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Journal of Positive Behavior Interventions

DOI: 10.1177/10983007020040040401

2002; 4; 208Journal of Positive Behavior InterventionsLise Fox, Glen Dunlap and Diane Powell

Young Children with Challenging Behavior: Issues and Considerations for Behavior Support

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Young Children with Challenging Behavior:Issues and Considerations for Behavior Support

Journal of Positive Behavior Interventions

Volume 4, Number 4, Fall2002, pages 208217

Abstract: The critical importance of intervening early to promote the social and emotional de-

velopment of young children is a recurring theme in several reports commissioned by national

organizations and leaders (i.e., Child Mental Health Foundations and Agencies Network; Na-tional Research Council of the Institute of Medicine; U.S. Surgeon General). There is an in-

creasing awareness that socialemotional difficulties and problem behaviors in young children

are highly likely to continue in school. In addition,young children who show the most chronic-

ity and stability of problem behavior are more likely to be members of families who experience

marital distress, parental depression, and poverty. Young children in urban environments who

have problem behavior are likely to also face challenges in health, poverty, and access to qual-

ity childcare and other services. In this article, the complexity of the urban context is described

with a focus on the lives of young children and their families. The authors present a discussion

of appropriate practices and research that provides a foundation for the development of effec-

tive early intervention programs for young children affected by environmental and develop-

mental challenges. The emphasis of program recommendations is on comprehensiveness in the

design of family-centered behavioral support options.

Lise Fox

Glen Dunlap

Diane PowellUniversity of South Florida

208

There is an increasing awareness among educators, re-searchers, and policymakers that many young children arebeginning their school experiences without the requisiteemotional, social, behavioral, and academic skills that willbe necessary for success. Recent national organization andcommission reports have emphasized the critical impor-tance of early intervention and prevention in the supportof young children who have socialemotional difficulties(Child Mental Health Foundations and Agencies Network,2000; Department of Health and Human Services, 2001;National Advisory Mental Health Council, 2001; Shonkoff& Phillips, 2000). This phenomenon is sharply evidentwithin urban school environments where many of the stu-dents are more likely to be poor, have limited English pro-ficiency, move frequently, and live in one-parent homeenvironments (National Center for Education Statistics,1996), all factors that have been associated with less suc-cessful educational outcomes. Research indicates thatmany children who have difficulty with the successfultransition into kindergarten programs continue to show

social and emotional problems throughout their school ca-reers and into adulthood (Huffman, Mehlinger, & Kerivan,2000).

The alarming frequency in which young children whoenter school display severe problem behavior has resultedin an interest in providing early intervention to children inthe toddler and preschool years (Department of Healthand Human Services, 2001; Shonkoff & Phillips, 2000;Simpson, Jivanjee, Koroloff, Doerfler, & Garcia, 2001). Apromising approach for delivering early intervention isthrough the use of positive behavior support. Positive be-havior support has been demonstrated to be effective withindividuals with disabilities and students at risk for dis-abilities in a variety of settings with applications of positivebehavior support occurring primarily within school oradult service programs where there are professional pro-gram staff and mandates for providing behavior supportto address challenging behavior (e.g., IDEA 1997).

In this article, we discuss the issues relevant to provid-ing behavior support to young children with challenging

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Volume 4, Number 4, Fall 2002 209

behavior. We describe the nature and course of challengingbehavior in young children that necessitates a systematicand comprehensive approach to intervention. We also dis-cuss the complexities associated with providing services toyoung children in urban environments. The article con-cludes with a description of the elements that must beconsidered in the design of behavior support models foryoung children.

Prevalence, Course, and Correlates ofProblem Behavior

Challenging behaviors in young children not only occur atsignificant rates but are also often precursors to long-term,serious difficulties. Although problematic behaviors intoddlers and preschool-age children have often been dis-missed as age-appropriate expressions of developmentalchange or transient responses to adverse environmental

conditions (Campbell, 1995), an emerging body of re-search supports the robustness of early onset externalizingbehavior problems.

Findings from prevalence studies vary depending onthe sample characteristics and method used. However, areview of studies with community samples of preschoolchildren found rates of oppositional defiant disorder(ODD) between 7% and 25% (Webster-Stratton, 1997). Ina study of 3,860 two- to five-year-old children identifiedthrough pediatric visits, 16.8% of the children met the cri-teria for ODD, with half of the cases (8.1%) considered se-vere (Lavigne et al., 1996). Rates were highest (22.5%) for3 year olds and lowest (15%) at 5 years. In this study,attention-deficit disorder was identified in 2% of the par-ticipants and was almost always co-occurring with ODD.

