Practice Forum

Evidence-Based Practice in Infant and Early Childhood Psychology

This article highlights practice and training considerations for school psychologists and trainees interested in working with young children and their families

By Florence Rubinson, Anastasia E. Yasik, and Barbara A. Mowder

Evidence-based practice (EBP) in infant, toddler, and early childhood psychology has the potential to improve the health of an increasingly diverse community by focusing on the needs of the youngest, most vulnerable members of society and the families charged with their care and nurturance. Although infant and early childhood psychology may seem like a narrow and specific area, evidence-based practice with young children and their families is vitally important, considering the broad implications for future long and short-term developmental outcomes (Nelson, Westhues, & MacLeod, 2003). While school psychologists have long understood the importance of children's early years to ensure healthy physical, cognitive, and social-emotional maturation, most school psychologists practice in public schools with school- age children (Curtis, Chesno Grier &, Hunley, 2003; Mowder, Goliger, Sossin, & Rubinson, 2003). Considering the growing evidence base related to the importance of practice with infants, toddlers, young children and their families as well as the increasing opportunities to work with this population (Debey, 2009), this article highlights practice and training considerations for school psychologists and trainees interested in working with young children and their families.

Current Interest in Infants, Toddlers, and young Children

There are many specific reasons for school psychologists' current interest in infants, toddlers, and young children. For example, low birth weight (LBW) continues to increase in the United States accompanied by high survival rates (Herrod, Chang, & Steinberg, 2010). Preterm and LBW infants, especially very low birth weight (< 1500 grams), present unique challenges for early intervention since LBW is often a precursor for a myriad of developmental, medical, sensory, and learning difficulties (Espy, Fang, Charak, Minich, & Taylor, 2009; Nozyce & Grant, 2009). In addition, children under 5 years of age experience considerable trauma (e.g., grief, physical and/ or sexual abuse, neglect, medical and other complex trauma) similar to that experienced by older children (National Child Trauma Stress Network, 2008). Researchers have well documented the long-term and deleterious effects of trauma on children (Findling, Bratton, & Henson, 2006). Another area of continued interest is the incidence of Pervasive Developmental Disorders (PDD) and the five subtypes of PDD (i.e., Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder-NOS) usually diagnosed in early childhood have tripled in the past 25 years (Centers for Disease Control and Prevention, 2007). Early identification and treatment of PDD are associated with better communication, behavioral, and cognitive outcomes than diagnosis and intervention at later stages of development (Lord & McGee, 2001). Another area of concern involves externalizing problems (e.g., aggression, hyperactivity) that are the most common psychological referral issues for young children (Egger & Angold, 2006; Wilens et al., 2002). Gilliam (2005, 2008) exposed high rates of prekindergarten expulsions for young children exhibiting challenging behaviors. Nationally, the rates of expulsion are more than three times higher in prekindergarten than the rate for children in kindergarten through twelfth grade. Without high quality psychological treatment, which is often inadequate for poor and culturally and linguistically diverse children, approximately half of these children are at risk for severe disturbance later in their lives (Campbell, Pierce, Moore, & Marakovitz, 1996).

On the positive side, young children increasingly have access to psychological services because they are enrolled in daycare, preschools, state-funded Universal Prekindergartens, and Head Start programs, or receive remedial services through special education and Early Intervention systems (United States Department of Education, 2006) where school psychologists are able to provide services. Moreover, psychologists increasingly treat young children in trauma centers, pediatric-care facilities, foster-care agencies, hospitals, and social service agencies (Evangelista, 2009). With the increase of private and public options for infant and early childhood care and education, mental health professionals including school psychologists, can potentially play a crucial role in optimizing outcomes for young children (Debey,2009).

School psychologists serving older children from kindergarten through twelfth grade also have a stake in evidence-based practice with infants and young children. Mental health disorders in early childhood interrupt development and when not addressed adequately at young ages become more intractable during school age and beyond (Knitzer, 2000). More over, school psychologists, regardless of their specific area of practice in terms of developmental age (e.g., children, adolescents) or area of concern (e.g., assessment, intervention, cognition, mental health), invariably touches on issues related to young children and their families (e.g., extended families, foster care, grand-parenting, parenting). Inevitably, students reside within some level of family structure, and although the specific client may be an older sibling or family member, appreciating a younger sibling's dynamics, needs, resources, and strengths is pertinent to professional practice. Further, families may require assistance in understanding the assessment of young children from a developmental as well as social-emotional perspective. Indeed, for some parents the complex, specialized process of assessing young children, especially infants, is often alarming. School psychologists can be vital resources for assisting families understand these assessments as well as intervention options (e.g., educational placements, home and school-based interventions, psychopharmacology, treatment modalities) and the roles various infant and early childhood professionals play in facilitating young children's growth and development.

