate different aspects ofthe child's development and im- ply dtterent intervention strategies. A careful anal- ysis of the regulatory systems is necessary to define What may be the most effective avenue and form of intervention, The cultural, familial, and individ- ual codes are embedded in temporal and behavioral context that vary in magnitude of time and scope of behavior basic point that emerges from this anal ¥sis s that there will never be a single intervention Strategy that will solve all developmental problems. Costeffetiveness will not be found in the unive sallty ofa treatment but in the individuation of pro- ‘rams that are targeted atthe relevant nodal points {ora specific child in a specif family in a specific social context In consideration of the temporal dimensions of regulation, what are the Implications for interven- ton? Frequently, models of intervention attempt to cover a wide ange of contexts fora single identified problem, Some early intervention programs for ‘isabled infants are designed to intervene on the level ofthe child, family, and occasionally the larger context of social support systems (Dunst, Trivete, & Cross, 1986), Although well intentioned, a great {eal of effort may be expended with minimal results. [A more precise understanding of regulatory ystems and dlagnostic decision making may provide more effective forms of intervention, "TRANSACTIONAL MODEL OF INTERVENTION ‘The transactional model has implications for early Intervention, particularly for identifying targets and strategies of Intervention. The nonlinear premise that continuity in individual behavior is a systems property rather than a characteristic of individuals provides a rationale for an expanded focus of inter- vention efforts. According to the model, changes in Dbehavior are the result of a series of interchanges among individuals within a shared system following specifiable regulatory principles. Emphasis is placed ‘onthe multdirectionality of change while pinpoint- ‘ng regulatory sources that mediate change. BY ex- amining the strengths and weaknesses of the reg ‘latory system, targets can be identified that mini- mize the necessary scope of the intervention while ‘maximizing cos efficiency. In some cass, small a terations in child behavior may be all that is nec: essry to reestablish a well regulated developmental system, In other cases, changes inthe parents’ per ception ofthe child may be the mos strategic inter: ‘vention. A third category includes cases that require Improvements in the parents ability to take care of ‘the child. These categories have been labeled reme- ation, redefinition, and reducation, respectively, oF the “three Rs" of intervention (Samerofl, 1987), ‘An abstraction of the regulatory model that fo- cuses only on the three Rs of early intervention can be scen in Figure 7.7. Remediation changes the way the child behaves toward the parent. For exam- ple, in cases in which children ate diagnosed with known organic disorders, intervention may be di- rected primarily toward remediating biological dys- regulations. By improving the chil’s physlal sta- tus, the child will be better able to elicit caregiving from the parents. Redefinition changes the way the parent interprets the child’s behavior. Atibutions3.Rs of Intervention fate [igure 7.7. The Rs of eal intervention within a ans: sectional mode to the child of difficulty or wilfulness may deter parent from positive interactions. By refocusing the parent on other, more acceptable, attributes of the child, postive engagement may be facilitated. Reeducation changes the way the parent behaves toward the child, Providing training in positioning techniques for parents of physically handicapped children isan example of this form of intervention Each category of intervention is described furth ‘with examples of early intervention techniques used for each regulatory code, Intervening with Low-Birth- Weight Infants In the previous edition ofthis handbook, we de- scribed the transactional model of intervention as applied to children with failure to thrive Samerott ‘& Rese, 1990), For this edition, we have chosen an- ‘other condition of interest to ealy interventioniats that of low birth weight (LBW). LBW is associated with a variety of developmental problems and rep- resents a significant portion of health care costs [LBW infants have been described as more dificult to care for and less responsive to parent interaction attempts (Feld, 1987; Spiket, Ferguson, & Brooks: ‘Gunn, 1993), having dlifculty regulating distress (Cine, Greenberg, Ragorin, Robinson, & Basham, 1983), and being at sk for cognitive and social- ‘emotional difculties (Achenbach, Phates, Howell, Raub, & Nurcombe, 