Inclusion FAQs

My daughter has cerebral palsy and is easily startled by loud noise. Is a home-based center a better option than a traditional child care center?

The best environment for your daughter will depend on what is happening in that environment and how much the child care providers are able to support your daughter’s learning and care for her needs. If the home-based center tends to be a more calm, quiet environment and the child care provider is responsive when your daughter becomes easily startled, then that may work well. I would recommend spending time in any environment you are considering for care to observe and listen before you take your daughter. Talk to the child care provider about your daughter and see how open they are adjusting to the environment. That way, you can get a sense of whether or not it will be a good fit. However, it’s possible that your daughter may need time and support to adjust to the noises in either environment. Trying strategies such as easing her into care by starting for brief periods of time so she can get used to the noise level, allowing her to wear headphones, earmuffs, or a stocking cap to try to lessen the noise (if she’s comfortable with that), and cueing her before loud predictable noises like a vacuum or music might help. Talk to the child care providers in both programs to share what you do at home to help her manage noises and how you soothe her if she needs it after becoming startled. If they are willing to listen and work with you, then that’s a great place to start.

I’m concerned about my child and the level of attention he receives from child care staff. Is the LENA Grow system a reasonable option for my child’s child care program?

The LENA Grow program is a professional development program for ECE teachers and providers that gives objective feedback about how much they are engaging with the children in their care. It is intended to be a strengths-based approach to build on provider skills and enhance the experiences, and, therefore, the brain development, of the children in the setting. It would be a good fit for a program that was looking to provide more support to providers in order to increase engagement. Using LENA Grow, early childhood providers can see a breakdown of how much conversation each child experienced and work to provide equitable opportunities for interaction to each child. Data from LENA shows that children in LENA Grow settings who start out experiencing the least amount of talk see the greatest gains in interaction.  For more information, visit https://www.lena.org/lena-grow/.

Are there specific behavior management techniques for young children with aggressive behavioral disorders so that they can participate in activities as fully as possible?

When children exhibit behaviors, the best approach is to understand the behavior. For example, the behavior itself is something easily seen, but the underlying reasons may require a little more detective work. One important fact to remember is that all behavior has meaning. Behavior can be influenced by a child’s developmental age, temperament, and environmental factors.  For example, a child with a language delay may hit or push because they do not have the words to express what they want. It is important to keep in mind that children under three years of age are driven by their emotions and not by logic. They experience a lot of “big” feelings and react based on how they feel. When a caregiver has a better sense of understanding, they can be more empathetic to the child and respond in a supportive manner. First and foremost, it is essential that caregivers remain calm in the moment. 

Offering choices is another strategy to help young children maintain their independence, but remove the opportunity for a power struggle. Allow the child to make a choice between two different activities they can participate in. This shows the child the caregiver respects their feelings. Use words to validate a child’s feelings such as, “You feel mad because Timmy took your toy.” 

Consistency, especially in rules, also helps the child understand what to expect. Sometimes, a child may feel so overwhelmed by their feelings, there is no reasoning with them. In order for a message to be heard, they must calm down first. Provide a safe space, such as a cozy corner, where a child can go when they feel overwhelmed. Once they are calm, debrief the situation. 

Finally, children who display behaviors may have sensory needs not being met. For example, a child may prefer movement activities over sitting down to participate in an activity. Offer an individualized support for that child such as a wiggle chair to sit at the table while completing an activity. It is always best to meet a child where they are developmentally. If a task is too hard, the child may feel frustrated before even attempting the activity.

My child is hearing impaired. Are there simple, transition techniques I can suggest to his home care provider?

If your child wears hearing aids, make sure your provider understands all the details about them, including doing sound checks, changing batteries, and trouble shooting. Let your provider know what your child is able to hear and what may be more difficult.  

Share tips that you have found successful at home:

  • Does your child benefit from reading lips?
  • Does your child benefit from using sign language? 
  • What signs does he/she know?
  • Does it help for the source of sound to be closer to your child?
  • What helps your child when he/she does not understand?  
  • If your child is learning new words/signs, be sure to share them with your provider so they can be incorporated into the daily routine. 
Is there free assistance available to guide setting up child care environments in a way that will support access for children with physical disabilities?

There are many resources including articles and webinars available to help programs set up an inclusive environment for children with disabilities.  Examples can be found at Early Childhood Learning & Knowledge Center (ELKC)   https://eclkc.ohs.acf.hhs.gov/video/environments-support-high-quality-inclusion and at the Extension Alliance for Better Child Care https://childcare.extension.org/specific-ideas-for-child-care-providers-to-help-children-with-physical-disabilities/.  

