Long-Term Head Start Impacts on Cognitive Outcomes for Children With Disabilities

Developmental Outcomes for Children With Disabilities

Children with disabilities have significant risk factors for poor cognitive and social emotional outcomes (Baker et al., 2003). Sharpe and Rossiter (2002) demonstrated that cognitive development scores are lower for children with a chronic illness when compared with children who are not ill. Furthermore, children with attention deficit hyperactivity disorder (ADHD) were shown to have lower behavioral and cognitive scores at ages 2, 3, 4, and 6 years compared with nondisabled peers (Loe et al., 2008). In addition, children with disabilities exhibit poor social-emotional skills by misunderstanding interactions, exhibiting poor listening and reading of facial expressions, and exhibiting a lack of emotional responses (Laver-Bradbury, 2012). Children with developmental or intellectual disabilities tend to have more behavioral difficulties than children who develop without disabilities (Einfeld et al., 2011). Children with disabilities are more likely to be bullied and engage in bullying behaviors than children without disabilities (Blake et al., 2016).

Children with disabilities are at higher risk of long-term implications for their cognitive, health, social, vocational, economic, and psychological well-being. These risks increase if the child is also living in poverty. Disabled children tend to have more health-related needs, along with social and environmental factors that prevent them from participating fully in society (Halfon et al., 2012). Children with disabilities experience higher rates of social-emotional issues, which have long-term implications for an increase in the risk of further disabilities being diagnosed, as well as links to poverty and Supplemental Security Income dependency (Lee et al., 2016). In addition, children with disabilities often show deficits in transition and career success and require interventions to increase self-determination (Moore & McNaught, 2014; Zheng et al., 2014). Childhood mental health issues along with other emotional and behavioral problems are also increasing as ADHD and other disabilities are becoming more prevalent (Currie & Kahn, 2012). Some research argues that disabled children are at a higher risk for criminal involvement than their able-bodied peers (Oshima et al., 2010). As of 2010, disabilities for youth within the juvenile justice system were estimated at 23.0% to 57.7%, which is significantly higher than youth in the general population which is estimated to be around 13% being within the system (Oshima et al., 2010). All these statistics provide evidence to the fact that children with disabilities experience more challenges than their able-bodied peers.

Parents and families of children with disabilities experience significant challenges in their efforts to meet their child’s growing needs. These families experience challenges with understanding their child’s needs and locating resources to help their child succeed. Most often, families are the strongest advocates for their disabled children, and children who have strong family support and advocacy are shown to receive higher quality care (Currie & Kahn, 2012). Many families experience barriers associated with locating adequate day care and learning programs that meet their child’s developmental needs and allows the parent to fulfill employment and family obligations (Rosenzweig et al., 2008). Challenges with adequate care and educational support affect the whole family dynamic.

Programs for Children With Disabilities

In an effort to support children with disabilities, several mandates have been implemented, including No Child Left Behind (NCLB), the Individuals with Disabilities Education Improvement Act (IDEIA), and the Every Student Succeeds Act (ESSA). IDEIA requires that every student with disabilities is provided a free and appropriate public education which may include an Individualized Education Program (IEP) and specially designed evidence-based instruction (Russo-Campisi, 2017). IEPs include the student’s current level of academic achievement and performance, goals and objectives, programs and supports, accommodations and modifications, assistive technology, behavior considerations, and statewide assessments (Center for Parent Information and Resources, 2017). Various early interventions are provided through IDEIA, and services include the family so they can understand and assist with their child’s development (Center for Parent Information and Resources, 2017).

Head Start for Children With Disabilities

Head Start is the largest federal early intervention and education program in the United States (U.S. Department of Health and Human Services [USDHHS], Office of Head Start, 2018). Head Start began in 1965 to promote school readiness for children in low-income families. The program offers a variety of services to serve the educational, nutritional, health, and social needs of its participants (USDHHS, Office of Head Start, 2018). The Head Start Act requires USDHHS to provide federal financial assistance to local public, nonprofit, and for-profit organizations to serve as Head Start agencies (42 U.S.C. § 9836(a)(1)) (USDHHS, Office of Head Start, 2018). In addition, federal law mandates that at least 10% of children enrolled by each Head Start agency are to be children with disabilities, as defined in the Individuals with Disabilities Education Act (IDEA; 42 U.S.C. § 9835(d)(1)). In 2018, 132,212 (12.8%) children who enrolled in Head Start had disabilities that were categorized in the IDEA (USDHHS, Office of Head Start, 2018).

