Early object exploration linked to communication skills in preterm and full-term infants

A few months ago, we reviewed a study on identifying early learning delays in preterm infants. Well, this study provides us with an additional skill to keep an eye on when working with preterm and full-term infants. Keep reading to learn how object exploration at 6 months can predict communication skills at 12 months.

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Researchers observed 20 extremely preterm infants* (gestational age < 28 weeks) and 20 full-term infants engage in play with their mothers at 6 months and 12 months of age. (Note: the preterm infants were observed at their corrected ages; more on age correction here.) At 6 months, the researchers measured how often infants engaged in oral and manual exploration of toys. For example, an infant could engage in oral exploration by mouthing a rattle and manual exploration by transferring the rattle from hand to hand. Then at 12 months, the researchers measured the infants’ gestures, vocal productions, cognitive skills, and word comprehension.

Not surprisingly, the preterm infants tended to score lower on measures of cognitive skills and language skills than full-term infants. This fits with the broader findings of previous research showing that “preterm infants as a group, do not tend to catch up to peers’ language by school-age.” 

But what may take you by surprise is that neither neonatal condition (preterm vs full-term) nor cognitive performance were significant predictors of 12-month word comprehension, gestures, or vocal production when also considering object exploration. For all infants in this study, oral exploration at 6 months was a significant predictor of word comprehension at 12 months and manual exploration at 6 months was a significant predictor of gesture and vocal production at 12 months.

So what does this mean for EI SLPs? Diagnostically, we would certainly still consider preterm birth a risk factor for future language difficulties. However, we may also consider object exploration skills at 6 months as a possible predictor of communication skills at 12 months for both preterm and full-term infants. As for intervention, the authors note that supporting object exploration could enhance communication skills, but they didn’t explicitly examine whether or not this is the case. We’ll keep you posted as more comes out on this topic!

*One limitation of this study is that the extremely preterm infants selected to participate were deemed “healthy.” Many extremely preterm infants receiving EI services have health complications relating to preterm birth.

NOTE: Interested in another paper on the link between motor skills and communication? Check out this recent review on infant siblings of children with autism. 

Zuccarini, M., Guarini, A., Iverson, J.M., Benassi, E., Savini, S., Alessandroni, R., Faldella, G., & Sansavini, A. (2018). Does early object exploration support gesture and language development in extremely preterm infants and full-term infants? Journal of Communication Disorders, 76, 91–100.

Throwback (2009 & 2015): Speech delay? Language delay? Measuring it, and what’s common in toddlers with autism

For all the SLPs who work with younger children with autism (so ages 2–4), this one’s for you! The following is a review of two studies from the last decade that can help you understand and characterize the various expressive language profiles you may see in these children, as well as brainstorm therapy!

The first paper reports on a meeting of experts in early autism and language development. (NOTE: If you’re a science groupie who gets googly-eyes for big names, pop on over and look at the author list; #sofamous). The purpose of the group was to create a list of measures of the expressive spoken language of children with autism from 12 to 48 months of age. These benchmarks can be used in assessment (as part of a comprehensive assessment including parent report, natural language samples, and/or direct assessment), or to guide intervention.  

In the article, you’re provided with a chart (see Table 1) divided into “First Words (12–18 mos)”, “Word Combinations (18–30 mos)”, and “Sentences (30–48 mos)”. Then within each of those categories, you have measures for:

  • Phonology

  • Vocabulary

  • Grammar

  • Pragmatics

…and within each of those categories, the child must meet at least one marker, at minimum, to be placed within that category.  

So, for example, for the Sentences (30–48 mos): Phonology section, markers are:

  • 70%+ intelligible from a speech–language sample

  • Consonant inventory of at least 16–24 different consonants (75% correct), from a speech–language sample

  • Age equivalent score of at least 36 months on a standardized test (e.g. GFTA or other)

…and the child must meet the intelligibility criteria or the standardized test criteria in order to be considered as meeting that benchmark. 

