1. Very Early Communication Intervention for Infants Born with NAS & Their Mothers

2. Thanks! ETSU, Research Development Committee Grant: 15-026M Collaborative support from Families Free, especially Lisa Tipton & Judy Clark Graduate Assistants: Kristi Moore Kaitlyn Turney Kara Costner

3. Purpose To pilot a very early communication intervention program with 8 babies who were born with NAS, aged 4-10 mos, and their mothers. Specific Aims To develop supplementary materials and modify the Hanen Program, It Takes Two to Talk ® (Manolson, 1983) to specifically target communication and interaction between the babies and their mothers To measure and analyze mothers’ facilitating communication behaviors To measure and analyze babies’ prelinguistic communication behaviors To measure and analyze frequency and duration of turn- taking between mothers and their babies To measure and analyze mother-baby attachment and temperament

4. The Basic Intervention Program 2 Assessment Sessions 12 Responsive Education/Prelinguistic Milieu Treatment Sessions (Yoder & Warren, 2002) 2 Final Assessment Sessions Responsive Education Based on the It Takes Two to Talk ® program (Manolson,1983). Being modified in consultation with the developer and publisher, the Hanen Centre, to focus more intensely on prelinguistic communication. Prelinguistic Milieu Treatment It focuses on establishing foundational communication skills that develop before babies start talking (e.g., Fey et al., 2006; Warren et al., 2008; Yoder & Warren, 2002)

5. Responsive Education with Mothers First half-hour, SLP works with mom individually Videos, role-play, handouts and worksheets Examples of the topics includes: Observing how and why your child communicates You make the difference Allow your baby to lead Adapt to share the moment Add language to the interaction Daily routine talk Play the 3A way Moving forward with music, rhythm & rhyme

6. Prelinguistic Milieu Treatment with Babies First half-hour, graduate students trained in PMT work with the baby individually on selected goals Examples of communication targets: To communicate for a purpose To use gaze, gestures and vocalization to communicate To pay attention to people and toys with someone else To take turns in play routines To imitate sounds & gestures To babble

7. Coaching and Practicing All Together In the last half hour of the session, the speech- language pathologist coaches the mother while she practices the techniques and strategies taught earlier in the session. Model, offer suggestions during the interaction, reinforce correct use of techniques, use video- feedback, debrief, set “homework”.

8. Recruitment & Research Design Mothers and their babies are referred to the basic intervention program through Families Free based on their counsellors’ judgment about their readiness for the program All mothers receive the intervention regardless of their choice to participate in the research component Babies must be 10 months of age or less at the beginning of the intervention Early exploratory single subject multiple baseline design 2 sessions/weeks of pre-intervention baseline testing 12 sessions/weeks of intervention 2 sessions/weeks of post-intervention baseline testing 2 sessions/weeks of maintenance testing, 12 weeks after the final intervention session

9. Data Collection Infant Social and Communication Behavior Scales (Cress, 2014) MacArthur-Bates Communication Development Inventory (Fenson et al., 1993)* Mullen Scales of Early Learning (Mullen, 1995) Mini-MBQS (Moran, 2009)* Infant Behavior Questionnaire (Rothbart, 1981)* Adult Temperament Questionnaire (Derryberry & Rothbart, 1988)* 10-15 minute mother-baby videos of daily living and play activities: Pre-intervention, During Intervention*, Post- Intervention, Maintenance* Mothers’ and babies’ demographic, health, and developmental histories * Additionally collected for the research study

10. Independent Variables Mothers Age, education, SES, prenatal & current substance use, temperament Babies Age, gestation, birth weight, NAS recovery history, neurodevelopmental diagnosis, temperament

11. Dependent Variables Mothers Communication and Interaction: Overt interpretation of infants’ behaviors, linguistic mapping, directiveness, responsiveness, use of questions, wait time, and prompting Attachment and Bonding Babies Communication and Interaction Rates of potential and actual protoimperatives, protodeclaratives, communicative acts, gestures, gaze shifts, joint attention, vocalizations, reciprocal vocalizations, and canonical vocalizations Receptive and expressive vocabulary size General Developmental Levels Mothers & Babies Interaction Frequency, duration of reciprocal turn-taking during daily & play routines

12. References Cress, C. (2014) Infant Social and Communication Behavior Scales). In development. Derryberry, D. & Rothbart, M. K. (1988). Arousal, affect, and attention as components of temperament. Journal of Personality and Social Psychology, 55, 958-966. Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates,E., Hartung, J. P., et al. (1993). MacArthur Communicative Development Inventories. San Diego, CA: Singular Publishing Group. Fey, M. E., Warren, S. F., Brady, N., Finestack, L. H., Bredin-Oja, S. L., Fairchild, M., et al. (2006). Early effects of responsivity education/prelinguistic milieu teaching for children with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 49, 526-548. Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders,53,156-167 Girolametto, L., Pearce, P. & Weitzman, E. (1996).The effects of focused stimulation for promoting vocabulary in children with delays: A plot study. Journal of Childhood Communication Development, 17, 39-49. Manolson, A. (1983) It Takes Two to Talk. Toronto, ON: The Hanen Program. Moran, G. (October, 2009) Mini-MBQS. Retrieved http://Works.bepress.com/gregmoran/49http://Works.bepress.com/gregmoran/49 Mullen, E. M. (1995).Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Services, Inc., Rothbart, M. K.(1981). Measurement of temperament in infancy. Child Development, 52, 569-578. Tannock, R., Girolametto, L., & Siegel, L. (1992). Language intervention with children who have developmental delays: Effects on an interactive approach. American Journal of Mental Retardation, 97, 145-160 Warren, S. F., Fey, M. E., Finestack, L. H., Brady, N. C., Bredin-Oja, S. L., & Fleming, K. K. (2008) A randomized trial of longitudinal effects of low-intensity responsivity education/prelinguistic milieu treatment. Journal of Speech, Language, and Hearing Research, 51, 451-470. Yoder, P. & Warren, S.F. (2002). Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 45, 1158-1174.