1990) Itis estimated that of the ‘S11 Dlion spent on health cate fr infants, approx: mately 35% is spent on the 796 of infants who are LBW Ghiono & Behrman, 1995) Various eatly in- tervention programs have been developed toaddress the needs of LBW infants and their famillesand may ‘be used toillustrate the transactional model of early intervention. This nonexhaustive review highlights Individual programs that focus on a particula as pect of the transactional model and, when taken together, have implications for future intervention cor. REMEDIATION. As represented in Figute 7.7, the strategy of remediation isthe class of intervention techniques designed to change the child, with even- tual changes occurring in the parent (upward arrow) Remediation isnot aimed at changing the family of cultural codes. The intervention goal is to fit the child to preexisting caregiving competencies that could operate adequately, given appropriate infant triggering responses, Remediation is typically imple- mented outside of the family system by a profes- sional whose goal isto change an identifiable con- dition in the child, Once the child’ condition has been altered, intervention is complete ‘One form of remediation aimed at LBW infants is the prevention of ealy delivery. There ae, however, {ew proven ways to safely delay delivery. Pharmaco: logical interventions in the final stages of pregnancy have been found to suppress preterm labor, but typ: ‘cally these drugs are effective for only a bret pe- tod of time and often have serious side effects for the mother and infant (Nathanielsz, 1995; Ricciot, Chen, & Sachs, 1999), LBW, premature infants are born ill-equipped to eal with the sensory environment outside of the ‘womb (Als, 1992). Infants placed In neonatal inten- sive care units (NICUSs) are exposed to a variety of sensations, including multiple people Involved in the direc eae ofthe infant, mechanical support sys tems, and round the clock activity and light expo- sure. Whereas it was previously thought that LBW infants needed added stimulation to catch up with healthy infants, current NICU procedures support ‘the notion that sensory stimulation needs tobe de- ‘creased for LBW infants in order to optimize de- velopment. Field and colleagues have demonstrated that for LBW infants, enti stroking ina prone pos tion and passive movement ofthe limbs in a supine position decrease the stress associated with being Jn a NICU (Field et al, 1986). On follow-up, in fants who received the touch intervention showed ‘more weight gain, mature habituation, orientation, and spent more time awake than LBW infants who i travsacrionan mecutation ise did not receive the touch intervention. The pos tive effects of the intervention extended one yeat postdischarge, withthe intervention infants sor ing higher on the Bayley Scales of infant Develop- ‘ment. Field etal (1986) suggested thatthe interven- tion facilitates the motor activity and alertness of ‘the infants, which in turn facilitates parent-infant interaction that contributes to later mental and psy~ chomotor development, ‘This example of remediation is an intervention ‘aimed at changing the chil, with the expectation thatthe child will become a more responsive inter: action partner. In this tegard, remediation allows the child to participate more fully in the practicing fam- lly. Remediation is indicated when there isa teason- able expectation that the child's condition can be altered and thatthe family and cultural code do not prevent implementation ofthe intervention. Reme- lation is mos effective when there is time-limited Intervention aimed at the child with the support and assurance that the family can take over routine care- slving activities once the intervention is complete. ‘There are instances, however, in which the cultural or familia code cannot operate succesfully and a second strategy needs to be implemented -the stat egy of redefinition, REDEFINITION. Redefinition as an Intervention strategy Is indicated when existing famlly codes do not fit withthe child's behavior, Redefinition is rep- resented by the horizontal arrow between the par ents at Time T and Time? in Figure 77, Redefinition strategies are directed primaclly toward the fciita- tion of more optimal parenting interactions through an alteration in parental beliefs and expectations. Redefinition is warranted when the parents have de fined the child as abnormal and ate unable or unwill- {ng to provide normal caregiving, Diffultes in care- aiving may arise from a variety of sources, including 8 failure of parents to adapt to a disabling condi ton in the chil, failure of the parents to distinguish ‘between their emotional reactions