Early Intervention Strategies for Children with Speech & Language Impairment

1. Early Intervention Strategies for Children with Speech & Language Impairment Nancy J. Scherer, Ph.D.

2. Overview of Presentation • Rationale for early intervention • Goals for early intervention • Early intervention models • Teaching Parents

3. Rationale • Much of language development occurs prior to three years of age • Language functioning is requisite for successful academic performance and social functioning • Early intervention may lessen risk of long-term communication impairment

4. Advances in Early Language Intervention • Focus on teaching functional skills for immediate use • Attention to generalization, maintenance of newly learned skills • Emphasis on naturalistic approaches rather that didactic instruction • Empirical evidence of effective intervention to improve communication skills

5. Teach in everyday contexts where communication is needed Teach specific communication forms at the moment they are useful Teach to promote generalization and maintenance Which teaching strategies? Who can teach? What should be taught? What evidence of effectiveness? Are developmental changes possible? What changes in functional communication skills? Are there effects in other developmental domains? Implications of These Advances

6. Goals for Early Intervention • Promote pre-linguistic communication • Communication intention (e.g.,Request, comment,protest) • Communication modalities • Vocalizations • Gesture • Sign • Early linguistic communication • Early vocabulary development • Word combinations • Syntax/morphology • Articulation • Pragmatics

7. Milieu Teaching • Naturalistic language teaching strategy designed to teach communication skills in everyday conversational interactions • Hart & Rogers-Warren (l978)

8. Principles of EMT • Children are motivated to practice language when there is a functional consequence. • Adults can create opportunities for functional language by arranging the environment to facilitate requests. • Adults model target words (Focused Stimulation) • Structured prompting procedures elicit and model new words in response to requests. • Expansion, praise and access to requested objects encourages practice of new words. • Provides functional, social and linguistic consequences for child’s language production.

9. Milieu Teaching has positive effects on children’s communication when implemented by clinicians and teachers • Increases child use of targets • Vocabulary (Kaiser et al, l993; Scherer & Kaiser, in press) • Early syntactic/semantic forms (Kaiser & Hester, l994) • Moderately complex syntax (Warren & Kaiser, l986) • Increases child frequency of communication (Warren et al, l994; Kaiser et al, l993) • Results in generalization across settings, people, and language concepts (Warren & Bambara, l989; Goldstein & Mousetis, l989) • Results in maintenance of newly learned targets (Warren & Kaiser, l986) • Is more effective than drill-practice methods for early languagelearners (Yoder, Kaiser et Alpert, l991, Kaiser, Yoder, et al,1996)

10. Findings From Single Subject Research on Parent-Implemented Milieu Teaching • Parents can learn a range of strategies to criterion levels • Environmental arrangement (Alpert & Kaiser, l992; Hemmeter & Kaiser l990) • Responsive interaction strategies (Hancock & Kaiser, 2002;Kaiser et al, l996) • Modeling language targets (Hancock & Kaiser, 2002) • Prompting target production using EMT techniques (Kaiser, Hancock & Nietfeld, 2001) • Parents can generalize these strategies to home interactions with their children (Hancock & Kaiser, 2002) • Parents maintain their newly-learned skills over 6-18 months (Kaiser, et al 2001).

11. Modeling Mand + Model Time Delay Incidental Teaching Four Milieu TeachingProcedures Hybrid: Enhanced Milieu Teaching (Kaiser, l993) Environmental Arrangement PLUS Responsive Interaction

12. Environmental Arrangement • BIG Environmental Arrangement • Child preferred activities and materials • Strategies and room arrangements to promote child engagement • Strategies and room arrangements to support positive behavior • Routines • Little Environmental Arrangement • Strategies to promote requesting

13. Environmental Arrangement Choose Toys and Materials of Interest • Developmentally appropriate • Promote speech andlanguage targets • Can be structured to promote requesting • Can be used in a playroutine • Adapt toys and activities to fit the child’s interest and abilities • Cause and effect (bubbles, balls on track, shape sorter) • Routines and simple schemes (cars on track, jumping spiders, art, playdough, feeding babies) • Moderate schemes (doll house, simple games, housekeeping, farm) • Child is engaged….but not obsessed

14. Environmental Arrangement Sustaining Child Engagement • Actively engage in play with child • Mirror child actions • Exchange materials • Take turns • Talk about what child is doing • Add parts to materials • Praiseengagement—let the child know you notice • Bean engaging, responsive partner • Manage time • Anticipate when child is interest in waning • Change before she does • Use a timer

15. Follow the child’s lead (topic, play, joint attention) Balance verbal turn taking Treat nonverbal turns as communicative Contingent imitation of child actions in play Enter into and expand child’s play Provide meaningful feedback for communicative behavior Model talk at the target level appropriate to the communicative context Model specific language targets in context Expand child utterances (meaning and lexical expansions at target level and using specific targets) Provide meaningful verbal feedback for communicative behavior Responsive Interaction(Adapted from Weiss, et al , 1985)

