Throwback (2011): Increasing sound production through imitation therapy

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Imitation is the sincerest form of flattery. However, every SLP has worked with a child who simply doesn’t imitate. No matter how many times we blow raspberries, make animal noises, or wave our arms wildly, we are met with blank stares. Yet imitation during early development is a crucial building block to successful communication. 

This study looked at a systematic method for teaching nonverbal toddlers the skill of imitation. All children in the study were 18–19 months old, showed minimal babbling, did not imitate sounds, and did not produce any phonetically consistent forms. All of the children scored lower than the 2nd percentile on the PLS-3 or PLS-4 scores. Sounds like your typical El late talker, right?

Back in 1972, Zedler developed a therapeutic technique referred to as Technique Imitation Therapy (IT) for use with young children who did not develop language as expected. He believed that a child’s language development is dependent on the child’s awareness that his or her own behavior can affect others. The idea is that providing opportunities for the child to direct an adult’s attention and actions, the child will realize that their own actions can influence others. With reinforcement (as always), the child should eventually be able to learn how to imitate.  

In the present-day study, clinicians implemented Imitation Therapy with 18–19-month-old toddlers 2–4 times per week in 50 minute sessions, until the child spontaneously imitated verbalizations at least eight times in two consecutive sessions. This took between 16–18 sessions for the group of children, or approximately 8 weeks.

Imitation Therapy consists of four steps, starting with the adult serving as the sole imitator of everything the child does and says, until the child realizes that the adult is imitating him/her. Next, when the child begins to do some basic imitation of the adult, he is positively reinforced. Then, the adult begins to only imitate the child’s oral movements or sounds produced. At the final stage, the adult and child imitate each other reciprocally, with the goal of the child imitating sounds consistently. At the end of the study, all children showed a significant increase in their sound production and repertoire of phonemes. Specifically, all children had at least 13 phonemes and produced 100+ sound productions per session. Talk about measureable progress! This article describes the procedure in great detail, so that any SLP could recreate IT at their next home visit.  

The authors do mention that small sample size and lack of a control group are limitations of this study. However, each of the children missed a week of therapy due to fall/spring break. During this break, they experienced a decrease in sound production, which subsequently increased when therapy was again initiated. This observation reinforces the evidence that IT may have been a factor in the children’s progress. At a minimum, imitation therapy appears to be a promising technique to try with nonverbal toddlers who struggle to imitate.   

 

Gill, C., Mehta, J., Fredenburg, K., Bartlett, K. (2011). Imitation therapy for non-verbal toddlers. Child Language Teaching and Therapy, 27(1), 97–108.