Empirical Evidence of the Value Added by Parents...

EmpiricalEvidenceoftheValueAddedbyParents’ParticipationinEarlyLanguageInterventionAnnP.Kaiser,PhDVanderbiltUniversityDepartmentofSpecialEducationVanderbiltKennedyCenter Va

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1ann.kaiser@vanderbilt.edu

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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•FormoreinformationAnn.Kaiser@Vanderbilt.edu

ThistalkwillbepostedatKidtalk.org