How relationship focused intervention promotes developmental learning
Gerald Mahoney and Frida Perales
Relationship focused intervention (RFI) is an early intervention model that encourages parents to engage in highly responsive interactions with their children. The purpose of this paper is to address the conceptual underpinnings for RFI. We discuss the process of developmental learning based upon brief observations of three children with Down syndrome playing by themselves. We observe that the most salient characteristic of children’s play is the extent to which they practise or repeat the developmental behaviours that characterise their current developmental functioning. Although children’s developmental functioning is assessed by their new and emerging developmental skills, consistent with Piaget’s concept of assimilation, children’s developmental learning appears to be highly dependent upon massive amounts of spontaneous practice of their existing developmental behaviours. In addition we review data from descriptive and intervention studies that we recently published which indicate that parental responsive interaction enhances children’s spontaneous activity, and that children’s spontaneous activity is correlated with their rate of development. We conclude that RFI enhances children’s development less by teaching the skills and behaviours that characterise higher levels of developmental functioning and more by encouraging children’s assimilative learning which results from their practising and repeating the developmental behaviours they have already learned.
How relationship focused intervention promotes developmental learning
Relationship focused intervention (RFI) is an approach to promoting the developmental
and social emotional functioning of young children with developmental delays by
encouraging parents to engage in highly responsive interactions with them. RFI was
derived from two basic concepts supported by child development theory and research:
(1) parents are likely to have a greater impact on their children's development
than professionals or other adults because of the substantially greater number of
opportunities they have to provide developmental stimulation and support to their
children; and (2) parents promote their children's development by engaging in highly
responsive interactions with them.
There is increasing evidence that relationship focused intervention can be effective
at accelerating the development of young children with developmental delays and
disabilities including children with Down syndrome. More then 20 RFI studies have
been published which indicate that this intervention is effective at promoting the
development of children with wide range of developmental risks and disabilities[1,2]. Most notable of these is a large randomised
control study reported by Landry and her colleagues which indicated that pre-term
children made significant developmental improvements after receiving 6 months of
RFI[3,4]. Quasi-experimental RFI studies that
included children with Down syndrome have also reported significant improvements
in children's development which were associated with increases in maternal responsiveness[5,6,7]. Furthermore, research reported by Mahoney
and Perales indicated that RFI resulted in a 50% improvement in children's rate
of cognitive development and 150% improvement in their rate of communication development,
point to RFI as a promising method for realizing the promise of early intervention.
Yet, despite its increasing empirical support, relationship focused intervention
is viewed as controversial primarily because the procedures of this intervention
are markedly different from those that are most often used in contemporary early
For the past 30 years, early intervention has been dominated by the use of behavioural
instructional techniques to encourage children to learn and use the behaviours and
skills that characterise higher levels of developmental functioning. There is considerable
variability in the way behavioural techniques are implemented, ranging from orthodox
behavioural procedures such as discrete trial training to modified behavioural techniques
in which the incidental teaching paradigm is used to teach targeted behaviours and
skills to children in the context of child initiated activities and routines. However,
regardless of the types of methods used, the underlying assumption of most contemporary
early intervention is that children's development can be enhanced by teaching and
encouraging them to use higher levels behaviours that they would not have learned
on their own.
In contrast to this model, relationship focused intervention deemphasises teaching
higher level developmental behaviours and encourages parents and adults to respond
to and support actions and communications that children are already doing. Despite
the extensive research literature indicating that parental responsiveness is associated
with higher levels of development, many early intervention professionals are concerned
that rather than enhancing children's development, RFI may inhibit or have no impact
on developmental growth because it does not focus on teaching advanced developmental
skills. This concern is partly related to the fact that no credible theoretical
model has yet been advanced to explain how responsive interaction promotes developmental
The purpose of this paper is to address the conceptual underpinnings for RFI. We
will discuss the process of developmental learning as it occurs in infants and toddlers
with Down syndrome. This discussion will be based upon brief observations of three
children with Down syndrome who were 12, 24 and 36 months old when they were observed
playing by themselves. We will argue that insofar as children's play is a critical
element of developmental learning, the most salient characteristic of their play
is the extent to which they practice or repeat the developmental behaviours that
characterise their current stage of developmental functioning. Although children's
level of developmental functioning is assessed by their new and emerging developmental
skills, we will propose that children's developmental learning is highly dependent
upon massive amounts of spontaneous practice of their existing developmental skills
which is the basis for assimilative learning. We present data that indicates that
one of the primary effects of parental responsiveness is that it enhances children's
spontaneous activity. As a result, we propose that RFI enhances children's development
less by teaching the skills and behaviours that characterise higher levels of developmental
functioning and more by encouraging assimilative learning processes of practice
Three children with Down syndrome
The following is a description of the play behaviour of three children with Down
syndrome: Meghan who was 12 months old; William who was 24 months; and Natalie who
was 36 months. Each of these children was videotaped while playing alone with a
set of toys that were matched to their developmental level. Within a week of these
observations, these children's developmental functioning was assessed with the Bayley
Scales of Mental Development. Results indicated that Meghan's developmental age
was 6 months; William's was 13 months and Natalie's was 18 months. Thus all three
children had approximately a 50% delay in their rate of development and had developmental
scores that were associated with moderate levels of mental impairment.
