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Project Head Start 




Mainstreaming Preschoolers: 

Children with 


DHEW Publication No. (OHDS) 78-31115 

U.S. Department of Health, Education, and Welfare 

Office of Human Development Services 
Administration for Children, Youth and Families 
Head Start Bureau 

Special Message to Parents 

This book is meant to help parents as 
well as teachers understand main- 
streaming and emotional disturbance. 
Chapter 3 describes specific ways in 
which parents can help their emotion- 
ally disturbed child. But parents will 
find the other chapters useful in learn- 
ing more about development in emo- 
tionally disturbed youngsters, tech- 
niques and activities to promote learn- 
ing, how Head Start functions in serv- 
ing handicapped children, and what 
resources outside of Head Start are 
available to help fill their child's spe- 
cial needs. 

This series on Mainstreaming Preschoolers was developed by the staff of CRC Education and Human Development, 
Inc., a subsidiary of Contract Research Corporation, 25 Flanders Road, Belmont. Massachusetts 02178. under Con- 
tract No. HEW 10.5-76-1139 for the Administration for Children, Youth and Families. 

For sale by the Superintendent of Documents, U.S. Government Printing Oflice 
Washington, D.C. 20402 

Stock Number 017-092-00036-7 

Mainstreaming Preschoolers: 

Children with 



A Guide for Teachers, Parents, 
and Others Who Work with 
Emotionally Disturbed Preschoolers 


Miriam G. Lasher 

Instructor, Department of Child Study, Tufts University, and Education Director 
of Preschool Unit, Cambridge-Somerville Mental Health and Retardation Center, 
Cambridge, Massachusetts 

Use Mattick 

Associate Professor, Early Childhood Education Coordinator, Therapeutic Tutoring 
Program, Children with Special Needs in the Family and Clinic, Wheelock College 

Frances J. Perkins 

Associate Professor in Psychology, Wheelock College 

AMERiCAN royf(5W19»if OR THE BLIND, li^C. 

and Irr -mf^ Y loea- ' 

Caren Saaz von Hippel, Ph.D. 

Director of Research and Evaluation, CRC Education and Human Development, 
Inc., Contract Research Corporation 

Linda Gaines Hailey, M.Ed. 

Research Associate, CRC Education and Human Development, Inc., Contract 
Research Corporation 

The authors were fortunate in being able to draw on the advice and contribu- 
tions of many knowledgeable and talented people during the preparation of this 
book. Chief among them were the following experts on emotional disturbance and 
early childhood education, who reviewed the text in its successive versions and 
gave us many excellent suggestions for improving it: 


Albert H. Fink, Ph.D., Associate Professor, Coordinator of Programs of Behavior 

Disorders, Indiana University 
Morris Stambler, M.D., Director, Baycove Day Center for Children, Tufts-New 

England Medical Center, Boston, Massachusetts 
Gloria S. Wrenn, M.A., Coordinator of Handicap Services, WAGES Head Start, 

Golds boro. North Carolina 

A number of people assisted us in different ways with certain sections of this 
book. We thank them for their valuable help. 

Joyce Evans, Ph.D., Director, Division of Special Projects, Southwest Education 
Development Laboratory, Austin, Tbxas 

Alice H. Hayden, Ph.D., Director, Model Preschool Center for Handicapped Chil- 
dren, Child Development and Mental Fletardation Center, University of Washing- 

Shari Kieran, Ed.D., Lecturer, Eliot-Pearson Department of Child Study, Tufts 

Jacqueline Liebergott, Ph.D., Associate Professor, Department of Communication 
Disorders, Emerson College 

Sheldon Maron, Ph.D., Assistant Professor of Special Education, Department of 
Special Education, Florida State University 

Ra3anond Schimmer, M.A.T., Assistant Director of Baycove Day Center for Chil- 
dren, Tufts-New England Medical Center, Boston, Massachusetts 

Judith Siegel, M.S., Coordinator, Rhode Island Child Find/Placement/Service Pro- 

Janet Zeller, M.S., Supervisor and Instructor, Graduate Special Needs Program, 
Wheelock College. 

Much of the credit for the success of this book is due to the team responsible 
for the visual and stylistic aspects. Their creative efforts were essential, and we 
are very grateful. The skill and enthusiasm of the production staff, on which we 
have relied so frequently in the past, were demonstrated even more impressively 
in this difficult and complex effort. 

CRC Education and Human Development, Inc. 

Editor: Nancy Witting 

Graphic Design Unit: Kristina Engstrom, Sandra Baer, Linda HaUey 

Designer: Alison Wampler 

Photographer: Harriet Klebanoff 

Illustrator: Stephanie Fleischer 

Contract Research Corporation 

Production Staff: Barbara Boris, Mary Tfess Crotty, Kelly Gerry, Barbara 

In addition, we wish to thank the associations of the National Advisory Board 
to this project who reviewed our book during its development. They made many 
valuable suggestions. 

American Association of Psychiatric Services for Children; American Physical 
Therapy Association; American Psychological Association; National Society 
for Autistic Children. 

We are grateful to the Resource Access Projects and the Regional Office 
staff of the Administration for Children, Youth and Famihes for their review of 
this book and their help in organizing the national field test. We also thank the 
teachers, aides, parents, trainers, directors, and others in the 40 Head Start 
programs across the country who field tested this book and provided invalu- 
able feedback. We thank as well the Head Start and other preschool programs 
who permitted us to take photographs at their centers. 

Finally, we have special thanks to Mrs. Rossie Kelly, the Project Officer, 
and Raymond C. Collins, Chief of the Program Development and Innovation 
Division, Head Start Bureau, for their continued commitment and support dur- 
ing this project. Rossie Kelly's involvement throughout the project, in discus- 
sions, coordination of reviews of this book among Program Development and 
Innovation staff, and continued receptiveness and helpfulness required to com- 
plete a project of this scope were essential. In addition, we thank the following 
persons for their interest, involvement, and review of this book during its vari- 
ous developmental stages: Pamela Coughhn, Ph.D.; Laura Dittman, Ph.D.; 
Jenni Klein, Ed.D.; Jerry Lapides, Ed.S.; Ann O'Keefe, Ed.D.; Margaret G. 
Phillips, Ed.D.; and Linda Randolph, M.D. 

Caren von Hippel 
Linda Hailey 
Miriam Lasher 
Use Mattick 
Frances Perkins 


Project Head Start was initially conceived and launched as a national program 
of comprehensive developmental services for preschool children from low-income 
families. The early design also indicated that the comprehensive program should be 
tailored to the needs of the individual community and of the individual child. 

The Head Start Program Performance Standards require local programs to 
develop an educational plan that provides procedures for ongoing observation, 
recordmg, and evaluation of each child's growth and development for the purpose 
of planning activities to suit individual needs. The Performance Standards also 
require that classroom materials and activities reflect the cultural backgroimd of 
the children. Thus, individualization has always been a major thrust of the Head 
Start program. 

The Congressional mandate to assure that not less than 10 percent of enroll- 
ment opportunities in Head Start be available for handicapped children presented 
special opportunities and challenges to Head Start programs to further their 
efforts in the individualization of services. Head Start classes are small, rnaking it 
possible for teachers, worldng with a professional diagnostic team, to design a pro- 
gram to meet the special needs and capabilities of each child. 

Mainstreaming handicapped children into classrooms with non-handicapped 
children has become a major activity for Head Start. However, teachers and 
other staff are continually asking for assistance in mainstreaming a child with a 
specific handicapping condition. This series of eight manuals, Mainstreaming Pre- 
schoolers, was prepared by ACYF to help meet this need. 

The series was developed through extensive collaboration with many persons 
and organizations. Under contract with Contract Research Corporation, teams of 
national experts and Head Start teachers came together to develop each of the 
manuals. At the same time, the major national professional and voluntary associa- 
tions concerned with handicapped children were asked to critique the materials 
during their various stages of development. Their response was enthusiastic. Vari- 
ous f^eral agencies concerned with handicapped persons — the Bureau of Educa- 
tion for the Handicapped, the President's Committee on Mental Retardation, the 
Office of Developmental Disabilities, the National Institute of Mental Health, the 
Office of Handicapped Individuals, National Institute of Child Health and Human 
Development/National Institute of Health, and Medicaid/Early and Periodic 
Screening, Diagnosis, and Treatment — also enthusiastically reviewed the mate- 
rials as they were being developed. Finally, drafts of each of the manuals were 
reviewed by teachers, paraprofessionals, parents, social service and health person- 
nel, and various other specialists in Heaa Start programs across the country. 

It is hoped that this series will be helpful to the variety of people beyond the 
Head Start community — in public schools, day care centers, nursery schools, and 
other child care programs — who are involved in providing educational opportuni- 
ties and learning experiences to handicapped children during the preschool years. 

Blandina Cardenas, EdD. 
Administration for 
Children, Youth and Families 


Introduction 2 

Chapter 1: What Is Mainstreaming? 3 

What Does Mainstreaming Mean? 4 

How Is Mainstreaming Carried Out? 6 

What Is Your Role in Mainstreaming? 7 

Chapter 2: Where to Find Help in Your Area 9 

Finding Out About Resources 10 

Who Are the Specialists? What Do They Do? 18 

Chapter 3: Parents and Tkachers as Partners 21 

What Parents Can Do 23 

What Teachers CanDo 27 

Chapter 4: What Is Emotional Disturbance? 31 

How Is Emotional Disturbance Defined? 33 

Recognizing Problems for Referral 41 

Chapter 5: How Emotional Disturbance Affects Learning in 

Three- to Five-Year-Olds 45 

Children Whose Behavior Is Withdrawn 46 

Children Who Behave Anxiously 50 

Children Who Behave Aggressively 53 

Children Who Behave Hyperactively 57 

Children Whose Behavior Is Psychotic 59 

Medication 64 

Chapter 6: Mainstreaming Children with Emotional Disturbance 69 

Planning 70 

The Physical Setting and Classroom Facilities 80 

General Teaching Guidelines 82 

Techniques and Activities 90 

Chapter 7: Other Sources of Help 125 

Professional and Parent Associations, and Other Organizations 126 

Bibliography 133 

Appendix 137 

Screening and Diagnosis 138 

Chart of Normal Development: Infancy to Six Years of Age 141 


The Purpose of This Book 

This book was written for teachers, 
parents, and others who live with or 
work directly with emotionally dis- 
turbed preschoolers. It provides useful 
ideas for helping emotionally disturbed 
children learn and feel good about 
themselves, and answers many ques- 
tions, including: 

What is mainstreaming? 

What is emotional disturbance? 

How does emotional disturbance eiffect 
learning in three- to five-year-olds? 

How can you design an individualized 
program for a disturbed child? 

What activities are especially useful for 
disturbed children? 

How can parents help their disturbed 

Where can you go to seek help — peo- 
ple, places, and information? 

The Organization of This Book 

This is one of a series of eight books 
on children with handicaps, written for 
Head Start, day care, nursery school 
and other preschool staff, and parents 
of children with special needs. Each 
book is concemea with one handicap- 
ping condition. The other seven books 

• health impairments 

• hearing impairment 

• learning disabilities 

• mental retardation 

• orthopedic (physical) handicaps 

• speech and language impairments 
(communication disorders) 

• visufd handicaps. 

There are certain guidelines that are 
similar in working with all handicapped 

Preschoolers. These guidelines should 
e useful to teachers and parents who 
are directly involved with children with 
special needs. They are described in the 
chapters "What Is Mainstreaming?" 
"Parents and Tbachers as Partners," 
"Where to Find Help in Yoiir Area," 
and the sections on planning, the physi- 
cal setting, and general teaching guide- 
lines in the chapter "Mainstreaming 
Children with Emotional Disturbance." 
While these chapters (or sections of 
chapters) are largely the same in most 
of tne books in this series, the examples 
and suggestions provided in each book 
are specific, and will help you apply the 
general information to a child with a 
particular handicap. 

A Word on Words 

In this book the terms handicapped 
children and children with special needs 

mean the same thing. 

Chapter 1: 




Definite steps must be 
taken to ensure that 
handicapped children par- 
ticipate actively and fully 
in classroom activities. 

What Does 



"Mainstreaming" means helping 
people with handicaps live, learn, and 
work in typical settings where they will 
have the greatest opportunity to 
become as independent as possible. In 
Head Start programs, mainstreaming is 
defined as the integration of handi- 
capped children and non-handicapped 
children in the same classroom. It gives 
handicapped children the chance to join 
in the "mainstream of life" by including 
them in a regular preschool experience, 
and gives non-handicapped children the 
opportunity to learn and grow by expe- 
riencing the strengths and weaknesses 
of their handicapped friends. 

However, mainstreaming does not 
simply involve enrolling handicapped 
children in a program with non- 
handicapped children. Definite steps 
must be taken to ensure that handi- 
capped children participate actively and 
fully in classroom activities. As a Head 
Start teacher, it is your role to take 
these steps. 

Mainstreaming is not new to Head 
Start. Since its beginning. Head Start 
programs have included handicapped 
children in classrooms with non- 
handicapped children. The Economic 
Opportunity Amendments of 1972 
(PubUc Law 92-424) required that ten 
percent of the Head Start enrollment in 
the nation be handicapped children. 
Two years later, the Headstart, Eco- 
nomic Opportunity, and Community 
Partnership Act of 1974 required that, 
by fiscal year 1976, not less than ten 
percent of the total number of enroll- 
ment opportunities in Head Start pro- 
grams in each state be available to 
handicapped children. And most 
recently, Public Law 94-142, the Educa- 
tion for All Handicapped Children Act, 
has mandated that the public schools 

provide "free, appropriate education" in 
the "least restrictive setting" for handi- 
capped children from 3 to 21 years of 
age. Thus, mainstreaming has become 
an important and well-accepted 
approach in the education of young 
handicapped children. 

It is the function of Head Start pro- 
grams to: 

serve hfindicapped children in an 
integrated setting or mainstream 
environment with other children; 
provide for the spedal needs of the 
handicapped child; and work closely 
with other agencies and organiza- 
tions serving handicapped children 
in order to identify handicapped 
children, £ind provide the full range 
of services necessary to meet the 
child's developmental needs. 

(Head Start Transmittal Notice 75.11 - 9/11/75.) 

Research has shown over and over 
that the early years of hfe are critical 
for learning and growth. It is during 
this time that children's cognitive, 
communicative, social, and emotional 
development can be most influenced. 
If special needs are recognized and 
met during these years, handicapped 
children will have a much better 
chance of becoming competent and 
independent adults. Handicapped 
youngsters who are given the oppor- 
tunity to play with other children in 
the Head Start classroom learn more 
about themselves and about how to 
cope with the give-and-take of every- 
day Ufe. This is one of the first steps 
toward developing independence. By 
participating in regular preschool set- 
tings tnat are able to provide for spe- 
cial needs, with teachers who know 
how to adapt teaching techniques and 
activities, children with special needs 
will truly have a "head start" in 
achieving their fullest potential. 

Benefits of 

There are many benefits to main- 
streaming — benefits that affect both 
handicapped and non-handicapped 
children, as well as their parents and 

Mainstreaming Helps 
Handicapped Children 

Participating in a mainstream class- 
room as a welcome member of the class 
teaches children with special needs self- 
reliance and helps them master new 
skills. For some, it may be the first 
time in their lives that they are 
expected to do for themselves the 
things they are capable of doing. Work- 
ing and playing with other children 
encourages handicapped children to 
strive for greater achievements. Work- 
ing toward greater achievements helps 
them develop a healthy and positive 
self -concept. 

Attendance in a preschool program 
provides a way for oiscovering 
undiagnosed handicaps. Some handi- 
caps don't become evident until after a 
child enters elementary school, and by 
then much important learning time has 
been lost. A preschool teacher is able to 
observe and compare many children of 
the same age, which makes it easier to 
spot problems that may signal a handi- 
cap. Preschool may therefore be the 
first chance some children get to 
receive the services they need. 

Mainstreaming Helps 



Mainstreaming can help non- 
handicapped children, too. They learn 
to accept and be comfortable with indi- 
vidual differences among people. Stud- 
ies have shown that children s attitudes 
toward handicapped children can 
become more positive when they have 
the opportunity to play together regu- 
larly. They learn that handicapped chil- 
dren, just like themselves, can do some 
things better than others. In a main- 
stream classroom, they have the oppor- 
tunity to make friends with many (Af- 
ferent individuals. 

How Is 

Carried Out? 

Mainstreaming can be carried out in 
a variety of ways. How you decide to 
mainstream a particular handicapped 
child will depend upon the child's 
strengths, weaknesses, and needs, and 
wiQ also depend upon the parents, the 
staff and resources within your pro- 
gram, and the resources within your 
community. As you know, every child 
is an individual with different needs 
and abilities. This is just as true for 
handicapped children: they display a 
broad range of behavior and a Dili ties. 

Some handicapped children may 
thrive in a full-day program with non- 
handicapped children. Others will do 
best in a mainstream environment for 
only part of the time, attending special 
classes or staying at home for the rest 
of the day. For still others, mainstream- 
ing may not be the most helpful 
approach. The principle to follow is that 
handicapped children should be placed 
in the least restrictive environment. 
This means that the preschool experi- 
ences of handicapped children should be 
as close as possible to those of non- 
handicapped children, while still meet- 
ing the special needs created by their 

As you and your program staff get 
to know each child, and as you work 
with the child's parents and specialists 
in your community's agencies and pub- 
lic schools, you will be able to decide 
what is best for each child. This book 
describes how mainstreaming can be 
carried out by the parent/Head Start/ 
specialist team in order to provide the 
best program for both handicapped and 
non-handicapped children. 

This book also discusses different 
kinds of handicapping conditions 
broadly known as emotional distur- 
bance, and describes the functioning of 
emotionally disturbed children in the 
major skill areas. 

Finally, the book describes how you 
can provide mainstreaming experiences 
for emotionally disturbed clularen. 
Mainstreaming children who are dis- 
turbed can be a challenging yet reward- 
ing experience for you, and extremely 
beneficial to the disturbed children. 
Even children with severe emotional 
problems can profit from: 

• the warm and caring atmosphere 
of your classroom 

• the structure of a routine super- 
vised by concerned adults 

• the interaction with non- 
handicapped children of the same 

Mainstream experiences can help dis- 
turbed children to learn about and bet- 
ter understand themselves and the 
world around them. 

What Is 
Your Role in 

This book approaches mainstream- 
ing from the standpoint of child devel- 
opment. It emphasizes the importance 
of seeing handicapped children first and 
foremost as children, with the same 
needs all children have for love, accep- 
tance, exploration, and a sense of com- 
petence. By understanding how all chil- 
dren develop and learn you can better 
understand the effects of a particular 
handicapping condition. For example, 
knowing the importance of feeling trust 
and self-confidence will help you under- 
stand the effects of emotional distui-- 
bance on a child's development. You 
can then use this knowledge to plan 
appropriate activities for building on 
the child's strengths and working on 
his or her weaknesses. 

The teaching techniques and activi- 
ties provided in this book are designed 
to help develop skills in particular areas 
of development — motor, social, cogni- 
tive, language and speech, and self- 
help — and can be used with any child 
or group of children in your classroom, 
whether they are handicapped or non- 

As a teacher, your role in main- 
streaming includes: 

• developing and putting into effect 
an individualized program that 
meets the needs of each child in 
the classroom, including the special 
needs of a child with a handicaph 
ping condition 

• working together with the parents 
of a handicapped child so that 
learning situations that occur in 
your classroom are reinforced by 
the pEirents at home 

• finding out, through your handicap 
coordinator or social services coor- 
dinator, what special services a 
handicapped child is receiving and 
how you can get a specialist to pro- 
vide information that can enhance 
yovu" classroom teaching 

• arranging referrals through yoiu- 
handicap coordinator or social serv- 
ices coordinator for diagnostic eval- 
uation, if you feel a child has a 
problem that has not been clearly 

In carrying out this role, there are 
many resources that can be tapped to 
assist you. Later in the book they wiU 
be described in more detail, but they 
are summarized on the following chart. 


Where to Go 
for Help 

There are many resources you can 
tap for help with a handicapped child. 
T^e advantage of these resources by 
actively seeking them out. For detailed 
information on Head Start and other 
resources in your area, see Chapter 2. 
For detailed information on national 
professional and parent associations 
and other organizations, and a list of 
helpful materials, see Chapter 7. 




Public schools 

Head Start staff 

Community agencies 
Colleges and universities 
Hospitals and clinics 
State Department of 

rw^ 1 

Child's parents 


Public school teachers 

of handicapped children 

Resource Access Projects 




with emotional 



State and federal agencies 
for the handicapped 
Professional associations 
Parent organizations 

Chapter 2: 

Where to 


Help in 

'Your Area 

Provision of services to 
handicapped children is 
not a solo effort. 

10 Head Start is a comprehensive child 
development program for all eligible 
children — handicapped and non- 
handicapped. It includes mainstream- 
ing experiences in the classroom; medi- 
cal, dental, mental health, and nutri- 
tion services; parent involvement; and 
social services. Ih strengthen services 
to handicapped children, Head Start 
programs are required to make everg 
effort to work with other programs and 
agencies that serve these children. This 
cooperation is essential. 

Provision of services to handi- 
capped children is not a solo effort. As 
you have already found out (or soon 
will), it requires the involvement and 
cooperation of many people with differ- 
ent kinds of skills and knowledge. You 
are the primary planner of the child's 
daily educational program and the per- 
son who is central in carrying it out. 
But it will help you and the child if 
you can identify and work with special- 
ists in your program and in your com- 
munity. You and the specialists can 
achieve more working as a team than 
as individuals. This chapter discusses 
how to find out about local or regional 
resources, what they provide, how you 
can make the most of what is avail- 
able, and the kinds of specialists you 
may meet as you work with handi- 
capped children. 

Out About 

Tb find out about resources, start by 
asking questions. Ask other teachers, 
your center director, and other program 
staff to recommend people who can 
answer your questions. You need some 
basic information about the kinds of 
support personnel available in your pro- 
gram. For example: 

• Is there a handicap coordinator, a 
mental health professional, or a 
health coordinator who is familar 
with emotional disturbance and 
disturbed children, and who can 
suggest materials, methods, and 
additional resources? 

• Is there an educational coordinator, 
a director of educational services, 
or another classroom teacher who 
can help you to make any changes 
in your program as needed by a 
disturb^ child? 

• Does the program have a social 
worker, a social services director, 
or a parent-involvement staff mem- 
ber who can help arrange contacts 
with the child's family and with 
resources outside the program? 

• Does your program have consul- 
tants, whether from public schools, 
nearby colleges or universities, 
community health or social serv- 
ices agencies, a state department 
of education, the State Develop- 
mental Disaljilities Council, or local 
chapters of national associations 
serving emotionally disturbed chil- 
dren? (For more information on 
national associations, see the sec- 
tion in Chapter 7 on professional 
and parent associations.) 

Head Start 



Certain components — social serv- 
ices, health services, educational serv- 
ices, handicap services, and parent 
involvement — are found in Head Start 
programs. Programs vary greatly, how- 
ever, in the number of staff members 
providing these services. 

In a given program, one person may 
be both the social services director and 
the parent involvement coordinator. In 
another program, several people may 
work in each component. These staff 
members may work part-time or full- 
time. They may be a part of your pro- 
gram or outside consultants to your 
program. Their job titles may vary. It 
often happens that people with the 
same title do different jobs, or that peo- 
ple with different titles do the same 
job. A job title only gives you a small 
clue. You will need to find out who does 
what, when, and where, and how you 
can get things going. 

Social Services 

Social services staff (whether a full- 
time director, a part-time social case- 
worker, or a community aide) usually 
coordinate contacts among a child's 
family, the Head Start program, and 
outside community resources. This per- 
son (or people) can help you put 
together a team of specialists to work 
with you and a disturbed child in your 
class. When needed, the teacher and 
the social services person work together 
to arrange referrals for children and 
families who need diagnosis and treat- 
ment. Social services staff oversee the 
foUow-up, too, making sure appoint- 
ments are made and coordinating serv- 
ices if several agencies are involved. It 
is important that you get information 
from the social services person about 
the kinds of services a child is receiv- 

The social services component is an 
extremely valuable resource to you in 
your efforts to provide handicapped 
children with a good education in a 
mainstream setting. 

Health Services 

The health services component of 
the Head Start program must include 
medical, dental, mental health, and 
nutritional services. The specialists who 
carry out these services may work on a 
full-time, part-time, or consultant basis. 
The person responsible for coordinating 
all these health services can draw upon 
a number of services outside of the pro- 
gram for diagnosis and treatment. This 
means they^can help you get health 
information or the services of special- 
ists for a child. For example, a speech- 
language pathologist may be called 
upon to assess a child's communication 
skills. An audiologist (hearing special- 
ist) may be recruited to assess a child's 
hearing. A mental health professional 
such as a psychologist can diagnose 
emotional disturbance. Other specialists 
such as a neurologist (nervous system 
specialist), an occupational therapist 
(activities specialist), a physical thera- 
pist (movement specialist), or an oto- 
laryngologist (ear, nose, and throat spe- 
cialist) may be consulted when neces- 

You will want to know who in your 
program is responsible for contacting 
and coordinating health service agen- 
cies, and what your relationship is with 
the agencies. What kinds of assistance 
can you expect from them? What con- 
ference arrangements are being made 
among team members? While some 
agencies are more accessible than 
others, all Head Start programs (no 
matter how large or small) havfe or will 
have access to these resources, either 
within the program or through outside 

Be sure that the parents are com- 
pletely informed of any plan for ser- 
vices for their child, and that they give 
their consent. 


12 Educational Services 

This component comprises all 
aspects of the educational program. All 
Head Start programs, however, should 
use the resources of local institutions of 
higher learning (junior colleges, colleges, 
universities, and University Affiliated 
Facilities) that are available to them. 

In many programs, the people who 
are responsible for educational services 
(including outside educational consul- 
tants) can provide guidance and advice 
to teachers in the classroom. This 
advice would include helping you to 
observe a child systematically, to 
assess a child's skills, and to develop 
and carry out an individualized educa- 
tion plan for a disturbed child. Your 
center's educational director should be 
able to help you tailor classroom activi- 
ties to meet each child's needs. 

Parent Involvement 

Parent involvement, a cornerstone 
of Head Start, encourages family par- 
ticipation in ail aspects of the program. 
Head Start believes that the gains 
made by a child in Head Start must be 
understood and built upon by the 
child's family and by the community, 
lb achieve parent involvement in a 
child's Head Start experiences, each 
program works toward increasing par- 
ents' understanding of their young 
child's needs and how to satisfy them. 
Project Head Start is based on the 
premise that successful parent involve- 
ment requires parents to participate in 
making decisions about the program 
and about the kinds of activities that 
are most helpful and important for 
their child. 

In some Head Start programs, the 
parent involvement component may be 
combined with social services. In 
others, it is a separate service. Regard- 
less of its place m the organization of 
your program, the people in this compo- 
nent are responsible for the coordina- 
tion of all activities that involve the 
child's family. 

You probably realize that the parent 
involvement component is especially 
important for families of handicapped 
children. Since they have lived witn the 
child you are trying to help, they know 
a great deal about their child's needs 
and strengths. The more the home and 
Head Start can exchange information 
and work together, the oetter the child 
will do in your class. 

Handicap Services 

A handicap coordinator is responsi- 
ble for supervising the mainstreaming 
of all handicapped children in the pro- 
gram. This person is usually famihar 
with special education methods and 
materials, and should be able to teach 
you how to use them in your classroom 
if you need help. 

Many Head Start programs have a 
close working relationship with the 
local school system. The local school 
system may pay for specialists to work 
with handicapped children. Under 1975 
federal legislation, Education for All 
Handicapped Children Act (Public Law 
94-142), local school districts must pro- 
vide a free public education to all handi- 
capped children from 3 to 21 years of 
age. Some states have their own special 
education laws, which require services 
for children from infancy to age five. 
You will want to learn as much as you 
can about these laws in your own state 
so that you can take advantage of the 
services. Your local public school direc- 
tor of special education is a good 
resource for such information. 

It is important for 
teachers and parents 
to exchange informa- 
tion on the child's 
needs and progress on 
a regular basis. 

One aspect of the Education for All 
Handicapped Children Act that con- 
cerns Head Start teachers and parents 
is its outreach component. Under the 
law, public school systems are required 
to demonstrate a practical methoa for 
identifjdng unserved and underserved 
handicapped children, so that they can 
receive the special services they need. 
Called Child Find, Child Search, or 
Child Identification in different states, 
the method varies from state to state. 
In some, it consists of an advertising 
campaign to let parents, teachers, and 
others know whom thev should contact 
if they suspect a child has a handicap 
that has not been recognized. In other 
states, there is a formal program of 
screening and diagnosis m addition to a 
public awareness campaign, lb take 
advantage of this service, which is your 
right under the law, call the director of 
sjiecial education in your local school 
system, the sujierintendent of schools 
in your town, or the special education 
section of your state's department of 

Since the Head Start program in 
many states enrolls children for whom 
the public school system is also respon- 
sible, the school district mav be able to 
provide many services for these chil- 
dren in your classroom, such as free 
diagnoses and specialists' services. The 
handicap coordinator should be in close 
contact with the public schools in your 
community, and should know all of the 
resources available and how to link up 
with them. 


1^ Who Knows About 
Resources and 

The staff person in your program 
who is responsible for handicap services 
may be the best person to contact to 
find out about resources and services. 
In your community, there are other 
people who can tell you what agencies 
or people provide the services you need 
for a handicapped child. 

The special education supervisor in 
your public school system is one person 
to contact for information about local 
resources. It is also a good idea to con- 
tact this person to alert the school sys- 
tem to the special needs of a child. 
After all, the child will probably be 
starting public school after leaving 
Head Start. 

Your local hospital may have a 
department called a child development 
unit, which deals with all sorts of devel- 
opmental problems in children. Some- 
times the hospitals have specialty 
clinics for children with particular 
health and developmental problems, 
including emotional disturbance. The 
services the clinics can offer will vary, 
depending on the staff and funds they 
have. But the hospital will often be able 
to suggest other resources for you to 

Some states have a University Affil- 
iated Facility, which provides direct 
services to handicapped children and 
their families. The address for this 
resource is given in Chapter 7, page 

The Resource Access Project (RAP) 
in your region should be contacted. 
RAPs are designed to link local Head 
Start staff with a variety of resources 
to meet the special needs of handi- 
capped children. They identify all possi- 
ble sources of training and technical 
assistance and enlist their support in 
helping Head Start programs find and 
serve handicapped chilc&en. The 
addresses of tne RAPs are given in 
Chapter 7, page 131. 

Parents of school-aged disturbed 
children are often very knowledgeable 
about the resources that can be tapped. 
Find out if your community has an 
organization for parents of disturbed 

How to Make the Most 
of Available Resources 

You can make the most of available 
resources by taking the following steps: 

1. Be Precise ' 

Be precise about the help you need. 
For people to be helpful, they have to 
understand exactly what you need. You 
may want to discuss your problem first 
with other Head Start teacners and 
specialists, so that you end up with a 
clear idea of what you need to know. 

2. Develop Objectives 

With your team of specialists, 
develop objectives about what each of 
you wants to achieve in working with a 
particular handicapped child. That is, 
know what you are aiming for so you . 
can plan activities to meet that aim, ' 
and so you will know when you have 
reached it. 

3. Agree on Responsibilities 

You and the specialists should work 
together to determine what you expect 
from one another. People sometimes 
start out with different expectations — 
such as who is responsible for working 
with the child (the specialist or the 
teacher), or who is responsible for 
checking on whether tne plan has 
worked. Responsibilities need to be 
spelled out so that an agreement can be 

4. Be Sure You Understand 

Advice and explanations that don't 
tell you specifically what you can do for 
the child in your classroom leave you 
as stranded as you were before. If you 
don't vmderstand, ask. Some specialists 
are used to saying things in compli- 
cated ways, and they need to be 
reminded to say them in plain English. 
Once you get the general idea, you will 
be able to develop activities on your 

5. Keep in Touch 

Feedback on both sides is very 
important. You need to know what the 
specialists are doing for the child and 
how the child is progressing. The spe- 
cialists need to Imow what the child is 
doing in your classroom and how the 
child is progressing. And everyone — 
the parents, the specialists, and you — 
needs to know what everyone else is 
doing, so that the services can be coor- 
dinated. Otherwise, two specialists 
could be providing the same services 
for a child — or even worse, no one 
could be providing them. 

Feedback won't happen by itself. 
Plan a schedule of contacts — meetings 
and phone calls are fine — and hold 
yourself and the specialists responsible 
for sticking to it. 

6. Consider Parents Specialists 

Try to work with parents in the 
same way that you work with special- 
ists. Some parents are sp)ecialists on 
their own cnild's needs, strengths, prob- 
lems, Hkes, and dislikes. Furthermore, 
like working with specialists, working 
with parents involves agreed-upon 
goals, knowing what each of you is 
doing, sharing information on how the 
child is progressing, and maintaining 
regular contact. 

7. Expect a Lot 

You will be working with a child 
who has problems that may be unfamil- 
iar to you, and for which there are no 
easy solutions. This means you need to 
expect a lot, both from yourself and 
from others hired to help a child with 
special needs. 

If you are going to get the most 
from resource persons both inside and 
outside your program, you need to be 
doing a great deal yourself. You need to 
identify what the child can currently do 
and what he or she is developmentaUy 
prepared to learn. At the same time, 
you win have to maintain a program 
that is good for all the children in the 

Expect a lot from the people your 
program has hired on a full-time, part- 
time, or consultant basis. Don't be 
impressed by their titles, backgrounds, 
or anything else except how helpful 
they really are to you, the handicapped 
child, and the child's family. 



Using Local 
Resources for 


• observes child 

• records information 

• develops questions 

• identifies where help 
is needed. 





Head Start 
for Referral 

• receives results 

• coordinates program 

• coordinates follow- 




Educational Services 
Handicap Services 
Health Services 
Parent Involvement 
'ocial Services 

• determines additional 
information needed 

• plans strategy for 
gathering information 

• provides, seeks, and 
coordinates services 

• makes referral to out- 
side agency. 

• observes child 

• notes information 

• develops questions 

• identifies where help 
is needed. 





k Psychologist 




Occupational therapist 






Physical therapist 

Social worker 



Colleges and universities 


National associations 

Public school personnel 

Resource Access Projects 

Social service agencies 

State department of 

University Affiliated 

• provide additional 
information and/or 

• recommend steps to 

Head Start 
for Referral 


▼ ▼ frc 

• processes referral 
reviews questions 

aws together infor- 
mation and resources 
from within program 


• translates information 
into educational activi- 

• carries out educational 

ssesses progress. 


translates information 

into home activities 

discusses educational 

plan with Head Start 


assesses progress. 

'' Who Are 
the Specialists? 

What Do 
They Do? 

This section describes the specialists 
emotionally disturbed children are most 
likely to need help from. Other special- 
ists who work with handicapped chil- 
dren are described in the section begin- 
ning on page 20. 

