Journal of Positive Behavior Interventions

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Young Children with Challenging Behavior: Issues and Considerations for Behavior Support
Lise Fox, Glen Dunlap and Diane Powell
Journal of Positive Behavior Interventions 2002; 4; 208
DOI: 10.1177/10983007020040040401
The online version of this article can be found at:
http://pbi.sagepub.com/cgi/content/abstract/4/4/208

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Young Children with Challenging Behavior:

Issues and Considerations for Behavior Support

Lise Fox
Glen Dunlap
Diane Powell
University of South Florida

Abstract: The critical importance of intervening early to promote the social and emotional development of young children is a recurring theme in several reports commissioned by national
organizations and leaders (i.e., Child Mental Health Foundations and Agencies Network; National Research Council of the Institute of Medicine; U.S. Surgeon General). There is an increasing awareness that socialemotional difficulties and problem behaviors in young children
are highly likely to continue in school. In addition, young children who show the most chronicity and stability of problem behavior are more likely to be members of families who experience
marital distress, parental depression, and poverty. Young children in urban environments who
have problem behavior are likely to also face challenges in health, poverty, and access to quality childcare and other services. In this article, the complexity of the urban context is described
with a focus on the lives of young children and their families. The authors present a discussion
of appropriate practices and research that provides a foundation for the development of effective early intervention programs for young children affected by environmental and developmental challenges. The emphasis of program recommendations is on comprehensiveness in the
design of family-centered behavioral support options.

There is an increasing awareness among educators, researchers, and policymakers that many young children are
beginning their school experiences without the requisite
emotional, social, behavioral, and academic skills that will
be necessary for success. Recent national organization and
commission reports have emphasized the critical importance of early intervention and prevention in the support
of young children who have socialemotional difficulties
(Child Mental Health Foundations and Agencies Network,
2000; Department of Health and Human Services, 2001;
National Advisory Mental Health Council, 2001; Shonkoff
& Phillips, 2000). This phenomenon is sharply evident
within urban school environments where many of the students are more likely to be poor, have limited English proficiency, move frequently, and live in one-parent home
environments (National Center for Education Statistics,
1996), all factors that have been associated with less successful educational outcomes. Research indicates that
many children who have difficulty with the successful
transition into kindergarten programs continue to show

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social and emotional problems throughout their school careers and into adulthood (Huffman, Mehlinger, & Kerivan,
2000).
The alarming frequency in which young children who
enter school display severe problem behavior has resulted
in an interest in providing early intervention to children in
the toddler and preschool years (Department of Health
and Human Services, 2001; Shonkoff & Phillips, 2000;
Simpson, Jivanjee, Koroloff, Doerfler, & Garcia, 2001). A
promising approach for delivering early intervention is
through the use of positive behavior support. Positive behavior support has been demonstrated to be effective with
individuals with disabilities and students at risk for disabilities in a variety of settings with applications of positive
behavior support occurring primarily within school or
adult service programs where there are professional program staff and mandates for providing behavior support
to address challenging behavior (e.g., IDEA 1997).
In this article, we discuss the issues relevant to providing behavior support to young children with challenging

Journal of Positive Behavior Interventions

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behavior. We describe the nature and course of challenging

behavior in young children that necessitates a systematic
and comprehensive approach to intervention. We also discuss the complexities associated with providing services to
young children in urban environments. The article concludes with a description of the elements that must be
considered in the design of behavior support models for
young children.