Head Start has a number of regulations to ensure that children with disabilities are served in the best way possible. According to section 1310.22 of the Head Start policies and regulations, the program must comply with the Americans with Disabilities Act. Each agency must specify special requirements for children with disabilities including special pick-up and drop-off requirements, special seating requirements, special equipment needs, any special assistance, and special training for bus drivers and monitors. Section 1308.4 of the Head Start policies and regulations require that each child with a disability within the program must have an extensive disabilities service plan. These plans seek to ensure that the child will have their needs met and services will be modified accordingly for children with disabilities. An IEP is constructed with considerations of the child’s strengths. Furthermore, there is active location and recruitment regulation for children with disabilities to meet the 10% federal regulation. Parent participation and transition of children into Head Start and from Head Start into public school is regulated under section 1308.21. Some of the requirements under section 1308.21 regarding children with disabilities include supporting parents, informing parents how to foster the development of their child, providing follow-up assistance, accessing needs for the child, and building parent confidence, skills, and knowledge among other things to support the parent and ease transition (USDHHS, Office of Head Start, 2019).

Impacts of Early Intervention Programs for Children With Disabilities

NCLB led to improvement in academic achievement for students with disabilities. This includes more students with disabilities graduating with a standard diploma, more time spent in general education classes, and decreased dropout rates (Straus, 2015). Children with developmental disabilities who participate in early childhood special education show improved literacy skills before kindergarten (Pears et al., 2016). The Promoting Alternative Thinking Strategies (PATHS) curriculum is used in Head Start classrooms and is a curriculum for children aged 3 to 5 years and includes 44 lessons focusing on social emotional competence, problem-solving skills, self-control, prevention or reduction of behavior and emotional problems, and creating a positive classroom environment (Arda & Ocak, 2012). The Head Start Impact Study (HSIS) found positive cognitive and social-emotional outcomes at age 5 years among children who enrolled in Head Start at age 3 years (Puma et al., 2010). Zhai et al. (2011) found that Head Start had significant and consistent effects on improvement in children’s cognitive development at age 5 years, but the study did not distinguish between students with and without disabilities. Although Lee et al. (2016) discussed the outcomes for children with disabilities at age 5 years, this study did not investigate the outcomes at later ages. While evidence indicates short-term benefits to Head Start participation, there is little research investigating the long-term outcomes of Head Start participation solely on children with disabilities.

Other Factors That Effect Developmental Outcomes for Children With Disabilities

Children with disabilities are more likely to live in poverty or have material hardships (Parish et al., 2008; Shahtahmasebi et al., 2011). In addition, gender (Gray et al., 2012), race, maternal education, and other household characteristics (Baker et al., 2010; Cooper & Lanza, 2014; Sabol & Chase-Lansdale, 2015) may affect developmental outcomes for children with disabilities. Research indicates that early exposure to increased environmental risks for children with intellectual disabilities increases the risk of poor outcomes. When analyzing the effect of early education, it is important to note that family factors, such as parental education and employment, may enhance the impact of Head Start on social-emotional outcomes (Lee et al., 2016; Love et al., 2005). In addition, while some research shows that Head Start has little overall impact on developmental outcomes, looking at other factors indicates that Head Start has a larger impact on children at the lowest skill levels (Bitler et al., 2017). For example, although the overall effects on cognitive skills have been shown to fade away by the first grade, these effects persist for Spanish-speaking children.

In sum, there is a need to examine the long-term impact of Head Start on children with disabilities in the ecological context by considering various factors, such as child and family contextual aspects. The purpose of the current study is to determine long-term impacts of Head Start on children’s cognitive developmental outcomes using the nationally representative HSIS data. Specific research questions for this study are: (a) Do children with disabilities who enroll in Head Start at age 4 years have better cognitive outcomes when they are 4 to 9 years old? (b) Are there other factors associated with long-term cognitive development for children with disabilities?

Target Sample

The HSIS Phase 1 and Phase II data were obtained through the Child Care and Early Education Research Connections, provided by the Inter-University Consortium for Political and Social Research (ICPSR). Within the HSIS data (n = 4,442), at the beginning of data collection in 2002, 570 children who were reported to have disabilities documented by parents, teachers, and doctors were selected for the current study sample. To determine effects of the same duration of Head Start enrollment, children who entered Head Start at age 4 years and enrolled for 1 year were selected for the target sample for this study. Children who entered Head Start at age 3 years (n = 292) had different durations of Head Start enrollment because they could enroll for either 1 or 2 years. Thus, children who were at age 4 years with documented disabilities and who were eligible for Head Start were selected for the target sample to estimate the effects of 1 year of Head Start enrollment (n = 278).