Questions Related to Early Childhood Practice

Considering the far-reaching implications of effective mental health and educational interventions with young children and their families, school psychologists have a clear mandate to improve practice with this population. To do so effectively, four important questions need to be discussed.

  1. What is the current state of evidence- based practice in early childhood psychology?
  2. What competencies are necessary to work with young children and their families?
  3. What do training programs need to do to prepare trainees to meet the needs of young children and their families?
  4. What resources in professional training and education are available?

Current State of Evidence-Based Practice with Young Children

School psychologists are mindful of psychology's recent focus on evidence- based practice. In the past decade, there has been controversy as well as mounting support for an evidence-based approach in professional psychology that produces optimal client outcomes (see Hunsley, 2007). Evidence-based practice (EBP), a model based on a scientific foundation, includes attention to contextual variables (i.e., client characteristics, needs, developmental status, culture, and preferences) and incorporates a substantial role for clinical judgment and expertise (APA Presidential Task Force on Evidence-Based Practice, 2006; Hardimann, Theriot, & Hodges, 2005; Kazdin, 2008). Odom (2009) endorses using research to promote positive outcomes for young children and their families. However, Odom and others note that a large gap continues to exist between EBP and implementation of early childhood interventions supported by a solid research base (Campbell & Halbert, 2002; McLean, Snyder, Smith, & Sandall, 2002). Although the reasons for this breach are beyond the scope of this article, Kazdin provides interesting ideas that can apply to early childhood practice for making research more user-friendly for parents and practitioners. Kazdin encourages researchers and practitioners to maintain a common focus on improved outcomes for children and join in (1) studying the processes that explain how mental health interventions work to produce change, (2) studying moderating variables that effect decision making in clinical situations, and (3) encouraging more emphasis on qualitative research that is well suited for studying individual experience. No matter how effective interventions are in a research setting, practitioners are more likely to implement them if researchers provide practice implications (Dunst & Trivette, 2009).

Many areas in early childhood practice have a strong research base while other areas still require a good deal of research. For example, Bowlby's (1982) attachment theory supported by Ainsworth's (1979) empirical studies continues to motivate a body of research that informs psychologist's work with young children. Emerging self-regulation in young children and the mechanisms involved in acquisition and maintenance of self-regulatory behaviors comprises a vast literature (Berger, Kopman, Livneh, & Henik, 2007; Eisenberg, Smith, Sadovsky, & Spinrad, 2004). Family-based intervention (Kumpfer & Alvarado, 2003), mental health consultation in early intervention and preschool settings (Perry, Brennan, Bradley, & Allen, 2006), play therapy for social-emotional disorders (Bratton & Ray, 2000; Bratton, Ray, Rhine, & Jones, 2005), family-school partnerships (Bates, 2005; Sheridan & Kratochwill, 2008), and mental health prevention programs (Beckwith, 2000) enjoy an adequate evidence base. There are effective programs for young children found in a growing collection of journals (e.g., Early Childhood Services: An Interdisciplinary Journal of Effectiveness, Clinical Child Psychology and Psychiatry, Child Development, Journal of Early Childhood and Infant Psychology) and databases (e.g., the National Registry of Evidence- Based programs and Practices, and What Works Clearinghouse). Conversely, there are many areas within infant and early childhood psychology in dire need of further research. Although this is not an exhaustive list, areas in need of a more comprehensive evidence base related to practice include: autism, pervasive developmental disorders, psychopharmacology, attention deficit hyperactivity disorder, aggression, and trauma (Mowder, Rubinson, & Yasik, 2009).

Effective practice linked to effective assessment intended for young children also depends on adequate evaluation instruments. While there has been a demand for improved technical adequacy for norm-referenced assessment tools used with young children, there has not been a consensus on the criteria for evaluating technical adequacy (Alfonso & Flanagan 2009). Alfonso and Flanagan suggest the following criteria for evaluation instruments intended for use with young children: adequate test floors, item gradients, standardization, validity, and reliability. Moreover, classification systems with limited support for valid diagnosis with young children are the foundation of many of the instruments used with infants, toddlers, and young children (Angold & Costello, 2009; Postert, Averbeck-Holocher, Beyer, Muller, & Furniss, 2009). Along with the need for technically adequate assessment instruments, school psychologists face other challenges related to assessment of young children. Rapid and uneven development across domains and behavioral issues (e.g., short attention span, high activity levels, low frustration tolerance) are common in young children and influences the psychologist's ability to provide reliable and valid assessments (Nagle, 2000). Further, school psychologists need to address the substantial lack of evidence for assessment of young children and their families from culturally and linguistically diverse backgrounds (Fernandez, 2009). Without accurate assessment, the outcomes of interventions naturally linked to assessments are questionable (Mowder et al., 2009).