Prevalence, Course, and Correlates of

Problem Behavior
Challenging behaviors in young children not only occur at
significant rates but are also often precursors to long-term,
serious difficulties. Although problematic behaviors in
toddlers and preschool-age children have often been dismissed as age-appropriate expressions of developmental
change or transient responses to adverse environmental
conditions (Campbell, 1995), an emerging body of research supports the robustness of early onset externalizing
behavior problems.
Findings from prevalence studies vary depending on
the sample characteristics and method used. However, a
review of studies with community samples of preschool
children found rates of oppositional defiant disorder
(ODD) between 7% and 25% (Webster-Stratton, 1997). In
a study of 3,860 two- to five-year-old children identified
through pediatric visits, 16.8% of the children met the criteria for ODD, with half of the cases (8.1%) considered severe (Lavigne et al., 1996). Rates were highest (22.5%) for
3 year olds and lowest (15%) at 5 years. In this study,
attention-deficit disorder was identified in 2% of the participants and was almost always co-occurring with ODD.
Problem rates for children living in poverty appear to
fall into the high end of the range. Using the Child Behavior Checklist (Achenbach & Edelbrock, 1991), rates of over
25% for parent reported clinical level externalizing problems (Webster-Stratton, 1997) and rates as high as 39% for
teacher reported problems in boys (Kaiser & Hancock,
2000) have been found among children in Head Start. A
study using classroom observations found higher levels of
physical aggression in children in Head Start compared
with children in community childcare, although the community participants displayed higher levels of verbal aggression (Kupersmidt, Bryant, & Willoughby, 2000).
Evidence supports the view that early problems often
persist and that the roots of later problems are found in the
early years. A review of longitudinal studies revealed that
approximately 50% of preschool children with externalizing problems continued to show problems during their
school years, with disruptive behavior diagnoses showing
the highest rates of persistence (Campbell, 1995). There
appears to be remarkable stability in the early years, with
88% of boys identified as aggressive at age 2 continuing to
show clinical symptomatology at age 5 and 58% remaining

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in the clinical range at age 6 (Shaw, Gilliom, & Giovannelli,

2000) and into adolescence (Egeland, Kalkoske, Gottesman, & Erickson, 1990; Pierce, Ewing, & Campbell, 1999).
Accumulating support exists for an early starter developmental pathway for conduct disorders beginning
with aggressive, impulsive, and oppositional behaviors in
the preschool years, progressing to conduct disorder
symptoms such as fighting, lying, and stealing in middle
childhood, and the emerging into serious behaviors in
adolescence, including interpersonal violence and property violations (Loeber, 1990; Patterson, DeBaryshe, &
Ramsey, 1989; Tremblay, Phil, Vitaro, & Dobkin, 1994).
Furthermore, it appears that children who display problems at an early age are most likely to develop serious and
intransigent antisocial problems in adolescence and adulthood (Webster-Stratton, 1997).
The risk and protective factors that influence the
course of a childs development toward emotional and behavioral well-being or problems are complex, synergistic,
and cumulative. The more risk factors a child experiences,
the higher the risk for poor outcomes, including emotional
and behavior problems (Landy & Tam, 1998; Rutter, 1990;
Shaw, Winslow, Owens, & Hood, 1998). Risk and protective factors occur at multiple levels and are generally categorized into child factors, family and parenting factors,
school-related factors, and community factors. Children
living in persistent poverty, especially those living in poor
and violent neighborhoods, have increased susceptibility
to emotional and behavioral problems both through direct
effects on children and contributions of family stress
(Brooks-Gunn, Duncan, Klebanov, & Sealand, 1993;
Dodge, Pettit, & Bates, 1994; Klebanov, Brooks-Gunn, &
Duncan, 1994; Myers, Taylor, Alvy, Arrington, & Richardson, 1992). Family factors are paramount in shaping the
development of infants and young children. Chronic family adversity and the resulting disorganized, stressful, and
chaotic family environments are demonstrated risk factors. Such family stress may in turn affect levels of maternal depression and other parent psychological states,
maternal responsiveness, parent management strategies,
marital conflict and degree of maternal support, all factors
that have been found to influence the development of disorders in young children (Deater-Deckard, Dodge, Bates,
& Pettit, 1998; Huffman et al., 2000; Landy & Tam, 1998;
Shaw et al., 2000).
Once children move outside the home setting, negative experiences in preschool and school may further exacerbate their adjustment difficulties. Peer rejection and
academic difficulties both contribute to child problems
(Arnold, 1997; Patterson et al., 1989), with reading disabilities in particular associated with conduct problems (Sturge,
1982). Poor-quality childcare and ineffective behavior
management by teachers in childcare and school settings
may also worsen childrens problems (NICHD Early Child
Care Research Network, 1998; Webster-Stratton, 1997). Al-