The Virginia Infant and Toddler Specialist Network also offers support to programs in the area of inclusion.  Email TA@va-itsnetwork.org for more information.  Additional inclusion resources and webinars can be found at va-itsnetwork.org.  Select Inclusion under the Early Care Providers tab and then Inclusion Resources and Webinars for a list.

How do I determine if my child will receive the level of support they need in a child care program?

Prior to enrollment, meet with the family day home provider or the director, if your child is at a center based program, to share your concerns, the child’s needs, and developmental goals.  Establish a positive, open relationship with opportunities to continue to share needs, concerns and be available for questions as the need arises. Once your child has enrolled and has been attending on a regular basis, you should pay attention to several things. Do you feel like your child is making progress? Are you seeing your child gain developmental/learning skills and be able to use those skills to do things that are important to him/her and to you? If your child is making progress and you feel like you have a good partnership with the provider, then hopefully the level of support is appropriate.  If no, then talk to the provider about your concerns. 

Do I need to adjust my ratios in order to provide inclusive services?

No. However, there may be times during the day that extra help may be needed when children need more individualized attention.  For example, this could be when a child needs to be fed or needs assistance to use the restroom.  Decisions about staff-child ratios should be based on the individual setting and the needs of all children including the unique needs of children with disabilities.

What is the difference between an accommodation and inclusion in a child care setting?

Inclusion ensures that all individuals with disabilities can learn alongside their non-disabled peers.Appropriate accommodations are ensured for children with disabilities which is how their needs are met in the child care setting.  For example, we may have a child sit near the provider if they are hearing impaired.  Or add large knobs to puzzle pieces to help children with a physical disability to be able to manipulate the pieces more easily.  These accommodations allow all children, both children with and without disabilities, to be in the same, inclusive setting.

How do you prepare a young child for an inclusive child care environment?

There are a few simple steps that families can take that will help most young children feel better prepared to start any child care program.  First, they can talk positively about starting a new child care program but also allow the child to talk openly about fears or worries. Reading children’s books about starting a new school or going to child care can be a big help for parents in getting a conversation started. Be sure to also read books that include children with disabilities.  Parents can help a child create a paper chain with just enough “links” until start day. Make it part of the daily routine to have the child tear off the link for that day, then count how many days/links are left. This representation of time will help many children feel less anxious and more excited about starting child care. You can also create a photo album or video featuring the new child care environment to share with your child.  Include important places, such as thebathroom and the place where meals are served; important people that the child will see every day; and the most common toys, equipment, and activities, especially those that are the child’s favorites and that will help the child feel more comfortable on their first day. Finally, give your child “practice” in the new environment. Plan to visit the child care several times prior to your child’s first day, first when there are fewer children present and play is unstructured and again during the busiest time of the day.

Are child care programs responsible for providing alternative eating utensils, larger spoons for instance, during mealtime for children with grasp delays?

According to the Americans with Disabilities Act, “Centers have to make reasonable modifications to their policies and practices to integrate children, parents, and guardians with disabilities into their programs unless doing so would constitute a fundamental alteration.” So, yes, purchasing a few larger spoons can generally be carried out without much difficulty or expense to the program.  

My son is nonverbal due to developmental delays. How can he participate during circle time when the other children sing songs?

The caregiver can provide instruments as an alternative for children to play who are nonverbal or they can move their body to the rhythm of the music/song.  Another adaptation would be to provide props that relate to the songs (i.e. stars on sticks for Twinkle, Twinkle Little Star) to keep children engaged in the activity.  Each child should be able to choose how, or if they want to participate.

As a child care director, how do I encourage providers to embrace an inclusive classroom when it adds additional tasks to their busy days?

Including a child with a disability or delay in an early childhood program can be challenging at times. But including a child with special needs in an environment with typically-developing children can be extremely worthwhile, not only for the child with a disability or delay, but for all the children. Ensuring specialized professional development opportunities, having a supportive administrator (if in a center setting), and collaborating with early childhood special education professionals can all be a tremendous source of information and support. Providers should also be willing to ask questions when they aren’t sure what to do or how to handle a situation.  Knowing that they have support when they need it can make all the difference in their willingness to work in an inclusive environment.

Are typically developing children delayed in learning opportunities by including children with disabilities in their child care environment

No. In fact, research shows that inclusion benefits all children while supporting children with disabilities. Typically developing children benefit by learning respect for a child whose abilities are different than theirs, increased empathy for others, how to respond appropriately, as well as how to offer help to another child.

How should child care program staff handle a situation in which a child is being teased and excluded because of a disability?

