Responsive Teaching: Early intervention for children with Down syndrome and
Gerald Mahoney, Frida Perales, Bridgette Wiggers and Bob Bob Herman
Responsive Teaching is an early intervention curriculum designed to address
the cognitive, language, and social emotional needs of young children with developmental problems.
This innovative intervention model was derived from research conducted primarily with children
with Down syndrome and their mothers. Results from these studies indicated that during the early
childhood years, parents promote their children's development by engaging in highly responsive
interactions throughout their daily routines. The effects of responsiveness are mediated by
the impact it has on children's use of several pivotal developmental behaviours, such as social
play, attention, initiation and persistence. Responsive Teaching helps parents learn to use
Responsive Teaching strategies to promote the pivotal developmental behaviours that are relevant
to their children's developmental needs. Research with 50 children with developmental problems
and their parents indicated that Responsive Teaching was highly effective at addressing children's
developmental and social emotional needs. The effects of this intervention were mediated by
the impact that RT strategies had on children's pivotal developmental behaviours.
Mahoney G, Perales F, Wiggers B, Bob Herman B. Responsive Teaching: Early intervention for children with Down syndrome and
other disabilities. Down Syndrome Research and Practice. 2006;11(1);18-28.
Responsive Teaching (RT) (Mahoney & MacDonald, 2007) is a child development early intervention
curriculum that was designed to be implemented by parents and other caregivers who spend significant
amounts of time interacting with and caring for young children. RT was developed to help adults
maximise the potential of each of their routine interactions with their children so that they
support and enhance children's development and well being. This curriculum encourages children
to develop and use the 'pivotal behaviours' that are the foundations for developmental learning,
such as social play, initiation, problem solving, joint attention, conversation, trust, cooperation,
persistence and feelings of competence. The instructional strategies that are at the heart of
Responsive Teaching are 'easy to remember' suggestions that adults can incorporate into daily
routines with children.
Responsive Teaching is designed to promote three domains of developmental functioning. These
include the following:
- Cognition - children's ability to think, reason, solve problems and learn new information
about their world and relationships;
- Communication - children's ability to convey their feelings, observations and intentions
and respond to the feelings, observations and intentions of others through nonverbal, symbolic
and spoken language;
- Social-emotional functioning - children's ability to engage in and enjoy developmentally
appropriate interactions with parents, adults and other children as well as to comply with
reasonable rules and expectations.
In this paper we will discuss four issues related to Responsive Teaching. First we will describe
the research findings conducted mostly with children with Down syndrome that provided the empirical
foundations for the design of this curriculum. Second, we will describe the procedures for implementing
this intervention. Third we will describe the results of a one year study of the effectiveness
of Responsive Teaching that was conducted with 50 children who had developmental problems or
delays. Finally, we will discuss the implications that this curriculum has for early intervention
Empirical foundations for Responsive Teaching
How do parents influence children's development?
In the 1980s, Mahoney and his colleagues initiated a series of studies designed to determine
how parents influenced the rate of development of their young children with developmental disabilities.
The sample for these studies included 60 mother-child pairs in which 90% of the children had
Down syndrome and the remaining children had conditions such as Williams' Syndrome and hydrocephaly.
The sample included twenty children each at the 12- 24- and 36- month age range. For the entire
sample, children's average chronological age was 24.7 months and their average Bayley Developmental
Age (Bayley, 1969) was 13.9 months.
The first study (Mahoney, Fingers & Powell, 1985) assessed the relationship of mothers' style
of interacting with their children to children's rate of developmental progress as measured
by the Bayley Scales of Mental Development (Bayley, 1969). Mothers were videotaped while
they played with their children in their homes with a set of developmentally appropriate toys.
The first 10 minutes of these videotapes was coded with a global rating scale referred to as
the Maternal Behavior Rating Scale (Mahoney, Powell & Fingers, 1986). The 18 items on this scale
assessed three dimensions of mothers' interactive style. These included responsiveness or child
orientation, quantity of stimulation, and directiveness or performance orientation. Responsiveness/child
orientation included items such as sensitivity, responsiveness, reciprocity, enjoyment and playfulness.
Quantity of stimulation included items that assessed how much social, physical and verbal stimulation
mothers provided their children. Directiveness or performance orientation included how much
mothers attempted to teach or direct their children's play.
