Transcript KidTalk: Naturalistic Communication Intervention Strategies for Parents and Teachers of Young Children

KidTalk: Naturalistic
Communication Intervention
Strategies for Parents and
Teachers of Young Children
CEC 4/20/2010
Ann Kaiser, PhD; Megan Roberts, MS-CCC-SLP; Courtney Wright, MA, CCC-SLP
Today’s Schedule
9:00-9:10 Introductions
9:15- 10:25 Setting the Context for Communication
10:25-10:35 Break
10:35-12:00 Modeling and Expanding Play
12:00-1:00 Lunch
1:00-2:25 Modeling and Expanding
Communication
• 2:25-2:35 Break
• 2:35-4:00 Environmental Arrangement and
Prompting Strategies
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Introductions
• Tell us:
– Your name
– Occupation (setting, population you work
with)
– Why you came to this workshop/what you
want to get out of this workshop
Format of the Session + Materials
• We want this to be an interactive session
– Watch and discuss videos in small groups
– Practice strategies in pairs
– Prizes for participation!
• Materials
– Folders with handouts and worksheets (1 for
each person)
– Toy kit (1 for each group)
– Dry erase board with markers (1 for each
group)
Setting the Foundation for
Communication
Enhanced Milieu Teaching (EMT): Part 1
What is Enhanced Milieu Teaching?
• EMT is an evidence-based intervention
with 20 years of research.
• EMT is a naturalistic, conversation-based
intervention that uses child interests and
initiations as opportunities to model and
prompt language in everyday contexts.
• EMT can be used throughout the day as
part of the everyday interactions.
• EMT is an effective intervention.
EMT: An Effective Intervention
250
200
168
150
100
50
77
22
0
Pre
Post 1
Post 2
Post 3
Time
6
5.49
5
4.86
4
MLUw
Number of Different Words
210
3.78
3
2
1.4
1
0
Pre
Post 1
Post 2
Time
Post 3
EMT’s Positive Effects
• Increases child use of language targets
– Vocabulary (Kaiser et al, 1993; Scherer & Kaiser, in press)
– Early syntactic forms (Kaiser & Hester, 1994)
– Moderately complex syntax (Warren & Kaiser, 1986)
• Increases child frequency of communication
(Warren et al, 1994; Kaiser et al, 1993)
• Results in generalization across settings,
people, and language concepts (Warren & Bambara, 1989;
Goldstein & Mousetis, 1989)
• Results in maintenance of newly learned
targets (Warren & Kaiser, 1986)
– Is more effective than drill-practice methods for early
language learners (Yoder, Kaiser et Alpert, 1991; Kaiser, Yoder, et al., 1996)
EMT’s Positive Effects
Children in Treatment Show Greater Developmental
Gains at Post 1 than Children in Control Group
Experimental
Control
105
100
Experimental
95
All Syntax
All Productive
Express Age
Ave(Prod, syn, voc)
Intellig.
SICD-R
SICD-E
EOW
Diversity
MLU
SICD-ER
Total Ut.
MLU 1-2
PVT, EOW, Divers
PPVT
90
McArthur
Control
EMT’s Positive Effects
• Children receiving parent-implemented EMT show
more language growth over time than children
receiving EMT from a therapist only
EMT’s Positive Effects
• Children receiving parent-implemented EMT
show more language growth over time than
children receiving EMT from a therapist only
Average Months Gained on SICD-E/SICD-R in 6 months
Pre- Post 1
Intervention
Post 1-Post 2
Follow-up
(6 mos)
(6 mos)
ParentImplemented
EMT/RI
5.5 Exp
6.7 Rec
8.5 Exp
6.0 Rec
TherapistImplemented
EMT
5.1 Exp
4.3 Rec
1.5 Exp
3.3 Rec
Systematic Reviews of EMT Studies
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Hancock, T.B., & Kaiser, A.P. (in press). Implementing Enhanced Milieu Teaching
with Children Who Have Autism Spectrum Disorders. In P. Prelock & R.
McCauley (Eds.), Treatment of autism spectrum disorders: evidence-based
intervention strategies for communication & social interaction. Baltimore:
Paul Brookes
Kaiser, A.P., & Trent, J. A. (2007). Communication intervention for young
children with disabilities: Naturalistic approaches to promoting
development. In S. Odom, R. Horner, M. Snell & J. Blacher (Eds.),
Handbook of Developmental Disabilities, (pp. 224-246). New York:
Guilford Press.