Meghan is seated by herself in the floor of her living room. Spread out in front
of her are: a bucket with several toys in it including a soft doll, rattles, a ball,
snap beads and a soft cloth form. There are also a play xylophone which has a pull
string and a mallet, a peg board and hammer, and a book. Our observation of Meghan
lasted 5½ minutes. While mother and the person videotaping were present in the room,
there was no prompting or encouragement for Meghan to perform any specific actions.
Meghan handled all of the objects with the exception of the book and the ball. She
performed a total of 24 separate acts which could be classified into five categories:
mouthing (N=2); shaking/waving (N=9); patting/clapping/banging (N=7); vocal play
(N=2); and throwing/dropping (N=4). In addition, Meghan used her hands for vocal
play (N=3) and clapping (N=2). Meghan distributed these play activities across objects,
seldom engaging in any one activity for more than 10 seconds at a time. During the
periods of time in which we were unable to code Meghan's behaviour, she remained
active either by vocalising or engaging in gross motor activity.
William is seated on the floor of the living room with approximately 20 toys and
pieces scattered about him. The toys he is involved with include a play telephone
with a pull string and an attached receiver, an undressed doll with a bib, a bucket
with plastic blocks or shapes, a shape sorter, a soft-cushion ball, a pull toy that
is shaped like an insect that has wire antennas and wheels, an empty plastic box,
and a plastic cylinder.
William attended to the details of objects by touching them with his finger or manipulating
them (e.g., turning the wheels on the telephone) (N=5); used objects according to
their intended function (e.g., hold the toy telephone to his ear) (N=2); activated
the wire antenna to produce an effect (N=2); used the bib on the doll, and strings
and appendages of objects to lift objects (N=6); engaged in object permanence activities
such as playing peek-a-boo by covering and uncovering the eyes of the doll with
the bib (N=4); and engaged in "in-and-out" activities such as putting
objects in and out of a container or transferring objects from one container to
another (N=6). William was highly attentive and performed a total of 25 acts in
five minutes, distributing these activities across 9 different objects. Throughout
the observation, he vocalised frequently using a combination of consonant-vowel
vocalisations, word-like vocalisations, and three real words. While William was
in a sitting position most of the time, twice he crawled to different locations.
He interrupted his play with objects three times, but for less than 10 seconds each
Natalie was seated in a high chair in her living room. On the tray of the high chair
were two interlocking stacking blocks, a doll, a play bottle, a cup and spoon. Natalie
was observed while seated at her chair for four minutes.
Natalie played without stopping throughout the entire observation. We observed four
categories of play. This included 5 episodes of functional play including putting
the stacking blocks together, drinking from the cup, eating with the spoon, and
feeding the doll with the baby bottle; one episode of "in and out play"
where she put one of the stacking blocks inside the cup; and one episode of simple
pretend play where she drank from one of the staking blocks. During 75% of her play
time she engaged in more elaborate pretend play in which she reenacted her mother
feeding her. In this sequence she pretended to use the spoon to mix food in the
cup, scoop the food from the cup and then feed herself with the spoon. She was animated
and expressive during this sequence, constantly jargoning and occasionally using
vocalisations that sounded like real words (e.g., hot, good) or familiar phrases
(e.g., "Come and get it) that would be appropriate for this sequence.
