Child Language Disorder Week 11 Lecture

Child Language Disorder Week 11 Lecture

Overview of Linguistic Interventions

  • Focus on children around the developmental level who are linguistic communicators.
  • Emphasis on improving the content, form, or use of language.

Enhanced Milieu Teaching (EMT)

  • Definition: A naturalistic conversation-based intervention that utilizes a child's interests and initiations to model and prompt language in everyday contexts.
  • Application: Used throughout daily interactions; designed for both Speech-Language Pathologists (SLPs) and families, promoting everyday opportunities for language enhancement.
  • Evidence Base: Supported by twenty years of research demonstrating its effectiveness.
Efficacy of EMT
  • Increases use of language targets including:
    • Vocabulary
    • Early syntactic forms (early sentence structure)
    • Moderately complex syntax
    • Early grammatical morphemes
  • Increases frequency of communication (children communicate more often post-EMT).
  • Supports generalization of acquired skills across different contexts, settings, and partners (e.g., home, school, community).
  • Demonstrated more effectiveness relative to drill-based practices (e.g., adult-directed drills).
Principles of EMT
  • Communication Promotion: Adult and child interactions are facilitated based on the child's interests.
  • Engagement Enhancement: Using preferred toys/activities increases child attention and language targets addressed.
  • Social Participation: Teaching play and participation aligned with child motivations rather than imposing adult-directed activities.
  • Joint Attention Strategies: Encourages sharing attention on objects and expanding language related to those objects.
  • Turn-taking: Discussions on readings about mirroring and mapping highlight balancing communication turns.
  • Communication Goals:
    • Increase duration and rate of engagement and communication.
    • Encourage diversity in communication (expand beyond nouns to include verbs and phrases).
    • Target communicative functions (requests, comments, questions).
    • Increase mean length of utterance (MLU) for broader syntax and morphology skills.

Ingredients of EMT

  • Environmental Arrangement: Supports natural communication modes similar to PMT.
  • Child Engagement: Adults (SLPs or trained parents) play with and engage the child actively, following their lead.
  • Response Modeling: Adults respond to the child’s communication by modeling language in meaningful contexts.
  • Skill Expansion: Expansion of child communication is correlated with improved language outcomes, identified through randomized control trials (RCT).
  • Use of Time Delay: Introducing time delays prompts child independence in communication.
  • Newly Teaching Prompts: Use of varied prompts to stimulate language practice in naturalistic contexts.
EMT Prompt Techniques
  1. Time Delay:
    • Wait for a child's independent communication following a verbal prompt.
    • This approach provides processing time and encourages the child to formulate a response on their own.
  2. Mand Model:
    • Adult asks questions or gives choices while modeling an expected response if necessary.
    • Useful when child intentions are unclear or nonverbal cues are present.
  3. Modeling:
    • Provide clear verbal models or examples of the correct responses with an expectation for the child to imitate or respond.
    • Establish joint attention; facilitate sustained engagement.
    • Example scenario included about a child's interaction with their mother while playing with cars, promoting two-word combinations.
  4. Prompt Hierarchy for Communication Goals:
    • Provide prompts and feedback using known targets and expectations to facilitate responses while allowing positive reinforcement for attempts.

Focus Stimulation

  • Definition: A technique that imposes a high density of input for targeted language focusing on a small set of language targets.
  • Goal: Encouraging spontaneous language use through modeling, without demanding immediate responses.
  • Indirect Language Facilitation: Focused on providing models without prompting direct responses; more about exposure than elicitation.
  • Comparison with General Language Stimulation: Focused stimulation is specified and selective, contrasting with general techniques that aim solely for overall language enhancement without target specification.
Implementation of Focus Stimulation
  • Utilize structured play and follow child activities.
  • Use repetitive modeling of the chosen language input without requiring children to imitate.
  • Create opportunities for meaningful language interaction through contextually relevant play.
  • Examples for Focus Stimulation: Examples provided where caregivers model specific words frequently (e.g., “more”) in various contexts to reinforce language acquisition.

Summary of Other Language Facilitation Strategies

  • These complement formal approaches like EMT and FS:
    1. Imitation: Enhances language development through child imitation of language at current or advanced levels.
    2. Noticing and Responding: Adults acknowledge both verbal and nonverbal attempts at communication, reinforcing turn-taking.
    3. Self Talk and Parallel Talk: Strategies for adults to narrate their actions (self talk) or the child's actions (parallel talk) to provide clear language models.
    4. Expansion and Recasting: Modify child utterances for grammatical accuracy while maintaining meaning and expanding information content.
    5. Communication Temptations: Construct situations that prompt communication from children by placing desired objects just out of reach.
    6. Buildup and Breakdown: Process of presenting complex sentences following child utterances, then segmenting them into smaller, manageable parts to support understanding.
    7. Three-to-One Rule: Encourages adults to make three comments for each question presented, reducing pressure on the child while maintaining conversational flow.
    8. Expected Waiting: Promotes processing and response opportunities through anticipatory waits after posing questions.
Effective Strategy Selection
  • Emphasis on blending approaches (e.g., EMT and Focus Stimulation) based on the individual child's needs and evidence gathered during language interventions. Assessments should guide the use of direct versus indirect approaches based on the child’s communicative development stage.
Conclusion
  • Effective language intervention requires a thoughtful combination of strategies aligned with the specific needs of children with language delays or disorders.
  • Importance of caregiver involvement and coaching in early language interventions is critical for fostering communicative success.
  • Focus on the child's interests and natural context to establish meaningful language practices.