Parent Training and Coaching

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Early intervention SLPs know that we have the biggest impact on our clients’ communication skills by supporting their caregivers—the people who are with them all the time, not just for one or two brief sessions per week—to deliver interventions and use strategies themselves, all day long. We train, we model, we coach, and we hope for the follow-through. But what parent-delivered interventions are effective? Which strategies are parents most likely to learn and run with? How much training is enough? How is that training best delivered?

We need to know the research!

The five research study reviews below all specifically address communication interventions via parent training, for a variety of disability types (Developmental Language Disorder [DLD], hearing loss, autism, and multiple challenges) and communication targets, getting at just those questions we need answered. Need to shake up your routine? You’ll also read about novel service-delivery methods, including online and group trainings.

Pay attention to the terms the researchers use for simple strategies you already do, probably unconsciously. Did you realize you were teaching “linguistic mapping,” or using the POWR method? While we need to be wary of losing ourselves in professional jargon, especially when working with families, there are times when a cool-sounding name has real value—like empowering parents with the thought that they are “doing therapy” when they play with their kids!

 

Training parents to support children with developmental language disorder

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As SLPs working in EI, we know that developmental language disorder presents risk for later academic skills. We also know that parent-implemented language interventions can be effective (see Roberts & Kaiser, 2011, for a meta-analysis of parent-implemented language interventions). This study examined whether parent-implemented Enhanced Milieu Teaching (EMT) would impact receptive and expressive language growth in children with language disorder (with cognitive standard score > 80 and no other primary diagnoses; see article for full inclusion/exclusion criteria).

The researchers examined three groups of 24–42-month old children:

  • Typical language

  • Language disorder w/ no treatment, or a “wait-and-see” approach

  • Language disorder w/ parent-implemented Enhanced Milieu Teaching

Families in the treatment group participated in 28 training sessions (workshops, clinic, and home visits) over a three-month period. EMT strategies were trained in four phases: 1) setting a communicative context, 2) modeling and expanding communication, 3) time delay strategies, and 4) prompting strategies (see Table 5 for examples and description). During training at the clinic, therapists and parents practiced strategies using a specific set of toys. Home visits also included integrating strategies into functional family routines such as snack. All children were assessed with monthly language samples (MLU, total words, different words) plus the Preschool Language Scale, Fourth Edition (PLS-4), at the beginning and end of the study.

So what happened? Parent-implemented EMT was effective for improving language outcomes for children with LI, and parents in the treatment group used significantly more strategies than either other group! Parent use of strategies for typically-developing children and those with language disorder undergoing “wait and see” were about the same.

Children whose parents used EMT:

  • significantly improved their PLS-4 Total and Expressive Communication scores and gained an average of 50 more words than untreated children with language disorder

  • gained an average of 15 more words per month compared to untreated children with language disorder

  • grew at about the same rate as children with typical language

Fantastic, right? But what about the kids with language disorder undergoing a “wait and see” approach? They showed significantly slower growth. Not only did those “wait and see” kids start out with lower language abilities, it looks like “waiting and seeing” might just hold them at a disadvantage when compared to those who have access to intervention. The authors stated, “Children in the LI-control group did not catch up but fell farther behind their peers with TL.”

How about a little extra info? The authors also looked at which child characteristics predicted language growth and outcomes. They examined risk at birth (e.g., a NICU stay), cognitive skills, and receptive skills (based on the Bayley-III scores). Risk at birth and cognitive skills were not predictive of expressive language analyses performed. However, “Receptive language at the start of the study predicted growth in language for all three groups of children after controlling for differences in IQ.”

The authors note that more research is needed to determine long-term outcomes. For example, how would these children progress over a period of 12 months? What kind of gains would come from 28 hours of traditional therapy in 3 months? Overall, parent-implemented EMT looks to be a promising model to add to our intervention options for young children with developmental language disorder.

Note: For our bilingual SLPs, see Peredo, Zelaya, & Kaiser, 2017 for a study on adapting parent-implemented EMT for Spanish-speaking families.

Roberts, M. Y., & Kaiser, A. P. (2012). Assessing the effects of a parent-implemented language intervention for children with language impairments using empirical benchmarks: A pilot study. Journal of Speech, Language, and Hearing Research. doi: 10.1044/1092-4388(2012/11-0236).