General observations about the play of children with Down syndrome
- Without prompting, all three children continually interacted with the toys that
were near them. Despite the fact all three children had substantial delays
in their rate of development, they all spontaneously played with the toys provided
- The most dominant feature of children's play was the repetition of the same actions.
Meghan and William repeated the same type of activities with several different toys,
while Natalie reenacted the same eating sequence with the same toys. On several
occasions each of the children paused briefly from playing. However, after little
more than a few seconds they resumed their play without any prompting or encouragement.
- The activities the children did typify the play behaviours that children without
developmental problems commonly do at these children's respective developmental
ages. Meghan who was at the 6 month developmental age level engaged in
banging, waving, throwing/dropping vocal play and occasional mouthing. These are
the kinds of behaviours that typically developing children commonly do in the 4
to 8 month developmental age range. William, whose developmental age was 13 months,
engaged in "in and out" play, used objects to produce an effect, used
levers (e.g., strings, bibs) to obtain objects, and used objects functionally. These
behaviours typify the play of children at the 10 to 14 month developmental age range.
The pretend sequence that Natalie engaged in was typical of the type of pretend
that children engage in from 15 to 18 months developmental age.
- Differences between the levels of play observed in these three children appeared
to reflect their thinking and understanding much more than their skill at using
objects. For example, many of the behaviours Natalie did while playing
did not require a greater amount of skill at using objects than the behaviours that
William did. Yet there were obvious differences between the play of these two children.
The overriding theme of Natalie's play was pretending her mother was feeding her.
The theme of William's play was exploring the functional, spatial and relational
features of the objects that were near him. Differences between these children appeared
to result from their having different cognitions, or knowledge and understanding,
about what objects could be used for.
The role of repetitive experience in children's developmental learning
Adolph and her colleagues from New York University have been investigating how children's
motor experience contributes to the development of their gross motor competencies.
In one study, they examined how children's neurological maturation (e.g., chronological
age), body dimensions and motor experience contributed to the quality of their crawling
from their first attempts at crawling until they began walking.
Results indicated that children's age and body dimensions alone could not account
for the speed and efficiency of later forms of crawling. However, the amount of
children's experience with early crawling patterns (e.g., belly crawling) was the
best predictor of the speed and efficiency that they attained the more advanced
form of crawling using their hands and knees.
In another study, Adolph et al. attempted to both identify the changes that occur
as toddlers become more proficient walkers, and the factors that contributed to
these changes. As children became bigger,
older and more experienced their steps became longer, narrower, straighter and more
consistent. They conducted regression analyses to examine how children's body dimension,
neurological maturation and experience predicted their walking skill. Results indicated
that the amount of experience children had walking was the only significant predictor
of the rate they improved their ability to walk.
Results from these studies suggest that children's rate of motor development is
more dependent upon their amount of experience in engaging in gross motor behaviours
than it is on other factors that are often thought to effect motor development,
including children's body shape and neurological maturation. To explain why motor
experience might be such a major influence on children's motor development, Adolph
et al. described their observations of children who were learning to walk. According
to these investigators:
"Infants' everyday experiences with locomotion occur in truly massive doses,
reminiscent of the immense amounts of daily practice that promote expert performance
in world class musicians and athletes. … walking infants practice keeping balance
in upright stance and locomotion for more than six accumulated hours per day. They
average between 500 and 1500 walking steps per hour so that by the end of each day,
they may have taken 9,000 walking steps and traveled the length of 29 football fields".
"infants everyday walking experiences occur in a wide variety of events, places
and surfaces. … the variety of everyday walking experience resembles variable and
random practice schedules …. (that) lead to a process of continually generating
solutions anew". [10: p 494-495]
Based upon these observations, Adolph et al. concluded that the magnitude and diversity
of experience children have in engaging in spontaneous or self initiated movement
lies at the heart of motor learning and developmental change.