Then, you’d look across the other measures to (so vocabulary, grammar, and pragmatics) to see where they fit in each of those categories. 

Overall, this provides a really nice way to consider data from multiple sources (and, importantly, to know which pieces of data to prioritize), and supports SLPs in describing the spoken expressive language of kids with ASD in a systematic fashion.

 

So, how do most kids with ASD perform with these benchmarks?

Aha! That’s what the next paper looked at.

The authors of this article evaluated over 100 kids ages 2–3 years old using the “Spoken Language Benchmarks” (what we just described! From the last paper.) They found:

Considering phonology, vocabulary/grammar, and pragmatics as three separate skill sets…

  • Most of the children’s lowest score was in pragmatics (of course, right?! They have autism…)

  • And the two most common profiles were:

    • phonology > vocabulary/grammar > pragmatics

    • phonology = vocabulary/grammar > pragmatics

    • See Table 3 for six other profiles observed, too! That table is really fascinating, seeing what’s most versus least common…

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So let’s chat about this. Basically, they found that, “… phonology tends to be relatively intact for most individuals whereas pragmatic difficulties are nearly universal…” and “… in terms of pragmatics, 88% of the children fell into the Prelinguistic group, which reflects a developmental level of less than 12 months of age.”

Nearly half of the kids achieved higher phonology scores than vocabulary/grammar and pragmatics. So it’s an area of relative strength! And when we think about kids with ASD on our caseloads, I’m sure you can remember many kids fitting this profile—good speech skills, and expressive language and/or pragmatics not so much.

Overall, being able to weigh relative strengths of phonology, vocabulary, grammar, and pragmatics for our kids with ASD helps inform treatment, and also could be quite helpful in identifying which types of treatment tend to help which types of children with ASD in both clinical work and research.

 

Ellawadi, A.B., & Weismer, S.E. (2015). Using Spoken Language Benchmarks to Characterize the Expressive Language Skills of Young Children With Autism Spectrum Disorders. American Journal of Speech–Language Pathology, 24, 696–707.

Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R… Yoder, P. (2009). Defining Spoken Language Benchmarks and Selecting Measures of Expressive Language Development for Young Children With Autism Spectrum Disorders. Journal of Speech, Language, and Hearing Research, 52, 643–652.

A (free) decontextualized vocabulary test for toddlers

If only we had a crystal ball to predict late talkers’ later language skills (ok, those would be nice in so many areas of our field!). As SLPs we are always trying to get an accurate picture of how many words a child uses and understands. But because we don’t have a dedicated assessment of toddlers’ early vocabulary, we often do this through parent report, either formally (like an MCDI) or informally. However, researchers have found that parents' report of their child's vocabulary doesn't do as good of a job when we try to use it to predict later language. It seems that parent report may not be giving us all of the information that we need about a child’s vocabulary in order to predict their later language abilities.

We know that there’s a continuum of what “knowing a word” entails for a toddler. When they first learn to say the word “milk,” they may only know it within the context of breakfast. The word “dog” however, they may use all day long whenever they see a dog or a picture of one. A parent would rightly conclude that a child knows both “milk” and “dog,” even though the child’s “level of knowing” varies between the two words. Contrast this with a picture ID vocabulary assessment, in which all of the words are presented out of context. For a toddler to correctly identify a word during the assessment, he would have to have a strong understanding of what that word really means without all of the support that context provides.

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Because of this, Friend et al. (2018) set out to create a picture ID test for young children and test if it could better predict preschool language abilities than parent report. They developed the Computerized Comprehension Test (CCT) in which children are asked to identify decontextualized pictures from a field of two. They then tested it with 16-, 23-, and 36-month-old children. At 16 months, parent report continued to best predict preschool language abilities. However once the child reached 23 months, the CCT was a stronger predictor of later language abilities with great psychometric properties.