Problem rates for children living in poverty appear tofall into the high end of the range. Using the Child Behav-ior Checklist (Achenbach & Edelbrock, 1991), rates of over25% for parent reported clinical level externalizing prob-lems (Webster-Stratton, 1997) and rates as high as 39% forteacher reported problems in boys (Kaiser & Hancock,2000) have been found among children in Head Start. Astudy using classroom observations found higher levels ofphysical aggression in children in Head Start comparedwith children in community childcare, although the com-

munity participants displayed higher levels of verbal ag-gression (Kupersmidt, Bryant, & Willoughby, 2000).

Evidence supports the view that early problems oftenpersist and that the roots of later problems are found in theearly years. A review of longitudinal studies revealed thatapproximately 50% of preschool children with externaliz-ing problems continued to show problems during theirschool years, with disruptive behavior diagnoses showingthe highest rates of persistence (Campbell, 1995). Thereappears to be remarkable stability in the early years, with88% of boys identified as aggressive at age 2 continuing toshow clinical symptomatology at age 5 and 58% remaining

in the clinical range at age 6 (Shaw,Gilliom, & Giovannelli,2000) and into adolescence (Egeland, Kalkoske, Gottes-man, & Erickson, 1990; Pierce, Ewing, & Campbell, 1999).

Accumulating support exists for an early starter de-velopmental pathway for conduct disorders beginning

with aggressive, impulsive, and oppositional behaviors inthe preschool years, progressing to conduct disordersymptoms such as fighting, lying, and stealing in middlechildhood, and the emerging into serious behaviors inadolescence, including interpersonal violence and prop-erty violations (Loeber, 1990; Patterson, DeBaryshe, &Ramsey, 1989; Tremblay, Phil, Vitaro, & Dobkin, 1994).Furthermore, it appears that children who display prob-lems at an early age are most likely to develop serious andintransigent antisocial problems in adolescence and adult-hood (Webster-Stratton, 1997).

The risk and protective factors that influence thecourse of a childs development toward emotional and be-

havioral well-being or problems are complex, synergistic,and cumulative. The more risk factors a child experiences,the higher the risk for poor outcomes, including emotionaland behavior problems (Landy & Tam, 1998; Rutter, 1990;Shaw, Winslow, Owens, & Hood, 1998). Risk and protec-tive factors occur at multiple levels and are generally cate-gorized into child factors, family and parenting factors,school-related factors, and community factors. Childrenliving in persistent poverty, especially those living in poorand violent neighborhoods, have increased susceptibilityto emotional and behavioral problems both through directeffects on children and contributions of family stress(Brooks-Gunn, Duncan, Klebanov, & Sealand, 1993;Dodge, Pettit, & Bates, 1994; Klebanov, Brooks-Gunn, &Duncan, 1994; Myers, Taylor, Alvy, Arrington, & Richard-son, 1992). Family factors are paramount in shaping thedevelopment of infants and young children. Chronic fam-ily adversity and the resulting disorganized, stressful, andchaotic family environments are demonstrated risk fac-tors. Such family stress may in turn affect levels of mater-nal depression and other parent psychological states,maternal responsiveness, parent management strategies,marital conflict and degree of maternal support, all factorsthat have been found to influence the development of dis-orders in young children (Deater-Deckard, Dodge, Bates,

& Pettit, 1998; Huffman et al., 2000; Landy & Tam, 1998;Shaw et al., 2000).

Once children move outside the home setting, nega-tive experiences in preschool and school may further exac-erbate their adjustment difficulties. Peer rejection andacademic difficulties both contribute to child problems(Arnold, 1997; Patterson et al., 1989), with reading disabil-ities in particular associated with conduct problems (Sturge,1982). Poor-quality childcare and ineffective behaviormanagement by teachers in childcare and school settingsmay also worsen childrens problems (NICHD Early ChildCare Research Network, 1998;Webster-Stratton, 1997). Al-

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210 Journal of Positive Behavior Interventions

though all of these environmental factors are intercon-nected, their effects are also modulated by child factorsinvolving temperament and cognitive abilities.