tothe child and ‘the childs actual behavior, and maladaptive patterns of care that extend across generations. Examples of thefts kind of problem are parents who disqualify tMemselves as adequate caregivers by automatically translating a child's physicat or mental handicap {nto a condition that can only be treated by profes- sional (Roskes, 1972), Examples ofthe second kind ate parents who become disenchanted with child fearing because they find a poor ft between their expectations of child behavior and the child's actual Performance. The third situation is marked by care- aiving that is constrained by childhood experiences ‘of the parents that prevent them from distinguish- {ng current caregiving demands from their past ex- periences LBW infants are often sent home in a Biolog cally vulnerable stat. Parents may be called upon to continue massage techniques provided inthe NIC\ :monitor the child's sleep pattems, and adjust feed- Ing practices to meet the needs of a small infant Although parents may feel competent to cate for 8 healthy infant, they may feel overwhelmed by the demands of caring for a vulnerable LBW infant. In this instance, the parents define caregiving as an ex- traordinary experience that they are unable to man- age. Redefinition interventions may be aimed at no malizing the care of the infant and decreasing the ‘emphasis on “special ate" the child demands. High- lighting the normal developmental asks of sleping, cating, and play would redefine the parents’ role as ‘one that is familiar andl consistent with the parents Image of caregiving. Once parents consider the no mative aspect of rasing an LBW infant, they may then be able to proceed with thei intuitive parent- Ing (Bamard, Morisset, & Spleker, 1993; Papousek & Papousek, 1987), Tn some cases, the need for redefinition ex. tends beyond normalizing the parents’ experience fof categiving. In these cases, the parents atebu- tions of the child’ behavior prevents them from engaging in sensitive caregiving. The Vermont In- tervention Program for Low Birthweight Infants (Achenbach, Phares, Howéll, Rauh, & Nurcombe, 1990; Nurcombe eta, 1984) was aimed at enhane- Ing the mother’s adjustment to the eae of an LBW infant by enabling her to appreciate her infant's ine ‘dividual temperament and sensitizing her tothe be. hhavioral cues ofthe child, By redefining the infant's behavior to it the mother’ expectation for normal development, the.mothers were abe to engage in ‘more reciprocal interaction patterns related to op- timal development (Rauh, Achenbach, Nurcombe, Howell, & Tei, 1988), Occasionally, parents are unresponsive to pro- ‘grams aimed at redefining the child's behay- lor because of beliefs that are entrenched acrossa2 ARNOLD J. SAMEROFF AND BARBARA H. FIESE generations. Recent work of attachment researchers has demonstrated that current caregiving activities are framed in light of the parents’ relationship with their own caregivers (Crowell & Feldman, 1988; Main & Goldwyn, 1984). Mothers whose working models of attachment are tempered by inconsistent, unreliable, or abusive relationships are more likely to form insecure attachments with ther children. The ‘current relationship between mother and child is proposed to bea patil reenactment of the mother relationship with her mother, and current behavior is guided by generational patterns of relating. At tachment relationships are malleable, however, and interventions aimed a redefining the attachment re lationship have been found to be effective in a sam- ple of high-tsk infants and their mothers. Liebe man, Weston, and Paw (1991) conducted infant parent psychotherapy sessions with mothers and in- fants whe had been classified as anxiously attached, “Anxious attachments are characterized by inconsis- tent parental response to Infant distress and a re- sistance on the part ofthe infant to be soothed by familiar caregivers. Insecure attachments ate over- represented in LBW infants (Fasterbrooks, 1988; Wille, 1991). However, there Is some question as 0 ‘whether low birth weight in itself isa rsk factor for attachment disorders o f associated features of low birth weight such as lowSES, alcohol and drug abuse, for disrupted education may be more directly related toattachment classfcation in LBW infants. Infant parent psychotherapy aimed at defining the cur- rent caregiving relationship hasbeen shown toaffect a mothers responsiveness to her child’ signals and Increase active engagement between mother and child. Redefnition interventions are aimed atdistin- ‘gushing the current relationship between mother Jand child from the mother’s own upbringing. By ‘asting out the "ghosts in the nursery” (Fraberg, ‘Adelson, & Shapiro, 