At the crossroads: overcoming concerns to envision possibilities for toddlers in inclusive child care.

Lee, Yoon-Joo

Abstract. This paper describes the experiences of three toddlers with developmental delays and their caregivers in an inclusive child care center. Case study methodology was used to synthesize data representing initial issues presented by parents, caregivers' reflections on their relationships with the toddlers, and interactions between toddlers with special needs, their caregivers, and their typical peers within the child care setting. Analyses of parent interviews, caregiver journals, and child observations yielded two overarching themes--concern and possibility. Both parents and caregivers expressed specific concerns about children's behavioral differences, and how they create challenges to inclusion, but they also envisioned the possibility of increased social opportunities in inclusive child care for children with disabilities. Caregivers found that working in an inclusive setting created the possibility for early childhood professionals to learn about and better understand developmental differences. Implications for practice and future research are discussed.

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The period from birth to age 3 is viewed across disciplines as a time of rapid development, during which infants and toddlers need individualized attention and families are most apt to benefit from supportive services. As more and more mothers join the workforce, they are relying increasingly on early childhood professionals for the care and education of their infants and toddlers (Brault, 1992). The importance of quality child care, particularly for the youngest children, recently has taken on national significance (NICHD Early Child Care Research Network, 1996). In spite of this increased interest in general child care issues, however, little attention has been focused on the child care needs of children at risk for developmental delays.

High-quality child care has been associated with more positive outcomes for children. Quality child care, which is characterized by more stable and educated teachers, a strong collaboration among teachers as well as between parents and teachers, better teacher-child ratios, more developmentally appropriate practices, and better administrative support, can act as a buffer for children who are at risk biologically and environmentally (Delaney, 2001; McCormick, Noonan, Ogata, & Heck, 2001; Odom, Schwartz, & ECRII Investigators, 2002). More information is needed, however, about the variety of challenges presented by children with special needs before we can find effective strategies for addressing them.

With increasing implementation of legislation that supports integrating infants and toddlers with disabilities into programs designed for their typically developing peers, awareness is growing about the need to provide inclusive child care services to young children with disabilities and their families (Recchia, 1995; Wesley, 1994). Findings from previous studies indicate many advantages to all of the child participants in inclusive early childhood settings (Bruder, Deiner, & Sachs, 1990; Odom, 2000; Odom et al., 2002; Peck, Carlson, & Helmstetter, 1992; Ross, 1992; Walton, 2001). Children developing typically have been observed to be more aware of other children's needs, less uncomfortable with disability, and more accepting of human difference (Peck, Carlson, & Helmstetter, 1992; Walton, 2001). When interacting with children with developmental delays, they seem able to make adjustments in their responses to their companions' different developmental levels (Guralnick, 1999). Mso, children with disabilities have shown developmental gains, particularly in the areas of communication and social skills (Odom & McEvoy, 1990), an added benefit from increased interactions with typically developing children in integrated settings (Buysse, Goldman, & Skinner, 2002). Because very young children are not yet biased toward disability in the ways that older children may be, young children with disabilities in inclusive child care settings may have greater opportunities for full participation in activities and interactions (Ross, 1992).

Researchers have uncovered multiple ways in which the social interactions of children with disabilities are different from those of typically developing children. Preschool children with disabilities have been found to be less successful in their social bids to peers, appear to take the lead in interactions less often, and tend to have more disruptive play when entering the play group (Guralnick, Conner, Hammond, Gottman, & Kinnish, 1996; Kopp, Baker, & Brown, 1992). Children with disabilities tend to spend more time in solitary play and onlooker behavior than their typically developing peers (Hestenes & Carroll, 2000; Kopp et al., 1992). These children are also more likely to remain in teacher-directed activities, and teachers engage in interaction with them more often than do peers (Brown & Bergen, 2002).

Overall, children with disabilities seem challenged by child-child interactions in ways that extend well beyond what would be expected based on their general developmental level. Thus, a teacher's presence and support may play an important role in facilitating interactions between children with developmental delays and their typically developing peers in inclusive classrooms (Hestenes & Carroll, 2000). Teachers' initiatives are often necessary to engage children with developmental delays in social interactions and get them involved in non-solitary play (Harper & McCluskey, 2002). The impact on teachers of supporting children with disabilities within inclusive child care needs further exploration, as more studies have focused on teachers' perceptions of inclusion than on their actual day-to-day experiences of providing care for young children and their families (Recchia, Berr, & Hsiung, 1998).

