empirical evidence of the value added by parents...
TRANSCRIPT
EmpiricalEvidenceoftheValueAddedbyParents’ParticipationinEarlyLanguageInterventionAnnP.Kaiser,PhDVanderbiltUniversityDepartmentofSpecialEducationVanderbiltKennedyCenter Va
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Today’sTalk• Theroleofparentsinlanguagedevelopment• Parentsasimportantpartnersinlanguageintervention
• EvidencefromVanderbiltKidtalkProjects• Evidencefrommetaanalyses
• Implicationsforadvancingparent-implementedlanguageinterventionsinresearchandpractice
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CommunicationRequiresPartners
receiving
sending
receivingsending
receiving
sending
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Parentsarechildren’sfirstandmostenduringcommunicationpartners
• Parentsarethefirstlanguageteachers
• Responsivetothewholechildasacommunicator,aswellashislanguage
• Investedintheimmediatefunctionandmeaningsofchildcommunication
• Primary,caringrelationshipisafoundationforcommunicationandteaching
• Quantityandqualityoflinguisticinputprovidedbyparentsimpactschildlanguagedevelopment(Hart&Risley,1995;Smith,Landry,&Swank,2000;Tamis-LeMonda,Bornstein,&Baumwell,2001;)
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DancingintheDark
• Easytoreadsocialcues• Followadependabledevelopmentaltrajectory
• Interestedinpartnersandobjects
• Usemultiplestrategiestolearnlanguage
• Quicklymovethroughdevelopmentalstages
• Maybedifficulttodeterminechildintentions
• Slower,possiblydisrupteddevelopmentaltrajectory
• Varyinsocialandobjectinterest,play,dailylivingskills
• Fewerstrategies,lesswelldeveloped
• Maymoveslowlythroughdevelopmentalstages
Typicalchildren Childrenwithcommunicationdelays
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Wecanmaketheprocessofcommunicationeasierforparentsandtheoutcomesfortheirchildrenbetterwitheffectiveparenttraining
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ENHANCED MILIEU TEACHING ValueAd
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Parent-ImplementedEnhancedMilieuTeaching
• Basedontwoassumptions:• Communicationislearnedininteractionswithpartners
• Changingpartnersupportforcommunicationcanchangechildoutcomes
• Goals:• Improvinggeneralizedcommunicationoutcomesforchildren
• Understandingtheconditionsinwhichcommunicationandlanguagearelearned
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EMTParentImplementedRCTsPopulation Intervention Dosage, mode StatusChildren withID(DS,ASD,DD)
ParentonlyParent+therapist
2Xweek,36sessions Kaiser&Roberts,2013
Toddlerswithreceptive/ expressivedelays
Parent+therapist 2xweek28sessions Roberts&Kaiser,2015
Minimally verbalpreschoolerswithASD
Parent+therapist+Direct teaching+EMT/JASPER
3xweek48sessions,iPad,Direct teaching
HRSA Ongoing
2Yr oldswithASD Parent+ therapist+EMT/JASPER+Behaviorsupport
2xweek48sessionshomeonly
IES Ongoing
3-4Yr oldswithDS Parent+ therapist+EMT/JASPER+iPad
2x parent+therapist;2xtherapistonly,48sessions
Merck Ongoing
2-3Yr olds SpanishLanguage delayed
Parent+ therapist 2xweekhomeInSpanish, 24sessions
NIDCDOngoing
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ACascadingInterventionModel
ParentTraining
ParentUseofStrategies
ChildLanguage
HowtoTeachParents?
WhattoTeachParents?
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Responsiveness Percentage of child utterances to which the adult responds
Matched turns Percentage of adult turns that are in response to the child’s previous utterance
Targets Percentage of adult utterances that include a child language target
Expansions Percentage of child utterances to which the adult adds a word
Time Delays Number and percentage of episodes that include correctly executed steps of the nonverbal prompting hierarchy
Prompting Number and percentage of episodes that include correctly executed steps of the verbal prompting hierarchy
MaximizingInterventionEffects
ParentTraining
ParentUseofStrategies
ChildLanguage
EnhancedMilieuTeaching(EMT)
• EMTisawidelystudiedinterventionwithconsistentlypositiveeffectsonvariouslanguageformsandstructures(Kaiser&Hampton,2016).