1975), iis possible to redefine the current relationship inorder that more sensitive forms of interaction may be maintained. Mothers ‘who feel thet their current caregving interactions ‘wll be appreciated are mote likely to engage in pos- hnive and reciprocal interactions than mothers who believe that their child Is unlikely toe a source of reward and positive esteem, Redefnition interventions aimed at parents often Incorporate the represented aspects of the family code, Family stories offer one avenue to access the parent's current belles about thei child. The story that parents tell about thelr chil’s birth may re ‘yea symbolic images of family Ife that are related to relationship adaptation (Oppenheim, Wamboldt, Gavin, Renout, & Emde, 1996) and may offer clues toefective interventions. Contrast these to stories told by mothers of LBW infants 35 to how they in volve the infant in the story yas horrible. remember It asternibe, The whole experience was ust Wehada terilematerity ward nurse had eamelbacked in contractions mean, itwas hhorible. And then it wasnt my OB that delivered, his coverage came in and was a el er, just a jerk He was like, "What do you want to do?” Las like, *T dont think we're paying you the money for me to make the Gecision,” and then my baby was delivered and devel ‘peda lung infection. didn't se him until the follow: {ng day. was Just terible all the way around. {can remember right when they took hm. was wondering where he as. seemed ike hours and Twas alone it the toom. I'm lke, “shoulda somebody be paying a In this brief vignette, the image of the child is pushed away to accommodate the mother’s need to be the central focus. Redefniion interventions may be ale at bringing the child back into the picture and exploring the mother’ feelings about placing ‘ategiving needs ofthe baby above her needs for per sonal attention, A traumatic bith experience does rot necessarily mean that the parent isnot able to accept the child as part of a normative experience, as highlighted inthe second story -My seater bag broke really early and I was scared be use, you know, usually your water bags don't break that ary So, went to the doctorand he wanted me #0 go, you knost, homefor bed ret Isas thinking ve got two young children at home and Vim supposed t Bed rest And started to have contractions so they told me tocome in and they put me on medication that helps Your contractions stop. Iwas in therefor three days ‘And then started having more contractions and {sad this kid fs going to come out tonight and they go "No, no, isnot.” And they say, "Well she's cated to thee 40 we have to take her to the delivery room." 1 dont know but the contractions were really welrd because they would stat and then they would stop and then there was lke nothing and, you know, she nally came fut. An they told me to breathe correct and she just fame out. And was I ever glad. They told me it was a Bie. T thought I was going to have a boy but it did't ‘matter tome, you know, if was going to havea boy er {gle And she was breathing on her own, which with preemies they don't breathe on thet oven, and with het She di. 1 was just happy and glad that she was kay. She had fie fingers and five toes. In this case, the mother’ story ofthe child con- ‘cluded with a normative statement, “She had five fingers and five toes.” The mother had performed her oven redefinition, paving the way for a norma- tive integration ofthe child into the family. Redet- {nition Interventions ae aimed at altering parents beliefs and expectations about thee child, If beliefs that the child Is deviant are changed, then norma- tive caregiving can begin or esume. The parents are free to use the skills that ate already in thelr reper- tolre. There are cases, however, n which the parents ddo not have the requisite skills or knowledge base for effective parenting. In this case education Is indicate, REEDUCATION. Reeducation refers to teaching parents how to raise their children. Reedueation Is represented by the downward arrow from par- ent to child at Time 2 in Figure 7.7. Iti directed toward parents who do not have the knowledge base to use @cultural.code to regulate their childs development, Reeducation is typically aimed at fam- Iles and individuals who are considered at risk be- cause of environmental conditions or characteris ties of the parents (eg, teenage mothers, alcoholic parents, and fallure to complete high schoo). Pub- health initiatives have been used on occasion to reeducate large segments of society to change their caregiving behaviors. Instructional materials suchas Keysto Caregiving Spiet,Johnson-Crowley, Sumner, & Barnard, 1990) are almed at instuct- ing