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though all of these environmental factors are interconnected, their effects are also modulated by child factors
involving temperament and cognitive abilities.
Conversely, protective factors can operate at the child,
family, school, and community levels to counteract adverse
factors and promote social and emotional health. For the
individual child, easy temperament and intellectual ability
have been the most noted protective factors. At the family
level, the presence of two parents, competence of parents,
a positive relationship with at least one parent, and social
support are significant elements in a childs life. In preschool or school, two important variables are positive relationships with peers and teachers (Huffman et al., 2000;
Landy & Tam, 1998; Shonkoff & Phillips, 2000).
Taken together, these findings indicate that disruptive
disorders in young children are multicausal, occur at high
rates, especially among disadvantaged children, and for a
large number of children, problems will persist without
intervention.

Complex Context of Early Years and

Urban Environments
The daily lives of families in urban environments are replete with conditions that contribute to the known risk
factors for emotional and behavioral problems in young
children and that, at the same time, offer few resources and
supports to families for negotiating the demands needed
because of the hazards present in such environments. The
everyday stresses on families include financial strain, poor
and often overcrowded housing, transience, neighborhood
violence and crime, lack of transportation, and social isolation. Welfare reform has added the demands of work to
the lives of many single mothers, often in low-paying jobs
for employers who make few allowances for the responsibilities of parenting young children. These stressors influence outcomes for young children through direct pathways
and indirectly through effects on maternal well-being and
parenting capabilities (Brooks-Gunn & Duncan, 1997;
McLoyd, 1998). As stated by Hanson and Carta (1995,
p. 204), The stress associated with these societal concerns
can sap parents energy, try their patience, undermine their
sense of competence and reduce their sense of control over
their lives. Subsets of young children living in families
where domestic violence, substance abuse, or maternal depression are present face even greater instability and turmoil in their daily lives.
Immigrant populations in large cities are growing in
size and diversity. For these families, language, culture, and
intergenerational acculturation issues are added complications in negotiating employment, social services, childcare,
education, health care, and other systems within a largely
monolingual dominant culture (Washington & Andrews,
1998). Providers of services and supports to families and
their young children living in such environments must

address the realities of urban life and understand that living in these demanding conditions may well leave families
with little extra time and energy to meet the special needs
of a child with disruptive behavior.
Serving young children living in urban environments
in natural settings presents challenges due to the wide variety of situations in which they spend time. These include
early intervention programs and an assortment of childcare arrangements as well as their own homes. Young
children living in low income families (> 200 of federal
poverty level) whose mothers work are found in centerbased care (26%), family childcare (14%), relative care
(28%), or with a parent (28%) or baby-sitter (4%; Capizzano, Adams, & Sonenstein, 2000). In addition, 30% of
such children receive their regular care in two different
arrangements, and 7% receive their care in three or more
different arrangements; these multiple arrangements are
most commonly a combination of formal and informal
care (Cappizano & Adams, 2000). Center-based care includes both private childcare and publicly funded preschool programs such as Head Start and prekindergarten,
which have varying mandates and resources for serving
children with behavior disorders. Furthermore, the quality
of childcare arrangements is highly variable, and providing
supports for children with challenging behaviors within
such settings requires adapting to a variety of contextual
issues. These can include programs of marginal quality
with already overwhelmed resources, early childhood education cultures that may view behaviorally based interventions as incompatible with developmentally appropriate
practice, and programs with few incentives and little investment in serving children with special needs.
Also, certain populations of identified or at-risk young
children are served in a variety of different living arrangements or specialized childcare arrangements. Children eligible for early intervention services through Part C of the
Individuals with Disabilities Education Act (IDEA) may
be served in segregated or inclusive center-based settings,
while children receiving Part B services are found in a variety of school-based classroom settings that often include
children with various special needs. Children who have been
abused or neglected may live in foster care, in kinship care,
or in informal care with relatives. In recent years, many
programs for teen mothers and for substance abusing
mothers have developed child-focused service components
that include center-based childcare. Finally, homeless shelters and domestic violence shelters often have their own
childcare programs for resident young children.
Just as young children with behavior challenges are
found in a variety of settings across service systems, intervention services for young children and their families are
embedded in a number of different systems. An analysis of
federal policies and programs that address risk factors for
social and emotional problems in young children (Cavanaugh, Lippitt, & Moyo, 2000) identified 29 separate

