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The Relationship of Parent-Child Interaction to the Effectiveness of Early

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Article in Topics in Early Childhood Special Education · March 1998

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TECSE 18:1 5-17 (1998) 5

The Relationship of Parent-Child

Interaction to the Effectiveness of Early
Intervention Services for At-Risk Children
and Children with Disabilities

Gerald Mahoney, Children's

Hospital Medical Center
of Akron, Glenna Boyce,
Utah State University
T he results from four early intervention evaluation studies are described in rela-
Rebecca R. Fewell, University
of Miami Donna Spiker,
Stanford University, and
C. Abigail Wheeden, Children's
Hospital Medical Center
of Akron
tionship to their impact on parent-child interaction as measured by the
Maternal Behavior Rating Scale. Intervention studies included the Infant Health
and Development Program, the Longitudinal Studies of the Effects and Costs of
Alternative Types of Early Intervention, the Play and Learning Strategies Program, and
the Family-Centered Outcome study. Results from these analyses indicated that inter-
vention effects on child development were unlikely to occur unless mothers modified
their style of interacting with their children. Although these studies indicated that
mothers of children who participated in intervention modified several different
parameters of interactional style, only their level of responsiveness was positively
associated with their children's developmental outcomes. These results are discussed in
relationship to child-focused and relationship-focused models of early intervention.

No man can reveal to you aught but that which already
lies half asleep in the dawning of your knowledge.
—Kahlil Gibran
During the past 30 years, numerous researchers have
reported statistically significant correlations between the
manner in which parents interact with their children and
the rate of developmental growth children attain during
the early years of life. Consistent findings have been
cited for a wide range of dyads, including children from
low socioeconomic (SES) families (Bradley, 1989), those
born prematurely (Beckwith &c Cohen, 1989), and those
with moderate to severe developmental disabilities
(Brooks-Gunn & Lewis, 1984; Mahoney, Finger, &
Powell, 1985). In the 1980s several early intervention
demonstration projects incorporated information regard-
ing parent-child interaction—that is, relationship-
focused intervention (Bromwich, 1981; MacDonald,
1989; Mahoney & Powell, 1988) directly into the inter-
vention design. However, only recently has there been a
more widespread recognition that research regarding
parent-child relationships may have critical implications
for the design of early intervention services (Sandall,
1993; Thorp & McCollum, 1994).
Up to this point, most intervention efforts have been
conceptualized primarily from a child-focused, directive
teaching framework (e.g., McBride & Peterson, 1997;
McWilliam, Tocci, & Harbin, 1995; Meisels, Dich-
temiller, &c Liaw, 1993). The acceleration of children's
development, including cognition, language, and social
and motor functioning, has been assumed to be linked to
increasing the frequency of children's participation in
specially designed learning activities and routines. Early
intervention curricula have typically consisted of interre-
lated instructional activities designed to help children
acquire the skills and concepts that are either logically
(e.g., task analysis; Bagnato, Neisworth, & Munson,
1989), intuitively (e.g., preschool activities; Russell, 1994),
or empirically (e.g., prerequisite developmental skills;
Bricker & Cripe, 1992) related to desired developmental
outcomes. Often, parents have been encouraged to imple-
ment and support intervention activities at home (i.e., as

Address: Gerald Mahoney, Family Child Learning Center, 143 Northwest Ave., Bldg. A Tallmadge, OH 44278.