In addition to being skilled in the 
area of a specific handicap, specialists 
should be familiar with the needs of 
children from low-income and minority 
families. This familiarity may be an 
asset in: 

• providing a more complete and 
accurate diagnosis 

• identifying underlying environmen- 
tal factors that may contribute to 
the disturbance 

• helping you develop an appropriate 
and realistic individualized plan for 
the child. 


A psychologist conducts screen- 
ing, diagnosis, and treatment of 
people with social, emotional, 
psychological, behavioral, or 
developmental problems. There 
are many different kinds of psy- 

What Is Done 

Psychologists may ask chil- 
dren questions, observe them at 
play, ask the parents questions, 
and observe the children 
interacting with the parents. 
They may choose to administer 
standardized tests to assess 
children's problem-solving abili- 
ties and adaptive behavior (such 
as ability to use language, to 
play with others, and to do 
things independently). Psycholo- 
gists sometimes use play activi- 
ties to understand and treat chil- 
dren. At times they may want to 
talk with the whole farmly to 
help with problems they might 
have concerning a particular 
child. Psychologists can also help 
to decide what kinds of educa- 
tional programs and activities 
would oe best to improve 
children's problem-solving abili- 
ties and adaptive behavior. 

Psychologists are 
often called upon 
to observe and 
test young chil- 
dren with sus- 
pected emotional 




A pediatrician is a medical doc- 
tor who specializes in childhood 
diseases and problems, and in 
the health care of children. 

What Is Done 

A pediatrician can examine 
general health conditions to 
determine whether a child should 
spend a full day in your class- 
room and what activities are 
within the child's capabilities. 
Nutritional problems may be 
identified. Ii there are specific 
health problems, the pediatrician 
may prescribe medication, or 
may suggest another specialist. 


A psychiatrist is a medical doc- 
tor who conducts screening, 
diagnosis, and treatment of psy- 
chological, emotional, behav- 
ioral, and developmental or 
organic problems. Psychiatrists 
can prescribe medication. They 
generally do not administer 
tests. There are different kinds 
of psychiatrists. A child psychia- 
trist is a medical doctor who 
specializes in psychological/ 
behavioral and developmental 
problems of childhood. 

What Is Done 

A psychiatrist spends time 
talking or playing with a child. 
He or she may or may not 
interview the child's parents. 
While observing how the child 
relates to others, communicates, 
and plays, the psychiatrist is 
also alert for signs of some 
physical problem that might 
indicate a nervous system disor- 

A neurologist is a medical doc- 
tor who conducts screening, 
diagnosis, and treatment of 
brain and nervous system disor- 

What Is Done 

A neurologist performs a 
physical examination to deter- 
mine how the body gains infor- 
mation from the sense organs, 
and how it uses the muscular 
system to perform motor acts. 
He or she may do special tests 
such as lumbar punctures or 
electroencephalograms (EEGs). 
The EEG is used to determine 
abnormal patterns of activity in 
the brain. This test can help the 
neurologist decide whether the 
child's abnormal behavior is 
related to some underlying cen- 
tral nervous system condition. 


Other Specialists 

Below is a Kst of other spe- 
cialists who may work with 
handicapped and non- 
handicapped preschoolers. 

An Audiologist conducts 
screening and diagnosis of hear- 
ing problems and may recom- 
mend a hearing aid or suggest 
training approaches for people 
with hearing handicaps. 

A Dentist conducts screen- 
ing, diagnosis, and treatment of 
the teeth and gums. 

A Nutritionist evaluates a 
person's food habits and nutri- 
tional status. This specialist can 
provide advice about normal and 
therapeutic nutrition, and infor- 
mation about special feeding 
eqmpment and techniques to 
increase a person's self-feeding 

An Occupational Therapist 

evaluates and treats children 
who may have difficulty perform- 
ing self-care, play, or preschool- 
related activities. The aim is to 
promote self-sufficiency and inde- 
pendence in these areas. 

An Ophthalmologist is a 
medical doctor who diagnoses 
and treats diseases, injuries, or 
birth defects that affect vision. 
He or she may also conduct or 
supervise vision screening. 

An Optician assembles cor- 
rective lenses and frames. He or 
she will advise in the selection of 
frames and fit the lenses pre- 
scribed by the optometrist or 
ophthalmologist to the frames. 
An optician also fits contact 

An Optometrist examines the 
eyes and related structures to 
determine the presence of visual 
problems and/or eye diseases, 
and to evaluate a child's visual 

An Orthopedist is a medical 
doctor who conducts screening, 
diagnosis, and treatment of dis- 
eases and injuries to muscles, 
joints, and bones. 

An Otolaryngologist is a 
medical doctor who conducts 
screening, diagnosis, and treat- 
ment of ear, nose, and throat dis- 
orders. This specialist may also 
be known as an E.N.T. (ear, nose, 
and throat) doctor. 

A Physical Therapist evalu- 
ates and plans physical therapy 
programs. He or she directs 
activities for promoting self- 
sufficiency primarily related to 
gross motor skills such as walk- 
ing, sitting, and shifting position. 
He or she also helps people with 
special equipment used for mov- 
ing, such as wheelchairs, braces, 
and crutches. 

A Social Worker provides 
services for individuals and fami- 
lies experiencing a variety of 
emotional or social problems. 
This may include du^ect coimsel- 
ing of an individual, family, or 
group; advocacy; and consulta- 
tion with preschool programs, 
schools, clinics, or other social 

A Speech-Language Patholo- 
gist conducts screening, diagno- 
sis, and treatment of children 
and adults with communication 
disorders. This person may also 
be called a speech clinician or 
speech therapist. 

Chapter 3: 



Teachers as 


I ^IVi 

A joint family/teacher 
effort is essential for 
developing the best 
program for a child. 

22 One of Head Start's unique achieve- 

ments has been the involvement of par- 
ents in the education of their children. 
Parents are the primary educators of 
their children, and their involvement is 
the cornerstone of a successful Head 
Start program. This partnership is 
even more important in the education 
of a child who is handicapped, for the 
following reasons: 

• Parents know their children 's 
strengths and limitations better 
than anyone else. They can help a 
teacher understand and plan for 
their child. 

• A joint family/teacher effort is 
essential for developing the best 
program for a child and for 
ensuring that the child will benefit 
as much as possible from the Head 
Start experience. 

• Head Start may be the first pre- 
school experience the child and 
parents will participate in. Making 
it a successful experience will have 
positive effects on the child's 
school years to come. 

Parents as Decision-Makers 

Head Start has always considered 
parents important decision-makers for 
their child, because they are the main 
influence on the child's development. 
They are affected by the changes in 
their child that come about through 
your efforts, the efforts of specialists 
who provide services, and the experi- 
ence of mainstreaming. They should be 
called upon to reinforce what you are 
teaching in preschool if maximum 
progress is to be made. For all these 
reasons, it is important that the par- 
ents participate directly in what you 
are trying to accomplish with the child 
in the program. 

The direct involvement of parents in 
decisions affecting their child is essen- 
tial. They should decide with you what 
and how you teach their child, and 
what efforts they will make at home. 
They should participate in decisions 
involving formal assessment and diag- 
nosis of their child, and selection and 
arrangements for any special services 
that are needed. They snould be a part 
of any decisions that are made as a | 
result of evaluations of their child's j 
progress. ' 

One of the major areas in which par- 
ents are needed as decision-makers is in 
the development of an individualized 
education plan for their child. This plan 
is a written statement developed in 
meetings of the diagnostic team, the i 
parents, and the teacher. It spells out | 
the educational goals for the child, the i 
activities that take place in the class- 
room, the involvement of parents, the 
special services provided by other agen- 
cies, and details of the evaluation proce- 
dure. Parental consent is reqiiired oy 
law at two points: to give permission 
for the diagnostic process to take place, 
and to give permission to put into 
effect the individualized education plan 
that has been developed for the child. 
This requirement is intended to guaran- 
tee that parents have their rightful say 
in the education of their child. 

The rest of this chapter discusses 
specific ways in which parents can help 
in the education of their child, and pro- 
vides guidelines for teachers in working 
with the parents of handicapped chil- 

Can Do 




As parents, you are the first and 
most important educators of your child. 
You can help in your child's education 
in a number of ways, both at home and 
in the classroom. You can begin by tak- 
ing the following steps: 

1. Get to know your child's teacher. 
Share with the teacher information 
about the family and daily routines. 
This will help to give the teacher a bet- 
ter idea of how to help your child in 
daily tasks and in learning new skills 
and behaviors. 

^. Recognize that you have a tremen- 
dous influence on the growth and devel- 
opment of your child. What you do 
does make a difference. You can partici- 
pate in your child's learning in many 
ways: showing interest and pride in his 
or her accomplishments, selecting and 
demonstrating skills he or she needs to 
learn, offering encouragement and guid- 
ance when he or she meets with a diffi- 
cult task. 

O. Seek guidance from your child's 
teacher if you are not certain how to 
use everyday events at home as learn- 
ing experiences for your child. The 
teacher may be able to suggest specific 
activities you can do with your child to 
help him or her build necessary skills or 

4. Build on Head Start's firm com- 
mitment to a partnership between 
teachers and parents. You aren't alone 
in your efforts to help your child. You 
now have others who can help promote 
the well-being and development of your 
child: the teacher, other staff members 
in the program, agencies and public 
school resources in the community, and 
other parents. 


Help your child feel more comfortable in preschool by taking time to explain what the 
new situation will be like, and by accompanying him or her for a short time. 

24 The next section discusses how to 
prepare your child for the Head Start 
program, what to discuss with the 
child's teacher, and how to use every- 
day events in the home to foster your 
child's development. 

Preparing Your Child 

You can help both your child and 
the program staff by preparing the 
child for the Head Start program. Just 
before the start of class, Ibring your 
child to the Head Start center. Intro- 
duce yourself and the child to the 
teacher and other staff members. 
Encourage your child to explore the 
classroom and to plav with some of the 
materials. Try to make sure that the 
child has a good time during this visit. 

Some disturbed children will be fear- 
ful of leaving home, while others wiU be 
excited about meeting other children 
and learning new things. Sometimes a 
child will have both of these feelings at 
the same time. You and the teacher 
mav want to discuss whether it would 
be helpful to your child if you remain in 
the classroom during the first few days. 
At some point your child will feel com- 
fortable in the classroom without your 
being there. This takes more time for 
some children than for others. 

A little bit of home at preschool and 
a little bit of preschool at home go a 
long way toward helping children feel 
comfortable and secure. Perhaps at 
home you can hang some pictures of 
the classroom or the teacher. Or your 
youngster could be sent to class with a 
favorite toy or familiar object from 
home, to increase his or her feelings of 

Try to have your child arrive in 
class on time. Let the teacher know of 
important events at home that might 
influence the child's behavior in class. 
These special events may be happy 
times (such as birthdays, a family visi- 
tor, or a trip), or unhappy times (such 
as disruption in the family routine, ill- 
ness, or death). 

Understanding What 
Your Child 
Needs to Learn 

You may feel that you need help 
from the teacher in understanding the 
skill areas — such as language skills, 
motor skills, social skills, self-help skills 
— that your child has serious 
weaknesses in. Don't hesitate to 
approach the teacher for this help, or 
for help in figuring out wavs to use 
daily home activities to help build on 
the child's strengths and work on the 
child's problems. Try to talk frequently 
with the teacher in terms of specific 
skills or behaviors. Exchange sugges- 

Ask to see for yourself what the 
teacher does and how he or she does it 
in the classroom. You might even want 
to try practicing skills with your child 
in the classroom. Sometimes it is better 
for you to work with a child other than 
your own. But in either case it will give 
you practice and an opportimity to 
exchange ideas with tne teacher. 

Describe to the teacher an average 
day at home, in order to leam how you 
can use these ordinary events to work 
on the skills or behaviors the child is 
having problems with. 

As a parent, you can help your child become 
more patient, concentrate better on tasks, 
and develop self-confidence. 

Additional Effort 

All young children learn by having 
different experiences and by trying 
things out. This means that your child 
needs to be involved as much as possi- 
ble in daily activities at home, just like 
other children. If it's good for a non- 
handicapped child to help clean up after 
a meal, rather than rushing away from 
the table, then it's good for a disturbed 
child. Any task the child can perform 
can go a long way toward helping him 
or her build up self-confidence. 

You will wish to make some addi- 
tional efforts to help your child become 
appropriately involv^ in daily events. 
Children cannot be expected to learn 
new and better ways of acting by them- 
selves. Some children will need extra 
help to become actively involved in 
daily routines, while others may need 
extra help to calm down and become 
more purposeful in using their energy. 
Some children may need extra help in 
daily events that seem routine and sim- 
ple to others. For example, a bossy, 
threatening child may need extra help 
in forming and maintaining friendships 
with neighborhood children. Work out 
with the teacher what you can realisti- 
cally do, but recognize that extra effort 
is necessary. 

Home Activities 

Activities at home should be as 
enjoyable as possible for the child and 
for the family. Don't overburden your- 
self or your child. Ask the teacher to 
suggest things that can easily be built 
into the daily routine. If the sugges- 
tions are too hard to carry out, they 
may not get done. 

On the other hand, if you are willing 
to take a more active teaching role at 
home, ask for suggestions for extra 
things you can do. Talk with the 
teacher about what you Uke to do with 
your child and about what the child 
likes to do at home. Those activities 
can aU be learning opiwrtunities. 

If you would like some specific 
activities to do at home with your 
child, look over the activities in Chapter 
6. Remember, however, that you need 
not be a formal teacher for your child. 
Often the best way to help your child is 
to be loving and helpful, and to use the 
dailv routine as a way to teach the 

1. Using the Daily Routine 

Most of the things that you do at 
home can be used to help a child with 
special needs learn more about the 
world. For example, you can describe 
what you're doing when you prepare 
meals, set the table, or do the laundry. 
You can use bedtime to tell a happy 
story or recall a pleasant experience. 
You can use bath time to talk about 
feeling wet. You can give the child sim- 
ple chores, like putting the napkins by 
each plate, passing the cookies, putting 
clothes in the laundry basket. Don't 
expect the job to be done perfectly the 
first time, or even the second. With 
patience and affection you can help the 
child improve. 

Be reasonably consistent in what 
you ask your child to do. If you expect 
your child to sit at the table during 
mealtimes, then you should expect that 
at every meal (except, of course, during 
times of illness or other stress). 


26 Expensive toys or materials are not 
needed to help children learn. The kinds 
of things that are in all homes — pots 
and pans, socks, spoons, and magazine 
pictures — are all good teaching aids. 
Pots and pans can be used as rhythm 
instruments, can be stacked or nested, 
or can be sorted. Socks can be matched 
by color, counted, and folded together. 
Pictures can be named, or used to tell 

Most handicapped children need 
more, not less, stunulation from people 
around them. A good and simple way 
to achieve this is for you and other 
members of the familv to talk to the 
child about what you re doing as you 
do it, and to listen to and encourage 
your child to talk. It is very important 
to talk and listen to all children, partic- 
ularly disturbed children. However, 
some disturbed children easily become 
over-stimulated. These children need 
help in focusing their attention. 

Confusion and failure can result if 
you shower the child with too many 
activities. As you work with your child, 
you will recognize when the child has 
had enough. You can help the teachers 
recognize this limit, too. 

2. Fostering Independence 

Help your child become as independ- 
ent as possible. It's tempting for aU of 
us to do things for children that they 
could do on their own, since we can do 
them faster and better. But it is very 
important for handicapped children to 
learn to do as much as they can by 
themselves. Independence helps chil- 
dren feel good about themselves and 
improves their ability to get along with 

If your child is fearful about toilet- 
ing, for example, you may worry that 
he or she may have frequent "acci- 
dents" at preschool. You may even feel 
that you should put the child back into 
diapers. Doing so, however, is a disserv- 
ice to your cMld, who learns best about 
the world and daily routines by partici- 
pating firsthand. You might ask the 

teacher to suggest ways in which you 
can make toileting less fearful for your 
child so that eventually he or she can 
perform this routine without your assis- 

3. Praise and Encouragement 

We all benefit from honest praise — 
children as well as adults. Praise pro- 
gram staff honestly for their efforts 
with your child, and ask them for feed- 
back on your work with the child. 
Remember also to praise your child's 
achievements. For some children, even 
small tasks can take a lot of time to 
master. Every achievement — from 
learning to handle foods appropriately 
at mealtime to managing to spend an 
evening with a baby sitter without con- 
tinually crying or acting destructively 
— represents real progress and 
deserves real praise. 

Also, praise the child for trying, 
even if failure or mistakes result. Con- 
tinued effort is essential for children 
with special needs, who have many 
obstacles to overcome. Repeated, 
steady praise will help the child to keep 
on trying. 

It is important, however, that your 

E raise be honest, and that your child 
as done something to earn it. Dis- 
turbed children, just like other children, 
are very good at recognizing insincer- 
ity. If you praise your child at times 
when he or she has not been trying or 
has not mastered something, the 
yoimgster will be confused and wiU not 
understand what your expectations are. 

Ask the teacher to share assessment 
results with you. Everyone involved 
should understand how the child is 
functioning and share pleasure at the 
child's progress. 

Can Do 

for a 


Parents of children with special 
needs are as concerned about their chil- 
dren as any other parents, if not more 
so. One difference for parents of a dis- 
turbed child is that their child may not 
be as predictable as other children. This 
lack of predictability makes the child 
more difficult to plan for, to teach, and 
to live with. You may want to keep in 
mind the suggestions below as you talk 
with parents. 

Maintain regular contact with parents and 
provide them with helpful information. 

1. Establish and Maintain Contact 

Describe the Head Start program in 
detail, and invite the parents to observe 
and participate in the classroom. Work 
out the child's educational goals in con- 
ference with them. Review the child's 
short- and long-term goals with the par- 
ents at least every three months, or 
whenever needed. 

Although at least two home visits a 
year are required in Head Start pro- 
grams for all children, you may need to 
make more visits if a chUd is handi- 
capped. Maintain contact with the par- 
ents as often as you can. Visits, phone 
calls, notes, and sending children's proj- 
ects home with them can help parents 
see the skills their child is learning. As 
with any child, don't contact parents 
only when there is a problem. Ask 
yourself, as often as you have time, 
"What did the child do today or this 
week that shows some progress or 
enjoyment? How can I find time to tell 
the parents, along with everything else 
I have to do?" 

Some teachers and parents send a 
notebook back and forth each day or 
so. Tfeachers write a short note and 
send it home. Parents write one back 
for the chUd to take to preschool the 
next day. Other teachers and parents 
prefer to check with each other over the 
phone. The most useful way is usually 
the one that is most comfortable for 
the parents. 

2. Know the Family's Limits 

Everyone has a personal limit on 
how much he or she can do for a child 
in the classroom and at home. Get to 
know families well enough to under- 
stand these limits. Make sure that the 
suggestions you give them for working 
with their child can easily be included 
in their daily routine. For example, in 
families with several children, it may be 
difficult to spend a large amount of 
time alone with one child. Try to help 

Earents plan family activities that are 
enefici^ to both the disturbed child 
and other members of the family. 


28 3. Focus on the Child's Education 

Families of handicapped children 
may have all kinds of feelings about 
having a handicapped child. Some may 
feel angry, some guilty, and some 
embarrassed. Some may feel that they 
have a special responsibility to protect 
their child from all problems and frus- 
trations, and they may expect much 
less from the child than he or she is 
really capable of. They may need the 
help of a psychologist, a social worker, 
or a counselor in learning to accept and 
deal with these feelings. 

While you can be supportive and 
sympathetic, you haven t been trained 
to be a social worker and should not 
try to take that role. Suggest to these 
parents that they talk to people who 
can help them work through their feel- 
ings, if you feel they need it. You 
should concentrate on the child's educa- 
tional program. 

4. Be Reassuring, but Be Honest 

Parents may be worried and upset 
when their child is about to be eva- 
luated or re-evaluated. At such a time, 
it might be tempting for you to tell 
them not to worry, that everything will 
be fine. It is natural for you to want to 
soothe their anxiety. However, you 
shouldn't tell them these things 
because in fact you don't know if 
things really will be fine. A false sense 
of confidence can be hurtful. Be reas- 
suring, be calm, be understanding — 
but be truthful. 

Parents may ask you questions 
about the child's problems that you 
can't answer: "What's wrong with my 
child?" "Will my child learn to behave 
like other children by the end of the 
year?" Don't be afraid to say that you 
don't know the answers, but help par- 
ents find someone with whom they can 
discuss their concerns. Your social serv- 
ice personnel should be able to help you 
find people who can provide some 
answers. The answers to other ques- 
tions, such as "What will my child be 
like when he grows up?" are often 
uncertain and complicated. Beware of 
people who have easy answers. 

Some parents need reassurance and 
evidence that they can help their cMld. 
Help them see the many things that 
they already teach their children. 

5. Recognize £ind Deal with Yoiu* 

Be aware and honest with yourself 
about your own feelings toward a hand- 
icapped child and his or her family. 
Negative feelings (such as blame, anger, 
sorrow, nervousness, and fear) are 
understandable. Getting to know the 
child and the family helps to reduce 
some of these negative feelings. 

Think positively about children with 
special needs. Focus on their strengths 
and be optimistic about helping them. 
Work on improving skills or eliminating 
behaviors that are making it difficult 
for such children to understand them- 
selves and play with others. Help the 
parents see their child as someone who 
can grow, learn, and improve, no mat- 
ter how severely handicapped. Most of 
us feel better about ourselves when peo- 
ple look at our strengths rather than 
our weaknesses. 

6. Working with Parents 

You and parents may not always 
agree on what children can and should 
be allowed to do, both at preschool and 
at home. In such cases, it may be best 
to talk with the parents to reach a com- 
promise that works for you, the par- 
ents, and the child. 

At times parents may be hard to 
reach. Single parents and parents with 
long working hours may have Httle or 
no free time. Try to accommodate par- 
ents' schedules in arranging home 
visits and conferences. Their Hmited j 
participation in program activities does 
not necessarily indicate that they are 
not interested in their child or their | 
chUd's performance in your classroom. ■ 
Rather, they may be overwhelmed with 
other family responsibilities or prob- 

of Parents 

Parents of Children 
with Special Needs 

Parents of handicapped youngsters 
often have special concerns. In general, 
it is wise for you to wait until they 
bring up these problems, rather than to 
suggest what the problems might be. 
Otherwise, you could be creating a 
problem that they have never felt. 

Reading about some of the concerns 
that parents of children with handicaps 
often have should help you understand 
what some parents mean when they 
hint at a concern without actually say- 
ing it. 

Enrollment in a Meiinstream Classroom 

Parents may worry that their child 
will not fit into the Head Start pro- 
gram. You may need to reassure the 
family that you want the child in your 
classroom, and that you believe the 
child will enjoy and learn from your 
classroom. Invite the parents to watch 
and listen to what is going on — let 
them see for themselves how their child 
plays and works with the other children 
and with you. Seeing is believing. 

Acceptance by Other Children 

Parents are sometimes concerned 
that their child will not be liked and 
accepted, and that other children may 
be cruel and teasing. 

You can reassure them that 
preschool-aged children are usually too 
young to notice handicapped children 
as different unless the handicap is very 
obvious or their behavior is very differ- 
ent. You can also tell them that you do 
not allow teasing or bullying of any 
child in your classroom, and that you 
will deal with it firmly if it should 

Of course, some children just don't 
get along well with others, but this is 
not a problem that is limited to chil- 
dren with special needs. It is not a rea- 
son to avoia the classroom, any more 
than it is a reason to avoid the rest of 
the world. You can tell parents that 
managing these situations, when and if 
they arise, is a normal part of your job. 

Throughout the year, keep the par- 
ents as informed as you can about how 
their child is getting along with the 
other children. If problems do arise, 
you may want to ask the parents how 
they handle similar situations at home. 

You have developed a number of 
techniques for helping children cooper- 
ate and get along in your classroom. 
You will probably find that these tech- 
niques are just as useful for a child 
with special needs. 

Teacher's Time 

Assure the parents of a handicapped 
child that you will have time for their 
youngster. Describe to them what you 
will be doing with their child and 
explain that you wiU have your aide, 
volunteers, and other staff members to 
help you. Discuss also any outside 
assistance the child will be getting. 


30 The Future 

Parents may worry that their child 
will not make progress in your pro- 
gram. You can assure them that there 
are many things that you can teach 
their clmd, and that their child will 
learn a lot from the other children in 
the class, too. But be careful not to 
offer the parents false hopes. Make it 
clear that you can't make long-range 
predictions about how far the child will 

Erogress in the future, but that you will 
elp the child learn as much as he or 
she can in Head Start. Be honest when 
you describe the skill areas you are 
working on with their child, and keep 
them well informed of their child's 
progress. Ask the family, in turn, to tell 
you how they see the child progressing 
at home. 

As with non-handicapped children, if 
you genuinely like a child, and if you 
and other staff members in your pro- 
gram have worked out a sensible plan 
to meet the child's needs and stimulate 
his or her development, you have a 
solid basis for working out a real part- 
nership with the parents. While parents 
of handicapped youngsters have some 
concerns that are different from the 
concerns of other parents, you can use 
the same ways of working with them 
that you have already developed in 
your conversations and personal con- 
tacts with other parents. 

Parents of 



Many Head Start programs have 
children with handicaps in their classes. 
It is not unusual for parents of non- 
handicapped children to be concerned 
about the presence of an emotionally 
disturbed child in the class. This con- 
cern may be greatest if parents suspect 
that the emotionally disturbed chila is 
potentially hurtful or aggressive (for 
example, if they think that the child 
may hit other children for no apparent 
reason) or is otherwise abusive (for 
example, if they think that the child 
may scream at other children or 
destroy other children's work). Try to 

explain to apprehensive parents that 
you have adequate staff in your class- 
room to manage an emotionally dis- 
turbed child. Because some disturbed 
children can be more impulsive and 
impredictable than others, you cannot 
guarantee the parents that their child 
will never have an impleasant experi- 
ence in your classroom. Explain to par- 
ents that no child would ever be 
enrolled in your class if it were thought 
that the child could seriously hurt 
someone. Also explain that the dis- 
turbed child has been enrolled because 
you and other professionals believe that 
the child's behavior can improve, and 
because the child has strengths and 
abilities to contribute to group learning 
experiences. It is good for all the chil- 
dren to see that a child's behavior can 
change, and to recognize that they have 
the ability to cope with a range of 
behaviors, with the teacher's help. 
Assure parents that every effort wiU be 
made to provide a safe and happy 
learning experience for all children. 

Some parents may also be con- 
cerned that their child wiU pick up 
undesirable behavior from disturbed 
children (for example, giving up when a 
task becomes too hard, shouting and 
grabbing food at mealtimes, or break- 
ing toys). You can explain to parents 
that it is normal for children to imitate 
other children. This is one of the ways 
they learn. However, undesirable benav- 
ior tends to be dropped quickly, once it 
has been tested and met with disap- 
proval and/or fovmd unsatisfying. ' 

If the parents of a non-handicapped 
child have these concerns, invite them 
to your classroom. This may help to 
show them that an emotionally ois- ' 
turbed child is first and foremost a 
child and an individual, like their own 
child. Visiting a mainstream classroom 
may help dispel unfounded fears par- 
ents may have about a child whom 
they have never met. On the other 
hand, visiting your classroom may 
sometimes reinforce parents' concerns. 
Be prepared to explain what your pro- 
gram can offer their child. 

Chapter 4: 





Learning about emotional 
disturbance can help you 
realize the special needs 
of disturbed children. 

32 Like all children, emotionally dis- 
turbed children need a warm and 
caring atmosphere in which to grow 
and learn. And like other children, 
they have good days and bad days, 
mth disturbed children, however, their 
bad days may be especially bad, and 
may continue for long periods of time. 
For this reason, they may need an 
extra measure of warmth, understand- 
ing, and tolerance from you. As you 
will learn, working with these children 
is not an easy job. They will often try 
your patience, your trust, and your 
teaching skills. However, as you work 
with them and learn more about them, 
you will find that meeting the chal- 
lenge they present can be personally 
and professionally rewarding to you 
and of tremendous value to the chil- 

At one time or another you may 
have an emotionally disturbed child in 
your classroom. You may receive a 
"diagnostic evaluation " for this child 
from a psychologist or psychiatrist. 
This evaluation will outline the child's 
development — both strengths and 
needs — and will explain what special 
services the child should receive from 
you and other specialists. On the other 
hand, you may only receive a report 
that says the child is "emotionally dis- 
turbed. " This report may identify the 
specific kind of disturbance by name 
only. The advantage of using these 
names or categories is that a single 
word can stand for a whole range of 
related behaviors. However, classifying 
a child usually limits rather than 
extends our understanding, and often 
produces negative and inaccurate 
expectations for that child. The use of 
these names doesn 't allow us to think 
of the range of skills and behaviors a 
child may demonstrate. It doesn 't 
describe the severity of the child's 
problem with a particular skill or set 
of skills. For example, the term "dis- 
turbed" cannot possibly tell you 
whether a child has problems with 
sharing. One disturbed child may have 
problems sharing a certain toy with 
certain people, while another disturbed 
child may have trouble sharing any- 
thing with anyone. Still another dis- 

turbed child may have no special diffi- 
culty sharing. A word or phrase cannot 
possibly describe all of the possibilities 
to you. Describing children in terms of 
strengths and weaknesses is much 
more valuable to you than being able 
to fit them into a category. 

Another real disadvantage of class- 
ifying is that the terms tend to stick 
with a child for a long time, regardless 
of whether the handicapping condition 
is still present. This can lead to social 
isolation and incorrect assumptions 
about a child's ability. Young children 
change and grow so rapidly that some 
children with handicaps may overcome 
their disabilities before entering public 
school Names acquired in preschool 
are likely to follow children into public 
schools, and may be used as a basis for 
excluding them from the regular school 
program. It is hard to outlive or live 
down how you have been classified Do 
your best to get to know the whole 
child and add important information to 
the diagnosis. 

This chapter looks at how emo- 
tional disturbance is defined by Project 
Head Start and by other professionals 
in the field. It also considers what emo- 
tional disturbance means for those who 
teach and work with disturbed chil- 
dren. Learning about emotional distur- 
bance can help you to realize the spe- 
cial needs of disturbed children, and to 
recognize when to refer a child for 
diagnostic evaluation. However, only 
by working with a disturbed child will 
you recognize his or her uniqueness, 
capabilities, and problems. ' 

How Is 

The "Head Starr 

In defining handicapping condi- 
tions, Project Head Start distin- 
guishes between categorical defini- 
tions, which are used for reporting 
purposes, and functional definitions, 
which describe the child's areas of 
strength and weakness. The categori- 
cal definition uses Project Head 
Start's legislated diagnostic criteria. 
An interdisciplinary diagnostic team 
(or a professional who is qualified to 
diagnose the specific handicap) must 
use this definition to make a categori- 
cal diagnosis of a child. This diagno- 
sis is used only for reporting pur- 
poses. A functional definition or diag- 
nosis, on the other hand, assesses 
what a child can and cannot do, and 
identifies areas that call for special 
education and related services. The 

functional assessment should be 
developed by a diagnostic team, with 
the child's parents and teacher as 
active participants. Another term for 
functional assessment or functional 
diagnosis is developmental profile. 

According to Project Head Start, 
the following categorical definition of 
emotional disturbance is to be used for 
reporting purposes in Head Start pro- 

A child shall be considered seriously 
emotionally disturbed who is identi- 
fied by professionally qualified per- 
sonnel (psychologist or psychiatrist) 
as requiring specied services. This 
definition would include but not be 
limited to the following conditions: 
dangerously aggressive towards 
others, self-destructive, severely 
withdrawn and non-communicative, 
hyperactive to the extent that it 
affects adaptive behavior, severely 
anxious, depressed or phobic, psy- 
chotic or autistic. 

("Transmittal Notice Announcement of Diagnostic 
Criteria for Reporting Handicapped Children in 
Head Start," OCD-HS, September 11, 1975.) 

As the Head Start definition indi- 
cates, there are many "conditions" that 
fall within the broad scope of emotional 
disturbance. Professionals in the field of 
emotional disturbance (such as psychol- 
ogists and psychiatrists) usually refer 
to these conditions as "diagnostic cate- 
gories." They are discussed in Chapter 
5. This chapter focuses on a more gen- 
eral definition of emotional disturbance. 


^^ A Functional 

Emotional disturbance can be gener- 
ally defined as an abrupt break, slowing 
down, or postponement in developing 
and maintaining meaningful relation- 
ships with other persons, and/or in 
developing a positive and accurate 
sense of self. Generally, children who 
are emotionally disturbed may have dif- 
ficulty in: 

• developing the capacity to give and 
take in relationships with other 

Eeople. For example, Tina may not 
e able to treat other persons as 
they treat her. 

identifying and appropriately 
expressing feeKngs and motives. 
For example, Masao may not know 
that he is happy when something 
good happens. He may express 
himself by throwing a toy or hit- 
ting another child, rather than by 

learning skills and gaining self- 
confidence. For example, Patrick 
may have difficulty learning skills, 
may not have confidence in his 
ability to perform a task, and may 
not be able to demonstrate that 

asking for and accepting help. For 
example, Virginia may not be able 
to ask for help when a task gets 
too hard or to allow another child 
who has offered help to be her 
partner in a game. Some disturbed 
children have trouble accepting 
their dependency on others. 

Within each of these developmental 
areas, emotionally disturbed children 
may show widely different behaviors. A 
child's behavior is influenced by many 
factors, including: 

• the environment of a child (for 
example, whether it is permissive 
or strict, unresponsive or attentive) 

• individual coping styles (that is, 
the ways a child has learned to 
handle problems) 

• the range of behavior sldlls known 
to a child (for example, whether the 
child has learned a number of ways 
to handle a problem and under- 
stands the appropriateness of these 
ways in a given situation. Clare 
may have learned that she can go 
outside to play if she asks nicely, if 
she cries long enough to become 
disruptive, or if she follows her 
mother around the house begging 
to go outside. Of these various 
ways, Clare has learned that ask- 
ing nicely is most effective and 
causes fewer conflicts with her 

I mother. Albert, on the other hand, 
' has learned that he always gets 
what he wants by crying. So cry- 
ing is the approach he takes.) 

Obviously a variety of factors contrib- 
ute to how children learn to behave. 
These factors can be altered or changed 
to encourage more appropriate behavior 
and a better understanding of self and 
of the world. 

Levels of 



Tb distinguish between disturbed 
children and children who have behav- 
ioral problems that do not require spe- 
cial services, Head Start refers to 
"seriously" disturbed children in its 
definition. Head Start does not use the 
word "seriously" to distinguish differ- 
ent levels of disturbance, but rather 
to distinguish "disturbed" from 
"non-disturbed" children. In fact, all 
disturbed children who require special 
services fall within the Head Start defi- 
nition, even though behavior may vary 
drastically from child to child. 