An important question to consider is whether the magnitude and diversity of experience
children have in engaging in spontaneous or self initiated play also lies at the
heart of cognitive learning and developmental change. Comparable to Adolph's descriptions
of children's motor activity, the patterns of play we observed in the brief observations
of the three children with Down syndrome are likely repeated throughout their day
whenever similar play opportunities occur. Had we observed Meghan when she was in
her crib, play pen or on the floor with her parents or other children, she would
have likely engaged in the same patterns of "banging, waving throwing and mouthing"
(BWTM) that we had observed, particularly if toys and material were near her that
were similar to the ones we used in our observation. In fact, Meghan was so intensely
involved in the patterns of play that we observed, it seems unlikely that we would
have been able to get her to do anything else with toys and materials other than
Most children engage in massive amounts of repetition of their play behaviours before
transitioning to higher levels of play behaviour. For example, as displayed in Table
1, it is well documented through developmental tests and play profiles that typically
developing children engage in banging, waving throwing and mouthing from approximately
the time they are 4 months until they are 8 months old. Assuming that children play
as much as four hours per day, and that at the "Meghan stage of development"
children engage in at least two BWTM episodes per minute, in the course of one day
children engage in approximately 500 repetitions of this type of play behaviour.
If they sustain this rate of play each day of the month over a four month period
of time, a typically developing child would engage in approximately 60,000 repetitions
of BWTM before transitioning to the next level of developmental play.
Typically developing child
Developmental quotient (DQ) (% delay)
Chronological age range to transition from Banging, Waving,
Developmental age range of Banging, Waving, Throwing,
Months to transition from Banging, Waving, Throwing,
Banging, Waving, Throwing, Mouthing acts per month
Total Banging, Waving, Throwing, Mouthing acts to transition
Table 1 | Learning efficiency model*.
Repetitions needed to transition through Banging, Waving, Throwing
and Mouthing. *Assumes no pivotal behaviour deficits
Piaget described two processes that contribute to children's cognitive development:
assimilation and accommodation. Assimilation
is the process in which children incorporate the world into their existing modes
of perceiving, thinking and acting. Accommodation is the process in which children
modify their ways of perceiving, thinking, and acting to better fit the structure
and demands of their world. During assimilation children become increasingly proficient
with their current modes of thinking, perceiving, and acting. They also learn how
their behaviours can be used across a wide range of toys and materials in a variety
of contexts. As this occurs, they are learning about the uses of recently acquired
perceptions, cognitions and behaviours as well as the limitation of these behaviours.
Accommodation which is manifested by children developing new ways of thinking and
acting is likely motivated both by children's dissatisfaction with the adequacy
of current forms of thinking, perceiving and acting as well as by their discovering
different ways of thinking, perceiving and acting. As a result, accommodation, or
learning new skills, may be as dependent on children's willingness to give up current
ways of perceiving, thinking and acting as it is on their discovering and learning
new ways of perceiving, thinking and doing.
The 60,000 repetitions of banging, waving throwing and mouthing may be critical
to developmental learning because this is the amount of experience typically developing
children need to: (1) learn the uses of these behaviours; (2) learn the limitations
of these behaviours and (3) discover new ways of perceiving, thinking and acting.
These are the assimilation processes that appear to be prerequisite to children
making the accommodative modifications in which they learn to use the next higher
levels of perceiving, thinking and acting. Since the overwhelming focus of children's
play is on practising or repeating their current developmental behaviours, it is
possible that developmental learning may be much more dependent on assimilative
learning than it is on accommodation, or learning new skills, behaviours and ways
Developmental learning and Down syndrome
Early developmental learning generally proceeds through the same sequence for children
with Down syndrome as it does for typically developing children. As depicted on
Table 1, Meghan, like typically developing children, will
engage in banging, waving throwing and mouthing when she is at the developmental
age range of 4 to 8 months. However, because Meghan has a 50% delay in her rate
of development, she will be functioning at the 4 to 8 month developmental age range
when her chronological age is between 8 to 16 months.
Developmental quotient (DQ)
Chronological age range to transition from Banging, Waving, Throwing, Mouthing
Developmental age range of Banging, Waving, Throwing, Mouthing activities
Months to transition from Banging, Waving, Throwing, Mouthing
Banging, Waving, Throwing, Mouthing acts per month
Total Banging, Waving, Throwing, Mouthing acts to transition
Table 2 | Pivotal behaviour deficit model1.
Repetitions needed to transition through Banging, Waving, Throwing and Mouthing.