Imitation: a simple and powerful strategy for parents of toddlers at-risk for ASD

While we all know that involving parents in early intervention for toddlers with ASD is important, knowing where to start can be another matter altogether. What if there was one simple and effective strategy that we could teach parents right off the bat--one they could master easily with a big impact? Imitation might fit that bill.

Imitation is a strategy you already have in your toolbox: it’s as simple as copying what a child says or does. It’s been researched in different forms for decades, and it belongs to a family of strategies called “responsive” language strategies. Other responsive strategies include following the child’s interests, avoiding questions and directions, and responding to his communication attempts.

The great thing about imitation as a strategy is that it naturally incorporates many components of other responsive strategies. If a parent is imitating his child, then he is probably following his child’s interests, reducing the number of questions he asks, and paying more attention to how his child is communicating. If we teach parents to imitate, maybe we won’t need to explicitly teach the other responsive strategies!

These researchers did a small study in which they taught three parents of toddlers with ASD* to imitate their children’s actions, gestures, and words (the format of the sessions is fully described in the article!) Generally speaking, the sessions had these components:

  1. The therapist reviewed the parent’s questions or concerns that had come up since the previous session.

  2. The therapist explicitly taught the parent about why imitation is important and how to use it.

  3. The therapist played with the child and pointed out when she imitated the child.

  4. The parent played with the child while the therapist provided the parent with constructive coaching and feedback.

  5. The therapist summarized the session and answered the parent’s questions. 

The results showed that all three of the parents were able to master the imitation strategy, and all three children made improvements in their social eye gaze. An extra cool bonus? As parents started imitating their children, the number of questions and directions they gave naturally decreased without the therapist explicitly instructing them to do so. Talk about getting some great bang for your buck! Imitation shows promise of being a simple and efficient “first strategy” to teach parents.

*or suspected ASD 

Killmeyer, S., Kaczmarek, L., Kostewicz, D., & Yelich, A. (2018). Contingent Imitation and Young Children At-Risk for Autism Spectrum Disorder. Journal of Early Intervention. doi:10.1177/1053815118819230.

 

Parent training: Supporting complex communication needs

Many early intervention centers are moving from a direct therapy model to a parent training/coaching model. This shift in philosophy can be challenging for many therapists, especially those who have heard “all you do is play!” from parents a few too many times. Teaching our intricate strategies to a parent with no background in language development is not easy!

Douglas et al., sheds some light on effective parent training and coaching. The study included four children with complex communication needs, multiple developmental areas impacted. At baseline, parents struggled to provide communication opportunities and often did not give adequate wait time. Parents then participated in training sessions based on the POWR method which involved the following steps:

  1. Prepare” a developmentally appropriate activity

  2. Offer opportunities for communication” (e.g. giving choices, asking questions, commenting)

  3. Wait for the child’s communication” (at least 5 seconds)

  4. Respond” appropriately to child’s communication

The best part of this training? It was all provided online. Parents participated in the training by watching videos on various modules on their own time. Their skills were then assessed in person. Do you see kids at daycare? Do you work with kids whose parents clean the kitchen during therapy? Of course you do. Providing training for parents to watch on their own time might motivate them to become more involved in their child’s communication. 

After receiving this online training parents increased their communication opportunities provided to the child and increased their responses to the child’s communication. The children also showed increased communicative attempts. Parent feedback indicated that they would prefer to have in-person coaching sessions to go along with the online trainings (us too!), as well as more video examples of strategies being implemented. This is definitely something to consider if you’re working with a parent training model for your EI students.

Douglas, S. N., Nordquist, E., Kammes, R., & Gerde, H. (2018). Online parent training to support children with complex communication needs. Infants & Young Children. doi: 10.1097/IYC.0000000000000101.


Parent training: Vocabulary growth for toddlers with hearing loss

Toddlers with hearing loss do not gain vocabulary at the same rate as toddlers with normal hearing. Some of the reasons for this delay are out of our control as therapists. We cannot change a child’s speech perception or the age at which the child received amplification. What we can do is manipulate the child’s environment to promote vocabulary growth.

Lund trained six parents of toddlers with hearing loss in two strategies: transparent naming and linguistic mapping.