@pro-ed
6 Topics in Early Childhood Special Education 18:1
supplemental interventionists). However, these home
intervention activities were presumed to augment what
parents typically did with their children rather than to
modify the manner in which they interacted with their
children.
BARRIERS TO RELATIONSHIP-FOCUSED
INTERVENTION
A recent study of early intervention practice provid-
ed a description of the people professionals interacted
with and the content of home-based early intervention
sessions (McBride &c Petersen, 1997). Observations of
160 sessions indicated that interventionists primarily
worked directly with children, although often in con-
junction with another parent or adult: "The content of
these interactions focused almost exclusively on the
child's development or caretaking needs, and home inter-
ventionists spent over half of the time directly teaching
the child" (p. 226). These researchers concluded that
their data describe a model of child-focused intervention
in which the interventionist functions as the key agent of
change, and there is little, if any, emphasis on enhancing
or supporting parent-child relationships.
We maintain that these data are illustrative of a
widespread reluctance of early intervention professionals
to incorporate relationship-focused concepts directly
into early intervention practice. Although this reluctance
may be related partly to the fact that early intervention
professionals have had limited training to implement
relationship-focused procedures (McBride & Petersen,
1997; Mahoney & Wheeden, 1997), we believe that pro-
fessionals have a number of legitimate concerns that
have fueled skepticism about this approach. These include
concerns about (a) the generalizability of research findings
to populations of children with disabilities; (b) the
incompatibility of these findings with the basic premises
of traditional child-focused, directive teaching models;
and (c) the potential that relationship-focused proce-
dures could devalue cultural, religious, and individual
values and beliefs about parenting or childrearing. These
concerns are described briefly in the following para-
graphs.
First, there has been debate about whether research
findings from studies of typically developing children
generalize to dyads of children with disabilities. For
example, findings have shown that high levels of paren-
tal directiveness tend to be negatively associated both
with children's active participation in social and nonso-
cial activities and with their level of cognitive and lan-
guage functioning (Field, 1980). However, some have
argued that these findings do not pertain to children with
disabilities and that these parents need to use qualita-
tively different parenting styles to address the unique
needs of their children. These researchers have proposed
that the high levels of directiveness observed among par-
ents interacting with low-functioning children may be an
appropriate strategy for engaging these children in the
types of experiences they need to achieve higher levels of
adaptive and developmental functioning (Marfo, 1991;
Maurer & Sherrod, 1987; Tannock, 1988).
Second, there is a fundamental incompatibility
between findings from the parent-child interaction litera-
ture and the basic premises of the predominant early
intervention curricula (Mahoney, Robinson, & Powell,
1992). Parent-child interaction literature suggests that
effective interactions are characterized by high responsive-
ness and moderate to low directiveness. In contrast, as
described previously, most early intervention curricula
have tended to emphasize directive, child-focused
instruction with domain-specific developmental and
functional goals serving as primary teaching targets.
Numerous studies have reported that these types of
instructional techniques (e.g., modeling, shaping, prompt-
ing, selective reinforcement) can be effective at helping
young children, including children with severe disabili-
ties, acquire a variety of developmental skills. Accepting
concepts from the parent-child literature, with its
emphasis on adults interacting responsively with chil-
dren, would require professionals to repudiate the tradi-
tional, directive teaching model.
Third, there is a tendency to reject intervention
paradigms that may question the skills, competencies,
cultural values, or beliefs of parents. A central theme of
"family-centered service" is that parents are experts
regarding their children, and their cultural folkways and
mores must be valued (Baird & Petersen, 1997). Many
professionals have shied away from parent-child inter-
vention procedures that encourage parents to modify
their interactions with their children in a manner that
supports research findings for fear that these patterns
conflict with family styles. These professionals view the
parent-child literature as posing an ethical dilemma to a
field of service that is fundamentally committed to
respecting diversity and supporting family choice.
Each of these factors pose legitimate barriers to
infusing parent-child research findings into early
intervention practice. Nonetheless, findings from the
parent-child literature are compelling. Although the
statistical relationships that have been reported between
parent-child interaction and various child outcomes are
modest, seldom accounting for more than 20% of vari-
ance, these relationships are equivalent to and often even
greater than the effect sizes of early intervention services
on child development. Furthermore, if a transactional
model of development (Sameroff & Friese, 1990) is a
valid characterization of the social and environmental
factors that contribute to children's development, then it
is likely that early intervention efforts might only be
Early Intervention Effectiveness
effective at enhancing children's development and func-
tional outcomes if they encourage parents to adopt inter-
active qualities that research suggests are associated with
children's development (Mahoney & Wheeden, 1997).
Based on this rationale, it is reasonable to hypothe-
size that the limited effectiveness of some traditional
child-focused, directive intervention models at accelerat-
ing developmental growth (e.g., Farran, 1990) is related
to their failure to promote the parental interactive qual-
ities that research suggests support the development and
well-being of children. Given the relatively small child
development effects reported for various early interven-
tion efforts to date (Baumeister & Bacharach, 1996;
Farran, 1990), we can no longer ignore the potential
implications of the parent-child literature simply
because professionals have concerns about the meaning
and generalizability of this literature.
REEXAMINING EARLY
INTERVENTION OUTCOMES
The purpose of this investigation was to reexamine
the developmental outcomes attained in four indepen-
dent intervention research studies in relationship to
parent-child interaction: the Infant Health and Devel-
opment Program (IHDP; 1990), the Longitudinal Studies
of the Effects and Costs of Alternative Types of Early
Intervention (Casto & White, 1993), the Play and
Learning Strategies (PALS) program (Fewell & Wheeden,
1998), and the Family-Centered Outcomes study
(Mahoney & Bella, in press). These studies were derived
from disparate theoretical frameworks and used a vari-
ety of intervention content and procedures. They were
selected because they shared a common interest in evalu-
ating parent-child interaction. However, only one of
these studies involved intervention procedures that were
explicitly designed to change patterns of interaction.
Thus this analysis enables us to examine the contribution
of parent-child interaction to early intervention effec-
tiveness under conditions in which this is both an intend-
ed and incidental outcome. Results from this analysis
thus help us to examine the merits of the hypothesis that
intervention outcomes are fundamentally dependent on
parents' adopting the interactive qualities that research
suggests are associated with children's development.
In each of these studies, mothers' style of interacting
with their children was assessed with the Maternal
Behavior Rating Scale (MBRS; Mahoney, 1992, see
Table 1). The MBRS is a global rating scale consisting of
12 items that have been reported in the child develop-
ment literature as being significant influences on the
development of young children (Mahoney, Powell, &
Finger, 1986). Previous research has indicated that raters
can achieve acceptable levels of interrater reliability
7
using this scale (Mahoney et al., 1986); that items on the
scale have moderate to high levels of correlation with
similarly defined constructs from other parent rating
scales (Boyce, et al., 1995); that the scale is sensitive to
parental characteristics that are statistically related to
children's developmental functioning (Mahoney et al.,
1985); and that the scale is also sensitive to changes in
parents' styles of interacting with their children that were
promoted through early intervention services (Mahoney
& Powell, 1988; Mahoney, Wiggers, & Lash, 1996).
To analyze mothers' styles of interaction, we created
scale scores that were based on a factor analysis of
MBRS ratings of 150 dyads (Boyce et al., 1996). This
analysis identified three factors: maternal affect/anima-
tion (acceptance, enjoyment, expressiveness, inventive-
ness, and warmth); achievement orientation (achievement,
praise); and responsiveness (effectiveness, responsiveness,
sensitivity, directiveness, pace). Because the directiveness
and pace items were associated negatively with the respon-
siveness factor, and because directiveness has been a par-
ticular focus of the parent-child literature, we divided the
responsiveness factor into two subscales: responsiveness
(effectiveness, responsiveness, sensitivity) and directive-
ness (directiveness, pace).
THE INFANT HEALTH AND
DEVELOPMENT PROGRAM
The IHDP was an eight-site, comprehensive early
intervention program for low-birthweight premature
infants (Gross, Spiker, &c Haynes, 1997). The interven-
tion consisted of home visits (weekly in the first year,
biweekly thereafter), intensive center-based services for
children (25-30 hours per week) during Years 2 and 3,
and bimonthly parent groups. The home visit component
focused on learning activities tailored to the individual
needs of the child (Sparling & Lewis, 1985) and assis-
tance for parents in managing self-identified problems
(Wasik, 1984). The day-care program consisted of a cur-
riculum of learning activities aimed at enhancing chil-
dren's intellectual and social competence. The parent
groups provided information on health and safety, child-
rearing, and other parenting concerns. None of these
intervention components were designed with the specific
intent of modifying mothers' style of interacting with
their children, although mothers were given specific
instruction about learning activities.
The major finding reported for the IHDP was that
children in the intervention group showed significantly
higher cognitive scores than children in the control or
follow-up groups, both at 24 and 36 months (Gross et
al., 1997). However, follow-up studies conducted when
the children were 5 and 8 years failed to show sustained
8 Topics in Early Childhood Special Education 18:1