1.Assumes no learning inefficiencies
There are at least two possible reasons why children with Down syndrome experience
delays in their rate of development. First, the compromised neurological processes
that are associated with Down syndrome are thought to result in less efficient learning[12,13]. Consequently, children with Down syndrome
must experience substantially more repetitions to learn the same amount of information
as children whose neurological processes are not compromised. As illustrated on
if Meghan engages in the same amount of banging, waving throwing and mouthing
each day as do typically developing children, she would experience twice as many,
or 120,000, repetitions of these behaviours before she transitions to the next higher
level of development. Perhaps because of her learning inefficiencies, it takes eight
months for Meghan to obtain the amount of repetitive play experience she needs to
transition to the next phase of development. The 120,000 repetitions represent the
amount of experience that Meghan must "bang, wave, mouth and throw" to
effectively progress through the assimilation processes of (1) learning the uses
of these behaviours, (2) learning the limitations of these behaviours, and (3) discovering
alternative ways of thinking and acting.
Second, children with Down syndrome have also been reported to have "pivotal
behaviour deficits" that limit the degree to which they engage in the repetitive
play and social activities that are the foundations for developmental learning (e.g.,
In other words, as illustrated on
while a typically developing child might engage in 500 repetitions
of banging, waving throwing and mouthing per day, children with Down syndrome who
are at the same developmental age level may have pivotal behaviour deficits, such
as limited persistence, that result in their engaging in only one
half as many repetitions each day. Assuming that Meghan who has a 50% delay in development
has a pivotal behaviour deficit which results in her engaging in one half as many
repetitive acts as a typically developing child, even if she had no learning inefficiencies,
she would need twice as much time as a typically developing child (e.g., 8 months)
to obtain the 60,000 repetitions that are needed to transition to the next phase
How relationship focused intervention promotes children's development
Figure 1 | The relationship between mothers' level of
responsiveness and children's level of pivotal behaviour use (N = 45)
In RFI parents are taught to use Responsive Interaction (RI) strategies to interact
more responsively with their children. RI strategies such as "imitate your
child" or "follow your child's lead" encourage parents to become
highly supportive of their children's previous behaviours; strategies such as "take
one turn and wait" promote high levels of parent child-reciprocity; while strategies
such as "do what my child can do" help parents match their children's
current level of developmental functioning.
Clearly, the effects of RFI do not result from parents teaching developmental skills
to their children. While responsive interaction strategies were derived from the
child development literature describing what parents appear to do to promote their
children's development, they are not well suited to encouraging children to say
or do advanced developmental behaviours that they are currently unable to do. The question is what child behaviours do
these strategies encourage that could account for the apparent impact they have
on children's development?
Figure 2 | The relationship between children's level of
pivotal behaviours and their developmental age as assessed by the Vineland Adaptive
Behaviour Scale and play based assessment (N = 45) 
In our research we have found that rather than teaching the skills and behaviours
that characterise higher levels of developmental functioning, responsive interaction
strategies primarily impact children's participation and engagement in interactions.
As displayed in
Figure 1 when parents engage in high levels
of responsive interaction, children display high levels of behaviours such as attention,
persistence, interest, initiation, cooperation, joint attention and affect. We refer
to these as "pivotal developmental behaviours" both because these are
the child behaviours or processes that are described as the foundations for developmental
learning and because, as displayed in
Figure 2, we have found
that the degree to which children use these behaviours are highly correlated to
their level of developmental functioning.
We maintain that when parents use responsive interaction strategies they encourage
their children to develop the habit of using pivotal behaviours. The more children
habitually use pivotal behaviours either while playing alone or communicating and
socialising with their parents and others, the more children practise and repeat
their current behaviours. By using responsive interaction strategies that increase
their responsiveness with their children, in addition to providing their children
information about their immediate activities and interests, parents appear to be
encouraging their children to develop the habit of engaging in the repetitive, assimilative
leaning processes that are prerequisites for acquiring advanced developmental skills
Figure 3 | The impact of RFI changes in mothers' responsiveness
to changes in children's pivotal behaviour (N=50) 
To illustrate this phenomenon, in a recent evaluation of an RFI called Responsive
Teaching, we found that the degree to which responsive interaction strategies successfully
encouraged parents to increase their responsiveness with their children was directly
related to increases in their children's use of pivotal behaviours during intervention (See
Figure 3). Children
of parents who made substantial increases (e.g., 51%) in their responsiveness made
a 46% improvement in their use of pivotal behaviours; children whose parents made
moderate increases (17%) in their responsiveness showed a 24% increase in their
use of pivotal behaviour; while children of parents who did not increase their level
of responsiveness during intervention made only a 4% improvement in their pivotal
behaviours. Furthermore, children's increased use of pivotal behaviours was significantly
related to the impact that intervention had on their rate of cognitive and communication
development. Compared to children who did not improve their use of pivotal behaviours
during intervention, on average children who made large pivotal behaviour increases
attained 22% higher cognitive development ages and a 45% higher communication development
Summary: Putting RFI into a conceptual framework
In this paper we have used Piaget's concepts of assimilation and accommodation to
refer to two different types of learning that appear to be involved in child development.