Although research findings provide preliminary support for the concept of inclusive child care for children, more attention must be focused on meeting the special needs of families and on caregivers' day-today challenges of providing high-quality inclusive care. In the past, few training programs for child care providers or early intervention professionals addressed the issues and skills involved in providing services within an integrated or inclusion setting. This trend is changing as professional preparation programs become increasingly concerned with the issues of inclusion across early childhood settings (Bruder, 1993).

Issues such as the importance of a mutually supportive relationship with parents need to be emphasized, as parents and teachers may disagree about the values, processes, and scope of inclusion (Seery, Davis, & Johnson, 2000). Increased and more authentic communication between parents and caregivers has been shown to have a positive impact on the degree to which children's needs are met (Devore & Hanley-Maxwell, 2000). Parents are more likely to express positive feelings toward inclusive settings when appropriate role models for behavior, speech, and social skills can be provided (Hanson et al., 2001; Odom, 2000; Seery et al., 2000; Walton, 2001). How an individual setting is able to meet a particular child and family's needs over time, however, may depend on a number of complex and intersecting variables. Research designed to help uncover these variables can inform our understanding of this process, leading to improved practice and care.

The purpose of this study was to explore the child care experiences of three toddlers with special needs in an inclusive infant-toddler child care center, with particular attention on parents' initial concerns, caregivers' perceptions of their growing relationships with the toddlers (see Recchia & Sekino, 1998), and the children's experiences with peers. Findings from cross-case analyses of the toddlers were synthesized to provide a closer look at specific caregiving needs and challenges for families and caregivers, and at the nature of the interactions between these children, their teachers, and their typical peers within the child care setting.

The following research questions were explored in the study:

* What thoughts and feelings do these parents express regarding their children's entrance into inclusive child care?

* How do the caregivers describe their developing relationships with these toddlers with special needs?

* How are the issues raised by parents and caregivers reflected in children's social experiences in the classroom?

Methods Setting

This study was part of a larger study focused on caregiver-child relationships (Recchia, Sekino, Bautista, & Lee, 1998) conducted at a university-based infant and toddler child care program that served as a training site for graduate students studying infant and toddler development and practice. The program provided relationship-based care within the context of an early education setting. Caregivers learn to observe and interpret children's cues, and respond contingently to their needs and requests on an individualized basis, while supporting their integration into the infant-toddler classroom. Care was provided within an inter-age group for up to 10 children, ages six weeks to 36 months, with a consistent adult-child ratio of at least one adult to three children. The mixed age group provided a natural context for daily adaptations to the curriculum.

As an integral part of the center program, ongoing communication between parents and caregivers took place in many ways. Written daily communication forms, informal conversations at drop-off and pick-up, and regularly scheduled conferences helped facilitate building relationships with families, a critical component of family-centered practices (Axtmann & Dettwiler, 2003).

Participants

Three toddler boys with special needs, their mothers and fathers, and their "key caregivers" were selected for the case portraits. These three boys were chosen based on their availability; at the time of the study, they constituted the center's total population of children with diagnosed disabilities. All children were enrolled in the university-based infant/toddler child care center for a minimum of 12 hours per week. Child characteristics are described in Table 1.

Mothers and fathers of each of the toddler boys participated in the Developmental Visit (see Procedures section). All of the families were affiliated with the university in some capacity. Child A and Child C were both cared for at home, primarily by their fathers, before being enrolled at the center, while Child B was cared for at home by a nanny.

The key caregivers for these children were graduate students in early childhood special education, enrolled in a practicum course at the college that is based at the center. The caregivers ranged in age from 23 to 35 years, and had little (< 1 year) to no previous experience working with this age group or in inclusive child care. Caregivers were at different stages in their graduate training. Each caregiver was at the center for a minimum of eight hours of caregiving per week.

Each student caregiver was assigned a study infant or toddler as his or her "key child." As the "key caregivers" for these children, the students were expected to pay extra attention to them and to focus on them for their child observation assignments. However, the students were jointly responsible for all of the children at the center, and were not expected to have an exclusive one-to-one relationship with their key children.

