There is a growing body of philosophical, legal, and empirical support for integrated preschool programs. Yet, many young children with moderate to severe disabilities are not successfully integrated into regular preschool classes. An impressive body of literature highlights the value of integration for children with disabilities. Unfortunately, much less information is available on specific strategies for accomplishing this goal. This may be due, in part, to the difficulty in operationalising educational policies such as least restrictive environment and integration. This paper identifies a continuum of instructional strategies that promote the entry of young children with moderate to severe disabilities into regular preschool classrooms. The continuum is based on the concept of ‘power.’ Power judgements assess the relationship between the cost of a strategy (e.g. staff time, extra resources, potential for negative side effect, etc.) and its potential benefit. Effective power judgements result in the use of strategies that are likely to produce the desired effect with the lowest expenditure to effort, resources, and disruption of teachers and children.

This study examined the effects of simulation training and a prompt hierarchy on the acquisition of self-catheterization skills by a 4-year-old male with myelomeningocele. Training was conducted in the subject's preschool setting. The child was first taught to perform clean intermittent catheterization on a doll, then on himself. Catheterization skills were identified through task analysis. The skills were clustered into three tasks of diapering, cleansing, and catheterization. Edible reinforcers were used to reward the child for self-catheterization skills performed to criterion. Results of a multiple baseline design across tasks showed that simulation training and the prompt hierarchy facilitated acquisition of clean intermittent catheterization.Myelomeningocele (also referred to as spina bifida or meningomyelocele) is a midline defect of the skin, spinal column, and spinal cord (Wolraich, 1983). During a normal pregnancy, the spinal cord forms into a straight column covered first by membranes (meningo-) and then a bony spine. Myelomeningocele develops during the fourth to fifth week of pregnancy, when the spinal cord (myelo-) and vertebrae around it fail to develop into a tubular structure (Korabek & Cuvo, 1986), the spinal cord pouching out into the membranes and through the defect in the vertebrae into a sac (-cele) on the back. Two other types of open spine defects are meningocele and spina bifida occulta. In meningocele, only the membranes surrounding the spinal cord pouch out. In spina bifida occulta, the site of the defect is internal and involves only the bony vertebrae (Korabek & Cuvo, 1986; Wolraich, 1983).Myelomeningocele is one of the most common birth defects in the United States, occurring in one to two babies out of every one thousand live births (Wolraich, 1983). The exact cause is, as yet, unknown. Because myelomeningocele does not progress, it is considered static. However, several health problems often accompany this condition. Approximately 80% of infants with myelomeningocele have hydrocephalus (Apgar & Beck, 1972; Lorber, 1978; Swinyard, 1980; Wolraich, 1983), a condition in which cerebrospinal fluid cannot leave the brain and be absorbed into the bloodstream. As a result, pressure builds, causing brain damage and mental retardation. Early detection is essential so that brain damage can be prevented by surgical