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federal programs that affect young children in the areas of

health, early childhood care and education, family support
and child welfare, mental health and disabilities, child nutrition, and socioeconomic status. Similarly, an examination of the funding streams for early childhood mental
health services found 39 different governmental sources of
funding (Wishman, Kates, & Kaufman, 2001). These reports note that differing policies, procedures, and disciplinary philosophies among programs create difficulties in
coordinating efforts, and despite the multiplicity of programs, services do not reach all children in need. Notably,
although there are many federal and state programs that
impact young children at risk for, or who have been identified with, emotional or behavior problems, there is no
program, system, or funding stream with this population
of young children as it sole focus.
The result is a system of programs and services that is
fragmented and difficult for families to understand and
navigate. In most communities, families do not have access
to any visible single point of information about services
for young children with behavior issues. Multiple eligibility criteria based on income, diagnosis, test scores, age,
geographic area, and specific risk factors create barriers for
families trying to access services. In addition, families may
lose services or be forced to change providers based on
changing circumstances that affect eligibility. Examples include IDEAs Part C to Part B transition at age 3, loss of
Part C services if retesting shows improvement above cutoff levels, and loss of Medicaid eligibility and services with
rise in income. Finally, families must often seek services
from multiple agencies in order to obtain the full range of
needed supports.
This complex and fragmented system for serving families and their young children with emotional and behavior
problems presents challenges not only to already overburdened families seeking services but also to early interventionists who seek to provide family-centered services
within natural settings. The needs of urban families call for
a system of supports that provides services within the child
and familys natural environments, including childcare,
services offered at nontraditional times to accommodate
the schedules of working families, providers who can provide information in the familys primary language, a coordination of services among agencies, and changes in
program eligibility to ensure a full range of services and
program continuity.

Positive Behavior Support and

Early Intervention
The complexity of the environments and risk factors of
young children in urban environments who have challenging behavior creates a need for comprehensive services that
address the ecological needs of the family unit in an effort
to influence the behavior and development of the child. In

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a recent review of the science of early intervention, it was

determined that early intervention programs specifically
designed to enhance parenting behavior and the development of the child have the greatest impacts (Shonkoff &
Phillips, 2000). Thus, in addressing the needs of young
children who have problem behavior, it is essential for intervention programs to shift their focus from intervention
with the child to supporting the family in securing the resources, skills, parenting skills, and social support needed
to provide a nurturing environment for the child (Shonkoff & Phillips, 2000; Simpson et al., 2001).
Positive behavior support (PBS) offers many of the
components necessary to address the unique needs of each
individual child and family. PBS has been conceptualized
as the process that is broadly applied to address the deficient behaviors of the individual and the deficient contexts
associated with problem behavior (Carr et al., 1999). The
behavior support process includes interventions and supports that are focused on enhancing the ecology of the individual with the ultimate goal of improving peoples lives.
When young children have problem behavior, comprehensive applications of PBS are necessary to provide the family and other caregivers with strategies to address the
childs problem behavior, to teach the child new skills, and
to ensure that the family has the resources, support, and
knowledge to nurture the development of the child (Dunlap & Fox, 1996).
Although the bulk of research on PBS has addressed
the needs of older individuals with challenging behavior,
an increasing number of demonstrations exist regarding
the efficacy of PBS applications for young children and
their families. Research has demonstrated that the implementation of functional assessment, functional communication training, and family-centered behavior support
processes result in important outcomes for young children
and their families (Blair, Umbreit, & Bos, 1999; Blair, Umbreit, & Eck, 2000; Dunlap & Fox, 1999; Frea & Hepburn,
1999; Galensky, Miltenberger, Stricker, & Garlinghouse,
2001; Lane, Umbreit, & Beebe-Frankenberger, 1999; Moes
& Frea, 2000; Reeve & Carr, 2000).
Dunlap and Fox (1999) have described an early intervention model for young children with pervasive developmental disorders and challenging behavior that uses PBS
as the framework of services. Their model, the Individualized Support Program (ISP), was designed as an adjunctive
program to the childs ongoing services with a goal of helping families and other caregivers address the childs challenging behavior (Dunlap & Fox, 1996; Fox, Dunlap, &
Philbrick, 1997). The ISP model provided comprehensive
and individualized family support to young children and
their families within home and community contexts. The
ISP interventionist provided family support, PBS, and
served as the support team facilitator for all of the informal
and formal service providers in the childs life. Most important, the ISP model focused on assisting the family with