Competencies for Early Childhood Practice

Psychologists providing services to young children and their families require a specific knowledge base unique to infant, toddler, and early childhood practice. Psychological services for this population are characterized by a focus on early childhood as a distinct developmental period; the fundamental and pervasive influence of families with attention to cultural and diverse contexts, collaborations with other professionals and appropriate models of practice. Indeed, practice with young children and their families involve defining characteristics that are considerably different from those necessary for practice with older children (Mowder et al., 2009).

Evidence-based practice in infant and early childhood psychology requires recognition that the first five years in a child's life represent a distinct developmental stage that school psychologists need to completely understand and consider in every facet of practice: the unique aspects of early childhood development relate to rapid physical growth (Perlmutter, 2006), cognitive development and social advancement (Anderson, 2003), as well as emerging language and communication skills, and the challenges of developing self-regulation (Harvey & Macklem, 2009). Understanding attachment and its relationship to social-emotional development is critical in early childhood practice (Bowlby, 1982). Further, the development of play skills, beginning in infancy, has a significant role in development and as the medium often used to assess and intervene in atypical development (Drewes, 2009). School psychologists who work with young children need to understand the unique issues regarding vulnerable populations such as preterm infants and children with acquired or developmental disabilities. In order to diagnose disorders and disabilities in young children, competent practitioners need to understand the limitations of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR; APA, 2000). Although the DSM-IV-TR includes diagnoses for children, it lacks developmentally sensitive parameters (Evangelista, 2009) and does not adequately address influences of family functioning (Mayes, 1999). Alternative systems that psychologists working with young children generally use are the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC: 0-3) (Zero to Three, 2005), and the Diagnostic Manual for Infancy and Early Childhood (ICDL-DMIC; ICDL, 2005). Both are categorical systems more appropriate to diagnose disorders and disabilities in early childhood. However, the DC: 0-3 and ICDL-DMIC require additional research to better demonstrate their reliability and validity.

Another unique competency associated with early childhood practice involves the central importance of families in the lives of young children. At no other point in children's lives are parent-child interactions and family dynamics along with cultural environment more influential than in the early years (Donohue, Falk, & Provet, 2000; Sameroff, 2004). Thus, evidence suggests a family- centered approach in which families and professionals collaborate in producing positive outcomes for young children (Bleecker & Sherwood, 2004; Lehman, Lambarth, Friesen, MacLeod, & White, 2006). Parental involvement in assessment and intervention is necessary considering young children's limited ability to express concerns, while a perspective of genuine collaboration between families and practitioners will strengthen the possibility of successful outcomes (Seligman & Darling, 2007). Moreover, parent assessment and intervention as well as assessment of family functioning are critical aspects of early childhood practice (Mowder & Shamah, 2009). Associated with the primacy of parents and families in early childhood practice, practitioners need to recognize the importance of an awareness and attention to diverse cultural belief systems within families that are vital for understanding family dynamics, child development, and building relationships with families (Fernandez. 2009). Cultural competence requires attention to ethnicity, race, class, gender, religion, sexual identity, and language both within families and between families and the relevant institutions (Mowder et al, 2009).

An additional competency vital to early childhood practice is collaboration with other professionals is necessary to appropriately serve children of all ages; such partnerships are particularly important in working with young children. Service delivery for young children and their families is often complex, involving many discipline-specific specialists (e.g., physicians, educators, speech-language pathologists, physical and occupational therapists, behavioral consultants) in addition to a school psychologist. Best practice suggests that close collaborations among professionals and integration of services are necessary for optimal service delivery (Shonkoff & Meisels, 2000). Linkages between early childhood providers permit opportunities for mutual planning and feedback and tend to create holistic and contextual understandings of young children (Hepburn, Kaufmann, Perry, Allen, Brennan, & Green, 2007). Whether psychologists work within a team structure (e.g., multidisciplinary, interdisciplinary, or transdisciplinary) or collaborate with individual early- childhood professionals, partnering with other experts requires learning about their work, good communication skills, and trust in the abilities of these professionals (McLean & Crais, 2000) as well as consultation/collaboration skills (Rubinson, 2009). Therefore, psychologists working with young children need a unique set of skills for working effectively with other service providers treating young children.

