When it comes to toys, less is more!

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When a parent asks, “Is there a good toy I can buy to help with Timmy’s language development?” how do you typically answer that question? We already know that symbolic play is pretty important for language development, so we could go with an old TISLP favorite: pick toys that can “be” stuff rather than toys that “do” stuff.

But what other evidence-based suggestions can we give?

This study looked at whether the visual simplicity (or complexity) of a toy changed how parents talked to their toddlers during play. Researchers took visually “busy” ring-stackers and stacking blocks and simplified them by taking out some of the patterns and textures of the toys. Then they recorded the interactions between mothers and infant while playing with each type of toy. From the recordings, three kinds of parent comments were coded:  

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It turned out that moms offered more specific vocabulary to their toddlers (36% of utterances) while playing with the simple versions of the toys. While playing with visually busy toys, Moms only used more specific vocabulary in ~8% of their utterances.  

How did this study come to be? You’ll probably relate to the authors pointing out how, you pick up a kind of ambiguous toy, try to name it, and think, “What is this?!?” There are times when even people with great vocabularies are at a loss for words, and that’s not a great thing to have happen when we’re working with a language-delayed toddler. Sometimes it’s hard to name parts of really busy toys (lots of bright and unique colors, many different parts and pictures, stuff like that). While this study doesn’t tell us that those award-winning educational toys are bad for language development, it does tell us that adults may not refer to these visually busy toys very specifically during play. So if you have a little one on your caseload who would benefit from repetition of more specific vocabulary—help the family pick out some of their more simple toys to use during play!

 

O’Neill, D. K., Deglint, T. J., McKinnon, A. M., Nyhout, A., & Scott, J. (2019). Busy toy designs reduce specificity of mothers’ references to toy parts during toy play with their toddlers. Canadian Journal of Speech-Language Pathology and Audiology.

A quick course on cerebral palsy

Join me in my rabbit hole for a moment, SLP friends. Bring coffee. Last month, Developmental Medicine & Child Neurology had a whole issue on cerebral palsy (CP).

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Our search takes us back to 2017, when a HUGE group of researchers lead by Iona Novak described diagnosis and treatment options based on their systematic review (note: this research team also included SLPs and people with CP/parents of people with CP as authors, so we have the FULL EBP triangle going on here!). Cerebral palsy is a huge umbrella diagnosis; but in general, CP is defined as a non-progressive disorder of posture and movement related to an injury or some problem in the developing brain. It can be diagnosed between 1 and 2 years, and sometimes a provisional diagnosis is given until CP can be confirmed or ruled-out after a period of development, around 5 years. For a diagnosis of CP, a child has to demonstrate motor dysfunction and either abnormal neuroimaging or a risky clinical history (genetics, stroke, maternal health risks, etc.). Table 1 in Novak et al. will give you a thorough overview of identification and diagnosis.

Last month, Msall published a commentary on a recent paper by Boychuck et al., who surveyed international experts on CP to compile a list of red flags clinicians should keep in mind (see Table 3 or read the Msall’s one-page commentary for more information):

  • Children should be referred for evaluation if they demonstrate things like:

    • Holding hands in fists, asymmetry, or head lag after 4 months

    • Tightness in legs between 6–12 months

    • Requiring support to sit after 9 months

    • Hand preference before 12 months

  • Children should be referred for monitoring if they demonstrate:

    • A persistent startle after 6 months

    • Consistent toe-walking or asymmetric walking after 12 months

  • Children should be referred to SLPs any time there are feeding or communication delays or concerns

    • Speyer et al. reported a high prevalence of feeding (53.5%), drooling (44%), and swallowing (50.3%) problems in children with CP.