Assimilation is related to the spontaneous practice and repetition of children's
current thinking, perceiving, and acting; accommodation refers to the acquisition
of new perceptions, concepts, and behaviours. We used observations of the play behaviour
of children with Down syndrome who were at three different levels of development
to illustrate how the majority of the play activities children engage in, at least
during the early stages of child development, constitute massive amounts of assimilative
learning. We conjectured that the amount of time it takes children to transition
from one level of play behaviour to the next is related to the number of repetitions,
or assimilative learning experiences, children need before they are ready to acquire
the next higher level of perceptions, behaviours, or concepts.
Figure 4 | RFI conceptual model
As indicated on Figure 4
the notion that assimilative learning
is a major component of child development may help to explain how RFI increases
children's rate of developmental functioning. As parents use RI strategies to become
more responsive, they focus more on supporting and encouraging the behaviours or
activities their children are already capable of doing as opposed to prodding their
children to perform higher level behaviours or communications. This is reflected
in children's increased use of behaviours that we have called pivotal behaviours,
such as attention, initiation, and interest. While these parents continue to model
or demonstrate behaviours and communications that reflect higher levels of development,
the focus of their interactions is on supporting their children's spontaneous, self
initiated behaviours rather than coaxing their children to perform higher level
behaviours. Thus by increasing their level of responsiveness, these parents are
encouraging their children to engage in higher frequencies of assimilative learning.
Insofar as children's development is dependent on the number of assimilative activities
they experience, this would shorten the time children need to obtain the repetitive
experiences they need to give up their old skills and begin to use higher levels
of behaviour, and thereby increase children's rate of development
RFI versus traditional early intervention practices
In the prevailing early intervention model the three children with Down syndrome
described in this paper would likely be viewed as lacking the advanced developmental
skills exhibited by the children at the next higher chronological age level. As
a result, for Meghan early intervention would likely focus on teaching her through
some form of direct instruction the types of developmental skills that William exhibited.
For William, early intervention would likely focus on teaching him the developmental
behaviours that Natalie exhibited. For both children, the prevailing early intervention
model would focus almost exclusively on promoting their accommodative learning by
teaching them advanced developmental behaviours that are more in line with their
current chronological age.
Based upon previous research regarding the traditional early intervention model
as well as our own clinical experience, we could reasonable anticipate that after
a few months of this type of instruction both children would successfully learn
the advanced developmental behaviours that are being targeted as their intervention
objectives. This would be indicated by their ability to perform these behaviours
when prompted. Yet it is unlikely that these new developmental skills would transfer
to children's unprompted, spontaneous play behaviour much before they attain the
developmental age at which typically developing children normally produce these
behaviours. This might not occur until several months after these children learned
these behaviours in early intervention. Rather, when playing by themselves, these
children would likely continue to use the types of play behaviours that are reflective
of their current developmental age even though they "know" advanced developmental
Is the delay with which children transfer behaviours they learn through early intervention
instruction to their spontaneous behaviour simply attributable to a failure of generalisation
as often described, or is it attributable to the failure of early intervention to
encourage children's assimilative learning? Might it be that children fail to use
these newly learned behaviours because they have not yet had sufficient assimilative
learning experiences, especially related to discovering the limitations of their
existing behaviours and recognising how other behaviours might help them to function
more efficiently, to motivate them to give up their current behaviours and begin
to use advanced developmental behaviours?
If developmental learning is the result of massive quantities of repetitive experience
as suggested both by our discussions of children's play behaviour and from the results
of the motor learning research reported by Adolph and her colleagues, it would appear
that both the effects maternal responsiveness has on children's development and
the effectiveness of RFI at accelerating children's development result from the
impact that RI has on children's assimilative learning. Furthermore, the fact that
these developmental effects have been reported with children with Down syndrome
suggests that whether children's developmental delays are related to learning inefficiencies
or to pivotal behaviour deficits, by engaging in highly responsive interactions,
adults can promote children's assimilative learning which can lead to significant
improvements in their developmental functioning.