• Gainsinlanguagehavebeenobservedinchildrenwithintellectualdisabilities:
• Acrosssettings(Alpert&Kaiser,1992;Hancock&Kaiser,1996;Kaiser,Hancock,&Nietfeld,2000;Kaiser&Roberts,2013)
• Classesoflanguagestructures(Goldstein&Mousetis,1989;Warren,Gazdag,Bambara,&Jones,1994),
• Globallanguagedevelopment(Hancock&Kaiser,2002;Kaiseretal.,2000;Kaiser&Roberts,2103).
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EMTStrategies• SettingtheFoundationforCommunication
• PlayandEngage• NoticeandRespond• TakeTurns• MirrorandMap
• ModelingandExpandingPlayandCommunication
• ModelingandExpandingPlay• ModelingLanguage• ExpandingCommunication
• UsingEnvironmentalArrangement(EA)StrategiestoPromoteCommunication
• UsingPromptingStrategiestoPromotePractice
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MaximizingInterventionEffects
ParentTraining
ParentUseofStrategies
ChildLanguage
Teach
First10minutesofeachsession•Re-statedthestrategy,gaveexample•Roleplayed•Discussedwaystousethestrategy
Model15minutesofeachsession•Modeledthelanguagesupportstrategy•Highlightedstrategyuse
Coach15minutesofeachinterventionsession•Coachedthecaregiverwhileshepracticedthestrategywiththechild
Review
Last10minutesofeachsession•Discussedthesession•Linkedparentandchildbehaviors•Madeaplanforhomeuseofstrategies
Teach-Model-Coach-ReviewParentTraining(ParentInterventionRobertsetal,2014;)
• Basedon6adultlearningstrategies(Dunst &Trivette,2009).
• Simultaneoususeofdifferentmethodshasthelargesteffect(d=1.25).
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BenchmarksforEnhancedMilieuTeachingtaughtusingTeach-Model-Coach-Review(Roberts&Kaiser,2015;Robertsetal.,2014)
PrimaryInterventionbytherapist
ParentTraining Parentimplementa-tion
Content 6keyEMTstrategies atspecifiedfidelity
Key TCMRbehaviorsinworkshopsandsessionatfidelity
6keyEMTstrategies atspecifiedfidelity
Dosage 15 minutes 15-25 minutes 15minutesinsession
Frequency 24sessions, 1clinicand1home/week,
4workshops, 24sessions
3 activitiespersession
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BenchmarksforEnhancedMilieu
TeachingImplementation
• Samecriteriafortherapistinprimaryinterventionandparent• Parentassessedacrosshomeandclinic• Observationaldatacodedfromvideotapes• 20%ofsessionsfortherapistandparentwithIOA
uMatched Turns 80%
Percentage of adult turns that are in response to the child’s previous utterance
uResponsiveness 90%
Percentage of child turns to which the adult responds
uTarget Level Talk 50%
Percentage of adult utterances that contain a child target
uExpansions >40%
Percentage of child utterances to which the adult adds a conten word w
uTime Delays 3-5 @ 80%
Number and percentage of episodes that include correctly executed steps of the nonverbal prompting hierarchy
uPrompting 1-5 @ 80%
Number and percentage of episodes that include correctly executed steps of the verbal prompting hierarchy
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• Therapists• Provideintensiveinterventionusingallcomponents• Highleveloffidelity• Canfinetuneinterventiontoincludeotherstrategies(directteaching,morecomplexforms,peers)
• Can“prime”childrensothatparentsarelikelytobemoresuccessful
• Parents• Teachinthecontextofrelationshipandemotionalconnection• Havemoreopportunitiestoteachinfunctionalcontextsandroutines
• Immediatelybenefitfromtheimprovedcommunicationwiththeirchild
• Cantailorstrategiesandcommunicationtothechild’schangingcommunicationskillsandneeds
WhyParentPlus Therapist?
