Intervention: First WordsIntervention: First Words

““Parents are their children’s first Parents are their children’s first and most enduring teachers”and most enduring teachers”

(Kaiser & Hancock, 2003, p. 9)(Kaiser & Hancock, 2003, p. 9)

Involving Caregivers in InterventionInvolving Caregivers in Intervention

Providing parent training in indirect language Providing parent training in indirect language stimulation may be the best approach to late stimulation may be the best approach to late talkers with no additional risk factors (Paul, 2000)talkers with no additional risk factors (Paul, 2000)

Parent –training has positive effects on children’s:Parent –training has positive effects on children’s: Vocabulary size (Girolametto et al., 1997)Vocabulary size (Girolametto et al., 1997) Word combinations (Girolametto et al., 1997)Word combinations (Girolametto et al., 1997) Communication behavior (Hemmeter & Kaiser, Communication behavior (Hemmeter & Kaiser,

1994; Wilcox, 1992; but not Girolametto et al., 1994; Wilcox, 1992; but not Girolametto et al., 1993, Kott & Law, 1995)1993, Kott & Law, 1995)

Morphology and syntax (Fey et al. 1993, 1997)Morphology and syntax (Fey et al. 1993, 1997)

Parents’ Behaviors ChangeParents’ Behaviors Change Learned to read infant’s behavior cues (Barnard, Learned to read infant’s behavior cues (Barnard,

1997; Seifer et al., 1991)1997; Seifer et al., 1991) Learned milieu therapy techniques & responsive Learned milieu therapy techniques & responsive

interaction strategies (Hemmeter & Kaiser, 1994; interaction strategies (Hemmeter & Kaiser, 1994; Wilcox 1992; Kott & Law,1995, )Wilcox 1992; Kott & Law,1995, )

Learned to recast at increased rates (Fey et al., Learned to recast at increased rates (Fey et al., 1993, 1997)1993, 1997)

Learned focused stimulation techniques Learned focused stimulation techniques (Girolametto et al., 1998)(Girolametto et al., 1998)

Changed communication behavior (Girolametto, Changed communication behavior (Girolametto, 1988; Girolametto et al., 1993; Mahoney & Powell, 1988; Girolametto et al., 1993; Mahoney & Powell, 1986; McConkey & O’Connor, 1982; Tannock et 1986; McConkey & O’Connor, 1982; Tannock et al., 1992; Weistuch & Lewis, 1985)al., 1992; Weistuch & Lewis, 1985)

Arguments Against Parent-TrainingArguments Against Parent-Training

Parents should not be asked to substitute Parents should not be asked to substitute a teacher role for their parental role a teacher role for their parental role (Turnbull & Turnbull, 1990)(Turnbull & Turnbull, 1990)

Family-centered approaches should focus Family-centered approaches should focus on needs that parents identify (Dunst & on needs that parents identify (Dunst & Leet, 1987)Leet, 1987)

Professional presumption that parents do Professional presumption that parents do not have adequate skills stigmatizes not have adequate skills stigmatizes parents (Greene, 1999) parents (Greene, 1999)

Timing is EverythingTiming is Everything

Teaching parents is a good idea when :Teaching parents is a good idea when : They are interested in participatingThey are interested in participating It is a priority that they are committed toIt is a priority that they are committed to Support, time, and energy are availableSupport, time, and energy are available Their children are developmentally likely to Their children are developmentally likely to

benefitbenefit Their children’s communication needs can be Their children’s communication needs can be

met through parent interventionmet through parent intervention

(Kaiser & Hancock, 2003)(Kaiser & Hancock, 2003)

The Hanen ProgramThe Hanen Program

Old Principles Still ApplyOld Principles Still Apply Same physical levelSame physical level OWLOWL Follow the child’s leadFollow the child’s lead

This is a child-centered intervention This is a child-centered intervention techniquetechnique

The Hanen ProgramThe Hanen Program

New TechniquesNew Techniques Prompt for better turnsPrompt for better turns The 3 A’s: Allow, Adapt, AddThe 3 A’s: Allow, Adapt, Add Establish RoutinesEstablish Routines

Prompt for Better TurnsPrompt for Better Turns

Take one turn at a timeTake one turn at a time At first, just slip your turn inAt first, just slip your turn in

Wait with expectationWait with expectation Lean forwardLean forward Open your eyes wide and raise eyebrowsOpen your eyes wide and raise eyebrows Point or gesture to the childPoint or gesture to the child

Label the turnsLabel the turns Your turn; my turnYour turn; my turn

3 A’s: Allow the Child to Lead3 A’s: Allow the Child to Lead

Don’t anticipate the child’s needsDon’t anticipate the child’s needs Set up situations to arouse curiosity & Set up situations to arouse curiosity &

interestinterest Follow the child’s agendaFollow the child’s agenda Imitate the childImitate the child Interpret all attempts to communicateInterpret all attempts to communicate

Parallel talkParallel talk

Adapt to Share the MomentAdapt to Share the Moment

Focus on the child, not the toy or activityFocus on the child, not the toy or activity Actively participate in the child’s activityActively participate in the child’s activity Encourage participation in daily activitiesEncourage participation in daily activities Comment rather than questionComment rather than question When you do ask questions, ask those When you do ask questions, ask those

that are real, age-appropriate, and on-that are real, age-appropriate, and on-topictopic