Conversely, protective factors can operate at the child,family, school, and community levels to counteract adversefactors and promote social and emotional health. For theindividual child, easy temperament and intellectual abilityhave been the most noted protective factors. At the familylevel, the presence of two parents, competence of parents,a positive relationship with at least one parent, and socialsupport are significant elements in a childs life. In pre-school or school, two important variables are positive rela-tionships with peers and teachers (Huffman et al., 2000;Landy & Tam, 1998; Shonkoff & Phillips, 2000).

Taken together, these findings indicate that disruptivedisorders in young children are multicausal, occur at highrates, especially among disadvantaged children, and for alarge number of children, problems will persist without

intervention.

Complex Context of Early Years andUrban Environments

The daily lives of families in urban environments are re-plete with conditions that contribute to the known riskfactors for emotional and behavioral problems in youngchildren and that, at the same time, offer few resources andsupports to families for negotiating the demands neededbecause of the hazards present in such environments. Theeveryday stresses on families include financial strain, poorand often overcrowded housing, transience, neighborhoodviolence and crime, lack of transportation, and social iso-lation. Welfare reform has added the demands of work tothe lives of many single mothers, often in low-paying jobsfor employers who make few allowances for the responsi-bilities of parenting young children. These stressors influ-ence outcomes for young children through direct pathwaysand indirectly through effects on maternal well-being andparenting capabilities (Brooks-Gunn & Duncan, 1997;McLoyd, 1998). As stated by Hanson and Carta (1995,p. 204), The stress associated with these societal concernscan sap parentsenergy, try their patience, undermine theirsense of competence and reduce their sense of control over

their lives. Subsets of young children living in familieswhere domestic violence, substance abuse, or maternal de-pression are present face even greater instability and tur-moil in their daily lives.

Immigrant populations in large cities are growing insize and diversity. For these families, language, culture, andintergenerational acculturation issues are added complica-tions in negotiating employment, social services, childcare,education, health care, and other systems within a largelymonolingual dominant culture (Washington & Andrews,1998). Providers of services and supports to families andtheir young children living in such environments must

address the realities of urban life and understand that liv-ing in these demanding conditions may well leave familieswith little extra time and energy to meet the special needsof a child with disruptive behavior.

Serving young children living in urban environments

in natural settings presents challenges due to the wide va-riety of situations in which they spend time. These includeearly intervention programs and an assortment of child-care arrangements as well as their own homes. Youngchildren living in low income families (> 200 of federalpoverty level) whose mothers work are found in center-based care (26%), family childcare (14%), relative care(28%), or with a parent (28%) or baby-sitter (4%; Capiz-zano, Adams, & Sonenstein, 2000). In addition, 30% ofsuch children receive their regular care in two differentarrangements, and 7% receive their care in three or moredifferent arrangements; these multiple arrangements aremost commonly a combination of formal and informal

care (Cappizano & Adams, 2000). Center-based care in-cludes both private childcare and publicly funded pre-school programs such as Head Start and prekindergarten,which have varying mandates and resources for servingchildren with behavior disorders. Furthermore, the qualityof childcare arrangements is highly variable, and providingsupports for children with challenging behaviors withinsuch settings requires adapting to a variety of contextualissues. These can include programs of marginal qualitywith already overwhelmed resources, early childhood edu-cation cultures that may view behaviorally based interven-tions as incompatible with developmentally appropriatepractice, and programs with few incentives and little in-vestment in serving children with special needs.

Also, certain populations of identified or at-risk youngchildren are served in a variety of different living arrange-ments or specialized childcare arrangements. Children eli-gible for early intervention services through Part C of theIndividuals with Disabilities Education Act (IDEA) maybe served in segregated or inclusive center-based settings,while children receiving Part B services are found in a va-riety of school-based classroom settings that often includechildren with various special needs.Children who have beenabused or neglected may live in foster care, in kinship care,or in informal care with relatives. In recent years, many

programs for teen mothers and for substance abusingmothers have developed child-focused service componentsthat include center-based childcare. Finally, homeless shel-ters and domestic violence shelters often have their ownchildcare programs for resident young children.