As a research and training site that is integrated with the university's early childhood master's and doctoral programs, the center provides opportunities for ongoing study of teacher preparation and teacher development. Thus, students, as opposed to lead teachers, were selected as participants for this study.

Procedures

All data were recorded over the one-semester period during which the student caregivers were beginning their work in the infant room. Parent data were recorded shortly before their children began at the center. Caregiver data were recorded weekly throughout the semester, and child data were recorded at three intervals during the semester.

Parent Data. At program entry, families participated in the Developmental Visit (Axtmann & Dettwiler, 2003), a videotaped intake procedure that focused on child and family needs. Parents and their child met for about one hour with the center director, an infant room teacher, and the child's key student caregiver. The parent interview, an integral part of the Visit, provided an opportunity for parents to share their perspectives on their children. Parents were asked to describe their children's special caregiving needs, and to begin making a plan with the caregivers to help them care appropriately for their children.

Caregiver Data. Student caregivers responded to a series of brief questionnaires, one each week, as a part of their practicum assignments throughout the first 15 weeks of their caregiving at the center. They described: 1) how they were feeling more comfortable as caregivers, and 2) any changes in their relationships with the children. Responses were recorded in student notebooks and students received regular feedback from the course instructor.

Child Data. Children were videotaped in play interactions with their peers and key caregivers for 15-minute intervals in the center's activity room at three intervals during the semester. Videotapes were later reviewed and coded for observed social behaviors, in line with previous studies on adult-child and peer interactions (Eckerman, Davis, & Didow, 1989; Holemberg, 1980; Howes, 1988). These observation data were also examined in another study that compared the social experiences of these three children to the experiences of their typically developing peers (Lee, 1999).

Coding Process

Parent Data. Developmental visit videotapes and reflective notes were reviewed for each of the three study families. Particular attention was focused on responses to the question, "Does your baby have any special caregiving needs?" Parent anecdotes that described aspects of children's strengths and needs, as well as any expressed concerns regarding inclusion, were recorded for further review. Once all parent data were collected, anecdotes were examined across all three cases for emergent themes, as well as for areas of similarity and difference.

Caregiver Data. Caregiver notebooks were reviewed for specific responses relevant to caring for key children with special needs. These relevant anecdotes were recorded for further review. After all the caregiver data were collected, anecdotes were reviewed across cases to look for emergent themes.

Child Data. Each video segment was divided into coding intervals, based on meaningful units of activity and child transition, and each interval was coded separately. The coding system took three perspectives into account: that of the target child, the key caregiver, and peers. Rather than tracking the quantity of initiations and responses, the researchers chose to record whether or not these behaviors occurred during a given interval. Interactive play videos were coded for instances of initiation, responsiveness, and social exchange. These variables have been repeatedly identified in the literature as essential components of social skills (Eckerman et al., 1989; Holemberg, 1980; Howes, 1988).

First, each target child's initiations and responses were coded, indicating whether the target child was engaging a key caregiver or peer (coding A for adult and P for peers), in order to clarify these differences in children's interactions with others. Second, peers' social behaviors (initiation/ responsiveness) toward the target child were coded. Whenever a social interaction occurred between the target child and any peer, the level of social exchange--coordinated, interfering, tangential, or unrelated--was coded (see Lee, 1999, for a full description of the coding).

Finally, key caregivers' responses to their key children (target children) and peers were coded for all specific behaviors observed during the coding interval. Key caregiver response categories were taken from the coding system used by Recchia (1997). When the coding was completed, each 15-minute segment was summarized to present an overview of the key child's behavior. Anecdotal descriptions of specific social interactions were recorded to provide a clearer picture of how the key child interacted with the key caregiver and other children. These anecdotal descriptions were used as the basis for this study.

Reliability

To establish inter-rater reliability, the two researchers met several times to review the videotaped observations together, coding the same data. This served as an important initial step in clarifying different definitions and terms in the coding system and becoming adept in using the coding procedure. Following this collaborative review of the videotapes, both researchers reviewed the same three full segments (33 percent) separately, then came together to compare their coded variables. Reliability was computed using the formula agreements/agreements + disagreements. After reaching an 87 percent reliability rating on these jointly coded tapes, the remaining observations were coded by just one researcher.