Results from this study indicated that the way mothers interacted with their children accounted
for almost 25% of the variability in children's rate of development. Whether children were 12,
24 or 36 months of age, the children who had the highest rates of development were the children
whose mothers were high in responsiveness or child-orientation, and low in behaviours that involved
directing their child's play and teaching their child (Mahoney, Fingers & Powell, 1985). These
results suggested that if mothers provided high levels of verbal and physical stimulation and
attempted to teach their children developmental behaviours by guiding and directing them, their
children had lower Bayley Developmental Scores compared with the other children who were at
their same age level. However, if mothers engaged interactions in which they focused on enjoying
and having fun with their children and in which they responded to their children by encouraging
and supporting the behaviours that they were initiating on their own, their children had higher
Bayley Developmental Scores.
The next two studies were conducted to determine if the way mothers communicated with their
children was related to their children's rate of communication development (Mahoney, 1988a,
b). The same observations of parent-child interaction as used in the preceding study were also
used for these studies. Each of the verbal and nonverbal communications that took place between
mothers and their children during the full 20 minute observation was transcribed. The structure,
complexity and pragmatic function of each of these utterances were then coded. The manner that
mothers and children responded to each others' communicative attempts was also coded.
Results indicated that there were no significant correlations between the structure and pragmatic
functions of mothers' communication with children's rate of development and level of communication
functioning. These findings suggested that the content and complexity of mothers' conversations
with children were not related to the rate that children were developing their language and
communications skills. However, the way mothers responded to their children's communication
attempts was strongly associated with children's level of communication functioning.
Mothers' responsiveness to their children's communication was classified into one of three general
patterns. One group of mothers, called Responders, was highly responsive to their children's
verbal and nonverbal attempts to communicate. These mothers treated their children's attempts
to communicate as legitimate communications, even if their children's vocalisations or gestures
had no obvious meaning or their intentions were unclear. Responders' communications tended to
be focused on their children's conversational topics or play interests. The second group of
mothers, called Attenders, was highly attentive to their children, but did not respond frequently
to the communications their children initiated. They communicated a great deal with their children,
but their communications were focused on providing information (e.g., names, colours, functions
of objects) or asking their children to answer questions that were often not related to what
children were currently interested in communicating about. The third group, called Ignorers,
was very inattentive to their children's communication. While they did speak to their children,
they either ignored or failed to pay attention to most of their children's communication attempts.
The children of these three groups of mothers had very different levels of communication functioning.
Their rate of language development was assessed with the REEL (Receptive and Expressive Emergent
Language Scale) (Bzoch & League, 1970). Children of Responders had higher language age scores
(MLanguage Age = 15.3 months) than children of Attenders (MLanguage Age
=12.7 months) who in turn had higher language age scores than children of Ignorers (MLanguage
Age =11.6 months). The differences between these three groups of children were also reflected
in their communication with their mothers, including their frequency of vocal and communicative
behaviours, percentage of spontaneous and elicited imitation, use of words, and number of meaningful
nonverbal communications (Mahoney, 1988b).
Overall, results from these three studies suggest that parents promote their children's cognitive
and communication development primarily by engaging in highly responsive interactions with them.
While similar findings had been reported with children who do not have disabilities prior to
these findings (e.g., Ainsworth & Bell,
1975; Elardo, Bradley & Caldwell, 1975;
Stern et al.,
1969; Lewis & Goldberg, 1969), this research was the first to document this effect with children
with Down syndrome and other disabilities. These findings were provocative because they contradicted
the prevailing methodologies that were being used in early cognitive and language interventions
(Bailey & Wolery, 1984), many of which are still being used today (e.g.,
Guralnick, 1997). At
the time that these results were published, the majority of early intervention professionals
were using highly directive instructional procedures such as modelling, shaping, elicited imitation,
prompting and extrinsic reinforcement to teach cognitive and communication skills to children
with disabilities. Professionals who worked collaboratively with parents were recommending that
parents also use directive instructional procedures with their children at home, which was clearly
in conflict with these research findings.
How does responsiveness promote children's learning and development?
In contemporary early intervention practice, intervention objectives consist of the developmental
behaviours and concepts that children have not yet mastered (Lynch & Beare, 1990;
& Bricker, 2000; Weisenfeld, 1986). This is based upon the idea that children who have developmental
problems or delays will 'catch up' as they learn and use these higher level developmental skills.
Directive instructional procedures must be used to help children perform and learn the skills
that have been targeted as their intervention objectives, since children are unlikely to engage
in these behaviours on their own.
Figure 1 | The relationship between mothers' to children's global pivotal
However, the idea that children's development is accelerated by teaching them developmental
skills they do not know cannot be the way that responsive interaction promotes development.