Research questions/future directions
- Is the commonly observed failure of children with Down syndrome to transfer behaviours
that are learned through didactic instructional methods to their spontaneous, self-initiated
activity due to a failure of generalisation or to a failure to emphasise assimilative
- How does children's rate of self-initiated practice or repetition of current
behaviours (e.g. assimilative learning) contribute to their developmental learning
- Might language delays of children with Down syndrome be related to deficits in
pivotal behaviours such as social initiation, joint activity or joint attention
as well as to learning inefficiencies?
- Are the effects of traditional early intervention methods dependent upon children's
level of initiation or their abilities to use other pivotal behaviours?
- McCollum JA, Hemmeter ML. Parent-child interaction intervention
when children have disabilities. In: Guralnick MJ, editor, The effectiveness of
early intervention. Baltimore: Brookes; 1997: p.549-576.
- Trivette CM. Influence of caregiver responsiveness on
the development of young children with or at risk for developmental disabilities.
- Landry SH, Smith KE, Swank PR. The importance of parenting
during early childhood for school-age development. Developmental Neuropsychology.
- Landry SH, Smith KE, Swank PR. Responsive parenting: Establishing
early foundations for social, communication, and independent problem-solving skills.
Developmental Psychology. 2006;42(4):627-642.
- Seifer R, Clark GN, Sameroff AJ. Positive effects of interaction
coaching and infants with developmental disabilities and their mothers. American
Journal on Mental Retardation. 1991;96:1-11.
- Mahoney G, Powell A. Modifying parent-child interaction:
Enhancing the development of handicapped children. Journal of Special Education.
- Mahoney G, Perales F. 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. 2005;26(2):77-85.
- Warren SF, Yoder PJ. Communication and language intervention:
Why a constructivist approach is insufficient. Journal of Special Education.
- Adolph KE, Vereijken B, Denny MA. Learning to crawl.
Child Development. 1998;69(5):1299-1312.
- Adolph KE, Vereijken B, Shrout PE. What changes in infant
walking and why? Child Development. 2003;74(2):475-497.
- Piaget J. The psychology of intelligence. Totowa,
New Jersey: Littlefield, Adams & Co; 1963.
- Jernigan TL, Bellugi U, Sowell E, Doherty S, Hesselink
R. Cerebral morphologic distinctions between WS and DS. Archives of Neurology.
- Pennington BF, Moon J, Edgin J, Stedron J, Nadel L.
The neuropsychology of Down syndrome: Evidence for hippocampal dysfunction. Child
- Fidler DJ. The emerging Down syndrome behavioral phenotype
in early childhood - Implications for practice. Infants and Young Children.
- Wishart J. Cognitive abilities in children with Down syndrome:
Developmental instability and motivational deficits. In: Epstein C, Hassold T, Lott
I, Nadel L, Patterson D, editors. Etiology and Pathogenesis of Down syndrome.
New York: Wiley Liss; 1995.
- Mahoney G, MacDonald J. Autism and developmental delays
in young children: The Responsive Teaching curriculum for parents and professionals.
Austin, TX: PRO-ED; 2007.
- Mahoney GJ. Kim JM, Lin CS. The Pivotal Behavior Model
of Developmental Learning. Infants and Young Children. 2007;20(4):311-325.
Correspondence to Gerald Mahoney • e-mail:
Paper prepared from presentations and discussions at the Down
Syndrome Research Directions Symposium 2007, Portsmouth, UK. The
symposium was hosted by Down Syndrome Education International in
association with the Anna and John J Sie Foundation, Denver. Major
sponsors also included the Down Syndrome Foundation of Orange
County, California and the National Down Syndrome Society of the
USA. Information about the symposium can be found at
Received: 5 November 2007; Accepted: 12 November 2007;
Published online: 2 July 2008
DSE's Reading and Language Intervention for Children with Down Syndrome (RLI) is an evidence-based programme designed to teach reading and language skills to children with Down syndrome.
RLI incorporates best practice in structured activities delivered in fast-paced daily teaching sessions. It was evaluated in a randomised controlled trial and found to improve rates of progress compared to ordinary teaching.
Find out more...