Results and Discussion

After all phases of coding were completed, findings were synthesized for each case, and cases were examined alongside each other for overarching themes. Cross-case analyses revealed two overarching themes in the data: concern and possibility. These themes were heard in both parents' and caregivers' voices and related to the challenges and strengths of individual children, demonstrated in their interactions with peers and teachers.

Theme of Concern and Challenges for Toddlers With Disabilities

Parents. Each of the parents expressed concern about their children being different from others, and about the ways in which their children's differences might create challenges within the inclusive setting. They shared concerns related to their children's diagnoses, and expressed their sometimes ambivalent feelings about whether their children's unique needs would be met in the child care setting. Parents also provided information that would help the caregivers understand their children better.

Child A's parents seemed to be most concerned with physical and language development. His mother provided very factual information regarding A's delays: "Since he has low muscle tone, when he goes up the slide he doesn't realize if he is in danger.... Because of his verbal delays, we're starting to use some sign language because he can't say any words." Child C's mother not only expressed her concerns about his development, but also provided additional information to address the ways that she saw her child compared to others his age. "He's a little bit delayed in language," she said. "He is not doing many things that other kids his age are doing, so I would like someone that is with him to help him with that, to stimulate him." Two comments made by Child B's parents focused on his social skills, and relating to other children. They were concerned that Child B would be unnoticed since he was very shy and spent too much time by himself.

Father: He is very shy. He's not very aggressive. I worry about him. I want him to be in a situation where he's with other children and he's socializing, but I worry that he won't let his needs be known. I have fears that he will be ignored because either the other children are louder or making more noise.... He can sit by himself for a really long period of time, so he did things on his own. The [previous] nanny did not talk to him or cuddle him or interact with him.

Mother: It's tough for a child like him.... It's a delicate balance because on the one hand we want him to be stimulated as a child but on the other hand we don't want him to be overwhelmed or taken over.

Caregivers. Parents' concerns seemed to be reflected in the caregivers' approaches to working with the children. In their weekly journals, the caregivers shared the ways in which they related differently to the children with special needs. All three student caregivers expressed the importance of building relationships with parents as a means of getting to know their key children better. Each mentioned significant instances of communication with parents in their notebooks. They seemed to look to the parents to provide information about their key children, which would help them to better understand the children's special needs. All of the caregivers felt excited and satisfied when parents shared information with them. Following are some excerpts from their journals, used here to illustrate these points.

(Child A's caregiver): Sensory diet: Both parents on different occasions explained the how's and why's to me. Mom brought me a pamphlet to read that went more into depth about it. It made me feel good that they trusted me with this because he is my key child and didn't just go to other caregivers who have known A longer.

(Child B's caregiver): I got to meet with B's parents again and talk to his PT.... Meeting with B's parents helped. Several ideas were shared about how to make B more comfortable in both separating and supporting his physical development.

(Child C's caregiver): I feel very comfortable with C's family. I guess it's because we've known each other from the start.... I am interested to know what C's occupational therapy, physical therapy, and speech therapy programs are and to see how to complement them with C's activities in the center.

From the caregivers' points of view, communication with parents was an important component of building a trusting relationship. Information from parents also helped them to better understand the challenges they met as they worked to support children's interactions with peers. Caregivers' weekly reflections on their experiences in the classroom demonstrated a growing awareness of their concern for the children. Child C's caregiver, who seemed to be a very good observer of her own behaviors and interactions with her key child and other children, had this to say:

 I realize that although I am consciously
 trying to interact with C,
 when I'm with other kids it's so easy
 for me to ignore him or not to hear
 what he is saying, despite his very
 clear message.... How difficult it
 must be for children like C who are
 not heard as much as other children
 who make lots of noise.

She also worked indirectly through peers to involve Child C in play with them, incorporating higher levels of facilitation and explanation. However, even though C responded positively to her interventions, he needed consistent cues to maintain interactions with peers. Although Child B's caregiver occasionally attempted to facilitate interactions with peers, the child expressed limited interest.

Children. Observations of the children at play provided evidence that validated parent and caregiver concerns. For example, most of the time, Child A and Child B remained passive, showing low levels of responses toward peers. These two children had very subtle ways of expressing their emotions and communicating to others. Because it was hard to understand their social intentions in some cases, it was less likely that their social interactions with other children could be easily extended. The following anecdotes provide examples of the children's classroom interactions.

