The Difficult Child and an Inclusionary Model That Can Work
By Judith S. Bloch and Janice L. Friedman

Mrs. Cartwright was at her wits’ end. Mr. Cartwright had just lost one of his two jobs and Billy, their three-year-old, was driving her crazy. He just did not listen. He was constantly moving, and he always seemed to be doing things she had told him to stop. He climbed on furniture and broke everything he touched. When Billy was with other children, he pushed and hit. In fact, when the children saw him approaching, they would run the other way.

Despite the demands of caring for her family, Mrs. Cartwright was scheduled to begin a new job. She needed child care for Billy. But how could she enroll him at a child care center? She was afraid the center would ask him to leave when the staff saw how active, noisy, and disobedient he was. Her gut feeling told her that Billy needed something more than regular child care, but she didn't know what that was.

Including a child with disabilities in a child care setting is a major challenge because children with social and behavioral problems are "...among the most difficult to include" (MacMillan, Gresham, & Forness, 1996, p. 145). Sometimes, parents discuss their concerns about their child's development or behavior with the staff. More often, however, it is the child care staff that informs parents of a possible problem. This article will address issues involved in including children with disabilities in a setting for typically developing children.

Legal Rights for Children With Disabilities
The reauthorization of IDEA (Individuals with Disabilities Education Act for Children 3-21, 1997) continues to provide all children with disabilities the right to a free and appropriate education at no cost to parents. Federal and state legislation requires local education agencies (in some states the local education agency is the public school district) to conduct free, multidisciplinary evaluations for all children with suspected disabilities. A child who is classified with a disability must receive special education and/or related services in the least restrictive environment. Federal legislation defines a least restrictive environment as follows:

"To the maximum extent appropriate, children with disabilities...are educated with children who are not disabled ...and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occur only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily" (University of the State of New York, 1997, p. 15).

Core concepts from IDEA include parents' rights to participate in the identification, evaluation, and placement of children with disabilities as well as to participate in the preparation of a written individualized education program (IEP) for their child. An IEP is written by a team consisting of a child’s parents, special education teacher, regular education teacher (if the child participates in a regular education environment), representative of the local educational agency, and a person who can interpret evaluation results. Others who are knowledgeable about the child may be invited at the team’s discretion (Individuals with Disabilities Education Act Amendments of 1977, pp. 55-56). The IEP states the special services a child will receive, the duration of special services, short-term and long-term goals of the program, and the child's current level of functioning.

A Challenge to the Early Childhood Community
IDEA creates additional responsibilities and concerns for early childhood programs (Johnson, 1994). As the number of preschoolers with disabilities included in child care increases, there is a growing expectation that the child care community will identify children with disabilities, inform parents about their concerns, and help them access children's legal rights.

Facilitating Inclusion
Over the last ten years, there has been a dramatic increase in the number of preschoolers with disabilities who attend inclusive (or integrated) preschools and child care settings (Janko, Schwartz, Sandall, Anderson, & Cottam, 1997). Leading professional organizations in early childhood and early childhood special education are endorsing inclusion and parent involvement as "best practice" (Bennett, Deluca, & Bruns, 1997; McDonnell, Brownell, & Wolery, 1997). Inclusion (formerly known as mainstreaming) is the process of including children with disabilities in education classes for typically developing children. Inclusion serves as one way to provide children with disabilities a least restrictive environment (Scruggs & Mastropieri, 1996). These services may be provided "in a variety of natural settings, including family homes, preschools, child care facilities, and other community settings in which children without disabilities would be found" (McDonnell et al., 1997, p. 263).

Attitudes about inclusion, access to specialists and collaborative planning, and curriculum are important factors influencing the success of inclusion (Bennett et al., 1997). In addition, research has indicated that staffing, class size, number of children with disabilities, and the nature and quality of a child's disability are also significant factors in successful programs (Young, Marsland, & Zigler, 1997). A 1996 survey conducted by Scruggs & Mastropieri (Bennett et al., 1997) found that two thirds of the teachers surveyed supported the concept of inclusion. However, only 25-33 percent said they had sufficient time, training, and resources to implement inclusive practices successfully.

