While early intervention programming is not new in North America, such programs have gone through a rapid expansion in recent years. This has been motivated by the recognition of the need for timely intervention, the development of a family rather than a child focused practice philosophy and the desire on the part of funding organizations to save money by promoting less expensive programming. This article reviews the various components of early intervention programmes in North America while also questioning aspects of current practice. There is a clear need for family-centered intervention. This should not be in question. However, the fundamental question should not be whether family centered intervention is necessary but rather how can empirical research inform best practices? It is the conclusion of the authors that this will be the key challenge in the coming years.