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.

Teaching parents language strategies during shared book reading

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As early intervention SLPs, we know the importance of teaching parents to use language facilitation strategies (see the Heidlage & Roberts meta-analyses we discuss in the last bullet point, here). We also know the value of shared book reading as a context for language learning. These researchers decided to take a close look at the process of teaching parents to use naturalistic language strategies during book reading. To do this, they taught two mothers, one with a three-year-old with ASD and one with a 5-year-old with cerebral palsy, two sets of strategies.

The first set of strategies was engagement strategies for parents to use before, during, and after reading books.

  • Before book reading:

    • Say the title and author (e.g. “This book is called ____ and is written by ____.”)

    • Ask a question to build interest (e.g. “What do you think this book is about?”)

  • During book reading:

    • Make encouraging statements (e.g. “I like how you’re sitting so nicely with me!” “Good job turning the page.”)

    • Use nonverbal and verbal means to focus the child’s attention (e.g. point to a picture and say, “Look! It’s a gorilla!”)

  • After book reading:

    • Ask a closing question to maintain interest, or relate the book to the child’s life (e.g. “Which animal makes a funny sound, a cow or a sheep? Why? What sound does our dog make?”)

The second set of strategies was components of the intervention program Parent-Implemented Communication Strategies (PiCS) (Meadan et al. 2014).

  • Modeling: demonstrate a word, phrase, or gesture with the expectation that the child will imitate (e.g. “Turn the page”)

  • Mand–model: in addition to the model, use a verbal prompt in the form of a question (e.g. “What do you want?”), a choice (e.g. “Should we read the cat book or the tractor book?”), or a command (e.g. “Say ‘turn the page”).

  • Time delay: pause within an established routine to give the child an opportunity to initiate communication (e.g. label all of the pictures on a page except for one, point to the last picture, and look expectantly at the child for five seconds).

They taught parents these strategies via two initial teaching sessions followed by 12 weeks of twice-a-week coaching sessions. The two initial teaching sessions included reviewing the material, watching example videos, role-playing, and feedback. The coaching sessions used the following format:

  • The researcher reviewed the target strategy

  • The researcher provided feedback on the previous session using a video clip, giving direct positive and constructive feedback

  • The mother and child engaged together in shared storybook reading while the researcher observed

  • The mother reflected on her own use of the strategies, and the researcher provided suggestions and feedback. Together, they problem-solved any concerns or issues

The researchers found a connection between the mothers’ use of the PiCS strategies and the child’s communication, providing support for teaching parents to use the PiCS strategies during shared book reading. They also found that the hands-on practice/coaching component was key for the mothers to use the PiCS strategies successfully. Because we EI SLPs are already familiar with the strategies that were taught to the parents in this study, this is definitely something we can use in our sessions!

 

Akamoglu, Y., & Meadan, H. (2019). Parent-implemented communication strategies during storybook reading. Journal of Early Intervention. doi: 10.1177/1053815119855007.

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.

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.

“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.