It is no wonder that there is such widespread concern among the majority of the teachers surveyed. Historically, early childhood programs have been designed for children without developmental delays or disabilities. Most schools expect four-year-olds to follow directions, use words to express simple needs and ideas, wait their turn, and toilet independently. Now, teachers are seeing children who are not toilet trained; do not play appropriately, obey the teacher, or follow directions; and have inadequate language skills to express their needs. Staff members will need to add a new repertoire of skills if they are to work effectively with this new population. These skills should include an understanding of screening, evaluation and use of standardized tests; parent communication; and more individualized instructional methods.

"Screening is the process of collecting data to decide whether more intensive assessment is necessary" (Salvia & Ysseldyke, 1995, p. 9). Screenings are brief. A child with a suspected disability should be observed carefully by staff who focus on the way the child performs or behaves in the classroom and how he or she interacts with adults, other children, and materials. Ask yourself these questions: Can the child use words to express his or her ideas and needs? Does he or she seem to understand directions? How does he or she play with other children? Does he or she wander aimlessly around the classroom when not directly involved with a teacher? If a teacher suspects a disability, it becomes the school's responsibility to inform the child's parents and recommend an evaluation.

An evaluation is suggested when the results of a screening indicate that more information is required to determine a child's need for special education and/or related services. Federal regulations entitle children with suspected disabilities to a free, multidisciplinary evaluation. As defined in IDEA, an evaluation consists of an assessment of the child's performance across all major domains of development—physical, emotional, cognitive, and social. This evaluation will determine whether a child has a disability and the nature and extent of special education and/or related services needed. In addition, the instruments used in an evaluation must be reliable and valid (NAEYC, 1991) and administered in the child's native language or other mode of communication.

Federal regulations clearly state that an evaluation must include information provided by the parent about the child. Therefore, parents must give their consent before an evaluation is conducted. If a parent refuses consent, the local education agency may choose to pursue the process legally.

After an evaluation has been performed, the team reviews the results of all tests to determine the child’s eligibility to receive special education and/or related services. Eligibility requirements are broadly outlined in IDEA and more specifically detailed in the legislation passed in each state. Evaluation results must be shared with the parents in the form of a written report. This report becomes the IEP which, as stated above, describes a child's current level of functioning, placement in necessary services, and long-term and short-term goals.

Testing Concerns
Early childhood educators need to be aware of the problems associated with testing preschoolers. Young children are often uncooperative with unfamiliar adults in unfamiliar settings; they are not always motivated to try and may not have the required attention span to sit through the testing procedures, or have the language skills to respond. Bronfenbrenner (1974) and NAEYC (1991) clearly caution against placing a child in artificial environments for assessment. While federal and state regulations may require the use of standardized tests, they should always be combined with information about a child's behavior in natural environments (home and school), as reported by primary caregivers such as parents and teachers.

Parental Involvement
Parental involvement encompasses a broad spectrum of activities which range from volunteering in the classroom to formal or informal contacts with the teacher to being available for the child at home (Workman & Gage, 1997). Bronfenbrenner argues that strategies which incorporate parent involvement are more effective in improving children's performance (Bennett et al., 1997). The crucial phase for laying the groundwork for on-going dialogue with parents and sharing in the remedial work is at the beginning. However, it is also the most difficult and sensitive phase for staff and parents to negotiate.

When the teacher and director are in accord about a child's behavior, a conference with the parents needs to be scheduled. Intense reactions to a suggestion that a child may have a developmental delay and/or a disability can almost always be expected. It is important to remember that the psychological preparation for the birth of a child always involves the wish for a perfect child. Parental expectations and fantasies about their child and family are threatened by the suggestion that their child may have a disability (Bloch, 1978; Bloch & Seitz, 1989; Spiegle-Mariska & Harper-Whalen, 1991).

