Journal of Child Psychology and Psychiatry 51:12 (2010), pp 1297–1299
Editorial: Early prevention and intervention –
the Five W (and one H) questions
I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
(R. Kipling, 1902)
Wallace and Rogers (2010) identified four main
ingredients for successful prevention and interven-
tion studies. Trained as a researcher and a clinician
according to the Boulder scientist-practitioner model
(Raimy 1950, also see Davison, 1998) and writing
this editorial in Boulder, my immediate association
to the four ingredients was: four ingredients – five W
questions…and Kipling’s little poem.
In any good science and clinical work, the five W
and one H questions are imperative and in early
prevention and intervention work, maybe even more
so. Why early prevention and intervention? To
enhance the well-being of all those involved: the
children, their families, communities and society in
general on all realms. For Who and by who? For
those who need it! The term early, usually refers to
children between the ages of 0–6 years. Yet who
determines who needs it, and who is, or is not eligible
to receive it? Or who needs more or less in terms of
duration and intensity? There are no simple answers
to these questions especially when resources are
limited. Whom does it involve? Just the child? The
parents? Who are the professionals? Are parents
included as co-interveners? What kind of early pre-
vention and intervention programs? What are the
targeted skills? What are the targeted domains of
development? What kind of a relationship exists
between the service provider/s and the family? How
are the prevention and intervention programs deliv-
ered? How is the relation between the service pro-
viders and the family affecting the attained or
unattained goals? Is the prevention or intervention
program evidence based? Are there manuals? Is
there also enough freedom for creativity and for truly
tailoring the program for the unique needs?
When? As early as possible! When is the earliest?
For some children it is as soon as they are screened
or diagnosed with a certain risk marker or condition,
which necessitates intervention. For other children,
early may mean for example, as early as space per-
mits, or as early as the professional makes a referral
or as early as their parents are willing to engage in
early prevention or intervention programs. And
finally, Where? Some prevention and intervention
studies are carried out at the homes, some at the
 2010 The Author. Journal of Child Psychology and Psychiatry
 2010 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA
doi:10.1111/j.1469-7610.2010.02344.
educational placement of the child, some at hospi-
tals, some outdoors and some in multiple settings.
The answer to the where question optimally depends
on the specific needs of the child and her family but
at times may be the best possible place at any given
time.
Combined, these questions present even greater
challenges as we proceed to ask What works best for
Whom? Why? How? When and Where? This special
section offers answers to some of these questions. It
represents a truly international research effort,
including studies conducted in Australia, Canada,
England, Ukraine and the USA and researchers from
even a larger number of countries. The papers
address many aspects of the five W (and one H)
questions and as a body of work clearly demonstrate
the benefits of early screening and intervening.
The first two papers address early intervention in
the field of autism. With the growing incidence of
autism spectrum disorders (ASD) and our ability to
diagnose it earlier and earlier, professionals have
been facing the challenge of providing evidence-
based treatments for younger and younger children
who have the condition, as well as developing pre-
ventive measures for those who are at risk for it. In
the first paper in this issue, Wallace and Rogers
cleverly point out that investigators do not need to
reinvent the wheel when designing early prevention
and intervention programs for young children with
ASD. Based on previous intervention studies with
infants born prematurely, infants at risk for intel-
lectual disabilities and infants with developmental
delays (other than autism), these authors review the
existing methodologically sound studies using the
guidelines provided by Nathan and Gorman (2002)
and identify the main ingredients for a successful
intervention program and its evaluation. These
ingredients include parent involvement; tailoring the
intervention to the specific needs of the child and
family; focusing on a broad range of developmental
targets; and providing early, intense interventions
for a long duration. Once the main ingredients are
identified, Wallace and Rogers offer an excellent
discussion of the implications for research in early
intervention for ASD. They point out the need for
studies in which specific intervention variables are
examined in relation to intervention characteristics
such as specific versus general developmental
intervention and intensity and mode of delivery of
the intervention.
One of the main ingredients is delivering the
intervention as early as possible. Yet, too often,
1298 Editorial
waiting lists prevent an early start of an intensive
program. Therefore, Coolican, Smith and Bryson
(2010) examined whether parents can be trained in
the interim to provide Pivotal Response Treatment
for their young children with ASD. Their data nicely
revealed that indeed three sessions of two hours of
parent training were associated with positive out-
comes in children’s functional verbal utterances and
responsivity, with all parents reporting on these
positive changes. The parents improved in their
skills of delivering the intervention over time. More-
over, the increase in parental skills of delivering the
intervention was associated with an increase in
functional language utterances and responsivity by
the children. These findings are encouraging in
revealing that brief parent training can provide an
immediate cost-effective intervention that can be
adopted widely.