Specialists in emotional disturbance 
do not aU agree that levels of emotional 
disturbance can be determined accu- 
rately. Some believe that three levels 
can be clearly distinguished from one 
another: mild, moderate, and severe. 
They use these classifications to indi- 
cate the severity of the disturbance. 
Other specialists believe that levels are 
difficult to establish because of the dif- 
ficulty in evaluating young children and 
because of problems with the tests 
themselves. A further consideration is 
that disturbances show themselves 
with different intensities under various 
conditions. Chapter 5, which describes 
the diagnostic categories of emotional 
disturbance, does not distinguish levels 
of disturbance. 


Masao doesn Y always 
know how to express 

^^ Commonly 

Many emotionally disturbed chil- 
dren do not have other handicaps, but 
some do — particularly those who are 
seriously disturbed. These children 
require a very special kind of help. You 
wiu need to worK closely with the 
diagnostic team to determine how best 
to help such children, and to seek out 
other resources as necessary. 

Some experts have found that learn- 
ing disabilities and communication dis- 
orders are likely to be associated with 
emotional disturbance. Learning disa- 
bilities, as defined by Project Head 
Start's legislative diagnostic criteria, 
mean a disorder in one or more of the 
basic psychological processes involved 
in understanding or in using language. 
This disorder may result in an imper- 
fect ability to listen, think, speak, and 
to learn pre-reading skills. 

A small percentage of disturbed 
children, most of whom are severely 
disturbed, have still other handicaps. 
These may include visual handicaps, 
hearing impairment, physical handi- 
caps, and mental retardation. 

Emotional disturbances interfere 
with or exaggerate the range of behav- 
iors usually shown by young children. 
Additional handicaps simply compound 
the child's problems. If an emotionally 
disturbed cnild has been diagnosed as 
having other handicaps, you wQl want 
to take the following steps: 

• Get some background information. 
Set up a conference with parents 
and ask such questions as: How 
have the child's handicaps been 
dealt with by the family and physi- 
cians in the past? What are the 
child's strengths, weaknesses, and 

Read other relevant books, such as 
those in this series. They can pro- 
vide useful information and sugges- 
tions on how to help children with 
other handicaps. 

If at all possible, discuss the child 
with those specialists who diag- . 
nosed the cMld's handicaps. Feel 
free to ask lots of questions about 
the specialists' impressions of the 
child and about the handicap itself. 
Encourage specialists to give you 
information that is useful to you in 
your individual classroom. You 
may need to familiarize the special- 
ists with your classroom faciGty, 
the daily routine, resources that 
are available to you, and other 
aspects of your program. 

Ask more experienced teachers to 
help you plan for this child. 

Try to find ways to provide experi- 
ences that seem to fit the chila s 
individual needs (for example, a 
place to retreat or a substitute 
task when a child cannot seem to 
handle a group activity). At the 
same time, make sure that a handi- 
capped child has as many of the 
usual preschool experiences as pos- 
sible. Most handicapped children 
do best if the teacher adjusts their 
program to their abilities and spe- 
cial needs without making them 
feel isolated from the rest of the 

Related to 

Accurate diagnosis will enable you 
and others to give the kind of help that 
a child needs. This means, first of all, 
that someone has to recognize that a 
diagnosis is called for. If tests are 
given, they have to be appropriate, and 
administered by trained people. Fur- 
ther, the test results have to be prop- 
erly interpreted. Accurate diagnosis, 
therefore, can sometimes be tricky. 

Some problems related to diagnosis 



difficulty in identifying the type of 
emotional disturbance (the diagnos- 
tic category) 

difficulty in determining what the 
handicap is when the child's behav- 
ior can have a variety of causes 
(for example, a non-verbal child's 
problem may stem from physical 
or psychological factors) 

mistaking cultural and lifestyle dif- 
ferences for handicaps 

problems with the testing situation 

lack of regularly scheduled 

Some emotionally dis- 
turbed children have 
additional handicaps. 

3^ Identifying the 

Because children are unique individ- 
uals, they respond to situations in dif- 
ferent ways. This means that, for exam- 
ple, aggressive children may each dem- 
onstrate their disturbance differently, 
making it difficult to diagnose their 
problem accurately. If an aggressive 
boy bottles up his hostility, he could be 
mistakenly diagnosed as withdrawn 
and given inappropriate and inadequate 
help. This fact underscores the impor- 
tance of having a trained individual 
conduct the diagnostic evaluation. 

Determining the 

Diagnosis can be especially difficult 
when a single behavior can have a vari- 
ety of causes. It is important, therefore 
that each child be adequately screened 
for all possible problems. A non-verbal 
child, for example, may have a serious 
hearing loss that has never been recog- 
nized. It may be that the child truly 
wants to enjoy conversations with you 
and other children. But since the child 
cannot adequately hear what is being 
said, it is difficult for him or her to 
respond verbally. This experience can 
be very frustrating, and sometimes the 
child will act nervous, fearful, or timid. 
However, if the hearing loss is detected 
and treated, the child will learn to com- 
municate with others. 

''Street-wise'' children have learned to be assertive. They are not necessarily 

Cultural and 
Differences for 

Many tests commonly given to chil- 
dren are standardized to fit children 
[from a middle-class, white American 
'background. Some children from low- 
income and/or minority families may 
not have learned the social behavior 
■and school-related skills that children 
from white, middle-class families have 
learned. This means that when they are 
tested they do not perform according to 
test standards. 

1 If they speak, for example, Spanish, 
Chinese, or a non-standard EngUsh dia- 
lect at home, they may not understand 
or may misunderstand what is being 
said to them. This means they can't 
answer the test questions correctly and 
may appear to be emotionally dis- 

Children from low-income and 
minority families may also display 
behavior that makes perfectly good 
sense for the child in his or her environ- 
ment, but not in the eyes of someone 
who is unfamiliar with the child's life- 
style. For example, some children are 
"street wise" at an early age: they 
know how to fight for their rights and 
take care of themselves. This behavior 
might include using physical force and 
yellmg to settle problems, rather than 
talking things out. These children may 
JDe very assertive in this way because it 
is how they have learned to respond 
and, perhaps, because this way is 
acceptable to other people around them. 
They may in fact not be disturbed at 

Circumstances like these can mean 
that children from minority and low- 
income families may appear disturbed 
when compared with children from 
white, middle-class families. The prob- 
lem is often not with the children but 
with the tests or with the value system 
of the diagnostician. Diagnosticians, 
then, should be familiar with a child's 
background and should also have a 
good deal of insight into how different 
lifestyles promote or affect a child's 
behavior or skill level. 

Emotional disturbance occurs at all 
income levels and in all ethnic groups. 
But you should be especially careful 
about drawing any conclusions from 
intelligence or psychological develop- 
ment tests given to children from low- 
income or minority families. You may 
be told that a particular child has been 
tested and found to be disturbed. But if 
your experience with the child makes 
you think the child is functioning well, 
teU the responsible person in your pro- 
gram that the child should be looked at 
more carefully. 


40 Problems with the 
Testing Situation 

The testing situation itself may 
interfere with accurate assessment of 
both handicapped and non-handicapped 
children. For example, a disturbed Doy 
who is overly concerned about making 
mistakes, as is typical for some dis- 
turbed children, may say that he can't 
do a task that he really can. In another 
case, testing may make a non-handi- 
capped girl so "nervous" that her 
behavior may be at3^ical for her. While 
her usual behavior might be friendly 
and outgoing, a testing situation might 
make her tense and guarded. Or, for 
example, a non-handicapped child who 
is shy and not used to answering ques- 
tions may act disturbed in a diagnostic 
situation, but perfectly normal in a 
more familiar situation. 

Sometimes it is helpful to have a 
child's parent or parents present during 
testing. Their presence may help the 
child feel comfortable. In addition, the 
parents will be able to say whether 
their child is behaving typically. 

Lack of Regularly 
Scheduled Reassessment 

Children at the preschool age are 
growing and changing rapidly. If 
assessment is not conducted on a regu- 
lar and routine basis, it is difficult to 
know for certain the kind and amount 
of development that has taken place in 
a child. Lack of reassessment can be 
disastrous for a child. It can mean that 
a child whose behavior has changed or 
whose source of disturbance has 
changed is no longer receiving appropri- 
ate services. It can mean that a cnild 
who is no longer disturbed remains 
classified as disturbed. Tb provide a 
child with the best possible services 
and to keep track of his or her develop- 
ment, it is important that regular 
assessment be an integral part of that 
child's program. 

With help, most disturbed children 
wiU gradually show some improvement. 
Some children may improve as they 
mature, only to show more disturbance 
again when they are under stress, that 
is, when something special happens to 
them (an upcoming vacation, the birth 
of a sibling, or illness or death in the 

A very shy child may 
seem disturbed during 

for Referral 

An accurate diagnosis can help you 
understand a disturbed child's behavior. 
But children grow and change. You are 
in an excellent position to observe the 
child for behavior that is consistent 
with the diagnosis and behavior that 
isn't. It is critical to note inconsistent 
behavior and alert the child's parents of 
the need for re-evaluation. 

You are also in an excellent position 
to recognize behavior that may indicate 
undiagnosed distiirbance. Some dis- 
turbed children may not be diagnosed 
before they are enrolled in Head Start. 
Children who are only mildly or moder- 
ately disturbed, for example, may be 
enrolled in your program without ever 
having been recognized as handicapped. 
You may be the first person in the life 
of the child who can alert other profes- 
sionals to the problem, so that services 
for that child's special needs can finally 
begin. Sometimes parents need advice 
and encouragement from teachers to 
recognize and face problems that may 
have troubled them in their child's 
behavior. Diagnosis, first and foremost, 
is needed to point out the extra help 
and services these children need. 


Learn to Observe 

Your own classroom observation, 
plus conversations with parents about 
their children, can be the best founda- 
tion for deciding whether to refer a par- 
ticular child to a professional diagnosti- 
cian. As a classroom teacher, you 
observe children and draw conclusions 
every day. 

Do you have a child in your class 
who strikes you as difficult to handle, 
hard to get along with, or slow in learn- 
ing new skills? If you observe the child, 
figure out what might improve the 
behavior, and try several approaches, 
you may find that the child s problems 
are not as serious as you first thought. 
And if they still seem serious, you can 
conclude tnat a professional evaluation 
is in order. 

This process of carefully observing 
and drawing conclusions helps you plan 
activities to meet the individual needs 
of all children. Even though you aren't 
a professional diagnostician, don't un- 
derestimate your ability to spot pos- 
sibly serious problems that may signal 
a handicapping condition in a cMld. 



Ask Questions 

Ask yoiirself some good, basic ques- 
tions to determine whether a child 
should be referred for professional eval- 

Is the child's social and personal behav- 
ior (ability to share, cooperate, and 
interact with other children, and to be 
reasonably independent) so limited that 
it keeps Mm or her from participating 
fully with the other children? 

Does the child's learning style or rate 
of learning prevent him or her from 
participating fully with other children? 
For example, a child who has a short 
attention span and who is constantly 
on the move may have difficulty learn- 
ing a group activity. Or a child who 
learns very quickly may retreat from 
the group to practice skills that other 
children are not yet ready to learn. 

If your answer to either or both of 
these questions is yes, and if the par- 
ents agree, referral is in order. If it 
turns out that the child is not handi- 
capped, you and the parents will be 
reassured and wiU gain a better under- 
standing of the child. If a problem does 
exist, the child will then be able to 
obtain the needed help. 

Recognize Individual 

Distinguish between those children 
whose temperaments and individual 
learning styles you find difficult and 
those cmldren who may be handi- 
capped. Children, like adults, can be 
qmet and thoughtful or very energetic 
and into everything. Some get frus- 
trated more easily than others, some 
get distressed and upset more easily 
than others, and some demand more 
attention than others. It is helpful to 
ask yourself: "Do I find this child diffi- 
cult because of individual style differ- 
ences between the two of us? Or is the 
behavior of the child genuinely different 
from the behavior of other children the 
same age?" Children who appear differ- 
ent are not necessarily distiu*bed. You 
should try to discover why they behave 
differently. If you can't come up with 
any logical answers, you may need to 
seek help. 

Get Professional Help < 

Tb find out why (and sometimes 1 
how) a child's behavior appears differ- ' 
ent from what is considered normal, it 
may be necessary for you to seek refer- 
ral and assessment for the child. From 
the child's point of view, referral is bet- 
ter than non-referral. This means that if 
you think a handicap might accoimt for 
the behavior you have observed, it is 
best to have the child professionally 
evaluated. If you find out that the child 
does not have a handicap, no harm has 
been done. If, on the other hand, a 
handicapped child is not diagnosed, the 
child's special needs will not be met. , 
Regularly scheduled re-evaluation is 
preferreci over non-referral for children 
who have already been diagnosed: as i 
vou have read, children can sometimes 
be incorrectly diagnosed. If a child 
enters your class already diagnosed as 
emotionally disturbed, take an espe- 
cially close look. Have the child re- 
evaluated if you have doubts about the 


that Do Not 





Children who are emotionally dis- 
turbed show unusual behaviors often 
and for long periods of time. However, 
children who are not emotionally dis- 
turbed may sometimes show these 
same, unusual behaviors from time to 
time. With non-disturbed children, these 
behaviors are almost always short-lived 
and caused by a situation that you can 

For example, Victor was an out- 
going, sociable four-yeai^old until his 
parents separated. Victor's mother, Mrs. 
Williams, was forced to go on welfare 
because she couldn Y find a job to help 
support the family. Being on welfare 
upset Mrs. Williams, and her usual 
cheerful and caring behavior began to 
change. It seemed that now she was 
impatient, screaming at Victor about lit- 
tle things. At other times, she neglected 
Victor and his sisters altogether 
Victor's behavior began to change, too. 
He no longer wanted to be with the 
other children at preschool He was 
very quiet and, every now and then, 
would go silently into a comer and cry. 
Ms. Jones, Victor's teacher, was very 
concerned about Victors new behavior 
She contacted the social services coordi- 
nator, who met with Victor's mother to 
discuss the problem. 

Several months later, Mrs. Williams 
was able to find a job. As she began to 
feel more confident in herself and in her 
ability to take care of her family, her 
attitude toward Victor and his sisters 
began to return to normal By the end 
of the year, Victor was beginning to 
seem more like his old self. 

Of course, it is not always easy to 
determine which behaviors signal real 
problems in a child, particularly if the 
child is new to your class. You will 
want to observe the children in your 
class carefully and work closely with 
parents. Additionally, you may want to 
discuss some of the problem behaviors 
with other staff (for example, with the 
program's director or handicap coordi- 
nator, or with your aide). 

Unfortunately, there are no hard 
and fast rules that certain behaviors, 
continuing over a certain length of 
time, definitely indicate emotional dis- 
turbance. Be careful not to jump to 
conclusions. Learn the facts ancf give 
the behavior reasonable time to 
improve. You will often have to rely on 
your careful observations to know when 
to refer a child. 


** Steps 

If you have reason to suspect that 
you have an undiagnosed emotionally 
disturbed child in yoiir class, take the 
following steps: 

1. Find out if the standard screen- 
ing tests have been given. Talk to the 
handicap coordinator, the person 
responsible for coordinating health serv- 
ices, or someone else in your program 
who you think could be helpful. 

^, If the child has been screened, 
no problems have been found, and you 
are still concerned about the child, 
speak to the handicap coordinator. The 
parents will have to give their permis- 
sion for further testing. Explain the 
professional diagnostic process and the 
reasons for it to the parents. 

O. While waiting for a professional 

• Talk with the parents about what 
they notice to help you work more 
effectively with the child. Reassure 
them that you care and you want 
to be helpful. 

• Continue to observe and keep 
notes to help you plan suitable 

• Chapter 6 discusses guidelines and 
ways of conducting activities for 
children. Use them if they seem 
appropriate and if you find they 

• Find out the resiilts of additional 
tests so that you can determine 
whether your individualized plan 
for the child needs to be changed. 
Discuss with the parents the 
results of the tests and any sug- 
gested changes in the services the 
child is receiving. 

Chapter 5: 




Learning in 

3-to 5-Year-Olds 

You can learn a great 
deal about a child's func- 
tioning by observing a 
child on a daily basis. 

46 Good teaching involves finding out 
what each child can currentlg do and 
what each needs to learn. You are in a 
position to learn a great deal about a 
child's functioning, because gou have 
the opportunitg to observe the child on 
a dailg basis and to talk with the 
child's parents. Th help gou, this chap- 
ter contains detailed information on 
how emotional disturbance mag affect 
learning in three- to five-gear-olds. 

The previous chapter defined emo- 
tional disturbance and discussed how 
to recognize problems for referraL The 
Head Start definition that was given in 
Chapter 4 listed different diagnostic 
categories of disturbance. This chapter 
describes the five categories that are 
most common in preschool-aged chil- 
dren: withdrawn (including depressed), 
anxious, aggressive, hgperactive, and 

The major characteristics of chil- 
dren with each of the five tgpes of dis- 
turbance are described in this chapter. 
Also described are how theg function 
in the major areas of self-concept, 
social, speech and language, motor, 
and cognitive development. For each 
diagnostic categorg the developmental 
areas are listed in their order of diffi- 
cultg for the child, from easiest to most 

Each description that follows refers 
to an "average" child. These descrip- 
tions should serve as guidelines, not 
rigid rules. Since all children are dif- 
ferent, the descriptions won't necessar- 
ily applg to children in gour class. 
Some children mag behave as 
described while others mag behave dif- 
ferentlg. As gou get to know the chil- 
dren, gou will also get to know how 
each child functions. It is gour exper- 
tise as a teacher that will help children 
learn and develop as much as theg pos- 
siblg can. 




Is Withdrawn 

All children enjoy being alone from 
time to time. But children who are 
withdrawn seem to spend most of their 
time apart from a group. It is not so 
much that they enjoy being alone. 
Rather, they seem to feel uncomfort- 
able when people and activities get too 
close to them. Consider Janie, for exam 
pie. Whenever the children gather 
around the water table, she moves 
toward the edge of the activity area 
and silently watches the other children 
splashing and pouring water from bot- 
tles to cups and back again. On the 
other hand, if Janie is alone at the 
water table, she will pour and splash 
the water herself, though not vigor- 
ously. Clearly, Janie knows what the 
activity is all about. What she doesn't 
seem to know is how to participate in 
the activity with other children. 

Children who are withdrawn also ' 
seem unusually uncomfortable when 
they don't know what to expect or how 
to handle a given situation, especially a 
new experience. For example, Danielle 
began to cry when her teacher said thai 
the doctors would be coming to 
examine the children. The only contact 
she had ever had with a doctor before 
was at the clinic where she was vac- 
cinated. Because she did not know 
what the examination at the preschool 
would be like, but rememberai her past 
experience with the doctor, she was 

Most withdrawn children have a 
favorite spot in the classroom, usually 
away from active areas and frequently 
on the floor. They do not interact with 
other children and adults, but react by 
moving away when someone gets too 
close. Withdrawn children appear disin- 
terested in and unaware of most of 
what goes on. They seem to have few 
interests and frequently need self- 
comfort in the form of thumb-sucking, 
rocking, masturbating, or pulling on 
their hair or ears. 

Few preschool children are 
diagnosed as depressed. There are, how- 
ever, some young children who seem to 
be depressed. Their behavior is similar 
to that of the withdrawn child, with 
one difference: they seem unhappy 
about something. It is not always clear 
to themselves or to others why they are 
so sad. Most depressed children seem 
to do little more than daydream. They 
startle and cry easily. Some of them 
can be comforted. Some can be cheered 
up by playing for a while. Most de- 
pressed children will become sad and 
quiet many times during the day. 

Like other children, withdrawn or 
depressed children are individuals. This 
means that their behavior can cover a 
wide range. One child may seem to be 
overly shy and timid; another may 
seem completely withdrawn. With gen- 
tle guidance, most can be helped. Most 
have the potential to learn all the skills 
other children learn, once they have 
gained some self-confidence and feel 
free enough to let themselves go and 
play with others. 

The following are descriptions of 
skills and behavior typically exhibited 
by withdrawn children. 



Most withdrawn children acquire 
cognitive skills at the expected age and 
learn to use most manipulative mate- 
rials. Their need to withdraw, however, 
usually makes it hard for them to put 
their knowledge and skQls to use. It is 
safe to assume that most withdrawn 
children know and are able to do far 
more than they can express by words 
or actions. 

Most withdrawn children learn pri- 
marily from watching others, at a safe 
distance. They generally will not join 
group activities, and are very timid 
about trying new activities and about 
using materials. Their hesitant use of 
materials is due to anxiety and lack of 
self-confidence, rather than to inability. 

A withdrawn child may have a favorite spot 
in the classroom. 

48 For example, most withdrawn children 
in preschool know different colors, even 
if they take only one crayon and make 
a barely visible mark with it on one 
edge of the paper. They often have nor- 
mal dexterity (as, for example, in 
stringing beads), but might string the 
same bead over and over, rather than 
ask the teacher to put a knot at the 
end of the string. 

\^^th a great deal of gentle support, 
most withdrawn children can gradually 
develop the confidence to master new 
tasks. While they will stubbornly refuse 
to do any task that makes them anx- 
ious, they do wish to please and will try 
most activities with your protective 
support. For example, they may play 
with the pegboard after much reassur- 
ance and after having watched other 
children place the pegs. But they may 
refuse to work with finger paints, 
despite days of watching others use 
them. When invited to join, they may 
just shake their heads, or turn away. If 
you tell such a child to sit at the finger 
painting table, the child may obediently 
sit down, but stick his or her hands 
firmly under the table. Nonetheless, the 
child may be silently learning the task 
by watching. 

Motor Skills 

Most withdrawn children move theii 
bodies as little as possible, although 
tests show that their gross and fine 
motor development is appropriate to 
their age level. Some withdrawn chil- 
dren sit motionless for long periods of 
time, or move only parts of their 
bodies, holding the rest rigidly still. For 
example, they might use toys with 
their hands, while sitting in the same 
spot on the floor. 

When these children do use their i 
bodies, their movements tend to be 
awkward, weak, and quite restricted. 
They may appear to be poorly coordi- 
nated. Many withdrawn children have a 
tendency to "fold-up" easily and drop 
on a chair or to the floor in a flabby 
heap, as if their bones were rubber. ; 
Withdrawn children also use their 
bodies to comfort themselves. They dis- 
play mannerisms such as thumb suck- 
ing, twisting their hair, and rocking. 

As these children gain self- 
confidence and are helped to overcome 
their need to withdraw, their body 
movements begin to appear much more 

Speech and 



Many withdrawn children under- 
stand language and are quite capable of 
speech, but speak rarely or not at all in 
preschool. They may express pleasure 
with a smile that fades as quickly as it 
appears and displeasure or discomfort 
by whimpering or crying softly. When 
they do talk, it is usually in a voice so 
soft that it can hardly be heard. When 
these children timidly request some- 
thing in the classroom, their attempts 
to communicate tend to get lost. This 
is particularly true since withdrawn 
children give up quickly when they get 
no response. Talking and being talked 
to seem to make withdrawn children 
very uncomfortable. Often they will 
react by turning away or sitting there 
with a stony face. Since a withdrawn 
child responds to others so seldom, 
other children soon stop trying to com- 
municate with him or her, unless they 
see your continuing efforts to talk with 
the child. 

By their tense, withdrawn behavior, 
these children express loneliness, anx- 
iety, and a sense of isolation. But their 
watchfulness and hesitant imitations of 
others communicate a desperate wish 
to be like other children. Sometimes 
they communicate their need for com- 
panionship and security by pleading 
looks or by clinging to an adult. 

Offer a withdrawn 
child a great deal of 
gentle support. 



Social Skills 

Most withdrawn children think 
poorly of themselves and are uncertain 
of their ability to do many tasks suc- 
cessfully. For example, although Anita 
has made many necklaces by stringing 
beads, she always begins the activity 
by sajdng, "I'm just dumb. I don't 
think I can string these ol' beads." 

The way withdrawn children deal 
with their negative feelings about them- 
selves and what they can do is by mov- 
ing away from the group and into their 
own personal "shell." They avoid mak- 
ing a wrong move by not moving at all, 
or by moving with such unsureness 
that nothing is accomplished. Since 
they do not trust themselves to be able 
to do anything well, they either avoid 
doing anything or very carefully 
imitate others. Their discomfort with 
others is evident in their lack of respon- 
siveness. For example, they may turn 
away when other children attempt to 
play with them, refuse to answer ques- 
tions, or ignore the activity around 
them. But they also have a tremendous 
need for approval, which shows up in 
their constant attempts to please and 
to do (or at least pretend to do) as they 
are told. Feeling quite incapable of deal- 
ing with a problem, they avoid it. They 
typically give up toys or turns without 
a struggle, looking stunned or sobbing 
softly instead. Since withdrawn children 
seem uneasy about receiving comfort 
from others, they comfort themselves 
by rocking or rubbing themselves. Not 
daring to let angry feelings out at 
others, some of them may turn on 
themselves, falling to the floor, destroy- 
ing their papers or games, or even 
depriving themselves of a treat. 

Feeling incapable of doing the right 
thing at the right time and in the right 
way, a withdrawn child does not play 
and relate like other children. Instead 
the child builds a protective shell of 
passivity around him- or herself. 


50 Timid and apprehensive, withdrawn 
children are nevertheless aware of what 
is going on around them. Many with- 
drawn children are careful observers of 
other children and adults. They watch 
out of the comers of their eyes, but 
turn away quickly if looked at. In their 
play they often imitate the gestures 
they have seen other children use in 
their games. Sometimes they will 
imitate the entire activity, except for 
vigorous movements and lively excla- 

Most of the time, withdrawn chil- 
dren make no effort to get along with 
others. They ignore efforts by others to 
include them in play, sometimes turn- 
ing their backs to them. Other times 
they seem quite unaware of other chil- 
dren, and become annoyed when other 
children try to play with them, some- 
times ruiming away or whispering 
unkind things to other children. 
Because of these behaviors, it is very 
difficult for withdrawn children to 
develop friendships with other children. 

Many withdrawn children find their 
self-imposed isolation and exclusion 
from the group very frightening. These 
children are likely to find separation 
from important adults (such as a par- 
ent) terrifying. This is particularly true 
when a child enters preschool. The child 
may cling to his or her parents, or just 
sit and sob. In these cases, adjustment 
to preschool may be a long and difficult 
process. It may take many weeks or 
months of your continued and caring 
attention for these children to allow 
themselves to begin to open up and 
relate to you and other cnildren in the 
smallest of ways (for example, smiling 
occasionally, showing interest in 
another child's activity, or asking for 
help when a task becomes too difficult). 

Who Behave 

All children go through periods of 
strong fears and anxieties. They learn 
to deal with their fears either by them- 
selves (often in their play, by acting out 
a frightening experience such as a visit 
to the dentist), or with the help of other 
people (parents, teachers, and other 
children). But there are some children 
who are so anxious for such a long time 
that they can hardly think of anything 
else. Perhaps they are always thinking 
of the territjle things that could happen 
to them or to others in their family. 
Sometimes this fear becomes genera- ' 
lized. That is, they begin to be afraid of 
other things that reaUy wiU not harm 
them. For example, if they are afraid of 
a particular dog in the neighborhood, 
they may begin to fear all dogs, or all 
animals. This fear can also be carried 
over to include people, things, or situa- 
tions. For instance, if Eva is anxious 
about animals, she may even begin to 
fear animal crackers. Or, if Anton is j 
afraid of separation from his mother, 
when he goes to preschool he may 
begin to expect something to happen to 
his mother that wiU prevent her from 
ever coming back to take him home. 
Sometimes such extreme anxiety 
becomes focused on a single object, 
place, or situation. When this occurs, it 
can be called a phobia. It is normal for 

Ereschool children to have passing pho- 
ias (of dogs, insects, school, or trains, 
for example). But when phobias persist 
for a long time (many months) or 
become so limiting that they prevent 
the child from performing his or her 
daily routine, they go beyond the limits 
of normal. Phobic children are one type 
of anxious children. i 

Anxiety can make some children j 
overly fearful, or phobic, but other anx- ' 
ious children may display other behav- 
iors. Anxiety makes some children 
aggressive, others hyperactive (overac- 
tive), and others withdrawn. There are 

some anxious children who behave in 
all of these ways, in a rapid and confus- 
ing succession. 

Anxious children look worried, little 
things bother them, and they cry a lot. 
Some will wet or soil themselves. Some 
will get stomachaches or headaches. 
They might bite their nails, rub their 
hands together a lot, or blink their 
eyes. Some bang their heads against 
tne floor when they are upset. 

Anxious children may be awkward 
and overly cautious. They get upset 
about f allin g or other minor hurts. 
Others are impulsive and impetuous in 
an attempt to hide their anxieties. But 
many of them show their anxieties in 
their play. For instance, when they play 
house or play with puppets, they may 
act out fearful situations (such as tak- 
ing a bath, going on a trip, or being left 
with a baby sitter for the afternoon). 
They may become confused or scared 
by their own make-believe (believing, 
for example, that the water has terrible 
monsters in it, that they will have an 
accident during the trip, or that the 
baby sitter will treat them unkindly). 
They have more trouble than other chil- 
dren knowing the difference between 
make-believe and real life. 

Most anxious children are eager to 
do well, to do the right thing, and not 
to make mistakes. They may be skillful 
but insist that they "can't do it." 
Tfeachers often call them perfectionists 
because they want everything they do 
to be perfect. If they tear their picture, 
for example, they mil insist on making 
a new one rather than repairing the 
torn one. They may refuse to stop an 
activity until it is completed to their 

Meiny anxious children wiU stay 
away from "messy" activities such as 
finger painting or building with clay. 
They may get upset when there is a 
spot on their clothes or arms, and they 
may wash their hands a lot. They tend 
to avoid playing with children their 
own age, preferring to play with 
younger children or grownups. 

Anxious children do best in situa- 
tions where they understand everything 
that is going on and when they know 
exactly what to expect. They like to do 
familiar things in tne same way each 
time. They do not like changes and can 
become really upset and frightened of a 
new experience such as a field trip or 
trjdng a new game. They are very 
troubled by unstructured situations, 
such as the transition from one activity 
to another. Many anxious children get 
upset at rest time because it is unstruc- 
tured. They may feel that if they relax 
too much they will lose control of the 

In teaching children who are anx- 
ious, it is very important to: 

• reassure them about the obvious 
("You will be very safe on the field 
trip. We wiU all go and come back 
on the bus together.") 

• explain clearly what is expected of 

• reassure them that you are confi- 
dent in their abilities to do what 
others can do. 


Anxiety can lead to random, repetitive 
busy work. 

^^ Cognitive 

Anxious children generally under- 
stand how to use materials because 
they spend a great amount of time 
silently and secretively watching 
others. However, their tentative, half- 
hearted efforts and their reluctance to 
try new things may delay their mastery 
of skills. 

Anxiety usually interferes with the 
thinking of these children. An anxious 
child might suddenly forget the steps 
necessary to continue a game or project 
and become confused. This leads to ran- 
dom, repetitive "busy work." For exam- 
ple, in tne middle of a lotto game, 
Hisako was suddenly unable to match 
any more pictures. She began to wail 
that somebody had taken the picture 
she was looking for. Making no further 
effort to participate in the game, she 
resorted to counting the lotto cards 
over and over again. 

Speech and 



Many anxious children are expert 
talkers. Most of their talk relates to 
their fears and concerns. Though they 
may talk a lot and quite clearly, what 
they say is often confused and therefore 
hard to understand, t'or example, 
Hsiao-Ti said to the teacher, "Before 
the cookies got on the table, I got aU 
eaten up." But what she really meant 
was, "I got the cookies on the table 
before they were cdl eaten up." 

Other anxious children may com- 
municate mostly in non-verbal ways. 
They tend to communicate with eye 
contact and tentative or fearful ges- 
tures. Some whimper or cry when 
upset, waiting for others to figure out 
what is wrong. 

Social SkiUs 

When they are feeling less anxious, 
many of these children can play and 
get along well with other cMdren. Usu- 
ally, though, they tend to watch from a 
safe distance, and become upset when 
other children are noisy or come too 
close. If they become too uncomfort- 
able, they may suddenly turn on other 
children with aggression (for example, 
grab a toy away from another child, or 
say unkind things). They show their 
interest in others by watching and com- 
menting on their activity. Their com- 
ments often describe possible disasters 
("It's going to fall," "We're going to 
get lost"). 

On the other hand, anxious children 
tend to be very dependent upon and 
demanding of adults, constantly seek- 
ing help and reassurance. For example, 
on a trip to the zoo, Johnny insisted on 
holding Mrs. Jay's hand and asked 
repeatedly, "The animals can't get out 
of the cages, can they?" Anxious chil- 
dren may tell the teacher what other 
children are doing wrong in order to 
have teachers stop the behavior that is 
upsetting them. At other times, 
though, they may withdraw entirely 
from adults and show no need to be 
demanding, dependent, or eager for 

Motor Skills 

Although tests generally indicate 
that anxious children have the potential 
for normal gross and fine motor devel- 
opment, their body movements appear 
restricted, tense, and awkward. TTieir 
anxiety makes them overly cautious 
and often timid. They seem unable to 
put their "whole selves" into any activ- 
ity. Because of the tension in their 
body movements, it is often difficult toi 
tell how weU coordinated they may be. 
In manipulating objects, they may be 
extremely gentle, barely touching the 
object. Sometimes their hands and fin- 
gers may tremble, making assembly of 
puzzles, form boards, and other objects 


Anxious children tend to be fearful, 
unsure of themselves and their abilities. 
They often say that they cannot do 
what is asked of them. For example, an 
anxious girl may stop midway in mak- 
ing an Easter basket, even though she 
is actually able to complete the task. If 
you tell her that you believe she can 
finish the basket and offer some direct 
help, she may begin to feel that she can 
successfully complete the project. 

Most anxious children like to be 
praised for their skills. They work hard 
to please the teacher and themselves. 
They are overly sensitive to criticism 
and truly afraid of disapproval and/or 
punishment. Many of them worry 
about what others think of them and 
about what others might do to them. 
Often they don't know themselves what 
they want, but they don't Uke other 
people telling them what to do, either. 

Anxious children are often overly 
sober and serious. But they may sud- 
denly get excited with outbursts of cry- 
ing or anger, or with speUs of uncon- 
trollable laughter. 

Who Behave 

Assertiveness is a valuable charac- 
teristic. It helps children be active and 
energetic and get to work on their own. 
But assertiveness has its negative side, 
too. It can cause children to have angry 
outbursts, to snatch away toys, to hurt 
others, or to destroy things. Some chil- 
dren have learned that a verbal or 
physical attack is an effective way to 
get what they want: a toy, attention 
from an adult, and so on. In the class- 
room, though, most children learn more 
effective ways of interacting with 
others, especially with some help from 
the teacher. 

