Intervention: First Words “Parents are their children’s first and most enduring teachers” (Kaiser & Hancock, 2003, p. 9)

Involving Caregivers in Intervention  Providing parent training in indirect language stimulation may be the best approach to late talkers with no additional risk factors (Paul, 2000)  Parent –training has positive effects on children’s:  Vocabulary size (Girolametto et al., 1997)  Word combinations (Girolametto et al., 1997)  Communication behavior (Hemmeter & Kaiser, 1994; Wilcox, 1992; but not Girolametto et al., 1993, Kott & Law, 1995)  Morphology and syntax (Fey et al. 1993, 1997)

Parents’ Behaviors Change  Learned to read infant’s behavior cues (Barnard, 1997; Seifer et al., 1991)  Learned milieu therapy techniques & responsive interaction strategies (Hemmeter & Kaiser, 1994; Wilcox 1992; Kott & Law,1995, )  Learned to recast at increased rates (Fey et al., 1993, 1997)  Learned focused stimulation techniques (Girolametto et al., 1998)  Changed communication behavior (Girolametto, 1988; Girolametto et al., 1993; Mahoney & Powell, 1986; McConkey & O’Connor, 1982; Tannock et al., 1992; Weistuch & Lewis, 1985)

Arguments Against Parent-Training  Parents should not be asked to substitute a teacher role for their parental role (Turnbull & Turnbull, 1990)  Family-centered approaches should focus on needs that parents identify (Dunst & Leet, 1987)  Professional presumption that parents do not have adequate skills stigmatizes parents (Greene, 1999)

Timing is Everything  Teaching parents is a good idea when : They are interested in participating They are interested in participating It is a priority that they are committed to It is a priority that they are committed to Support, time, and energy are available Support, time, and energy are available Their children are developmentally likely to benefit Their children are developmentally likely to benefit Their children’s communication needs can be met through parent intervention Their children’s communication needs can be met through parent intervention (Kaiser & Hancock, 2003)

The Hanen Program Old Principles Still Apply  Same physical level  OWL  Follow the child’s lead  This is a child-centered intervention technique

The Hanen Program New Techniques  Prompt for better turns  The 3 A’s: Allow, Adapt, Add  Establish Routines

Prompt for Better Turns  Take one turn at a time At first, just slip your turn in At first, just slip your turn in  Wait with expectation Lean forward Lean forward Open your eyes wide and raise eyebrows Open your eyes wide and raise eyebrows Point or gesture to the child Point or gesture to the child  Label the turns Your turn; my turn Your turn; my turn

3 A’s: Allow the Child to Lead  Don’t anticipate the child’s needs  Set up situations to arouse curiosity & interest  Follow the child’s agenda  Imitate the child  Interpret all attempts to communicate Parallel talk Parallel talk

Adapt to Share the Moment  Focus on the child, not the toy or activity  Actively participate in the child’s activity  Encourage participation in daily activities  Comment rather than question  When you do ask questions, ask those that are real, age-appropriate, and on- topic

Add Language & Experience  Talk about what’s on your child’s mind  Emphasize key words  Use gestures  Slow down  Repeat the same words/phrases predictably in the same context and across contexts  Expand the child’s utterances

Manolson, 1992, p. 42

Establish Routines  3 Types of Routines Social routines (pady cake) Social routines (pady cake) Routines of daily living (brushing teeth) Routines of daily living (brushing teeth) Routines with toys (clean up) Routines with toys (clean up)  5 Characteristics A theme (knock em down routine) A theme (knock em down routine) Predictable Predictable Reversible Reversible Allow increased child participation over time Allow increased child participation over time Repeatable Repeatable

Focused Stimulation  Exposure to high concentrations of a specific target in a meaningful communicative context(very imprt-first words)  Target selection is based on normal developmental guidelines  The intervention agent can be the clinician or a trained parent  This is a hybrid intervention technique

Targets  Language Form Semantic relations Semantic relations  Language Content Early vocabulary Early vocabulary Semantic functions Semantic functions  Language Use Initiation Initiation Greetings Greetings Question and answer Question and answer

Vocabulary Example (Girolametto et al., 1998)  With the parent, choose 10 words from a list of 20 pre-selected by the clinician  Set up routines that allow frequent modeling of the target words  Focus on a small number at any one time  Replace words when the child uses them 3X in 3 different contexts  Still follow the child’s lead

Techniques  Multiple repetitions  Stress target in pragmatically appropriate ways (over emphasis the word) eg (ball goes IN the box)  Arrange the environment to create opportunities for the child to  Child response requirements vary In some applications responses are not required or elicited and in others prompts may be used In some applications responses are not required or elicited and in others prompts may be used  Child use of targets are acknowledged and praised  Natural consequences are provided(run and catch example)

Enhanced Milieu Teaching Environmental Arrangement  Choose activities and objects of interest to the child  Create pragmatically natural activities to prompt language  Provide natural consequences for using language  Child initiates with a request

Responsive Interaction  Follow the child’s lead  Respond to the child’s verbal and nonverbal attempts  Provide meaningful semantic feedback  Expand the child’s utterances using language at a slightly more advanced level

Milieu Teaching Procedures  Time Delay Establish joint attention and wait Establish joint attention and wait  Model Present the verbal target you want the child to use, up to twice Present the verbal target you want the child to use, up to twice  Mand Ask a question to elicit the verbal target Ask a question to elicit the verbal target Tell the child what to say – elicit an imitation Tell the child what to say – elicit an imitation

Child Feedback  When the child responds correctly: Acknowledge Acknowledge Expand Expand Provide the natural consequence/material Provide the natural consequence/material  When the child responds incorrectly: Repeat the prompt Repeat the prompt Model the correct response Model the correct response Provide the natural consequence/material Provide the natural consequence/material

Teaching Parents Teaching Sequence  Environmental arrangement  Responsive interaction strategies  Milieu teaching prompts  Criteria are set that must be reached before moving to the next level

Teaching Parents Teaching Techniques  Provide positive examples: Live Live Video Video Role-play Role-play  Coaching and feedback Allows parents to be immediately successful Allows parents to be immediately successful Give tips and instructions while parents practice Give tips and instructions while parents practice Be precise, supportive, and clear Be precise, supportive, and clear