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Maximizingchildoutcomesbyteachingacrosssettingsandroutines
TeachinPlay• Extendedengagement• Teachjoinattentionskills• Multipleteachingopportunities
• Teachsymbolicplaytosupportcognition,language
TeachAcrossActivitieswithinHome
• Teachfunctionallanguageskills• Improvedailyinteractions• Improvebehavior
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• Parentslearn arangeofstrategiestocriterionlevels.• Environmentalarrangement(Alpert&Kaiser,1992;Hemmeter &Kaiser1990)• Responsiveinteractionstrategies(Hancock&Kaiser,2002;Kaiseretal.,
1996,Robertsetal,2014;Roberts&Kaiser,2015)
• Modelinglanguagetargets(Hancock&Kaiser,2002)• PromptingtargetproductionusingMTtechniques(Kaiser,
Hancock&Nietfeld,2001;Robertsetal,2014)
• Parentsgeneralizethesestrategiestohomeinteractionswiththeirchildren(Hancock&Kaiser,2002;Kaiser&Roberts,2013).
• Parentsmaintain theirnewly-learnedskillsover6-18months(Kaiser,etal2001;Kaiser&Roberts,2013;Hampton,etal.,2017).
EMTParentOutcomes
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ChildOutcomesfromParent-ImplementedEMT
• Increaseschilduseoflanguagetargets• Vocabulary(Alpert&Kaiser,1992;Hemmeter &Kaiser1990;Kaiseretal,
1993;Scherer&Kaiser,2012;Kaiser&Roberts,2012,Roberts&Kaiser,2013;Wrightetal,2013)
• Earlysyntacticforms(Kaiser&Hester,1994;Robertsetal,2014)• Increaseschildfrequencyofcommunication(Kaiseretal,1993;Kaiser&Roberts,2012;Wrightetal,2013;Curtisetal.,inreview)
• Resultsingeneralization acrosssettingsandpeople,(Kaiser&Roberts,2012;Wrightetal.,2013)
• Resultsinmaintenance ofnewlylearnedtargets(Robertsetal.,2014;Kaiser&Roberts,2012)
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LongerMLUwhenparentsaretrained
1
1.2
1.4
1.6
1.8
2
2.2
2.4
2.6
Pre Post1 Post2 Post3
MeanLengthofU
tteranceinW
ords
Parent+Therapist- TrainedProbeParent+Therapist- UntrainedProbeTherapist- TrainedProbe
Therapist- UntrainedProbe
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Kaiser&Roberts,2013ChildrenwithID
GreatereffectsofparenttrainingforchildrenwithASD
21
5052545658606264666870
Pre Post1 Post2 Post3
PLS-4TotalStandardScore
Therapist- ASD Therapist- DD
Parent+Therapist-ASD Parent+Therapist-DD
d = .73d = .23
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Kaiser&Roberts,2013
EffectsOverTime• RCT28sessionsofparent-implementedEMT
• ToddlerswithExpressiveonlyorexpressive/receptivedelays
• AssessedPre,Post,6mos,12mos followup
• Parentstrainedtofidelity,strongmaintenanceoffidelity
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Roberts&Kaiser,2015Hampton,Kaiser&Roberts,underreview
75 77
61
84 8676
5565758595
Expressivelanguage(PLS-4)
Receptivelanguage(PLS-4)
Expressivevocabulary(EOWPVT-3)
StandardScore
Pre Post
84 8676
9480 77 70
86
55
65
75
85
95
105
StandardScore
Intervention Control
PLSAuditoryScoresat6,12mofollowup
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Expressiveonly
Receptive/Expressive
PositiveEffectsonBehaviorat12mo followup• Theinterventiongrouphadsignificantlyfewer:• totalproblembehaviors-6.589,
95%CI[-11.804,-1.385])
• externalizingbehaviors-2.231,95%CI[-4.355,-0.108]),
• internalizingbehaviors-2.091,95%CI[-3.791,-0.391]).
• Effectssizesfortreatmentvscontroldifferences• totalproblembehavior,d =-0.434• externalizingbehavior,d=-0.346• Internalizingbehavior,d =-0.440
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Curtis,etal,underreview
EffectsonEarlyGrammaticalPerformanceIPSynZScoresforTreatmentandControlGroupsatPre,Post,6months&12months
-6.00
-5.00
-4.00
-3.00
-2.00
-1.00
0.001 2 3 4
Pre Post 6months12months
Treatment
Control
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ParentsAppreciateKidTalk• “It’sbeenareallygoodsupportsystemformeandreallyencouragingandsupportive.Youneedthatwithachildwithspecialneeds.”
