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 • • • • • • 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 • • • • • 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). • • • • • 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” – – – – 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. – – – – – – 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
© Copyright 2024