When the discrepancy between a parent’s wish and the reality is too great, the recognition of a disability can be overwhelming. Parental reaction to the possibility of a problem may trigger grief, anxiety, and anger. If handled inappropriately, parents’ reactions may interfere with their ability to process information or take the necessary steps toward addressing the problem. Such awareness will influence the manner in which the conference proceeds.

Try to focus on observable behaviors—how the child behaves in the classroom setting and the child's talents, strengths, or charms. At the same time, it is important to focus on the way his or her behavior is different from that of other children the same age. It is a good idea to obtain information about the child's functioning at home and in other community settings. Is this information in agreement with the classroom observations? It is necessary at this time to avoid a discussion of the causes for the disability and how the disability will affect a child’s future. Discussion of such matters is inappropriate and premature and may only serve to frighten or alienate parents.

Generally, early childhood educators will encounter three types of children. Child #1 is developing typically; there is no need for further evaluation. Child #2 has not mastered the milestones other children his or her age have. He or she may have interfering behaviors that hinder his or her ability to participate in learning situations (Bloch, 1987; Bloch, Hicks, & Friedman, 1995). Child #3 is a puzzle. No one is sure what is going on. An evaluation would be recommended for child #2 and child #3.

Similarly, parents exhibit behaviors and reactions which can fit into a particular category. Some parents suspect something is just not right about their child, but they do not want to face their worries or share their concerns with anyone. A teacher's voiced and specific concerns may be a relief and a response to their own nagging doubts. In all likelihood, these parents will accept the recommendation for an evaluation of their child. Another group of parents aren't really sure there is a problem. They are responsive to the teacher's concerns, but they may want to use a "wait and see" approach. There are also parents who don't seem concerned about their child's development. In fact, when the teacher expresses his or her concerns, the parents may become angry, accuse the school of mishandling their child, deny there is a problem, and refuse to take their child for an evaluation. These parents may even threaten to pull their child out of the program.

With the latter two groups of parents, it is possible to take a pro-active approach without confrontation. The teacher's job is not finished even if the parents do not want to schedule an evaluation. In such instances, the anxiety, fear, or denial is so powerful that the parents need more time to consider the teacher's concerns. A three-month observation period can be planned, so that both the teacher and parents can observe specific behaviors at home and school. At the end of this time, they need to meet again and share judgments regarding specific skills. This approach accomplishes a few things. First of all, the teacher is not challenging the parents. Instead, he or she is setting the stage for home/school partnerships and collaboration. In addition, he or she is recognizing parents’ expertise in matters pertaining to their own child and demonstrating respect for that capability. A focus on observed performance also gives the parents direction at a point of emotional turmoil (Bloch & Seitz, 1989).

Let's say the teacher observes a three-year-old child who:

  • has a limited vocabulary and is not yet using "20-50 words" (a skill which should be mastered by a two-year-old child)
  • "requires prompting in order to use language he/she is capable of producing"
  • "takes an unusually long time to understand and respond to what is said" (Bloch, 1987).

Over the next three months, the teacher and parents would observe the intensity and frequency of these behaviors. They would each keep a list of the words used by the child. The parents would then meet with the teacher again to discuss their observations. At this time, the teacher could present his or her recommendation that the child undergo an evaluation.

There is no doubt that including a child with disabilities in a child care setting is a challenging task. Questions about how a child with disabilities can be integrated into the classroom; how staff will meet the demands of all children and a child with disabilities; and how other parents will react to the inclusion of a child with disabilities into a classroom of typically developing children can be overwhelming. But with an increased understanding of the issues, inclusion can work. Everyone can reap the rewards associated with helping a child with special needs conquer his or her disabilities. The staff’s new knowledge and skills will also enhance the quality of the program offered to all children.

Judith S. Bloch, ACSW, is founder of Variety Pre-Schoolers Workshop (VPSW). Established in 1966, VPSW was one of the first preschools on the eastern seaboard to identify and educate youngsters with serious learning, language, and/or behavior problems. She is also the author of The Five P’s (Parent/Professional Preschool Performance Profile) System.