Thinking about the diagnostic process and transition to treatment, EI SLPs should be pretty well-versed in interacting with parents, but it’s always nice to have a reminder of parent priorities as they begin to plan for their child’s interventions. Byrne et al. conducted focus groups of parents and providers and found that overall, parents of children with CP want:

  • Honesty and directness from providers, with information specific to their child (not just a general prognosis)

  • Explanations of the assessments and tools used to make the diagnosis (including the names of the assessments)

  • Written material (it helps to be able to refer back)

  • Support from providers and assistance in securing services 

In terms of treatment in CP, EI is critical for development. We have to help build those brain connections and take advantage of early neuroplasticity. While CP is a motor disorder (so you will probably need involvement from PT and OT in some capacity), many children with CP have feeding and communication difficulties, so SLPs are likely to be involved on intervention teams. For communication, Novak et al. recommended supporting parent–child interaction, and considering AAC. If feeding is a concern, the team should assess swallowing safety because pneumonia is particularly risky for people with CP. For those of you providing family-centered services in natural environments, you’re already on the right track for service delivery for this population. McCoy et al. measured gross motor outcomes in children with CP, but their message is powerful for all EI providers. The number of therapy visits (including PT, OT, AND Speech) did not predict outcomes, but family-centered services and the focus of sessions (e.g., incorporating overall health and well-being and engaging in structured play activities) did. So keep coaching those parents on how to implement interventions in enjoyable and contextualized settings.

 

Boychuck, Z., Andersen, J., Bussieres, A., Fehlings, D., Kirton, A., Li, P., …, & Majnemer, A. (2019). International expert recommendations of clinical features to prompt referral for diagnostic assessment of cerebral palsy. Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.14252.

Byrne, R., Duncan, A., Pickar, T., Burkhardt, S., Boyd, R., Neel, M. L., & Maitre, N. L. (2019). Comparing parent and provider priorities in discussions of early detection and intervention for infants with and at risk of cerebral palsy. Child: Care, Health, and Development. doi: 10.1111/cch.12707.

McCoy, S. W., Palisano, R., Avery, L., Jeffries, L., Fiss, A. L., Chiarello, L., & Hanna, S. (2019). Physical, occupational, and speech therapy for children with cerebral palsy. Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.14325.

Msall, M. E. (2019). Establishing community pathways for the early recognition of cerebral palsy: Red flags, enablement, and family support. Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.14314.

Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Hernandez-Brunstrom, J., …, & Badawi, N. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment. JAMA Pediatrics. doi:10.1001/jamapediatrics.2017.1689.

Speyer, R., Cordier, R., Kim, J., Cocks, N., Michou, E., Wilkes-Gillan, S. (2019). Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta-analyses. Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.14316.

Parent input predicts toddlers’ vocabulary development

This longitudinal study of 50 families and their typically-developing children examined how parent input effects child vocabulary scores one year later. Controlling for factors like the child’s prior vocabulary skill, quantity of input, and SES, they found that:

  • At age 1 ½, quantity of parent input most predicted later vocabulary.

    Note this doesn’t mean other things they didn’t measure couldn’t also impact it, like joint attention or parental responsivity

  • At age 2 ½, diversity of vocabulary in the input most predicted later vocabulary, even when controlling for input.

    Also, other research on children this age has found that vocabulary grows best when directed to the child, not via ambient conversation.

  • At age 3 ½, language complexity matters most

    e.g. decontextualized language like narratives, and explanations (such as answering “Why?” questions fully) 

And for an Early Intervention SLP, this all seems pretty logical. But transforming it into a simplified version for coaching parents could also be quite useful, such as saying:

  • For babies and one-year-olds, talk to your child, and focus on amount.

  • For two-year-olds, talk to your child, and focus on words.

  • For three-year-olds, talk to your child, and focus on sentences and stories.

… and then coaching what this would look like, specifically. Then, of course, the question becomes—would this be adequate, and would it make a difference? We don’t know. The next review (actually, the next two!) show research that digs in deeper to what’s needed for success.

 

Rowe, M.L. (2019). A longitudinal investigation of the role of quantity and quality of child-directed speech in vocabulary development. Child Development. doi: 10.1111/j.1467-8624.2012 

Throwback (2017): Not just more talk, but Toy Talk

We know that the language input children receive matters. But telling parents to “talk more” might not cut it, especially as you approach the twos and threes! So how can we instead make sure the input supports the child’s grammatical growth?