As you are well aware, some chil- 
dren are more easily irritated or 
angered than others. Some have a hard- 
er time controlling themselves than 
others. Nevertheless, their aggressive 
outbursts fall within the normal range 
of behavior if they are occasional occur- 
ences. A child is considered disturbed 
only when his or her typical ways of 
reacting to others are by forceful and 
uncontrolled physical aggression (hit- 
ting, biting, scratching, kicking) and/or 
by verbal aggression (shouting, scream- 
ing, cursing, name-calling). 

Aggressive children tend to hurt 
others with or without provocation. 
Some of them respond with anger only 
to particular situations, as when they 
can't have a toy. Others will explode 
more at times of stress, such as when 
they are tired or have been confined to 
a small space for a long time. Still 
others seem to use aggression as their 
major means of communication. These 
children appear to be angry deep down 
inside and very suspicious or hateful 
toward people in general. Even after 
hurting or upsetting another person, 
the aggressive child is unable to calm 


54 down or to refrain from the next out- 
burst. Many of them are quite destruc- 
tive. You may see these children ripping 
books, pulling dolls apart, or breaking 
crayons into oits. They may also be 
very demanding and impatient. They 
may play with other children for a 
while and then suddenly push them out 
of the way or grab their toys. They 
may disturb others, interrupt or inter- 
fere with their play, and refuse to coop- 
erate with the teacher. 

Though these children may appear 
to be bullies, their hard, aggressive 
behavior is the way in which they cover 
up their inner sense of fear, vulnerabil- 
ity, and inferiority. Aggressive children 
are actually fearful of their own aggres- 
sion and of attack by other people. For 
example, in the midst of an attack on 
another child, an aggressive child may 
suddenly appear to be anxious and con- 
fused. This is because he or she may 
desperately want to get away from the 
situation to hide his or her lack of self- 

Even the most aggressive child does 
not fight all the time. He or she can 
become deeply involved in activities 
and usually enjoys vigorous play. How- 
ever, aggressive children are set off 
more easily than other children. At 
times you may be able to identify those 
situational or environmental factors 
that provoke aggressive behavior. They 
are likely to include such things as: 

• over-stimulation 

• seeing violence among adults 

• inadequate space for motor 

• growing up in an aggressive 

At other times it wiU be difficult to 
determine what provokes the aggres- 
sive behavior because almost anything 
appears to set off the child. As you 
begin to learn about the child, his or 
her environmental needs (for example, 
the noise or activity level that pro- 
motes less aggressive behavior and 
encourages concentration), and suitable 
outlets for aggressive behavior (for 
example, a punching bag) you will be 
able to work more effectively with him 
or her. 


Most aggressive children learn and i 
enjoy all age-appropriate cognitive ' 

tasks. Some children, however, are eas- 
ily distracted by the activity of other 
children or by their own need to change 
activities frequently. This lack of con- 
centration is most often seen in aggres- 
sive children who are also learning 

Many aggressive children are a lot 
more capable than their poor self-image 
and anxious distrust permit them to be. 
Their cleverness may be expressed in 
fighting rather than in constructive 
accomplishments. However, with reas- 
surance, structure, and redirection (hit- 
ting a punching bag instead of children, 
pounding nails instead of the teacher, 
knocking down tenpins instead of block 
buildings), they often are able to show 
their real constructive ability. 

Lacking confidence, an aggressive child may 
throw the play-dough rather than attempt to 
make something. 

Speech and 



Many aggressive children have a 
good command of speech and language 
skills, similar in development to other 
preschool children. They can tell you 
clearly what they want and how they 
feel ("I'm gonna eat all dem cookies. 
They's all mine!"). While the message 
of their communication tends to be 
more hostile than friendly, many 
aggressive children do convey an eager- 
ness for positive relationships ("You re 
my friend, come play with me"). 

Other aggressive children communi- 
cate physicaSy more than verbally. 
They will, for example, grab a toy from 
another child rather than ask for it. 
You can help these children by gently 
reminding them to use words to com- 
mimicate what they want. 

Motor Skills 

Most aggressive children show good 
potential for doing activities that 
require gross and fine motor coordina- 
tion. They enjoy vigorous whole body 
movements (running, climbing, jump- 
ing, throwing, pounding, and so on), 
and may be particularly quick to learn 
such gross motor skills. However, care- 
lessness about their own safety may 
lead to sudden, uncoordinated moves, 
causing tumbles or head-on collisions. 
When upset, they may be particularly 
awkv^'ard and use gross motor activity 
as a way of avoiding or getting away 
from the upsetting situation. Fine 
motor tasks that require patience and 
continued effort (such as putting a puz- 
zle together) are more difficult for 
aggressive children. They may need to 
take many breaks from a simple fine 
motor task in order to complete it. 

You can encourage better use of fine 
and gross motor skills by observing the 
child to determine how much space he 
or she needs to perform a task comfort- 
ably and successfully, and without 
infringing upon the space of other chil- 
dren. For example, if you notice that 
Carl is drawing all over the table 
instead of the paper, perhaps he needs 
a bigger piece of paper. If a bigger 
piece of paper is unmanageable at the 
table with other children, you can try 
taping a larger piece to the wall close to 
where other children are working. 


Many aggressive children appear to 
think poorlv of themselves. They are 
frightened oy their own uncontrolled 
behavior and fear aggression in others. 
They tend to destroy their work and 
declare that it was "no good." Aggres- 
sive children lack confidence and are 
reluctant to learn nev/ skills. For exam- 
ple, they might throw the play dough 
at other children rather than try to 
make an object out of it. They need 
praise and reassurance to help them 
feel better about themselves. 



Social Skills 

Aggressive children have great 
trouble relating to people. Although 
they are often eager to be friendly, it is 
difficult for them to learn to trust 
others. Their response to other people 
is determined more by their own feel- 
ings than by the way other people treat 
them. They tend to be angry or hostile, 
demanding, and defiant. They often 
defeat their friendly intentions by hurt- 
ing others. For example, they may say 
something that sounds mean, or 
squeeze another child's hand too hard. 
They occasionally play with others, but 
the unpredictability of their attacks 
makes friendship difficult. Additionally, 
they have a tendency to strike out 
when they sense the negative reaction 
they are provoking in others. You may 
hear an aggressive child say, for exam- 

Ele, "I hit him because he was going to 
it me!" 

Frequently, other children will 
exclude an aggressive child from their 
play. This upsets the child even more. 
He or she may react by even more 
aggressive attacks, or by crying piti- 
fully. In such a situation, the teacher 
can help by suggesting behavior that is 
more acceptable to the other children, 
by encouraging the other children to 
accept the child and help him or her 
learn, and by standing by protectively 
to ensure success. 

Aggressive children need more pro- 
tection than people usually realize. 
They need protection from physical and 
verbal attack by others as well as from 
their own outbursts. Without this pro- 
tection, their aggression wiU only 
increase. Gaining control is a difficult 
task for aU young children, but is a par- 
ticularly painful and slow process for 
aggressive children. The teacher can 
assist such children toward self-control 
by letting them know that: 

• he or she understands how hard 
the process is 

• he or she has confidence in their 
ability to learn self-control 

• he or she will try to protect them 
from hurting or being hurt 

• he or she will permit them to con- 
trol their own behavior as they 
demonstrate increasing ability to 
do so. 

Who Behave 

At one time or other, most children 
seem to have an unlimited supply of 
energy. This is particularly true when 
they are overstimulated or excited. 
They may rush around so fast and for 
so long that it is exhausting just to 
watch them! Such behavior, however, is 
a normal part of a child's development, 
because it is generally seen in combina- 
tion with less active behavior. 

However, there are some children 
whose typical way of behaving is to be 
constantly on the move. These children 
are called hyperactive or hyperkinetic. 
When other children might be merely 
lively and enthusiastic, these children 
become overexcited. They cannot wait 
for explanations or turns, and seldom 
pause long enough to relax, to watch, 
or to listen to what is going on. They 
tend to rush without purpose into situ- 
ations, endangering themselves or 
others. For example, they may build a 
block structure so quickly that it tum- 
bles down, or pour juice so fast that it 
spills all over. 

Hyperactive children cannot tolerate 
not being able to move around freely. 
When they do manage to sit down, 
their bodies squirm, turn, and twist. It 
is impossible for them to stay with a 
chosen activity for any reasonable 
period of time: their ability to attend to 
a single task may be as short as ten to 
twenty seconds! They seem unable to 
screen out unimportant noises, which 
make them even more restless and scat- 

Because hyperactivity may have 
either physical or emotional causes and 
because no two children are the same, 
hyperactivity can be expressed in a 
variety of ways. Some hyperactive chil- 
dren may appear very anxious. Others 
may be aggressive toward other chil- 
dren. Frequently they get in the way of 
others, often without meaning to or 
even realizing that they are causing a 
disruption. They may also show aggres- 
sive behavior when they meet with a 
challenge or a restriction, rushing 
around needlessly and/or having a tem- 
per outburst. 

Most hyperactive children do have 
peaceful, contented moments, when 
they play and relate happUy. But their 
mood swings are more extreme than 
those of other young children and their 
behavior is more inconsistent. Their 
hyperactivity normally can be seen in 
their difficulty with relationships with 
other children, their poor attention 
span, and their lack of control over 
gross and fine motor movements. 


Schedule and time 
activities well to pre- 
vent a hyperactive 
child from losing 

^^ Speech and 

Many hyperactive children under- 
stand and can use language well. How- 
ever, because they have difficulty stay- 
ing with a task or keeping their mind 
on what they want to say, they may 
alter or confuse the meaning of their 
thoughts, making it difficult to get the 
drift of what they are saying. Their 
speech gives you a sense of urgency 
and bewilderment rather than a sharing 
of information and ideas. In addition, 
their speech is often so fast that they 
run words and thoughts together. For 
these reasons, most hyperactive chil- 
dren rely primarily on body language to 
express themselves. They need to be 
encouraged to express themselves in 


Hyperactive children have difficulty 
acquiring cognitive skills because of 
their inability to sit quietly, listen to 
instructions or explanations, and con- 
centrate on a task. If they pursue the 
task and it becomes more oifficult, they 
quickly lose interest and move off to 
something else. 

In their calm moments hyperactive 
children may show far more Imowledge 
and ability than their usual, scattered 
performance would lead one to expect. 
These calm moments are best realized 
when the noise level of the classroom is 
low and the room isn't too crowded. 


Many hyperactive children think 
poorly of themselves. They are usually 
aware of and troubled by their uncon- 
trolled behavior. It is frustrating for 
them to make mistakes (to knock over 
the blocks or spill the juice), because 
they really want to play and get along 
with others. All day long they seem to 
be searching actively for something 
they need and can't find. As they rush 
about they may injure themselves fre- 
quently, which can make them feel 
helpless and unprotected. One minute 
they may be cheerful, the next crying 
and miserable. 

Social SkiUs 

Hyperactive children are generally 
friendly toward adults and other chil- 
dren and want to be liked. They fre- 
quently offer to help adults and tiy 
tneir best to please. However, they 
have difficulty playing with other chil- 
dren because of their inability to con- 
centrate on tasks during cooperative 
and interactive play, and their inability 
to remain part of a group except for 
brief periods of time. Peaceful moments 
of plajdng with other children are often 
interrupted by sudden swings in mood 
or imcontrolled behavior. They may 
become aggressive, or get in the way of 
others without meaning to. Their inabil- 
ity to wait for a turn may make the 
other children angry. Also, their inces- 
sant, confused talk may be irritating to ; 
the others. i 


When the boundless energy of ' 

hyperactive children is guided toward <. 
active tasks and play (arranging tables 
and chairs, washing paint brushes, help- 
ing to set up playground equipment), 
these children can function and cooper- 
ate well. But restriction can lead to 
needless running and to temper out- 

Motor Skills 

The hardest task for hyperactive 
children is making appropriate use of 
gross and fine motor skills. They sim- 
ply can't help moving their bodies 
nearly all the time, often in an uncon- 
trolled manner. This constant move- 
ment makes functioning in other areas 
very difficult as well. 

Although these children seem to 
enjoy gross motor play such as cUmb- 
ing, bike riding, and jumping, their 
motor development is imeven and is 
often influenced by how well they have 
learned to play with other children. 
They may seem perfectly able, for 
example, to throw a ball against a wall, 
but have difficulty throwing the ball to 
another child. In addition, a number of 
experts believe that many hyperactive 
children have perceptual and coordina- 
tion problems. This may account for 
the many accidents these children have: 
bumping into walls, tables, children, or 
building blocks; stumbling or tripping; 
spilling; and so on. 

Whose Behavior 
Is Psychotic 

Professionals differ in their under- 
standing of the severe disorders of 
childhood commonly referred to as 
childhood psychosis. No one is really 
sure what causes psychotic disorder in 
a very young child, and many persons 
have spent their professional careers 
trying to prove whatever theory they 
believe about the causes of psychosis. 
Many use other diagnostic terms to dis- 
tinguish types of psychotic disorders, 
such as autism, atypical development, 
borderline states, and childhood schizo- 
phrenia. Some professionals feel these 
diagnostic terms refer to real differ- 
ences in behavior among psychotic chil- 
dren, while others do not oeUeve the 
differences are sufficiently clear-cut. 
This book describes psychotic disorders 
in general, making no distinction in 


A psychotic child will 
need your gentle 
encouragement during 

60 In spite of professional disagree- 
ment over diagnostic terms and possi- 
ble causes of psychosis, most profes- 
sionals agree that this group of child- 
hood disorders presents very special 
educational challenges. Children whose 
behavior is psychotic need to be worked 
with by highly trained persons. They 
are rarely mainstreamed into a Head 
Start or other preschool setting, except 
when other specialized facilities are 

Most professionals also agree that 
regardless of the diagnostic term, there 
are some clusters of symptoms that are 
usually present in most childhood dis- 
orders in this group. In their book, 
Autism (New York: Halstad Press, 
1976), Edward Orwitz and Edward 
Ritvo list five clusters of symptoms: 

• problems in the way the child per- 
ceives the world (cognitive skills) 

• problems in the sequence and rate 
at which the child achieves certain 
developmental milestones (cogni- 
tive slaUs) 

• problems in speech and language 
development (speech and language 

• problems in forming relationships 
with other people (social skills) 

• problems in the way the child uses 
his or her body (motor skills). 


Psychotic children have many prob- 
lems with learning. Often their thinking 
is confused. For instance, they mix up 
events that happened long ago with 
events that are happening right now, 
much more often and for a much longer 
time than is normal for yoimg children. 
They also get confused when objects 
are moved to different places. For 
example, when the tables and chairs 
were moved around, Maria suddenly 
did not know where she was. She began 
to wail that she was lost. Later on she 
complained that the tables and chairs 
were "lost." Psychotic children seem 
particularly confused when they have 
to adjust to changes in routine, such as 
during transition times, trips, and vaca- 

Many psychotic children seem to 
have problems learning through hearing 
and seeing. They have an exaggerated 
response to both: they either complete- 
ly ignore what can be heard and seen, 
or they get overexcited by soimds and 
by things they see. Some prefer to 
learn through their sense of touch or 
their sense of smell. As with other chil- 
dren, it is a good idea to teach psy- 
chotic children through the channels to 
which they are most receptive. Four- 
year-old Paul seemed "deaf" to all the 
talking around him, but his teacher 
knew that he loved music. She was 
delighted when he memorized an entire 
song from a record, and decided to use 
music as a bridge for teaching him. She 
began by making up a song with Paul 
about daUy routines, to help him make 
transitions more easily. 

Unless you intervene, 
a psychotic child may 
repeat a task over and 

Psychotic children are quite uninter- 
ested in social games like pla)dng 
house, and most will stay away from 
creative play like modeling clay. How- 
ever, some psychotic chil(&en can learn 
to do some tasks very well. Some of 
them have an easy time with sym- 
bols (such as numbers, letters, and/or 
words), which they enjoy manipulating 
(counting, adding, or making up little 
stories or poems). Many of these chil- 
dren are excellent at manipulating toys 
and doing puzzles. Their aoility to put 
together construction sets, puzzles, and 
other problem-solving games that 
depend on manipulation is limited only 
by their tendency to repeat endlessly 
the same task. Plepeating tasks in this 
way helps them to master some skills, 
but it also limits their opportunity to 
learn other skills. 

Some psychotic children have a fan- 
tastic memory. Some, in fact, don't 
seem to be able to forget anything that 
has ever troubled them. For example, 
Kenny's favorite phonograph record got 
a crack in it. Kenny continued to look 
for that crack and complain about it, 
long after the record had been replaced. 
His concern about the damaged record 
persisted for a long time, and came out 
during activities that were in any way 
related to record playing. Other psy- 
chotic children seem to remember ran- 
dom facts, which they string together 
in a way that may have little meaning 
to the listener. 

Psychotic children have definite pref- 
erences for toys and will usually do well 
with those toys that appeal to them. 
They may become deeply involved with 
their play, and continue with a task no 
matter what is happening in the room. 
In fact, they are apt to get upset when 
they are stopped, unless they are 
encouraged to move from one activity 
to another without having to give up 
the first (for example, taking the toys 
they have been working with to the 
snack table). You can facilitate the 
learning experiences of these children 
by having their routines remain the 

same, keeping the toys and materials in 
a consistent location, and having the 
people who are important to them 
remain a constant part of the preschool 

Perception of the World 

Children with psychotic disorders 
may seem too sensitive or not sensitive 
enough to such stimuli as sights, 
sounds, tastes, touch, pain, and tem- 
perature. Some children may overre- 
spond to the tactual feeling and/or 
temperature of objects. Others may not 
respond at all. 

Sometimes there may be rapid 
shifts in the sensitivity of one child. At 
times he or she may be unresponsive to 
high degrees of stimulation. At other 
times the child may seem completely 
overwhelmed by even a mild degree of 
the same stimulus. 

Sequence and Rate of 

The most striking quality of psy- 
chotic children is that they don't seem 
to develop and act in ways typical for 
their age. Sometimes they may seem to 
be generally delayed in everything. 
Most often, however, what is striking is 
the unevenness of their progress. 

Their functional development is gen- 
erally very uneven in nearly all skill 
and behavioral areas. A child who han- 
dles his or her body very well may be 
very late in learning to talk. Another 
child may learn to talk almost perfectly 
at a very early age, but have no idea of 
how to use words to communicate with 
other people or to get what he or she 
wants. At times a child may use lan- 
guage with clarity of meaning. At other 
times the same child wiU seem unable 
to use language at all. 

Psychotic children rarely function in 
a whole and iategrated manner. This 
quality accounts for the colloquial and 
unkind terms that are often used to 
describe such children. "Crazy," 
"cracked," and "mental" refer to the 
broken and fragmented functioning of 
these children's minds. 


^^ Speech and 

In general, a psychotic child seems 
either to avoid communicating or to be 
unable to communicate. Many psy- 
chotic children can be taught communi- 
cation skills. However, they wiU only 
use these skills on their own when they 
begin to relate to others. Other psy- 
chotic children may never learn to talk. 

Some psychotic children may show 
that they do understand and can use 
language in an imitative way. They 
may echo the end of whatever is said to 
them, and speak in an artificial, parrot- 
like voice that does not express reeling 
or have the normal rhythm and inflec- 
tion of a sentence. Some may repeat 
rhymes and the words to television 
commercials as though they made up a 
private language. Sentences may be 
strung together that have little mean- 
ing to the listener. For example, at 
lunch, the teacher asked TiUy if she 
wanted more carrots. In a high-pitched 
voice, TlUy repeated the teacher s words 
exactly: "Do you like more carrots, 
inly honey?" and then shouted a com- 
plete advertisement about a supermar- 
ket. While there was no apparent con- 
nection between the supermarket adver- 
tisement and the children's lunch, Tilly 
did seem to be trjdng to respond and 

Psychotic children tend to confuse 
words that are associated with each 
other (pail and shovel, for example). 
Some may use odd "code words ' to 
refer to things. While many children 
may do these things when they are 
first learning to speak, they usually cor- 
rect themselves as they get older, 
whereas psychotic children do not. Psy- 
chotic chll(i-en also typically confuse 
"you" with "I." 

The body language of psychotic chil- 
dren communicates their isolation from 
and fear of people: no social smile, no 
eye contact, and turning or moving 
away from people who try to approach 
them. They communicate their confu- 
sion by getting upset when they have 
to deal with change, but their concen- 
trated play also communicates their 
real ability to enjoy manipulating and 

Psychotic children often seem to enjoy 
manipulating and learning. 

Social SkiUs 

Psychotic children rarely develop 
meaningful relationships with other 
people. Most avoid contact with others. 
They may not smile, make direct eye- 
to-eye contact, or reach out to be 
picked up. Some may become overly 
attached to one person and frightened 
of all others. Some may cling to adults 
during times of distress, but refuse to 
relate at any other time. Some may 
seem unable to distinguish at all among 
different people. Still others may seem 
completely unaware of the existence of 
others, or may prefer inanimate objects 
to people. 

Other children can usually adjust to 
a psychotic child's avoidance of contact. 
They can play side-by-side with no 
problem, unless or until the psychotic 
child becomes destructive and unpre- 
dictable. Such outbursts should be 
explained as clearly as possible to other 
children when the child enters the class. 
Of course, you will want to help the 
child to limit these outbursts as much 
as possible. 

Motor Skills 

Gross and fine motor coordination 
may or may not be well developed. In 
either case, psychotic children tend to 
use their bodies in very strange ways, 
such as walking in circles, rocking back 
and forth, moving their arms up and 
down in flapping motions, and so on. 
They may walk pigeon-toed or glide 
gracefully about the room. Some psy- 
chotic children spend long periods of 
time in what loots like an uncomfort- 
able position. Others may sway back 
and forth a lot. StUl others may walk 
around and around the room in exactly 
the same order (from the block shelf to 
the piano, to a certain chair, to the 
painting easel, to the block shelf, to the 
piano, and so on) unless someone stops 
them. They seem to move for the sake 
of moving, rather than use movement 
as a way of getting from one activity or 
place to another. 

Some psychotic children are able to 
use their hands with very good control 
and can manipulate toys skillfully. 
They may repeat a body skQl endlessly, 
however, until they are helped to move 
on to something else. 

Psychotic children often use their 
bodies to comfort themselves (as in 
rocking or rubbing) and also to express 
strong feelings. When they are upset 
they may hurt themselves until they 
are stopped. For example, a child may 
rhythmically bang his or her head 
against the wall or floor, or bite or hit 
him- or herself. 


64 Self-Concept 

It is difficult to get an accurate pic- 
ture of how psychotic children feel 
about themselves. These children do 
not respond well to tests. Their 
responses are so inconsistent and 
uneven, when they respond at all, that 
professionals are unable to get a clear 
picture of their functioning. 

From all appearances, however, psy- 
chotic children nave a poorly defined 
sense of self. Sense of self can be 
defined as knowing where one's body 
and thoughts stop and the external 
environment begins. Typically they 
may, for example, seem confused or 
angry upon seeing themselves in a 

Besides having difficulty separating 
themselves from the environment, psy- 
chotic children seem to have difficulty 
sorting out what is real from what is 
make-believe. Unlike other children, 
who may pretend to be an animal or a 
car, some psychotic children insist that 
they are a "kitty" or a "steam shovel." 

Psychotic children, however, seem 
to be aware of the difference between 
pleasure and anger, caring and hostil- 
ity, in themselves and in others. For 
example. Carmen was told firmly by 
her teacher that she must stop throw- 
ing blocks in the air, "because I do not 
want you to get hurt." Carmen raised 
her arm over her head and shouted, 
"Be kind to yourself!" 


Drugs are sometimes used to help 
emotionally disturbed children control 
the behaviors that are causing them 
problems. Within Head Start and other 
preschool programs there are generally 
few emotionally disturbed children who 
require medication. 

Project Head Start's policy regard- 
ing the use of medication is the follow- 

Whenever possible, arrangements 
should be made with the family and 
the physician to schedule admmis- 
tration of medication during times 
when the child is most Ukely to be 
under parental supervision. Other- 
wise it is the responsibility of the 
Head Start director or his/her desig- 
nee to supervise the administration 
of medication in accordance with 
state requirements as to specific 
personnel who are designated to dis- 
pense drugs and be accountable for 
them. In addition, over-the-counter 
drugs (e.g., aspirin, nose-drops) 
should be administered only by per- 
sonnel who are knowledgeable aboui 
their use and side effects. Other 
drugs must not be given unless the^ 
have been prescribed by a physician 
for a particular child. AU medicatioi 
must be adequately labeled. Drugs 
must be stored out of the reach of 
children and prescription medica- 
tions must be kept under lock and 
key. Before any medications are 
administered, recorded parental con 
sent must be on file. Special precau 
tions are of particular importance 
when treatment for a specific handi 
capping condition requires adminis- 
tration of potentially harmful drugs 
(e.g., anticonvulsants, ampheta- 

(Transmittal Notice 73.4, 2-28-73, pages 9 and 10.) 

This section discusses why and ho\ 
drugs are used and how you may help 
a child who is taking medication. 


a Drug? 

Before any drug is prescribed, a dis- 
turbed child should be thoroughly eval- 
uated by a medical doctor, usually a 
neurologist. This evaluation generally 
includes a physical examination as well 
as psychological testing. Sometimes 
observations by a psycnologist or expe- 
rienced educator wno works with the 
child provide useful supplemental data 
for the doctor. 

How Is the 
Proper Dosage 

The amoimt of a drug (dosage) that 
a child takes is based partly on age and 
body weight. Most doctors start out by 
giving a child a small dose to see what 
effect it has on behavior. The doctor 
works closely with the family to find 
out what dosage is suitable for chang- 
ing the behavior without producing side 
effects. The dosage may have to be 
increased to bring about the desired 
change. As the child grows bigger and 
heavier, the dosage may have to be 
increased to maintain the same effect. 
In cases in which the child's behavior 
and functioning improve, the dosage 
may be decreased and eventually 


Medication can help some children perform 
tasks better by allowing them to concentrate 

66 What Should 
You Know When 
a Child Is on 

1 . You should always be informed 
when a child begins to take a drug, and 
when the dosage is changed. 

L. The person who administers the 
drug and others who work closely with 
the child need careful instructions 
about how, when, and how much of the 
drug to give, the side effects to watch 
out for, and the expected effects on the 
child's behavior. 

O. You, the child's parents, and the 
doctor must keep in close touch with 
each other to compare notes about how 
the drug is working. 

4. You should know whom to call 
with questions and in case of emer- 
gency (usually the child's doctor). 

5. The drug must be kept in a safe 
place at home and the parent must be 
truly reliable about giving the recom- 
mended dose at a regular time. Nothing 
is more confusing to a child than to 
take a drug irregularly. One day the 
child feels controlled and able to engage 
in preschool activities; the next day the 
same child is unmanageable and 
thoroughly unhappy with everj^hing 
and everybody. This is also hard on the 
teacher and the other children in the 


Goes Along 
>vith the 

Drugs should always be used in 
combination with a ^ood educational 
program. Often a child needs individual 
tutoring and special work to learn the 
skills that he or she was unable to learn 
when his or her behavior was out of 
control. Nearly always, the family 
needs to talk with a counselor to learn 
more about the behavior and ways to 
work with it at home. 

Used as part of a comprehensive 
plan of education, therapy, and family 
work, a drug can make the child more 
pleasant to be with, so that he or she 
can have more positive experiences 
with people and in learning situations. 
The drug is a temporary crutch that 
enables the child to ej^erience success 
— sometimes for the first time. The 
increased attention span that a drug 
can produce allows a child to feel like a 
competent person who is able to learn 
and master new skills. Some parents 
have reported that the drug tnerapy 
enabled them to relax with their cmld 
for the first time, and to redirect their 
own energy toward other things that 
could help the child. 

What Are the 
Side Effects 
that May 

1 . A drug may sometimes mask 
another problem that needs attention. 
For instance, a child who comes to pre- 
school hungry in the morning may 
appear very restless. Feed the child 
breakfast and observe his or her reac- 
tion. Sometimes a child is given a drug 
just to keep him or her quiet and out of 
trouble, while no one pays any atten- 
tion to the real causes of the child's 

Li. When a child first starts to take a 
drug, you may notice that he or she 
has a loss of appetite, is restless or 
cranky, or has difficulty f allin g asleep. 
If you notice that a child appears 
groggy, drowsy, poorly coordinated, or 
very irritable, he or she may be react- 
ing adversely to the drug. Your obser- 
vations shoiild be reported immediately 
to the nurse, the child's parents, or the 
child's doctor. 

o. Medication sometimes causes a 
child to grow somewhat more slowly in 
height or weight. 



and the 

Children who are hyperactive are 
administered drugs more frequently 
than children with other kinas of emo- 
tional disturbance. These children can 
generally be helped a great deal by the 
use of drugs combined with a good 
therapeutic and educational program. 
The drugs normally prescribed for these 
children are stimulants, commonly 
called "speed." The effect of these 
drugs on children, however, is the oppo- 
site of speed: they appear to slow a 
child down so that he or she can con- 
centrate better. The child becomes more 
able to keep his or her mind, eyes and 
ears on the task at hand. Body move- 
ments and thoughts can be organized 
more purposefully. The child does not 
jump or look around, wiggle, bounce, or 
tap ringers as much because the drug 
helps shut out irrelevant stimuM. 

The drugs that are administered to 
young children for h5T3eractivity and 
distractibility are not habit forming 
when given properly. The amounts 
given do not cause addiction. However, 
as a child's body gets used to a drug, 
he or she may buHd up some "toler- 
ance" to it. The dose may then have to 
be increased in order to continue to 
have the same effect on the child's 
behavior. Parents should be aware that 
the child's dosage may change. This 
does not mean that the child has 
become addicted. 

Not all h5^eractive children are 
helped through the use of drugs. Some- 
times the drugs do not produce any 
change in their behavior. In these 
cases, the doctor generally discontinues 
the drug and explores other kinds of 
therapy more completely. 

You may have seen articles in news- 
papers and magazines about situations 
in which thousands of school children 
were on drugs that had been prescribed 
over the telephone by doctors who had 
never seen the children in person. 
Drugs can be improperly used. Ask 
questions if a child in your class is tak- 
ing a drug. If you have misgivings, 
speak to the child's doctor. 



Chapter 6: 






Mainstream experiences 
can help disturbed 
children learn about 
themselves and the 
world around them. 

70 This chapter provides suggestions 
on how to mainstream children with 
emotional disturbance in your pro- 
gram. Included are techniques for plan- 
ning, ideas for classroom arrange- 
ments, general teaching guidelines that 
are useful for all children, and specific 
techniques and activities for use with 
emotionally disturbed children. 

With any disturbed child in your 
class, there are some important steps 
to take. 

1. Get to know the child. Learn the 
child's strengths as well as needs. 

Z. Get to know the child's parents 
and work together with them. They can 
give you valuable suggestions. You can 
provide them, in turn, with ideas that 
you have found useful in working with 
the child. 

3. Learn all you can about emotional 
disturbance. Read enough about it so 
that you feel comfortable, prepared, 
and confident Talk to other teachers, 
parents, and friends who have worked 
or lived with disturbed children. 

4. Avoid being overprotective, but be 
alert to the child's needs for support If 
you do things for children that they 
can do on their own, the success is 
yours, not theirs. And if you ask them 
to do things they aren 't capable of, 
they will fait The best encouragement 
for learning and improvement is a 
good, solid success. You can create the 
circumstances that make this not only 
possible, but likely. 


The planning process for an emo- 
tionally disturbed child has the same 
purpose as for other children: to help 
you map out a course of action for 
working with the child. This process 
calls for the involvement of several peo- 
ple: the teacher, the parent or parents, 
Head Start staff representing the vari- 
ous service components, and service 
providers from outside agencies. 

The goal of the planning process is 
to produce an Individualized Education 
Program (I.E. P.) for the child, which is 
now required by Public Law 94-142, 
Education for All Handicapped Chil- 
dren Act, and by Head Start Perform- 
ance Standards. Based on an evaluation 
of the child, the Individualized Educa- 
tion Program states the child's present 
level of ^ucational performance, the 
annual goals and short-term instruc- 
tional objectives for the child, and eval- 
uation procedures for determining 
whether instructional objectives are 
being achieved. 

From the point of view of Project 
Head Start, tne planning process is as 

1 . An interdisciplinary team is 
required to make two lands of diag- 
noses: a categorical diagnosis and a 
functional diagnosis. A categorical diag- 
nosis is simply a statement of the kind 
and severity of the child's handicap. 
This kind of diagnosis is useful to you 
only for reporting or record-keeping 
purposes. A functional diagnosis or 
assessment is a developmental profile 
that describes how the child is function- 
ing, and that identifies the services the 
child requires to meet his or her special 

L. Based on the functional assess- 
ment, an individualized education plan 
is to be developed for the child. This 
plan describes the child's participation 
in the full range of Head Start services, 
and the additional outside services that 
are needed to respond to the child's 

O. Periodically, ongoing assessments 

of the child's progress are to be made 
by the Head Start teacher, the child's 
parents, and (if needed) by the full 
diagnostic team. If these re-evaluations 
show that the child's individualized edu- 
cation plan or the services he or she is 
getting are no longer appropriate or 
needed, they should be changed to suit 
the new circumstances. 

4. When the child leaves the pro- 
gram. Head Start should make arrange- 
ments for the continuity of needed 
services in elementary school. This can 
be done in a variety of ways, but usu- 
ally involves holding a conference with 
parents, the school, and service pro- 
viders. The elementary school should be 
given a description of the services the 
child has been receiving, recommenda- 
tions for future services, and the child's 
records from preschool. 

As the child's teacher, you are 
involved in many of these procedures. 
Your part in the process is described in 
more detail in the following six steps. 
These steps are Just as useful with non- 
handicapped children as they are with 
disturbed children. 

Step 1: Observe each child in a vari- 
ety of activities, identify strengths and 
weaknesses, and record your observa- 

Step 2: Set objectives based on what 
is reasonable for the child to achieve. 

Step 3: Select classroom activities 
and teaching techniques that can best 
help each child reach the objectives. 
Sedc outside assistance as needed. 

Step 4: Develop the plans with the 
child's parents and specialists. 

Step 5: On a continuing basis, 
observe, evaluate the child's progress, 
and develop new objectives. 

Step 6: When the child is ready to 
leave Head Start, make plans to ensure 
that there is continuity of needed serv- 
ices with the public school. 

Each of these steps in the planning 
process for handicapped children is dis- 
cussed in greater detail below. For help 
in individualizing your activity plan- 
ning for disturbed children, see the 
activities section, page 96. 



72 Step 1: 


The process and purpose of observ- 
ing is the same for all children. The 
purpose of observing a child is to iden- 
tify the child's developmental level — 
the level at which the child is actually 
functioning. This can teU you much 
about the child as an individual. 
Progress is made by building on the 
child's strengths and working on areas 
that are weak. As you observe the child 
in a variety of activities, you should 
take careful notes. Another name for 
this process is assessment, or evalua- 
tion. Evaluation is particularly neces- 
sary and useful to the plaiming process 
because it makes you aware of the 
basis for what you do in the classroom. 
The following example describes a situ- 
ation that calls for evaluation. 