Parents who are responsive focus primarily on encouraging their children to say and do things
they already know. They support their children by joining their activity by doing or saying
things that are similar to what their children are doing (Mahoney & MacDonald, 2007
). The more
parents encourage their children to engage in behaviours that they are not yet able to do, the
less responsive and more directive they become. Thus, one must ask the question of how responsive
interaction can promote children's development if it does not help children learn targeted higher
level developmental skills. Mahoney and his colleagues conducted the following study which helps
to explain this apparent paradox.
This study included 45 infants and toddlers with developmental disabilities who were 25 months
old and had a variety of developmental problems (Mahoney, Kim & Lin, in press). These children
were divided into two groups: children of High Responsive Mothers (n=28) and children of Low
Responsive Mothers (n=17) based upon ratings of how mothers interacted with their children using
the Maternal Behavior Rating Scale (Mahoney, 1999). The manner in which these children interacted
with their mothers was then measured using the Child Behavior Rating Scale (CBRS:
Mahoney & Wheeden, 1998). As illustrated
on Figure 1, children of High Responsive mothers had higher ratings
on each of the seven CBRS items than did children of Low Responsive Mothers.
These findings suggest that, although responsive interaction may not be effective at teaching
higher level developmental skills or concepts, it may be highly effective at teaching a different,
but perhaps more critical, class of developmental behaviours. Most of the behaviours measured
by the CBRS are considered by child development experts to be the processes or patterns of behaviour
that children themselves must demonstrate in order to learn. Specifically, the amount children
learn from a particular activity or experience is largely dependent on how actively they are
engaged in the activity. Many of the 'behaviours' that are assessed by the Child Behavior Rating
Scale reflect the critical behavioural processes that children utilise to initiate and maintain
active engagement in activities.
To test the idea that children's developmental learning is influenced by the amount they engage
in the behaviours measured by the CBRS, the 45 infants and toddlers described above were divided
into two groups, High Engagers and Low Engagers. High Engagers had average CBRS scores that
were above the midpoint, while Low Engagers had scores that were at the midpoint or lower. The
average developmental age scores of these children was then compared on two developmental measures,
the Vineland Adaptive Behavior Scale (Sparrow, Balla & Cicchetti, 1984) and the Transdisciplinary
Play based Assessment (Linder, 1993). As illustrated on
Figure 2, across the nine developmental
subscales from these two assessments, when differences in children's age were controlled, children
who were High Engagers had significantly higher developmental age scores than children who were
These results suggest that the behaviours parents encourage when they interact responsively
with their children are the learning processes that are the foundations for developmental learning.
Following the work of Koegel and his colleagues (Koegel, Koegel & Carter, 1999), we refer to
these as pivotal behaviours. That is, the child behaviours that parents promote by interacting
responsively are pivotal to wide areas of functioning such that improvements in these behaviours
enhance children's ability to learn the skills and concepts that are the foundations for higher
levels of developmental functioning.
Figure 2 | The relationship of children's pivotal behaviour level to their child development
Based upon the empirical research findings reported above, the Responsive Teaching curriculum
was organised around the idea that responsive parents promote children's development more
by encouraging children to engage in pivotal developmental behaviours and less by directly
teaching the skills and concepts that are the benchmarks of higher levels of functioning. The
more responsively parents interact with their children, the more they prompt their children
to use these pivotal behaviours. Parents who consistently engage in a responsive style of interacting
with their children in the multitude of interactive episodes they have each day help their children
to develop habits of using these pivotal behaviours or learning processes. Over time this helps
to maximise children's development and social-emotional well-being.
Implementing Responsive Teaching
The Responsive Teaching curriculum includes 66 Responsive Teaching strategies and 16 Pivotal
Behaviours that are targeted as developmental intervention objectives. Responsive Teaching Strategies
are brief, easy-to-remember suggestions that parents can use to use to monitor and change how
they interact with their children at any time and in any situation. These strategies, which
are listed in Table 1, are designed to help parents incorporate the five interactive dimensions
that are associated with responsiveness into their own interactions with their children. These
dimensions include the following:
- Reciprocity - frequent episodes of interaction that are characterised by a balanced,
'give and take' relationship;
- Contingency - interactions that have an immediate and direct relationship to a
child's previous behaviours that support and encourage the child's actions, intentions,
- Shared Control - guidance and direction that facilitates and expands the actions
and communications which the child initiates or leads;
- Affect - expressive, animated and warm interactions that are characterised by
enjoyment or delight in interacting with the child;
- Match - interactions and requests that are adjusted to the child's developmental
level, current interests, and behavioural style or temperament.