Consider Toy Talk. It’s a strategy parents are taught to use (in this study, via three parent coaching sessions right before the child’s second birthday), where they’re told to respond to the child’s interests in play, and importantly:

“Talk about the toys” and “Give the object its name” 

Simple, huh? But the effects are substantial. It will basically: force adults’ use of nouns instead of pronouns in the subject position, which pulls the subject and verb away from one another, rather than allowing contractions that may be learned by the child as one unit instead of two morphemes. So it looks like this:

Without toy talk:

It’s soft.

He’s running. 

With toy talk:

The kitten is soft.

The horse is running.

It also makes learning verb tense and agreement easier by forcing marking and helping kids notice these morphemes in the parents’ input:

Without toy talk:

Hop onto the horse.

Drink some water. 

With toy talk:

The cowboy hops onto the horse.

The horse drinks water. 

Toy Talk has been found to be fairly easy for adults to learn and use, and improves the growth trajectories of the children’s unique combinations of subjects and verbs and tense-agreement morphemes.

We don’t yet know how big of an impact strategies like this could make for kids with DLD, but so far it looks promising, and certainly worth trying! Learn more, and grab a parent-friendly handout here.

 

Hadley, P.A., Rispoli, M., Holt, J.K. (2017). Input Subject Diversity Accelerates the Growth of Tense and Agreement: Indirect Benefits From a Parent-Implemented Intervention. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2017_JSLHR-L-17-0008

Hadley, P.A., Rispoli, M., Holt, J.K., Papastratakos, T., Hsu, N., Kubalanza, M., McKenna, M.M. (2017). Input Subject Diversity Enhances Early Grammatical Growth: Evidence from a Parent-Implemented Intervention. Language Learning and Development. doi: 10.1080/15475441.2016.1193020.

Let’s hear it for the verbs! Parents’ early verb use predicts children with ASD’s later verb vocabulary

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Verbs are important for early language development; they are the building blocks for early sentences and help kids tell us about the things that are happening around them. But as we know, many of our children with ASD struggle to learn and use them flexibly. We know from the literature that for typically developing children, parents’ verb use can predict their later verb vocabulary. These researchers wanted to know if the same was true for children with ASD.

To do this, they measured the verbs that parents of children with ASD used during “follow-in utterances.” Follow-in utterances are comments that parents make during moments when they and their child are both focused on the same thing. So if a child knocked down a tower of blocks and looked up at his mom, her saying, “The tower crashed!” would be a follow-in utterance. The researchers looked at three aspects of parent verb use during follow-in utterances:

  1. The quantity of verb input, i.e., how often parents said verbs

  2. The diversity of verb input, i.e. how many different verbs parents said

  3. The grammatical informativeness of verb input, i.e. how much rich morphological information surrounded the verb. For example, “We’re jumping” would be more grammatically informative than “jump.” (See the article’s appendix for additional definitions and examples.)

They found that together, these three aspects of parent verb use during follow-in utterances predicted children with ASD’s later verb vocabulary. Because this is a correlational study (and doesn’t tell us what causes what), we’ll need further research to tell us if teaching parents to increase their quantity and quality of verb use will improve their children’s verb vocabulary. That being said, here are some ways authors describe that this line of research may impact what we teach parents:

  • We could teach parents to expand what their child says by adding a verb. For example, if the child says, “baby,” we could teach the parent to respond with, “the baby is sleeping,” rather than adding on to the noun phrase (e.g. “little baby”).

  • We could encourage parents to use diverse verbs during follow-in utterances, rather than over-relying on a small number of verbs and verb forms (such as “I want _____,” or “I need ______”).

  • We could teach parents to use grammatical language, rather than telegraphic. Because including grammatical morphemes seems to support children’s learning of verbs, we could teach parents to model fully grammatical language. For more research about using grammatical vs telegraphic language, see our previous review here.

 

Crandall, M.C., McDaniel, J., Watson, L.R., Yoder, P.J. (2019). The relation between early parent verb input and later expressive verb vocabulary in children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-L-18-0081.