Hancock, T. B., & Kaiser, A. P. (2006). Enhanced Milieu Teaching. In R.
McCauley & M. Fey (Eds.), Treatment of Language Disorders in Children,
(pp. 203-233). Baltimore: Paul Brookes.
Kaiser, A. P., & Grim, J. C. (2005). Teaching functional communication skills. In
M. Snell & F. Brown (Eds.), Instruction of Students with Severe Disabilities,
(pp. 447-488). Upper Saddle River, NJ: Pearson.
Kaiser, A. P., Yoder, P. J., & Keetz, A. (1992). Evaluating milieu teaching. In S. F.
Warren & J. Reichle (Eds.), Causes and effects in communication and
language intervention Vol. 1, (pp. 9-47). Baltimore: Paul H. Brookes.
EMT Strategies
• A set of tools to help facilitate a child’s
communication growth:
– Setting up an interactive context between the
adult and child through play
– Noticing and responding to child
communication; balancing turns
– Modeling and expanding play
– Modeling and expanding communication
– Using environmental arrangement (ea)
strategies
– Using prompting strategies
Strategy 1: Play and Engage
• The first goal is to set up an interactive
context between the adult and child.
• Communication develops on a platform
of shared joint attention and
engagement.
– Social interaction between child and adult
– Play with objects and partner
– Everyday routines where communication is
functional
Why Play and Engage?
• Children learn best when they are
engaged and interacting with a
communication partner.
– Play helps engagement and interaction
• Children are more likely to be engaged
and learn language while doing activities
they enjoy.
• When the adult plays with the child at his
or her level, the adult optimizes the
opportunity for communication to occur.
How to play and engage?
Be at the child’s level.
Do whatever the child is doing .
Follow the child’s lead (1, 2).
Avoid directions and let the child lead the play (1, 2).
Avoid questions and let the child initiate the
communication (1, 2).
• Choose toys that are interesting and engaging.
• Put away toys that aren’t being used (1, 2)..
• Substitute undesired activities with desired
activities (1, 2).
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When to Play and Engage?
• Whenever possible
• At least once a day for at least 15 minutes
of concentrated and individualized adultchild time
Strategy 2: Notice and Respond to all
Communication
All children are communicating now
a. How?
Prelinguistic
• Point
•Reach
• Show
• Lifts arms up
• Give
• Shakes head
• Vocalizations
Linguistic
• Signs
• Pictures
• Symbols
• Words
b. Why?
Requesting
Commenting
Understanding Child Communicating?
Watch this video and look for:
1. How is this child communicating?
2. Why is this child communicating ?
Why Notice and Respond?
• Noticing and responding to all
communication teaches the child that
their communication is important to you.
• By acknowledging all communication
and communicative attempts you
reinforce the child for communicating.
• The more the child communicates, the
more practice they receive and the easier
communication becomes.
Notice and Respond to Communication
• Notice and respond every time the child
communicates.
• Respond by talking about what the child
is doing.
• Language is most meaningful when it’s
related to what the child is doing OR in
response to what the child is
communicating.
• Example 1 & 2: responding
• Example 3 & 4: talking about what the child is doing
When to notice and respond?
• As much as possible
• In all contexts throughout the day
– Play
– Meals
– Routines (bath, car, dressing)
Goal 1: Responding to Communication
• Responsiveness: you should respond to
90% or more of the child’s
communication.
Strategy 3: Take Turns
• Take turns communicating with the child.
• Allow time for the child to communicate.
• Play a game of “communication catch”
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Child communicates
Adult responds (and waits)
Child communicates
Adult responds (and waits)
• Only say something after the child
communicates.
• Examples (1, 2, 3, 4)
Why Take Turns?
• It allows the child more opportunities to
communicate.
– More opportunities = more practice =
growth in communication skills.
• It teaches the child how to have a
conversation.
– Child communicates
– Adult communicates and WAITS, which
signals to the child that it is his or her turn to
communicate
When to take turns?
• As much as possible
• In all contexts
– Play
– Meals
– Routines (bath, car, dressing)
Goal: Matched Turns
• Matched turns > 75% (75% of what you
say should be “matched” or in response
to the child’s communication).
Strategy 4: Mirror and Map
• Mirroring: adult imitates the child’s
nonverbal behaviors.
• Mapping: adult “maps” language onto
these actions, by describing these actions.
Why use mirroring and mapping?
• Mirroring allows the adult to join in the
interaction with the child.
• Mapping provides the child with a language
rich description of the activity.
• Mirroring and mapping allows the adult to
have balanced turns when the child is not
communicating.