Be physically available and interactive
Play frequently together
Get into my child's world
Use mirroring and parallel play to join an activity
Expect my child to interact
Take one turn and wait
Keep my child for one more turn than usual
Play with sounds back and forth
Get from my child as much as I give to him
Communicate less so my child communicates more
Joint Action Routines
Play face-to-face games without toys
Sustain repetitive play or action sequences
Join perseverative play (make it interactive)
Play with my child with toys
Make a habit of communicating during joint activity routines
Observe my child's behaviour
Take my child's perspective
Be sensitive to my child's state
Respond quickly to my child's signals, cries or nonverbal requests
Respond immediately to little behaviours
Discipline promptly and comfort
Respond to unintentional vocalisations, facial displays and gestures "as if" they were
Accept incorrect word choice, pronunciation approximations by responding to my child's
intention or word
Translate my child's actions, feelings, intentions into words
Rephrase unclear vocalisations and word approximations with words that match my child's
actions or intentions
Interpret noncompliance as a choice or lack of ability
Explore how responsive strategies can be used to enhance my child's participation throughout
Encourage multiple caregivers to use responsive strategies
Communicate without asking questions
Imitate my child's actions and communications
Give my child frequent opportunities to make choices
Expand to show my child the next developmental step
Expand to clarify my child's intention or develop my child's topic
Wait silently for a more mature response
Play for a purpose
Change the environment
Wait with anticipation
Respond to my child in playful ways
Be more interesting than my child's distractions
Accompany communication with intonation, pointing and nonverbal gestures
Act as a playful partner
Interact for fun
Turn routines into games
Repeat activities my child enjoys
Be physical but gentle
Respond affectionately to my child's cries and needs for attention
Comfort my child when fussy, irritable or angry
Value what my child is doing
Treat my child's fears as meaningful and legitimate
Accept whatever my child does
Talk about the novel, funny and good things my child is doing
Interpret my child's behaviour developmentally
Know the developmental skills my child seems ready to learn
Request actions that match my child's developmental level
Act in ways my child can do
Communicate the way my child communicates
Have developmentally appropriate rules and expectations
Read my child's behaviour as an indicator of interest
Follow my child's focus of attention
Follow my child's lead
Behavioral Style Match
Be sensitive to my child's sensations
Observe how my child ordinarily engages in interaction
Respond to my child's behavioural state
Have expectations that conform to my child's behavioural style
Table 1 | Responsive Teaching Strategies.
Responsive Teaching Strategies are based upon the principle of 'active learning'. They help
parents engage in responsive interaction before this is their routine style of interacting with
their children. As parents use RT strategies, many discover the impact responsiveness has on
their children's engagement and participation. These experiences help parents appreciate the
implications this style of interaction has for all encounters with their children. It motivates
them to incorporate RT strategies into their spontaneous interactions, and eventually results
in their instinctively using a responsive style of interacting with their children.
Pivotal Behaviours are a small set of developmental processes that children use to learn developmental
skills and competencies across the three developmental domains of cognition, communication and
social emotional functioning. The pivotal behaviours included in Responsive Teaching were identified
from contemporary theory and research in child development, including constructivist theories
of cognitive development (Piaget, 1963;
Vygotsky, 1978), communication theories of language
development (Bates, Benigni, Bretherton, Camioni & Volterra, 1979;
Bruner, 1975, 1983), and
developmental theories of social-emotional development (Bowlby, 1969;
Goleman, 1995). They are
the developmental behaviours that parents and others promote by engaging in responsive interaction.
Responsive Teaching targets the 16 pivotal behaviours listed in
Table 2 as the intervention
objectives that are used to address children's developmental needs.
For each pivotal behaviour included in Responsive Teaching, there are 6 to 10 sets of Discussion
Points. These describe in simple language the theories of development that are the basis for
this curriculum. They explain how the pivotal behaviour that has been targeted as the intervention
objective will both improve children's developmental learning and help parents attain the outcome
they want for their child. Discussion Points have been designed so that parents can complete
each intervention session having a few clearly defined ideas to think about that support the
RT strategies that they have been asked to use with their children. Discussion Points formalise
what good professionals typically do. They provide a focused and cohesive structure for providing
child development information to parents.
RT Intervention sessions can be conducted individually with parents and their children either
in homes or centre-based settings, or with groups of parents whose children have similar developmental
concerns. Each session focuses on one or two pivotal behaviours that are relevant to the needs
of the child. For each pivotal behaviour, the interventionist introduces one or two sets of
Discussion Points to provide parents with background information about the pivotal behaviours
they are being asked to encourage their children to use throughout the daily routine. Sessions
also help parents to learn and use one or two RT strategies which the curriculum recommends
for promoting the pivotal behaviours being targeted. In addition, when pivotal behaviours are
first introduced, and periodically thereafter, parents and professionals assess the child's
use of the pivotal behaviour being targeted with the Pivotal Behaviour Rating Scale. This assessment
tool provides objective criteria for assessing children's progress on their intervention objectives.
