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

“Try this at home” isn’t enough

The effects of coaching on teaching parents reciprocal imitation training

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There is an ever-growing research base for parent-implemented interventions for children with ASD, and for good reason! We know that in order for children with autism to make progress, they need high treatment intensity. The most cost-effective, naturalistic way of reaching that treatment intensity is by teaching their parents how to use intervention strategies with their children on a daily basis. The other side of this coin, however, is that we also know that treatment fidelity is an important factor in child outcomes; how closely parents adhere to the intervention will impact their child’s progress.  

This study looked at how one-on-one coaching affected parents’ ability to implement an evidence-based intervention for their child with ASD, and how their use of the strategies impacted their child’s outcomes. The intervention taught to parents was reciprocal imitation training (RIT). RIT is a naturalistic developmental behavioral intervention (NDBI; Schreibman et al., 2015) that teaches young children with ASD to spontaneously imitate within a social interaction. It uses naturalistic behavioral strategies such as following the child’s lead, modeling, prompting, and reinforcement.  

Three parents and their children with ASD participated in this study. The parents attended a training where they learned all of the ins and outs of how to do the intervention. Then they went home and video recorded their attempts to use the strategies once per day. After a few weeks, a clinician came to their home and provided coaching on the strategies once per week for 6-7 weeks. The researchers then went through the recordings and measured both the parents’ use of the strategies over time and the children’s growth in imitation skills. They found that parents were able to implement RIT with high accuracy (yay!), but only after individualized coaching support. While some of the parents improved significantly after the initial training, they all needed a therapist to come to their house and coach them in order to master the strategies. The children in the study all increased their spontaneous imitation, but only after their parents became consistent and accurate with at least some of the components of the intervention.

This study extends our understanding of the importance of coaching parents on strategies rather than relying solely on verbal instruction or suggestions. Here we have data to show how these parents needed more than just verbal instruction; they needed live feedback and training in order to use the strategies accurately and consistently, and only then did child outcomes improve. Providing parents with active coaching provides parents with the tools needed in order to support their children’s social communication. 

Note: If you are interested in learning more about RIT, you can check out this article. And here is the measure that the researchers used to evaluate the parents’ use of the strategies.

 

Penney, A. & Schwartz, I. (2018). Effects of coaching on the fidelity of parent implementation of reciprocal imitation training. Autism. doi: 10.1177/1362361318816688.

Long-term outcomes of Hanen’s Target Word program

How much of a long-term impact does parent-implemented speech–language therapy have on late talkers? That’s an important question. Most studies have focused on short- or medium-term outcomes and have not looked into long-term follow-up results.

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These researchers wanted to know the medium- and long-term effects of a low-dosage parent program for late talkers. To do this, they provided the Hanen’s Target Word program to 30 parents of 24-month-old late talkers, and followed a different set of 30 parents–child pairs that did not receive the program. The program included five group sessions and two individual video-feedback sessions over the span of three months. They then tested parents’ use of the strategies at 36 months, and language skills at 36 and 48 months.

They found that the program accelerated the vocabulary growth for the late talkers, but by age 4, there were no longer any differences between the two groups’ expressive vocabularies and both had reached age-appropriate scores. Both groups, however, continued to fall behind their peers in syntax and grammar.

The parents who participated in the study followed their child’s lead more and put less communicative pressure on their child; however, the parents did not significantly improve in how often they responded to their child’s communication or in how much linguistic stimulation they provided their child. Through analysis, the researchers found the strategy of reducing communicative pressure to be specifically associated with children’s language growth.

Here are some important considerations and takeaways from the study:

  • Null long-term results don’t mean that the intervention wasn’t worthwhile. As we know, increasing two year olds’ vocabularies can help ease the frustration of not being able to communicate which is an important goal of early intervention.

  • Dosage and coaching style play an important role in treatment outcomes. The authors discuss how the parent results of this study differed sharply from the Roberts and Kaiser (2015) study in which the researchers taught parents Enhanced Milieu Teaching (EMT) strategies, and parents were able to learn all of them. One of the reasons why is that the intervention dosage was much higher for the EMT study (four workshops and 24 hour-long sessions, compared to two), giving parents more opportunity for practice and feedback. Adjusting the dosage or coaching style of the Target Word program may be one option for increasing its long-term effectiveness.