• What the adult says is more meaningful since
the adult and child are doing the same action
and language is “mapped” right on top of
what the child is doing.
How and When to Mirror and Map?
• Use mirroring and mapping when the
child is not communicating.
• Mapping must come after mirroring.
• First imitate the action and then label the
action with words.
– Child: {feeds baby}
– Adult: {feeds baby} eat.
• Example 1, 2, 3
How and When to Mirror and Map?
• Mirror (imitate) close to the child’s
actions to make language more obvious.
• Avoid mirroring behaviors that are
unacceptable (e.g., throwing toys,
hitting).
• Balance mapping and playing (e.g., don’t
over map).
Let’s Review
• Do what the child does, following his lead.
• Make statements (no questions, no
directions).
• Respond when the child communicates.
• Talk about what the child is doing.
• Wait for communication.
• Only talk after the child talks.
• Mirror and map when the child is not
communicating.
Let’s Practice: In Pairs
• In pairs, practice mirroring and mapping
with the toys in the toy kits.
• Take turns being the adult and child.
Modeling and Expanding
Play and Communication
Enhanced Milieu Teaching (EMT): Part 2
EMT Strategies
• A set of tools to help facilitate a child’s
communication growth:
√ Setting up an interactive context between the
adult and child through play
√ Noticing and responding to child
communication; balancing turns
– Modeling and expanding play
– Modeling and expanding communication
– Using environmental arrangement (EA)
strategies
– Using prompting strategies
Play Goals
1. Extend the time the child plays with a
toy.
2. Expand the different actions the child
does with the same toy.
3. Expand the types of different toys the
child uses.
Why do we teach play ?
• Linking words with engaging activities
maximizes opportunities for teaching
language.
• Choosing toys that are interesting keeps
the child engaged.
• Expanding play activities allows more
language modeling and facilitates
language learning.
Play at your child’s level
• Manipulative play: basic exploration of materials,
taking apart and combining objects, and combining
items because they go together
– Example 1, Example 2
• Pre-symbolic play: manipulating objects to
themselves, extending play actions/objects to others,
and the first sequence type play.
– Example 1, Example 2
• Symbolic play: substituting objects, using an agent
as if it is alive, and complex sequences of play.
– Example 1, Example 2
• Example 1, Example 2
How to model new play actions?
• Continue to follow the child’s lead.
• Set a new toy object in sight or model a new
action and WAIT to see if the child shows
interest.
• Do what the child does and try to add a
different action.
• If the child shows interest, model a new play
action with the object.
• As always, follow the child’s lead and if the
child is not interested, try again later with a
different object or action.
Modeling New Play
• Modeling new play
– Example 1
– Example 2
– Example 3
– Example 4
Using Routines in Play
• Routines are a predictable sequence that
have a beginning, middle and end.
• Children learn language during small
routines in play because they know what
actions (and words) will come next.
• Examples
– Scoop beans, pour beans, dump beans.
– Person in car, drive car, get out of car
• Video
Let’s Practice: Small Group
• Complete play worksheet using toys in
the toy kit.
When to model new play?
• When the child is doing the same action
with the same object multiple times.
• When the child is doing an undesired
action with the toy (e.g., eating play-doh,
hitting the baby, mouthing pretend food).
Language Goals
1. Increase the rate at which the child
communicates.
2. Increase the diversity of
communication.
3. Increase the child’s independence.
• Increase spontaneous communication
• Decrease the dependence on adult cues
Why model language?
• Children learn language through
modeling.
• Contingent modeling that is in response
to a child’ s communication is the most
powerful form of modeling.
• Simplifying language to match the
child’s language targets helps the child
learn language more quickly.
– Easier to imitate, easier to understand
– Example 1, Example 2
How to model language?
• We pick targets based on the language
the child is already using and what the
child should learn next.
• How does the child communicate now?
– Gestures, vocalizations
– Single words
– 2 words
– 3 words
– 4 words
Choosing Communication Targets
Child Target
Adult Target
Vocalizations, no gestures
Single words
Vocalizations & gestures
Single words
Gestures, vocalizations,
some single words
50+ words (including a
variety of verbs)
Two word utterances with
different types
Single words
Two words
3-5 words.
Goal: Targets
• 50% of what you say should be one of the
child’s targets:
• 50% should be slightly higher than the
child’s current targets
– 1-2 words above his/her level
– All words should be teaching words (nouns, verbs,
modifiers)
When to model new language?
• After the child communicates.