• “Beingabletolearnthroughplayissoeffective!”
• “Mychildlookedforwardtohertherapy.Youtaughtmesomuchaboutmychild!“
• Mn Ratingsforpositiveeffectsonchildcommunication:4.8/5
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Summary• ParentscanlearnEMTstrategiestocriterionlevels
• Whentrainingissystematic:TMCR;multimodal,criterionbased• Trainingoccursacrosssettingsandroutinesathome• Relativelybrieftraining
• Parentsgeneralizetohomesettings• Changesinobservationaldata;minimalchangesinLENAdata• Estimatingrelationshipbetweenparentbehaviorandchildoutcomesiscomplexduetosampling,differenceinchild
• Parentsmaintaintosomeextentovertime• Responsiveness,modeling,expansions• Lesscorrectprompting
• Childeffectsaremoderate• .2.-4dependingonpopulation,measure• Besteffectsforobservationalmeasures(NDW,rate,SCU)
• Theremaybebenefitsbeyondtargetedlanguage• Behavior• Parent/childrelationship
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ChallengesandLimitations
• Requiresaskilledinterventionist• Teachingparentsvschild• Adaptingtospecificchildneeds• Behaviorsupportskills• Mode
• Effectsdependonparentlearninganduseofstrategiesathome
• Childeffectsaremoderate,varybymeasure• Needforculturalandlinguisticadaptations• Needtospecifyphenotypicadaptionsforchildrento
maximizeoutcomes
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MetaAnalysesofParent-ImplementedInterventionsforCommunication
• GroupDesign• Roberts&Kaiser,2011• Hampton&Kaiser,2016• Kaiser,Cunningham,Heidlage,Trivette,Roberts,etal.,2017(BridgingtheWordGapWorkGroupI;ongoing)
• SingleCase(syntheses,SCmetaapproach)• Moyleetal.,2014• Meadan etal.,2016• Frey,Barton,etal.,2017(BridgingtheWordGapWorkGroupI,ongoing)
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Meta-analysis:Rationale• Structuredresearchtechniquewithdocumentationateachstepofsearch,coding,andanalysis
• Replicationoftheprocessispossible.• Themagnitudeanddirectionofallresultsarecodedforeachstudy
• Quantitativeexaminationoftherelationshipbetweenstudycharacteristicsandstudyresults.
• Theresultsofthesmallstudiesarepooled,increasingthestatisticalpowertodetectdifferences.
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WhyMetaAnalyses• Lookingforeffectsbeyondasingleinterventionorapproach
• Applyingacommonstandardforoutcomes(standardizedeffectsizes:similarmeasuremeasurementconstructs)
• Potentialforexaminingmoderatorsoftreatmentoutcomes Va
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Limitations
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Onlyasgoodasthedatathatcanbeaccessedfromthestudies
MeasuresofrelevantconstructsDesignofthestudy:Samplesize,randomization,threatstovalidityDescriptionofpopulation,intervention,fidelity
EffectSizesreflectboththetreatmentandcomparisongroup
Standardizedmeandifferencebetweentwogroups:Subtractthemeanofonegroupfromtheother(M1–M2)anddividetheresultbythestandard deviation(SD)ofthepopulationfromwhichthegroupsweresampled.
Roberts&Kaiser,2011Meta-analysisQuestions
• Doestrainingimpactparentuseoflanguagesupportstrategies?
• Doparent-implementedinterventionspositivelyaffectlanguageoutcomesofyoungchildrenwithlanguageimpairmentscomparedtocontrol?
• Doparent-implementinterventionspositivelyaffectlanguageoutcomescomparedtotreatmentbytherapists?
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Meta-analysis:Kaiser&Roberts,2011
• StudyType: 13randomizedgroupexperiments1matchedcontrol
• AverageSampleSize:25participants(range12-47)• Diagnosis:6DD;8LanguageDelay• Age:Majorityofstudiesincludedchildrenbetween24and36monthsofage.
• Intervention:• 6studieswereHanenParentProgram• 8werebetween10-13weeksandhadlessthan26hoursofparenttraining.