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the advocacy skills needed to secure resources and services

needed by the child and family system.
In the ISP model, the behavior support process began
with functional assessment (ONeill et al., 1997; ONeill,
Vaughn, & Dunlap, 1998) and person-centered planning
(Mount & Zwernick, 1988). The functional assessment
process provided detailed information on the childs problem behavior, activities, and contexts that were difficult for
the child and family; the relationship of the problem behavior to antecedents and consequences; and the function
of the behavior. The person-centered planning process
provided the family and the childs care providers with the
mechanism to articulate the dreams and challenges for the
child and the family system. These two processes informed
the development of a behavior support plan that addressed
problem behavior, ecological supports, and family lifestyle
issues. Once the support plan was developed, the interventionist assisted the family and all other caregivers in implementing the plan in all of the childs environments and
activities. In addition, the interventionist helped the family in identifying and accessing the additional resources,
information, and the social support needed by the family
system.
The ISP model provides a demonstration of the efficacy of using positive behavior support to address the
challenging behavior in young children who have an identified developmental disability (Dunlap & Fox, 1999). The
model has been implemented in several communities and
states (Tampa, FL; Connecticut; New Hampshire; Montgomery County, PA), with reports from providers on the
success of the approach for young children who have a
range of disabilities and who reside in a diversity of communities including urban settings.
Behavior support efforts for young children in urban
environments should involve similar components to the
ISP model. In addition, the complexities of the lives of
urban families would require primary consideration in the
provision of behavior support. In these contexts, ecological interventions and systems-change supports would be
essential to assisting families in addressing their childs behavioral challenges. The use of PBS as the framework for
intervention with young children and their families who
live in urban environments will most likely require assisting families in accessing basic resources (financial, housing,
medical), the developing of parenting skills, and acquiring
social support, as well as the developing and implementing
a behavior support plan for the child. Furthermore, behavior support efforts will need to involve all of the childs
caregivers within diverse environments (e.g., siblings, grandparents, childcare, home). Behavior support efforts that
neglect to acknowledge and assist families with meeting
their most basic needs will most likely experience limited
success in helping families achieve the lifestyle outcomes
necessary to support and nurture their children with challenging behavior.

Key Considerations in the Design of

Behavior Support Efforts
In the previous section of this article, we described the use
of PBS for addressing the needs of young children with
problem behaviors. The following section addresses some
issues and challenges that need to be considered by systems
and provider agencies as behavior support efforts are designed for individual children and families. These issues
tend to focus on the manner in which services are made
available, organized, and delivered rather than on the specific intervention and support strategies that compose the
behavior support plan. The major point is that the quality
of behavior support is essentially irrelevant if systems are
not arranged to ensure that young children and their families have direct access to the specific types of interventions
and supports that will be of help to them in their particular life circumstances. Thus, the considerations to be addressed in this next section relate to our quest to ensure
that the potential benefits of validated approaches are actually received and realized by children and families.
EARLY IDENTIFICATION

A great deal of important research has enabled early interventionists to delineate indicators of serious behavioral
disorders when children are young (Campbell, 1995; Reid,
1993; Walker, Severson, & Feil, 1995). In order for this
progress to produce value for children and families, early
detection and intervention mechanisms need to be activated. Fortunately, the last decade has witnessed encouraging steps in the form of child find and early screening
programs. A major contribution of Part C of IDEA has
been the implementation of early identification and evaluation systems. Part C, along with other federal and state
initiatives (e.g., Early Head Start), has led to significant improvements in the timeliness of detection and intervention. Still, state and local systems of identification and
intervention need to improve in many ways.
First, screening and identification systems are not yet
universal and, thus, many children are not identified until
(or later than) kindergarten and elementary school (Child
Mental Health Foundations and Agencies Network, 2000;
Department of Health and Human Services, 2001). This is
particularly true when children do not exhibit obvious developmental or physical disabilities. For children whose
challenges involve learning and/or activity disabilities, or
whose environmental circumstances place them at serious
risk for behavioral challenges, current screening programs
are typically irrelevant or inadequate. An important issue
that needs to be confronted is to define behavioral adaptation as a consideration for screening and assessment, independent or in combination with other disabilities.
A second issue involving early identification is what
happens after detection occurs. Too frequently, there are