At the beginning of the year, you 
meet five-yearold Margo. An obedient 
little girl, Margo always does every- 
thing you ask of her, silently and effi- 
ciently. She almost seems like what 
some teachers would call "a model 
pupil " There is, though, one thing that 
troubles you about Margo's behavior. 
She seldom plays with other children j 
and almost never stands up for her I 
rights. She allows other children to take 
away toys she is playing with, without 
even a word or gesture. When snack 
time comes and the little boy sitting 
beside her snatches away her crackers, 
she moves silently away from the table 
and begins thumbing through a picture 
book. Margo is a child you need to 
observe closely. Although her behavior 
isn't disruptive to you or other children 
in the class, her behavior does seem 

You think that there are several pos- 
sible explanations for Margo s behavior. 
Maybe Margo is just shy and has been 
used to playing alone at home. This 
suspicion is confirmed when you 
observe her in other social activities 
and when you talk with her mother. 
Maybe Margo really isn't hungry at 
snack and so gives up her share easily. 
But soon after snack she comes to you 
to ask for cookies and juice. Maybe she 
has never been away from her parents 
before, and just needs a little time to 
adjust to preschool You notice she says 
goodbye to her mother fairly easily in 
the morning, and doesn 't seem very 
upset after she has left. But since you 
know that children often hide separa- 
tion anxieties, you want to watch her 

Giving up too easily may be one indication of 
an emotional problem. 

Several weeks pass and Margo 
seems to be moving further and further 
away from playing with other children. 
The more assertive children seem to be 
taking advantage of her. At this point, 
you begin to think something is seri- 
ously wrong with Margo, for her 
unusual behavior is continuing and, in 
fact, getting worse. 

You start to keep notes. You write 
down all the behavior that seems 
unusual- what the circumstances are 
and what Margo does. Your careful 
observations and the notes you keep 
are the best beginning for figuring out 
what the problem could be. 

Anyone who works with children 
can be an observer in this way. If you 
notice a problem in a child, try to fig- 
ure out possible explanations for it. 
Tfest eacn explanation to see if it 
accounts for what you have observed 
and reject ones that don't fit the facts. 
Gradually, you can narrow down the 
possibilities. You may find yourself 
with one or two possible explanations 
of the problem or you may still not 
know. At that point you may decide to 
seek help. 

How to Observe 

Observation is a technique of 
focused looking and listening to what 
people say and do. Using observation 
as a tool for learning about children 
involves being systematic, watching for 
patterns, and using the information. 

Be Systematic 

Your first step is to decide what you 
want to observe. Thinking about Margo 
again, for example, you remember that 
in the dress-up comer Margo sat to one 
side, half watching the other children 
but making no attempts to join them. 
Since you know that dress-up requires 
social skills, you want to observe how 
she handles other activities that require 
such skills. 

You next think of other activities 
that require social skills. They might 
include oeing a character in a play, tak- 
ing turns on the tricycle, talking to 
other children, and participating in 
"Circle Time" or "Show and TfeU." You 
will want to observe Margo when she is 
doing these things. 

Your observation notes should 
include several kinds of information: 

• What the activity is: snack, for 
example, or sand table. 

• What is happening around the 
child. ("The room was noisy. A 
new child entered our classroom 
today. The playground was 

• The details of what Margo does 
and how she does it. ("Margo 
seemed to ignore Jeff today when 
he asked her to help him bmld a 
castle with the tinker toys. She 
turned away from him and walked 
to the other comer of the room.") 

• How you think the child is feeling. 
This information is harder to come 
by, because you can never reaUy be 
certain about how someone feels. 
You can only listen, observe, and 
try to draw some logical conclu- 
sions. (If Margo keeps saying, "I 
need my Mommy," you might 
write "Margo seems unusually 
lonely and worried today." If she 
smiles when you say that you will 
catch her at the bottom of the 
slide, you might write, "Margo 
seemed relaxed about playing on 
the slide today.") 

You continue to observe Margo 's 
skills regularly enough and long enough 
to get a sense of how she is function- 


74 Here are some general tips to help 

you be systematic as you observe. 

1. Note details 

It is very important to write down 
specific, detailed observations that 
focus exactly on what the child does. 
For example, if you write down, 
"Margo sat in the comer all day," this 
could mean that she was tired, she 
didn't want to join the activity going 
on, she didn't like the other children, or 
a number of other possibilities. How- 
ever, consider this version: "Margo sat 
in the comer by herself during circle 
time, cooking, snack, and rest period. 
She stared at the other children while 
they played. Twice she started to get 
up, as if to join them, but sat down 
again." These notes would be im- 
mensely helpful both to you and to a 
trained diagnostician, who would recog- 
nize that they could indicate a problem. 

For information to be useful to you 
and others, it must be specific. 

2. Write down the details as soon as 

Write down what you see as soon 
as possible, since it's easy to forget 
quickly the details of a child's behavior 
in a particular circumstance. Details are 
important: they describe a child's indi- 
viduality. They are also the best indica- 
tors of a child's needs. When you make 
notes, try not to be obvious about it. 
Write them down away from the child. 

3. Plan a realistic schedule 

Your observations should be sched- 
uled, just as your activities are. Ob- 
serve and make notes as often as neces- 
sarv to get a full picture of what the 
child does easily and has problems with 
in the skill area you are focusing on. 

4, Vary the settings in which you 

Children can behave differently in 
different activities and moods, so it's 
important to observe a child in a vari- 
ety of situations. Observe the child on 
the playgroimd and in the classroom. 
Observe the child as he or she plays 
alone, with other children, and with you 
and other adults. Observe the child 
when he or she seems to be feeling 
happy, sad, tired, rested, friendly, and 
angry, because these feelings affect the 
child's behavior. 

5. Vary your observer role 

You might also try to vary your 
role as an observer. You can act as a 
spectator-observer, watching but not 
participating. For example, you can 
observe from the side oi the room while 
another adult manages the classroom 
activities. Or you can be a participant- 
observer, taking part in the activity 
with the child. It is usually easier to 
observe as a spectator, so you might 
try this method first. Again, be careful 
not to call attention to yourself as you 
observe, otherwise the child might not 
act naturally. 

6. Start by observing one child at a 

As you become more experienced in 
observing, you will probably find that 
you can observe more than one child at 
a time. It's best not to try to do this, 
however, until you are pretty sure you 
won't get confused, or miss or forget 
important information. 

Watch for Patterns 

Watching for patterns is an impor- 
tant part of observation. You may 
notice that a child sometimes hits 
another child, seems unusually depen- 
dent on you, or is particularly attached 
to one toy. All preschool children act in 
these ways from time to time. What 
you want to know is whether the child 
often or always does these things. 
Carry a piece of paper and a pencil 
around with you and keep track for a 
few days. Be sure you are objective 
(factual) about your observations — try 
to keep your own feelings and reactions 
separate. In this way, you will be able 
to see the patterns that point to the 
particular skills with which the child 
needs help. 

Going back over all the notes you 
have made can help you discover pat- 
terns you didn't see before. You should 
review your notes on a regular basis. 
The information in them can help you 
identify new skill areas and behavior 
you might want to find out more about, 
either by observing or by other assess- 
ment methods. 

Use the Information 

Once you have observed a child sys- 
tematically, written down your observa- 
tions, and reviewed your notes, you will 
be able to identify areas of strength 
and weakness in the child's skills. This 
information can be used to develop 
objectives for the child, and to select 
activities and teaching techniques that 
meet the child's needs. This information 
can also become a basis of discussion 
with other teachers, the parents, and 
the specialists. 

For example, when you review the 
observations you made about Margo, it 
becomes clear that she does have a 
problem with social skills. In particular 
you notice that she has a lot of trouble 
in group games. Since your objective is 
to improve Margo 's socialization during 
group games, you select activities that 
involve this skill. However, it would be 
unfair and unrealistic of you to expect 
Margo to feel comfortable in a group 
right away, so you wiU have to modify 
the activity. You may first want to 
encourage Margo to play with one 
other child, perhaps someone she espe- 
cially likes or who Ukes her. As she 
learns to play successfully with one 
child, you might want to introduce 
another child into the play activity. 


76 Step 2: 

Set Objectives 

An important part of the planning 
process is developing individual objec- 
tives that will lead to the maximiim 
development of each child. The objec- 
tives need to be realistic in terms of the 
purpose of Head Start and the 
program's staff and time resources. 
Most important, the objectives should 
be developmental objectives. In other 
words, you can't expect to make a dis- 
turbed four-year-old function exactly 
like most other four-year-olds, but you 
can help the child progress to his or her 
next developmental level. 

Here are some guidelines for setting 

1. Develop specific objectives 

When you have gotten together 
your observations, you will find some 
areas of strength and some of weak- 
ness. This information becomes useful 
when it is translated into what the 
child needs. State objectives in terms of 
observable skills and behaviors that the 
child needs to learn for effective func- 
tioning. Start with what the child does 
well and use those abilities as a bridge 
to new learning. 

For example, your objective may be 
to increase Edgar's vocabulary. Since 
you have observed that he enjoys 
music and easily learns new songs, you 
deliberately select songs that have new 
words for him to learn. In addition, you 
encourage Edgar to make up songs 
that teU a story or to add new verses to 
songs he already knows. 

Or your objective might be to help 
Mary EUen interact with others with- 
out conflict. From observation you 
know that she is particularly skilled at 
building with blocks. In the block cor- 
ner you set up a project that involves 
Mary EUen with a small group of other 
children. You set a task that necessi- 
tates cooperation among the children. 

Some teachers believe that setting a 
target date for the achievement of each 
objective helps them to measure a 
child's progress. Others feel that set- 
ting a target date is unrealistic and 
serves little purpose. Children, after all, 
wiU only master a skill when they are 
ready to do so. Pushing toward a tar- 
get date can sometimes put teachers in 
the position of expecting the child to 
accomplish something he or she is not 
ready to do. On the other hand, it is 
important to keep setting objectives 
and to observe a child's progress 
toward reaching them. Ii there is no 
progress at all, it may be that you 
should try another approach or set a 
different goal for the time being. You 
can go back to working toward your 
original objective when you can see 
greater readiness on the part of the 


Some disturbed children will need 
to be shown how to play with other 

Develop both long- £ind short-term 

Set long-term objectives first; then 
work backward and set short-term 
objectives. For example, developing 
trust may be your long-term objective 
for Tbny, so that he can separate easily 
from his mother at the beginning of the 
preschool day, share a favorite toy with 
another child, or talk with you about 
something that is troubling him. Short- 
term objectives include helping Tbny to 
become comfortable in the school set- 
ting (trusting the new environment) by 
helping him to become involved in 
pleasurable activities, by offering praise 
for his accomplishments, by demon- 
strating care and support when he 
seems frustrated, or by assisting him 
whenever necessary. 

Keep in mind that setting both 
long- and short-term objectives in your 
work with emotionally disturbed chil- 
dren can be difficult. You need to be 
flexible and to stay alert to the child's 
progress and to new strengths and 
needs as they emerge. 

Step 3: 

Select the Program, 


and Techniques 

If your Head Start program has 
several program options, you need to 
consider which one can best meet the 
objectives you have set for each child. 
For some disturbed children, a full-day, 
center-based program is best. For 
others, a part-day program combined 
with a home-based program or a special 
class might be best. The particular 
combination of Head Start and other 
services that is best and the amount of 
time spent in each varies from child to 
child. It is a good idea, however, to 
start off by expecting the child to par- 
ticipate in all Head Start activities 
along with the other children. The 
child's program can then be revised, if 
and when it becomes necessary. 

lb make it possible for disturbed 
children to participate in all your usual 
classroom activities, think about ways 
to adapt them and prepare them dif- 
ferently. You can use a variety of teach- 
ing techniques to make sure the child 
gets what ne or she needs. For exam- 
ples, look at the activities in this 


78 Step 4: 

Develop Plans 
with Parents and 


Sometimes it is hard for parents to 
recognize changes in their child from 
day to day. In the classroom you have 
the opportimity to see a child for long 
stretches of time, to observe the child 
performing a wide variety of activities, 
and to compare each child with many 
other children. For these reasons, you 
can observe a child's daily progress and 
set realistic objectives based on your 
observations. On the other hand, par- 
ents know a great deal about their child 
that no one else can learn simply by 
being the child's teacher. Moreover, for 
education to be effective, parent and 
teacher goals for the child need to be 
consistent so that both are working as 
much as possible, in their different 
roles, toward the same end. Develop 
your plans with parents. Share with 
parents the progress their child is mak- 
ing in your classroom and ask them to 
share with you the child's accomplish- 
ments at home. As you work together 
with parents, you might invite them to 
observe the program and to assist in 
class activities. 


Specialists typically see a child for 
short periods of time doing a limited 
number of tasks, and interacting only 
with themselves and the parents. 
Sharing your observations with special- 
ists can provide them with valuable 
information on the child's activity in a 
more normal setting. In turn, the spe- 
cialists can help you understand what 
lirnits the handicap imposes on the 
child's activities, and may be able to 
help you develop objectives that are 
based on the child's needs and abilities. 

Step 5: 

Continue To 
Observe, Reassess, 
and Make 

While a formal assessment of each 
child's development and progress may 
occur only once a year, you should aim 
for more informal evaluations much 
more often. (Flemember how quickly 
children change at this age, especially 
in a stimulating classroom!) As you 
observe and record regularly a dis- 
turbed child's responses in major skill 
areas, your understanding of that child 
and the effects of the emotional distur- 
bance wiU grow. Keep in mind the 
objectives toward which the child is 
moving, and how much progress has 
been made. 

Refer often to your past observa- 
tions, and look for patterns in skill 
areas and other behavior. If, for exam- 
ple, a child shows a pattern of silently 
withdrawing from group activities, con- 
sider whether you have seen some 
improvement in this area. Try to figure 
out which activities the child has 
enjoyed most and which ones seem to 
have caused the most improvement. 
Try to include more of these kinds of 
activities in the future. 

Step 6: 

Head Start 
and the 
Public Schools 

With the Education for All Handi- 
capped Children Act, public schools will 
increasingly be providing the benefits 
of mainstream classrooms and special 
services to handicapped children. After 
being in a mainstream preschool class- 
room and receiving special services, 
emotionally disturbed children will need 
to have these advantages continue. 
There are several things you and a 
handicap or social services coordinator 
can do to contribute to the continuity 
of the education that a disturbed child 
has been receiving in your program. 

Some Head Start programs have 
developed formtd relationships 
with the public schools in their 
areas, to assist in the tremsition 
between preschool and elementary 
school. If your program has no for- 
m£d relationships with the public 
schools, you might explore the pos- 
sibility of establishing them. Your 
program director or handicap coor- 
dinator will know where to go for 
suggestions on how to achieve this. 

Elducational continuity is made 
easier if community providers of 
special services to Head Start chil- 
dren continue to provide them to 
these children when they go on to 
public school. Before a child leaves 
Head Start, you can discuss the 
child's future plans with the spe- 
cialists who have been working 
with him or her. 

The participation of parents in the 
education their child has been get- 
ting in Head Start is a valuable 
foimdation to build on. Encoiu-age 
parents to continue their involve- 
ment and to make sure that the 
child receives needed services in 
elementary school. 

Finally, you can keep in touch with 
the cfuld and his or her family 
after the child leaves your class- 
room. A telephone call or a visit to 
find out how things are going will 
be appreciated by the parents. If 
the child is having problems, your 
suggestions on how to deal with 
them would be welcomed. 


Observe carefully and 
record information. 



Setting and 

No two Head Start programs have 
the same classroom facilities, and few 
of them have ideal physical settings. 
But wonderful learning environments 
often exist without modem buildings, 
fancy furniture, or expensive materials. 
The children and the staff really make 
any preschool program. 

By and large, most handicapped 
children don Y require special classroom 
arrangements or extra materials. You 
can adapt and reorganize the materials 
you already have to meet the needs of 
disturbed children. Basically, the class- 
room should be arranged to suit the 
ways you use it every day, with modifi- 
cations to suit the special needs of a 
disturbed child. These modifications 
should not be necessary very often, and 
they are sure to be minor. 

There are moments when handi- 
capped children need special help in 
dealing with the physical setting of the 
classroom. Such help should be given 
freely. In general, arrange your room so 
that the child can explore the space and 
use the materials with as little assis- 
tance as possible. Here are some sug- 
gestions that are useful with all chil- 
dren. They are particularly helpful for 
children with handicaps, including emo- 
tional disturbance. 




If you have a child in your program 
who is overly active, who rushes 
around with apparently little fore- 
thought, or wno gets confused easUy, 
clearfy defined traffic patterns are 
essential. Making a floor plan before 
the beginning of the program year may 
help you to recognize and correct traffic 
problems before they happen. Don't 
overlap traffic routes and activity areas 
— this will disrupt the children who are 
involved in the activities. Make sure 
there is enough space between furniture 
groupings to keep "collisions" to a 


Keep your room arrangement as 
simple and uncluttered as possible, 
especially at the beginning of the year. 
As the children get used to it and learn 
to handle a more complex environment, 
you can gradually increase the amount 
of materials and nvunber of activity 
areas. The use of well-defined and con- 
sistent space patterns wiU avoid confu- 
sion and help the children become 
familiar with the classroom organiza- 
tion. The space in which each activity 
occurs should be clearly marked. 

For example, you might want to put 
masking tape on the floor to indicate 
the big olock area, the housekeeping 
comer, and other areas. Other space 
cues, such as cabinets and movable par 
titions, can be moved around as needed 
Mark storage areas clearly. Make sure 
children know where they are and what 
belongs in them, and can get at them 
easily. Be consistent about where mate- 
rials are kept and where activities take 

Noise Level 

Avoid placing noisy activities next 
to quiet activities. Noise and movement 
distract some children from quieter 
tasks. Noise interrupts the rest breaks 
that some handicapped children need. 
You will need to determine what noise 
levels are most comfortable for dis- 
turbed children. Some children may feel 
imcomfortable in a quiet room. For 
others, a noisy room is hard to tolerate. 
Try to provide quiet places in the room, 
perhaps sectioned off, for the child with 
a low tolerance for noise. 

Space Cues 


Some children aren't used to sharing 
(or don't seem to want to share) a room 
with a lot of other children. They may 
use more than their share of the space. 
You can use physical signals to limit 
their movement. For example, when 
Sean sits in a circle, he might extend 
his legs and kick the child next to him. 
lb avoid this, try a masking-tape "x" 
or a rug square on the floor where Sean 
is to sit. A file cabinet or a bookcase 
can be strategically placed to define the 
space you want a child to occupy. More 
subtle cues, such as a friendly touch or 
placing a disruptive child directly in 
front of you, wdl also help Umit 
children's movement. 

In general, the more obvious the 
space cue, the easier it is for the child 
to understand. As the children learn to 
use space properly, you can gradually 
eliminate the more obvious cues (rugs, 
tape), and substitute a less obvious one 
(a spoken reminder). 

Even the spoken reminder will no 
longer be needed when the child learns 
and accepts the Umits of his or her own 


There should be a quiet place avail- 
able where children can go on their 
own. Some classrooms have cubbies 
where children keep their personal 
belongings. These are sometimes large 
enough to be used as nice "escape 
hatches." You can even rig up a curtain 
that can be drawn across the cubby, if 
the child would like this. Try to arrange 
your book area so that it is soft and 
comfortable, and has private nooks and 

Everyone needs to get away from it 
all every once in a whQe. 





There are many good ways to teach. 
Because of your personality, tempera- 
ment, and values, you have developed 
your own individual teaching style, 
which is reflected in the activities you 
choose, and in the ways you interact 
with children. Good teaching tech- 
niques are often the same for the educa- 
tion of any child, whether handicapped 
or non-handicapped. So it is best not to 
try to change your natural teaching 
style for a msturbed child. It will onlv 
serve to make both you and the child 

With disturbed children, you will 
want to apply your teaching skills con- 
sciously, using those skills that most 
effectively serve the needs of the child. 
You do much the same for every child. 
But since children who are handicapped 
have problems that seriously interfere 
with overall performance, they require 
extra consideration. Below are some 
basic principles that you may already 
know and use with all children. They 
are particularly useful in working with 
children who have handicaps, including 
emotional disturbance. 



Your Feelings 

and Keep Trying j 

A couple of weeks before preschool 
opened in the fall, Ms. Lazon was asked 
to take responsibility for Linda, a four- 
year-old disturbed child who was about 
to enter the program. For two weeks 
Ms. Lazon had thoughts like these: 

Me? I've never worked with a dis- 
turbed child before. I won't know 
what to do with her. She'll just be a 
nuisance and create problems for aU 
the other children. Her parents will 
see I don't know what I am doing. 
What should I do if she tries to hit 
me? Who will help me with her? 
How will I be able to have enough 
patience to tolerate her temper tan- 
trums? Why wasn't some other 
teacher chosen for this? Everybody 
will see I don't know how to work 
with this child, and I'll be embar- 
rassed. If I try something and it 
doesn't work, what on earth wiU I 
do then? 

If Ms. Lazon had spoken with other 
staff members in her program about 
these worries, instead of keeping them 
to herself, she might have felt less 
apprehensive and more confident of her 
ability to manage Linda. Talking with 
the director of the program, she might 
have been able to find out more about 
the specific behavior that Linda was 
likely to show, and what kinds of help 
were available to her. She could have 
learned about materials to obtain, edu- 
cational sessions to attend, and organi- 
zations, hospitals, or clinics to contact 
for special help. 

Starting Out 

Some adults are nervous and wor- 
ried about working with a handicapped 
child for the first time. This is a typical 
reaction when they don't know the 
child very well yet (if at all). As a result 
they sometimes start out thinking of 
the child as a ''disturbed child." As 
they spend time with the child, watch 
the child, play with the child, and pro- 
vide warm and caring direction, they 
usually find that they have begun to 
think of the child as a ''child with an 
emotional disturbance," and soon they 
think of him or her as a "child, " plain 
and simple. 

Your first efforts working with the 
child may not all be successful — this 
is to be expected. You may feel frus- 
trated and guilty. If something goes 
wrong (as things do from time to time), 
figure out what happened, and keep it 
in mind for the next time. 

Don't expect miracles. No one is 
asking you to solve all the child's prob- 
lems, or to make the child into the 
friendliest child in the class, or into the 
most liked or most successful. Some- 
times, even with the very best help 
from you, the staff, and specialists, a 
child just doesn't make as much 
progress as hoped. This was true of 
Sammy, a child with very serious prob- 




Sammy is a four-year-old with emo- 
tional disturbance. Although the 
teachers knew how difficult it would be 
to work with him, they accepted him 
into the program because they had been 
able to help other disturbed children. 

When Sammy started the program, 
he was hard to manage. He yelled, 
pushed children out of his way, and 
refused to do what was asked of him. 
He couldn 't sit still. He sometimes got 
so angry he lost all ability to speak and 
would pound his fists on the worktable. 

But every now and then, Sammy 
did seem to do better He had peaceful 
moments, and he kept still long enough 
to play at the water table. He made 
several approaches to play with other 
children. He could listen to a very short 
story if a teacher held him on her lap. 
Sometimes it looked as though a break- 
through was about to happen. 

But then the next day, Sammy 
would go back to his old behavior — or 
worse. Although his teachers were dis- 
couraged they tried to be even more 
sensitive to his needs and moods. They 
had regular staff meetings about 
Sammy. They asked a number of spe- 
cialists for suggestions and advice. 
They scheduled regular sessions with 
some specialists. They worked closely 
with his parents. 

But in spite of all their efforts, noth- 
ing worked. Sammy s problems are as 
serious now as they were on his first 
day in Head Start. 

Some children, like Sammy, seem to 
progress very slowly. All you can do is 
your best to try and help. There will be 
times when you will be disappointed 
and upset. However, there will also be 
many times when you wiU succeed in 
helping these children develop and 

Some children "s behav- 
ior problems improve 
very slowly. 

84 2. 


Aides and volunteers play a key role 
in all Head Start programs, and their 
assistance should oe included in class- 
room planning for children with special 


Your aide or assistant helps you 
teach activities and work witn children 
individually. This help is especially 
valuable if you have an emotionally dis- 
turbed child in your class who needs 
special attention and assistance. Aides 
should be included in developing educa- 
tional objectives for the child and in 
ongoing planning. Both you and the 
aide should agree on what the aide 
should do, and why, to help the child 
learn and play with other children. 

It is not a good idea to have the 
child work constantly with only one 
adult. This isolates the child from other 
children, defeating the purpose of main- 
streaming. Some children, however, will 
need the security of an attachment to 
only one adult in the classroom before 
they are able to work with several 
adults. You may want to assign an aide 
to work with such a child for a while. 

On the other hand, other problems 
can be created when a child has too 
many caregivers who come and go. 
This makes it hard for the child to form 
emotional attachments. Children learn 
better with the reassuring presence of a 
few people they know and care about. 

Care for the child should therefore 
be shared among several adults and 
individual attention should be limited 
to what the child needs so that he or 
she is not separated from the group too 


Experts have varying opinions 
about whether volunteers snould work 
directly with handicapped children. If a 
volunteer has been trained in the field 
of emotional disturbance or has worked 
extensively with disturbed children 
similar to those in your program, and if 
that volunteer is able to make a regu- 
lar, long-term commitment to worlong 
with a particular disturbed child, his or 
her contribution can be very valuable. 
If a volunteer does not meet these crite- 
ria, it may be best for that person to 
work with other children, freeing the 
teacher to spend more time with chil- 
dren who have special needs. 


Down Skills 

Every skill is really composed of 
many sub-skills — there is no such 
thing as a one-step activity. Skills such 
as role playing, sharing a toy, throwing 
a ball to another child, or joining in 
group activities consist of many sub-skills. 

Some children can master a new 
skill very quickly with little help from 
vou. These are children who already 
know the sub-skills and can use them in 
performing the new skill. Handicapped 
children, however, don't have some of 
the sub-skills necessary, and need to be 
taught them before they can succeed at 
the overall activity. Children with emo- 
tional disturbance have this problem in 
many skill areas. 

For these children, you can break 
down the activity into sub-skills that 
can be learned at their current sldll 
level. For example, if you want to teach 
a child to share a toy, you should make 
sure that the child Imows the meaning 
of "my turn" and "your turn," has the 
abUity to wait and delay gratification 
while another child uses the toy, and is 
willing to share the toy with another 
child. Or, if you are trying to teach a 
child to throw a ball to another cMld, 
the child must understand the concept 
of exchange, must be able to get the 
attention of the child to whom he or 
she is throwing the ball, and must pos- 
sess the fine and gross motor skills nec- 
essary to throw the ball. 





In addition to sequencing skills 
within an activity, sequence a series of 
activities. Start with simple activities 
and gradually increase the level of diffi- 
culty as a child learns. 

For example, Shana wanted to use a 
tricycle that Amani was using. She 
rushed over, began pulling the tricycle, 
and screamed at Amani, "Get off! Get 
off!" Tb help Shana learn a more appro- 
priate way of expressing her desire to 
use the tricycle, the teacher might 
sequence the activity as follows: 

• Hold Shana s hand (restraint), and 
try to explain the meaning of "my 
turn" and "your turn." 

• Give Shana a concrete way of 
knowing when it is her turn, such 
as "when Amani has finished rid- 
ing" or "when all the sand on this 
little timer is at the bottom." 

• When it is Shana 's turn, demon- 
strate to her how to go about get- 
ting the tricycle. For example, say 
to Shana, "Tbll Amani that his 
time is up and you would like to 
take your turn now." 

Be sure to demonstrate to a child 
how the skills learned in one activity 
can be used in others. A disturbed child 
may need to repeat a sub-skill, a skill, 
or an activity several times with your 
help and several more times without it, 
before moving on to new activities at a 
more difficult level. 

"Tell Amani that his 
time is up and you 
would like to take 
your turn now. " 



Plan your day so that the activities 
are varied. Alternate between active 
and quiet activities, between organized 
projects and free play. When you teach 
new skills, present them first in familiar 
contexts, along with some skills the 
child already has. This lessens the 
child's uncertainty and frustration. 

A child with emotional disturbance 
is especially sensitive to the pace of the 
day. Some disturbed children tire eas- 
ily, and may need more quiet time than 
other children. This doesn't necessarily 
mean a nap — often ten minutes alone 
in the book comer may be enough. 
Also, the child's attention span may 
need training and strengthening if he or 
she isn't used to preschool. If a child's 
attention span is short, make the activi- 
ties short, too. You can lengthen them 
as the child learns to pay attention for 
longer stretches of time. Finally, there 
should be extra time available for the 
child who needs more than one turn to 
understand or to do something. Provid- 
ing time for that extra turn or two can 
mean the difference between success 
and failure. 


Children with special needs are 
sometimes isolated from other children ] 
outside of preschool. One of the bene- 
fits of mainstreaming is that it offers 
these children the opportunity to play 
with other children and to learn a new 
skiU by seeing someone else do it cor- 
rectly. You can plan and organize yovr 
learning situations so that this interac- 
tion, called "peer modeling," can occur. 
In areas where a handicapped child is 
weak, another child (a peer) who has 
the skiU can act as a model. Likewise, 
in areas where a handicapped child 
excels, he or she might be paired with a 
less skilled child. 

No child, handicapped or non- 
handicapped, is good at everything or 
bad at everything. All children should 
have the opportunity to give help to 
their classmates and to receive help 
from them. 

Try very hard not to exclude a 
handicapped child from any activity 
that he or she can cope with and get 
something out of. Exclusion means iso- 
lation, and isolation means feeling dif- 
ferent and bad. lb include the child, 
give extra assistance or change the 
expectations for the child. For example, 
when the hamsters need to be fed, 
gather the children around and allow 
the disturbed child to hold open the 
cage door, if he or she is willing, while 
you put in the food. In this way, the 
child is a full participant in the activity, 
is not isolated, is not interfering with 
the other children, is having fun, and is 
also practicing needed social skills. 

Individualized teaching does not 
mean isolating a child. Rather, it 
involves modifying the activity so that 
all children can participate within the 
same learning situation, in ways most 
helpful to each. 



We have already mentioned the 
benefit of using children as models for 
each other. This principle applies 
directly to using non-handicapped chil- 
dren to assist you in mainstreaming 
children with special needs. Your 
youngsters will probably be eager to 
serve as helpers. This experience has a 
bonus: it helps them develop positive 
attitudes about handicapped people. In 
addition, their help will free some of 
your time for other responsibilities. 

Ways in which non-handicapped 
children can help in mainstreaming a 
handicapped child include: 

• alerting a child whose attention 
wanders that the teacher is about 
to give a direction 

• helping a confused or distracted 
child to organize his or her mate- 
rials (for example, lining up the 
paper, paste, euid scissors for an 
art activity) 

• sitting close to an easily frightened 
child to provide comfort (for exam- 
ple, when the lights go out during 
a film-strip) 

• introducing a new child to the 
physical setting of the clfissroom 
(for example, having one child 
show the disturbed child where the 
bathroom is) 

• providing a child with opportuni- 
ties to practice a newly leeuned 

Peer helpers should be used often, 
and this includes using a handicapped 
child in areas where he or she excels. In 
this way, all the children will learn that 
they each have areas of strength and 
weakness. They will also learn that the 
need to receive help does not mean that 
they are failures, or are less worthy 
than those who offer help. 

You may find there is a child in 
your class who is unusually responsible 
and enjoys being a big brother or big 
sister to a disturbed child. This is fine, 
but make sure thay you are not relying 
so much on your helper that he or she 
becomes a substitute teacher, or does 
more for the disturbed child than is 


88 8. 


It is sometimes hard to be accurate 
and realistic about what children are 
capable of doing for themselves. In the 
case of many children with special 
needs, it is all too easy to assume that 
they are more helpless than they really 
are. Seeing that they cannot do some 
things may make us think that they 
cannot do others. 

Furthermore, some parents may 
have overprotected their handicapped 
child to rnake up for all the extra prob- 
lems that their child has to deal with. 
This means that some children may 
come to Head Start expecting that 
everything will be done for them, sim- 
ply because this is what they are used 

Overprotecting a child hinders him 
or her from learning skills and behav- 
iors that are important in gaining inde- 
pendence. You have to ask yourself: "Is 
this really impossible for the child? 
Could the child do it alone with more 
time? Could the child do it with more 
help from me?" Think hard, and be 
honest. It is tempting to do things for 
a clumsy child because you can do 
them faster and better. But if you are 
always the one who gets a desired toy, 
settles a disagreement, and turns the 
book right-side up, the child won't have 
the chance to try to learn to do these ■ 
things. And isn't the child in your 
classroom so that he or she can learn to 
do them? 

Being extra patient and giving extra 
encouragement to children who try to 
do things on their own will pay oft 
many times in the future. You can help 
children think of themselves as able, 
not unable. When they grow up, they 
will be in the habit of expecting as 
much from themselves as they are 
really capable of. 


Making sure that confidential infor- 
mation stays confidential involves care- 
ful record-keeping and watching what 
you say. 

Project Head Start requires pro- 
grams to institute careful procedures, 
"including confidentiality of program 
records, to insure that no individual 
child or family is mislabeled or 
stigrnatized with reference to a handi- 
capping condition" (OCD Transmittal 
Notice N-30-333-1-30, "Head Start 
Services to Handicapped Children," 
February 28, 1973, page 6). The Head 
Start Performance Standards also spell 
out procedures to guarantee confiden- 
tiality of records: 

• Records must be stored in a locked 
place where unauthorized people 
can't see them. 

• The Head Start director must 
determine which staff members 
can see which parts of the records 
and for which reasons. 

• Parents must fill out written con- 
sent forms to give anyone outside 
of Head Start permission to see 
the records. 

These procedures are designed to 
make sure that all records on a handi- 
capped child and his or her family are 
seen only by people who need to see 
them for legitimate educational or med- 
ical reasons. 

Avoid copying down confidential 
information from the child's records. 
Limit the confidential information you 
do write down to what you need for 
working with the child. 

You should not repeat confidential 
information about children or their par- 
ents, either to other parents or to staff 
members who are not working with the 
children. This is an invasion of the pri- 
vacy to which all children and their par- 
ents have a right. 

If you need to share confidential 
information with another staff member 
to help him or her work better with the 
child, have your discussion in a private 
place and limit it to necessary informa- 
tion only. 

Tfeachers have sometimes been 
embarrassed to find that their com- 
ments about a handicapped child's fam- 
ily have been repeated to the family. 
Parents of children with special needs 
can be sensitive about this issue, and 
understandably so. Be discreet about 
what you say — and to whom you 
say it. 






This section is in two parts. The 
first suggests specific techniques for 
working with emotionally disturbed 
children. It includes guidelines for 
improving self-concept, tips to keep in 
mind, how to handle transition times, 
how to set limits, and how to use physi- 
cal contact as guidance. The second 
part describes how to modify a number 
of everyday preschool activities for use 
with disturbed children. 


There are a number of techniques 
that you can use to help emotionally 
disturbed children in your classroom 
learn better. This section discusses 
some of the more helpful techniques. 