• ControlGroup: 3communityservices,11non-treatmentcontrol
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Meta-analysis:Roberts&Kaiser,2011
Doesparenttrainingchangeparentbehavior?g CI p
Parent responsiveness .73 (.26, 1.2) .00Rate .26 (-.13, .64) .19
Use of language models .38 (-.03, .80) .07
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Meta-analysis:Roberts&Kaiser,2011
• Doparent-implementedinterventionspositivelyaffectchildlanguageoutcomes?(comparedtocontrol)
• Whichchildlanguageoutcomeshavethelargesteffects?
g CI p nOverall language .45 (-.02, .92) .06 7Expressive language .61 (.00, 1.21) .05 7Receptive language .35 (.05, .65) .02 7Expressive vocabulary .48 (.24, .73) .00 14Receptive vocabulary .38 (.10, .66) .01 5Expressive morpho-syntax .82 (.37, 1.38) .00 7Rate .51 (.18, .84) .00 9
z
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Meta-analysis:Roberts&Kaiser,2011
• Doparent-implementedinterventionspositivelyaffectchildlanguageoutcomes?(comparedtotherapistimplementedintervention)
g CI pOverall language .24 (-.26, .73) .35Expressive language .25 (-.43, .93) .47Receptive language .41 (.08, .76) .02Expressive vocabulary .14 (-.25, 54) .69Receptive vocabulary .19 (-.26, .64) .41Expressive morpho-syntax .42 (.06, .79) .02Rate -.15 (-.56, .27) .48
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RobertsandKaiser,2011Vocabularyoutcomesforparenttrainingstudies
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Hampton&Kaiser,2016MetaAnalysisQuestions
• WhataretheeffectsofinterventiononthespokenlanguageoutcomesforchildrenwithASD?
• Whatfeaturesofinterventionaccountfordifferencesinoutcomes? Va
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Meta-analysis:Hampton&Kaiser,2016
• StudyType: 16/26wererandomizedgroupexperiments• SampleSize:11-294• Diagnosis:AllchildrenwithASD;81%male;• Age:Mn 3.33yrs; range;1.75– 4.18months• Intervention:
• 92%includedsomenaturalisticteaching• 50%includedsomedirectteachingcomponents• Bothtargetedlanguageandcomprehensiveinterventions
• ControlGroup:treatmentsasusual,highlyvariable
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MetaAnalysisHampton&Kaiser,2016
• WhataretheeffectsofinterventiononthespokenlanguageoutcomesforchildrenwithASD?
•
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g CI n
Overall .26 (-0.11,.42) 26
Clinician .08 (-.47,0.62) 5
Parentonly .11 (-0.06,.28) 9
Parent+Clinician .42 (0.24-0.68) 12
Study
Random effects modelHeterogeneity: I−squared=57.7%, tau−squared=0.0825, p=0.0001
Clinician
Parent
Parent and clinician
Random effects model
Random effects model
Random effects model
Heterogeneity: I−squared=77.1%, tau−squared=0.2135, p=0.0044
Heterogeneity: I−squared=0%, tau−squared<0.0001, p=0.5264
Heterogeneity: I−squared=36.4%, tau−squared=0.0324, p=0.0993
Boyd et al., 2014Kasari et al., 2008Whalen et al., 2010Goods et al., 2013
Venker et al., 2012Carter et al., 2011Tonge et al., 2014Green et al., 2010Rogers et al., 2012Hardan et al. 2014Wetherby & Woods, 2006Schertz et al., 2013Drew et al., 2002Aldred, Green, & Adams, 2004