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lengthy delays between identification and intervention, or

the systems capacity to follow through with appropriate
and effective intervention is limited (Shonkoff & Phillips,
2000). Early identification without a complementary response is a frustrating and all too prevalent reality in many
of our nations communities.
Another issue closely related to the link between identification and intervention is the early involvement of families. Even when children are identified as being in need of
intervention and support, the message may not be communicated effectively with families so that the development of an appropriate program of intervention fails to
become a family priority. The involvement of families at an
early point in time is a complex topic that relates to numerous variables of family circumstance and the resources
and orientation of service systems. Families affected by
economic limitations and other competing priorities may
find it difficult or impossible to reach out for assistance, especially when the purpose and expected outcomes are
vague (Halpern, 2000). Systems of early intervention need
to remove barriers and adopt extensive family-friendly
outreach practices if early identification is to be matched
by functional family involvement (Knitzer, 2000; Simpson
et al., 2001).
CULTURAL COMPETENCE

A crucial factor in linking effectively with families to promote early identification and early intervention is cultural
competence. Gaining family involvement depends on relating effectively to provide cogent explanations regarding
the childs developmental needs and initiating a trajectory
of functional support. The process of communicating and
developing a functional relationship with the family depends on the ability of the early interventionist to develop
rapport, and this often hinges on the interventionists capacity to relate to the cultural context that defines the family (Hernandez & Isaacs, 1998; Lynch & Hanson, 1998).
The establishment of a cultural affinity constitutes the
foundation of the relationship and is therefore pivotal in
recruiting family involvement and participation (Harry,
1997; Hernandez & Isaacs, 1998; Kalyanpur & Harry, 1999;
Lynch & Hanson, 1998; Santarelli, Koegel, Casas, & Koegel,
2001).
A major issue for systems is to ensure that the personnel and programs of early identification, evaluation, and
intervention are infused with the cultural competence necessary for connecting with the families residing within the
targeted communities. This is especially critical in communities that contain multiple risk factors because it is the
families in these communities who are the most vulnerable
to competing priorities and distrust of service systems
(Halpern, 2000). Systems and provider agencies must assure that culturally competent professionals are consistently available and that programs and service options

avoid inflexible adherence to the assumptions of a dominant cultural perspective.

STRENGTH-BASED AND FAMILY-CENTERED PHILOSOPHY

Family-friendly, culturally competent systems of early intervention are needed to activate behavior support efforts
in resolving the challenging behaviors of young children.
The essential goal of early intervention services is to help
construct a foundation of support and family capacity that
will endure and, thus, serve as a longitudinal facilitator of
positive development and functional antidote to the later
emergence of serious behavioral challenges. As explicated
in the previous section on research foundations, effective
programs for addressing the challenging behaviors of
young children are those that stress parent education and
family support. The orientation must be on enhancing the
strengths of the family system because it is the family that
inevitably, and preferably, assumes the primary responsibility in guiding the childs behavioral development.
Several authors (e.g., Friesen & Stephens, 1998;
Lucyshyn, Dunlap, & Albin, 2002; Powell, Batsche, Ferro,
Fox, & Dunlap, 1997; Turnbull, Blue-Banning, Turbiville,
& Park, 1999) have argued that effective and enduring support efforts eschew the traditional expert-driven model
and embrace, instead, a collaborative model of parent
professional partnership. This model, in the case of early
intervention, assumes an approach that is fully centered
around the familys circumstances, needs, dreams, culture,
and specific priorities. The professionals role in this model
is to inform, guide, reflect, and join the family as a supportive interventionist with the objective of increasing the
familys capacity to achieve their goals (Bailey et al., 1998;
Turnbull et al., 1999).
The implications for systems and service providers are
dramatic. Efforts need to be undertaken to effect a transition from the expert-driven model to a family-centered
orientation. This transition can be very difficult for agency
personnel, professionals, and administrators, who have
been geared for decades toward the benevolent, authoritative role of the expert. Focusing on family strengths and
working in the posture of a facilitating family partner represents a change that can be disconcerting. However, to be
optimally effective in the endeavor of family-focused early
intervention, such change is vital.
ACCESS TO SERVICES