parents about what to expect from infants at different ages in terms of their behaviors, cues, State modulation, and feeding interactions. A get for reeducation efforts is weight gain during pregnancy. In the case of LBW, restricted mater nal weight gain has been found to be assocated with premature and LBW deliveries. Despite this, in a recent survey, one-quarter of the pregnant women questioned reported that they believed they should not gain more than 20 pounds during preg- nancy, reasoning that a smaller baby is easier to Geliver and that it would be difficult to lose more than 20 pounds after delivery (Carruth & Skinner, 1991), Reeducation interventions targeted to preg: nant women may reduce the incidence of LBW in those cases in which mothers intentionally cestiet ecb gain The majity of reducation efforts are directed toward the family or individual parent and serve to provide information about specific caregiving stills. The lant Heath and Development Program {UHDP, 1990) was one such reeducation interven- tion aimed at enhancing the development of LBW premature infants. The INDP veas 2 multisite clin- ical tial that combined family and. home-based ‘clucational interventions with child-ocused cen- ter interventions. For the purposes ofthis usta. tion, we limit ove discussion to the home-based ‘cucatonal component. The families enrolled in the program received interventions over a period of thee years. Weely home visits were provided for the fst year, with twice per month thereafter. The hhome vis provided parents with information on child development, instruction in the use of age appropriate games, and family suppor for identified problems. Intervention effects improved cognitive evelopment and reduced reports of chil behavior problems two and three years afer the intervention {Brooks Guan, Klebanow, Liaw, & Spike, 199). In tervention effects aso improved the quality of ma. ternal assistance, the chil’ persistence an ent siasm, and dyadic mutuality In laoratory sting (Spiker, Ferguson, & Brooks Gunn, 1993) Tm contrast to arg center-ased reeducation inet ventions are interventions tallored tome the needs of navidual families. MeDonough (1998) described the use of feedback to pres while viewing video tapes of family interactions to guide positive fam- Jy interactions Infants and thei entre fay are videotapes during a weekly pay session. Afterward the family views the videotape with the therapist. ‘The feedback potion ofthe session serves to fel state the parents’ understanding of child develop. ‘ment and to identify interactive behaviors that are teinorcing tothe parents, as wel as pattems of n- teraction that lead to less enjoyable exchanges. The Interaction guidance eatment approach focuses on existing adaptive puters of interaction and buds ‘on the family’s strengths TReeducation interventions are typically aimed at the practicing aspect of the family code. These interventions focus on the immediate and momen- tary exchanges between parent and child that are associated with optimal development. ti assumed that once parents have the fequisite knowledgeasa ARNOLD J. SAMEROFF AND BARBARA MH. FESE about their child's behavior that caregiving will pro- ‘eed to facilitate development in accord with the ‘cultural code. To date, interventions aimed at di rectly changing family practices and routines have rot been a central part of early intervention pro- grams. However, McDonough (1993) speculated that ‘regularly scheduled play sessions provide a comfort: ing routine to chaotic families. Future elforts are warranted to identify other family practices such as ‘mealtimes that may be amenable to reeducation in- SPECIFICITY OF INTERVENTIONS. Remediation, redefinition, and reeducation have been described as distinct forms of interventions aimed at targeting speciic aspects ofthe transactional process. How- ever, development is part of a system that Is of ‘ganized to include influence from multiple aspects ff the cultural, family, and individual code. An ‘examination of instancesin which interventions do not Work or have differential effectiveness may point to how choosing a form of intervention needs to be aligned with resources and characteristics of indi vidal families and children. Spiker, Ferguson, and ‘Brooks-Gunn (1993) commented on the THDP find- ‘ngs that educational interventions were more effec tive or some mothers than for others Mothers who expressed very low supportive presence during alab- oratory task tended to react to theirehildren in ahos- tile, detached, of highly inconsistent manner. The authors proposed that there are likely to be at least theo types of mothers involved in early intervention ‘programs: those