Measures

Findings for Research Question 1: Effects of Head Start Enrollment and Children’s Age

As shown in Table 2, as children became older, there were significant differences in cognitive test scores between Head Start and non-Head Start children. More specifically, Figure 1 indicates that compared with non-Head Start children, Head Start children had higher applied problem-solving scores at age 4 years (76.2 vs 81.2, p < .05) and at age 6 years (88.9 vs 92.3, p < .05). Similarly, as shown in Figure 2, Head Start children scored significantly higher on PPVT test at age 4 years (85.0 vs 87.3, p < .05) and at age 6 years (82.5 vs 85.7, p < .01) than non-Head Start children. Figure 3 indicates that children who attended Head Start also had higher word recognition scores at age 5 years (89.9 vs 93.2, p < .10) than non-Head Start children. Head Start children did not differ from non-Head Start children for all cognitive outcomes (applied problem-solving, PPVT, and word recognition) measured at age 9 years.

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Table 2.

Parameter Estimate, Standard Error, and 95% Confidence Interval Predicting Effects of Head Start Enrollment on Cognitive Outcomes.

Variables	Applied problem-solving	Word identification skills	PPVT
Intercept	86.14***	83.17***	88.80***
	3.35	3.27	2.24
	[79.55, 92.74]	[76.75, 89.59]	[84.38, 93.22]
Gender (1 = female, 0 = male)	0.81 ns	−1.92 ns	0.47 ns
	1.32	1.28	0.88
	[−1.78, 3.41]	[−4.44, 0.60]	[−1.27, 2.21]
Race
White (1 = yes, 0 = else)	3.72*	−2.04 ns	2.07 †
	1.80	1.76	1.22
	[0.19, 7.26]	[−5.85, 1.08]	[−0.32, 4.47]
Black (1 = female, 0 = male)	−3.66 ns	−2.95 ns	−4.25**
	2.22	2.18	1.50
	[−8.03, 0.71]	[−7.22, 1.32]	[−7.20, −1.30]
Hispanic	Reference	Reference	Reference
High academic skills prior to Head Start (1 = yes, 0 = else)	14.88***	11.67***	4.60***
	1.36	1.32	0.91
	[12.21, 17.55]	[9.08, 14.26]	[2.81, 6.39]
Household risk factors
Lowest risks	1.41 ns	3.40 ns	2.71 †
	2.30	2.26	1.56
	[−3.11, 5.93]	[−1.04, 7.83]	[−0.37, 5.79]
Moderate risks	−0.08 ns	0.01 ns	0.75 ns
	2.51	2.47	1.72
	[−5.04, 4.86]	[−4.87, 4.85]	[−2.62, 4.13]
Highest risks	Reference	Reference	Reference
Non-English speaking at home	−4.28*	−7.14***	−11.53***
	2.13	2.04	1.41
	[−8.48, −.086]	[−11.14, −3.14]	[−14.29, −8.76]
Living in urban area (1 = yes, 0 = else)	−0.15 ns	3.56*	2.20 †
	1.73	1.71	1.18
	[−3.56, 3.25]	[0.22, 6.91]	[−0.12, 4.52]
Total family income	0.09 ns	0.45 ns	0.20 ns
	0.56	0.55	0.38
	[−1.01, 1.18]	[−0.63, 1.53]	[−0.55, 0.95]
IEP	1.30 ns	2.01*	0.23 ns
	0.94	0.86	0.56
	[−0.55, 3.15]	[0.32, 3.70]	[−0.88, 1.33]
Interactions: Head Start × Age
No Head Start × Age 4 years (early)	−11.49***	−6.34***	−2.67*
	1.74	1.58	1.04
	[−14.91, −8.07]	[−9.45, −3.23]	[−4.72, −0.62]
Head Start × Age 4 years (early)	12.22***	3.89**	1.64*
	1.47	1.29	0.81
	[−15.11, −9.32]	[−6.43, −1.35]	[−3.23, −0.04]
No Head Start × Age 4 years (later)	−16.77***	−4.66**	−2.44*
	1.94	1.72	1.16
	[−20.58, −12.96]	[−8.03, −1.29]	[−4.71, −0.16]
Head Start × Age 4 years (later)	−11.91***	−2.09 ns	−0.12 ns
	1.48	1.28	0.82
	[−14.83, −8.98]	[−4.60, 0.42]	[−1.73, 1.50]
No Head Start × Age 5 years	−9.86***	2.40 ns	−1.46 ns
	1.76	1.69	1.23
	[−13.32, −6.40]	[−.92, 5.72]	[−3.89, 0.97]
Head Start × Age 5 years	−8.69***	5.67***	−0.22 ns
	1.29	1.21	0.85
	[−11.23, −6.15]	[3.29, 8.05]	[−1.88, 1.45]
No Head Start × Age 6 years	4.29*	5.43**	4.89***
	1.72	1.72	1.14
	[−7.67, −0.91]	[2.06, 8.81]	[−7.14, −2.65]
Head Start × Age 6 years	0.80 ns	6.72***	1.68*
	1.16	1.21	0.72
	[−3.07, 1.48]	[4.52, 8.92]	[−3.09, −0.26]
No Head Start × Age 9 years	2.32 ns	0.12 ns	0.55 ns
	1.78	1.71	1.16
	[−5.83, 1.19]	[−3.50, 3.25]	[−2.83, 1.73]
Head Start × Age 9 years	Reference	Reference	Reference