– Respond with a language target
• When you are doing the same action or
have the same object as the child.
– Child: {drives car}.
– Adult: {drives car} drive.
• While taking communication turns.
Let’s Practice: Small Group
• Add target language to play worksheet
Expanding Communication
• An expansion is imitating what the child
communicated and then adding more
words.
• The most powerful expansion includes
one of the child’s communication targets.
Why expand communication?
• Expansions immediately connect the
child’s communication to additional new
communication.
• The more the child hears and practices
language that is more complex, the better
his/her language skills become.
• Expansions help the child learn new
vocabulary and talk in more complex
sentences.
How to expand communication?
• When the child communicates, imitate
his/her communication and add target
words.
– Child: {points to ball}.
– Adult: {points to ball} ball.
– Child: ball.
– Adult: roll ball.
• Example
Expanding Gestures
• Point/reach:
– Child: {points to/reaches for baby}.
– Adult: {points to baby/reaches for baby} baby.
• Show
– Child: {hold up block}.
– Adult: {points to block} block.
• Give
– Child: {gives adult car to drive}.
– Adult: {takes the car} car.
Expanding Vocalizations
• Vocalizations referring to a specific word
– Child: {says “ah” and is pointing to cup}.
– Adult: {point to cup} cup.
• Vocalizations not referring to a specific
word
– Child: {says “ah” and is walking cow}.
– Adult: {walk the cow} walk.
When to expand communication?
• Whenever the child communicates, add 1
or 2 words.
Goal: Expansions
• Adults should expand at least 40% of
child communication.
Let’s Review
• Do what the child does.
• Model new play actions.
• Model new target language with these
actions.
• Expand the child’s communication with
target words.
Let’s Practice: In Pairs
• Take turns being the adult and child.
• When you’re pretending to be the child
using different forms of communication
(vocalizations, gestures, words).
Using Environmental
Arrangement (EA)
Strategies to Increase
Communication
Enhanced Milieu Teaching (EMT): Part 3
What is EMT?
• A set of tools to help facilitate a child’s
communication growth:
√ Setting up an interactive context between the
adult and child through play
√ Noticing and responding to child
communication; balancing turns
√ Modeling and expanding play
√ Modeling and expanding language
– Using environmental arrangement (EA)
strategies
– Using prompting strategies
What are EA strategies?
• Non-verbal tasks that encourage the child
to communicate with you.
EA Strategy 1: Inadequate Portions
• Providing small or inadequate portions of
preferred materials.
• Video example
• Let’s practice
EA Strategy 2: Assistance
• Creating situations in which the child
needs the adult’s help.
• Video example
• Let’s practice
EA Strategy 3: Waiting with Routine
• Setting up a routine in which the child
expects certain actions and then waiting
before doing the expected action.
• Video example
• Let’s practice
EA Strategy 4: Waiting with Cue
• Using associated objects (e.g., shoe to
foot) and then waiting before completing
the expected action.
• Video example
• Let’s practice
EA Strategy 5: Choice Making
• The adult holds up two objects and waits
for the child to communicate about which
item he/she wants.
• Video example
• Let’s practice
EA Strategy 6: Sabotage
• Not providing all of the materials the
child will need to complete the task OR
• Preventing the child from completing a
desired activity
• Video example
• Let’s practice
Why use EA strategies?
• Provide the child with more
opportunities to practice communicating.
– Increases the child’s rate of communication
• Provide you with more opportunities to
reinforce and teach new language by
– Responding
– Expanding the child’s communication
How to use EA strategies?
1. Set up the opportunity to encourage the
child to communicate by using an EA
strategy.
2. Wait until the child communicates
(gestures, vocalizes, says a word).
3. Expand this communication with a
target.
When to use EA strategies?
• When the child is not communicating
frequently.
• Some strategies work better than others
for different children.
– Use the ones that work best for the child.
– Avoid EA strategies that frustrate the child.
Let’s Review
• Use EA strategies to set up an
opportunity for the child to
communicate when he is not
communicating at a high rate.
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–
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–
–
–
Inadequate portions
Assistance
Waiting with routine
Waiting with cue
Choice making
Sabotage
• Expand this communication to include a
target.
EA Goal
• 80% of EA strategies used correctly (e.g.,
waited for communication and then
labeled with a target).
Prompting
Communication
Enhanced Milieu Teaching (EMT): Part 4
What is EMT?
