Infant Directed Speech: Not just for play!

1.png

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.

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.

2.png

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.

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.

December Quotes, website.png

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.

Identifying early learning delays in preterm infants

Do you remember a few months back when we learned that preterm infants don’t seem to catch up to their peers’ language skills by school age? Well, this study took a look at how premature and full-term infants learn, and found some interesting differences we can add to our list of things to watch in our preterm cases.

The authors repeated assessments on 23 full term and 30 preterm infants over a period of 18 months to see if there were changes in how the infants performed on means-end tasks, which included a towel or a turntable as the means, and a fun toy as the end. In other words, the authors recorded whether the babies could pull the towel or turn the turntable to get a toy. Success requires a whole bunch of sensory, motor, and cognitive abilities to interact, and typical infants can complete a one-step means-end task like towel pulling by about 8 months (see here for an older study). They also recorded how much time the infants spent exploring, how many different ways the infants interacted with the task, and how many times the infants successfully completed the trials.

1.png

The authors found that all infants got better at getting the toy with age, but preterm infants as a group were less likely to succeed in both tasks compared to full-term infants (2.25 times less likely in the towel task and 1.55 times less likely in the turntable task). The authors also found differences in how the babies explored during the tasks. While everyone explored more over time, babies who explored more early in development had more success with the means-end tasks overall. Not only that, but preterm babies showed more variability in their exploration later in development than the full-term babies. As it turns out, we decrease the variability in exploration as we fine-tune our skills. Think about it this way—when we learn a new skill, we try it this way, try it that way, try it another way, and store maps for the most efficient ways to do the skill. We explore less as we get good at it, but pre-term babies continued to explore different behaviors longer than full-term babies in the means-end tasks.

OK, got it. But how can we use it? Diagnostically, we could use these tasks during assessments (the authors suggest the towel task for 5- to 7-month-olds and the turntable task for 11- to 13-month olds). Red flags would include lack of exploration in earlier ages and lots of variability in exploration later in infancy. For intervention, we should remember to encourage infants to explore solutions. Instead of modeling the solution, have fun in the learning process! We can also call attention to the end object so infant can see what happens to the toy when she acts on the towel or the turntable. Help these babies become the little scientists they were born to be!

 

Cunha, A. B., Babik, I., Ross, S. M., Logan, S. W., Galloway, J. C., Clary, E., & Lobo, M. A. (2018). Prematurity may negatively impact means-end problem solving across the first two years of life. Research in Developmental Disabilities. Advance online publication. doi: 10.1016/j.ridd.2018.03.007

Facilitating parent–child playgroups: A how-to guide

3.png

Most of us early interventionists work with families one-on-one. But how great would it be to facilitate a parent/child playgroup? Not only could you work with multiple children at once, but you could also connect families going through similar experiences. Green et al. investigated a specific type of playgroup geared toward enhancing parent interaction in communication (referred to as EPIIC) playgroups.

The EPIIC playground was structured like a typical morning preschool session. They did a hello song, a play activity, story time, and snack. They also built in time to address each child’s individual IFSP goals. Each playgroup session had a different theme, such as “what makes me learn to love books” and “what makes me laugh.”

Instead of the teacher or SLP leading the group, the parents worked directly with their children while being coached by the SLP. For instance, the SLP might model a page or two of shared book-reading, and then let the parent take over. The SLP facilitates the session, while parents interact with their child, learn new strategies, and meet other parents in their same boat!

After seven playgroup sessions, all children demonstrated increased communication skills. All of the parents improved their use of communication strategies with their children. Informally, parents reported being very happy with the playgroup, and felt that they learned new strategies and gained knowledge. The EPIIC playgroup model seems like a pretty epic way to deliver evidence-based services to families. Get it?

For a specific breakdown of the playgroup schedule and a full list of the topics used, be sure to check out the original article here.

 

Green, K. B., Towson, J. A., Head, C., Janowski, B., & Smith, L. (2018). Facilitated playgroups to promote speech and language skills of young children with communication delays: A pilot study. Child Language and Teaching, 34(1) 37–52.

Hip hip hooray for symbolic play!

4.png

We know how important play is for the under-three crowd. But what types of play should we be focusing on to promote communication? Quinn & Kidd looked at two different types of play: functional vs. symbolic play. Which one promotes greater communication development? 

Functional play involves using toys for their intended purpose. To promote functional play, the children and parents in this study were provided with magnetic drawing boards, wooden peg and hammer sets, puzzles, and musical instruments. Conversely, symbolic play involves the non-literal use of objects, such as using one object to represent another. The authors added that this typically occurs ~in the spirit of enjoyment~ (lol). To promote symbolic play between parent and child, the pair was given toy household items, toy phones, a teddy bear, and ambiguous items like block shapes and a piece of cloth.

This study found that during symbolic play, parents and their children engaged in joint attention more often and for longer periods of time. Symbolic play also elicited significantly more symbolic gestures from both toddlers & their parents. Symbolic gestures are gestures that represent an object or action, such as using fingers to pretend to comb a doll’s hair.

Joint attention and use of symbolic gestures are both foundational skills that are crucial for language development. The authors suggest that symbolic play is so vital to communication development because it requires collective negotiation and agreement of the representational function of objects. Symbolic play cannot successfully occur unless both the parent and child understand what the objects represent. These negotiations occur naturally and without the use of language. Toddler’s brains are pretty amazing, huh?

This study contributes to our understanding of the importance of engaging in symbolic play when working with our population. Symbolic play naturally requires the use of foundational skills necessary for communication. So, feel free to keep on using that hairbrush as a microphone, SLPs!

 

Quinn, S., & Kidd, E. (2018). Symbolic play promotes non-verbal communicative exchange in infant-caregiver dyads. British Journal of Developmental Psychology. 10.1111/bjdp.12251.

