KidTalk: Naturalistic Communication Intervention Strategies for Parents and Teachers of Young Children CEC 4/20/2010

1. KidTalk: Naturalistic Communication Intervention Strategies for Parents and Teachers of Young ChildrenCEC 4/20/2010 Ann Kaiser, PhD; Megan Roberts, MS-CCC-SLP; Courtney Wright, MA, CCC-SLP

2. 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

3. 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

4. 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)

5. Setting the Foundation for Communication Enhanced Milieu Teaching (EMT): Part 1

6. 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 effectiveintervention.

7. EMT: An Effective Intervention

8. 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 generalizationacross 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 languagelearners (Yoder, Kaiser et Alpert, 1991; Kaiser, Yoder, et al., 1996)

9. EMT’s Positive Effects Children in Treatment Show Greater Developmental Gains at Post 1 than Children in Control Group

10. EMT’s Positive Effects • Children receiving parent-implemented EMT show more language growth over time than children receiving EMT from a therapist only

11. 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

12. Systematic Reviews of EMT Studies • 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 interventionVol. 1, (pp. 9-47). Baltimore: Paul H. Brookes.

13. 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

14. 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

15. 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.

16. 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).

17. When to Play and Engage? • Whenever possible • At least once a day for at least 15 minutes of concentrated and individualized adult-child time

18. Strategy 2: Notice and Respond to all Communication All children are communicating now • How? • Why? • Linguistic • Signs • Pictures • Symbols • Words • Prelinguistic • Point • Show • Give • Vocalizations • Reach • Lifts arms up • Shakes head Requesting Commenting

19. Understanding Child Communicating? Watch this video and look for: • How is this child communicating? • Why is this child communicating ?

20. 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.

21. 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

22. When to notice and respond? • As much as possible • In all contexts throughout the day • Play • Meals • Routines (bath, car, dressing)

23. Goal 1: Responding to Communication • Responsiveness: you should respond to 90% or more of the child’s communication.

24. Strategy 3: Take Turns • Take turns communicating with the child. • Allow time for the child to communicate. • Play a game of “communication catch” • Child communicates • Adult responds (and waits) • Child communicates • Adult responds (and waits) • Only say something after the child communicates. • Examples (1, 2, 3, 4)

25. 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

26. When to take turns? • As much as possible • In all contexts • Play • Meals • Routines (bath, car, dressing)

27. Goal: Matched Turns • Matched turns > 75% (75% of what you say should be “matched” or in response to the child’s communication).

28. Strategy 4: Mirror and Map • Mirroring: adult imitates the child’s nonverbal behaviors. • Mapping: adult “maps” language onto these actions, by describing these actions.

29. 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.

30. 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

31. 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).

32. 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.

33. 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.

34. Modeling and Expanding Play and Communication Enhanced Milieu Teaching (EMT): Part 2

35. 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

36. Play Goals • Extend the time the child plays with a toy. • Expand the different actions the child does with the same toy. • Expand the types of different toys the child uses.

37. 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.

38. 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

39. 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.

40. Modeling New Play • Modeling new play • Example 1 • Example 2 • Example 3 • Example 4

41. 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

42. Let’s Practice: Small Group • Complete play worksheet using toys in the toy kit.

43. 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).

44. Language Goals • Increase the rate at which the child communicates. • Increase the diversity of communication. • Increase the child’s independence. • Increase spontaneous communication • Decrease the dependence on adult cues

45. 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

46. 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

47. Choosing Communication Targets

48. 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)

49. 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.

50. Let’s Practice: Small Group • Add target language to play worksheet