RT does not prescribe a fixed sequence of activities for addressing pivotal behaviours. Rather
it is a menu driven curriculum that provides interventionists the flexibility of choosing intervention
objectives, RT strategies and Discussion Points that are best suited both to the developmental
needs of children and to the learning pace and style of parents. RT sessions can last from 30
minutes to one hour. Typically sessions are provided on a weekly basis to give parents the time
they need to try to use and explore the information presented in each session. However, there
is no evidence that different levels of intensity of RT sessions would be more or less effective.
Responsive Teaching has also been designed so that parents can implement it with their children
on their own.
Feelings of Control
Feelings of Confidence
Table 2 | Responsive Teaching Pivotal Behaviours.
The effectiveness of Responsive Teaching
Recently Mahoney and Perales (2005) reported results from a one year evaluation of the children
and parents who were involved in the development of the Responsive Teaching curriculum. This
evaluation examined whether children who received Responsive Teaching made significant developmental
and social emotional improvements, and whether the improvements they achieved in this program
were related to either their parents' learning to interact more responsively (e.g., reciprocity,
contingency, shared control, affect and match) and/or to improvements in children's use of pivotal
Fifty mother-child pairs participated in this evaluation. The children's ages ranged from 12
to 54 months, with 85% of the children being younger than 36 months when they began. The average
age of the mothers was 32.6 years and most were Caucasian (89.1%) and married (92.7%). The sample
included 20 children with Autism Spectrum Disorders (ASD) and 30 children with Developmental
Disorders (DD). All of these children had significant delays in cognition and/or communication.
While children with DD (Mean age = 23.3 months) were younger than children with ASD (Mean age
= 32.4 months), the developmental ages for these two groups were nearly the same.
Subjects received RT during weekly one hour parent-child sessions. They received an average
of 33 sessions over a one year period of time. A comprehensive child development assessment
was conducted at the beginning and end of intervention to evaluate the effects of this intervention.
The Transdisciplinary Play Based Assessment (TPBA, Linder, 1993) was used to assess children's
cognitive and language development. The Temperament and Atypical Behavior Scale (TABS) (Bagnato,
Neisworth, Salvia & Hunt, 1999) and the Infant Toddler Social Emotional Assessment (Carter &
Briggs-Gowan, 2000) were used to assess children social-emotional functioning.
Mothers' style of interaction and children's pivotal behaviour were also assessed from a seven
minute videotaped observation of children and mothers playing together. A modified version of
the Maternal Behavior Rating Scale (Mahoney, 1999) was used to assess mothers' style of interacting
with their children, and the Child Behavior Rating Scale (Mahoney & Wheeden, 1998) was used
to assess children's pivotal behaviour.
As expected, pre- post comparisons indicated that the Responsive Teaching strategies helped
mothers make significant increases in their levels of Responsiveness and Affect while interacting
with their children. In addition, over the course of intervention, children made improvements
in all seven of the pivotal behaviours assessed by the Children's Behavior Rating Scale.
To assess intervention effects on children's cognitive and language development a proportional
change index (PCI) was computed. PCIs compare children's rate of development during intervention
to their rate of development before intervention. PCIs indicated that children's rate of development
during intervention was 123% greater than it was before intervention. Specifically, children
made a 64% increase in their rate of cognitive development, a 167% increase in their rate of
expressive language development and a 138% increase in their receptive language development.
Children with DD did not have social emotional problems at the beginning of intervention as
indicated by their TABS scores, and made little improvement in this domain during intervention.
However, children with ASD made a 36% improvement in their overall scale score from the TABS.
This was evident on three TABS subscales, detached, under-reactivity, self regulation. Similarly,
on the ITSEA the scale scores for children with ASD improved by 15% in Self Regulation and 20%
in Social Competence.
To determine whether Responsive Teaching was truly responsible for these developmental improvements,
analyses were conducted to examine if the changes in mothers' responsiveness and children's
pivotal behaviour that were promoted through Responsive Teaching were related to the developmental
and social emotional improvements that children made. If the children who made the greatest
improvements were the ones whose mothers' changes in responsiveness resulted in the improvements
in their pivotal behaviour, then there would be a strong reason to believe that Responsive Teaching
is a highly effective developmental intervention curriculum (Shadish, Cook & Campbell, 2002).