Throwback Pub (2012): Training parents to support children with developmental language disorder

As SLPs working in EI, we know that developmental language disorder presents risk for later academic skills. We also know that parent-implemented language interventions can be effective (see Roberts & Kaiser, 2011, for a meta-analysis of parent-implemented language interventions). This study examined whether parent-implemented Enhanced Milieu Teaching (EMT) would impact receptive and expressive language growth in children with language disorder (with cognitive standard score > 80 and no other primary diagnoses; see article for full inclusion/exclusion criteria).

The researchers examined three groups of 24–42-month old children:

  • Typical language

  • Language disorder w/ no treatment, or a “wait-and-see” approach

  • Language disorder w/ parent-implemented Enhanced Milieu Teaching

6.png

Families treatment group participated in parent training in 28 sessions (workshops, clinic, and home visits) over a three-month period. EMT strategies were trained in four phases: 1) setting a communicative context, 2) modeling and expanding communication, 3) time delay strategies, and 4) prompting strategies (see Table 5 for examples and description). During training at the clinic, therapists and parents practiced strategies using a specific set of toys. Home visits also included integrating strategies into functional family routines such as snack. All children were assessed with monthly language samples (MLU, total words, different words) plus the Preschool Language Scale, Fourth Edition (PLS-4), at the beginning and end of the study.

So what happened? Parent-implemented EMT was effective for improving language outcomes for children with LI, and parents in the treatment group used significantly more strategies than either other group! Parent use of strategies for typically-developing children and those with language disorder undergoing “wait and see” were about the same.

Children whose parents used EMT

  • significantly improved their PLS-4 Total and Expressive Communication scores and gained an average of 50 more words than untreated children with language disorder

  • gained an average of 15 more words per month compared to untreated children with language disorder

  • grew at about the same rate as children with typical language

Fantastic, right? But what about the kids with language disorder undergoing a “wait and see” approach? They showed significantly slower growth. Not only did those “wait and see” kids start out with lower language abilities, it looks like “waiting and seeing” might just hold them at a disadvantage when compared to those who have access to intervention. The authors stated, “Children in the LI-control group did not catch up but fell farther behind their peers with TL.”

How about a little extra info? The authors also looked at which child characteristics predicted language growth and outcomes. They examined risk at birth (e.g., a NICU stay), cognitive skills, and receptive skills (based on the Bayley-III scores). Risk at birth and cognitive skills were not predictive of expressive language analyses performed. However, “Receptive language at the start of the study predicted growth in language for all three groups of children after controlling for differences in IQ.”

The authors note that more research is needed to determine long-term outcomes. For example, how would these children progress over a period of 12 months? What kind of gains would come from 28 hours of traditional therapy in 3 months? Overall, parent-implemented EMT looks to be a promising model to add to our intervention options for young children with developmental language disorder.

Note: For our bilingual SLPs, see Peredo, Zelaya, & Kaiser, 2017 for a study on adapting parent-implemented EMT for Spanish-speaking families.

 

Roberts, M. Y., & Kaiser, A. P. (2012). Assessing the effects of a parent-implemented language intervention for children with language impairments using empirical benchmarks: A pilot study. Journal of Speech, Language, and Hearing Research55(6), 1655-1670.

Throwback Pub (2014): Telegraphic or grammatically complete prompts—which is best?

“Dog sitting.”  or “The dog is sitting.”

Which would you choose to use as a model in therapy for a language delayed toddler?

If you said the first sentence, you’re not alone. The common assumption among many pediatric SLPs and parents of young children is that short phrases with the grammar removed—aka: “telegraphic utterances”—are a better choice for young kids because they make it easier for them to understand and imitate. And, popular, research-based treatment programs like Enhanced Milieu Teaching (Hancock & Kaiser, 2006) include telegraphic prompts, so they have to be good, right?

But, here’s the problem: previous research has actually shown just the opposite (e.g., van Kleeck et al., 2010). And, in fact, some studies have shown that when young kids don’t hear grammatically complete models, they begin to assume that those telegraphic utterances are the rule (e.g., Leonard & Deevy, 2011), and then have trouble using them in spontaneous productions (e.g., Theakston, Lieven, & Tomasello, 2003).

So, what’s an SLP to do?

That’s where this study comes in. Because we know that hearing correct syntax and morphology is important, and particularly for young kids with language impairments, Bredin-Oja and Fey wanted to find out what happens when models for imitation are grammatically complete. Can young kids with expressive delays still imitate them? And, how does that compare to their ability to imitate telegraphic models?

5.png

Five 2-, 3-, and 4-year-olds with expressive language delays participated in 14 play-based therapy sessions. Seven of the sessions involved grammatically complete prompts (“The boy is jumping”), and seven included telegraphic models (“Boy jumping”). Results show that all five of the kids responded just as reliably to grammatically complete prompts to imitate as they did to telegraphic. And, three* of the five kids included morphemes in their imitated utterances only following a grammatically correct model.

This small study has big implications when it comes to the models that we provide in therapy, and also how we teach parents to talk to their young kids. Put simply, the message has to be simplified, but not at the expense of accuracy when it comes to grammar. The authors provide some helpful suggestions for how clinicians and parents can achieve this at the end of this article.

*Two of the kids didn’t produce the morphological markers at all, regardless of whether they were presented in a telegraphic or a grammatically complete utterance. The authors hypothesized that they were probably just not developmentally ready to produce those language forms, and that makes a lot of sense and aligns with previous research (e.g., Fey & Loeb, 2002). 

 

Bredin-Oja, S. L. & Fey, M. (2014). Children’s responses to telegraphic and grammatically complete prompts to imitate. American Journal of Speech-Language Pathology, 23, 15 – 26.