  • Reducing communicative pressure may be an especially important strategy for parents. This is a simple strategy to teach parents, and these results demonstrate how powerful it can be for supporting language growth in toddlers.

  • Ongoing monitoring is important for late-talkers. Nearly one third of the children who participated still had language scores below the normal range at four years of age, but fewer than half of those children received speech–language therapy after the study. Monitoring is important to ensure that these children don’t fall through the cracks when language demands as they grow older.

One final note: this isn’t a replication study of Hanen’s Target Word program, but rather it’s a study that tested its effectiveness in real-world contexts. That’s awesome for two reasons: (1) authors aren’t tied to Hanen, which helps eliminate bias, and (2) real-world contexts = more like what we SLPs face = more clinically applicable! 

Want more? These authors also published a study of Hanen’s Target Word program (so popular!) This retrospective study (looking back at client charts) similarly showed gains in communicative participation and vocabulary for children who participated in the program.

 

Kruythoff-Broekman, A., Wiefferink, C., Rieffe, C., Uilenburg, N. (2019). Parent-implemented early language intervention programme for late talkers: parental communicative behaviour change and child language outcomes at 3 and 4 years of age. International Journal of Language & Communication Disorders. doi: 10.1111/1460-6984.12451

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 

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.

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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-delivered communication intervention for infants and toddlers who are DHH

If you’re an early intervention SLP, you’ve probably had a child who is deaf or hard of hearing (DHH) on your caseload at one time or another. Why? Well, advances in hearing aid and cochlear implant technology have certainly improved the speech and language outcomes of children who are DHH, but aided hearing isn’t the same as typical hearing. And even with early amplification, these children often still miss out on language stimulation pre-amplification, which can lead to delays.

In this study, they taught the parents of nine 6 to 24-month-olds with hearing loss to use four different strategies to promote and reinforce their communicative attempts. This included visual strategies such as moving toys in the child’s line of sight, and interactive strategies such as following the child’s lead and modeling target language to their actions. Parents were also taught responsive strategies like balancing the number of conversational turns that they took when communicating with their child, and linguistically stimulating strategies like expanding on their child’s spontaneous utterances.

The parents who participated in the training and delivered the intervention used more strategies that support communication compared to the parents in the control group. And, by the end of the study, the infants and toddlers who received the intervention demonstrated more prelinguistic communication skills compared to the children in the control group.  

The beauty of this study is twofold: 

First, the strategies that were included in the intervention are all things that we as EI providers are already well-versed in. {That’s because we’re all pretty darn familiar with enhanced milieu teaching (Hemmeter & Kaiser, 1993), prelinguistic milieu teaching (Yoder & Warren, 2002), and The Hanen Program (Girolametto, Pearce, & Weitzman, 1996)}. Second, if you’re an EI therapist, a big part of your job already involves parent training and coaching. This article provides a very simple, clear description of the key strategies that you can teach parents of infants and toddlers on your caseload who are DHH. Definitely the kind of article that you can read and then immediately apply to your practice, which is the best kind of article, am I right?!

 

Roberts, M. (2018). Parent-Implemented Communication Treatment for Infants and Toddlers With Hearing Loss: A Randomized Pilot Trial. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2018_JSLHR-L-18-0079

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. PPVT-3 scores significantly correlated with things like marital status, income, and level of caregiver education, and foster parents were significantly more likely to have those things going for them than the birth parents in this study. There were differences in receptive language scores between groups (children placed in foster care vs those with biological parents), with children in foster care having better scores on average. Once Zajac and friends controlled for factors such as parent level of education and income, differences between groups were not significant. The takeaway is that the ‘whole picture’ is important: not just placement, but the factors associated with the characteristics of the caregivers in the placement. 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

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

Throwback (2012): Teaching parents to break into their child’s world

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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, 16(6), 568–85.