 Even when Child A gestures and vocalizes
 to another child "come, come,"
 his peer does not respond to Child A's
 initiation. Only the key caregiver understands
 Child A's gesture and asks
 him, "Are you telling him to come?"

 The key caregiver and Child B are
 playing with puzzles at the table.
 Child B attempts to give a puzzle piece
 to another boy. The boy just looks away
 from Child B and turns his body away.

Child A often "tuned out" others' behaviors. He appeared to become immersed in his own activities and enjoyed playing alone. Child B, on the other hand, generally stayed close to the caregiver and directed his initiations and responses to her rather than to peers. He initiated through vocalizing, gesturing, locomotion, and physical contact. Usually, his interactions with peers consisted of looks and occasional gestures. Sometimes he just sat near the caregiver and watched other children playing. Following are some examples of the children's behavior.

 Child A is playing with two cars. The
 caregiver asks, "Where are those two
 cars going?" He vocalizes without looking
 at the caregiver.

 The caregiver and Child B are sitting
 on the floor. Another child is holding
 a big yellow ball. The caregiver asks
 the other child, "Do you want to roll
 the ball to Child B?" The other child
 says "no" and walks away. When Child
 B looks at the other child and points
 to the ball, the caregiver says, "Go get
 it. Go get it. There is the ball." Child
 B looks briefly at the other child, walks
 closer to the caregiver and touches her.

As these examples indicate, the children's high level of self-absorbed play, and the frequency of play with caregivers rather than peers, made it more difficult for caregivers to extend their social play with peers. Overall, the social interactions of the three children with developmental delays usually constituted a single exchange (initiation/ response). They often related to peers through indirect interaction. As a result, all of the caregivers tried to facilitate children's interactions with peers, and worked directly and indirectly through peers to involve them in play with others. However, the toddlers with disabilities, especially Child A and Child B, were often more interested in either playing by themselves or staying near their caregivers. The caregivers needed to work hard at facilitation and explanation. The following anecdotes provide some examples.

 Child A and another child are playing
 at the water table side by side. The
 other child turns toward Child A,
 touches his smock, and vocalizes to
 him. After glancing at the key
 caregiver, Child A touches his peer's
 T-shirt and vocalizes to him. The
 caregiver says to the other child, "You
 are wet," then asks Child A, "Are you
 wet?" Child A walks away from the
 table.

 Child C is playing with a girl of his age
 at the sandbox. The caregiver is also
 sitting next to them. The caregiver
 teaches the girl a game that compares
 the quantity of sand presented in two
 hands. When the caregiver puts out
 two hands, Child C just touches the
 sand in the caregiver's hand, while the
 girl looks at the caregiver's two hands.
 The girl holds sand in her hands and
 repeats several times, "Show me, show
 me which hand has the most." Then,
 she turns to Child C and asks him several
 times, "Show me which hand has
 more." Child C just looks at her with
 a smile and explores the sand in the
 sandbox. The caregiver intervenes and
 asks the girl, "Can I choose?"

In the second example, Child C responded positively to the caregiver's interventions, but continued to need cues to maintain an interaction with his peer. He seemed unable to process his peer's attempts to involve him in a problem-solving game, and focused on the simpler sensory task of exploring the sand. After repeated attempts to involve him in higher level play with no appropriate response, the peer reluctantly engaged the teacher in the game.

Overall, social exchanges with peers occurred infrequently; when they did, they remained unrelated or tangential. As in the example described above, the limited social skills of the toddlers with disabilities made it difficult for them to be engaged in sustained play activities with peers without ongoing adult support.

Interfering exchanges were observed infrequently, and they were usually initiated by a peer. All three children sometimes responded with negative behaviors, but rarely initiated them. The following anecdote describes one of these rare occurrences.

 Child A is going up the slide, as the
 caregiver sits alongside it. As Child A
 is sliding down, another child goes to
 the slide. They take turns sliding
 down. Then, the other child sits on top
 of the slide as Child A attempts to go
 up. He begins to vocalize "no" to Child
 A with an attempted hitting gesture.
 Child A responds in the same manner,
 although neither actually makes contact
 with the other. The caregiver does
 not intervene. When the other child
 eventually comes up the slide, the two
 children just look at each other.

There were more frequent interfering exchanges in Child C's observations because of one particular girl who often approached him in negative ways, as demonstrated in the following example. It seemed that C's experiences were colored by this power dynamic.