Salt et al., 2002Roberts et al., 2011Solomon et al., 2014Siller, Hutman, & Sigman, 2013Bloch et al., 1980Casenhiser, Shanker, & Stieben, 2013Strain & Bovey, 2011Dawson et al., 2010Cohen et al., 2006Vivanti et al., 2014Remington et al., 2007Howard et al., 2005
−2 0 2Favors BAU Favors Intervention
0.26
0.08
0.11
0.42
−0.56 0.27 0.35 0.65
−0.50−0.06−0.06 0.00 0.10 0.41 0.43 0.43 0.56 1.57
−0.34 0.05 0.16 0.24 0.25 0.27 0.49 0.55 0.58 0.59 0.95 1.09
95%−CI
[ 0.11; 0.42]
[−0.47; 0.62]
[−0.06; 0.28]
[ 0.24; 0.60]
[−0.88; −0.24][−0.29; 0.83][−0.23; 0.92][−0.46; 1.77]
[−1.50; 0.50][−0.58; 0.46][−0.52; 0.41][−0.32; 0.32][−0.29; 0.49][−0.16; 0.98][−0.23; 1.09][−0.37; 1.23][−0.23; 1.35][−0.85; 3.99]
[−1.34; 0.65][−0.40; 0.49][−0.24; 0.55][−0.25; 0.73][−0.53; 1.02][−0.27; 0.81][ 0.25; 0.73]
[−0.04; 1.14][−0.06; 1.22][ 0.07; 1.12][ 0.33; 1.56][ 0.53; 1.65]
W(random)
100%
4.8%
50.6%
44.5%
6.0% 4.0% 3.9% 1.6%
1.9% 4.3% 4.7% 6.0% 5.3% 3.9% 3.4% 2.6% 2.7% 0.4%
1.9% 4.9% 5.3% 4.5% 2.7% 4.1% 6.7% 3.8% 3.5% 4.2% 3.6% 4.0%
Hampton&Kaiser,2016
Spokenlanguageoutcomesbyimplementer
.08
.11
.42
Parent+Clinician
ParentOnly
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ClinicianOnly
MetaAnalysisSummaryHampton&Kaiser,2016
• ForchildrenwithASD,thereappearstobevalueaddedbyincludingparentsincomprehensiveorlanguagespecificearlyintervention
• Fewstudiescomparedparent-implementeddirectlytoclinicianimplemented
• Nosignificanteffectsforotherinterventionfeatures– age,comprehensive/targetedintervention,dosage
• Widerangeofmeasuresforspokenlanguage;mostincludevocabulary
• AlthoughESarepositive,actualgainsweremodest• FindingssimilartothoseinKaiser&Roberts,2013
• ChildrenwithASDmaybenefitrelativelymorefromclinicianplusparent-implemented
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Meta-analysis:Kaiseretal-BWG,2017
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1. ConductedasonepartofmajorliteraturereviewrelatedtoBridgingtheWordGap
2. (HRSAResearchNetwork)
3. 1.Whatistheimpactofparent-implementedinterventiononchildexpressiveandreceptivelanguageoutcomes?
2.Whatistheimpactofparent-implementedinterventiononchildvocabularyoutcomes?
3.Dochildvocabularyoutcomesvarybytypeofintervention?
Meta-analysis:Kaiseretal.-BWG,2017• StudyType: 25randomizedgroupexperimentswithBAU
• AverageSampleSize:68%hadlessthanN=50• Diagnosis:44%Languagedelay;36%ASD;20%other
• Age:0-8years;36%0-3yrs ;56%4-5Yrs• Intervention:
• 7sharedbookreading;• 18naturalisticplay/routines
• ControlGroup:BAU,waitlist
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Meta-analysis:Kaiser-BWG,017
• Whatistheimpactofparent-implementedinterventiononchildexpressiveandreceptivelanguageoutcomes?
g CI p n
Expressive language .27 (0.10- 0.44) .05 13Receptive language .09 (-0.11, 0.28) NS 10
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Meta-analysis:Kaiser-BWG,2017
Whatistheimpactofparent-implementedinterventiononchildvocabularyoutcomes?Dochildvocabularyoutcomesvarybytypeofintervention?
g CI p n
Vocabularyoverall .39 (.06-.71) .05 16VocabularyRoutines .41 (.19-.62) .00 7VocabularyNaturalistic .38 (.19-.56) .05 9 Va
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● Overallresultssupporttheuseofparentimplementedinterventionstoimprovechildvocabularyandexpressivelanguagedevelopment.