While the CCT is still in its early phases, it shows promise of becoming a useful instrument for EI SLPs to get a more accurate picture of toddlers’ vocabulary, especially after age two. In its current state, it could serve to complement other assessments already in your toolkit, such as an MCDI. And while we’ll never have a crystal ball to tell us what a child’s language will be like years down the road, assessments such as this may give clues to help us make more informed decisions about assessment and treatment.  

Note: The authors have published all of their CCT materials online, including the computerized assessment, training videos/instructions, and data sheets. I tested out the program myself, and while there was a learning curve, it didn’t prove to be too challenging! Let’s all take a moment and cheer for these scientists giving us access to the materials we need!

 

Friend, M., Smolak, E., Patrucco-Nanchen, T., Poulin-Dubois, D., & Zesiger, P. (2018). Language Status at Age 3: Group and Individual Prediction From Vocabulary Comprehension in theSecond Year. Developmental Psychology. Advance online publication. doi: 10.1037/dev0000617

Want to increase generalization? Try matrix training

Let’s talk about matrix training. It’s a language intervention that’s been around for a while (e.g., Goldstein, 1983), and there’s quite a bit of evidence to demonstrate that it can be used as a framework to teach vocabulary and functional language skills. But, probably more importantly, kids can learn new and untrained language targets by participating in matrix training. Tell me more, right?

Well, the way that it works is that language targets (for instance, adjectives and nouns) are written on the vertical and horizontal axes of a table—aka: matrix. The targets can be either all unknown words or a combination of known and unknown depending on the client. Then, those targets are used to create various combinations. So, if you’re focusing on increasing your client’s understanding of adjectives and nouns, your matrix could look like this:

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Matrix training is based on the idea of recombinative generalization (Goldstein, 1983)—which basically means that if we teach a word combination {brown + bear} and then expose the child to one of the same words again but in a new combination {brown + bird}, the child can generalize their understanding or use of untrained, related targets {brown + horse}.

So, the matrix essentially serves as a visual guide that can be used to identify the sequence for instruction by making it easy for you to see which treatment targets are related. For instance, if you choose targets that are in the yellow diagonal cells (brown bear, red bird, blue horse, yellow duck, green fish) as well as the teal cells just above them (brown bird, red horse, blue duck, yellow fish), many of the same adjectives and nouns will be repeated in your intervention. By doing this, your client can then generalize their understanding to related, untrained targets (such as, brown horse, brown duck, red duck, brown fish, red fish, blue fish).

In this study, matrix training was used as a framework for intervention with three children between the ages of 22 and 35 months with severe language delays and/or ASD. The training focused on teaching the toddlers simple, one-step directions (e.g., shake) that included animals (e.g., dog). Three individual matrices were created based on each child’s knowledge of the target actions and animals before the training began. The intervention targeted six (or, 30%) of the one step action–object instructions with each child, and included components of discrete trial training (antecedent, responses, and consequences) as well as verbal and physical prompts and reinforcement. After training, the other 70% of the action-object combinations that weren’t directly taught were probed, and each of the three children demonstrated some level of generalization to these unknown targets (and, one of the toddlers demonstrated understanding of all of the untrained action-object combos!). 

Talk about more getting a little more bang for your buck, am I right?!

Although this study only included 3 participants, the findings suggest that matrix training is a simple framework to implement that has the potential to cut down on time spent on teaching language targets in intervention. This is particularly exciting news for our youngest clients who demonstrate the most significant language delays.

Curiel, E.S.L., D. M., Sainato, D. M., & Goldstein, H. (2018). Matrix training for toddlers with Autism Spectrum Disorder and other language delays. Journal of Early Intervention40(3), 268–284.

Throwback (2011): Increasing sound production through imitation therapy

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Imitation is the sincerest form of flattery. However, every SLP has worked with a child who simply doesn’t imitate. No matter how many times we blow raspberries, make animal noises, or wave our arms wildly, we are met with blank stares. Yet imitation during early development is a crucial building block to successful communication. 