Remaining with parental implemented programs
but with a different sample – a high-risk, multi-
ethnic group in an inner-city London borough, Scott
et al. (2010) examined the efficacy of the Primary Age
Learning Skills (PALS) trial, an evidence-based par-
enting group program on parent–child relationship
and literacy. The program involved 18 sessions, of
which 12 were dedicated to parent–child relationship
and six to literacy. About 30% of the allocated fam-
ilies for the intervention did not attend at all and the
mean attendance was 4.8 sessions. The data nicely
demonstrated that after one year, at follow-up, even
with such a low attendance rate, the intervention
specifically contributed to more optimal parent–child
relationships (e.g., more praising, less negative
affect), but not to reducing children’s behavior
problems and improving their literacy compared to
the usual social services offered. These findings
suggest that the intervention in this population has a
positive impact and that the literacy component was
probably just not intense enough, thus pointing to a
need for more comprehensive programs, which as
suggested by Wallace and Rogers involve multiple
developmental domains for intervention.
Havighurst, Wilson, Harley, Prior, and Kehoe
(2010) conducted a 6 month follow-up evaluation of
The Tuning in to Kids (TIK) intervention program, a
6 sessions parenting-group program (targeting
parents’ own emotion awareness, regulation, and
communication in parent–child relationship). Par-
ticipants were the primary caregivers of young chil-
dren from lower to middle class areas in Melbourne,
evaluated at three time points: pre-, post- and at
follow up. Results indicated that parents in the
intervention group showed more emotion couching
and empathy at time 2 and 3, whereas the compar-
ison group did not change. Furthermore, children
whose parents were in the intervention group
showed better emotional knowledge and were
reported by their teachers and parents as having
fewer behavior problems at time 3 compared to
children whose parents were in the comparison
Journal of Child Psychology and Psychiatry  2010 Association for Child and Adolescent Mental Health.
group. Thus, TIK is a promising addition to available
parenting programs.
Moving on into early assessment of risk, Jee et al.
(2010) examined the utility of two screening ques-
tionnaires among children in foster care: the Ages
and Stages Questionnaire–social-emotional (ASQ:
SE) and the more broad Ages and Stages Question-
naire (ASQ). All children were from the medical
home practice for children in foster care in Roches-
ter, New York. The findings were clear in that the
more specific social-emotional screening tool ASQ-
SE was more sensitive than the more general ASQ
and improved the detection rate of social-emotional
problems (six-fold increase) compared to regular
provider surveillance. The findings that toddlers and
pre-school-aged children presented more potential
social-emotional problems than infants emphasizes
the need for early screening and intervention as
suggested in the Rogers and Wallace aforementioned
review.
Geoffroy et al. (2010) examined the contribution
of early childcare to the cognitive development of
socially disadvantaged children. This report is part
of the Quebec longitudinal study (QLSCD) in which a
representative sample of infants was followed from
infancy with the current study evaluating school
readiness at age 6 years and first grade achieve-
ments in receptive vocabulary, mathematics, and
reading at age 7 years. Children of mothers with low
level of education scored significantly lower on
readiness and academic tests, unless they previ-
ously received early formal childcare. Furthermore,
among children of mothers with low level of educa-
tion, those who received early formal childcare
scored higher on all measures compared to those
with parental care. Interestingly these findings held
only for mothers with low level of education in that
childcare participation (formal, informal and paren-
tal) was not associated with cognitive outcomes
among children of mothers with higher levels of
education, pointing to the increased risk that
children of mothers with low levels of education are
facing.
Finally, Dobrova-Krol, Bakerman-Kranenburg,
Van-Ijzendoorn and Juffer (2010) examined a group
of HIV-infected children and a comparison group of
uninfected children, with about half of each group
residing in institutions and the other half in family
homes. The results were clear in that more than 40%
of the institution-reared children did not exhibit a
clear attachment pattern, and that institutional
care, but not HIV infection status, was associated
with lower levels of attachment security and higher
levels of indiscriminate friendliness. The findings
that higher indiscriminate friendliness was related to
higher levels of positive care among the institution-
reared children suggest once again that the same
behavior may have different connotations in different
environments and that for those children who live in
institutions, indiscriminate friendliness is actually
 2010 The Author

an adaptive behavior, which elicits care-giving
behaviors.
The current studies make an important contribu-
tion to the field of early prevention and intervention.
I thank the contributors for choosing this special
section as an outlet for their excellent work. I look
forward to a future in which many more Why, Who,
What, When, Where and How questions in the
context of early prevention and intervention will be
addressed by scientists and practitioners devoted to
changing the life trajectory of young children and
enhancing their well-being wherever they may live.
Nurit Yirmiya
References
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Journal of Child Psychology and Psychiatry  2010 Association for Child and Adolescent Mental Health.
Editorial 1299
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