 The caregiver and Child C are sitting
 outside of a big cardboard box. Child
 C watches the other children with interest,
 including one girl who is very
 engaged in the game of moving in and
 out of the box. The caregiver asks him
 "Do you want to join the game?" He
 gets up and walks to the opening of the
 box. He looks into the box and says
 "Hi." The caregiver says, "Hello, he is
 saying hello to you." The girl moves
 out of the box quickly and forcefully,
 shouting "NO," pushing Child C away.
 The caregiver explains to her that he
 can also go in the box, but the girl
 keeps saying no. When the girl tries
 to push Child C with the door of the
 box, the caregiver holds her and explains
 to her that it is not okay, as
 Child C looks on with concern.

In summary, the children with developmental delays had difficulty maintaining social exchanges with peers for an extended period of time, and needed the help of caregivers' facilitations and interventions to make connections with their peers. Parents' and caregivers' concerns about the children's abilities seemed to be validated in these observations of their play.

Theme of Possibility and Strengths of Individual Children

Parents. Despite their expressed concerns, both parents and caregivers also had hopeful expectations for the children. Parents seemed to view the inclusive setting as a place where their children would have opportunities for developmentally meaningful experiences. They especially looked to the inclusive environment as a place where the children would have the chance for developmentally appropriate social experiences. They expressed hope for different intervention strategies and acknowledged their children's potentials. Each of the families clearly communicated their hopes about their children attending the center, as shown in the following anecdotes.

 Father (Child A): I think he will thrive
 in this situation. I can't offer him this
 no matter how many little playgroups
 I go to or to the park.... My biggest
 thing is because of the low tone and of
 his coordination, when he is playing
 with other kids he might bump into
 them. He is just starting to walk backwards.
 He will spin around and he'll
 fall flat, or he'll be running and he'll
 bump into or trip on something. Just
 protect him from that but still encourage
 him to do stuff.

 Father (Child C): By this age he should
 be eating by himself. We don't want
 to let him [go] without eating but at
 the same time we want him to eat [independently]
 .... We are concerned
 with his speech delay. His receptive
 skill is between 15 and 18 months. His
 communication skill is between 18 and
 22 months, so he's behind. He is going
 to be 27 months.... We hope this environment
 will help him to start talking
 with other kids.

Parents also seemed to want to communicate that their children were capable and needed acknowledgment for their capability.

 Mother (Child B): My worry is people
 may think that he doesn't do things
 and that he doesn't understand just
 because he approaches things so slowly
 and tentatively. I want to make sure
 that everybody is realizing that he is
 able and he just needs to be given the
 chance. He's capable of doing a lot of
 things.

Parents seemed to know their children's strengths and needs and clearly communicated them to the staff. They also expressed concerns that their children might look different and behave differently from others, yet they held many hopes for the possibility of potentially positive experiences in group care.

Caregivers. Caregivers appeared to believe more in the theme of possibility as they built close relationships with their key children. As time progressed, the caregivers felt a very special bond not only with the parents but also with the children. They seemed to connect with their key children in different ways than they did with the other children, as demonstrated in this comment by A's caregiver: "He tried to bite me today (in a friendly way) and I thought it might be a good sign because his mom had mentioned that he only does stuff like that with people he's close to."

Also, the caregivers were very eager to understand their key children and tried to be responsive to their needs. B's caregiver worked hard to read his expressions of separation, stating: "As B spends more time with us, I think he is a little more uneasy than he was the first few days. Seeing him so upset is communicating a lot to me." And C's caregiver wrote the following anecdotes in her journal, sharing her philosophy: "I always try to put myself in the child's shoes. If I am this child, what would be fun for me? Sometimes it does not work but it's been useful in avoiding having conflicts with them." She also described her growing understanding of C's approach to sensory materials:

 He seems too careful about touching
 the paint (like not wanting to get his
 hands dirty). He does the same thing
 with play dough and goop. He loves
 watching it, loves watching other children
 manipulate the material, but he's
 reluctant to really handle the materials
 himself.

Although the caregivers had difficulty at times with their own feelings of protectiveness toward the children with special needs, they challenged themselves to provide opportunities for peer interactions. They worked hard to encourage and support meaningful integrated social experiences for the children. Videotaped observations of children's play showed that the caregivers demonstrated a range of behaviors with their key children. Caregivers of Child A and Child B tended to articulate their responses to key children more than to peers when peers were present. On the other hand, the caregiver of Child C often chose to work through peers to involve her key child when more competent peers were present.