Just as young children with behavior challenges arefound in a variety of settings across service systems, inter-vention services for young children and their families areembedded in a number of different systems.An analysis offederal policies and programs that address risk factors forsocial and emotional problems in young children (Ca-vanaugh, Lippitt, & Moyo, 2000) identified 29 separate



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federal programs that affect young children in the areas ofhealth, early childhood care and education, family supportand child welfare, mental health and disabilities, child nu-trition, and socioeconomic status. Similarly, an examina-tion of the funding streams for early childhood mentalhealth services found 39 different governmental sources offunding (Wishman, Kates, & Kaufman, 2001). These re-ports note that differing policies, procedures, and discipli-nary philosophies among programs create difficulties incoordinating efforts, and despite the multiplicity of pro-grams, services do not reach all children in need. Notably,although there are many federal and state programs thatimpact young children at risk for, or who have been iden-tified with, emotional or behavior problems, there is noprogram, system, or funding stream with this populationof young children as it sole focus.

The result is a system of programs and services that isfragmented and difficult for families to understand and

navigate. In most communities, families do not have accessto any visible single point of information about servicesfor young children with behavior issues. Multiple eligibil-ity criteria based on income, diagnosis, test scores, age,geographic area, and specific risk factors create barriers forfamilies trying to access services. In addition, families maylose services or be forced to change providers based onchanging circumstances that affect eligibility. Examples in-clude IDEAs Part C to Part B transition at age 3, loss ofPart C services if retesting shows improvement above cut-off levels, and loss of Medicaid eligibility and services withrise in income. Finally, families must often seek servicesfrom multiple agencies in order to obtain the full range ofneeded supports.

This complex and fragmented system for serving fam-ilies and their young children with emotional and behaviorproblems presents challenges not only to already overbur-dened families seeking services but also to early interven-tionists who seek to provide family-centered serviceswithin natural settings. The needs of urban families call fora system of supports that provides services within the childand familys natural environments, including childcare,services offered at nontraditional times to accommodatethe schedules of working families, providers who can pro-vide information in the familys primary language, a co-

ordination of services among agencies, and changes inprogram eligibility to ensure a full range of services andprogram continuity.

Positive Behavior Support andEarly Intervention

The complexity of the environments and risk factors ofyoung children in urban environments who have challeng-ing behavior creates a need for comprehensive services thataddress the ecological needs of the family unit in an effortto influence the behavior and development of the child. In

a recent review of the science of early intervention, it wasdetermined that early intervention programs specificallydesigned to enhance parenting behavior and the develop-ment of the child have the greatest impacts (Shonkoff &Phillips, 2000). Thus, in addressing the needs of youngchildren who have problem behavior, it is essential for in-tervention programs to shift their focus from interventionwith the child to supporting the family in securing the re-sources, skills, parenting skills, and social support neededto provide a nurturing environment for the child (Shon-koff & Phillips, 2000; Simpson et al., 2001).

Positive behavior support (PBS) offers many of thecomponents necessary to address the unique needs of eachindividual child and family. PBS has been conceptualizedas the process that is broadly applied to address the defi-cient behaviors of the individual and the deficient contextsassociated with problem behavior (Carr et al., 1999). Thebehavior support process includes interventions and sup-

ports that are focused on enhancing the ecology of the in-dividual with the ultimate goal of improving peoples lives.When young children have problem behavior, comprehen-sive applications of PBS are necessary to provide the fam-ily and other caregivers with strategies to address thechilds problem behavior, to teach the child new skills, andto ensure that the family has the resources, support, andknowledge to nurture the development of the child (Dun-lap & Fox, 1996).

Although the bulk of research on PBS has addressedthe needs of older individuals with challenging behavior,an increasing number of demonstrations exist regardingthe efficacy of PBS applications for young children andtheir families. Research has demonstrated that the imple-mentation of functional assessment, functional commu-nication training, and family-centered behavior supportprocesses result in important outcomes for young childrenand their families (Blair, Umbreit, & Bos, 1999; Blair, Um-breit, & Eck, 2000; Dunlap & Fox, 1999; Frea & Hepburn,1999; Galensky, Miltenberger, Stricker, & Garlinghouse,2001; Lane, Umbreit, & Beebe-Frankenberger, 1999; Moes& Frea, 2000; Reeve & Carr, 2000).