The manner with which systems arrange for children and

families to access services can be facilitative or a massive
impediment to early intervention. Following early identification, evaluation, and the development of an individualized service plan, the challenge becomes one of locating
and accessing the appropriate types and intensities of services that the plan recommends. Ideally, a seamless process

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of linkage to qualified, family-centered service providers

would occur so that the child and familys needs would be
met expeditiously and as intended.
Unfortunately, for children with multiple risks and behavioral challenges, this ideal process rarely occurs. Professional specialization often makes it difficult to match a
child and familys idiosyncratic needs to the particular offerings of the local professional community. At the same
time, it is common for communities to lack appropriately
trained service resources so that finding a suitable provider
can be a futile endeavor. This may be especially true for
families seeking access to professionals who are skilled in
family-centered functional assessment and PBS. Although
such providers are becoming more numerous, gaining access can still be difficult.
Children and families affected by multiple challenges
and disabilities, and needing a comprehensive and multifaceted intervention approach, can encounter even greater
frustrations in accessing services. Service providers and
service agencies are usually specialized, and systems are
fragmented so that meeting multiple intervention objectives can mean extensive work in tracking down and obtaining the various types of services specified in the
intervention plan (Halpern, 2000; Knitzer, 2000). It is not
unusual for families with children who have behavioral
challenges and multiple risk factors to seek access to five or
more different providers and to simultaneously attempt to
arrange schedulings, transportation, finances, and some
kind of programmatic coordination and follow through.
This rapidly becomes a full-time job and beyond the
means of all but a few families. To counter this substantial
problem of access to appropriate services, systems must
find ways to counter the fragmentation and overspecialization that characterizes the field and to implement improved, community-based and family-friendly programs
for linking children and families with the services they
need.
COMPREHENSIVE ORIENTATION TO
SERVICE DELIVERY

An issue closely related to the last point involves the comprehensiveness with which early interventions are provided for children and families affected by problem
behavior. Families characterized by multiple risks and
stressors have needs for support that transcend the behavioral and developmental disabilities of the child. An optimal approach for enhancing the childs developmental
fortunes requires a focus not only on the childs intervention but also on supports for the family system as a whole
(Knitzer, 2000; Shonkoff & Phillips, 2000). This perspective is dictated by the reality that the childs progress is inextricably tied to the functioning of the family as a whole.
For this reason, a number of authors have asserted that
early intervention services must be broad based and evalu-

ated in terms of both child and family functioning (Powell

et al., 1997; Weissbourd & Kagan, 1989).
As with the orientation of family centeredness, the notion of providing comprehensive, broad-based supports
represents a shift from more traditional services, which
tend to be confined to a particular problem or disciplinary
purview. The transition to comprehensive supports demands that service systems be increasingly integrated, with
flexible funding and a consistent emphasis on familyfocused assistance.
PROVIDING FOR A CONTINUUM OF SUPPORTS

The level and type of services that are needed for intervention with children and families affected by challenging
behavior vary extensively according to the severity and
chronicity of the challenging behavior, the childs developmental functioning, and the resources and circumstances
of the family. Although supports should be provided from
a broad-based and family-centered perspective, the specific
kinds and amounts of support for any child and family system depend on their individual characteristics and situation. Some children and families will need only a little of
one type of intervention, but they may benefit greatly from
greater concentrations of another service. Some children
and families will need minimal support initially but relatively intensive supports later on. Services systems must be
arranged in a manner that allows families to access a flexible array of supports that fully meet their needs, including
the possibility of intensive supports that exceed typical service allocations.