Results from these analyses produced the following findings. First, the changes in mothers'
responsiveness during intervention accounted for 20% of the variance in changes in children's
pivotal behaviour. These findings indicate that there was a linear relationship between the
degree to which mothers changed their level of responsiveness with changes in children's pivotal
behaviour. When mothers did not change their responsiveness, children made negligible increases
in their pivotal behaviours. However, when mothers became more responsive, the degree that children
increased their pivotal behaviour was directly related to the degree to which parents changed
their responsiveness. The more responsive mothers became during intervention, the more children
increased their pivotal behaviour.
Second, changes in children's pivotal behaviour accounted for an average of 10% of the variance
in improvements in children's rate of development for each developmental domain. In other words,
how much children's pivotal behaviour changed during intervention was related to the improvements
in their Developmental Ages. Children who did not change their pivotal behaviour attained developmental
age scores that were comparable to their expected Developmental Age scores. However, children
who increased their pivotal behaviour attained Developmental Ages that were greater than their
Expected Developmental Ages.
Third, analyses were conducted to examine how changes in children's pivotal behaviour contributed
to changes in their social-emotional functioning. Results indicated that changes in children's
pivotal behaviour were not related to their social emotional improvements. Nonetheless, when
we divided the sample into children who did not change their pivotal behaviours during intervention
(No Change, n = 13) versus children who made at least some changes (Change, n =34), children
in the Change Group made improvements on four of the five TABS subscales that were at least
100% greater than improvements made by the No Change Group.
Results from this evaluation indicated that children made remarkable developmental and social
emotional improvements when their parents used Responsive Teaching with them. The magnitude
of developmental improvements that we observed is comparable to, and in most cases far greater
than, the level of improvements that have been reported for most other early intervention procedures
(c.f., Guralnick, 1997). While there was no Control group, the analyses that were conducted
suggested that the effects of treatment were causally related to Responsive Teaching. Approximately
one third of the parents who participated in this project were not very successful in using
RT strategies. This was indicated by the fact that the RT strategies had no impact on these
mothers' level of responsiveness with their children. Children of these mothers made no improvements
in either their pivotal behaviour or in their development or social emotional functioning during
intervention. However, for the remaining two-thirds of the sample, the picture was just the
opposite. RT strategies were effective at helping these mothers learn to interact more responsively
with their children. How much these mothers improved their responsiveness was related both to
increases in their children's pivotal behaviour and to improvements in their children's developmental
and social-emotional well-being.
Implications of Responsive Teaching for parents of children with Down syndrome
There are several important implications that Responsive Teaching has for children with Down
syndrome and their parents. First, it is important to note that children with Down syndrome
and their parents were the starting point for developing this curriculum. As explained earlier
in this paper, the process of developing the intervention procedures that are now known as Responsive
Teaching were initiated because of research findings which suggested that parental responsiveness
played a major role in fostering the cognitive and communication functioning of young children
with Down syndrome.
Although only one child with Down syndrome was included in the Responsive Teaching evaluation
sample, the overall results of the evaluation suggested that RT can improve the developmental
status of children with a wide range of disabilities. The child with Down syndrome who participated
in the Responsive Teaching evaluation made developmental gains that were comparable to the other
children in our sample. This child made a 113% improvement across all developmental domains
and a 145% improvement in his rate of language development. While these results are encouraging,
clearly they are not sufficient for claiming that Responsive Teaching is an effective intervention
for these children. To make this claim, Responsive Teaching would need to be validated with
a larger, more representative sample of children with Down syndrome, and intervention outcomes
would need to be examined for more than one year of time.
Second, one of the unique features of Responsive Teaching is that this curriculum promotes social
emotional functioning as well as cognitive and communication development. In fact, the same
RT strategies that are recommended to promote pivotal behaviours related to children's cognitive
and communication development are also used to promote pivotal behaviours related to social
emotional development. In the evaluation of Responsive Teaching, children's progress in each
of the three developmental domains had less to do with extent to which intervention focused
on these domains, and more to do with how responsive children's mothers became during intervention.
The instructional strategies that RT recommended to promote children's cognitive and communication
development also helped to address children's social-emotional needs, even though this was not
the focus of intervention.
Recently, there have been concerns regarding the number of children with Down syndrome who have
either behaviour problems (Cuskelly & Dadds, 1992;
Coe, Matson, Russell, et al., 1999;
1986) or severe social emotional disturbances such as Autism (Capone, 2005;
Howlin, 1995; Kent,
1999). One implication of these reports is that developmental interventions must not only address
the cognitive and communication problems of children with Down syndrome, they must also attempt
to prevent or address behavioural or social emotional problems as well. We are unaware of any
developmental intervention other than Responsive Teaching that has been reported to address
all three of these developmental domains. Future evaluations of Responsive Teaching with children
with Down syndrome and other disabilities need to determine whether this intervention is effective
at addressing the social emotional functioning of these children as well.