16. What Skills Do You Need? • Basic EMT strategies • Environmental Arrangement • Responsive Interaction • Milieu Teaching Strategies • Strategies for supporting positive behavior and engagement • Choosing activities and routines for teaching communication • Ability to Individualize to fit children’s communication needs • Choosing targets that advance child’s skills • Teaching child’s targets • Keeping track of progress • Changing as the child changes

17. Basic Responsive Strategies • Create a context for conversation • Make yourself an available partner • Use routines, activities, child interest, child action to define the topic • Follow the child’s lead • Join, follow, focus on the child • Maintain positive boundaries • Imitate child’s actions:Mirroring

18. Mirroring Non-verbal Turn-taking Definition: Connecting and communicating with the child without using words. • Mirroring occurs when the adult imitates the child’s nonverbal behaviors • Mirroring means you wait, watch, and then do exactly what he did if you can

19. Mirroring Non-verbal Turn-takingExamples • Imitating/Mirroring the child’s nonverbal, appropriate play behaviors • Child rolls his truck on the table; the adult rolls her own truck on the table • You can both drive cars on the table without mirroring, but when he stops his car and you immediately stop your car too, then you are mirroring • When he slices one piece off of the playdough and you slice one piece off, you are mirroring

20. Mirroring Verbal Turn-takingExamples • To balance your turns with the child, you should respond to every child verbal utterance • Talk only when the child talks • Be sure to pause after your response to allow the child to take another turn • If more than 5 seconds pass without a verbal or nonverbal behavior from the child, you should take another turn • Mirror the child’s actions and talk about the action • Map the child’s nonverbal communication with words

21. Example of Mirroring C/A: (Mirroring) A: We make music C/A: (Mirroring) C: (Vocalizes) A: Say more (Model) C: (Vocalizes) A: Say more (Model) C: (Vocalizes) A: More music (Model) C/A: Mirroring

22. Milieu Teaching Procedures • Prompt language use in functional communicative contexts using • Model • Mand +Model, • Time Delay, • Incidental Teaching • Teach elaborated language forms (TARGETS) in context • Provide functional consequences for communication including positive feedback and expansions

23. Model Procedure • Prompts child to imitate modeled language response • Response is functional for child • Access to reinforcer • Child does not yet use form spontaneously • Model begins with “SAY” • Make the prompt clear to the child • Adult waits for child response • Model is repeated once if child does not respond • Approximations may be accepted • Criteria for response are predetermined

24. Examples of Model Procedure C: X A: Say I roll (Model) C: I roll A: I roll marbles (Expansion) C: (reaches for marbles) A: Say more marbles (Model) C: More marble A: More marbles (Expansion) C: (Marbles in track) A: Marbles roll (Model) C: Me some A: Say marbles go (Model) C: Marble go

25. Model Procedure • Model a target word that child does not produce spontaneously • Two prompts—unless you lose child interest • Focus and move fast—keep the model in the pace of the conversation • Expand, praise, and provide the requested object

26. Mand • A prompt for a communicative response • Real Question • What do you want? • What are you painting? • An instruction to verbalize preference or give information • Tell me what you want • Tell me when you are ready • An opportunity to indicate a choice • Do you want milk or tea? Test Questions

27. Example of Mand-Model A: Which one? (Mand) C: (Reaches) A: Say give horse (Model) C: Give horse A: Give me horse (Expansion) C: Give horse A: Give me more horse (Expansion) C: Give me more A: Say more horse C: More horse

28. Time Delay …the pause that transitions to spontaneous requesting • Set up environment to promote request (routines, needs assistance) • Look at child expectantly • Hold up object or physically interrupt action • WAIT….up to 5 sec • Reinforce child initiated responses!!!

29. Example of Time Delay A: (Holds car on track) C: Go A: Say go cars (Model) C: Go cars

30. Expansion • Definition: • Repeat child’s utterance and ADD new information. • Expansions can be lexical, “correcting” the sentence by fixing an ending, correcting a word, or replacing a nonspecific word with a specific word • or meaning expansions—adding new words/meanings to the sentence.

31. Expansion Example A: Which one? (Mand) C: X A: Say yellow block (Model) C: Yellow block A: Want yellow block (Expansion) A: Stack blocks (Model) C: Stack block A: We stack blocks (Expansion)

32. Summary • Model procedure is the heart of EMT; it is always the fall back correction procedure • Mand-model procedure teaches choice making and response to general instructions (“tell me) and real questions • Time-delay helps children transition to initiating verbal communication at target level; its use depends on child learning • Expansion increases the child’s linguistic complexity • Incidental teaching is simply these procedures done in response to a child request

33. Choosing Targets • Each child should have: • Vocabulary targets • Specific words or categories with specific words • Prelinguistic transition and one-word children will have small set of targets with lots of repetition • Vocabulary matches child cognitive skills and linguistic skills • Phonology and articulation also dictate choices • Two semantic/ syntactic target classes above MLU level • One word children will not have these • Plan multiple examples of target classes

34. Examples

35. Summary: EMT • Hybrid model of early language intervention that utilizes natural language teaching opportunities • Validated through evidence-based studies • Used with wide range of disabilities • Promotes speech production in addition to language • Can be applied to prelinguistic children as well as children using words • Parents and teachers can be trained