Summary
In this article, we have described the evidence that clearly
indicates a need to provide behavior support efforts to
children and their families during the toddler and
preschool years. We also describe the difficult and complex
circumstances of young children with challenging behaviors and their families who live in urban communities
that necessitate the development of a highly flexible,
community-based model of both family and behavior support. In our discussion, we provided guidance on how
behavior support efforts must be arranged and the considerations needed to develop effective systems of support.
PBS offers a very promising intervention approach
with demonstrated efficacy in resolving the challenging
behavior of individuals and creating systems of problem
behavior prevention and intervention (e.g., schoolwide
systems). We believe that positive behavior support has
equal promise in addressing the needs of families with
young children in urban environments. However, in this
article we discuss the unique complexities associated with
the delivery of behavior support to young children. It is evident that the delivery of services calls for an integrated

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and coordinated approach that targets the entire family

system for intervention and support services.
We have described an approach to early intervention
that is uncommon within most urban communities, although there is recent widespread recognition that this
type of service system is necessary for achieving effective
outcomes. The approach we describe also stretches the traditional concept of behavior support services. Professionals who are knowledgeable about PBS will be challenged to
think deeply about ecological supports, familys access to
services, and family unit needs. Families who are stressed
by meeting their most basic needs are unlikely to be able or
available to provide the intervention and guidance needed
to address their childs challenging behavior.
It is reasonable to conclude that the knowledge and
technology for achieving behavior change for young children with challenging behavior is known; the challenge
that remains is the delivery of those supports in ways that
reach the most vulnerable families. Implementing an effective system of behavior support will require the involvement of professionals, practitioners, policymakers,
community leaders, and families to develop policies that
are effective, arrange service delivery systems in ways that
are responsive, and consider new approaches in meeting
the needs of young children and their families.
ABOUT THE AUTHORS

Lise Fox, PhD, is a research professor in the Department of

Child and Family Studies at the University of South Florida.
Her publications and research interests include supporting
children with disabilities and challenging behavior in developmentally appropriate environments, positive behavior support, and family support. Glen Dunlap, PhD, is a professor
of child and family studies at the University of South Florida,
and principal investigator of the OSEP Center on EvidenceBased Practices: Young Children with Challenging Behavior,
and the NIDRR Research and Training Center on Positive
Behavior Support. Diane Powell, PhD, is an assistant professor in the Department of Child and Family Studies at the
University of South Florida. She has experience in service delivery and research in the fields of early childhood mental
health and family support and has directed federally funded
projects focusing on support for young children affected by violence and parent involvement in education. Address: Lise
Fox, Department of Child and Family Studies MHC 2113A,
University of South Florida, 13301 Bruce B. Downs Blvd.,
Tampa, FL 33612.
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Action Editor: Wayne Sailor

Notice
The College Board and Disabilities Rights Advocates
Announce Agreement to Drop Flagging
From Standardized Tests

The College Board and Disabilities Rights Advocates

(DRA) announced that as of October 1, 2003, the College
Board would discontinue the practice of identifying score
reports on standardized tests taken by students who require extended test-taking time because of documented
disabilities. Such special testing accommodations have been
identified on the score report by the words nonstandard
administration, a practice commonly referred to as flagging.
The decision to discontinue flagging stems from a
1999 lawsuit against the Educational Testing Service (ETS)
that resulted in ETSs agreement to remove all flags from
the score reports of ETS-administered tests that are not
owned by the College Board. ETS develops the test times
and administers and scores the SAT and several other tests
owned by the College Board.

With respect to College Board tests, DRA and the College Board had agreed to convene a Blue Ribbon Panel of
jointly selected experts to consider issues related to the
flagging of score reports. That panel recommended, by a
vote of four to two, that the College Board discontinue
flagging the score reports of tests taken with extended
time.
DRAs clients were extremely pleased with the settlement. Chris Elms, President of Californians for Disability
Rights (CDR) stated, This settlement is a victory for all
persons with disabilities seeking to attend college or graduate school because it makes higher education much more
accessible to persons with disabilities. International
Dyslexia Association (IDA) President Harley A. Tomey III
added, While IDA wishes the agreement could have been
reached sooner and without litigation, we congratulate
ETS and the College Board for coming to the understanding that this is the right thing to do.

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