This study looked at a systematic method for teaching nonverbal toddlers the skill of imitation. All children in the study were 18–19 months old, showed minimal babbling, did not imitate sounds, and did not produce any phonetically consistent forms. All of the children scored lower than the 2nd percentile on the PLS-3 or PLS-4 scores. Sounds like your typical El late talker, right?

Back in 1972, Zedler developed a therapeutic technique referred to as Technique Imitation Therapy (IT) for use with young children who did not develop language as expected. He believed that a child’s language development is dependent on the child’s awareness that his or her own behavior can affect others. The idea is that providing opportunities for the child to direct an adult’s attention and actions, the child will realize that their own actions can influence others. With reinforcement (as always), the child should eventually be able to learn how to imitate.  

In the present-day study, clinicians implemented Imitation Therapy with 18–19-month-old toddlers 2–4 times per week in 50 minute sessions, until the child spontaneously imitated verbalizations at least eight times in two consecutive sessions. This took between 16–18 sessions for the group of children, or approximately 8 weeks.

Imitation Therapy consists of four steps, starting with the adult serving as the sole imitator of everything the child does and says, until the child realizes that the adult is imitating him/her. Next, when the child begins to do some basic imitation of the adult, he is positively reinforced. Then, the adult begins to only imitate the child’s oral movements or sounds produced. At the final stage, the adult and child imitate each other reciprocally, with the goal of the child imitating sounds consistently. At the end of the study, all children showed a significant increase in their sound production and repertoire of phonemes. Specifically, all children had at least 13 phonemes and produced 100+ sound productions per session. Talk about measureable progress! This article describes the procedure in great detail, so that any SLP could recreate IT at their next home visit.  

The authors do mention that small sample size and lack of a control group are limitations of this study. However, each of the children missed a week of therapy due to fall/spring break. During this break, they experienced a decrease in sound production, which subsequently increased when therapy was again initiated. This observation reinforces the evidence that IT may have been a factor in the children’s progress. At a minimum, imitation therapy appears to be a promising technique to try with nonverbal toddlers who struggle to imitate.   

 

Gill, C., Mehta, J., Fredenburg, K., Bartlett, K. (2011). Imitation therapy for non-verbal toddlers. Child Language Teaching and Therapy, 27(1), 97–108.

Throwback (2007): Helping parents develop joint attention skills

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So, we know that deficits in joint attention skills are one of the earlier-appearing red flags for autism. We also know that early intervention for the autistic population should include tasks to develop joint attention. And early intervention should involve parents. Schertz and Odom (2007) combined these concepts and found that when parents take the lead in designing and implementing activities (with a little help/guidance from a professional) to promote joint attention skills, magic can happen—all three toddlers in this study improved their joint attention skills.

The researchers stress that the parents did most of the work. The parents came up with activities and carried through with their plans in natural environments. The interventionist took a backseat role; however, he or she also served as a teacher of theory and best-practice for the parents.

What activities did the parents do with their children? (Or, what can we as SLPs teach caregivers to do to promote joint attention skills?)

  • focusing of faces: mirror play, imitating facial expressions, putting the parent’s face in the child’s line of sight

  • turn-taking: responding to child’s actions as if the child were actually interacting with them, building in some pause time after the parent’s utterance to wait for the child’s response, imitation of the child’s gestures, working the parent into the child’s isolated play

  • responding to joint attention: sharing attention to the same object through parent initiations (making the toy exciting, and practicing looking between the toy and the parent’s face)

  • initiating joint attention: parents expressed excitement about the toy, or giving the child surprise gifts to increase excitement.

 

Schertz, H.H. & Odom, S.L. (2007). Promoting joint attention in toddlers with autism: A parent-mediated developmental model. Journal of Autism and Developmental Disorders, 37, 1562–1575.

Review written by: Knothe, C., Cordia, R., Meuschke, H., & Brumbaugh, K.

Supporting toddlers in foster care

This review is a mash-up of a few different articles, because we have a mini-theme going on this month! Many of us have served children who are in foster care. It’s already known that children who have experienced some sort of abuse or neglect are at a higher risk for having language, social, and behavior difficulties (e.g., Chow & Wehby, 2018; Hoff, 2006; Stock & Fisher, 2006; also, see our discussion on trauma here). So not only are these kids in foster care battling a history of instability (whether in location, security, basic needs, family members, name it), but that history puts them at risk for difficulties in early development that have implications for social, behavioral, and academic impact later on in life. That doesn’t sound like a great start for a toddler, does it? Hopefully, we can do something to help. The following studies looked at children’s receptive language development in relation to foster placement and intervention options.  

Zajac et al. studied a group of children involved with Child Protective Services to see if receptive language scores on the PPVT-3 were related to whether children were placed in foster care or remained with their parents. They found that the children in foster care had average receptive language abilities on the PPVT-3 at 4 years of age, but children who remained with their biological parents had lower receptive language abilities. We need more information to really delve into the “why” here. But a prediction is that when parents feel more secure in their basic and emotional needs, they may be more likely to have energy to spend on addressing kids’ development (and the authors comment on making support available to families whose financial, emotional, and educational resources are stressed).

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At the same time, Raby et al. (some of the same authors were involved in both of these studies) looked at how the intervention Attachment and Behavioral Catch-up for Toddlers (ABC-T) affected foster parents’ sensitivity and responsiveness to their toddlers and whether the intervention affected receptive language development. Compared to families who received the Developmental Education for Families (DEF) intervention, which focused on motor and cognitive skills, families who received the ABC-T intervention were more sensitive and responsive to their toddlers, and toddlers whose foster families received the ABC-T training had better receptive language skills when tested with the PPVT-3. Not bad for 10 weeks’ worth of one-hour sessions!

If you’re not ready to add a new intervention training like the ABC-T to your workload but are thinking, “Wow, this is in line with what I’m seeing clinically, so how do I get and keep these kids on my caseload?” check out the Adrihan et al. review on a collaborative effort between a county’s EI and child welfare departments. They highlight systemic changes to screening, evaluation, and teaming processes that could increase access to EI services for these children who are at risk for social–emotional delays.

Adrihan, S. A., Winchell, B. N., & Greene, S. J. (2018). Transforming early intervention screening, evaluation, assessment, and collaboration practices: Increasing eligibility for children impacted by trauma. Topics In Early Childhood Special Education. Advance online publication. doi: 10.1177/0271121418791288

Raby, K. L., Freedman, E., Yarger, H. A., Lind, T., & Dozier, M. (2018). Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial. Developmental Science. Advance online publication. doi:  10.1111/desc.12753.

Zajac, L., Raby, K. L., & Dozier, M. (2018). Receptive vocabulary development of children placed in foster care and children who remained with birth parents after involvement with child protective services. Child Maltreatment. Advance online publication. doi: 10.1177/1077559518808224

Culturally congruent interventions for Latino families

When working with families from diverse backgrounds, it is imperative to make sure that our interventions are consistent with the family’s culture and values. Guiberson & Ferris studied caregiver interaction style in Latino families to identify interventions that would be culturally appropriate for the Latino population.  

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European–American families tend to use an independent style of interaction with their children: emphasizing the child’s individuality, following the child’s lead, and allowing the child to explore toys in different ways. This study found that the majority (75%) of Latino families interacted with their children using a more interdependent style. An interdependent interaction style emphasizes the child’s relationships and belonging to the family and cultural group. Caregivers who use an interdependent interaction style are more likely to direct the child’s attention, teach explicitly, show children how to play with toys, and use more commands and directives in their language.

Considering how Latino families tend to interact with their children, EI approaches that emphasize following a child’s lead may not be culturally appropriate for all Latino families. When working with families who use an interdependent interaction style, consider using the following interventions: 

  • Explicit teaching combined with attention directions

  • Modeling

  • Focused stimulation

  • Dialogic reading

Because these interventions give the caregiver more of an authoritative role in the interaction, they may feel more natural for Latino parents and therefore be more likely to be implemented. Latino mothers reported feeling more comfortable with a didactic style in which the parent gives commands, directs the child’s behavior, and explicitly teaches children how to complete tasks.