TABLE 1. The Maternal Behavior Rating Scale

Expressiveness The tendency of the caregiver to express and react emotionally toward the child. It assesses the voice quality to express a
range of emotions toward the child. Intensity, animation, and frequency are considered.
Enjoyment The parent's enjoyment of interacting with the child. Enjoyment is experienced and expressed in response to the child him-
self—his spontaneous expressions or reactions, or his behavior when interacting with his parent.
Warmth The demonstration of warmth is a positive attitude revealed to the child through pats, lap-holding, caresses, kisses, hugs,
tone of voice, and verbal endearments. Both the overt behavior of the parent and the quality of fondness conveyed are
included in this rating. It examines positive affective expression: the frequency and quality of expression of positive feelings
by the parent and the parent's show of affection.
Sensitivity to The extent to which the parent seems aware of and understands the child's activity or play interests. This item is assessed
child's interest by the parent's engaging in the child's choice of activity, parent's verbal comments in reference to child's interest, and
parent's visual monitoring of child's behavior or activity.
Responsivity The appropriateness and consistency of the parent's responses to the child's behaviors, such as facial expression, vocaliza-
tions, gestures, signs of discomfort, body language, demands, and intentions.
Achievement The parent's encouragement of sensorimotor and cognitive achievement. This item assesses the amount of stimulation
orientation by the parent, which is overtly oriented toward promoting the child's developmental progress whether through play,
instruction, training, or sensory stimulation.
Inventiveness The range of stimulation the parents provide their child; the number of different approaches and types of interactions and
the ability to find different things to interest the child, different ways of using toys, combining the toys and inventing games
with or without toys. Inventiveness refers to a variety of behaviors that are grouped together and directed toward the child.
Praise (verbal) The amount of verbal praise given to the child. Examples of verbal praise are "good boy," "that's a girl," and "good job."
Praise in the form of smiles, claps, or other expressions of approval are not included unless accompanied by a verbal praise.
Praise may be given for compliance, achievement, or the child being himself.
Effectiveness The parent's ability to engage the child in the play interaction. It determines the extent to which the parent is able to gain
the child's attention, cooperation, and participation in a reciprocal exchange characterized by balanced turntaking in play or
conversation.
Acceptance The extent to which the parent approves of the child and the child's behavior. Acceptance is measured by the intensity of
positive affect expressed toward the child and the frequency of approval expressed, either verbally or nonverbally.
Pace The parent's rate of behavior. The parent's pace is assessed apart from the child's; it is not rated by assessing the extent to
which it matches the child's pace.
Directiveness The frequency and intensity with which the parent requests, commands, hints, or attempts in other manners to direct the
child's immediate behavior.

intervention effects (Brooks-Gunn, et al., 1994; McCarton
et al., 1997).
Analyses were undertaken to determine the mediat-
ing influence of mother-child interaction on the develop-
mental outcomes children attained at 24 and 36 months
(Wheeden, 1996). Subjects included 298 mother-child
dyads from three of the eight IHDP sites. The sample
included intervention (n = 116) and follow-up (n = 182)
groups. There were no significant group differences on
initial status variables (infant birthweight, gender, mater-
nal education, and ethnicity; see Table 2). Videotapes,
made when the children were 30 months corrected age
for prematurity, permitted an opportunity to assess
mother-child interaction during free play.
Results indicated that mothers in the intervention
group had higher ratings on three of the four maternal
interactive style factors (affect, achievement orientation,
and responsiveness) than did mothers in the follow-up
group (see Table 2). Post hoc analyses of MBRS items
indicated that intervention mothers had higher levels of
expressiveness, enjoyment, warmth, sensitivity, respon-
siveness, achievement orientation, inventiveness, effec-
tiveness, and acceptance. There were no group differ-
ences on ratings of praise, pace, and directiveness.
Stepwise multiple regressions were computed to
examine the relationship of maternal style factors and
intervention to children's developmental outcomes, as
measured by the Stanford-Binet (Terman & Merrill,
1973) at 36 months and the Bayley (Bayley, 1969) at
24 months. Results indicated that responsiveness
accounted for 2 5 % of the variance in children's
Stanford-Binet scores, intervention accounted for 4% of
the variance, and directiveness was negatively related to
Stanford-Binet scores, accounting for 1.6% of the vari-
ance. Similarly, responsiveness accounted for 13% of the
variance in children's Bayley scores, intervention
accounted for 4 % of the variance, and directiveness was
negatively related to Bayley scores, accounting for 1.5%
of the variance.
These results are noteworthy for several reasons.
First, even though the IHDP curriculum did not specifi-
cally intend to modify mothers' style of interacting with
their children, change in maternal style was a highly sig-
nificant outcome of this intervention. Second, maternal
style accounted for six times more of the variance in chil-
dren's developmental outcomes than did membership in
the intervention group itself. Third, the relationship of
maternal style to children's development appeared to be
Early Intervention Effectiveness 9