Improving Self-Concept 

Self-concept is a term used to 
describe how a person feels about him- 
or herself. Chilcfren who feel able and 
valued by others usually develop a posi- 
tive self-concept. They see their world 
as a friendly, pleasurable, and exciting 
place to be, and they are eager to try 
out new things. Because these children 
feel good about themselves and because 
they want to learn, they are often suc- 
cessful at what they do. 

On the other hand, children who 
repeatedly meet with failure or with 
disapproval may begin to think of 
themselves as less able or valued. These 
children are more likely to develop a 
negative self-concept. They begin to see 
the world as an unpleasant and 
frightening place, where trying new 
things is scary. EasUy discouraged, 
these children often feel that they can't 
possibly succeed. They may hesitate to 
try anything new or may devalue both 
their efforts and their products. Low 
self-esteem can cause children to fail 
over and over again because they 
expect failure rather than success. 

A child's self -concept is affected by 
the people who are important to him or 
her. For example, if Jackie's parents 
and teacher think it is important for 
her to dress herself, she will enjoy their 
approval and feel proud of herself when 
she struggles into her snowsuit and 
boots. On the other hand, if Bobby's 
attempts to bmld a sandcastle are met 
with constant criticism, he is likely to 
lose interest in the activity, as weU as 
feel incapable, frustrated, and humil- 

Although poor self-concept is 
damaging to all children, it is a special 
problem for children with emotional dis- 
turbance, who may be very weU aware 
that in some ways they don't measure 
up to the other children or that they 
don't fit in with the group. An anxious 
child, for example, may realize that he 
or she is uncornfortable in situations 
where other children join right in. Or a 
hyperactive child may be aware that he 
or she is the one who always causes 
accidents at the water table. These feel- 
ings can cause children to feel less val- 
ued or worthy than other children. This 
is why disturbed children are very 
much in need of successes. With suc- 
cessful experiences, these children will 
feel better about themselves. 

The two most essential supports a 
teacher can provide to nurture a posi- 
tive self-concept are: 

• helping a child to experience many 
successes in varied activities 

• letting a child know that he or she 
is valued for his or her own self. 

Below are some guidelines you can fol- 
low to help children develop a better 
self -concept. 

Think Positively About the Child 

As you think about and plan your 
work with a child, focus on the child's 
strengths. Believe that the child's 
behavior can be improved upon and 
changed and recognize that your atti- 
tude toward the child plays an impor- 
tant role in what and how the child 
learns, and in how the child feels about 
him- or herself. 

Help Others to Think Positively About 
the Child 

Parents need to feel that they play a 
significant role in their child's learning. 
When you communicate to parents 
your appreciation for their child and his 
or her efforts and progress in preschool, 
parents are more likely to appreciate 
the child's efforts and accomplishments 
at home. Meeting with encouragement 
and praise from a variety of sources, 
chilcken are more likely to try new, 
more challenging experiences. 

Help other children in your class to 
think more positively about a disturbed 
child, too. Encourage them to include 
the child in their play. Design activities 
so that this can be done. Tfeach children 
by your example to treat others fairly 
and kindly. Encourage children to help 
a disturbed child learn necessary skUls 
or behavior by being helpers or friends. 

Work Positively with the Child 

All children need to be shown that 
they are cared about and that what and 
how they do things does matter. Praise 
progress, no matter how small. Praise 
the effort a child puts forth even 
though the results may not meet your 
(or the child's) expectations. Be posi- 
tive, even about failures. You can 
encourage success by saying, for exam- 
ple, "You tried very hard. With such 
good practice, I'm sure that you will 
learn how to do that soon." Be tender, 
accepting, loving, and patient. Use 
woras and gestures to express your 
supportiveness. As children begin to 
feel better about themselves and more 
self-confident in their abilities, you may 
begin to see that they can manage by 
themselves more often. Just knowing 
that they are performing well helps 
them feel good about themselves. How- 
ever, building a positive self-concept is 
a slow process and you will need to be 
patient. Some children wiU continue to 
depend on praise while others wQl grad- 
ually internalize your esteem for them 
and win feel genuinely self-confident. 



Tips to Keep in Mind 

1. Make It Simple 

When you are explaining some- 
thing, keep your directions simple. 
Use only a few words. Speak slowly 
and clearly. Some disturoed children 
become confused when you tell them 
too many things at one time. Others 
will not be able to sit still for lengthy 

Show the child how to do the par- 
ticular task. Physically move the 
child through the task so that he or 
she begins to "feel" what to do. For 
example, if you are teaching an anx- 
ious child how to use the sand table, 
gently guide his or her hands through 
the sand to show the child how the 
sand feels. 

Stand or sit close to the child dur- 
ing the task so you can help when 
needed (but only when needed!). 

Reduce clutter and noise. Use 
materials that are clear and plain, 
with bold lines. Avoid materials that 
have confusing backgrounds or 
crowded pages. 

2. Make It Short 

Some of the disturbed children 
you work with will be very active. 
Some may get easily distracted. It 
will be hard for them to sit and Hs- 
ten. When a child doesn't pay atten- 
tion, make sure that the activity isn't 
too hard. Most of us quit trying when 
we don't understand what to do. 
Some children also have problems 
when the activity is long, even when 
it is simple. Know when a child has 
had enough. 

3. Keep It Orgemized 

Help the children organize their 
world by providing structure for them. 
Plan each day so that it is balanced 
between quiet times and active times. 
Discuss the routine with the children. 
As you finish each activity, explain 
what comes next. You might even post 
a picture schedule to show the order 
and kinds of activities. Follow the same 
routine each day, so the children can 
anticipate the next activity. 

Give clear directions, but only one 
at a time. Show the child how to do 
what you are describing. 

Don't change activities abruptly. 
Let the children know that it will be 
time to stop "when the beU rings," 
"when the lights go off and on, ' or 
"when you hear music." This allows the 
children to get ready for the shift, and 
can help prevent tears and tantrums. 

4. Teach It 

It is t5T3ical for children to learn in 
informal ways. They pick up on lots of 
things that they see around them and 
soon recognize, know, and can respond 
to them. But children who are dis- 
turbed often have to be taught the 
appropriate responses that other chil- 
dren learn on their own. 

With some disturbed children, it 
helps to use more demonstrations alongj 
with words. Don't just tell them how to 
do something; show them how. 

Give the children lots of practice. 
Allow children to repeat the same activi 
ity in the classroom and on the play- 
groimd. The more they do an activity, 
the better they wiU remember it. 

Point things out and describe them. 
For example, "Look at how that lady is 
taking big, giant steps. Now she's tak- 
ing tiny, baby steps. Can you take a 
big step and a little step?" 

Tfeach in small steps and don't go 
too fast. But expect a little more from 
the children each day. Remind them of 
their successes and encourage them to 
try their best. 

5. Make It Meaningful 

Select activities that give a child a 
reasonable chance for success. Ingre- 
dients for success are self-confidence, 
notivation, and mastery. When chil- 
iren think they can do a task, enjoy 
:he challenge it provides, and have the 
lecessary skills, they are likely to 
become involved and gain a sense of 

Show an active interest in each 
child's accomplishments. Many children 
jnioy sharing their successes with each 
Dther — even showing off a bit. Others 
ire more self-conscious. They are 
Dleased with their success in a quiet 
A^ay and appreciate a friendly acknowl- 
edgment without much fanfare. 

Be sure to show respect for each 
child's work. Take the time to display a 
painting attractively. Put the child's 
lame on his or her work. Find a safe 
place to keep what the children make. 
Remind children to take their things 
lome and share their accomplishments 
ivith their family. For disturbed chil- 
iren, such respectful care for their work 
s particularly important. 

Handling TVansition 

The hardest times for many 
teachers and children are the transition 
times — the times between activities. 
For children with emotional disturbance 
these unstructured times can be disas- 
trous. Without careful management, the 
time can become confusing. And misbe- 
havior often results from confusion. 

When the children must all move 
from one area of the room to another, it 
helps to divide them into smaller 
groups. This cuts down on the milling 
around and sets a smoother tone for 
the next activity. 

Tb prepare children for a change in 
activity, teU them a few minutes ahead 
of time that they will have to stop 
when the bell rings, when they hear 
music, or when the lights go off and on. 
This winding-down time is especially 
important for many disturbed children. 

You might also find it helpful to 
assist a disturbed child during these 
times by walking with him or her, 
pairing the children with partners, and 
so forth. 


Take time to explain appropriate behavior 
to children. 

94 Setting Limits 

Some limits must be put on children 
to protect their physical safety. Safety 
limits are usually clear-cut: for example, 
"We walk in the classroom" and "Look 
both ways before crossing the street." 
State safety limits simply and fre- 
quently, and demonstrate them when 
necessary. Enforce them consistently, 
so that children will learn that they 
must be followed. 

Children also need limits to help 
them control their behavior. Unlike 
safety Umits, behavioral limits require 
you to make some judgments about 
what is appropriate and what is not. 
Each of us has a range of child behav- 
ior that we accept or can tolerate in our 
classrooms. (Some teachers don't mind 
a lot of noise or a messy paint area, 
while others can't stand this.) 

Whatever behavioral limits you set, 
be consistent in enforcing them. If the 
limits keep changing, the children will 
never know what you expect, and wiQ 
not learn what you are trjdng to teach. 
Praise children for their efforts, and try 
to ignore borderline but tolerable 
behavior. Let the children know that 
you accept and respect them, whatever 
the quality of their performance. As a 
result, the children will not feel person- 
ally threatened by failure. They will 
approach learning without fear. 

Before setting a behavioral limit, 
look carefully at the behavior you are 
concerned with, and ask yourself the 
following questions. 

How Does It Affect the Other 

Does the behavior disrupt the learn- 
ing of the other children? If the behav- 
ior does not disturb the other children, 
then perhaps you should try to learn to 
live with it. 

For example, if Andrew's thumb- 
sucking seems much more annoying to 
you than to everyone else in the class, 
then perhaps that behavior should be 

Can the Child Help It? 

Does the child have control over the 
behavior? For example, if Eddy races 
around the classroom and can't seem to 
slow down, then you should try to 
design activities for Eddy that use and 
direct this energy. Focusing on Eddy's 
need to expend energy, rather than on 
his racing around, can be helpful to you 

Is a Change Justified? 

Do you have a good reason for 
wanting to change the child's behavior? 
What is your educational reason for 
wanting to alter the behavior? In other 
words, make sure the behavior change 
is good for the chQd, not just more 

Patty is a child who has a hard time 
working in a group. She needs to 
develop better social skills. While a 
large group activity may be easier for 
you to manage, it may not be the best 
thing for Patty at this time. Encourag- 
ing Patty to participate in a small 
group activity (such as playing "doUs") 
can give Patty practice with the same 
skills and would probably aUow her to 
feel more relaxed. 

Can You Think of Substitute Behavior? 

What behavior do you want the 
child to substitute for the unacceptable 
behavior? One good way to help chil- 
dren change undesirable behavior is to 
teach them a good substitute. A child 
who hits other children can be taught 
to be angry with words, or to stalk 
away from the anger-producing situa- 
tion, or to hit a punching bag. Make 
sure that the new behavior competes 
with the undesirable one. Simon can't 
hit Carey and stalk away from her at 
the same time, so stalking away would 
be a successful technique for him. 

Physical Contact 

Physical contact can be used with 
emotionally disturbed children just as it 
is with normal children: 

• to ensure the safety of the child 
and of those around him or her 

• to provide support, guidance, and 

Ways of ensuring safety for an emo- 
tionally disturbed child range from 
offering your hand as support during a 
balance beam activity to rigorously 
holding (restraining) a child who is out 
of control and threatening to hurt him- 
or herself or others. 

Physical contact is a way of ex- 
pressing your affection for a child. In 
so many ways, emotionally disturbed 
children need this kind of contact. A 
gentle hug or pat often helps these chil- 
dren to start believing that they are 
worthwhile persons whom others can 
enjoy being with. You may find that 
some disturbed children shy away from 
physical contact. Be patient. It takes 
time to build trust and develop the abil- 
ity to accept affection. 

Physical contact is an especially 
good way of teaching many disturbed 
children, who can often learn best by 
being "moved through" an activity one 
or more times, until independent parti- 
cipation is possible. Put your hands on 
Marilyn's shoulders and walk her 
around the circle. Put the crayon in 
Peter's hand and put your hand over 
his, so that he can feel the motions of 
drawing a stencil pattern. 


96 Using physical guidance as you 

move Manlyn around a circle and as 
you help Peter with the stencil is a tem- 

Eorary technique that allows them to 
e successful on their own. In this 
sense, physical guidance (and stencils, 
too) are like training wheels on a two- 
wheel bike. The success children have 
with your help makes them more will- 
ing to try again, and the structured 
practice helps them learn more quickly. 
After a while, your help, just like the 
training wheels, will no longer be 

Physical restraint may be helpful 
when a child is truly out of control and 
when scolding only seems to make mat- 
ters worse — provoking another out- 
burst or making the child feel abso- 
lutely miserable. You should use 
restraint as little as possible, and only 
as a last resort. Physical restraint 
should be done in a matter-of-fact way, 
showing concern but not anger. After 
restraining a child you should spend 
some time with him or her until he or 
she has regained composure. This kind 
of restraint is time consuming and 
requires a firm understanding of the 
child's underlying problems, not just of 
the behavior you are trying to control. 


The general purposes of classroom 
activities are essentially the same for 
all children: 

• to promote ment£tl, physical, and , 
social development | 

• to teach skills in the major devel- 
opmental areas (motor, cognitive, 
speech and language, self-help, and 

• to allow for the practice and dis- 
play of these skills 

• to give each child the sense that he 
or she is a growing, competent 

It is the teacher's job to present activi- 
ties in a way that provides each child 
with the best opportunity for success. 
For a child with emotional disturbance, 
certain activity modifications may be 
necessary to ensure his or her success. 

This section describes a number of 
activities that take place daily in many 
preschools. Each description includes 
ways of modifying the activity so that 
children with various emotional disor- 
ders can participate and learn. The 
activities are presented in the order in 
which they might take place in a typi- 
cal full-day program. Of course, each 
teacher must decide which activities are 
best for the particular group, and 
arrange them in the order that makes 
the best sense for the particular pro- 

and Other 
Transition Times 

Many preschool children have not 
yet mastered the concepts of time and 
change. Without a sense of continuity 
and a sense of the future, transition 
times can be confusing to them. Dis- 
turbed children, especially, may be con- 
fused and fearful during transitions. 
They need the help of adults to get 
through these difficult times of the day. 

Handled properly, transition times 
can be used to teach children to: 

• deal with septiration from a loved 

• trust persons outside their immedi- 
ate family 

• cope with changing structure (for 
exEunple, end one activity and start 
a new one) 

• cope with a great deal of move- 
ment, noise, emd visual stimulation. 


For arrivals and departures, make 
sure that the adults follow a regular 
routine for greeting or sending off chil- 
dren, and in helping them dress or 
undress. If the adults are disorganized, 
the children wiU have to deal with even 
more confusion. 

Before changing an activity, make 
certain that the new area of activity is 
ready for use. Aides and volunteers 
should be free to orient the children, 
not busy with last-minute preparations. 

Alert children several times that a 
transition is about to take place. Transi- 
tions should not be surprises. An- 
nounce the day's schedule early in the 
morning, and then give a countdown 
before an actual change ("In a few min- 

utes we have to start cleaning up . . 
We should start to clean up now, 
because it's almost time for snack"). 

Conducting the Activity 

1. Before everyone starts moving 
around, ask the children to sit qui- 
etly for 10 to 20 seconds. This gives 
everyone (adults, too) time to orga- 
nize him- or herself. 

2. Announce the movement, then 
accompany the group to the new 
area. If someone else is taking 
charge of the new activity, 
announce that to the children, too. 
If you are going outside, don't let 
everyone race to the door or coat 
rack all at once. Send them up one 
at a time. If the children are to form 
lines, call out their names one by 
one, in the same order each time. 

3. During arrival times, try to have 
the same familiar face greet the chil- 
dren and talk about what they will 
be doing that day. The same proce- 
dure applies to departure times. As 
the adults help the children put on 
their coats, they can remind them 
about the next day's activities 
("Remember, tomorrow morning 
we're going to bake chocolate chip 





Adults often take transitions too 
lightly. Since transitions have no "prod- 
uct," some adults may not consider 
them a real activity. You should make 
sure that the program's staff do not 
underestimate the difficulty and impor- 
tance of transitions for children. 

Holidays, weekends, and vacations 
are not always understood or appre- 
ciated by youngsters in preschool. They 
need a great deal of reassurance that 
everything will resume as usual when a 
weekend, holiday, or vacation ends. 

When the weather is bad, leave 
plenty of time for dressing and undress- 
ing. Snowsuits and rain gear can com- 
plicate transitions. 

Modifications for an Aggressive Child 

Since an aggressive child has diffi- 
culty coping with change, it is impor- 
tant to remind him or her gently, and 
well in advance, that an activity is 
going to end and a new one begin. 
Repeat the reminder several times 
before announcing countdowns to the 
group. Encourage the child to express 
his or her feelings in words rather than 

Be especially aware of behavior 
when the group is in a line. Children 
naturally push and shove in lines, and 
aggressive children are particularly 

As an aggressive child learns to 
accept transitional routines and handle 
them successfully, gradually reduce the 
extra supports. Eventually the child 
may need only the amount of warning 
time you give the rest of the group. 

Modifications for a Hyperactive Child 

Although it is not likely that you 
can calm down a hyperactive child, you 
can help the child perform well by 
explaining directions clearly. Concen- I 
trate on giving the child directions that 
are short, simple, and specific. Rather 
than teU the child what not to do 
("Stop that running"), assign the child 
a small, clearly defined task ("I want 
you to sit in that chair for 10 sec- J 

onds"). Help the child to increase his or 
her self-awareness by reminding the 
child of his or her situation with a sim- 
ple phrase ("You're getting too ex- 
cited"). Try to maintain a cakn attitude 
and tone of voice while organizing the 
activity. Your calmness may have a , 
soothing effect upon the child and 
reduce the amount of stimulation with 
which he or she has to deal. 

Remind the children in advance that 
the activity will be changing. 


When the child appears to have 
learned the sequence of steps involved 
in the activity, you can begin to reduce 
the amount of individual instruction 
you have been giving the child. As the 
child becomes more self-aware and 
learns more self-control, you can also 
cut down on the number of reminders 
you give about getting too excited. At 
that point you can begin to concentrate 
on lengthening the child's attention 
span and on increasing his or her inter- 
est in performing tasks. For example, 
you might begin to give more than one 
instruction at a time to the child, and 
to explain what is going to happen 

Modifications for an Anxious Child 

Transition is probably the most dif- 
ficult activity for anxious children. 
They are being asked to leave what has 
become familiar and safe and enter a 
new situation. It is important to pre- 
pare an anxious child for a transition 
well in advance. Once such a child 
panics, it becomes difficult to communi- 
cate with him or her. 

Whenever possible, an anxious child 
should explore a new area and activity 
beforehand, with a trusted adult. For 
example, before a science activity you 
might allow the child to inspect the 
work area and show him or her how to 
handle any new equipment. To reassure 
the child of his or her return to a famil- 
iar area, give the child a favorite toy or 
book from the area. Escort the child 
between areas when the actual transi- 
tion takes place, too. 

Routine has a soothing effect on an 
anxious child. As the day and week 
become more predictable, the child will 
feel in greater control. At that point, 
you may be able to discuss the child's 
feelings with him or her. The child 
should learn to recognize when he or 
she is becoming anxious and to seek 
help from adults at such times. Simply 
discussing his or her feelings aloud can 
help the child cope, as do an adult's 



Modifications for a Withdrawn Child 

There are many different causes of 
withdrawal in children, and the source 
of the problem can affect how you work 
with a withdrawn child. Many pre- 
schoolers are frightened and shy 
because they are away from home for 
the first time. Those who have underde- 
veloped receptive language may be una- 
ble to understand what a new adult is 
saying. Those who have never been in a 
group before may not understand such 
concepts as moving together and begin- 
ning and ending activities on request. 
By studying the individual child 
closely, you will be able to determine 
how best to proceed. Most shy children 
will open up with a little individual 
attention from you. Children with lan- 
guage problems will require your doing 
extra things to get their attention, such 
as a touch or a gesture, until they are 
familiar with the procedure. Children 
who are unfamiliar with working in a 
group require patient instruction. 
Learning is a process that takes time. 

You may have in your class a with- 
drawn child who understands what 
behavior is desired but refuses to par- 
ticipate. This child may be fearful of 
attempting new activities and wiU need 
extra encouragement and support from 
you. Praise the child for any efforts. 
After the child has had some success 
with the activity, it should become 
easier for him or her to participate. 

Modifications for a Psychotic Child 

Psychotic children have great 
trouble understanding the world around 
them. Their ability to communicate ver- 
bally is Hmited. They have little sense 
of time. They have a hard time coping 
with noise and movement. And they 
have great difficulty tolerating changes 
in activity, setting, or personnel. For 
these reasons, a transition may be com- 
pletely incomprehensible and over- 
whelming to a psychotic chQd. | 

Initially, you should try to limit the 
number of transitions as much as possi- 
ble. The same adult should help the 
child through nearly every transition. 
When the child begins to act in a con- 
fused manner, the adult should attempt 
to calm the child, and try to interpret 
his or her feelings ("What's the matter? 
Are you afraid to go to lunch? Do you 
want me to take you?"). The adult may 
anticipate such confusion whenever 
there is a large amount of noise or 
movement in the area. A child's 
unusual behavior at these times often 
results from the child's confusion, fear, 
and inability to communicate needs and 
feelings verbally. 

Depending upon the severity of the 
disorder, you may be able to teach the 
child appropriate words and phrases to 
express nim- or herself. After gradual 
and gentle contact with other adults, 
the child may be able to work with 
them as well. Start by including one 
other adult in your instruction of the 
child. Once the child has learned to be 
comfortable with the new adult, you 
can gradually withdraw from the 

Circle Time 

For five-year-olds and most mature 
four-year-olas, circle time can be an 
excellent way to begin the daily activi- 
ties. Done early in the morning, circle 
time can help to encourage smooth 
transitions throughout the day. For 
younger children, three or four years 
old, it may be better to conduct circle 
time later in the day and focus on what 
the children have done that day. 

Circle time is helpful for improving 

ability to socialize 

ability to behave in a group 

daily orientation 

ability to listen 

speech and leinguage development. 


Have the day's schedule worked out. 
Vlake up a seating chart for circle time, 
[f furniture is to be used, arrange it in 
idvance. Have materials (felt or black- 
ooard and chalk) in order and on hand. 

Conducting the Activity 

1. Get all the children who will partici- 
pate seated quietly. 

2. Begin with a few simple remarks to 
orient the children and ease them 
into the learning situation ("Do you 
see something new in the room 
today?" "Let s talk about what hap- 
pened at the puppet show this 
morning"). You might describe the 
weather and mention upcoming holi- 

3. Give the children a clear idea of the 
day's schedule. Be sure to empha- 
size unusual or special events, 
annoimce absences, and identify 
other adults who are in the class- 
room that day. Hemember, however, 
that many children have short 
memories and may need gentle 
reminders of these facts during the 

4. Begin a speaking activity such as 
"Show and TfeU." 





The success of this activity depends 
on establishing and maintaining inter- 
est. Ask the children to sit quietly and 
to speak in turns. Encourage them to 
live up to these expectations on a regu- 
lar basis. 

Keep in touch with how well the 
group is paying attention. Try to 
involve as many children as possible in 
the discussion. Be ready to adjust your 
agenda according to the mood of the 

Place children and adults strategi- 
cally. Make sure that an adult is 
nearby in case a child begins to with- 
draw or feel restless. Often the close- 
ness of an adult will be enough to help 
a child. 

It is possible that circle time will 
simply be inappropriate for some chil- 
dren. Try to have other activities avail- 
able for these children, and, if neces- 
sary, staff to supervise them. 

It is important to establish proper 
procedures as quickly as possible. The 
child must learn that he or she can get 
attention by raising a hand and waiting 
for a turn, and that speaking out or 
clutching will not work. Once the child 
has learned the rules, you can use silent 
signals (finger to the lips, pointing) to 
remind him or her without interrupting 
the group. 

Praise the child for good group 
behavior ("Good sitting," or 'Nice job 
of paying attention"). In this way you 
let the child know that he or she has 
not been forgotten or unnoticed. 

Modifications for an Aggressive Child 

Aggressive children are often fearful 
of attack by others. Being close to 
others feels dangerous to them. They 
become overly sensitive when they feel, 
or imagine, that others are moving into 
their personal space. If possible, 
arrange the seating to provide extra 
space on either side of an aggressive 
child's chair. Seat the child in between 
unaggressive, non-threatening children. 
Placing the child next to an adult may 
not work well, because of the child's 
tendency to cling to adults. Watch 
closely for signs that an assault may 
take place: angry looks and threatening 
words or gestures. When these signs 
appear, you may need to involve the 
child in a different activity. 

Modifications for a Hyperactive Child 

Circle time is hard for hyperactive 
children. Despite their impulsiveness 
and need for Dody activity, they are 
asked to sit quietly in a chair. Despite 
difficulty focusing their attention, they 
are asked to follow closely a group con- 
versation that may cover several sub- 
jects in ten or fifteen minutes, with lit- 
tle individual attention from the group 

A good method to use during circle 
time is to call on the child frequently. 
When the child's energy is being 
focused on the task (discussion), he or 
she is likely to show less body move- 
ment. Calling on the child can increase 
his or her attention span somewhat. 
The shorter the time oetween ques- 
tions, the less danger there is tnat the 
child's attention will wander. 

It is unreasonable, however, to 
expect long periods of appropriate 
behavior from a hyperactive child early 
in the year. Keep activities short and 
give du-ections frequently. As vou see 
some improvement in the chila, make 

efforts to extend his or her attention 
span. You should always have an 
alternative activity available for the 
child. Some hyperactive children may 
learn an activity more easily by watch- 
ing other children perform it, particu- 
larly if an adult sits nearby to share 
their interest. 

Modifications for an Anxious Child 

Since an anxious child tends to view 
circle time as a situation that could be 
threatening, it is wise to seat such a 
child between non-aggressive children. 
As the child learns to perceive the situ- 
ation more realistically, he or she may 
become less sensitive to the closeness 
of other people. 

Offer an anxious child the opportu- 
nity to speak regularly, but don't per- 
sist if the child appears uncomfortable. 
Self-control is fra^e under pressure: 
the child may react badly if forced to 
respond or perform in front of a group. 
As the child becomes more comfortable 
and self-confident in the situation, you 
can gently encourage him or her to par- 
ticipate more. 

Modifications for a Withdrawn Child 

It is not a good idea to force a with- 
drawn child to participate in circle time. 
Although this child may not react as 
explosively as an anxious child, a 
slower, less demanding approach is usu- 
ally more effective. Let the child watch 
and listen. Watch carefully for the 
child's first attempts to communicate. 
Your response should be prompt, but 
not overwhelming. As the child's self- 
confidence increases, he or she will be 
much more willing to participate in dis- 

Modifications for a Psychotic Child 

The theme of circle time is com- 
munication, which is one of psychotic 
children's weakest skills. It may be 
impossible for these children to follow 
conversations or behave according to 
the rules. You may find it helpful to 
assign an adult to sit with the child 
during the activity. The adult may help 
to soothe the child's fears and enable 
him or her to sit with the group. As the 
year progresses, the child may have 
developed enough language to answer 
simple questions. Try to include the 
child as much as possible. 

Call on a restless child frequently to hold his attention. 





Formal instruction periods are often 
viewed as being most appropriate for 
children who are at least five years old. 
If formal instruction is part of your 
program, it should take place fu-st in 
the day and is best followed by outdoor 
play, circle time, story time, music, 
meals, and rest. 

Instruction activities usually concen- 
trate on pre-reading skills (formation of 
letters and numbers) and on simple con- 
cepts (size, shape, color). These activi- 
ties help children develop: 

• cognitive skiUs (following direc- 
tions, le£iming concepts) 

• fine motor skills (using a pencil, 
turning pages). 


Before preparing a lesson plan, you 
should have a clear understanding of 
each child's level of development and 
specific abilities. You can gather this 
information from any reports you have 
been given about the children as well as 
from your own informal observations 
and assessments. Otherwise it will be 
difficult for you to set realistic goals for 
the group, or for an individual child. 

Your lesson plan should define the 
goals of the activity, sequence the steps 
involved, and list any materials you 
may need. After you have worked out 
the lesson plan, gather all necessary 
materials. If any procedures are unfa- 
miliar to you, practice with them 

Conducting the Activity 

1. Gather the children in the work 
area. Make sure they are familiar 
with the lesson's rules of order. (For 
example, should they stay in their 
seats or sit on the floor?) 

2. Speak clearly, using simple sen- 
tences. Do not assume that the chil- 
dren are familiar with anything. 
Repeat important points several 

3. As you talk, try to determine how 1 
well the children are understanding 
the lesson. Ask questions and try to 
involve the children as much as pos- 
sible. Watch for puzzled faces and 
other signs of distress. 

4. Once the children get to work, stay 
with them in case they need help or 
reassurance. Encourage and praise 
their efforts. 

5. Watch the time and give children 
advance warning of when the activ- 
ity period will be up. 


Remember that this may be the 
children's first formal instruction. Make 
instruction a successful experience for 
them by working out lessons you know 
they are capable of doing. Praise them 
warmly for their efforts. 

Be prepared to adjust the activity 
at any time: to change the rules, to 
lengthen or shorten the time, and so on. 
The children's reactions will tell you 
when this is necessary. Take notes 
afterward on changes that will improve 
the next lesson. 

Make sure that important people in 
the child's life see the results of these 
lessons. Send children's completed work 
home with them and let parents know 
how their children are doing. 

It is important to establish vour 
authority early, so that all chiloren real- 
ize you are there to guide and help 

Modifications for an Aggressive Child 

Your first priority in working with 
an aggressive child is to make sure that 
he or she has successful learning experi- 
ences. Design some simple tasks you 
are sure the child can master with some 
help. After several successes, the child 
will feel more competent and may even 
begin to look forward to instruction. 

Aggressive children are afraid of 
their mipulses, and frightened children 
do not learn well. TVy to make an 
aggressive child aware that impulsive 
behavior interferes with everyone's day. 
Remind the child to use words when 
you sense that physical aggression is 
about to take place. Tbgether you and 
the child might decide upon quiet cor- 
ners or areas where he or she can go to 
work out anger or to take a break from 
the activity. 

Modifications for a Hyp>eractive Child 

In arranging the setting of the les- 
son, take into account a hyperactive 
child's restlessness. Do not exjject him 
or her to sit quietly for prolonged 
periods. Instead, break a task down 
mto small steps that can be done in a 
short amount of time, or include a sim- 
ple motor activity in the lesson. For 
example, after doing a number recogni- 
tion activity, let the child work with a 
form board puzzle, counting the differ- 
ent pieces as he or she goes. 

Directions to the child must be 
clear, precise, and short. You might 
explain a task one step at a time, wait- 
ing until each step is done before 
describing the next. For example, let 
the child attempt to mix paint follow- 
ing your instructions, before you begin 
to show him or her how to paint. 

Children enjoy being praised. Do it 
often and focus on their attempts rather 
than their products. 




Watch the child carefully for signs 
of restlessness. Point them out to the 
child so that he or she can begin to 
understand these feelings and monitor 
him- or herself ("When you work this 
hard, you seem to get tired"). You 
might offer the child 10 or 20 seconds 
to leave the task and compose him- or 

Modifications for an Anxious Child 

Anxious children tend to fear fail- 
ure, and to lack self-control. If you 
Eressure an anxious child to participate, 
e or she may panic and lose control. 
You must work just to calm the child 
and to help the child understand that it 
is more important to t/^ an activity 
than to do it perfectly. Gently encour- 
age the child by demonstrating the 
task. Then let the child do one part, 
and you do another. Offer praise for the 
fact of working, rather than for the 
quality of work. Permit the child to 
work at his or her own pace. 

You may find that the child is reluc- 
tant to put aside a task that he or she 
is doing successfully. Initially it is best 
to regard this refusal as a first step 
toward confidence. As the child grows 
more comfortable and trusting, you can 
encourage him or her to move on to 
other tasks. Once the child has a sense 
of competence and greater confidence, 
you can work with him or her to 
improve performance. 

Modifications for a Withdrawn Child I 

A withdrawn child may do best in 
instruction activities if he or she is 
given individual attention and instruc- 
tion. However, it may be difficult to j 
approach the child because he or she ' 
may feel uncomfortable close to others. 
You should be as non-threatening and 
soothing as possible. Since the child's 
language skills may be underdeveloped, 
take care to speak slowly and clearly, 
and act out wnat is desired if you can. 
The child may avoid eye contact and 
refuse to respond. If the child continues 
to refuse to respond, it may be best to 
find another activity that the child 
wo\ild like to work on. If this fails, let 
the child sit and watch, or place a toy 
or other materials nearlay for the child 
to use when he or she wishes. Constant 
probing may only cause the child to 
withdraw more. 

Modifications for a Psychotic Child 

The program of instruction for a 
psychotic child must be highly individ- 
ualized. Working consistently with one 
or two familiar adults, the child will 
probably be less confused and more in 
touch with the learning experience. 
Language development is also more 
likely to occur in individualized learn- 
ing. In some cases, a psychotic child 
may be able to tolerate and profit from 
small group experiences. These should 
be encouraged. 

Outdoor Play 

Outdoor play provides children with 
an opportunity to improve their: 

• social skills (peer interaction) 

• cognitive skills (developing spatial 
concepts such as up/down and tem- 
poral concepts such as slow/fast; 
recognizing cause and effect rela- 

• gross motor skills (balance, coordi- 
nation, rhythm). 


Examine the playground area 
closely. Eliminate any potential dangers 
(holes in the ground, large rocks, bro- 
ken glass). Make certain equipment is 
in good repair. 

Know which children may become 
uncontrolled in open areas. Playgrounds 
can be dangerous. (Work out play- 
ground rules in advance.) 

Learn a variety of simple games 
that children can play at preschool and 
at home. The activities should have 
varying degrees of structure and should 
be non-competitive. Work out a system 
for sharing playground equipment such 
as swings. 





Out-of-doors should not mean out-of- 
control. Some children get reckless on 
the playground. Do not hesitate to slow 
down overexcited children. Many play- 
ground accidents can be prevented by 
alert teachers. 

Try to adjust your participation to 
the needs of each child. Some children 
do perfectly well on their own. Others 
only need help getting started. Still 
others may need almost constant 

Some children are afraid of play- 
ground activity. They may need reas- 
surance that things are in control. 

Conducting the Activity 

1. AUow plenty of time for children to 
dress themselves as much as they 
can on their own. 

2. Explain playground rules carefully 
to the children before they go out- 

3. Observe the area closely. If possible, 
have one or two other adults assist 
in guiding outdoor play. 

4. Adults should refrain from engaging 
in lengthy conversations with one 
another, because this can detract 
from their availability to the children. 