Third, one of the primary things that parents request from their children's early intervention
program is information about what they can do at home to support or enhance their children's
development. Responsive Teaching is designed specifically to address this need. Many interventionists
are unsure of what they should ask parents to do at home, since often the types of activities
that they do with children in classrooms or clinics do not translate easily into activities
that parents can do with children during their daily routine. Because Responsive Teaching was
developed from observations of how parents typically interact with their children, RT provides
parents with information that can be easily incorporated into the routine activities they have
with their children. When we conducted the evaluation of RT, one of the questions we were concerned
about was whether RT would place additional stress on parents. We measured how stressed parents
were at the beginning and end of intervention using the Parenting Stress Index (Abidin, 1995).
We found that RT did not increase parents' stress, but rather was associated with slight decreases
in overall stress. While parents reported that they used RT approximately 2 hours each day with
their children, this occurred mostly during the normal activities they had with their children,
such as feeding, bathing, dressing and other routine social and communicative exchanges.
While parents were asked to play with their children to practice RT strategies, this lasted
no longer than 5 minutes at a time and only as many times during the day as parents desired.
As parents became more proficient with RT strategies, intervention recommendations shifted to
encouraging parents to incorporate RT strategies into their routine interactions with their
children. Thus, while RT requires parents to invest small amounts of time to learn to use these
strategies, the time parents are asked to devote to this intervention over and above the time
they normally spend with their children decreases over time. Rather than being a burdensome
intervention, most of the parents who have participated in this intervention report that RT
enhances their enjoyment of being with their children.
In this paper we have described a promising new early intervention curriculum called Responsive
Teaching. This curriculum is designed to help parents become more effective at promoting their
children's development and social emotional well being by infusing Responsive Teaching strategies
into their routine interactions with them. It evolved from research conducted with children
with Down syndrome which suggested that parents promote children's cognitive and language functioning
by engaging in responsive interactions with them. A one year evaluation of this curriculum showed
that it was highly effective at enhancing the development of children with autism and other
developmental disabilities. While only one child with Down syndrome participated in this evaluation,
the research findings that led up to the development of this intervention point to the likelihood
of its effectiveness with children with Down syndrome.
Gerald Mahoney, Ph.D • Verna Houck Motto Professor of Families and Communities, Mandel School
of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland,
Ohio 44106 • Tel: 216-368-1824
• E-mail: firstname.lastname@example.org
Abidin, R. (1995). Parenting Stress Index, 3rd Edition. Odessa, FL.: Psychological
Ainsworth, M.D. & Bell, S.M. (1975). Mother-infant interaction and the development of competence.
In K.J. Connelly & J. Bruner (Eds.). The Growth of Competence (pp. 97-118). New York:
Bagnato, S., Neisworth, J., Salvia, J. & Hunt, F. (1999). Temperament and Atypical Behavior
Scale. Baltimore, MD.: Brookes.
Bailey, D.B. & Wolery, M. (1984). Teaching Infants and Preschoolers with Handicaps. Columbus,
Bates, E., Benigni, L., Bretherton, L., Camioni. L. & Volterra, V. (1979). The Emergence
of Symbols: Cognition and Communication in Infancy. New York: Academic.
Bayley, N. (1969). Bayley Scales of Infant Development. New York: The Psychological Corporation.
Bowlby, J. (1969). Attachment and Loss. New York: Basic Books.
Bruner, J.S. (1975). From communication to language: A psychological perspective. Cognition,
Bruner, J. (1983). Child Talk. New York: W.W. Norton.
Bzoch, K. & League, R. (1970). The Bzoch-League
Receptive-Expressive Emergent Language Scale for the Measurement of
Language Skills in Infancy.
Capone, G.T. (2005). Down syndrome and comorbid autism-spectrum disorder: Characterization using
the aberrant behavior checklist. American Journal Of Medical Genetics Part A, 134(4),
Carter, A. & Briggs-Gowan, M. (2000). The Infant Toddler Social Emotional Assessment Manual.
The Connecticut Early Development Project, Department of Psychology, Yale University, New Haven,
Coe, D.A., Matson, J.L., Russell, D.W. et al. (1999). Behavior problems of children with Down
syndrome and life events. Journal of Autism and Developmental Disorders, 29(2), 149-156.