As the caregivers built strong relationships with their key children, they began to think more about their perceptions of them and they reflected more on their practice. For example, Child B's caregiver communicated how she was able to see his ability beyond his delays. This related to one of the concerns expressed by Child B's mother--that the caregivers learn that he could do more than what they might think him capable of.

 B has been more independent, which
 has helped me to look at him differently.
 Because B is walking and interacting
 more, I can see him differently.
 We have played more games/activities
 than usual. I can now do things with
 him and other children.

Children. Careful observations across time unveiled children's unique ways of participating in the social community of the classroom. The theme of possibility expressed by parents and caregivers resonated in these data. In the following example, taken from videotaped observations, Child B used physical contact and locomotion to initiate and respond in interactions with his key caregiver, demonstrating his communicative competence.

 The caregiver and Child B are playing
 with a puzzle. Another child joins
 them. The other child looks down at
 the table and stands up several times.
 He bangs the puzzle piece and then
 throws the piece several feet away.
 The caregiver says to the other child,
 "Go get it. Where is it? It's all the way
 over there." The boy just walks to the
 yellow ball near the table and plays
 with it. Child B, who was doing the
 puzzle, walks slowly to the puzzle
 piece, picks it up, and brings it to the
 caregiver. Child B smiles when she
 says "Thank you."

Across time, Child C used more vocalization and gestures as well as locomotion in his initiations and responses to both peers and adults. He was very aware of others' activities and often followed them with interest. For example, when he saw a child in the sandbox, he said "hi" to her, making a positive attempt to initiate an interaction. Compared to Child A and Child B, Child C was more emotionally responsive. He often expressed both positive and negative emotions. He smiled frequently in response to others and expressed negative feelings when he was approached by peers in a negative way. Also, Child C had a strong interest in younger children. He often stayed near a caregiver who was holding a baby, watching the baby very carefully. The following anecdote shows how he liked to play with a younger child.

 Child C holds a wooden caterpillar,
 dragging it on the floor. Behind him,
 a younger child crawls after the caterpillar.
 Child C slowly walks away from
 the child, looking at him and saying
 "mine." The caregiver says to the
 younger child, "Sorry, C wants to play
 with it." The younger child continues
 to slowly crawl after him. The
 caregiver suggests that Child C give
 another toy to the child. The caregiver
 gets another toy and gives it to Child
 C. Child C picks up the toy, puts it in
 front of the baby, and talks to him.

All three children were interested in other children's activities and aware of what was going on in the classroom. Although peer interactions did not occur frequently, there were several episodes in which children imitated others' behaviors. Child A was very interested in one particular boy in the classroom, and the following episodes show how they liked to imitate each other.

 Child A holds a toy in his mouth as he
 goes up the slide. When a caregiver
 tells him to take it out of his mouth
 because it is not safe, he does. After
 watching Child A, his friend at the
 table also puts a toy in his mouth and
 walks to the slide.

 Child A is playing at the water table.
 When the same boy mentioned above,
 who is playing alongside him, puts two
 objects on his head, Child A does the
 same thing. The two children smile,
 and the caregiver says, "You are getting
 wet." The children splash the
 water.

Summary. As discussed above, parents and caregivers expressed strong feelings of possibility for children with disabilities in the inclusive child care center, and on many levels, the children were very capable of being integrated into this environment. Successful integration was enhanced by a high level of support from the caregivers and open communication with parents. Despite having these supports in place, however, some persistent issues continued to be presented by the children with special needs that created ongoing challenges for fully integrating them in social experiences with their peers.

Parents' and caregivers' initial concerns continued to be reflected in the children's social behavior. Children with disabilities initiated less frequently and in more subtle ways, and were often less appropriately responsive to their peers. They relied on their caregivers for social support at a much higher level than most of the typically developing children at the center (see Lee, 1999; Recchia & Sekino, 1998). Although each of the children made consistent positive gains in social development, their social experiences with peers remained qualitatively different.