Modifications for an Aggressive Child 

The playground may be a frighten- 
ing place for aggressive children. They 
may fear that other children will 
become aggressive, and they are with- 
out the indoor structure that they rely 
upon to control their own aggression. 
Tney easily become overexcited and 
restless, which can lead to unpredict- 
able behavior, "accidents" in which 
other children get knocked about, over- 
enthusiasm in group games, and fights 
with others. 

You can anticipate an aggressive 
child's distress concerning loss of struc- 
ture by assuring him or her that every- 
thing is still being managed and is 
under control. Although impulsiveness 
is difficult to deal with, much of it can 
be avoided if the child's level of stimu- 
lation is controlled. For example, put 
away materials that are not being used, 
reduce the noise level by introducing a 
quiet activity, and slow down an activ- 
ity that is getting the child too excited 
(for example, roll the ball to a child 
instead of chasing him or her with the 
ball). Watch carefully and give verbal 
reminders to help keep the child in 
touch with what he or she is doing. For 
example, say to the child, "You're rush- 
ing around very fast. Can you show me 
how a turtle crawls?" 

■^^SBSWP?^ ?S5iP| 


Modifications for a Hyperactive Child 

' It is appropriate for children to let 
out energy on the playground, but care 
should he taken to keep the level of 
excitement manageable, lb help a 
hyperactive child, provide simple games 
that allow for a high energy level. Use 
frequent verbal reminders to keep the 
child focused on the game. Avoid nag- 
ging at the child. If you feel the child's 
behavior is out of line, give the child a 
clear, specific instruction to foUow. 

If the child appears to be losing con- 
trol, ask him or ner to sit down with 
you for 20 or 30 seconds. Danger signs 
include a flushed face, excessively loud 
yelling, and high, prolonged, artificial 

Modifications for an Anxious Child 

Anxious children are often unsettled 
by the noise and activity of a play- 
ground, and may begin to withdraw. 
They tend to fear unfamiliar activities, 
and may refuse to plav with other chil- 
dren. When they do play, they may 
complain about other children. Their 
general fear for their safety may be 
seen in their frequent complaints of real 
or imagined injuries. Sandlbox activities 
are often preferred by anxious as well 
as withdrawn children. 

An anxious child does best at play- 
ground activities that are structured, 
non-competitive, and quiet, and that 
offer little chance for injury. One exam- 
ple is walking with the teacher or with 
a small group. As the child begins to 
feel more comfortable on the play- 
groimd, you might set up games that 
include several children. 

Modifications for a Withdrawn Child 

A withdrawn child requires special 
attention on the playground. You or 
another adult should try to engage the 
child gradually in a few simple, quiet 
activities. This may take a long period 
of time. Once you have had a number 
of successes with the child, you can 
expand the activities to include practice 
in other skills. Very gradually you 
might attempt to introduce other chil- 
dren into the activity, adding one child 
at a time. 

Modifications for a Psychotic Child 

Psychotic children have much 
trouble coping with great changes in 
the setting. At first they may be 
extremely frightened on the play- 
ground, and may lose some ability to 
relate to familiar adults and surround- 
ings. You should provide a psychotic 
child with close supervision in an open 
area. Once the child is familiar with the 
area, you or one other adult may be 
able to engage him or her in simple 
activities such as short walks, rolling a 
ball, and so on. During these sessions 
you may be able to help the child prac- 
tice language skills. 



Directed Play/ 
Special Projects 

Directed play is a good way to teach 
general information and improve lan- 
guage. Directed play activities include 
exercises, body-image games, and cook- 
ing or science. Activities like these help 
cluldren increase their general knowl- 
edge and improve their: 

• social skills (cooperation and 

• cognitive skills (ability to follow 

• body image (ability to identify 
body parts) 

• language skiUs (general 


Gather all necessary materials and 
make sure you are familiar with them. 
If you are planning to cook or to try a 
science activity, try out any unfamiliar 
recipes or experiments on your own 

Conducting the Activity 

1. Give a clear, simple explanation of 
the activity to the group. Provide as 
much general information as the 
children can absorb along with the 
activity. For example, if you are 
cooking carrots, you might describe 
how they grow and why they are 
good for you. Define any new words 
and use examples andVor pictures 
whenever possible. 

2. A number of these activities (for 
example, exercises and dress-up 
games) do not require adult supervi- 
sion. However, you should play 
along with the children at first to 
make sure that they understand the 
procedure and any rules that are 



Directed play activities allow chil- 
dren to learn words while actually 
using the objects for which the words 
stand. Talk to the children throughout 
each activity. ("Move your arms. ' 
"Give me one egg, please." "What 
color is Billy's hat? ') Be sure to encour- 
age the children to use the words them- 
selves. Also try to use the same words 
in other activities. 

When toys or food are involved, con- 
flict is likely to occur among the chil- 
dren. Make sure you have a good 
sharing system and remind children of 
the rules. 

Cooking can be an exciting activity 
for children, especially those who come 
from homes where food is not plentiful. 
Some may be very anxious about get- 
ting their fair share of the food, which 
can cause them to disrupt the activity. 
Until the children learn to trust the sit- 
uation, you should control the activity 
carefully. Give children small, easy jobs 
to do at the start, while you play a 
larger role. Gradually you should be 
able to reduce your role. 

Modifications for an Aggressive Child 

Aggressive children tend to have 
irrational fears of being deprived of an 
equal share and of provoking aggres- 
sion in others. You can ease these fears 
by setting up an orderly and obvious 
system for using and snaring materials. 
As the child comes to trust the system, 
he or she will feel less need to grab and 

Whenever possible, match up an 
aggressive child with non-ag^essive 
children. This will help the child feel 
more at ease and lessen the chance that 
impulsive behavior will take place. 

In any close situation, watch the 
child carefully for signs of anger and 
loss of control. Help the child become 
more self-aware by pointing out when 
you think he or she is becoming upset. 

Modifications for a Hyperactive Child 

It is important not to overestimate 
a hyperactive child's ability to concen- 
trate, lb prevent failure, keep tasks 
short and very direct. Proviae a lot of 
verbal structure for the child and do 
not expect him or her to function suc- 
cessfully without adult supervision. 

TVy to anticipate the child's loss of 
attention. If you sense that the child is 
becoming restless, move him or her to 
another area or begin a different activ- 
ity. Otherwise the child may disrupt 
the group with extra body movement 
or loud talking. 

In time you wiU learn to recognize 
periods of low excitement in the child. 
Take advantage of these by introducing 
more complicated, self-directed tasks. 
For example, during a science activity, 
you might make the child responsible 
for measuring out a cupful of water. 

Modifications for £in Anxious Child 

Before the activity begins, carefully 
explain how toys or food will be given 
out, and explain the system for using 
and sharing materials. Over time, the 
child will come to trust you and the 



Modifications for a Withdrawn Child 

It is best not to force a withdrawn 
child to participate. Simply give the 
child time to watch and understand the 
activity. When the child begins to show 
some interest, you or another adult can 
try to engage the child by providing 
individual instruction. Gradually adult 
participation can be replaced by interac- 
tion with other children. Although you 
should not expect the child to com- 
municate much verbally (especially at 
first), you should speak to him or her 
regularly, in a non-threatening manner. 

Modifications for a Psychotic Child 

A psychotic child will need to have 
an adult partner in order to participate. 
In cooking, for example, the child and 
the adult can do some of the simpler 
tasks together. 

Don't expect the child to use imagi- 
nation and pretend. It is best to be lit- 
eral and direct as you work on the 
child's language development and con- 
cept formation. As the child's language 
skills improve, his or her partner can 
encourage him or her to name materials 
and describe how they are being used. 

Free Play 

Free play includes such activities as 
water table, sand table, puzzles, peg- I 
boards, blocks, and picture cards. These 
activities help children improve their: 

social skills 

ability to work independently 

ability to fantasize 

fine motor skills and coordination. 


Gather all necessary materials and 
organize them according to the type of 
activity or the level of difficulty. You 
might consider labeling them with 
words and/or pictures. Anticipate any 
problems with materials (for example, 
water may be spilled and sand may be 
scattered). Have aprons ready for par- 
ticularly messy activities. 

lb reduce confusion, divide a single 
area into smaller activity areas (such as 
the water play area and the puzzle 
table) and place materials in the rele- 
vant area. Have a system for passing 
out materials, for sharing, and for tak- 
ing turns. Know the relative level of 
difficulty of each activity, so that 
children won't be mismatched and 


Conducting the Activity 

1. Help children choose materials and 
get started. Point out rules for 
using different materials ("Put puz- 
zles on the green shelf after you use 
them." "Keep the water in the 
water table"). New materials should 
be shown and demonstrated to the 
entire group. 

2. Take some time to work with indi- 
vidual children, moving from one to 
another. But don't interfere with 
children who are playing well by 

3. Be alert for signs of difficulty. 
Grabbing, threatening, loud voices, 
or running may be signals to 
remind children of Umits, or to pro- 
vide help to a particular child. 

4. Tbward the end of the activity, give 
the children an advance warning 
that it will soon be time to clean up. 


Free play is an excellent opportu- 
nity to watch and measure chuldren's 
progress in socializing and in motor 
development. After free play routines 
have been established, and when chil- 
dren are working well on their own, 
your role might be shifted from facilitat- 
ing or participating in the play to 
observing the play. 

Modifications for an Aggressive Child 

An aggressive child may require 
extra help in selecting an activity and 
getting started, since he or she can eas- 
ily be confused by a less structured 
environment. Be careful to provide 
materials that you know the child can 
master. Aggressive children often act 
out their feelings rather than ask for 
help. This means you should watch 
closely for signs of trouble in the child, 
to prevent him or her from losing 

Modifications for a Hyperactive Child 

A hyperactive child has difficulty 
with free play. The child needs help 
from the teacher to get organized and 
to keep his or her attention focused on 
the activity. It is helpful for you or 
another adult to start an activity with 
the child, since adult interest often 
helps the child stay interested, too. 

As in other settings, you should 
remind the child when he or she is get- 
ting overexcited, and offer specific 
directions to help the child calm down 
and get back under control. 



Modifications for an Anxious Child 

Tb help cut down on interference 
from other children, provide an anxious 
child with a relatively isolated area. 
Once the child begins to feel safe, he or 
she will gradually move toward the 
other children. Anticipate frustration 
and provide the child with help in diffi- 
cult areas. 

Give an anxious child plenty of time 
to prepare for the end of the activity. 
Allow the child to replace favorite toys 
by him- or herself. Remind him or her 
that the materials will be available 

Modifications for a Withdrawn Child 

Free play is a valuable activity for a 
withdrawn child. It makes few de- 
mands, and allows him or her to watch 
other children play and communicate. 
Observing the child may help you to 
learn about the child's interests. You 
might then introduce several different 
activities you think the child would 

Don't try to rush the child into con- 
tact with his or her peers. When the 
child begins to play at similar activities 
next to the other children without 
apparent communication, you will know 
that the child has taken a first step 
toward real interaction. 

Modifications for a Psychotic Child 

A psychotic child does best when 
you provide individual attention and do 
activities with him or her. Puzzles and 
books may hold the child's attention for 
some time. Your presence and conversa- 
tion will reassure the child that the sit- 
uation is under control. Take this 
opportunity to work on language with 
the child. Many psychotic children 
develop language through imitation. 

Psychotic children require lots of individual attention. 



Many preschool programs provide 
breakfast, snack, and/or lunch. These 
meals can be a time for children to: 

• gain knowledge (general informa- 
tion about food) 

• improve their social skills (sharing 
and cooperating) and speech and 
language skills. 


Set the table with unbreakable uten- 
sUs and napkins. Have paper towels or 
sponges on hand to take care of spills. 

Conducting the Activity 

1. Make sure all children are seated 
before beginning a meal. Give them 
a few seconds to calm down before 
you start. 

2. Explain the system for requesting 
and passing food. Take some time 
at first to instruct children in the 
proper use of utensUs and in group 
table manners. 

3. Pass the food to the disturbed child 

r yourself, or have an aide do it. After 
I a period of time, the child should be 
i able to serve him- or herself. Allow 

adequate time for children to eat 

well and enjoy the meal. 

4. Allow adequate time for cleanup. If 
there are pokey eaters, give them 
some advance warning that another 
activity is soon to follow. 


Use this opportunity to expand the 
children's general knowledge. Explain 
the names and origins of the various 
foods they are eating. 

Food and eating can be a source of 
great anxiety to children who come 
from homes where food is not plentiful. 
It helps to reassure them that there is 
enough food for everyone. Never with- 
hold food to punish or control a child. 

Modifications for an Aggressive Child 

An aggressive child needs clear and 
simple instructions on table manners 
and use of utensils. Rules must be 
established early, and consistently 
applied. You may wish to sit next to an 
aggressive child during the initial 
period, and handle the passing and 
serving of food. If the child begins to 
lose control, you might send him or her 
to a "cooHng-off spot " at the edge of 
the activity setting. 

Modifications for a Hyperactive Child 

Give directions slowly to a hyperac- 
tive child, and in small parts. Insist 
that the proper utensils be used. Do 
avoid spilling accidents, take care to 
place open containers of food away 
from the child. Make the child aware 
when he or she is becoming overex- 
cited. It is a good idea to set up a 
cooling-off spot at the edge of the activ- 
ity setting, where the child can go 
when feeling restless or out of control. 



Modifications for an Anxious Child 

Allow an anxious child to eat at his 
or her own pace and according to 
needs, but insist upon the proper use of 
utensils. You may need to repeat rules 
on passing food to the child, to prevent 
him or her from grabbing or hoarding 

Do not pressure the child to eat if 
he or she refuses to. This will only 
result in stronger opposition. 

Modifications for a Withdrawn Child 

A withdrawn child may not be com- 
fortable eating in a group for some 
time. He or she may refuse to eat and 
may ignore requests by others to pass 

food. You can try offering the child par- 
ticular items, but do not pressure hirn 
or her. AQow the child to watch quietly. 
Offer him or her a snack later on. 

Modifications for a Psychotic Child 

It may take a psychotic child some 
time to learn the rules for mealtimes. 
You may have to repeat these rules, 
often and calmly, over a long period of 
time. Tfeach the child how to use uten- 
sils by example. If possible, you or 
another adult should sit next to the 
child to demonstrate procedure and to 
serve him or her. This can also be an 
opportunity to work on the child's lan- 
guage development. 

Music and Art 


Music and art can be relaxing activi- 
ties for children. Music provides an 
opportunity for children to improve 

• listening skills (auditory percep- 
tion, sound discrimination) 

• sense of rhythm 

• ability to follow directions. 

Art activities give children a chance to 
work on: 

• visual perception 

• fine motor skills 

• ability to follow directions. 


In most preschool programs art is 
an ongoing activity that is not separate 
from free play and/or teacher-directed 
activity. In these programs, art is often 
viewed as an extension or supplement 
to another learning experience. For 
example, the theme for a painting ses- 
sion might be "what we saw at the fire 
station. ' In some preschool programs, 
art is viewed as a separate activity. 


Prepare a lesson plan that breaks 
the music or art period down into short 
parts with different activities. Collect 
all materials and work out how you wiU 
introduce them to the group. If an art 
activity will be messy, have aprons 
available for the children. 

I Arrange a smtable area. Music may 
require chairs and a large, open area. 
For an art activity, you may need to 
provide protection for the furniture and 

Conducting the Activity 

1. Present instructions clearly and sim- 
ply. Give special attention to chil- 
dren who appear confused. 

2. Provide lots of verbal encourage- 

3. Watch for children who may be 
overexcited by loud music. If one or 
more children become too excited, 
turn the volume down, or remove 
the record periodically. 

4. Display children's completed proj- 
ects with their names on them. 
After the display, send the projects 
home with children so that parents 
get a chance to see the work, too. 

5. Announce transitions early to allow 
plenty of time for calming down and 
cleaning up. 


Keep the first assignments simple. 
It is easier to add tasks as you go 
along than it is to deal with a frus- 
trated group. Some children find partic- 
ular art materials (such as clay and 
fingerpaint) hard to work with. It 
might be best to start out with mate- 
rials that are less messy (such as cray- 
ons or chalk). 

If some children resist group sing- 
ing, don't force them to participate. 
Give them time to feel comfortable 
before joining in. 

Record players and other machines 
may be irresistible to some children. 
You might place the machine on a shelf 
out of children's reach. When the 
machines are not in use, store them 

Music time can leave children over- 
excited. It helps to calm them down 
with quiet music before ending the 




Modifications for an Aggressive Child 

You niust make it clear to an ag- 
gressive child that general behavioral 
expectations apply in music and art 
activities, just as they do in others. 
Music activities must be carefully 
paced to avoid getting the child too 
excited. Art must be carefully intro- 
duced and supervised to avoid overex- 
citement and frustration. Work closely 
with an aggressive child, giving much 
encouragement. As the child's self- 
control increases, such support will be 
less important. 

Modifications for a Hyperactive Child 

Pacing is very important for a 
hyperactive child. In music, do not con- 
tinue a high level of physical activity 
for too long. Give children time to com- 
pose themselves, and end the period 
with a series of slower, calming tasks. 
Art assignments should be short, use 
simple materials, and be accompanied 
by close attention. 


Modifications for an Anxious Child 

Begin music activities slowly. Dis- 
cuss any instruments you are using and 
the sounds they make. Prepare the 
child for loud noises, and try to find a 
volume level that is acceptable to the 

In art, show interest in the child's 
activity, but tiy not to discuss the 
quality of the finished product, or to 
put too much emphasis on the neces- 
sity of finishing it at all. 

Modifications for a Withdrawn Child 

Some young children are imf amiHar 
with art and music activities, but find 
them both extremely attractive. After a 
period of watching, a withdrawn child 
will probably join the activities of his 
or her own accord. You can encourage 
the child gently to participate, but 
avoid pressuring him or her. 

Modifications for a Psychotic Child 

Music can be particularly enjoyable 
to a psychotic child. Its rhythms are 
comforting, and the child often 
develops well-loved favorites. During 
group lessons, the child can enjoy the 
music apart from the group. During 
free play, the child may wish to listen 
to records. 

Art is a more difficult activity for 
the child. He or she may have trouble 
attending to the task, or using the 
materials properly. Good resmts may 
be obtained initially by working with 
the child on a one-to-one basis. Later 
the child may work in a group under 
close supervision. 

Story Time 

Story time can help children im- 
prove their: 

• social skills 

• cognitive skills (listening and 
memory skills) 

• speech and language skills. 


Find appropriate stories, taking into 
consideration vocabulary, plot, pictures, 
and length. Arrange the seating so that 
each child's personal space is clearly 

Conducting the Activity 

1. Read the story with expression and 
feeling, but be careful not to 
frighten the children. Show them 
the pictures as you come to them. 

2. Don't lose sight of the group. If you 
notice that a child's attention is 
wandering, use eye contact or ges- 
tures to regain his or her attention. 

3. When the story is over, ask the chil- 
dren specific questions. The story 
might also serve as the basis for an 
art or drama activity. 


Keep track of particularly successful 
stories. You wiU find there are classics 
that work year after year. 

Story time brings the children 
together in a group, and has a calming 
effect on them. It is a particularly good 
activity to have before major transi- 
tions (outdoor play or departure time). 



Modifications for an Aggressive Child 

Seat the child near you or another 
adult during the story, and arrange 
seating so that the child's neighbor is 
non-aggressive. Keep the child involved 
in the story with questions, glances, 
and gestures. Attention from another 
adult can help to avert impulsive 

Modifications for a Hyperactive Child 

Expectations must be simple and 
clearly defined for a hyperactive child. 
The child's space may be marked by 
tape, or the child may sit on a "story 
rug." He or she should be called on fre- 
quently, to maintain interest in the 
story. Remind the child when he or she 
is getting too excited. It helps to place 
the child near an adult. 

Modification for an Anxious Child 

Seat an anxious child somewhat 
away from other children, but stiU 
inside of the group area. Prepare the 
child for the story in advance. Make 
sure he or she knows that it is make- 
believe. Offer the child a chance to act 
out the story when it is over, to give 
him or her a sense of control, and to 
improve the child's ability to distin- 
guish between fantasy and reality. 

Modifications for a Withdrawn Child 

Since a withdrawn chUd may not be 
comfortable with language, it is helpful 
to read clearly and distinctly. Question 
the chUd last, after other children have 
answered, and phrase your questions so 
that they require only a yes or no 
answer. You wiU know that the child 
was trjdng to pay attention to the 
story if he or she responds to your 
questions. If the child's language is lim- 
ited, he or she might be asked to draw 
pictures of the story. 

Modifications for a Psychotic Child 

Since a psychotic child will have 
trouble with any group setting, an indi- 
vidual session with a familiar adult will 
probably be more successful. The child 
will be less fearful and more relaxed, 
and can be asked to repeat words and 
point to pictures. Psychotic children 
often have a good memory for detail, 
so your questions can be direct and 

Rest Time 

Rest time gives everyone a chance 
to relax in a quiet setting. For some 
children, a short nap is essential. 
Others can benefit from simply resting 


Arrange cots or rugs so that there 
is ample space between all children. 
More active children should be separa- 
ted from one another. 

Take time before rest period to set- 
tle the group down to a lower level of 
activity. Tbn or twenty seconds of quiet 
sitting may be enough. 

Conducting the Activity 

1. Darken the rest area, but leave 
enough light to keep fearful children 

2. Speak in low tones or whispers. 

3. Move as little as possible. The 
teacher's motion is a powerful dis- 

4. Many children have trouble waking 
without confusion. Wake sleeping 
children very gently, and allow 
them plenty of time to regain alert- 


After lunch is a good time for rest, 
although the exact place in the sched- 
ule depends on the length of the daily 

Some hyperactive and anxious chil- 
dren have great difficulty resting. You 
may need to shorten their periods and 
provide more active (but quiet) things 
for them to do. Children who need to 
nap should have a separate, appropriate 
area where they will not be disturbed 
by other activity. 

Modifications for an Aggressive Child 

It is impossible to force an unwilling 
child to relax. An aggressive child may 
feel unsafe in the rest time setting, and 
be unable to let down his or her guard. 
Until the child has built up a measure 
of trust, it is probably wiser to have a 
low-level activity (a puzzle, or a favorite 
book) available in case rest proves 
impossible. Once the child begins to feel 
safe, he or she may welcome the oppor- 
tunity to rest. 

Modifications for a Hyperactive Child 

It is generally useless to try to force 
a h5^ractive child to rest. Before aban- 
doning rest time entirely, however, you 
might try shortening the period for the 
child. Explain your expectations to the 
child and set a time limit that seems 

Modifications for an Anxious Child 

Place the child's rest area near a 
supervising adult. Try to eliminate dis- 
tractions. It helps to speak in whispers 
and to remain seated. A favorite toy or 
book may reassure the child that the 
program will resume after the rest. If 
the activity proves too difficult initially, 
reduce the child's participation time. 
Increase it gradually as the child's trust 




Modifications for a Withdrawn Child 

Rest time is often a withdrawn 
child's favorite activity: it is quiet and 
non-interactional (solitary). The biggest 
problem may be that the child is unwill- 
mg to end rest and enter new activity. 
Ti^ waking the child before the other 
children. Get him or her started in a 
less passive, but stiU non-interactional 
activity (folding blankets, going to the 
bathroom, loolong at a picture book). 
As the child becomes more comfortable, 
the rest of the day should seem more 
attractive to him or her. At this point 
these transitional activities will be less 

Modifications for a Psychotic Child 

It is very difficult for a psychotic 
child to rest quietly in a group. The 
great changes in setting and level of 
activity are extremely confusing. If the 
rest period is generally silent, with 
some sleeping or deep relaxing, it may 
be best to remove the child to another 
section. If a bit of noise and movement 
won't disturb the others, the child 
should be allowed to remain with an 
adult and engage in a quiet activity 
(singing softly, cuddling a favorite toy). 



If a bit of noise and movement wont disturb the others, allow some children to 
engage in quiet activities. 

IHps and Other 
Special Events 

Trips and other special events 
increase children's general knowledge 
and give children practice with: 

• social skills (sharing and cooperat- 

• speech and language skills (follow- 
ing directions, listening, speaking) 

• coping with a highly stimulating 


Visit the site of a trip or special 
event in advance to anticipate problems 
that might arise. Carefully plan trans- 
portation so that there is as little wait- 
mg time as possible. Know beforehand 
how you will keep the group together 
and how you will handle illness or mis- 
behavior. Be prepared to cope with 
highly excitable children. You may need 
to increase staffing for the event. 

Children should be prepared well in 
advance of any trip or special event. 
Give them specific details concerning 
what they will see and do, then check 
their understanding. For a party, 
review eating procedure. Special treats 
like cake and ice cream can make some 
children more anxious about getting 
their fair share, and may also be mes- 
sier than other foods. Finally, plan the 
schedule to ensure plenty oi time for a 
calm transition. 

Conducting the Activity 

1. Before leaving on a trip, check to 
see that each child is appropriately 
dressed and wearing a name tag. 

2. At the site, don't neglect the chance 
to add to children's general informa- 
tion. Ask children about what they 
see, and encourage them to ask you 

3. Review the trip when you return. 
Ask the children to describe or draw 
pictures of what they saw and did. 

4. At parties, make sure that the dis- 
tribution of food is orderly and that 
everyone gets his or her fair share. 
Watch the level of excitement and 
listen for rising noise. The activity 
should be enjoyable, but not uncon- 


On trips, work out a system to keep 
the group together. Some teachers have 
a single rope that each child holds on 
to. Others use a buddy system. 

Be sure that your timetable is not 
too tight. Allow plenty of extra time. 

Birthday parties for individual chil- 
dren may be a strain for both the birth- 
day child and the other children. It is 
probably a better idea to hold monthly 
parties for groups of children. 

Modifications for an Aggressive Child 

The aggressive child's greatest prob- 
lem here is his or her anxiety in loosely 
structured settings. Without walls and 
comfortable routine, the child may act 
wildly. This problem can be prevented 
by providing visible structure for the 
child. Keep him or her close and main- 
tain verbal contact. After some success, 
you can increase the distance slightly, 
while closely watching for signs of fear 
and uneasiness. 




Modifications for a Hyperactive Child 

An adult should keep a hyperactive 
child close and verbally engaged. Close- 
ness assures that the child will not lose 
the group or run into the street. Verbal 
contact helps to hold down the level of 
agitation and confusion. During parties, 
the child may need frequent reminders 
to slow down. 

Modifications for £in Anxious Child 

lb get an idea of how frightening 
trips are for an anxious child, start off 
with short trips — a walk to the comer 
or around the block. An adult should 
stay close to the child during initial 
trips. Try to give the child some sense 
of control. Don't force him or her to go. 
It is better to deal with a reluctant 
child in the preschool than with a pan- 
icky child on the street. 

Modifications for a Withdrawn Child 

Do not force a withdrawn child to 
go on trips if he or she is obviously 
unwilling or if you (and the parents) feel 
the timing is inappropriate. Let the 
child remain behind with a trusted 
adult with whom the child seems to feel 
comfortable. If a field trip seems appro- 
priate, keep a constant check on the 
child; he or she may dally along the 
way or wander away. 

Modifications for a Psychotic Child 

If a field trip seems appropriate for 
a psychotic child, include him or her 
but provide for close supervision. Some 
psychotic children are overwhelmed by 
the rapid transitions of field trips, and 
really are unable to cope with the expe- 
rience. If this is the case, leave the 
child behind with an adult who you feel 
can handle the child. 

You can use the buddy system to help a field 
trip go smoothly. 

Chapter 7: 




There are other sources of 
help you can draw on to 
assist you with children 
who are emotionally 

126 In addition to the specialists in your 
program, community, or region, there are 
other sources of help you can draw on to 
assist you with children who are emotion- 
ally disturbed Around the country are a 
number of associations concerned with 
helping those who are emotionally dis- 
turbed They can send you helpful infor- 
mation about emotional disturbance and 
about how you can work with disturbed 
children in the classroom. There are also 
many good books and articles that you 
may find usefuL These are listed in the 
bibliography at the end of this chapter. 

and Parent 
and Other 

For each association given in this 
section, we have listed their national 
addresses, whether they have local 
branches, what they do, and how they 
can help you. 

American Academy of Child Psychiatry 

This is a professional society of phy- 
sicians who are in training or who are 
graduates of child psychiatry residency. 
The primary goal of this organization is 
to stimulate and advance medical con- 
tributions to the knowledge and treat- 
ment of psychiatric problems. In addi- 
tion to providing consultation services 
to institutions, this organization has 
established programs that include: 
research, training, community child 
psychiatry, and psychiatric facilities for 
children. The organization publishes a 
journal, newsletters, and monographs 
focusing on the needs and status of 
children with psychiatric problems. For 
more information write to: 

American Academy of Child Psychiatry 
1800 R Street, N.W., Suite 904 
Washington, D.C. 20009 

American Association of 
Psychiatric Services for Children 

The purposes of this organization 
are to provide psychiatric services for 
children and related services for the 
community at large, and to promote a 
coordinated effort of psychiatrists, psy- 
chologists, and psychiatric social 
workers in serving the needs of chil- 
dren. This organization has branch 
offices in many communities and 
publishes a newsletter. For more infor- 
mation write to: 

American Association of Psychiatric 
Services for Children 
1701 18th Street, N. W. 
Washington, D.C. 20009 

American Association of 
University Affiliated Programs 

This organization is most interested 
in providing diagnostic services to indi- 
viduals with developmental disabilities 
(which include emotional disturbance) 
and in providing training for people 
who work with handicapped persons. 
University Affiliated Facilities provide 
services in areas such as early child- 
hood and special education, pediatrics, 
child development, child psychology, 
social work, child neurology, speech 
pathology, physical and occupational 
therapy, nutrition, and nursing. Nearly 
50 UAFs have been established 
throughout the country. The associa- 
tion has an official working relationship 
with Head Start. By writing to the 
address below you can find out if there 
is a program near you that can provide 
diagnostic treatment, training, and con- 
sultation services. For more informa- 
tion write to: 

American Association of University 
Affiliated Programs 
2033 M Street, Suite 406 
Washington, D. C. 20036 

American Psychological Association/ 
Division of Child and Youth Services 

This is a new division of the APA 
that draws on many disciplines other 
than psychology to study, develop, and 
foster appropriate services and service 
structures for children and youth. It is 
concerned with the prevention and 
treatment of emotional disturbance and 
emphasizes the necessity of high- 
quality services for mainstream chil- 
oren and youth. The Division can serve 
as a source of information. Write to: 

Director, Division of Child 

and Youth Services 

c/o American Psychological Association 

1200 17th Street, N.W. 

Washington, D.C. 20005 

Closer Look 

Funded through the Bureau of Edu- 
cation for the Handicapped, U.S. Office 
of Education, this special project 
attempts to provide bridges between 
parents and services for handicapped 
children, and to help parents become 
advocates for comprenensive services 
for their own handicapped child as well 
as for others. Qoser Look publishes a 
newsletter about handicaps and new 
programs, as well as information of spe- 
cial interest to parents. The staff will 
also respond to questions that you may 
have. The newsletters and information 
are free. Bv writing to themvou can be 
added to their mailing list. This organi- 
zation has regional branches. For more 
information write to: 

Closer Look 

Box 1492 

Washington, D. C. 20013 


128 Council for E^xceptional Children: 
Division for Children with 
Behavioral Disorders 

This division is concerned with 
teaching children with behavioral disor- 
ders, with training the teachers of these 
children to be more effective, with pro- 
moting research and development into 
more iimovative and responsible educa- 
tion for exceptional children, and with 
supporting legislation for services to 
these children. CEC and this division 
publish low-cost informational materials 
of interest to parents and professionals. 
CEC has local chapters. For more infor- 
mation, write to: 

Council for Exceptional Children 

Division for Children with Behavioral 


1920 Association Drive 

Reston, Virginia 22091 

Council for Ebtceptional Children 
Information Center 

This information center provides 
abstracts of current research and bibli- 
ographies of information currently 
available in publications and nonprint 
media. It also provides annotated list- 
ings of agencies that serve exceptional 
children and their families. Contact: 

Council for Exceptional Children 
Information Center 
1920 Association Drive 
Reston, Virginia 22091 

Instructional Materials Centers 

These centers have media and mate- 
rials suitable for use with emotionally 
disturbed children. Often the director or 
staff of the center can demonstrate 
materials, suggest especially good 
materials, and consult with you about 
your needs. 

Tb find out about a center, contact 
the Resource Access Project in your 
region, directors of special education in 
your state department of education, or 
colleges' and imiversities' special educa- 
tion departments. 

Mental Health Association, 
National Headquarters 

The Mental Health Association is a 
private organization with 1,000 local 
affiliate chapters whose aims are to 
improve attitudes toward mental illness 
and the mentally ill, to improve serv- 
ices for the mentally ill, to work for the 
prevention of mental illness, and to pro- 
mote mental health. 

The Mental Health Association 
sponsors broad programs of research, 
social action, education, and service. 
Special program emphasis is placed on 
improved care and treatment for men- 
tal hospital patients; aftercare and reha- 
bilitation; community mental health 
services; and treatment, education, and 
special services for mentally iU children. 

A catalog of publications is avail- 
able upon request. For more informa- 
tion write to: 

Mental Health Association, National 


1800 North Kent Street 

Arlington, 'Virginia 22209 

National Association of School 

The purposes of this organization 
are to serve the mental health and edu- 
cational interests of all children and 
youth, to advance the standards of 
school psychology, and to enhance the 
effective practice of school psychology. 
The Association publishes newsletters 
and research reports, and maintains an 
archives of professional material. NASP 
provides consultation to Head Start and 
other preschoolprograms through its 
local cnapters. For more information, 
write to: 

National Association of School 

1140 Connecticut Avenue, N.W., Suite 


Washington, D.C. 20036 

National Center for Law 
and the Handicapped, Inc. 

This organization was established to 
ensure equal protection under the law 
for handicapped people. It participates 
in selected court cases by consulting 
with the lawyers of handicapped people 
whose rights may have been violatea. 
Sometimes NCLH provides a lawyer 
for a handicapped person. The staff can 
answer questions and provide informa- 
tion about legal issues affecting dis- 
turbed children. For more information 
write to: 

National Center for Law and the 
Handicapped, Inc. 
1235 North Eddy Street 
South Bend, Indiana 46617 

National Etister Seal Society for 
Crippled Children and Adults 

The Society is a major provider of 
rehabilitation services to disabled per- 
sons of all ages with orthopedic, neuro- 
logical, or neuromuscular disabilities; 
sensory, communication, and learning 
disorders; or psychological and social 
dysfunction. Others served are parents 
and families of disabled persons and lay 
and professional persons seeking infor- 

The Society conducts programs of 
evaluation, treatment, education, voca- 
tional training, and advocacy. Support 
services such as equipment loan and 
transportation are also provided. 
Nearly 2,000 programs and facilities are 
organized on a state and/or local basis. 
The Chicago headquarters serves as a 
national spokesman about the Society, 
as an advocate of the disabled, and in 
support and leadership of the programs 
of its affiliate Societies. As an advo- 
cate, response is given to requests for 
information, and testimony is prepared 
on issues vital to the disabled. 