Providers should be proactive in working with all children on the social skills they need to help develop friendships.  It is especially helpful to work on discussing emotions, talking about the differences that make each person unique and understanding and being sensitive to another person’s feelings.  They should promote social interactions and peer partnerships all with the goal of teaching positive social skills.  Providers should model appropriate behavior and reinforce positive behavior.  All of these activities should help reduce the amount of teasing and help all children to develop friendships.  If teasing does occur, the providers should not overreact.  They should calmly ask why the teasing happened and remind them that we don’t hurt our friends.  Facilitate having the child tell the child who did the teasing that their words hurt their feelings. Providers should continue to reinforce positive social skills and behaviors and make sure that all children get some special time to spend with each child during the week.

Do you have any suggestions of activities that might help children with vocal and physical outbursts?

It sounds like you have two intense, active young guys in your center.  Using an “ inside voice” is a skill that can be difficult for some children to learn. I would start off by ensuring that both boys have had their hearing screened and that any concerns have been addressed. Often, a child who had or currently has multiple ear infections or some other type of hearing issue may speak louder than necessary so it’s important to rule out any issues with hearing first.  

Young children can be very sensitive to changes in their environment or routines. Often this sensitivity leads to behavior escalation that can be extremely disruptive. From your letter, it sounds like one way these boys express their frustration and displeasure is through loud, shrill voices. So instead of focusing on practice using the appropriate inside voice, let’s focus on ways of preparing them for positive management of their feelings. Since the upset is usually due to unexpected or unwelcome changes, providing warnings and practice can be helpful.

Use your circle time and other group activities to remind all the children of the classroom expectations. With some children, rules and expectations must be taught and practiced multiple times before they stick. Using books to reinforce rules and social conventions is a good strategy as well. Here is a list of CSEFL’s “book nooks” on various social emotional topics. There is a good one on loud voices and several on handling overwhelming feelings.  https://csefel.vanderbilt.edu/resources/strategies.html#booknook

It may be helpful to provide a verbal or visual cue to let the child know that there will be a transition to a new activity or some other frustrating activity.  This might be accomplished through a picture cue or a verbal prompt from you. Stand near him, make eye contact and provide the cue along with verbal reinforcement. It may take some thinking to come up with the best cue for him but here are some resources to start with. https://www.challengingbehavior.org/explore/pbs_docs/tips_for_visuals.pdf   

Another way of allowing the child to “practice” rules and managing frustration is through the use of a social story.  Social stories are simple short stories designed to allow the child to practice appropriate responses while reading the story.  Encourage the child to read the story with you often so that they can remind themselves of positive ways to respond to their frustration. The Center on the Social Emotional Foundations for Early Learning (CSEFL) has some great resources on creating and using social stories https://csefel.vanderbilt.edu/resources/strategies.html#scriptedstories

You mention in your letter that you are concerned about these issues being a red flag for developmental delays. I encourage you to discuss this situation with the child’s family and work together to decide whether a referral for further evaluation is appropriate. Meanwhile, using some of these tips might help these children be more successful in the classroom community. 

How do you handle children with special needs?

Just like all children, children with disabilities and other special needs are unique individuals with different strengths and challenges, making it difficult to generalize about the supports or resources needed to ensure their success. Children with disabilities spend most of their time doing and enjoying the same activities that other children do. Since children with disabilities are more like all children than they are different there are usually only a few changes that need to be made to support that child’s success. While it would be impossible to predict specific accommodations or supports an individual child with disabilities might need without knowing that child there are a few general ideas to keep in mind.

 Getting to know the child as an individual is the most important factor in successful inclusion. The child’s disability or special needs is only one small part of what makes them unique. Talk with the family and find out what the child likes and dislikes, their interests, strengths and challenges. This information will assist you in determining the accommodations and supports that will be needed as well as provide information about the strengths the child will be able to share with his or her peers. The child’s family is the expert on their child so the support and information they can give you is vital to the child’s successful inclusion.

It’s a good idea to read up on the particular condition the child has been diagnosed with.  This will give you general information about the child’s diagnosis but remember individual children with a particular condition may have a broad range of strengths and challenges.

Most children with disabilities receive support under an Individualized Family Service Plan (IFSP) or an Individual Educational Program (IEP).  A team made up of professionals and the child’s family develop a plan with goals for the child and strategies and supports to help the child achieve those goals. This team is ready to problem solve when issues come up and to provide ideas and additional strategies to help the child be successful.

Every child has unique strengths, interests and ideas and children with disabilities are no different. When provided needed supports every child can be successful. 