● FindingreplicateRobertsandKaiser’s(2011)● Positiveeffectofparent-implementedinterventiononchild
expressivelanguage(.61vs.27)● BUTdidnotreplicatereceptivelanguage(.35vs.09).● Vocabularyoutcomesweresimilar (.38/.41vs.39)● Sevenstudiesoverlapintwometaanalyses
● ESweresimilaracrosssharedbookreadingandroutine/play-basedlanguageinterventionsforvocabularyoutcomes(.38,.41)
● Fewstudies(lessthan20%)hadprimarilylowSESfamilies;fewstudiesreportdatatoallowSESanalysis
Meta-analysisSummaryKaiseretal.-BWG,2017
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EvidenceofEffectivenessforParentImplementedInterventions
• Roberts&Kaiser,2011• 14groupdesignstudiesacrosspopulationswithparent-implementedinterventionwithchildrenwithlanguageimpairmentunderage8
• ESforexpressivelanguaged=.67[0.00-1.21]• ESforexpressivevocabularyd =.42[.24-73]• ESforreceptivevocabularyd=.38[.10-.66]
• Hampton&Kaiser,2015• 22groupdesignstudiesofchildrenwithASDunderage8withparent-implemented(9)orparentplustherapist-implementedintervention(13)
• ESforspokenlanguageparentonlyg=.11[.06-.28]• ESforspokenlanguageparentplustherapistg=.42[.24-.60]
• Kaiseretal,BWG2017• 25RCTstudiesofchildrenunderage5withparent-implementedintervention
• ESforvocabularyoutcomesg=.38[06-.71]• ESforexpressivelanguageg =.27[0.10- 0.4]• ESforreceptivelanguageg=.09[-0.11,0.28]
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EffectSizesAcrossMetaAnalyses
0.61
0.42
0.29
0.35
0.09
0.430.38 0.38
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Roberts+Kaiser Hampton+Kaiser Kaiser-BWG
ExpressLang RecLang ExpVocab RecVocab Column1
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ImportantLimitations• Effectsarevariablewithinandacrossstudies• Effectsarerelativelymodestevenwhensignificant
• Largesteffectsaretreatmentvscontrol• Fewstudiesmeasurefidelityorexaminetheimpactoffidelity
• Parenttraining• Parentimplementation
• Relativelyisknownaboutactiveingredientsinparentimplementation
• ResultsarelargelyformiddleSESfamilies• Verylittleinformationaboutindividualdifferencesinparentsorchildren• Generalfindings:IQ,Receptivelanguagepredictbetterchildoutcomes
• Nofamilycharacteristicsconsistentlypredictimplementation
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BottomLine• Thereispotentiallyasmuchevidenceforthepositiveeffectsofincludingparentsinimplementingearlycommunicationinterventionasforanysingleaspectoflanguageintervention.
• Wecandobetterresearch,butwemustmovewhathasbeenresearchedintopractice
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ImplicationsforTranslatingResearchtoPractice:Describekeycomponentsofparenttraininginterventions
• Describethecomponentsoftheintervention• Whataretheactiveingredientsintheprimaryintervention?• Whatarethedosageandfrequencyoftheintervention?• Whatareinterventionactiveingredientsareparentstaught?• Whatarethe proceduresandsettingsforteachingparentstoimplementtheintervention?
• Whataretheproceduresandmeasuresforinsuringfidelityacrosstheprimaryintervention,trainingparentsandparentimplementation?