who provide inadequate affective And instructional support to thee children and those ‘who lack instructional skills but possess positive af fective qualities. Inthe fst case, Feducation would not be suficient and would warrant redefinition in- terventions to alter the parents’ affective response to their children. In the same regard, redefinition ef forts aimed at current interactions between parent and child may stimulate childhood experiences and require a more historical consideration of categiv- Ing (Lieberman & Pav, 1993). pillove effets from ‘one area of functioning to another, such as between the practicing and represented family, have been ‘documented in therapeutic interventions with fam- ilies (Zuckerman, Kaplan-Sanoff, Parker, & Young, 1997), Whether a similar pattern occurs in early ine tervention programs deserves further atention. For ‘example, during the McDonough (1993) program of Interaction guidance, it would be dificult to imag- Ine that increasing the satisfaction of parents in their interactions with thelr infant through reeducation ‘would not also redefine their attitudes and belils about the child ‘When faced with limited resources for eatly in. tervention programs, it i beneficial to consider the most cost-effective form of intervention that would affect multiple domains of adaptation. If education efforts aimed at parents also influence how they in- teract with their children and the belies they hold about development, then focused education pro- grams may be offered to large groups of parents However ifthe parent is unable to make use of the educational efforts because ofa past history of poor ‘caregiving oF lack of socal support, more intensive redefinition programs would be warranted. It is pos- sible to frame the three forms of intervention in the form ofa transactional diagnosis process. ‘Transactional Diagnosis and Environtype Codes ‘We have argued that it may be helpful to focus Intervention efforts according to problem identifi ‘ation and type of environtype code that i appica- ble to the problem. Such categorization would not ‘only lead to better program design but to better eval- uation models and research designs as well. In the ‘ase of remediation, the child is defined as develop ‘mentally atypical and interventions would be nec- cesary with any parent. The focus of remediation is to change the chil with litle alteration in the cultural or family code. Redefinition interventions are prescribed when the parents’ relationship with the child inhibits the child's normal growth and de- velopment. Intervention is necessary because of the particular relationship between the parent and child and involvesalteationsin the family code (most no- tably the represented family). Finally, in the case of. reeducation, the parent has been identified a5 be- Ing deficient in certain skills or knowledge, whereas the child’ condition s notin need of change. Here the purpose of intervention sto change the parent's knowledge ofall children or their cile’s particular condition and als involves alteration in the family ‘ode {most notably the practicing family). ‘A decision tree can be described for choosing the appropriate form of transactional ealyinterventicnt™ ecause in almost every case the child is brought into 2 program because he or she is perceived as having 2 problem, the fist decision to be made is whether remediation is appropriate or viable, For infants, re ‘mediation may take the form of medical interven- tons and is typically provided by health profession: als outside ofthe context ofthe family. Remediation Cannot be achieved in at least two instances: a case In which there sno procedure to modify the cond- tion ofthe child ora situation in which nothing can be found in the child that needs changing. In such cases, the parents’ knowledge of the developmen tal agenda and theie reactions to the child must be ‘examined, When parents show evidence of knowing the cultural code but atenot using with thelr hil, redefinition is necessary, When the child’ problems fan be identified as a result ofthe parent's lack of ‘knowledge about the cultural code, reeducation is indicated Redefinition requtes parents to identify areas of ‘normal functioning in thelr child to counter their focus on aspects of the child they ee a deviant. For redefinition In the case ofa biologically vulnerable child, the parents need to identity the developmen- tal aspects oftheir child that are normative and cast aside perceptions that may be influenced by their personal histories or beliefs about caregiving Inthe ‘ase of redefinition, the parents need to recognize that their child possesses the qualities necessary to bea rewarding interaction