Note. IEP = Individualized Education Program; PPVT = Peabody Picture Vocabulary Test.

†

p < .10. *p < .05. **p < .01. ***p < .001.

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Figure 1.

Interaction effects between children’s age and Head Start enrollment on children’s applied problem-solving skills.

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Figure 2.

Interaction effects between children’s age and Head Start enrollment on children’s Peabody Picture Vocabulary Test scores.

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Figure 3.

Interaction effects between children’s age and Head Start enrollment on children’s word identification skills.

Findings for Research Question 2: Other Factors Affecting Outcomes for Children With Disabilities

Compared with Hispanic children, White children had higher applied problem-solving scores (β = 3.72, p < .05). Black children had lower PPVT scores (β = −4.25, p < .01) than Hispanic children. Children who had higher preacademic skills prior to attending Head Start were likely to have higher applied problem-solving scores (β = 14.88, p < .001), higher word recognition scores (β = 11.67, p < .001), and higher PPVT scores (β = 4.60, p < .001). Children who had lower household risk factors had marginally higher PPVT scores than who had high household risk factors (β = 2.71, p < .10). Children who did not speak English at home scored lower applied problem-solving scores (β = −4.28, p < .05), lower word identification skills (β = −7.14, p < .001), and lower PPVT test scores (β = −11.53, p < .001) than those speaking English at home. Children with disabilities living in urban area had higher applied problem-solving scores (β = 3.56, p < .05) than those living in rural area. Children with IEP had higher word identification scores (β = 2.01, p < .05) than those without IEP.

Limitations

The current study did not consider types or quantities of disabilities for students. It might be possible that children with one disability may benefit more from Head Start when compared with children who have a different disability. Some subgroups of children with multiple disabilities may benefit more or less from Head Start. In addition, overall quality of Head Start has been regarded higher than other types of nonparental child care due to extensive funding (Currie & Neidell, 2007) and strict program mandates. However, the services and programs Head Start offers for children with disabilities might differ across Head Start sites due to quality variance within Head Start programs (Peck & Bell, 2014). Rather than utilizing macro policy analysis based on a nationally representative data set, a future study that captures various aspects of disabilities and focuses on specific Head Start program implementations might be more helpful to many families and practitioners who work with children with disabilities. However, the HSIS data that the current study used provide longitudinal cognitive outcomes for children with disabilities measured at five time points, from ages 4 to 9 years, based on individual assessment. This advantage is rare and makes this study unique and significant for the well-being of children with disabilities.

Role of Social Workers for Children With Disabilities

Social workers play an important role in addressing the long-lasting Head Start effects on children with disabilities. Reflecting on the significant progress children make while in Head Start, micro social workers should continue to support students throughout elementary school in a similar manner. The process of navigating through the various services and eligibility criteria can be challenging for parents who transition from involved early education programs to crowded and faster-paced upper education systems. During early intervention programs, social workers are often directly involved in planning and providing services to disabled children and their families (Rosenkoetter et al., 2007). The social worker should connect the child and family to another social worker who will take over after the transition to K–12 schools. In addition, social workers should continue to encourage active involvement from the family members to ensure their input is included within the child’s plan and services. Macro social workers should advocate for inclusion of all children in extracurricular programs so that disabled and nondisabled children can continue to develop their full potential in and outside the classroom. Furthermore, macro social workers should advocate for the expansion of Head Start to include more children disabilities.

Implications to Practice

In conclusion, while the long-term impacts of Head Start on children with disabilities are still being studied, there is no question of the short-term benefits on improved cognitive growth. Implementing new strategies for Head Start services that include more involved transitions to primary education settings may help to increase the long-term positive impacts of Head Start. Social workers should increase their involvement in IEP early interventions, as well as seek more input and involvement from families throughout the IEP process. Finally, schools should strive to offer more culturally competent services, especially for Black, Hispanic, and non-English speaking students with disabilities who are less likely to receive quality services.