Janice L. Friedman, M.A., is supervisor of Research and Information Management Services at Variety Pre-Schoolers Workshop in Syosset, NY.

The Five P’s

The Five P’s (Parent/Professional Preschool Performance Profile),an assessment instrument for young children with learning, language, or behavior problems, was developed by Judith S. Bloch at Variety Pre-Schooler’s Workshop (VPSW). It relies on shared and compared parent and teacher rating judgments of observed behavior of the child on 458 developmental milestones and interfering behaviors across all domains of development. The Five P’s was favorably reviewed in Buro’s Instititute’s The Tenth Mental Measurements Yearbook (1989) and The Thirteenth Mental Measurements Yearbook (1998).

The Five P’s is a reliable and valid instrument. National studies to support the reliability and validity of the instrument have been completed. A national normalization study to develop norms for The Five P’s began in 1990. Preliminary norms based on ratings from more than 460 teachers and parents yield age-equivalent scores. Data collection is ongoing and will be used to update norms periodically.


Bennett, T., Deluca, D., & Bruns, D. (1997, Fall). Putting inclusion into practice: Perspectives of teachers and parents. Exceptional Children, 64:1, 115-131.

Bloch, J. (1978, November/December). Impaired children: Helping families through the critical period of first identification. Children Today, 7:6, 1-6.

Bloch, J.S. (1987). The five p's: Parent/professional preschool performance profile. Syosset, NY: Variety Pre-Schooler's Workshop.

Bloch, J.S., Hicks, J.S., & Friedman, J.L. (1995). The five p's (parent/professional preschool performance profile) comprehensive manual. 2nd edition. Syosset, NY: Variety Pre-Schooler's Workshop.

Bloch, J.S., & Seitz, M. (1989, July). Parents as assessors of children: A collaborative approach to helping. Social Work in Education, 11:4, 226-244.

Bronfenbrenner, U. (1974). Developmental research, public policy, and the ecology of childhood. Child Development, 45, 1-5.

Janko, S., Schwartz, I., Sandall, S., Anderson, K., & Cottam, C. (1997). Beyond microsystems: Unanticipated lessons about the meaning of inclusion. Topics in Early Childhood Special Education, 17:3, 286-306.

Johnson, L.J. (1994). Challenges facing early intervention: An overview. In L. Johnson, R.J. Gallagher, M. La Montagne, J. Jordan, J. Gallagher, P. Hutinger, & M. Karnes (Eds.) Meeting early intervention challenges: Issues from birth to three. 2nd edition (pp. 1-12). Baltimore: Paul H. Brookes Publishing Company.

MacMillan, D.L., Gresham, F.M., & Forness, S.R. (1996). Full inclusion: An empirical perspective. Behavioral Disorders, 21:2, 145-159.

McDonnell, A.P., Brownell, K., & Wolery, M. (1997). Teaching experience and specialist support: A survey of preschool teachers employed in programs accredited by NAEYC. Topics in Early Childhood Special Education, 17:3, 263-285.

National Association for the Education of Young Children (NAEYC). (1991, March). Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children, 46:3, 21-38.

Salvia, J., & Ysseldyke, J. (1995). Assessment(Sixth Edition). Boston: Houghton Mifflin Company.

Scruggs, T.E. & Mastropieri, M.A. (1996, Fall). Teacher perceptions of mainstreaming/inclusion, 1958-1995: A research synthesis. Exceptional Children, 63:1, 59-74.

Spiegle-Mariska, J. & Harper-Whalen, S. (1991). Forging partnerships with families. Missoula, MT: Montana University, Division of Educational Research & Services.

University of the State of New York State Education Department (1997, June). Least restrictive environment. Albany, NY: The New York State Education Department.

Workman, S.H., & Gage, J.A. (1997). Family-school partnerships: A family strengths approach. Young Children, 52:4, 10-14.

Young, K.T., Marsland, K.W., & Zigler, E. (1997, October). The regulatory status of center-based infant and toddler child care. American Journal of Orthopsychiatry, 67:4, 535-544.