Cuskelly, M. & Dadds, M. (1992). Behavioral problems in children with Downs syndrome and their
siblings. Journal of Child Psychology and Psychiatry and Allied Disciplines, 33(4), 749-761.
Elardo, R., Bradley, R. & Caldwell, B.M. (1975). The relation of infants' home environments
to mental test performances from six to thirty six months: A longitudinal analysis. Child
Development, 46, 71-76.
Gath, A., (1986). Behaviour problems in retarded children with special reference to Down's syndrome.
British Journal of Psychiatry, 156-161.
Goleman, D. (1995). Emotional Intelligence. New York, NY: Bantam.
Guralnick, M.J. (Ed.). (1997). The Effectiveness of Early Intervention (pp. 549-576).
Baltimore, MD.: Paul Brookes.
Howlin, P., (1995). The recognition of autism in children with Down syndrome - implications
for intervention and some speculations about pathology. Developmental Medicine and Child
Neurology, 37(6), 398-414.
Kent, L., (1999). Comorbidity of autistic spectrum disorders in children with Down syndrome.
Developmental Medicine and Child Neurology, 41(3), 153-158.
Koegel, R.L., Koegel, L.K. & Carter, C.M. (1999). Pivotal teaching interactions for children
with autism. School Psychology Review, 28(4), 576-594. Baltimore, MD.: Paul Brookes.
Lewis, M. & Goldberg, S. (1969). Perceptual-cognitive development in infancy: A generalized
expectancy model as a function of mother-infant interaction. Merrill Palmer Quarterly,
Linder, T.W. (1993). Transdisciplinary Play-based Assessment: A functional approach to working
with young children (rev. ed.). Baltimore: Paul H. Brookes Publishing Co.
Lynch, E.C. & Beare, P.L. (1990). The quality of IEP objectives and their relevance to instruction
for students with mental retardation and behavioral disorders. Remedial and Special Education,
Mahoney, G.J. (1988a). Maternal communication style with mentally retarded children. American
Journal of Mental Retardation, 93, 352-359.
Mahoney, G.J. (1988b). Communication patterns between mothers and developmentally delayed infants.
First Language, 8, 157-172.
Mahoney, G. (1999). The Maternal Behavior Rating Scale-Revised. Available from the author,
Mandel School of Applied Social Sciences, 11235 Bellflower Rd., Cleveland, OH 44106-7164.
Mahoney, G.J., Kim, J.M. & Lin, C.S. (in press). Parental responsiveness and children's pivotal
behaviour: The keys to intervention effectiveness. Infants and Young Children.
Mahoney, G.J., Finger, I. & Powell, A. (1985). The relationship between maternal behavioral
style to the developmental status of mentally retarded infants. American Journal of Mental
Deficiency, 90, 296-302.
Mahoney, G. & MacDonald, J. (2007) Autism and Developmental Delays in Young Children: The
Responsive Teaching Curriculum for Parents and Professionals. Austin, TX: PRO-ED.
Mahoney, G. & Perales, F. (2005). A comparison of the impact of relationship-focused intervention
on young children with Pervasive Developmental Disorders and other disabilities. Journal
of Developmental and Behavioral Pediatrics, 26(2), 77-85.
Mahoney, G., Powell, A. & Finger, I. (1986). The maternal behavior rating scale. Topics in
Early Childhood Special Education, 6, 44-56.
Mahoney, G. & Wheeden, C. (1998). Effects of teacher style on the engagement of preschool aged
children with special learning needs. Journal of Developmental and Learning Disorders,
Piaget, J. (1963). The Psychology of Intelligence. Totowa, New Jersey: Littlefield, Adams
Pretti-Frontczak, K. & Bricker, D. (2000). Enhancing the quality of Individualized Educational
Plan (IEP) goals and objectives. Journal of Early Intervention, 23(2), 92-105.
Shadish, W.R., Cook, T.D. & Campbell, D.T. (2002). Experimental and Quasi-experimental Designs
for Generalized Causal Influence. New York: Houghton Mifflin.
Sparrow, S. S., Calla, D. A. & Cicchetti, D.V. (1984). Vineland Adaptive Behavior Scales.
Minnesota: American guidance services.
Stern, G.G., Caldwell, B.M., Hersher, T., Lipton, E.L. & Richmond, J.B. (1969). A factor analytic
study of the mother-infant dyad. Child Development, 40, 163-182.
Vygotsky, L. (1978). Mind in Society. Cambridge, MA: Harvard University Press.
Weisenfeld, R.B. (1986). The IEPs of Down syndrome children. Education and Training in Mental
Retardation and Developmental Disabilities, 21(3), 211-219.