Dunlap and Fox (1999) have described an early inter-vention model for young children with pervasive develop-mental disorders and challenging behavior that uses PBS

as the framework of services. Their model, the Individual-ized Support Program (ISP),was designed as an adjunctiveprogram to the childs ongoing services with a goal of help-ing families and other caregivers address the childs chal-lenging behavior (Dunlap & Fox, 1996; Fox, Dunlap, &Philbrick, 1997). The ISP model provided comprehensiveand individualized family support to young children andtheir families within home and community contexts. TheISP interventionist provided family support, PBS, andserved as the support team facilitator for all of the informaland formal service providers in the childs life. Most im-portant, the ISP model focused on assisting the family with



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the advocacy skills needed to secure resources and servicesneeded by the child and family system.

In the ISP model, the behavior support process beganwith functional assessment (ONeill et al., 1997; ONeill,Vaughn, & Dunlap, 1998) and person-centered planning(Mount & Zwernick, 1988). The functional assessmentprocess provided detailed information on the childs prob-lem behavior, activities, and contexts that were difficult forthe child and family; the relationship of the problem be-havior to antecedents and consequences; and the functionof the behavior. The person-centered planning processprovided the family and the childs care providers with themechanism to articulate the dreams and challenges for thechild and the family system. These two processes informedthe development of a behavior support plan that addressedproblem behavior, ecological supports, and family lifestyleissues. Once the support plan was developed, the interven-tionist assisted the family and all other caregivers in imple-

menting the plan in all of the childs environments andactivities. In addition, the interventionist helped the fam-ily in identifying and accessing the additional resources,information, and the social support needed by the familysystem.

The ISP model provides a demonstration of the effi-cacy of using positive behavior support to address thechallenging behavior in young children who have an iden-tified developmental disability (Dunlap & Fox, 1999). Themodel has been implemented in several communities andstates (Tampa, FL; Connecticut; New Hampshire; Mont-gomery County, PA), with reports from providers on thesuccess of the approach for young children who have arange of disabilities and who reside in a diversity of com-munities including urban settings.

Behavior support efforts for young children in urbanenvironments should involve similar components to theISP model. In addition, the complexities of the lives ofurban families would require primary consideration in theprovision of behavior support. In these contexts, ecologi-cal interventions and systems-change supports would beessential to assisting families in addressing their childs be-havioral challenges. The use of PBS as the framework forintervention with young children and their families wholive in urban environments will most likely require assist-

ing families in accessing basic resources (financial, housing,medical), the developing of parenting skills, and acquiringsocial support, as well as the developing and implementinga behavior support plan for the child. Furthermore, be-havior support efforts will need to involve all of the childscaregivers within diverse environments (e.g., siblings, grand-parents, childcare, home). Behavior support efforts thatneglect to acknowledge and assist families with meetingtheir most basic needs will most likely experience limitedsuccess in helping families achieve the lifestyle outcomesnecessary to support and nurture their children with chal-lenging behavior.

Key Considerations in the Design ofBehavior Support Efforts

In the previous section of this article, we described the useof PBS for addressing the needs of young children withproblem behaviors. The following section addresses someissues and challenges that need to be considered by systemsand provider agencies as behavior support efforts are de-signed for individual children and families. These issuestend to focus on the manner in which services are madeavailable, organized, and delivered rather than on the spe-cific intervention and support strategies that compose thebehavior support plan. The major point is that the qualityof behavior support is essentially irrelevant if systems arenot arranged to ensure that young children and their fam-ilies have direct access to the specific types of interventionsand supports that will be of help to them in their particu-lar life circumstances. Thus, the considerations to be ad-

dressed in this next section relate to our quest to ensurethat the potential benefits of validated approaches are ac-tually received and realized by children and families.

EARLY IDENTIFICATION

A great deal of important research has enabled early inter-ventionists to delineate indicators of serious behavioraldisorders when children are young (Campbell, 1995; Reid,1993; Walker, Severson, & Feil, 1995). In order for thisprogress to produce value for children and families, earlydetection and intervention mechanisms need to be acti-vated. Fortunately, the last decade has witnessed encourag-ing steps in the form of child find and early screeningprograms. A major contribution of Part C of IDEA hasbeen the implementation of early identification and evalu-ation systems. Part C, along with other federal and stateinitiatives (e.g., Early Head Start), has led to significant im-provements in the timeliness of detection and interven-tion. Still, state and local systems of identification andintervention need to improve in many ways.