The National Society building in 
Chicago houses a library collection of 
books, periodicals, and pamphlets on 
rehabilitation. The Society's Informa- 
tion Center produces and/or dissemi- 
nates several publications, including a 
professional journal entitled Rehabilita- 
tion Literature. A publications catalog 
is available. For more information 

National Easter Seal Society for 
Crippled Children and Adults 
2023 West Ogden Avenue 
Chicago, Illinois 60612 


130 National Society for Autistic Children 

Comprised of teachers, parents, and 
other professionals concerned with 
severe disorders of communication and 
behavior in children, the purposes of 
this organization are to provide infor- 
mation to the public about the S5TTip- 
toms and problems of the autistic child, 
to promote better understanding of 
autism, and to aid physicians in mak- 
ing earlier and more accurate diagnoses 
of autism. 

This organization maintains a 
National Information and Referral 
Service, supports the Institute of Child 
Behavior Research, and maintains a 
1,300- volume library of information on 
autism, emotional disturbance, and 
behavior modification. Its publications 
include the National Directory of Serv- 
ices and Programs for Autistic Chil- 
dren and a newsletter. 

The organization has local chapters. 
For more information write: 

National Society for Autistic Children 
621 Central Avenue 
Albany, New York 12206 

Resource Access Projects 

Resource Access Projects (RAPs) 
are designed to link local Head Start 
staff with a variety of resources to 
meet the special needs of handicapped 
children. Tney function as brokers, 
facilitatrng the delivery of training and 
technical assistance to meet local Head 
Start program needs in the area of 
services to handicapped children. While 
the RAPs wiU assist local grantees in 
determining and meeting their n^ds in 
the area of handicapped services, the 
cost of any required training or techni- 
cal assistance must be borne by the 
grantee and/or the resource provider. 

RAPs have been established to iden- 
tify all possible sources of training and 
technical assistance, and to enlist their 
support in helping Head Start find and 
serve handicapped children. Examples 
of resources include public health 
departments, community mental health 
centers, speech and hearing clinics, 
developmental disabilities councils, imi- 
versities and colleges, professional asso- 
ciations, and private providers of train- 
ing, technical assistance, materials, and 

The addresses for the RAPs in all 
regions of the country, and tne states 
served, are as follows. 



Resource Access Project 



New Hampshire 




Rhode Island 

Education Development Center, Inc. 

55 Chapel Street 

Newton, Massachusetts 02160 


New York 
New Jersey 
Puerto Rico 
Virgin Islands 

New York University 
School of Continuing Education 
3 Washington Sq. Village, Apt. IM 
New York, New York 10012 



West "\^ginia 




District of Columbia 

Mineral Street Annex 
Keyser, West Virginia 26726 


North Carolina 
South Carolina 

Chapel Hill Training Outreach Project 

T.incoLn School 

Merritt Mill Road 

Chapel Hill, North Carolina 27514 


The Urban Observatory 
1101 17th Avenue, South 
Nashville, Tennessee 37212 





University of Illinois 
Colonel Wolfe Preschool 
403 East Healey 
Champaign, Illinois 61820 


Portage Project 
Resource Access Project 
412 East Slifer Street 
P 0. Box 564 
Portage, Wisconsin 53901 


132 DREW 


Resource Access Project 


New Mexico 

Contract not awarded 
at time of printing. 



University of Kansas City 
Medical Center 
Children's Rehabilitation Unit 
39th & Rflinbow Boulevard 
Kansas City, Kansas 66103 


North Dakota 
South Dakota 

Mile High Consortium 
Hampden East I-Room 215 
8000 East Girard Avenue 
Denver, Colorado 80231 






Pacific Trust Tferritories 

Los Angeles Unified School District 
Special Education Division 
450 North Grand Avenue 
Los Angeles, California 90012 





University of Washington 
Model Preschool Center for 
Handicapped Children 
Expenmental Education Unit WJ-10 
Seattle, Washington 98195 


Easter Seal Society for Alaska 
Crippled Children and Adults 
726 E. Street 
Anchorage, Alaska 99501 


Many books have been published on 
children with emotional disturbance. It 
is not possible to list all of them here, 
but the ones mentioned are some of 
those that are especially good for 
understanding what emotional distur- 
bance is and tor helping you work with 
disturbed children in your classroom. 
Several books that can be especially 
useful to parents are also described. 

Books About 
Disturbance and 
Its Treatment 

Greenfield, Josh. A Child Called 
Noah. New York: Holt, Rinehart and 
Winston, 1970. 

A novelist/playwright describes family 
experiences with his autistic son. The 
narrative takes the form of journal 
entries recoimting the parents' strug- 
gles to understand what was wrong, 
and their search across the country for 

Hamblin, Robert; Buckholdt, David; et 
al. The Humanization Processes: A 
Social Behavioral Analysis of 
Children's Problems. New York: Wiley- 
Interscience, 1971. 

A major recent work on how to use 
behavior modification to manage 
acting-out aggressive children and 
autistic children. The approach is 
humane. The reading is not easy. 

Kessler, Jane. Psychopathology of 
Childhood. Englewood Cliffs, N.J.: 
Prentice-Hall, 1966. 

This is a major and classic text for 
those who want a more comprehensive 
coverage of the causes and treatment 
of all types of emotional disorders in 

Klein, Stanley. Psychological lasting 
of Children — A Consimiers Guide. 

Available from: The Exceptional Parent 
Bookstore, Room 708, Statler Office 
Building, Boston, Mass. 02116. 

This book describes and assesses the 
various tests commonly used with chil- 
dren of all ages, focusing on intelligence 
and achievement tests. This guide 
offers information about the appropri- 
ateness of tests for use with handi- 
capped and other children (such as 
those from minority and low-income 

Kozloff, Martin. Reaching the Autis- 
tic Child: A Parent Training Program. 
Champaign, 111.: Research Press, 1973. 

The author describes ways of training 
jarents to use behavior modification to 
lelp their own autistic children at 
lome, under professional supervision. 
'. ncluded are four detailed case histories 
of parents and their autistic children. 


134 Lasher, Miriam G., and Braun, Samuel 
J. Are You Ready to Mainstream: 
Helping Preschoolers with Letiming 
and Behavior Problems. Columbus, 
Ohio: Charles E. Merrill Publishing Co., 

This book describes practical ways to 
apply child development principles in 
working with special needs children in 
classroom and home settings. The text 
emphasizes the teacher's role in a com- 
prehensive approach to working with a 

Lewis, Richard; Strauss, Alfred; and 
Lehtinen, Laura. The Other Child 
2nd ed. New York: Grune and Stratton, 

A handbook for parents on the charac- 
teristics of brain-injured children, and 
on management techniques that have 
been found useful in working with these 

MacCracken, Mary. A Circle of 
Children. New York: New American 
Library, 1973. 

The author, a gifted volunteer-tumed- 
teacher, describes her beginning experi- 
ences in teaching seriously disturbed 
children in a special school. 

MacCracken, Mary. Lovey: A Very 
Special Child. New York: J.B. Lippin- 
cott Co., 1976. 

Further experiences recounted by the 
author on helping to bring out one 
severely withdrawn little girl. 

Park, Clara Clairbome. The Siege: 
The First Eight Years of an Autistic 
Child. Boston: Little, Brown and Co., 

A mother's account of her family's 
struggle to raise and get help for their 
severely autistic/learning disabled 
daughter. Several chapters describe in 
detail the mother's work with her 

Ross, Dorothea, M., and Ross, Sheila 
A. Hyperactivity. New York: John 
WUey & Sons, 1976. 

This book makes a substantial contri- 
bution to the literature on hyperactiv- 
ity, and is heavily referenced. It thor- 
oughly reviews current theories as to 
the cause of the disturbance, and 
methods of treating it. The book 
includes a 44-page reference list. 

Shaw, Charles R. When Your Child 
Needs Help. New York: William Mor- 
row & Co., 1972. 

This book is written for parents who 
know that they have an emotionally 
disturbed child or who suspect that 
they may have one. There are chapters 
on each of the major categories of emo- 
tional disturbance and a section on how 
to get appropriate help. 

Stewart, Mark A., and Olds, Sally 
Wendkos. Raising a Hyperactive 
Child. New York: Harper & Row, 1973. 

A very readable guidebook for parents 
and teachers on the problem of hyp^J"' 
activity and home management. The 
explanations are simple and the sugges- 
tions are practical. 

Guides to 
Teaching and 

Anderson, Zola. Getting a Head 
Start on Social and Emotional Growth 
(1976). Available from: Meyer Children's 
Rehaljilitation Institute, University of 
Nebraska Medical Center, Omaha, 
Nebr. 68105. 

This is a practical and easy-to-read 
guide for preschool teachers on develop- 
ing the social skills and emotional 
growth of young children. Chapter 1 1 
describes emotional problems and sug- 
gests methods for teachers in dealing 
with them. 

D'Audney, Weslee, and Dollis, 
Dorothy. Calendar of Developmentfil 
Activities for Preschoolers (1975). 
Available from: Meyer Children's Reha- 
bilitation Institute, University of 
Nebraska Medical Center, Omaha, 
Nebr. 68105. 

This is a resource book on preschool 
activities arranged in calendar format. 
The simpler activities are presented in 
the faU months and the more complex 
ones are presented in the spring 
months, allowing you to choose activi- 
ties appropriate to the child's develop- 
mental level. Also given are the skill 
areas involved in each activity. 

D'Audney, Weslee, ed. Giving a 
Head Start to Parents of the Handi- 
capped (1976). Available from: Meyer 
Children's Rehabilitation Institute, Uni- 
versity of Nebraska Medical Center, 
Omaha, Nebr. 68105. 

This manual is designed primarily to 
help Head Start teachers provide sup- 
port and encouragement to parents of 
children with handicaps. It discusses 
subjects such as the value of main- 
streaming, legal rights of the handi- 
capped and their families, and the dan- 
gers of labeling. It also provides spe- 
cific suggestions for working with par- 
ents of special needs children, including 
those with emotional disturbance. 

The Exceptional Parent Magazine. 
Psy-Ed. Corporation, 20 Providence 
Street, Room 708, Statler Office Build- 
ing, Boston, Mass. 02116. 

Addressed to the parents and teachers 
of handicapped youngsters and adults, 
this magazine has many articles of 
interest, including "what to do," "how 
to do it," and "where to get help." For 
a subscription, write to: The Excep- 
tional Parent, P.O. Box 4944, Manches- 
ter, N.H. 03108. 



136 Findlay, Jane, et al. A Planning 
Guide: The Preschool Curriculum — 
The Child, The Process, The Day. 

Chapel Hill, N.C.: Chapel HiU Training 
Outreach R-oject, n.d. 

This book elaborates on curriculum 
information found in the Learning 
Accomplishment Profile developol by 
Anne Sanford, and presents 44 pre- 
school curriculum units intended for 
developmentally delayed or unpaired 
children. It has a section on curriculum 
(who determines it, what it is, and what 
goes into it), a section on methods and 
principles (preparing instructional objec- 
tives, task analysis, error-free learning, 
and positive reinforcement), the 44 cur- 
riculum units, with objectives and skill 
sequences, and bibliographies. It is 
helpful, although not necessary, to use 
the Planning Guide together with the 

Hansen, S. Getting a Head Start on 
Speech and Language Problems (1974). 
Available from: Meyer Children's Reha- 
bilitation Institute, University of 
Nebraska Medical Center, Omaha, 
Nebr. 68105. 

This good, simple guide to working 
with preschool children who have 
speecn and language problems gives 
language milestones, screening proce- 
dures, and teaching techniques. 

Hogden, Laurel, et al. School Before 
Six: A Diagnostic Approach (1974). 
Available from: Cemrel, Inc. 3120 59th 
Street, St. Louis, Mo. 63139. 

School Before Six is printed in two 
volumes. Volume I includes procedures 
for assessing young children s learning 
needs and strengths through testing 
procedures in four developmental areas: 
large, small, and perceptual motor 
skjJls; language; social-emotional skills; 
and conceptual skills. General teaching 
strategies and activities are suggested 
to help children develop in each of these 
areas. Volume II includes a wealth of 
activities in areas such as science, art, 
table games, food preparation, lan- 
guage, social science, and music. Vol- 

ume I is extensively cross-referenced to 
Volume II to simplify the selection of 
appropriate activities for specifically 
diagnosed situations. 

Jordan, June, ed. Not All Little 
Wagons Are Red: The Exceptional 
Child's Early Years (1973). Available 
from: Council for Exceptional Children, 
1920 Association Drive, Reston, Va. 

This book discusses the importance of 
beginning early to develop programs 
for children with handicaps. Attention 
is given to helping children achieve a 
positive self-concept, good learning 
motivation, social skills, emotional sta- 
bility, and physical well-being. Two sec- 
tions are particularly helpful: the devel- 
opment or children who need special 
help, and program models and resource 
materials. The book includes many fine 
illustrations, and describes a variety of 
alternative ways to meet children's 

The Portage Guide to Early 
Education. Rev. ed. Portage, Wis.: 
Cooperative Educational Service 
Agency No. 12, 1976. 

This guide has three parts: a checklist 
of skills for determining an individual 
child's progress, a card file listing 
activities that can be used to teach 
these skills, and a manual of directions 
for conducting the activities. The areas 
covered in the program are infant stim- 
ulation, socialization, language, self- 
help, cognitive skills, and motor skills. 

Reinert, Henry R. Children in 
Conflict. St. Louis: The C.V. Mosby 
Co., 1976. 

A short overview of the field of teach- 
ing emotionally disturbed children. It is 
designed for beginning teachers or col- 
lege students. 


Ongoing assessment, 
balanced against overtest- 
ing, can help to provide 
an accurate picture of a 
child's developing skills 
and functioning. 





This section describes the nature 
and purpose of screening and diagnosis, 
and the use of tests in each of these 
processes. The overall goal of both 
processes is to evaluate or assess a 
child's functioning and to identify prob- 
lem areas, if any exist. 


Screening is a process that identifies 
children who need specific treatment 

(for example, eyeglasses or immimiza- 
tion shots) or who need to be referred 
for a diagnostic evaluation. Screening is 
therefore an important tool in the early 
identification or handicapped children. 

Screening procedures such as check- 
lists and tests are inexpensive, quick, 
and easily administered. They give the 
screener an overview of a child s per- 
formance. Tbachers, aides, and others 
need to be trained to use a particular 
screening procedure correctly. For the 
screening services that must be pro- 
vided for every child, see Project Head 
Start Performance Standards. 

Not all children who fail a screening 
test are found to have a problem when 
they are given a full diagnostic evalua- 
tion. This is because the results of 
screening tests are not exact, since the 
tests do not assess in depth a child's 
functioning in a given area. Also, 
because screening is done in a limited 
amount of time, the screener may not 
realize if a certain child is not perform- 
ing at his or her best at that particiilar 
time. For these reasons, a child who is 
not handicapped may fail a screening 
and be referred for further evaluation. 

On the other hand, some children 
who pass a screening test may, in fact, 
have a problem that wasn't detected in 
the screening. If you have a child in 
your class who has passed the standard 
screening tests and you still feel there 
may be something wrong, do not hesi- 
tate to ask an appropriate professional 
to look at the child more closely. 


Diagnosis is a process of gathering 
information from a variety of sources 
in order to get a comprehensive picture 
of a child's functioning and to identify 
problem areas. The diagnostic process 
assesses both physical and psychologi- 
cal functioning. 

A variety of tools should be used in 
the diagnostic process: interviews (with 
parents and other adults who know the 
child well, with the child, with social 
agency personnel the child has been 
receiving services from), psychological 
tests, medical and other reports/tests of 
physical functioning, and other sources 
of information about the child. The 
tests that are used in the diagnostic 
process take an in-depth look at a 
child's skills in particular developmental 
areas. In Project Head Start, diagnosis 
is to be conducted by an interdisci- 
plinary team of specialists (or a profes- 
sional who is qualified to diagnose the 
specific handicap). The diagnostic proc- 
ess should involve: 

1. A categorical diagnosis of a child, 
using Project Head Start diagnostic cri- 
teria, to be used solely for reporting 

L, A functional assessment of a 
child. This functional assessment is a 
developmental profile that describes 
what tne child can and cannot currently 
do and that identifies areas requiring 
special education and related services. 

3. An individualized program plan 
based upon the functional assessment 
and developed jointly by the diagnostic 
team, the parents, and the child's 

4. Ongoing assessment of the child's 
progress by the teacher, the child's par- 
ents, and (as needed) the diagnostic 

The results of the diagnostic process 
should inform the teacher and parents 
as to the child's strengths and 
weaknesses — and hence the child's 
needs in terms of further learning. The 
results of the diagnostic process often 
do not tell the teacher or parents what 
they should do to help the child in the 
identified problem areas. Diagnosticians 
themselves, depending on their knowl- 
edge of classrooms and of specific 
teaching techniques, may be able to dis- 
cuss with the teacher and parents spe- 
cific ways in which they can help the 
child in the classroom and at home. 
Often the teacher or parent needs to 
take the initiative in order to obtain 
this kind of information from a diagnos- 




The selection of appropriate tests, 
their administration, and their interpre- 
tation is often a difficult process, 
requiring a great deal of expertise. 
Sometimes the precise test needed has 
simply not yet been developed, and a 
diagnostician must use the best of 
what is available and then interpret the 
results with great caution. Many fac- 
tors can lead to inappropriate testing or 
inaccurate test results: 

• mistaking one handicap for another 

• mistaking cultural differences for 

• mistaking normal physical or men- 
tal immatvirity for handicaps 

• testing a child who is not used to 
test-like situations 

• testing a child when he or she is 
not feeling well 

• testing a child in a language that 
is not his or her home language 

• testing a particular developmental 
area in a child by requiring a 
response that involves behaviors in 
which the child has special needs 
(for example, testing cognitive 
functioning by requiring a verbal 
response from a withdrawn, non- 
verbfd child, or peer interaction or 
reality testing from a severely 
handicapped psychotic or autistic 

Even if children are given tests that are 
appropriate to their age, cultural back- 
ground, and suspected handicaps — 
and that are methodologically valid and 
reliable — test results can be inaccu- 
rately interpreted. 

Tb ensure that tests are appropriate 
to a specific purpose, and that they are 
administered and interpreted correctly, 
any screening test that a teacher wants 
to use should be discussed ahead of 
time with a trained professional who is 
knowledgeable about the test. Tfests 
used for diagnostic purposes should be 
administered and interpreted by special- 
ists trained in the use of the test. 

In addition to interviews and histo- 
ries, your own continuing observation 
of a child in a variety of situations in 
your preschool program is an invalu- 
able tool in understanding and helping 
a child learn. During the preschool 
years, children experience a great 
amount of development emd change in 
all areas. This means that ongoing 
assessment, balanced against over- 
testing, is needed to provide a more 
accurate picture of a child's developing 
skills and functioning. Ongoing assess- 
ment can help prevent mislabeling of 

For additional information on the 
diagnostic process — including proce- 
dures and persons — contact the 
Resource Access Project in your area. 

For additional information on tests, 
write to: 

Head Start Tfest Collection 
Educational Tfesting Service 
Princeton, New Jersey 08540 

Chart of 
Infancy to 
Six Years 
of Age 

The chart of normal development on 
the next few pages presents children's 
achievements from infancy to six years 
of age in five areas: 

• motor skills (gross and fine motor) 

• cognitive skills 

• self-help skills 

• social skills 

• communication skills (understand- 
ing language and speaking). 

In each skill area, the age at which 
each milestone is reached on the aver- 
age is also presented. This information 
is useful if you have a child in your 
class who you suspect is seriously 
delayed in one or more skiU areas. 

However, it is important to remem- 
ber that these milestones are only aver- 
age. From the moment of birth, each 
child is a distinct individual, and 
develops in his or her unique manner. 
No two children have ever reached all 
the same developmental milestones at 
the exact same ages. The examples that 
foUow show what we mean. 

By nine months of age, Gi Lin had 
spent much of her time scooting around 
on her hands and tummy, making no 
effort to crawl After about a week of 
pulling herself up on chairs and table 
legs, she let go and started to walk on 
her own, Gi Lin skipped the crawling 
stage entirely and scarcely said more 
than a few sounds until she was 15 
months old But she walked with ease 
and skill by 9'/2 months. 

Marcus learned to crawl on all fours 
very early, and continued crawling until 
he was nearly 18 months old, when he 
started to walk. However, he said single 
words and used two-word phrases 
meaningfully before his first birthday. 
A talking, crawling baby is quite a 

Molly worried her parents by saying 
scarcely a word, although she managed 
to make her needs known with sounds 
and gestures. Shortly after her second 
birthday, Molly suddenly began talking 
in two- to four-word phrases and sen- 
tences. She was never again a quiet 

All three children were healthy and 
normal. By the time they were three 
years old, there were no major differ- 
ences among them in walking or talk- 
ing. They had simply developed in their 
own ways and at their own rates. Some 
children seem to concentrate on one 
thing at a time — learning to crawl, to 
walk, or to talk. Other children develop 
across areas at a more even rate. 

As you read the chart of normal 
development, remember that children 
don't read baby books. They don't 
know they're supposed to be able to 
point out Daddy when they are a year 
old, or copy a circle in their third year. 
And even if they could read the baby 
books, they probably wouldn't follow 
them! Age-related development mile- 
stones are obtained by averaging out 
what many children do at various ages. 
No child is "average" in aU areas. Each 
child is a unique person. 

One final word of caution. As chil- 
dren grow, their abilities are shaped by 
the opportunities they have for learn- 
ing. For example, although many five- 
year-olds can repeat songs and rhymes, 
the child who has not heard songs and 
rhymes many times cannot be expected 
to repeat them. All areas of develop- 
ment and learning are influenced by the 
child's experiences as well as by the 
abilities tney are bom with. 


Chart of Normal Development 











0-12 Months 

Sits without support. 


Pulls self to standing 
and stands unaided. 

Walks with aid. 

Rolls a ball in imita- 
tion of adult. 

Reaches, grasps, 
puts object in mouth. 

Picks things up with 
thumb and one finger 
(pincer grasp). 

Transfers object 
from one hand to 
other hand. 

Drops and picks up 

Responds to speech 
by looking at 

Responds differently 
to aspects of 
speaker's voice (for 
example, friendly or 
unfriendly, male or 

Turns to source of 

Responds with ges- 
ture to hi, bye-bye, 
and up, when these 
words are accompa- 
nied by appropriate 

Stops ongoing action 
when told no (when 
negative is accompa- 
nied by appropriate 
gesture and tone). 

Makes crying and 
non-crying sounds. 

Repeats some vowel 
and consonant 
sounds (babbles) 
when alone or when 
spoken to. 

Interacts with others 
by vocalizing after 

Communicates mean- 
ing through intona- 

Attempts to imitate 

12-24 Months Walks alone. 

Walks backward. 

Picks up toys from 
floor without falhng. 

Pulls toy, pushes 

Seats self in child's 

Walks up and down 
stairs (hand-held). 

Moves to music. 

Builds tower of 3 
small blocks. 

Puts 4 rings on stick. 

Places 5 pegs in peg- 

Turns pages 2 or 3 at 
a time. 


Turns knobs. 

Throws small ball. 

Paints with whole 
arm movement, 
shifts hands, makes 

Responds correctly 
when asked where 
(when question is 
accompanied by ges- 

Understands preposi- 
tions on, in, and 

Follows request to 
bring familiar object 
from another room. 

Understands simple 
phrases with key 
words (for example. 
Open the door, or 
Get the ball). 

Follows a series of 2 
simple but related 

Says first meaningful 

Uses single word 
plus a gesture to ask 
for objects. 

Says successive sin- 
gle words to describe 
an event. 

Refers to self by 

Uses my or mine to 
indicate possession. 

Has vocabulary of 
about 50 words for 
important people, 
common objects, and 
the existence, non- 
existence, and recur- 
rence of objects and 
events (for example, 
more "^nd all gone). 








Follows moving 
object with eyes. 

Recognizes differ- 
ences among people. 
Responds to 
strangers by crying 
or staring. 

Responds to and 
imitates facial 
expressions of 

Responds to very 
simple directions (for 
example, raises arms 
when someone says, 
Come, and turns 
head when asked. 
Where is Daddy?). 

Imitates gestures 
and actions (for 
example, shakes head 
no, plays peek-a-boo, 
waves bye-bye). 

Puts small objects in 
and out of container 
with intention. 

Feeds self cracker. 

Holds cup with two 
hands. Drinks with 

Holds out arms and 
legs while being 

Smiles sponta- 

Responds differently 
to strangers than to 
famihar people. 

Pays attention to 
own name. 

Responds to no. 

Copies simple actions 
of others. 

Imitates actions and 
words of adults. 

Responds to words 
or commands with 
appropriate action 
(for example: Stop 
that. Get down). 

Is able to match two 
similar objects. 

Looks at storybook 
pictures with an 
adult, naming or 
pointing to familiar 
objects on request 
(for example: What is 
that? Point to the 

Recognizes difference 
between you and me. 

Has very limited 
attention span. 

Accomplishes pri- 
mary learning 
through own explora- 

Uses spoon, spilHng 

Drinks from cup, one 
hand, unassisted. 

Chews food. 

Removes shoes, 
socks, pants, 

Unzips large zipper. 

Indicates toilet 

Recognizes self in 
mirror or picture. 

Refers to self by 

Plays by self, initi- 
ates own play. 

Imitates adult 
behaviors in play. 

Helps put things 

Chart of Normal Development 









24-36 Months Runs forward weU. 

Jumps in place, two 
feet together. 

Stands on one foot, 
with aid. 

Walks on tiptoe. 

Kicks ball forward. 

Strings 4 large 

Turns pages singly. 

Snips with scissors. 

Holds crayon with 
thumb and fingers, 
not fist. 

Uses one hand con- 
sistently in most 

Imitates circular, 
vertical, horizontal 

Paints with some 
wrist action. Makes 
dots, lines, circular 

Rolls, pounds, 
squeezes, and pulls 

Points to pictures of 
common objects 
when they are 

Can identify objects 
when told their use. 

Understands ques- 
tion forms what and 

Understands nega- 
tives no, not, can't, 
and don't. 

Enjoys listening to 
simple storybooks 
and requests them 

Joins vocabulary 
words together in 
two-word phrases. 

Gives first and last 

Asks what and 
where questions. 

Makes negative 
statements (for 
example. Can't open 

Shows frustration at 
not being under- 

36-48 Months Runs around obsta- Builds tower of 9 

cles. small blocks. 

Walks on a Hne. 

Balances on one foot 
for 5 to 10 seconds. 

Hops on one foot. 

Pushes, pulls, steers 
wheeled toys. 

Rides (that is, steers 
and pedals) tricycle. 

Uses slide without 

Jumps over 15 cm. 
(6") nigh object, land- 
ing on both feet 

Throws ball over- 

Catches ball bounced 
to him or her. 

Drives nails and 

Copies circle. 

Imitates cross. 

Manipulates clay 
materials (for exam- 
ple, rolls balls, 
snakes, cookies). 

Begins to understand 
sentences involving 
time concepts (for 
example. We are 
going to the zoo 

Understands size 
comparatives such as 
big and bigger. 

Understands rela- 
tionships expressed 
by if . . . then or 
because sentences. 

Carries out a series 
of 2 to 4 related 

Understands when 
told. Let's pretend. 

Talks in sentences of 
3 or more words, 
which take the form 
agent-action-object (I 
see the ball) or agent- 
(Daddy sit on chair). 

Tfells about past 

Uses "s" on nouns to 
indicate plurals. 

Uses "ed" on verbs 
to indicate past 

Refers to self using 
pronouns I or me. 

Repeats at least one 
nursery rhyme and 
can sing a song. 

Speech is under- 
standable to 
strangers, but there 
are still some sound 








Responds to simple 
directions (for exam- 
ple: Give me the ball 
and the block. Get 
your shoes and 

Selects and looks at 
picture books, names 
pictured objects, and 
identifies several 
objects within one 

Matches and uses 
associated objects 
meaningfully (for 
example, given cup, 
saucer, and bead, 
puts cup and saucer 

Stacks rings on peg 
in order of size. 

Recognizes self in 
mirror, saying, baby, 
or own name. 

Can talk briefly 
about what he or she 
is doing. 

Imitates adult 
actions (for example, 
housekeeping play). 

Has limited attention 
span. Learning is 
through exploration 
and adult direction 
(as in reading of pic- 
ture stories). 

Is beginning to 
understand func- 
tional concepts of 
familiar objects (for 
example, that a 
spoon is used for eat- 
ing) and part/whole 
concepts (for exam- 

Ele, parts of the 

Uses spoon, spilling 

Gets drink from 
fountain or faucet 

Opens door by turn- 
ing handle. 

Takes off coat. 

Puts on coat with 

Washes and dries 
hands with assis- 

Plays near other chil- 

Watches other chil- 
dren, joins briefly in 
their play. 

Defends own posses- 

Begins to play house. 

Symbolically uses 
objects, self in play. 

Participates in sim- 
ple group activity 
(for example, sings, 
claps, dances). 

Knows gender iden- 

Recognizes and 
matches 6 colors. 

Intentionally stacks 
blocks or rings in 
order of size. 

Draws somewhat rec- 
ognizable picture 
that is meaningful to 
child, if not to adult. 
Names and briefly 
explains picture. 

Asks questions for 
information (why and 
how questions 
requiring simple 

Knows own age. 

Knows own last 

Has short attention 

Learns through 
observing and imitat- 
ing adults, and by 
adult instruction and 
explanation. Is very 
easily distracted. 

Has increased under- 
standing of concepts 
of the functions and 
groupings of objects 
(for example, can put 
doll house furniture 
in correct rooms), 
and part/whole (for 
example, can identify 
pictures of hand and 
foot as parts of 

Begins to be aware 
of past and present 
(for example: Yester- 
day we went to the 
park. Today we go to 
the library). 

Pours well from 
small pitcher. 

Spreads soft butter 
with knife. 

Buttons and unbut- 
tons large buttons. 

Washes hands unas- 

Blows nose when 

Uses toilet independ- 

Joins in play with 
other children. 
Begins to interact. 

Shares toys. Takes 
turns with assis- 

Begins dramatic 
play, acting out 
whole scenes (for 
example, traveling, 
playing house, pre- 
tending to be ani- 

Chart of Normal Development 














48-60 Months Walks backward toe- 

Jumps forward 10 
times, without fall- 

Walks up and down , 
stairs alone, alternat- betters, 
ing feet. 

Turns somersault. 

Cuts on line contin- 

Copies cross. 

Copies square. 

Prints a few capital 

Follows 3 unrelated 
commands in proper 

Understands com- 
paratives like pretty, 
prettier, and pret- 

Listens to long sto- 
ries but often misin- 
terprets the facts. 

Incorporates verbal 
directions into play 

sequencing of events 
when told them (for 
example. First we 
have to go to the 
store, then we can 
make the cake, and 
tomorrow we will eat 

Asks when, how, and 
why questions. 

Uses modals like can, 
will, shall, should, 
and might. 

Joins sentences 
together (for exam- 
ple, I like chocolate 
chip cookies and 

Talks about causality 
by using because and 

Ttells the content of a 
story but may con- 
fuse facts. 

60-72 Months Runs lightly on toes. Cuts out simple 


Walks on balance 

Can cover 2 meters 
(6 '6") hopping. 

Skips on alternate 

Jumps rope. 


Copies triangle. 
Traces diamond. 
Copies first name. 

Prints numerals 1 to 


Colors within lines. 

Has adult grasp of 

Has handedness well 
established (that is, 
child is left- or right- 

Pastes and glues 

Demonstrates pre- 
academic skills. 

There are few obvi- 
ous differences 
between child's 
grammar and adult's 

Still needs to learn 
such things as 
subject-verb agree- 
ment, and some 
irregular past tense 

Can take appropriate 
turns in a conversa- 

Gives and receives 

Communicates well 
with family, friends, 
or strangers. 












Plays with words 
(creates own rhyming 
words; says or makes 
up words having 
similar sounds). 

Points to and names 
4 to 6 colors. 

Matches pictures of 
familiar objects (for 
example, shoe, sock, 
foot; apple, orange, 

Draws a person with 
2 to 6 recognizable 
parts, such as head, 
arms, legs. Can name 
and match drawn 
parts to own body. 

Draws, names, and 
describes recogniz- 
able picture. 

Rote counts to 5, 
imitating adults. 

Knows own street 
and town. 

Has more extended 
attention span. 
Learns through 
observing and listen- 
ing to adults as well 
as through explora- 
tion. Is easily dis- 

Has increased under- 
standing of concepts 
of function, time, 
part/whole relation- 
ships. Function or 
use of objects may 
be stated in addition 
to names of objects. 

Time concepts are 
expanding. The child 
can talk about yes- 
terday or last week 
(a long time ago), 
about today, and 
about what will hap- 
pen tomorrow. 

Cuts easy foods with 
a knife (for example, 
hamburger patty, 
tomato slice). 

Laces shoes. 

Plays and interacts 
with other children. 

Dramatic play is clos- 
er to reality, with 
attention paid to 
detail, time, and 

Plays dress-up. 

Shows interest in 
exploring sex differ- 

Retells story from 
picture book with 
reasonable accuracy. 

Names some letters 
and numerals. 

Rote counts to 10. 

Sorts objects by sin- 
gle characteristics 
(for example, by 
color, shape, or size 
if the difference is 

Is beginning to use 
accurately time con- 
cepts of tomorrow 
and yesterday. 

Uses classroom tools 
(such as scissors and 
paints) meaningfully 
and purposefully. 

Begins to relate 
clock time to daily 

Attention span 
increases noticeably. 
Learns through adult 
instruction. When 
interested, can ignore 

Concepts of function 
increase as well as 
understanding of 
why things happen. 
Time concepts are 
expanding into an 
understanding of the 
future in terms of 
major events (for 
example, Christmas 
will come after two 

Dresses self com- 

Ties bow. 

Brushes teeth unas- 

Crosses street safely. 

Chooses own 

Plays simple table 

Plays competitive 

Engages with other 
children in coopera- 
tive play involving 
group decisions, role 
assignments, fair 

•ir us. GOVERNMENT PRINTING OFFICE : 1978 O— 272-363 

Hyi631 Lasher, Miriam G. 

L335 Mains trearaing 

M435 preschoolers: Children 

with emotional 


A guide for 



HV1631 Lasher, Miriam G. 

L335 Mainstreaming 

M435 preschoolers: Children 
with emotional 
disturbance: A guide 


OATI out 




NEW YOflK,-N. Y. IfiOll 





U.S. Department of Health, Education, and Welfare 

Office of Human Development Services 
Administration for Children, Youth and FamiUes 
Head Start Bureau 

DHEW Publication No. (OHDS) 78-31115