more consistent with previous empirical findings regard-
ing parent-child interaction (Beckwith & Cohen, 1989)
than with the apparent emphasis of the IHDP curriculum.
The IHDP curriculum encouraged parents to stimulate
children's development by prompting their participa-
tion in specially designed activities. This emphasis was
reflected by the intervention mothers being more achieve-
ment oriented in their interactions with their children.
However, achievement orientation was not statistically
related to children's development. Only maternal respon-
siveness, which was an incidental focus of the curriculum,
was positively associated with children's developmental
outcomes.
LONGITUDINAL STUDIES
OF EARLY INTERVENTION
The Longitudinal Studies of the Effects and Costs
of Alternative Types of Early Intervention (Casto &
White, 1993) was a controlled, multisite investigation of
early intervention effectiveness directed by the Early
Intervention Research Institute at Utah State University.
Sixteen research studies that included young children
who had disabilities or were at risk for subsequent
disabilities due to severe neonatal problems involved
different comparisons that focused on three themes:
(a) the intensity of intervention (i.e., amount of service
per week), (b) the age at which intervention began,
and (c) the ways in which parents were involved. Each
of these themes was designed to enhance the intensity of
children's exposure to developmentally stimulating activ-
ities. (See Innocenti, 1996, and White & Boyce, 1993,
for details of the individual site studies.)
In this investigation, we reexamined data from the six
sites that included observations of parent-child interaction.
To limit variability in the sample, only children between the
ages of 2 and 4 years (Al = 31 months) were included,
resulting in a sample of 238 dyads. All children had delays
in one or more domains of development. At each site, chil-
dren were randomly assigned to the ongoing intervention
program (typical intervention) or to an intervention pro-
gram in which services had been enhanced (expanded inter-
vention). The intervention services that participants in the

TABLE 2. Infant Health and Development Program Group Comparisons of Child, Mother/Family, and Mother
Interactive Style Characteristics

Follow-up a Intervention15

Variable M SD M SD F P

Child characteristics
Gender (% female) 51 49
Infant birth weight (grams) 1798 452 1804 410 1.22 .254
Mother/family characteristics
Mother's age (in years) 24.5 6.1 23.8 5.2
Mother's education (% high school 55 62 1.30 .119
completion and higher)
Mother's ethnicity (% White) 53 49
Marital status (% married) 38 43
Maternal Behavior Rating Scale
Achievement orientation 1.9 .7 2.3 .7 17.12 .000
Achievement 2.2 .8 2.7 .9 32.24 .000
Praise 1.7 .9 1.9 .9 2.22 .137
Affect/animation 2.5 .6 2.8 .6 15.64 .000
Acceptance 2.7 .8 3.0 .7 6.16 .014
Enjoyment 2.8 .8 3.1 .7 7.73 .006
Expressiveness 2.7 .7 3.1 .8 18.92 .000
Inventiveness 2.2 .6 2.4 .6 8.32 .004
Warmth 2.2 .8 2.6 .9 11.59 .001
Directive 3.2 .7 3.1 .6 0.93 .320
Directiveness 3.4 .9 3.2 .8 1.82 .179
Pace 3.0 .8 3.0 .6 0.09 .320
Responsive 3.0 .8 3.3 .8 13.11 .000
Effectiveness 2.0 .9 3.3 .7 7.61 .006
Responsiveness 2.8 .9 3.2 1.0 10.77 .001
Sensitivity 3.1 1.0 3.5 .9 14.41 .000
Child developmental status
Bayley Mental Development Index (24 months) c 94.1 18.0 106.0 20.1 28.1 .000
Stanford-Binet IQ (36 months) 86.7 17.5 98.4 18.2 30.3 .000

Note. Stanford-Binet = Stanford-Binet Intelligence Scale (Terman & Merrill, 1973).

a
N = 182. b N = 116. cBayley Scales of Infant Development (Bayley, 1969).
10 Topics in Early Childhood Special Education 18:1

typical intervention group received were primarily based
on a child-focused, directive teaching model and were rep-
resentative of curricula and service delivery patterns (e.g.,
center-based and home visitor programs) commonly used
during the period the study was conducted (1985-1990).
Parent involvement was also typical; the focus was on
demonstrations of intervention strategies to accomplish
specific curriculum objectives and progress in meeting
those objectives. In the expanded intervention group, chil-
dren and parents received the same intervention services as
provided in the typical intervention group, except that
services were expanded to allow for investigation of a spe-
cific intervention variable (e.g., more intervention service
time per week, earlier age for beginning services, parents
attending parent classes). Therefore, across all methods for
expanding services, children and/or parents had more
interaction with interventionists than participants in the
typical intervention groups.
For this study, we analyzed videotapes made at the
first or second reassessment of children and their moth-
ers playing together with a standard set of toys. Child
development was assessed concurrently and 1 year later.
An intervention (typical vs. expanded) by site MANOVA
examined whether any of the expanded interventions
had unique effects on the interactional behavior of moth-
ers and the developmental status of children. Because no
significant intervention by site interaction effects was
observed, data from all sites were combined into two
groups (typical and expanded). Typical and expanded
intervention groups were similar on most child and
maternal demographic characteristics (e.g., child age,
mother education, income, etiology); however, they were
significantly different on children's gender and mothers'
age (see Table 3).
Analyses of covariance, using mothers' ages as a
covariate, were used to determine the impact of inter-
vention services on mothers' styles of interacting with
their children and on children's development. Results
from these analyses are displayed in Table 3. Mothers in
the expanded intervention group were significantly less