These persistent challenges to inclusion create ongoing dilemmas for parents and caregivers in community-based child care settings. Inclusion provides opportunities for children with special needs to observe and learn from their more socially competent peers, as well as for caregivers to grow professionally, but additional help is often needed by observant and sensitive caregivers who are willing to take the time to build positive relationships with children that facilitate their comfortable social integration. For these three children, the growth of positive relationships, between children and caregivers and between caregivers and parents, was a key element to fostering their successful inclusion.

Implications for Practice and Research

Findings from this study are situated within a particular educational setting, and must be interpreted within this contextual framework. This setting provided a level of support that may not be replicable in other settings. However, studying these issues within such a supportive context, and with students who are learning to be teachers, allowed the researchers to look more deeply at the processes involved in learning to meet the needs of children with disabilities in child care. The findings suggest a number of interesting implications for practice and future research.

First, parents of children with special needs had specific concerns about their children entering child care. Establishing and maintaining open communication with these families was important to the caregivers as well as the parents. Programs that strive to be inclusive must take into consideration the need for ongoing communication between caregivers and parents of children with disabilities, and provide additional opportunities for these exchanges of information.

Caregivers of children with special needs expressed initial concerns about their ability to adequately meet both the needs of children and the expectations of parents. Across time, they developed perceptions of closeness to their key children that were more powerful than those of the other caregivers (see Recchia et al., 1998). This may have come about in part because the behavior of these children was more difficult to read, and because they were often less responsive to caregivers who knew them less well. Caregivers who are assigned key children with special needs may find that these children are more dependent on them for care and interaction than their typical peers, especially as they are first establishing relationships with them. These caregivers need support to continue to meet the challenges presented by the children in their care. Although this study suggests that the use of key caregivers can be a helpful structure for working with children with disabilities, particularly as a vehicle for developing relationships with children and families and learning about children's individual strengths and needs, this may not be easy to carry out in all community child care settings.

In a classroom environment where lower teacher-child ratios cannot be ensured, successful inclusion might require more creative staffing patterns to provide children with special needs the support that they need to be successful. Programs must become more adept at integrating community resources, such as early intervention specialists, student teachers, and community volunteers. Scheduling patterns may need to be reconsidered to capitalize on quiet times throughout the day as opportunities to work more closely with children with special needs in small groups. Coordinated and collaborative efforts are needed to best serve inclusion in child care.

These qualitative descriptions of the social interactions of children with special needs indicate limited levels of social exchange and expression. Caregivers may need to take greater responsibility in facilitating play for these children. This, too, can be particularly challenging when staffing ratios are not adequate to provide the time and space for caregivers to focus their attention in these ways.

Although these practices may seem daunting at first, it is important to keep in mind that understanding and accommodating individual differences is an ongoing process for all of those involved with young children. Thinking inclusively requires a willingness to expand our own perspectives on the possibilities for children's experiences in early care and education. The purpose of this study was not to provide specific suggestions for intervention, but rather to explore the underlying processes that contribute to parents' and professionals' understanding of inclusion as it relates to their own settings.

As more children with special needs are integrated into inclusive child care, parents and professionals must find ways to work together to create supportive experiences for them, based on authentic communication. Center policies and practices may need to be adjusted to accommodate increased opportunities for communication with parents, and for staff development and training that focuses on responding to individual differences in children. Caregivers need support and understanding as they work to create inclusive curriculum, and to develop strategies for responding inclusively to a variety of child needs. Administrative support for inclusion is essential to its success (Craig, Haggart, Gold, & Hull, 2000).

Much additional research is needed to help articulate the ways in which particular inclusion strategies are being used successfully across different child care settings. Although it is clear that the benefits of true inclusion come not from simply sharing classroom space, but from providing appropriate support in order to maximize all children's potential, this support must be provided in ways that are compatible with center structures and policies.

Table 1
Characteristics of Children

 A B C

Age at time 25 months 13 months 27 months
of study

Total months 8 months newly enrolled newly enrolled
in program

Special needs Infantile Mild hypotonia Hypotonia
 stroke Sensory Mild motor Motor/language
 integration delay delay
 disorder

Authors' Acknowledgment:

We would like to thank the children, families, graduate students, and staff who so graciously supported and participated in our research efforts. We are also grateful to Adora Bautista and Yumiko Sekino for their help with the initial data coding and analysis process.

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Susan L. Recchia

Teachers College, Columbia University

Yoon-Joo Lee

Brooklyn College, City University of New York