What are the effects of severe ADHD on a child’s social and emotional health? Does ADHD make it harder on a child to learn simple things like learning to drive a car or drive a four-wheeler?

According to the American Academy of Pediatrics, Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that affects children’s behavior, attention and learning. Children with this disorder are often easily distracted, impulsive and have difficulty concentrating. A child may exhibit over-activity or be a day dreamer who sits quietly but “spaces out” during class time. Although ADHD is not a learning disorder the child’s difficulty attending, concentrating and controlling their impulses can contribute to academic issues. If left untreated ADHD can have serious negative effects on self-esteem, school performance and social emotional development. Since riding a bike or operating other machinery takes some concentration and attention it may take longer for a child with ADHD to master those skills and they may need a great deal more supervision in those activities than other children. The good news is that there are medications and strategies that can work to support the success of a child with ADHD. Consult with the child’s pediatrician about options available to help.

If all four quads have down syndrome is there any chance that if the mother has more children will they have down syndrome as well? How is it that all four babies have down syndrome but no one else in the family does?

Down Syndrome is a chromosomal disorder that causes some degree of intellectual delay and may also cause heart defects and other health issues. The severity of these problems varies greatly. Down Syndrome affects about 3400 babies a year in the United States and according to the National Down Syndrome Society there are more than 400,000 individuals with Down Syndrome liv8ing in our country.  The three main risk factors for having a child with Down Syndrome are maternal age, a previous child born with Down Syndrome, and parents who are carriers of the gene causing the disorder. The risk of having a child with Down Syndrome increases with the mother’s age. Statistics provided by Easter Seals indicate that the risk at age 25 is 1 in 1250 and increases to 1 in 30 for mothers at age 45. Parents, like the ones you mention in your question, who have had one child with Down Syndrome have a slightly increased risk (about 1%) of having another child with the condition.  Since certain forms of Down Syndrome can be carried by one of the child’s parents, it is important that couples with an increased risk for having a child with the disorder receive prenatal screening and genetic counseling.

When a child has developmental or behavioral issues how can we approach the parent about the subject in a way that will not upset them, and will help get the child the help they need?

It can be difficult and uncomfortable to speak with families when you have concerns about their child’s development or behavior but it is vitally important that concerns get addressed quickly. Kudos to you for choosing to move forward in having this discussion rather than ignoring the signs.

This kind of discussion is easier and more effective if you have established a bond with the family. Scheduling a general conference at the start of the year is a great way to get to know the family and share your positive insights and feelings about the child. This helps forge a solid partnership with the family that you can build on when you have to discuss difficult topics.

Below are some ideas to help you set the stage to ensure a productive discussion with the family and positive action for the child. 

First, schedule the conference at a time that is convenient for the family and have the discussion in a private area. This is serious information and a private, uninterrupted discussion is vital. This is not information to be provided through a note home or at drop off or pickup.

Start off with genuine, positive comments about the child.  It’s important that the family knows you see both their child’s strengths as well as challenges.

Solicit the family’s ideas first. Rather than starting out with your concerns, ask the family for their observations —the parent may already have concerns but just not know how to express them.  Careful and gentle questioning and probing will allow the parent to share their observations and concerns.  Then you can follow up with the issues you have seen. This will open up a dialogue rather than a one-sided conversation. 

When you discuss the issues, especially when the concern is challenging behavior, refer to specific examples and situations and have documentation, if possible. It is often helpful to provide the family with a developmental checklist of milestones and red flags. This gives them information about strengths and possible areas of concern but never puts a label on it.

Avoid jargon or diagnostic labels — the use of these terms can lead to an emotional response from the family resulting in confusion and fear.  Simply emphasize that this is an area that needs to be checked out by a professional.  It’s a good idea to have developmental and referral resources available at the conference.  If the family is ready, you can assist with making a referral right there. If they seem reluctant, provide them with a good article or website to review. Sometimes seeing something in writing allows the parent to recognize the concerns at their own pace. If the family declines the referral, continue to check back and support them as they come to terms with the information. 

Are we required to accommodate behavioral issues?

We have a child (almost 3) who is very uncooperative and exhibits some very difficult behaviors (tantrums, biting, hitting, screaming, etc.) in the classroom. We have talked to the parents and encouraged them to seek an evaluation by a specialist, but so far they have refused to do this. As far as we know, he has not been diagnosed with any delays or special conditions. In the classroom we have tried all types of behavior management techniques and nothing works. We are constantly having to call his parents to come pick him up because of his behavior. We know that he was “put out” of another center before enrolling in ours, and we are also considering doing this because we don’t have the staff to provide the constant individual attention he needs. Are we required to accommodate his behavioral issues?