TABLE 3. Longitudinal Studies: Group Comparisons of Child, Mother/Family, and Mother Interactive Style Characteristics

Typical intervention 0 Expanded intervention 0

Variable M SD M SD F/t score P

Child characteristics
Age (in months) 31.9 5.7 31.4 5.7 .67 .51
Gender (% female) 52.1 39.5 1.96 .05
Etiology (% sample)
Intraventricular hemorrhage 50.4 55.5
Visual impairment 11.8 10.9
Developmental delay 10.1 8.4
Down syndrome 5.0 5.0
Other 22.7 20.2
Mother/family characteristics
Mother's age (in years) 28.9 5.5 30.5 6.1 -2.21 .03
Mother's education (years attended) 13.1 2.0 13.2 2.1 -.47 .64
Mother's ethnicity (% White) 74.8 78.2 -.61 .54
Family structure (% with two parents) 74.8 75.6 -.15 .88
Maternal Behavior Rating Scale
Achievement orientation 2.8 1.1 2.4 .9 8.92 .003
Achievement 3.0 1.2 2.6 1.1 7.70 .006
Praise 2.6 1.3 2.2 1.2 5.04 .026
Affect/animation 3.0 .7 3.0 .6 .05 .824
Acceptance 2.9 .8 3.0 .7 .79 .375
Enjoyment 3.0 .7 3.0 .8 .00 .974
Expressiveness 3.1 .8 3.2 .8 .02 .900
Inventiveness 2.8 .8 2.7 .7 1.00 .318
Warmth 3.0 .8 2.9 .7 1.01 .317
Directive 3.3 .7 3.1 .7 4.67 .032
Directiveness 3.4 .9 3.2 .9 4.24 .041
Pace 3.1 .7 2.9 .8 2.85 .093
Responsive 3.1 .7 3.2 .8 .56 .457
Effectiveness 3.1 .9 3.2 .9 .49 .487
Responsiveness 2.9 .8 3.0 .9 .51 .477
Sensitivity 3.3 .7 3.3 .8 .39 .535
Child developmental status
BDI age equivalent15 21.3 7.9 21.4 8.1 .00 .951
BDI age equivalent (1 year later) 29.9 10.9 29.8 10.6 .01 .927
a
N = 119. b BDI = Battelle Developmental Inventory (Newborg, Stock, &c Wnek, 1984).
Early Intervention Effectiveness
achievement oriented and directive than mothers in the
typical group. However, there were neither significant
group differences in mothers' responsive or affective inter-
active style nor in children's level of development.
Bivariate correlations were computed to examine
the relationship between maternal behavioral style and
children's current and subsequent development 1 year later.
Results indicated that responsiveness was associated pos-
itively with the concurrent and follow-up measures of
development, r = .27, p = .000, and r = .24, p = .001,
respectively, whereas maternal directiveness was associ-
ated negatively with these outcomes (concurrent r = -.15,
p = .02; follow-up r = -.13 p = .06). Because neither
affect/animation nor achievement orientation correlated
significantly with child development, these variables were
excluded from subsequent analyses.
Regression analyses were used to further examine
the relationship of maternal interactive style, child age,
and intervention group to children's development (mea-
sured concurrently and 1 year later). Maternal respon-
siveness and directiveness were entered into the regres-
sion, along with child chronological age and intervention
(typical vs. expanded). Results indicated that the regres-
sion models accounted for a moderate, yet significant,
portion of the variance in children's development (com-
bined model, current year R2 = .23; 1 year later R2 = .12).
In both analyses (current year and 1 year later), maternal
responsiveness and child age were significant predictors.
The betas for responsiveness were current year = .40,
significance of T = .00; 1 year later = .25, significance of
T = .00. Neither directiveness nor intervention were sig-
nificant predictors of child development in the analyses
for the current year or 1 year later.
These data replicate the findings from the original
Longitudinal Studies insofar as they indicate that the
expanded intervention services had no measurable
impact on children's development (Innocenti, 1996;
White &c Boyce, 1993). In addition, they extend the find-
ings of the original study in two ways. First, they indicate
that mothers who received the expanded interventions
showed lower levels of achievement orientation and
directiveness. Second, they indicate that only certain
aspects of maternal behavioral style were related to chil-
dren's development. Neither achievement orientation nor
directiveness appeared to be related to development.
However, responsiveness, a feature of interactive style
not affected by the expanded intervention procedures,
related consistently to children's development.
PLAY AND LEARNING STRATEGIES
PROGRAM
The Play and Learning Strategies (PALS) program
was a 3-month (24 sessions, 30 minutes each) pilot inter-
11
vention program designed to help adolescent mothers
acquire a more responsive, less directive style of interac-
tion with their children. A total of 100 volunteer mothers
were assigned to either the intervention or contrast
groups. The intervention focused on early developmental
skills, including play, language, cognition, and mother-
child interaction strategies (e.g., turn taking, interactive
match). Mothers were also taught strategies to handle
problem behavior, give positive reinforcement, and meet
child needs. Topics were addressed through the use of
contrasting examples on videotapes, hands-on practice
with their children, explicit feedback on their interactive
styles, and discussions. Each class was limited to 8 moth-
ers; children attend 25% of the time. Mothers were pro-
vided a simply written curriculum covering the content
emphasized.
Mothers in both groups continued to participate in
required parenting classes. These classes met daily for
50 minutes, focused on routine childcare (e.g., feeding,
bathing, diapering), and rarely included sessions with
children. No other intervention was provided to the
contrast group.
All participants were videotaped interacting with
their children in a free-play situation. Participants were
excluded from the analysis if initial child assessments had
questionable reliability due to the young age of the child
(e.g., less than 4 months), or if the mother attended fewer
than nine sessions. This resulted in 21 intervention dyads
that were matched with dyads in the contrast group.
Demographic characteristics and results are presented
in Table 4. There were no initial differences between the
two groups. Consistent with the PALS curriculum, inter-
vention mothers had less directive, more responsive styles
of interacting with their children than did mothers in the
contrast group. Although the difference on the respon-
siveness factor score did not reach significance (p - .11),
the difference as measured by the responsiveness item was
significant (p = .018). A stepwise multiple regression was
used to examine the contributions of children's develop-
ment at pretest and mother's style of interaction at
posttest to the developmental status of both child groups
at the end of the program. Only maternal responsiveness
entered as a significant predictor, accounting for 10% of
the variance in children's Developmental Activities
Screening Inventory-II (DASI-II) scores.
These results suggest that PALS was effective both
at modifying the manner in which mothers interacted
with their children and at enhancing children's develop-
mental functioning. Moreover, the results of the regres-
sion analysis indicated that mothers' responsiveness to
their children, a major intended focus of the program,
was more predictive of children's development at the end
of the program than was children's development at the
beginning of the program. Although responsiveness
accounted for only a modest amount of the variability in
12 Topics in Early Childhood Special Education 18:1