School psychologists use a variety of models in their work with young children and their families. Models with the greatest influence include the (1) medical model; (2) mental health model; (3) development, disability, and psychopathology models; (4) learning theory and behavioral models; and (5) family systems (Evangelista, 2009). These models whether used exclusively or in combination characterize service delivery for infants, toddlers, and young children. Although each model has potential value, space in this article permits only a short review of the most salient issues related to models of early childhood practice. Specifically, the medical model focuses on difficulties, deficiencies, or disorders specific to an individual and can overlook important contextual issues related to young children and their families. Early childhood practice has moved from focusing on individual children to appreciating family and community influences on mental health and development (Shonkoff & Phillips, 2000). Consultation, and indirect service delivery model, assumes that significant events, people, and settings are central to a youngster's mental health and behavioral problems and therefore can also be critical resources in their resolution (Donahue et al., 2000). As a result, the mental health or behavioral consultants work with direct caregivers (e.g., parents, day care providers, teachers, and in some cases therapists) who then work to optimize the function in young children. A large body of research, mostly looking at youngsters in Head Start, provides evidence that consultation with parents and educators contributes to overall change in client behaviors and positive relationships among adults in a child's life (Alkon et al., 2003, Green et al., 2004, 2006).

The competencies necessary to work effectively with young children and their families are broad based and undoubtedly unique. By articulating the general competencies necessary for early childhood school psychologists, considering that they often come from varied perspectives and work in many different employment settings, we are attempting to affirm a professional identity and strengthen our contribution to young children.

Training Programs and Available Resources

With a clear understanding of the competencies necessary to work effectively with young children and their families, training programs interested in preparing early childhood school psychologists need to provide specific curriculum and field based supervised experiences. However, there are no curricular guidelines for early childhood training as there are for early childhood educators and infant mental health specialists (Finello & Poulsen, 2005; Zeanah, Larrieu, & Zeanah, 2000). A curriculum for early childhood school psychologists should provide specific instruction related to infant and early development as well as family and parent functioning. Further, assessment, consultation, and intervention services need to be presented in the context of working with other professionals, a firm appreciation for diversity, and special attention to the unique ethical considerations involved in working with young children.

Coursework needs to specifically include the unique competencies required to effect positive outcomes for young children and their families. These competencies include:

  1. Developmental psychology specific to infants and young children.
  2. Family and parent functioning, assessment, and intervention.
  3. Assessment of young children, with an understanding of the unique issues surrounding evaluating young children as well as the need to acquire good observation and interviewing skills to augment standardized evaluation instruments.
  4. Consultation and intervention skills related to the specific needs of young children.
  5. An appreciation for the contributions made by other early childhood professionals and consultation/ collaboration skills necessary to work effectively with them.
  6. An understanding of the various models for integrated service delivery.
  7. Considerations for diversity.
  8. Ethical issues regarding early childhood professional practice.

Foley and Mowder (2000) emphasized the importance of field experiences that assist school psychologists in understanding child development as well as appreciating the relationships between families and other early childhood professionals. Supervised field work needs to specifically include:

  1. Training experiences (assessment, consultation, and intervention) that involve infants, young children, and their families.
  2. Training experiences with diverse families.
  3. Training experiences with other professionals providing services young children and their families.
  4. Seminar experiences specifically exploring the dynamics associated with providing services to young children and their families as well as related ethical concerns.

In terms of training needs for practicing school psychologists, Mowder, Goliger, Sossin, and Rubinson (2003) surveyed practicing school psychologists in New York State working in early childhood settings regarding their training needs. Participants requested further training in this order: intervention (83%), assessment (80%), diagnosis (66%), and pharmacology issues (64%). Interestingly, only about a third of the participants cited collaboration skills and multicultural skills as an area of further training needs. Conclusion

Early childhood psychology is an emerging practice area with an increasing evidence-base for practice. School psychologists can find effective programs and practice strategies in the growing collection of journals and online sites. At the same time, there is tremendous opportunity and need for further research and policy determinations. There is a need for specific standards for school psychologists to inform the early childhood professional or those seeking to become practitioners serving young children and their families. Moreover, training standards specific to early childhood psychology are essential for the continued growth of infant and early childhood psychology as a unique discipline. Further, policy implications that are sensitive to the developmental aspects of service provision with young children and their families are critical.


Early childhood psychology is an emerging practice area with an increasing evidence-base for practice. School psychologists can find effective programs and practice strategies in the growing collection of journals and online sites. At the same time, there is tremendous opportunity and need for further research and policy determinations. There is a need for specific standards for school psychologists to inform the early childhood professional or those seeking to become practitioners serving young children and their families. Moreover, training standards specific to early childhood psychology are essential for the continued growth of infant and early childhood psychology as a unique discipline. Further, policy implications that are sensitive to the developmental aspects of service provision with young children and their families are critical.


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