Wow, this sounds like a frustrating and difficult situation! It’s certainly important to figure out how best to support this child so that he can be successful. There can be lots of reasons for this kind of behavior in young children and it’s important to remember that these same behaviors, while distressing, are common in twos and young threes. Children this age have strong feelings and they often resort to the behaviors you mention because they don’t have the maturation or skills to express their wants and frustrations in a socially-appropriate manner.  Of course, the teacher must be able to keep everyone, including this child, safe so the situation can’t be ignored.

Although I don’t know the specifics of the situation I would like to offer a few ideas to consider.  I am sure you have reviewed the schedule, routines and so on in the classroom to make sure those are all developmentally appropriate for children of this age.  It’s also good to remember that children this age don’t always have the language skills they need to express their feelings so they often talk to us through their behavior.

The first thing to consider is what is the child communicating with their actions? When I am looking at challenging behavior in a particular child I find it easier to answer that question if I document the circumstances around the behavior—is there a particular time, situation, activity that seems to trigger it, does it occur on a particular day of the week—and then analyze this information to determine patterns. Often when the patterns become clear it’s easy to devise strategies to prevent the behavior. 

I would also invite the parents in for a strategy session. You don’t say how much discussion you’ve had with the family but parents are a great source of information about their child.  Perhaps they could provide insight on things that are happening at home that might be affecting the child’s behavior.   When you talk with them provide concrete examples of the issues you are having rather than general information about bad behavior.  This usually leads to a richer, more meaningful discussion. 

For other great information on handling challenging behavior in young children visit the Center on the Social Emotional Foundations of Learning at https://csefel.vanderbilt.edu/.

I encourage you to try every strategy possible before you resort to asking the family to remove their child from your program. Child care programs are considered places of public accommodation, and as such are governed by the Americans with Disabilities Act.  The Americans with Disabilities Act defines disability as “ an individual with a disability is a person who: (1) has a physical or mental impairment that substantially limits one or more major life activities; OR (2) has a record of such an impairment; OR (3) is regarded as having such an impairment.”

Although this child doesn’t have a diagnosis there is a possibility his situation might fall in the category of a disability.  If so, your program would be required to make reasonable modifications to your policies and practices unless doing so would be a fundamental alteration to the program or create an undue burden.  Each child care program must make their own determination on what constitutes a fundamental alteration or undue burden. I encourage you to review Commonly Asked Questions About Child Care Centers and the ADA for more information about how to make that determination. You can also contact the US Department of Justice ADA Information Line at 800-514-0301.

We have a 6 month old in our class who never stops crying and will never look me in the eye. He also does not seem interested in rolling over or starting to scooch around. Mom says the Dr. is not worried but I am. Any thoughts?

Physicians don’t always get an opportunity to observe the child in the detailed manner that his or her child care teacher would. Day to day care gives you insights that a brief physician’s visit might not offer. While it can be difficult to share concerns with parents, you as the teacher have lots of valuable information and insight to share with the child’s family.  Schedule a meeting with the parents in a private place and at a time when you won’t be interrupted.Start by asking them about their concerns and really listen to them. It’s always good to share positive comments about the child’s strengths before discussing concerns.  Information from developmental milestones checklists or screeners might be helpful so that the parents will know what is expected of a six month old. Also offer them resources such as information and support for a referral to early intervention. By sharing your concerns you may help to confirm  the parent’s own suspicions and help them begin the process of getting help for their child. 

My daughter is 2 and was diagnosed with Down Syndrome at birth. She is doing really well and we are ready to put her in a child care center near our house. I am worried that they may not be willing to enroll her. Should I call to see if they take children with special needs before I stop by?
Congratulations on your decision to place your child in child care. Your child will benefit greatly from high quality inclusive care.  Definitely share your child’s diagnosis with the provider but the fact that she has Down Syndrome should not be a barrier to participation in chld care. Under the Americans with Disabilities Act, most child care programs must enroll a child with a disability if the child’s disability does not pose a real safety threat or require complicated medical care. Children with Down Syndrome are usually easily accommodated in an inclusive setting—information and team work are the key. So be open with your provider about your child’s special needs and work with them to provide the support she needs in order to be successful.

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This project was supported by the Virginia Department of Education (VDOE) Grant #93.575, with funds made available to Virginia from the U.S. Department of Health and Human Services. Points of view or opinions contained within this document are those of the author and do not necessarily represent the official position or policies of VDOE or the U.S. Department of Health and Human Services.