TABLE 4. Play and Learning Strategies Program: Group Comparisons of Child, Mother/Family and Mother
Interactive Style Characteristics

Contrast0 Intervention0

Demographic characteristics M SD M SD

Child characteristics
Age (in months) 11.5 7.4 11.4 7.7
Gender (% female) 47 57 0.37 .548
Mother/family characteristics15
Mother's age (in years) 17.1 .9 17.1 1.3
Mother's education (grade level) 10.7 1.2 10.2 1.1
Mother's PPVT IQb 71.6 17.7 71.7 16.8
Number of children 1.3 .5 1.1 .3 2.50 .122
Intervention sessions attended 0 0 14.3 3.9
Maternal Behavior Rating Scale
Achievement orientation 1.8 .9 1.8 .6 0.00 1.00
Achievement 2.2 1.2 2.2 .9 0.02 .885
Praise 1.3 1.0 1.4 .6 0.04 .848
Affect/animation 2.9 .6 2.8 .5 0.43 .517
Acceptance 2.9 .5 3.0 .6 0.32 .573
Enjoyment 3.1 .7 2.9 .6 1.45 .235
Expressiveness 3.1 .7 2.8 .7 2.36 .133
Inventiveness 2.5 .6 2.8 .7 1.40 .244
Warmth 2.9 1.0 2.6 .7 1.24 .273
Directive 3.2 .4 2.8 .5 7.21 .010
Directiveness 3.2 .4 2.8 .6 5.13 .029
Pace 3.1 .4 2.8 .5 5.98 .019
Responsive 3.3 .4 3.6 .6 2.64 .110
Effectiveness 3.3 .5 3.4 .6 0.82 .776
Responsiveness 3.1 .5 3.6 .8 6.14 .018
Sensitivity 3.5 .5 3.7 .9 0.76 .387
Child developmental status
DASIIQ (Pretest)0 106.7 16.9 97.5 23.5 2.14 .151
DASI IQ (Posttest)c 95.7 9.1 104.6 13.2 6.48 .015
a
N = 21. bPPVT = Peabody Picture Vocabulary Test (Dunn & Dunn, 1981). CDASI = Development Activities Screening Inventory-II (Fewell & Langley,
1984).

children's development, the effect size of the intervention
on developmental functioning (eta squared = .14) was
nearly identical to the effect size of the intervention on
maternal responsiveness as measured by the individual
rating item (eta squared = .13). These preliminary results
suggest that changes in mothers' responsiveness con-
tributed to the enhanced rates of child development pro-
moted through PALS.
FAMILY-CENTERED OUTCOMES STUDY
The Family-Centered Outcomes study was conducted
to examine the impact of family-centered early interven-
tion services on parents and their children. The move-
ment toward family-centered intervention has been based
partly on two concepts. The first is that since parents are
the primary influences on their children's development,
the effectiveness of intervention ultimately depends on
parents becoming more active partners in the interven-
tion process. The second is that families of children with
disabilities are confronted with a number of challenges
that make it difficult for them either to engage in the
early intervention process or carry out routine childcare
responsibilities. Thus, family-centered intervention
practices require not only changes in the attitudes of
professionals toward parents, but also a fundamental
shift in the focus of early intervention from working
directly and exclusively with the child to collaborating
with families by providing an array of supports
responsive to their needs and priorities. This shift was
expected to enhance intervention by enabling parents to
become more effective at promoting the development
and well-being of their children (Dunst, Trivette, &
Deale, 1988).
The Family-Centered Outcomes study was a 12-
month longitudinal, field-based investigation designed
to test some of the assumptions underlying this family-
centered intervention model. Specifically, this study
attempted to determine whether services that reflected
two of the key components of family-centered practice—
comprehensive scope of family support services and ser-
vices that corresponded to the desire or needs of fami-
lies—would enable parents to interact more effectively
with their children and thus be more effective at pro-
moting children's developmental growth.
Early Intervention Effectiveness 13

Participants were 47 mother-child dyads who were
currently participating in early intervention programs.
Because this sample came from 36 programs, the services
that children and families received were assumed to
reflect a wide range of services typically associated with
early intervention. Most participants likely received
developmental activities individually tailored to the
unique characteristics of their children and designed to
accelerate all domains of child functioning.
The family-centered orientation of services was
assessed by asking mothers to complete the Family
Focused Intervention Scale (FFIS; Mahoney, O'Sullivan,
& Dennebaum, 1990) at the midpoint of the study. This
scale assesses the frequency or intensity of services that
families receive in the domains of child information,
family educational activities, systems engagement, per-
sonal family assistance, and resource assistance. Cluster
analyses were used to sort the sample into two highly
differentiated groupings. The first grouping was based
on the comprehensiveness of services that mothers
reported receiving. Across the five subscales of the FFIS,
families classified into the low family service group
received an average of 43% fewer services than did fami-
lies in the high family service group. The second grouping
classified families into "responsive to needs" clusters
based on the discrepancies between services parents reported
as being important and the services they actually received.
This resulted in a highly responsive service group that
reported almost no discrepancies between their ratings of
the importance of services and types of services they
received, and a low responsive group that had discrepan-
cies in which mothers' ratings of the importance of ser-
vices were, on an average, twice as great as their ratings
of services they received.