Transparent naming is using a new vocabulary word while visually signaling (pointing) to the referent. This has been found to increase children’s vocabulary skills (groundbreaking, I know).  All six parents were able to increase their use of transparent naming with just two 45-minute training sessions.

Linguistic mapping is a little more complex. It involves overlaying words on a child’s communicative act after that child has initiated intentional communication. This is not simply narrating the actions of a child. It requires the communication partner to correctly interpret a child’s communicative attempt and quickly generate an appropriate utterance to go with it.  Only half of parents were able to adequately demonstrate linguistic mapping after two training sessions, which suggests that a little more time might be needed to teach parents this particular skill.

After training sessions were completed, four out of six children increased their rate of word learning. If you have any tots on your caseload with hearing loss, or who are struggling with word learning, you might consider training parents in transparent naming and linguistic mapping.

Lund, E. (2018). Effects of parent training on vocabulary scores of young children with hearing loss. American Journal of Speech–Language Pathology. doi: 10.1044/2018_AJSLP-16-0239


Facilitating parent–child playgroups: A how-to guide

Most of us early interventionists work with families one-on-one. But how great would it be to facilitate a parent/child playgroup? Not only could you work with multiple children at once, but you could also connect families going through similar experiences. Green et al. investigated a specific type of playgroup geared toward enhancing parent interaction in communication (referred to as EPIIC) playgroups.

The EPIIC playgroup was structured like a typical morning preschool session. They did a hello song, a play activity, story time, and snack. They also built in time to address each child’s individual IFSP goals. Each playgroup session had a different theme, such as “what makes me learn to love books” and “what makes me laugh.”

Instead of the teacher or SLP leading the group, the parents worked directly with their children while being coached by the SLP. For instance, the SLP might model a page or two of shared book-reading, and then let the parent take over. The SLP facilitates the session, while parents interact with their child, learn new strategies, and meet other parents in their same boat!

After seven playgroup sessions, all children demonstrated increased communication skills. All of the parents improved their use of communication strategies with their children. Informally, parents reported being very happy with the playgroup, and felt that they learned new strategies and gained knowledge. The EPIIC playgroup model seems like a pretty epic way to deliver evidence-based services to families. Get it?

For a specific breakdown of the playgroup schedule and a full list of the topics used, be sure to check out the original article here.

Green, K. B., Towson, J. A., Head, C., Janowski, B., & Smith, L. (2018). Facilitated playgroups to promote speech and language skills of young children with communication delays: A pilot study. Child Language and Teaching. doi: 10.1177/0265659018755525.


Teaching parents to break into their child’s world

Young children with ASD and their parents face a unique set of challenges when it comes to language acquisition. Children with ASD tend to initiate less, have trouble responding to parent gestures like gaze and pointing, may have limited interest in objects, and demonstrate perseverative play.

Venker et al. (2012) trained parents of children with ASD in various types of verbal responsiveness. Parents participated in SLP-led education sessions and several individual and small group parent/child coaching sessions. Parents in the treatment group showed a significant increase in their use of the strategies at the conclusion of the study, compared to parents who were in a delayed treatment group.

So, what actually works for young children with ASD? The strategies below:

 
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These methods have documented evidence supporting their use with children with ASD. And this study found that parents can easily learn them. Following this study, children showed increases in prompted communication acts and non-verbal communication. For parents new to the world of ASD, these strategies are a great place to start.

Venker, C.E., McDuffie, A., Weismer, E. S., & Abbeduto, L. (2012). Increasing verbal responsiveness in parents of children with autism: A pilot study. Autism. doi: 10.1177/1362361311413396.


What about putting parent training online?

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Douglas et al. took communication partner training strategies that already have a good evidence base (see Kent-Walsh & McNaughton, 2005 and Douglas et al., 2014), and hosted them online for parents of young children with autism. They employed, “online interactive components to teach parents a communication strategy, as well as live practice sessions during which parents implemented the strategy, had an opportunity to ask questions, and engaged in self-reflection.” Results indicate “increased communication by the child”; however, note that this study is small, and “…further replication is necessary before generalizing results.”

Douglas, S.N., Kammes, R., & Nordquist, E. (2017). Online Communication Training for Parents of Children With Autism Spectrum Disorder. Communication Disorders Quarterly. doi: 10.1177/1525740117727491.


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