• Measureimplementationdosageandfidelity• Primaryintervention• Parenttraining• Parentimplementation• Parentgeneralizationandmaintenance
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Implications forResearchtoPractice: Buildsystemsforimplementation• Manualize treatmentswithfidelityinstruments
• Primaryinterventiondescriptions,fidelityinstruments,benchmarksforimplementation
• Parenttrainingintervention-- descriptions,fidelityinstruments,benchmarksforimplementation
• Parentimplementation,fidelityinstruments,benchmarks
• Developproceduresfortrainingparenttrainers• Complexskillset• Fluencyinusingprimaryintervention• Fluencyinparenttrainingstrategies• Skillsforrespondingtoparentcontext,needs,knowledge,• Abilitytotroubleshootchildchallenges(behavior,preferences,slowlearning)andparentchallenges(childbehavior,activities)
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BarrierstoEffectiveParent-ImplementedInterventionsinPractice• Fewprofessionalsaretrainedtoteachparents
• Fewlanguageinterventionapproachesarewell-specifiedforboththerapistimplementationandparenttrainingcomponents
• Generalneedforlongerterm,coordinatedinterventiontooptimizechildoutcomes. Va
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Appreciation!• KidTalk ResearchTeamatVanderbilt
– JenniferNietfeld,SuzanneThrower,CourtneyWright,LaurenHampton*,LizzyFuller*,JodiHeidlage*,KimMcCulla,TatianaPeredo,EmilyQuinn,JenniferCunningham*,MadelineHinson,SabrinaEvans,AshlynCampagna
• Familiesandchildrenwhoparticipatedinourstudies
• Ourfundingagencies:IES,NIH,MerckFoundation,HRSA,• NIDCD
• Meta*collaborators– ErinEBarton(Vanderbilt)andherstudents– JenniferFrey(GWU)andherstudents– MeganRoberts(NorthwesternUniv)andherstudents– CarolTrivette ETSU(BWG)andherstudents– BWGResearchNetwork:JudithCarta,PI,Univ.ofKansas– JodiHeidlage,JenniferCunningham,LaurenHampton,LizzyFuller,
• FormoreinformationAnn.Kaiser@Vanderbilt.eduThistalkwillbepostedatKidtalk.org
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KeyReferences• Kaiser,A.P.,&Roberts,M.Y.(2013).Parent-implementedenhancedmilieuteachingwithpreschoolchildren
withintellectualdisabilities.JournalofSpeech,Language,andHearingResearch,56,295-309.• Kaiser,A.P.&Roberts,M.Y.(2013).Parentsascommunicationpartners:Anevidencebasedstrategyfor
improvingparentsupportforlanguageandcommunicationineverydaysettings.PerspectivesonLanguageLearningandEducation,20(3),97-114..
• Wright,C.A.,Kaiser,A.P.,Reikowsky,D.I.,&Roberts,M.Y.(2013).EffectsofnaturalisticsigninterventiononexpressivelanguageoftoddlerswithDownSyndrome.JournalofSpeech,Language,andHearingResearch,56,994-1008.
• Kaiser,A.P.,&Roberts,M.Y.(2011).Advancesinearlycommunicationandlanguageintervention[Specialissue].JournalofEarlyIntervention,33(4),298-309.
• Kasari,C.,Kaiser,A.P.,Goods,K.,Nietfeld,J.,Mathy,J.,Landa,R.,Murphy,S.,&Almirall,D.(2014).Communicationinterventionsforminimallyverbalchildrenwithautism:Sequentialmultipleassignmentrandomizedtrial.JournaloftheAmericanAcademyofChild&AdolescentPsychiatry,56(6),635-646.
• Roberts,M.Y.,&Kaiser,A.P.(2011).Theeffectivenessofparent-implementedlanguageinterventions:Ameta-analysis.AmericanJournalofSpeech-LanguagePathology. Advanceonlinepublication.doi:10.1044/1058-0360(2011/10-0055)
• Roberts,M.,&Kaiser,A.(2012).Assessingtheeffectsofaparent-implementedlanguageinterventionforchildrenwithlanguageimpairmentsusingempiricalbenchmarks:Apilotstudy.JournalofSpeech,Language,andHearingResearch,55(6),1655-1670.
• Roberts,M.R.,Kaiser,A.P.Wolfe,C.,Bryant,J.,&Spidalieri,A.(2014).TheeffectsoftheTeach-Model-Coach-Reviewinstructionalapproachoncaregiveruseoflanguagesupportstrategiesandchildren’sexpressivelanguageskills.JournalofSpeech,Language,andHearingResearch..Advanceonlinepublication.doi:10.1044/2014_JSLHR-L-13-0113
• Roberts,M.Y.&Kaiser,A.P.(2015).Earlyinterventionfortoddlerswithlanguagedelays:Arandomizedcontrolledtrial.Pediatrics,134(4),686-693.doi:10.1542/peds.2014-2134.
• Hampton,L.H.,&Kaiser,A.P.(2016).Earlyinterventioneffectsonspoken-languageoutcomesorchildrenwithautism:Asystematicreviewandmeta-analysis.JournalofIntellectualandDevelopmentalDisabilities,60(5),444-463.
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Thankyou!
•Questions?Comments?
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ThistalkwillbepostedatKidtalk.org