Infant Directed Speech: Not just for play!

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How often do you coach parents of the infants and toddlers on your caseload to incorporate language elicitation strategies into play? Probably a lot. And for good reason—infant directed speech (the spontaneous changes in a caregiver’s language and speech that support language development, commonly called “motherese”) is often automatic for parents when playing hide-and-seek or exploring those new birthday toys.

But how often do you coach parents to address communication development during feeding?  If this is already a part of your practice, pat yourself on the back!  Currently, the majority of research on infant directed speech is within the context of play, but this study found promising results when examining changes in mothers’ speech and language with their infants and young toddlers across play, milk feeding and solid feeding routines. See the full article for a handy graphic about specific differences across these conditions and a detailed explanation of what we know about infant directed speech so far, but here are some key take-aways when it comes to feeding routines and capitalizing on infant directed speech:

  1. Caregivers naturally make more attention-directing statements during solid feeding compared to their adult-directed speech baselines.

  2. Caregivers’ type-token ratios are higher during feeding than even in play. (And that skill can be really difficult to teach!)

  3. Feeding happens at least three times a day, every single day.

  4. You can address feeding and language goals simultaneously.

Admittedly, this study has some significant limitations. The sample size was fairly small and consisted of a very heterogenous group of mother–child dyads without any significant medical diagnoses or feeding difficulties. This study is also one of just a few to take an in-depth look at infant directed speech during feeding, and the authors have several suggestions for further investigation in this area. But if you are already inclined to work language development into all parts of a toddler’s day (and let’s face it—of course you are, you’re an SLP), this study should be a great excuse to have a snack with your next client and their caregiver!

  

Zimmerman, E., Connaghan, K., Hoover, J., Alu, D., & Peters, J. (2019) Is feeding the new play? Examination of the maternal language and prosody used during infant-directed speech. Infant Behavior and Development. doi:10.1016/j.infbeh.2019.01.005

Additional commentary:

  • The first author of this paper was interviewed in a podcast episode discussing this paper. Check it out!

  • In the United States, is seems like we’ve put a lot of value on parent–child play; however, this hasn’t always been the case. This opinion piece is an interesting commentary parent–child play interactions.

Babble Boot Camp: Yes, it’s a thing

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Pretty much all therapy we do is reactive, as in response to a diagnosed speech or language delay. But what about preventative therapy? As early interventionists, we often see young children who have diagnosed conditions that will almost certainly lead to speech and language delays. What is the best way to work with families in this particular situation? Peter et al. studied a preventative intervention they coined “Babble Boot Camp.” Aside from the adorable name, this parent-implemented program actually had some pretty neat results.

The children in this study had been diagnosed with Classic Galactosemia (CG), which is a genetic disorder that can be diagnosed at birth. Children with CG have a very high rate of speech and language disorders, but, as is typical with EI, often don’t receive intervention until the speech and language delays become apparent. Instead of waiting for the inevitable, these researchers started young—at two months, to be exact.

Babble Boot Camp is a program of activities and routines specifically developed for children in the pre-speech or very early speech and language stages of development. Parents met with an SLP via telepractice for 10 minutes per week to receive training and consultation. Examples of activities included reinforcing and stimulating coos and babbles, joint book reading, naming objects, imitation, and expanding children’s utterances. The SLP provided ideas for incorporating these techniques into routines and daily activities.

All children who participated in this study showed greater babbling complexity and increased complexity of meaningful speech compared to the control child (who also had CG). The majority of the children also demonstrated age-appropriate expressive vocabulary and communication skills at 24 months, which is pretty impressive for children with such a high chance of delay. Although this study used a small sample size, it does provide preliminary evidence that a proactive approach to speech/language intervention may be effective in the long-term; so get those families enlisted!

 

Peter, B., Potter, N., Davis, J., Donenfeld-Peled, I., Finestack, L., Stoel-Gammon, C., . . . VanDam, M. (2019). Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia. F1000Research. doi:10.12688/f1000research.18062.1

And more...

  • Do you find the coaching model challenging? You’re not alone! Sometimes it can feel like scientists are telling us what to do without considering how challenging it is to implement their interventions in the real world. That’s why articles like this one are so exciting for practicing SLPs. These researchers interviewed early intervention SLPs about their experiences attempting to implement the coaching model. They gleaned insight from SLPs about their barriers, benefits, and experiences, and perspective. The bottom line? SLPs see the value in the coaching model, but need more and better training and ongoing support in order to be confident and competent in using it.

  •  Did you know that onomatopoeia (words that represent sounds, like “buzz”) are especially common in infant’s speech? Liang discovered that onomatopoeia are phonologically easier to recall, plan, and produce, which explains why infants acquire them at such a young age. The easiest forms for infants to produce are CV words like “moo”, and words with consonant harmony like “pop.”

  • When it comes to diagnosing autism, we all have two goals—to do it as early as possible, and to do it as quickly as possible, because both factors lead to the child receiving early intervention services sooner, and this is key. Mayes’ study showed that using the condensed version of a commercially available interview and checklist—the Short Form of the Checklist for Autism Spectrum Disorder—was just as effective at identifying toddlers and preschoolers with ASD as the full Checklist. I don’t know about you, but the idea of being able to reliably and accurately identify young children with ASD using 6 instead of 30 items is pretty encouraging news!

  • Reisinger et al. examined data on the vocalizations of 11 young boys with a diagnosis of Fragile X and their caregivers compared to peers matched by chronological age and developmental age.  They found that caregivers of children with Fragile X vocalized less often and took fewer conversational turns than caregivers of typically developing children, possibly contributing to a cycle of poor language development and a less than ideal language environment.

  • As EI providers, we’re always looking for new ways to support children with ASD through collaboration and coaching. Shire and colleagues’ recent study looked at training teaching assistants (TAs) to provide the play-based intervention, JASPER—Joint Attention, Symbolic Play, Engagement, and Regulation—to toddlers with ASD in an early intervention classroom. Through extensive coaching and support from a supervisor during the first year and assistance from group leaders during the second year, the TAs were able to effectively implement the JASPER program. And, the children showed the same level of improvement in joint attention during the first and second year of the study. But, play skills only significantly improved during year one, when the TAs were receiving the highest level of support. These results suggest that training TAs and other support staff to provide language intervention with children with ASD can be effective, but if we want long lasting effects, we may need to provide a high level of consistent support.

  

Douglas, S., Meadan, H., Kammes, R. (2019). Early interventionists’ caregiver coaching: A mixed methods approach exploring experiences and practices. Topics in Early Childhood Special Education. doi:10.1177/0271121419829899.

Liang, C.E. (2019). Phonological motivation for the acquisition of onomatopoeia: An analysis of early words. Language and Learning Development. doi:10.1177%2F0142723714550110.

Mayes, S. D. (2019). Assessing toddlers and preschool children using the checklist for Autism Spectrum Disorder. Infants & Young Children. doi:10.1097/IYC.0000000000000136.

Shire, S. Y., Shih, W., Ya-Chih, C., Bracaglis, S., Kodjoe, M., & Kasari, C. (2019). Sustained community implementation of JASPER intervention with toddlers with Autism. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-018-03875-0.

Reisinger, D. L., Shaffer, R. C., Pedapati, E. V., Dominick, K. C., & Erickson, C. A. (2019). A pilot quantitative evaluation of early life language development in Fragile X syndrome. Brain Sciences. doi:10.3390/brainsci9020027 

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.

Coordination Station: Combining verbal & nonverbal skills for infants with ASD

As early interventionists, we work on joint attention and early vocalizations with children all the time. However, do you ever target joint attention & vocalization together?

Heymann et al. studied the coordination of joint attention and vocalization in infants at high risk for autism. Infants in this study already had an older sibling with a diagnosis of ASD. Researchers followed these infants from 5 months to 36 months to track development of joint attention, vocalization, and whether or not the infant was eventually diagnosed with ASD or a language delay.

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As expected, infants who later developed ASD demonstrated lower joint attention and vocalization compared to their high-risk peers, and their communicative behaviors were less advanced. Interestingly, infants with ASD vocalized significantly less during joint attention moments compared to their peers as well. These differences in communicative skills have a feedback-loop effect on the child’s environment. Caregivers are less likely to respond to communicative attempts that do not include vocalization, so they might not even notice that a child is making a non-verbal bid for communication. Also, parents have been shown to use lower quality responses with infants who don’t use advanced behaviors. As you can see, infants with impaired communication skills may incite small or minimal changes in their home environment, and that is not ideal for language development!

So how can we take this information and apply it to our everyday therapy? The authors suggest targeting both vocalization & joint attention behaviors together could lead to enhanced communication skills in infants with ASD as well as their high-risk siblings. We can also coach parents to respond to less advanced and less salient communication bids from their infants. This information is also great to keep at the back of your mind while monitoring younger siblings of children with ASD so that they can receive intervention as early as possible!  

 

Heymann, P., Northrup, J.B., West, K. L., Parladé, M. V., Leezebaum, N.B., & Iverson, J.M. (2018). Coordination is key: Joint attention and vocalization in infant siblings of children with autism spectrum disorder. International Journal of Language & Communication Disorders, 53(5), 1007–1020.

Toddlers’ revisions signal normal development, not stuttering

Working with toddlers who stutter can be a major gray area for early intervention SLPs. Is the child going through a typical phase of language development, or is she truly showing disfluent behaviors? Do we intervene, or do we wait and see if she grows out of it? Parents often want concrete answers, but sometimes we just don’t have them when it comes to stuttering. However, new research may help us differentiate between stuttering-like behaviors and typical disfluencies in toddlers, specifically by observing “stalls” vs. “revisions.”

Revisions are replacements of a speaker’s word choice in a sentence with an alternative. For instance:

“(He) She wants to get ice cream.”

“(I gotta…) You gotta get pizza”

In these examples, the speaker initially uses one pronoun, but then revises the subject of the sentence to another.

Rispoli (2018) studied revisions in toddler’s language samples as they relate to grammatical development, such as Mean Length of Utterance (MLU) and Number of Different Words (NDW).  He found that revisions were positively related to MLU and NDW, as well as increased lexical diversity. Theoretically, this makes sense because in order for a revision to occur, the toddler must have other options with which to replace the word.

Stalls are repetitions or pauses that occur after the speaker has begun to speak. For instance:

            “I-I-I-I-I-I-I go to bed”

            “You---------you want a drink?”

Previous research by the same author indicated that stalls are not related to measures of grammatical development.

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How does this relate to the potential stutterer, you might ask? Well, since the use of revisions are actually positively related to grammatical development, they are not indicative of a fluency disorder. In fact, revisions increase with language development in both stutterers and non-stutterers at the same rate! You might even take revisions as a signal that your language therapy is working. Stalls, on the other hand, may be indicative of a fluency disorder, as they do occur more often in true stutterers than in typically-developing toddlers. And while intervening with toddlers who stutter might continue to be debatable, you may be able to reassure a worried parent that revisions, are in fact normal for a toddler. 

 

Rispoli, M. (2018). Changing the Subject: The Place of Revisions in Grammatical Development. Journal of Speech, Language, and Hearing Research. Advance online publication.  doi:10.1044/2017_JSLHR-L-17-0216.