Check out the original article for more in-depth descriptions of these interventions and information on Latino caregiver preferred activities.  

 

Guiberson, M. M., & Ferris, K. P. (2018). Identifying culturally consistent early interventions for Latino caregivers. Communication Disorders Quarterly. Advance online publication. doi: 10.1177/1525740118793858.

And more...

  • Bilgin et al. found that infants with difficulties regulating their feeding, sleeping, and crying have an increased risk of attention problems later in childhood. And many adults who had regulatory problems as infants still demonstrated attentional difficulties throughout adulthood.

  • Bontinck et al. used observations in the home setting to compare interactions between 2-year-olds and their older sibling with ASD with interactions between 2-year-olds and their older, typically developing sibling. Findings suggested that the 2-year-olds whose sibling had ASD attempted to initiate social interactions less frequently, demonstrated fewer positive responses to their sibling’s attempt to communicate or interact, and attempted to imitate their older sibling with ASD less frequently. And, when the researchers looked at total interactions—both positive and negative—between the sibling pairs, they found that higher levels related to more parent-reported ASD characteristics. What does this mean? Well, it suggests that younger siblings of children with ASD might be learning positive and negative behaviors. And, given that siblings provide the earliest form of social interaction, paired with the fact that siblings of children with ASD are at high risk for receiving the same diagnosis, findings from this study suggest that examining social interactions between siblings may provide insight into the development of young children whose sibling has ASD.

  • Typical disfluencies (e.g. revisions, phrase repetitions, filled pauses) are a normal part of preschoolers’ speech, and “appear at times of rapid language growth”. Generally, while children are learning new words and new sentence structures, typical disfluency rates can increase (see article for review). So how would this play out for bilingual children? That’s unknown, and the aim of Brundage & Rowe. In this study, they examined young (30-month-old) simultaneous Spanish–English bilingual children (with roughly 50-50 exposure to English and Spanish at home). They found slightly lower disfluency rates in Spanish, and lower disfluency rates, overall, compared to similar studies. Because their data is a bit unexpected compared to similar research on monolinguals, it’s difficult to know how to interpret this data. But, maybe that’s exactly the point? That it’s different for bilinguals? Future research should help clarify that.

  • After English, Spanish is the most common language spoken in the homes of U.S. children who are deaf or hard of hearing (DHH). Yet, we know very little about language and, specifically, vocabulary outcomes for this population. de Diego-Lázaront et al. looked at a variety of demographic, hearing-, and intervention-related factors to determine which might have a relationship with Spanish expressive vocabulary skills in 8 to 36-month-olds who are DHH. Results suggested that degree of hearing loss, range of functional hearing, and chronological age and age of intervention separately and combined predicted Spanish expressive vocabulary development. And, more specifically, the researchers found that the children who began receiving therapy early—by 6 months of age—received significantly higher scores on expressive vocabulary measures in Spanish.

  • Donegan-Ritter & Van Meeteren coached Early Head Start teachers on language strategies using video self-reflection and focused feedback. Teachers were able to increase their use of questioning, back and forth exchanges, and parallel talk with both infants and toddlers. Practice-based coaching may be an effective method for training teachers to increase their use of language strategies.

  • Dowd et al. looked at how young toddlers responded when a parent or experimenter got “hurt” (e.g., adults faked injuries when playing with a toy or fiddling with a clipboard) and suggest that we can see signs of social impairments by about 15 months. While we usually consider social concepts like empathy and emotional thinking to be later developing skills, the study’s results show us that we can start to see impairment fairly early in development.

  • Within a child’s first few years, the total number of words he produces often reigns king with regards to assessing his language level. When a child comes to us with a small vocabulary, one of our primary goals is generally to increase the total vocabulary.  However, Galeote et al. explain that a more nuanced approach than “total number of words” is important for fully capturing a child’s language and creating meaningful intervention plans.  We need to make sure that we are considering the makeup of a child’s word classes so that we can understand the child’s strengths and weaknesses and plan our intervention appropriately. With that understanding, if a child’s vocabulary was made up almost entirely of nouns, we would know to target verbs more intensively in intervention.

  • Infants as young as six months old can adapt their communication behaviors to their social environments! Ganea et al. found that non-blind infants of blind parents interact differently with their blind parents compared to non-blind adults.

  • Greenslade et al. provide further data that decreased initiation of joint attention, expressive language, and social communication behaviors during the infant and toddler years can predict pragmatic communication difficulties in the school years, even if a child does not meet criteria for a diagnosis of ASD.

  • Noyes-Grosser et al. offer a program review of New York State’s Part C services, and more specifically how children with ASD and their families respond to services. We can’t apply the results of this review to all of our readers, because Part C is interpreted and services are delivered differently state-by-state and even county-by-county, but the article offers a great overview of why we do things some of the things we do (e.g., COS statements). The authors also over some good tools for program evaluation (see here for Record Review Protocol and here for an EI Family Survey). For SLPs working in Part C programs, you might want to keep this citation handy to offer to your EI coordinators and/or supervisors.

  • Severini et al. implemented the Stay-Play-Talk (SPT) routine with two children with Down Syndrome who used high-tech AAC as their primary mode of communication. They found when peers were trained to use SPT strategies during free play there was an increase in stay and play behaviors for both children. (Sound familiar? We’ve written about Stay–Play–Talk before for children with ASD who use AAC, here and here.)

  • The parent-implemented Early Start Denver Model (P-ESDM; Rogers et al., 2012a) is an intervention that combines principles from Applied Behavioral Analysis (ABA) with a developmental, socially-focused approach to increase parent interactions that promote positive developmental outcomes for young children with ASD. Vismara et al. looked at whether the P-ESDM might also be an effective intervention for young children with fragile X syndrome (FXS) with and without a combined diagnosis of ASD. The first author of the study provided coaching to promote the use of the P-ESDM with four 1 ½ to 4-year-old children and their parents either in person or via video-conferencing. The parent-related outcomes were encouraging: all of the parents improved in their ability to accurately and consistently implement the P-ESDM intervention goals, and they found the coaching experience to be generally positive. The child-related outcomes (e.g., spontaneous communication and initiated joint attention) were more variable, indicating the need for more studies that examine the use of the P-ESDM with children with FXS with and without ASD.  

Bilgin, A., Baumann, N., Jaekel, J., Breeman, L.D., Bartmann, P., Bäuml, J.G. … Wolke. D. (2018). Early crying, sleeping, and feeding probelsm and trajectories of attention problems from childhood to adulthood. Child Development. Advance online publication. doi: 10.1111/cdev.13155.

Bontinck, C., Warreyn, P., Demurie, E., Bruyneel, E., Boterberg, S., Roeyers, H. (2018). Social Interactions Between 24-Month-Old Children and Their Older Sibling with Autism Spectrum Disorder: Characteristics and Association with Social-Communicative Development. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3660-4.

Brundage & Rowe (2018). Rates of Typical Disfluency in the Conversational Speech of 30-Month-Old Spanish–English Simultaneous Bilinguals. American Journal of Speech–Language Pathology, 27, 1287–1298.

De Diego-Lázaro, B., Restrepo, A., Sedey, A.L., Yoshinaga-Itano, C. (2018). Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families. Language, Speech, and Hearing Services in Schools. Advance online publication. doi: 10.1044/2018_LSHSS-17-0148.

Donegan-Ritter, M., & Van Meeteren, B. (2018). Using practice-based coaching to increase use of language facilitation strategies in early head start and community partners. Infants & Young Children, 31(3), 215–230.