partner. Ther current re- lationship with the child should be seen a distinct from past insults and unfulfilled expectations inthe lives ofthe parents. Reeducation is evident in programs that provide rect of indirect instructional support to parents TABLE 7.2. Transactional Interventions Applled to Levels of Environtype Codes ‘Transactional interventions (Thece #3) nvirontype code Remediation Redfinition Reeducation atta! “Media promotion of ‘adequate welght gain ‘Sung pregnancy Famly Redefine taily representations of past caregiving fn curren hile Parent [ICU touching of infant to stimulate growth In the case of LBW infants, Instructions about developmental tlmetables, age-appropriate games, and methods for identifying sources of support fall ‘within the realm of reeducation Interventions. Re- education allows parents to perform the tasks of caregiving once armed with sufficient developmen- tal information, ‘When taking a systems perspective, itis tempt- {ng to consider intervention always occuring at the Ievelof the family, However, the transactional model fof diagnosis and intervention proposed here pin- Points how intervention atthe level of the child ot parent alone may affect other aspects of the caregiv- ing system, Table 7.2 summarizes the interventions ‘that we have described, focusing on LBW infants as examples, The three types of intervention corr spond to different aspects of the environtype. Al- ‘though singular interventions may be aligned more closely with specific aspects of the cultural, famlly, fr parental codes, it should be evident that inter ventions in one area may influence other parts of the developmental agenda, Remediation almed at the individual child may afectthe family code by facilitating parent-infant interaction while stimulat- Ing edefinition ofthe child ‘This chapter has been ahmed at understanding the Impact of contextual fluences on development. ‘Through an ecological analysis, some aspects of the ‘environtype were highlighted as providing the reg Uulatory framework for healthy child development. ‘These factors included the cultural and family codes.16 ARNOLD J. SAMEROFF AND BARBARA H. FIESE {A case was made that the environment isan active force in shaping outcomes. However, the shaping force is constrained by the state and potentialities ofthe individual Sameroff, 1983). In an attempt to {incorporate both aspects in a coherent model of de- velopment, the utility of the transactional model for ‘designing programs to prevent cognitive and soclal~ ‘emotional problems was explored, The development ‘of these problems has been interpreted as deviations ina child-eating regulatory system. The prevention ‘of these problems has been defined as the adjust ‘ment of the child to beter it the regulatory system ‘or the adjustment of the regulatory system to etter ft the chil ‘Within this regulatory framework, transactions are ubiquitous, Whenever parents change their way of thinking about or behaving toward the child as a result of something the child does, a transaction has occurred. Most ofthese transactions are norma- tive within the existing cultural code and facilitate development. Intervention only becomes necessary ‘when these transactions are nonnormative. In our progres toward effective intervention programs, we hhave reached a key theoretical breakthrough. The problems of children are no longer seen a restricted tochildren, Social experience is now recognized asa critical component ofall behavioral developments, ‘both normal and abnormal. Unfortunately, we have not yet reached the evel of sophistication in theory ‘and research that would connect childhood prob- lems with corollary regulatory problems. There are any possible regulations tosolve the same problem and, therefore, many possible interventions, Pature research should test the relative efficacies of inter ventions atthe individual, family, or cultural level. “The complex model that characlerizes our mod xn understanding ofthe regulation of development seems an appropriate one for analyzing the etiol- ‘ogy of developmental disorders, It permits the un- ‘derstanding of intervention at a level necessary to Identify targets of intervention, and it helps us to ‘understand why initial conditions do not determine ‘outcomes, either positively or negatively. The model also helps us to understand why early intervention ttforts may not determine later outcomes. There are many points in development in which regulations ‘can facilitate of retard the chil’s progres. The hope ful part of this model is that these many points in ‘ime represent opportunities forchanging the course ‘of development. 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