First, screening and identification systems are not yetuniversal and, thus, many children are not identified until(or later than) kindergarten and elementary school (ChildMental Health Foundations and Agencies Network, 2000;

Department of Health and Human Services, 2001). This isparticularly true when children do not exhibit obvious de-velopmental or physical disabilities. For children whosechallenges involve learning and/or activity disabilities, orwhose environmental circumstances place them at seriousrisk for behavioral challenges, current screening programsare typically irrelevant or inadequate. An important issuethat needs to be confronted is to define behavioral adapta-tion as a consideration for screening and assessment, inde-pendent or in combination with other disabilities.

A second issue involving early identification is whathappens after detection occurs. Too frequently, there are



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lengthy delays between identification and intervention, orthe systems capacity to follow through with appropriateand effective intervention is limited (Shonkoff & Phillips,2000). Early identification without a complementary re-sponse is a frustrating and all too prevalent reality in manyof our nations communities.

Another issue closely related to the link between iden-tification and intervention is the early involvement of fam-ilies. Even when children are identified as being in need ofintervention and support, the message may not be com-municated effectively with families so that the develop-ment of an appropriate program of intervention fails tobecome a family priority. The involvement of families at anearly point in time is a complex topic that relates to nu-merous variables of family circumstance and the resourcesand orientation of service systems. Families affected byeconomic limitations and other competing priorities mayfind it difficult or impossible to reach out for assistance, es-

pecially when the purpose and expected outcomes arevague (Halpern, 2000). Systems of early intervention needto remove barriers and adopt extensive family-friendlyoutreach practices if early identification is to be matchedby functional family involvement (Knitzer, 2000; Simpsonet al., 2001).

CULTURAL COMPETENCE

A crucial factor in linking effectively with families to pro-mote early identification and early intervention is culturalcompetence. Gaining family involvement depends on re-lating effectively to provide cogent explanations regardingthe childs developmental needs and initiating a trajectoryof functional support. The process of communicating anddeveloping a functional relationship with the family de-pends on the ability of the early interventionist to developrapport, and this often hinges on the interventionists ca-pacity to relate to the cultural context that defines the fam-ily (Hernandez & Isaacs, 1998; Lynch & Hanson, 1998).The establishment of a cultural affinity constitutes thefoundation of the relationship and is therefore pivotal inrecruiting family involvement and participation (Harry,1997; Hernandez & Isaacs, 1998; Kalyanpur & Harry, 1999;Lynch & Hanson, 1998; Santarelli, Koegel,Casas, & Koegel,

2001).A major issue for systems is to ensure that the person-

nel and programs of early identification, evaluation, andintervention are infused with the cultural competence nec-essary for connecting with the families residing within thetargeted communities. This is especially critical in com-munities that contain multiple risk factors because it is thefamilies in these communities who are the most vulnerableto competing priorities and distrust of service systems(Halpern, 2000). Systems and provider agencies must as-sure that culturally competent professionals are consis-tently available and that programs and service options

avoid inflexible adherence to the assumptions of a domi-nant cultural perspective.

STRENGTH-BASED AND FAMILY-CENTERED PHILOSOPHY

Family-friendly, culturally competent systems of early in-tervention are needed to activate behavior support effortsin resolving the challenging behaviors of young children.The essential goal of early intervention services is to helpconstruct a foundation of support and family capacity thatwill endure and, thus, serve as a longitudinal facilitator ofpositive development and functional antidote to the lateremergence of serious behavioral challenges. As explicatedin the previous section on research foundations, effectiveprograms for addressing the challenging behaviors ofyoung children are those that stress parent education andfamily support. The orientation must be on enhancing thestrengths of the family system because it is the family that

inevitably, and preferably, assumes the primary responsi-bility in guiding the childs behavioral development.

Several authors (e.g., Friesen & Stephens, 1998;Lucyshyn, Dunlap, & Albin, 2002; Powell, Batsche, Ferro,Fox, & Dunlap, 1997; Turnbull, Blue-Banning, Turbiville,& Park, 1999) have argued that effective and enduring sup-port efforts eschew the traditional expert-driven modeland embrace, instead, a collaborative model of parentprofessional partnership. This model, in the case of earlyintervention, assumes an approach that is fully centeredaround the familys circumstances, needs, dreams, culture,and specific priorities. The professionals role in this modelis to inform, guide, reflect, and join the family as a sup-portive interventionist with the objective of increasing thefamilys capacity to achieve their goals (Bailey et al., 1998;Turnbull et al., 1999).