Dowd, A. C., Martinez, K., Davidson, B. C., Hixon, J. G., & Neal-Beevers, A. R. (2018). Response to distress varies by social impairment and familiarity in infants at risk for autism. Journal of Autism and Developmental Disorders, 48(11), 3885–3898.

Galeote, M., Checa, E., Sebastián, E., & Robles-Bello, M. A. (2018). The acquisition of different classes of words in Spanish children with Down syndrome. Journal of Communication Disorders, 75, 57–71.

Ganea, N., Hudry, K., Tucker, L., Charman, T., Johnson, M.H., & Senju, A. (2018). Development of adaptive communication skills in infants of blind parents. Developmental Psychology, 54(12), 2265–2273.

Greenslade, K. J., Utter, E. A., & Landa, R. J. (2018). Predictors of pragmatic communication in school-age siblings of children with ASD and low-risk controls. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3837-x

Noyes-Grosser, D. M., Elbaum, B., Wu, Y, Siegenthaler, K. M., Cavalari, R. S., Gillis, J. M., & Romanczyk, R. G. (2018). Early intervention outcomes for toddlers with autism spectrum disorder and their families. Infants & Young Children, 31(3), 177–199.

Severini, K.E., Ledford, J.R., Barton, E.E., & Osborne, K.C. (2018). Implementing stay-play-talk with children who use AAC. Topics in Early Childhood Special Education. Advance online publication. doi: 10.1177/0271121418776091.

Vismara, L.A., McCormick, C.E.B., Shields, R., & Hessl D. (2018). Extending the Parent-Delivered Early Start Denver Model to Young Children with Fragile X Syndrome. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s1

Cultural proficiency 101: Reconsidering the 30 million word gap

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Back in the 1980s, Hart & Risley conducted a hallmark study documenting that children from poor communities hear 30 million fewer words than middle class children. This finding has been often cited to document why so many low SES children perform poorly when they enter school and score lower on measures of language and vocabulary.

Sperry et al. brought the results of this study into question, with the idea that the original methodology of the study may have been culturally biased and not applicable to real-life environments. In particular, the original study looked only at directed speech from the primary caregiver (usually the mother) to the child. They did not measure the number of words spoken by other members of the household, speech that the child may have overheard, and they encouraged the family members not to talk to each other so that they could focus on just the mother/child interaction.

While interaction between the primary caregiver is certainly important, Sperry et al. attempted to expand our knowledge of children’s verbal environments by measuring all speech directed to the child and all bystander or “overheard” speech. The findings were quite interesting. There was no significant gap between number of words heard among any social or economic class. Additionally, some working class and poor communities showed an advantage in the number of words the children heard. Additionally, there was significant variation within classes, rather than between classes. For instance, in this study, poor African American families in the south addressed far more words to their children compared to primary caregivers from other low SES communities (e.g. rural, working class).

These results are important to consider as EI therapists working with diverse families. Often times minority families are viewed in a “one size fits all” context, viewing the majority group (middle class American families) as the model. In fact, in many cultures, children are not spoken to directly during the first few years of life, but still reach developmental language milestones similarly to American children. In sum, different cultures have different preferred ways of interacting with their children, which may all have different benefits. As culturally proficient therapists, we need to look at the whole family.

P.S. This article sparked a bit of a debate:

For a response to this article from another group of researchers, click here.

For Sperry et al.’s reply, click here.

And for even more on different qualities of child-directed speech, see Tal & Arnon’s study, where they found the number of variation sets differed between high-SES and low-SES groups. Variation sets happen when an adult focuses on a theme, and then talks a lot about that theme in a series of comments and questions. The authors suggest more information is needed on the different qualities of child-directed speech in order to make predictions about language outcomes.

 

Sperry, D. E., Sperry, L. L., Miller, P.J., (2018). Reexamining the verbal environments of children from different socioeconomic backgrounds. Child Development. Advance online publication. doi: 10.1111/cdev.13072