Add Language & ExperienceAdd Language & Experience

Talk about what’s on your child’s mindTalk about what’s on your child’s mind Emphasize key wordsEmphasize key words Use gesturesUse gestures Slow downSlow down Repeat the same words/phrases Repeat the same words/phrases

predictably in the same context and across predictably in the same context and across contextscontexts

Expand the child’s utterancesExpand the child’s utterances

Manolson, 1992, p. 42

Establish RoutinesEstablish Routines

3 Types of Routines3 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 Characteristics5 Characteristics A theme (knock em down routine)A theme (knock em down routine) PredictablePredictable ReversibleReversible Allow increased child participation over timeAllow increased child participation over time Repeatable Repeatable

Focused StimulationFocused Stimulation

Exposure to high concentrations of a Exposure to high concentrations of a specific target in a meaningful specific target in a meaningful communicative context(very imprt-first communicative context(very imprt-first words)words)

Target selection is based on normal Target selection is based on normal developmental guidelinesdevelopmental guidelines

The intervention agent can be the clinician The intervention agent can be the clinician or a trained parentor a trained parent

This is a hybrid intervention techniqueThis is a hybrid intervention technique

TargetsTargets

Language FormLanguage Form Semantic relationsSemantic relations

Language ContentLanguage Content Early vocabularyEarly vocabulary Semantic functionsSemantic functions

Language UseLanguage Use InitiationInitiation GreetingsGreetings Question and answerQuestion and answer

Vocabulary ExampleVocabulary Example (Girolametto et al., 1998)(Girolametto et al., 1998)

With the parent, choose 10 words from a With the parent, choose 10 words from a list of 20 pre-selected by the clinicianlist of 20 pre-selected by the clinician

Set up routines that allow frequent Set up routines that allow frequent modeling of the target words modeling of the target words

Focus on a small number at any one Focus on a small number at any one timetime

Replace words when the child uses them Replace words when the child uses them 3X in 3 different contexts3X in 3 different contexts

Still follow the child’s leadStill follow the child’s lead

TechniquesTechniques Multiple repetitionsMultiple repetitions Stress target in pragmatically appropriate ways Stress target in pragmatically appropriate ways

(over emphasis the word) eg (ball goes IN the box)(over emphasis the word) eg (ball goes IN the box) Arrange the environment to create opportunities for Arrange the environment to create opportunities for

the child to the child to Child response requirements varyChild response requirements vary

In some applications responses are not required In some applications responses are not required or elicited and in others prompts may be usedor elicited and in others prompts may be used

Child use of targets are acknowledged and praisedChild use of targets are acknowledged and praised Natural consequences are provided(run and catch Natural consequences are provided(run and catch

example)example)

Enhanced Milieu TeachingEnhanced Milieu Teaching

Environmental ArrangementEnvironmental Arrangement

Choose activities and objects of interest to the Choose activities and objects of interest to the childchild

Create pragmatically natural activities to prompt Create pragmatically natural activities to prompt languagelanguage

Provide natural consequences for using Provide natural consequences for using language language

Child initiatesChild initiates with a request with a request

Responsive InteractionResponsive Interaction

Follow the child’s leadFollow the child’s lead Respond to the child’s verbal and Respond to the child’s verbal and

nonverbal attemptsnonverbal attempts Provide meaningful semantic feedbackProvide meaningful semantic feedback Expand the child’s utterances using Expand the child’s utterances using

language at a slightly more advanced levellanguage at a slightly more advanced level

Milieu Teaching ProceduresMilieu Teaching Procedures

Time DelayTime Delay Establish joint attention and waitEstablish joint attention and wait

ModelModel Present the verbal target you want the child to Present the verbal target you want the child to

use, up to twiceuse, up to twice MandMand

Ask a question to elicit the verbal targetAsk a question to elicit the verbal target Tell the child what to say – elicit an imitationTell the child what to say – elicit an imitation

Child FeedbackChild Feedback

When the child responds correctly:When the child responds correctly: AcknowledgeAcknowledge ExpandExpand Provide the natural consequence/materialProvide the natural consequence/material

When the child responds incorrectly:When the child responds incorrectly: Repeat the promptRepeat the prompt Model the correct responseModel the correct response Provide the natural consequence/materialProvide the natural consequence/material

Teaching ParentsTeaching Parents

Teaching SequenceTeaching Sequence Environmental arrangementEnvironmental arrangement Responsive interaction strategiesResponsive interaction strategies Milieu teaching promptsMilieu teaching prompts Criteria are set that must be reached Criteria are set that must be reached

before moving to the next levelbefore moving to the next level

Teaching ParentsTeaching ParentsTeaching TechniquesTeaching Techniques Provide positive examples: Provide positive examples:

Live Live VideoVideo Role-playRole-play

Coaching and feedbackCoaching and feedback Allows parents to be immediately successfulAllows parents to be immediately successful Give tips and instructions while parents Give tips and instructions while parents

practicepractice Be precise, supportive, and clearBe precise, supportive, and clear