• A set of tools to help facilitate a child’s
communication growth:
√ Setting up an interactive context between the
adult and child through play
√ Noticing and responding to child
communication; balancing turns
√ Modeling and expanding play
√ Modeling and expanding communication
√ Using environmental arrangement (EA)
strategies
– Using prompting strategies
What is a prompt?
• A signal to the child to do or say something.
• There are 4 types of language prompts:
– Time delay
Least Support
– Open questions
– Choice questions
– Model procedure
Most Support
Time Delay
• An overt non-verbal cue for the child to use
language.
• The adult uses an expectant look and waits for
the child to verbalize before performing the
expected action or giving the child a desired
object.
– Environmental arrangement strategies may be used
as a time delay if used with an obvious “expectant
look”
• Time delay offers the least language support.
• Video Example
Open Question
• The adult asks an open question (e.g., no
single correct answer).
• Open questions offer a little more
support by verbally cueing the child to
verbalize his requests.
• Examples: What next? Where should the
car go? Tell me what you want. What
should the babies do?
• Video Example 1, 2
Choice Question
• The adult asks an choice question that
has no single correct answer.
• Choice questions offer even more support
by including the answer in the question.
• Example: “car or truck?”
• Video Example
Model Procedure
• The adult tells the child exactly what to
say.
• The model procedure offers the most
adult support because it tells the child
exactly what to say.
• Example: “Say ‘car.’”
• Video Example
What to Prompt?
• The child’s communication targets:
– Target 1: noun (e.g., cat)
– Target 2: verb (e.g., eat)
– Target 3: protoverb (e.g., in)
– Target 4: request (e.g., help, again)
Why Prompt Language?
• Gives the child an opportunity to practice
communication targets during a highly
motivating context.
• Gives the child functional practice and
reinforcement for communication.
How to Prompt Language?
• Wait for the child to request .
• Use an environmental arrangement
strategy (time delay) to elicit a request.
– Inadequate proportions
– Assistance
– Waiting as part of a routine
– Waiting with cue
– Sabotage
– Choice making
How to Prompt Language: Choices
1. Use the choice EA strategy (hold up 2
items).
2. Wait for the child to respond (if no
response, abandon the prompt since the
child isn’t interested, but don’t give either
object)
3. If the child does not use a target, say “
____ or _____”
4. If the child still doesn’t say the target, give
model (“say”) up to 2 times if he doesn’t
use a target.
How to Prompt Language: Choices
• Flow Chart
• Video Example 1
• Video Example 2
How to Prompt Language: Open Question
1. Wait for the request or use an EA strategy
(all but choice) to get a request
2. Say “Tell me what you want?” or “What do
you want?”
3. Wait for the child to respond or wait 5
seconds if no response.
4. If the child does not use a target, say “say
____”
5. Give model (“say”) up to 2 times if he
doesn’t use a target
How to Prompt Language: Open Question
• Flow Chart
• Video Example 1
• Video Example 2
How To Prompt Language?
• Stop prompting after the child says exactly
what you wanted him to say.
• Give the child enough time to response (5
seconds) before giving another prompt.
• End each prompting episode by giving the child
the requested object or action.
• After the child has said what you wanted him to
say or you have given two model prompts
– Expand if the child says the target
– Repeat if the child does not say the target
When to Prompt Language?
• Only when the child is requesting and not
using a target.
• Only as one of the many tools (not the
only tool) of Enhanced Milieu Teaching
• Not more than 3 times per 15 minute
session
– Too many demands may cause the child to
become frustrated.
• Discontinue prompting if the child loses
interest.
Let’s Review
• Prompt the child’s communication
targets when he is requesting and not
using a target.
• Use prompting sparingly so the child
does not become frustrated.
• Discontinue prompting if the child loses
interest.
Let’s Practice: In Pairs
• Practice with toys
• Practice both prompting options
Prompting Goal
• 80% of prompting episodes used
correctly (e.g., waited for request,
prompted a target, used the correct
prompting order, gave object/action at
the end).
Summary: What You’ve Learned
• A set of tools to help facilitate a child’s
communication growth:
√ Setting up an interactive context between the
adult and child through play
√ Noticing and responding to child
communication; balancing turns
√ Modeling and expanding play
√ Modeling and expanding communication
√ Using environmental arrangement (EA)
strategies
√ Using prompting strategies
How to Find More Information
• www.kidtalk.org
• PPT slides will be posted to CEC and
KidTalk websites
• Other CEC presentations
– EMT for kids with ASD: 4/22 @ 2:30- 3:30
– EMT during routines: 4/23 @ 8:30-9:30
Questions? Comments?
• Complete and return the feedback form