TABLE 5. Family-Centered Outcomes Study: Group Comparisons of Child, Mother/Family, and Mother
Interactive Style Characteristics

Time 1a Time 2°
Variable M SD M SD F P

Child characteristics
Age (in months) 17.3 .3
Gender (% female) 63.8
Etiology
Cerebral palsy (% of sample) 12.5
Down syndrome (% of sample) 38.3
Premature (% of sample) 11.1
Other (% of sample) 38.3
Mother/family characteristics
Mother's age (in years) 32.3 5.9
Mother's education (years attended) 14.5 2.4
Mother's ethnicity (% White) 93.6
Marital status (% married) 85.1
Maternal Behavior Rating Scale
Achievement orientation 2.8 .8 2.9 .8 0.23 .630
Achievement 3.2 .9 3.4 1.0 1.49 .229
Praise 2.5 1.1 2.4 1.0 0.06 .811
Affect/animation 3.0 .7 2.8 .7 2.49 .120
Acceptance 2.9 .7 2.8 .7 0.72 .399
Enjoyment 3.1 .9 2.8 .8 5.05 .029
Expressiveness 3.3 1.1 3.0 .9 5.53 .023
Inventiveness 2.6 .7 2.6 .8 0.16 .695
Warmth 3.0 1.0 2.8 .8 1.54 .221
Directive 3.5 .8 3.4 .7 2.12 .150
Directiveness 3.7 1.0 3.5 .8 1.00 .322
Pace 3.4 .8 3.2 2.58 .115
Responsive 3.0 .8 3.1 .8 0.95 .340
Effectiveness 2.8 .9 3.0 .7 3.64 .062
Responsiveness 2.9 .9 3.1 1.0 1.03 .315
Sensitivity 3.2 .9 3.3 .9 0.07 .796
Child developmental status
Bayley Mental Development Ageb 10.8 4.7 18.5 7.3 139.8 .000
REEL Expressive Language Agec 10.8 4.9 18.6 8.6 78.2 .000
REEL Receptive Language Agec 11.8 4.6 21.5 8.5 112.4 .000
REEL Combined Language Agec 11.3 4.6 20.0 8.2 115.0 .000
Vineland Social Maturity Age5 11.5 3.1 17.7 5.8 103.4 .000
a
N = 47. bBayley Scales of Infant Development (Bayley, 1969). CREEL = Receptive Expressive Emergent Language Scale (Bzoch & League, 1991).
d
Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984).
14
Assessments of parent-child interaction and child
and family functioning were collected at the beginning
and end of a 12-month period (see Table 5). Pre-/post-
comparisons indicated that over the course of interven-
tion there were no changes in the interactive style of
mothers. Changes in children's developmental ages were
significant, yet their rates of development during the
study appeared to be equivalent to their rates of devel-
opment prior to this study. That is, children's propor-
tional change indices (Wolery, 1983) for the three devel-
opmental measures used in this study—Bayley Mental
Development Index (Bayley, 1969), Receptive Expressive
Emergent Language Scale (Bzoch & League, 1991), and
Vineland Social Maturity Test (Sparrow, Balla, & Cicch-
etti, 1984)—ranged from an average of 69% to 115%
during intervention. Furthermore, analyses of these data
as a function of the family-centered orientation of ser-
vices indicated that neither of the parameters of family-
centered service assessed in this study had a significant
impact on encouraging mothers to modify their style of
interacting with their children or on enhancing children's
rate of developmental growth.
The Family-Centered Outcomes study thus presents
another example of an intervention evaluation in which
there was no observable acceleration of children's devel-
opment over a 1-year period. Although it is assumed that
parents will become more engaged in the intervention
process and/or more effective at interacting with their
children when they are provided a wide array of inter-
vention supports, our assessments of parent-child inter-
action produced no evidence to support this assumption.
Over the course of this study, there were no systematic
changes in parents' styles of interacting with their chil-
dren that were related to the type of family-centered ser-
vices they received.
DISCUSSION
At the outset of this article, we discussed two con-
trasting models for conducting early intervention. The
child-focused, directive teaching model emphasizes the
acquisition of specific skills or developmental milestones
offered on the IFSP and derived from tests and/or curric-
ula. The relationship-focused model assumes that inter-
vention should encourage and support the patterns of
parenting and caregiving that developmental research
indicates are associated with the optimal development of
children. Because the child-focused model emphasizes
the unique instructional qualities of specific activities
and experiences, it encourages adults to guide or direct
children to engage in developmentally stimulating activ-
ities. In contrast, the relationship-focused model encour-
ages adults to primarily support and sustain children's
involvement in activities they have selected.
Topics in Early Childhood Special Education 18:1
The four studies we presented provide a rich data-
base that sheds light on the relative merits of these two
models. If the child-focused model is an appropriate
framework for conducting early intervention, then the
effectiveness of early intervention should be related to
the intensity or frequency of services children receive.
Insofar as parental involvement is associated with inter-
vention effectiveness, parents' patterns of involvement
should be consistent with the characteristics of adult
interaction associated with the child-focused, directive
teaching model (i.e., achievement orientation, directive-
ness). On the other hand, if the relationship-focused
model is an appropriate framework for early intervention,
early intervention effectiveness should be dependent on
parental involvement, particularly as characterized by
their responsiveness with their children, more than on the
intensity or frequency of services.
Two of the projects described in this paper were pri-
marily based on a child-focused model: the Longitudinal
Studies and the IHDP. A primary characteristic of the design
in both of these studies was intensity of service (i.e., amount
of services provided). In the Longitudinal Studies, each of
the expanded interventions reflected an increased frequency
of service. In the IHDP, intensity was reflected by the treat-
ment group receiving a comprehensive and systematic array
of home- and center-based services that reflected the upper
limits of services that low-birthweight children might nor-
mally receive (Baumeister & Bacharach, 1996).
Results from the Longitudinal Studies provide no
evidence that increased intensity (i.e., number of services
received) had a significant impact on intervention effec-
tiveness. Although the IHDP appeared to have an impact
on enhancing children's development at least for the
short term, it is debatable whether these effects were a
by-product of the intensity or frequency of services chil-
dren received. Three studies have been published argu-
ing that the intensity of IHDP services contributed to
its effectiveness (Blair, Ramey, &C Hardin, 1995;
Ramey et al., 1992; Sparling et al., 1991). However,
none of these studies analyzed indices of intensity in
relationship to parent-child interaction styles. We
believe that our findings indicating that maternal respon-
siveness—an unplanned outcome of the IHDP—was the
predominant predictor of children's development and
raises the possibility that some of the more intensive
child-focused services of this intervention that did not
involve parents (e.g., the 25- to 30-hour-per-week child-
care program) may not have been the major factors con-
tributing to the developmental effects of this program.
This conclusion is compatible with another reanalysis of
the IHDP data conducted by Baumeister and Bacharach
(1996), who argue that a familial variable (i.e., maternal
IQ) was the major contributor to the IHDP outcomes.
The other two evaluations reported in this article,
the Family-Centered Outcomes study and the PALS pro-
Early Intervention Effectiveness
gram, examined intervention efforts that focused explic-
itly on parents. Both studies were based on intervention
concepts derived from the transactional model of devel-
opment. However, the Family-Centered Outcomes study
emphasized factors related to a wide array of supports
responsive to family priorities and needs, but not syste-
matically focused on the manner in which parents inter-
acted with their children. In this evaluation we found no
evidence either that parents modified their style of inter-
acting with their children or that children accelerated
their rate of development. In contrast, the PALS program
worked with mothers by addressing interactional pro-
cesses directly related to their children's development.
This study showed significant intervention effects not
only on mothers' styles of interaction, but also on their
children's development. As in the IHDP, these changes in
child development were directly related to mothers' lev-
els of responsiveness.
The contrasting results from these parent-directed
studies suggest that the critical determinant of interven-
tion effectiveness may not simply be that parents are
involved, or that the intervention focuses on family needs,
but rather that parents are encouraged and supported to
engage in highly responsive interactions with their chil-
dren. Parent-professional collaboration, responding to
the concerns and priorities of families, and other family
support activities that are hallmarks of family-centered
intervention, are undoubtedly crucial for engaging par-
ents in the intervention process. Yet our findings suggest
that these types of activities may be ineffective at enhanc-
ing children's development, unless they also encourage
parents to engage in more responsive interactions with
their children.
In general, the pattern of findings reported in these
four intervention studies provide relatively consistent
support for assumptions underlying the relationship-
focused intervention model—that intervention effective-
ness is fundamentally dependent on parent-child interac-
tion. Our findings suggest that the impact of interventions
on children's development was directly related to their
effectiveness at supporting and encouraging parents to
engage in responsive interactions with their children,
regardless of whether this was an intended or unintended
outcome. This was indicated by two findings. First, inter-
vention effects on child development did not appear to
occur unless mothers modified their style of interacting
with their children. Second, the one parameter of mater-
nal style that was consistently associated with significant
child outcomes was responsiveness—the very same inter-
active feature indicated by child development research to
be a significant influence on child development.
In contrast, our findings provide little, if any, sup-
port for the child-focused, directive teaching model. That
is, we found little evidence either that intensity or fre-
quency of early intervention services was a major predic-
15
tor of effectiveness and/or that the features of interactive
style associated with the child-focused, directive teaching
(e.g., achievement orientation and directiveness) contri-
buted to intervention effectiveness.
Although these results point to the centrality of
parent-child interaction to the early intervention process,
they do not lessen the seriousness of some of the con-
cerns raised about the relationship-focused model dis-
cussed in the introduction. However, we believe that
many of these concerns arise from our limited under-
standing of the interactional phenomena being discov-
ered through parent-child research. There is a need for
future research to continue to explore the relationship
between parent-child phenomena and theories of learn-
ing and development. We also need to determine how
parent-child phenomena affect the development of low-
incidence populations, such as children with autism, as
well as better understand how interactional principles
apply to minority and nontraditional families.
Finally, in a previous paper we raised concerns
about translating findings from the parent-child inter-
action literature into clinical assessment procedures (Maho-
ney, Spiker, & Boyce, 1996). Despite the results reported
in the present article, we maintain serious reservations
about using constructs derived from the parent-child
literature as bases for making evaluative judgments
about the childrearing skills of parents. The true value of
the information derived from the parent-child literature
does not depend on our developing another classification
taxonomy. Rather, the value of this literature is more like-
ly to emerge from serious inquiries focused on discovering
both the potential and limitations of parent-child
processes as a basis for developing and evaluating inter-
vention strategies and procedures. •
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