The implications for systems and service providers aredramatic. Efforts need to be undertaken to effect a transi-tion from the expert-driven model to a family-centeredorientation. This transition can be very difficult for agencypersonnel, professionals, and administrators, who havebeen geared for decades toward the benevolent, authorita-tive role of the expert. Focusing on family strengths andworking in the posture of a facilitating family partner rep-resents a change that can be disconcerting. However, to be

optimally effective in the endeavor of family-focused earlyintervention, such change is vital.

ACCESS TO SERVICES

The manner with which systems arrange for children andfamilies to access services can be facilitative or a massiveimpediment to early intervention. Following early identifi-cation, evaluation, and the development of an individual-ized service plan, the challenge becomes one of locatingand accessing the appropriate types and intensities of ser-vices that the plan recommends. Ideally, a seamless process



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of linkage to qualified, family-centered service providerswould occur so that the child and familys needs would bemet expeditiously and as intended.

Unfortunately, for children with multiple risks and be-havioral challenges, this ideal process rarely occurs. Profes-sional specialization often makes it difficult to match achild and familys idiosyncratic needs to the particular of-ferings of the local professional community. At the sametime, it is common for communities to lack appropriatelytrained service resources so that finding a suitable providercan be a futile endeavor. This may be especially true forfamilies seeking access to professionals who are skilled infamily-centered functional assessment and PBS. Althoughsuch providers are becoming more numerous, gaining ac-cess can still be difficult.

Children and families affected by multiple challengesand disabilities, and needing a comprehensive and multi-faceted intervention approach, can encounter even greater

frustrations in accessing services. Service providers andservice agencies are usually specialized, and systems arefragmented so that meeting multiple intervention objec-tives can mean extensive work in tracking down and ob-taining the various types of services specified in theintervention plan (Halpern, 2000; Knitzer, 2000). It is notunusual for families with children who have behavioralchallenges and multiple risk factors to seek access to five ormore different providers and to simultaneously attempt toarrange schedulings, transportation, finances, and somekind of programmatic coordination and follow through.This rapidly becomes a full-time job and beyond themeans of all but a few families. To counter this substantialproblem of access to appropriate services, systems mustfind ways to counter the fragmentation and overspecializa-tion that characterizes the field and to implement im-proved, community-based and family-friendly programsfor linking children and families with the services theyneed.

COMPREHENSIVE ORIENTATION TO

SERVICE DELIVERY

An issue closely related to the last point involves the com-prehensiveness with which early interventions are pro-

vided for children and families affected by problembehavior. Families characterized by multiple risks andstressors have needs for support that transcend the behav-ioral and developmental disabilities of the child. An opti-mal approach for enhancing the childs developmentalfortunes requires a focus not only on the childs interven-tion but also on supports for the family system as a whole(Knitzer, 2000; Shonkoff & Phillips, 2000). This perspec-tive is dictated by the reality that the childs progress is in-extricably tied to the functioning of the family as a whole.For this reason, a number of authors have asserted thatearly intervention services must be broad based and evalu-

ated in terms of both child and family functioning (Powellet al., 1997; Weissbourd & Kagan, 1989).

As with the orientation of family centeredness, the no-tion of providing comprehensive, broad-based supportsrepresents a shift from more traditional services, which

tend to be confined to a particular problem or disciplinarypurview. The transition to comprehensive supports de-mands that service systems be increasingly integrated,withflexible funding and a consistent emphasis on family-focused assistance.

PROVIDING FOR A CONTINUUM OF SUPPORTS

The level and type of services that are needed for inter-vention with children and families affected by challengingbehavior vary extensively according to the severity andchronicity of the challenging behavior, the childs develop-mental functioning, and the resources and circumstances

of the family. Although supports should be provided froma broad-based and family-centered perspective, the specifickinds and amounts of support for any child and family sys-tem depend on their individual characteristics and situa-tion. Some children and families will need only a little ofone type of intervention, but they may benefit greatly fromgreater concentrations of another service. Some childrenand families will need minimal support initially but rela-tively intensive supports later on. Services systems must bearranged in a manner that allows families to access a flexi-ble array of supports that fully meet their needs, includingthe possibility of intensive supports that exceed typical ser-vice allocations.

