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A discussion of early intervention for infants with down syndrome.

Recently, a physician-colleague brought to our attention an article entitled, "Early Intervention for Infants with Down Syndrome: A Controlled Trial," by Piper and Pless.1 Although it is encouraging to find that these investigators are exploring the parameters of early intervention with handicapped infants, some of their conclusions are of concern and have prompted the formulation of a response. In particular, we would like to discuss this article's findings in relation to (1) existing efficacy data that suggest early intervention with young handicapped children may be effective; and (2) methodologic weaknesses in the research design employed by Piper and Pless.
 A critical problem currently confronting the field of early intervention is the evaluation of the effectiveness of early programming for handicapped infants and their families. Major impediments to the documentation of program effects include the unsuitability of existing instrumentation for assessing the progress of handicapped infants and the scarcity of feasible evaluation research designs.2,3 To complicate matters further, randomly assigned control or untreated groups for comparison are rarely possible. Ethical concerns surrounding the withholding of services from infants assigned to control groups, coupled with recent state and federal mandates calling for the provision of educatinal services for all handicapped children of school age and permissive programming for the preschool child, are collectively operating to reduce and eventually eliminate available handicapped infants and children who might serve as non-intervention control subjects.4
 Despite the design limitations associated with research involving young handicapped children, efficacy findings based on descriptive and quasi-experimental methodology do exist.