yale study prelinguistic milieu teaching introduction study milieu communication teaching...
Post on 03-Jul-2018
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Overview
• Milieu Communication Teaching = PMT MLT• Rationale for treatment
– Child and parental predictors of languagedevelopment in prelinguistic children withdevelopmental delays
– Transactional model of development duringprelinguistic period
Overview continued• PMT
– Prompt hierarchy– Consequences– Facilitating play routines– Facilitating requests and turn taking– Facilitating eye contact– Facilitating gestures– Facilitating vocalizations– Facilitating comments– Suggested adaptations for (hyper?)active
children
What are child and family characteristicsthat predict growth rate of productive
vocabulary in children with DD ?Growth over 12 months
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Time in study
# w
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Transactional model in the prelinguisticcommunication period
Child object-
engagement&
communication
Adult descriptive talk,compliance &
linguistic mapping
Child vocabularyacquisition
Predictors of linguisticcommunication
• Defined as number of different words used tocommunicate in a conversational sample
• Parent:– Those after child object attention
• Descriptive talk– Those after child communication
• Linguistic mapping• Compliance
• Child– Comments– Requests
Coordinated attention to object andperson
• Can be either simultaneous or sequentialattention to object and person
• Can be shown in many ways:• Spoken word referring to an object and look
to adult.• Shifting gaze from object to person• Showing object to person• Giving object to person• Giving pictorial representation of object to
person
Why is nonverbal communicationimportant?
• The pragmatic aspects of communication are aprimary deficit of children with autism.
• Nonlinguistic pragmatic aspects ofcommunication might be easier to learn ifseparated from the (also difficult) symbolicaspects
• Provides the opportunity for parental responsesthat “teach” language.
• Functional communication via “easier” formsmay happen earlier in development than“harder” symbolic communication.
Another predictor of linguisticcommunication in initially nonverbal
children with ASD (Yoder, 2006)
• Diversity of object play
Summary of rationale for PMT
• Targets– Object play, Requests and Comments
• So parents can use…– Descriptive play, linguistic mapping, and
compliance• Which in turns help children learn to use
words to communicate.
Finding the child’s currency(reinforcers)
• Reading children’s behavior as indicativeof what delights them
• Being creative with a variety of toys– Activity for brainstorming before a session
• It changes
Suggested sequence of goals• Building routines
– If needed, object play expansion– if needed, increase frequency and diversity of noncommunicative
vocal acts– if needed, component building (without attn to adult)
• Simultaneous coordinated attention– Give, show, upturned palm to adult
• Sequential coordinated attention– Reach+gaze, clap+gaze, move object to adult and gaze, 2 point
gaze and voc• Combining all three components or conventional
gestures– Gesture, gaze, and voc– Distal point
(
Prompts for communication
• Prompt when child shows communicativeintent or need or primitive communicativeact.– Teachable moment
• Prompt hierarchy for every targetcommunicative form.
Consequence of communication
• Emphasis on functional reinforcement– Defined by child’s wants/communicative
intent.• Compliance (respond) to child’s requests• Linguistically map EVERY intentional
communication act IMMEDIATELY.– Watch the competitors for the favored
temporal sequence of act-map
Comments are difficult to teach directly
• “Direct” teaching often involves prompting andrewarding desired behavior.
• Can’t directly prompt comments– Declaratives are intrinsically self-initiated.– Over-use of “unexpected events” are less
evocative over time.• Can’t differentially reward comments using
functional rewards (i.e., adult attention).– Particularly in children who don’t use
comments much.
Adult modeling of comments mayindirectly facilitate child comment
development• Siller and Sigman, 2002
– 16 4-year olds with autism and theircaregivers.
– Parents’ nonword comments about theirchildren’s already-established focus ofattention at time 1 predicted…
– children’s gain in nonword comments over a12 month period.
– r = .67
Proposed ways treatments mayfacilitate commenting development
• Adult prompts and functionalreinforcement ->child coordinated attention to request–Transfer of stimulus control theory.
• Pairing functional rewards with socialrewards ->
child experiencing social interactions asrewarding–Acquired reward value hypothesis.
Proposed ways treatments mayfacilitate commenting development
(continued)• Acquisition of play skills may result in child
finding more events/objects of interest innatural environment.– Acquisition of broader interest hypothesis.
• Adult models of comments ->child using recently acquired forms tocomment.– Social learning theory.
Prompt hierarchy for gaze shiftfrom object to person (least to
most)• Time delay (wait) with desired object
naturally held• Calling name• Time delay with desired object held near
face.• Time delay with desired object held in front
of eyes• Insect gaze
Prompt hierarchy for give
• Time delay• Upturned palm• “Give x to me”• Physical prompt
– Message recipient does physical prompting– Person behind child does physical prompting
• Like PECS
Prompt hierarchy for reach
• Two levels– Distance of object from child
• Proximal• Distal• Distal and gradually up
– Prompts for reach behavior• Time delay• Verbal prompt• Demonstration• Physical prompt
– By message recipient
Prompt hierarchy for distal point
• Time delay• Verbal prompt (rarely used)• Demonstration• Physical prompt (by message recipient)
Prompt for vocal communication
• Time delay• Point to mouth or mouth “gesture” for
sound.• Spoken word demonstration (but word use
not necessarily expected)
Adaptations of PMT for children withhyperactive styles
• When child is rapidly shifting from one object toanother– Stay in one place, entice, and
differentially reward proximity of child toself.
– Create small work space• Tables and need to fade them
– Use smaller number of toys per session
Criteria for moving children fromPMT to MLT
• From treatment sessions– 1 unprompted nonverbal request/min + 1
unprompted nonverbal comment/min within atreatment session
OR– 5 unprompted, nonimitative grammatical words
used communicatively and referentially (can beused across several treatment sessions).
OR– 1 vocal communication with consonant/minute
within a treatment session
Milieu teaching principles• All teaching episodes begin with child communicative intent or
need• Avoid power plays
– How long is the teaching episode?– Why many prompts along the hierarchy or repetitions of
the same level prompt before “giving in” or “complying”.• When a child has never used a word or not used it in a
particular activity,– Use elicited imitation prompts
• Consequences in MLT include…– After child communication
• Linguistic mapping, expansion or phonemic recast– After non-response
• Corrective feedback
Efficacy of (R )PMT• Replicated evidence of effect on generalized and
maintained– Requesting– Comment– Comprehension of language– Use of words to communicate
• In children with DD.• Nonreplicated evidence of effect of generalized
and maintained– Requesting– Commenting– Use of words to communicate
• In children with ASD
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