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General Comments

The results of the present study can be incorporated in the following way. Simeonsson et al (1982), proposed that although there is empirical evidence for effectiveness of early intervention in 48% of the studies reviewed, this is in fact an underestimation. Effectiveness may in fact be closer to the 93% figure derived from the conclusions of contributors to this research area. In support of this hypothesis, the following explanations are proposed: (1) Handicapped children made progress but statistical significance was not obtained, given limited sample sizes. (2) Children made progress but it occurred in domains not measured by the dependent variables. For example, a child's behaviour or style or response may have improved but was not documented. Furthermore, maintenance of a certain level of development, or prevention of regression, may also be reflective of success but not recorded. (3) Children made no discernible progress in developmental domains but improvement was noted in management areas (e.g., seizure control, feeding, etc.). (4) Children made no discernible progress but improvement occurred in dimensions not specific to the child (e.g., family or sibling adjustment).

In order to verify the belief that intervention is in fact effective more frequently than the evidence suggests and to contribute to the improvement of future accountability efforts, two strategies for documentation are proposed. The first is concerned with methodology and the second is conceptual in nature.

From a methodologic point of view, systematic consideration needs to be given to problems of comparing treatment effects. Ethically, control groups are difficult to justify. The use of a contrast treatment also needs to be carefully considered in as much as it may in actuality not differ from a control condition if the treatment is minimal, and thus raises the same ethical problem as control groups. On the other hand, if the contrast group is in fact a genuine alternative treatment, generalizations based on comparisons between experimental and contrast groups can be confounded. The lack of significant differences between an experimental and a contrast group may indicate that both groups improved or that neither improved relative to the other over time. Given the nature of documentation found in the preceding review, such distinctions would be difficult to make. Further rnethodologic concerns include documentation of inter-rater reliability and details pertaining to subject variables.

The methodologic issues considered above assume that the evaluation of effectiveness should be based on empirical evidence. Although this is an


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