Summary

In this article, we have described the evidence that clearlyindicates a need to provide behavior support efforts tochildren and their families during the toddler andpreschool years.We also describe the difficult and complexcircumstances of young children with challenging behav-iors and their families who live in urban communitiesthat necessitate the development of a highly flexible,community-based model of both family and behavior sup-port. In our discussion, we provided guidance on how

behavior support efforts must be arranged and the con-siderations needed to develop effective systems of support.

PBS offers a very promising intervention approachwith demonstrated efficacy in resolving the challengingbehavior of individuals and creating systems of problembehavior prevention and intervention (e.g., schoolwidesystems). We believe that positive behavior support hasequal promise in addressing the needs of families withyoung children in urban environments. However, in thisarticle we discuss the unique complexities associated withthe delivery of behavior support to young children. It is ev-ident that the delivery of services calls for an integrated



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and coordinated approach that targets the entire familysystem for intervention and support services.

We have described an approach to early interventionthat is uncommon within most urban communities, al-though there is recent widespread recognition that thistype of service system is necessary for achieving effectiveoutcomes. The approach we describe also stretches the tra-ditional concept of behavior support services. Profession-als who are knowledgeable about PBS will be challenged tothink deeply about ecological supports, familys access toservices, and family unit needs. Families who are stressedby meeting their most basic needs are unlikely to be able oravailable to provide the intervention and guidance neededto address their childs challenging behavior.

It is reasonable to conclude that the knowledge andtechnology for achieving behavior change for young chil-dren with challenging behavior is known; the challengethat remains is the delivery of those supports in ways that

reach the most vulnerable families. Implementing an ef-fective system of behavior support will require the in-volvement of professionals, practitioners, policymakers,community leaders, and families to develop policies thatare effective, arrange service delivery systems in ways thatare responsive, and consider new approaches in meetingthe needs of young children and their families.

ABOUT THE AUTHORS

Lise Fox, PhD, is a research professor in the Department ofChild and Family Studies at the University of South Florida.Her publications and research interests include supportingchildren with disabilities and challenging behavior in devel-opmentally appropriate environments, positive behavior sup-port, and family support. Glen Dunlap, PhD, is a professorof child and family studies at the University of South Florida,and principal investigator of the OSEP Center on Evidence-Based Practices: Young Children with Challenging Behavior,and the NIDRR Research and Training Center on PositiveBehavior Support. Diane Powell, PhD, is an assistant pro-fessor in the Department of Child and Family Studies at theUniversity of South Florida. She has experience in service de-livery and research in the fields of early childhood mentalhealth and family support and has directed federally funded

projects focusing on support for young children affected by vi-olence and parent involvement in education. Address: LiseFox, Department of Child and Family Studies MHC 2113A,University of South Florida, 13301 Bruce B. Downs Blvd.,Tampa, FL 33612.

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Action Editor: Wayne Sailor

Notice

The College Board and Disabilities Rights Advocates

Announce Agreement to Drop Flagging

From Standardized Tests

The College Board and Disabilities Rights Advocates(DRA) announced that as of October 1, 2003, the CollegeBoard would discontinue the practice of identifying scorereports on standardized tests taken by students who re-quire extended test-taking time because of documenteddisabilities. Such special testing accommodations have beenidentified on the score report by the words nonstandardadministration, a practice commonly referred to as flagging.

The decision to discontinue flagging stems from a1999 lawsuit against the Educational Testing Service (ETS)that resulted in ETSs agreement to remove all flags fromthe score reports of ETS-administered tests that are notowned by the College Board. ETS develops the test timesand administers and scores the SAT and several other testsowned by the College Board.

With respect to College Board tests, DRA and the Col-lege Board had agreed to convene a Blue Ribbon Panel ofjointly selected experts to consider issues related to theflagging of score reports. That panel recommended, by avote of four to two, that the College Board discontinueflagging the score reports of tests taken with extendedtime.

DRAs clients were extremely pleased with the settle-ment. Chris Elms, President of Californians for DisabilityRights (CDR) stated, This settlement is a victory for allpersons with disabilities seeking to attend college or grad-

uate school because it makes higher education much moreaccessible to persons with disabilities. InternationalDyslexia Association (IDA) President Harley A. Tomey IIIadded, While IDA wishes the agreement could have beenreached sooner and without litigation, we congratulateETS and the College Board for coming to the understand-ing that this is the right thing to do.


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