The Importance of Parent Training in Early Language Intervention:The Hanen ApproachCindy Smith • The Hanen Centre
1© Hanen Early Language Program, 2012. All rights reserved.
The Importance of Parent TrainingThe Importance of Parent Trainingin Early Language Intervention:
The Hanen Approach
Cindy Smith, B. App. Sc. Speech-language PathologistHanen Instructor and Australasian Representative
Let’s look at...
1. Why do we want to start early with children with communication delays?
2. Why should we train parents and carers to be l i t ti i t ?language interventionists?
3. What is The Hanen Centre & what is the It Takes Two to Talk® Program?
4. What is involved in It Takes Two to Talk?
Why start early?
Some children we can predict will have communication delays e.g. Down Syndrome, GDD
Studies on brain plasticity and brain development
Long term impact on academic success, social competence, behaviour
Savings to society in terms of long-term need for support
Clegg, Hollis, Mawhood & Rutter, 2005Johnson, Beitchman & Brownie, 2010Tomblin, Zhang, Buckwalter & O’Brien, 2003 Tomblin, Zhang, Buckwalter, Catts, 2000
Why train parents to be interventionists?
Need to work with the people who are closest to the child
Know them the best
Have the biggest vested interestgg
Spend the most time
Promotes family well being
(Crnic & Stormshak, 1997)
“Active involvement by families is critical. Without it, intervention is unlikely to be successful - any short term effects are unlikely to be long-lasting”.
Bronfenbrenner 1974
What the experts sayabout working with families...
Bronfenbrenner, 1974
“The earlier parents of children with disabilities are involved in interventionprograms, the better the outcomes”.
Rossetti, 2001
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Kaiser and Roberts Meta Analysis (2011)
Meta-analysis - combined results of 18 studies that examined parent-implemented intervention
Compared experimental with control groups (control groups either non-treatment, therapist-delivered, or business as usual)
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business as usual)
Children average 24-36 months (range: 15-77 mos)
All interventions were between 10-13 weeks (less than 26 hours of parent training)
All programs taught responsive strategies
The Importance of Parent Training in Early Language Intervention:The Hanen ApproachCindy Smith • The Hanen Centre
2© Hanen Early Language Program, 2012. All rights reserved.
1. Did parent training positively affect parents’ use of strategies?
Positive impact on...• parent responsiveness
YES!
• parent’s use of language models• rate of communication with their child
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Positive & significant effects on:ti & i l
2. Do parent-implemented interventions positively affect child language outcomes?
YES!
• receptive & expressive language and vocabulary
• expressive morpho-syntax• rate of communication
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3. Is intervention more effective when delivered by a parent?
• receptive language – parents more effective
YES... for some language constructs
• expressive syntax – parents more effective
No significant difference in other constructs between intervention delivered by parent and SLP
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4. Do the effects of parent-implemented interventions differ for children with or without intellectual difficulties?
NO... except for expressive vocabulary
(larger effect size for children without ID)
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No difference in most language constructs for these two groups
It Takes Two to Talk® Research Randomized Controlled Trial, JSHR,1996
Child Changes:
social gains – increase in joint attention and turn taking
Parent Changes:
less directive; more responsive
had larger vocabularies and a greater variety of words
used more multi-word sentences
used more target words (in structured and free play situations)
p
language input slower, less complex
used more focused stimulation than control group
Outcomes of Study on It Takes Two to Talk (1996)
The Importance of Parent Training in Early Language Intervention:The Hanen ApproachCindy Smith • The Hanen Centre
3© Hanen Early Language Program, 2012. All rights reserved.
What about Malaysia?
Approximately 3.5 million children under the age of 6
Worldwide estimate that 7% of children have a language delay, due to various etiologies
Number of SLPs in Malaysia
Potentially 245,000 children with communication delay
Let’s look at...
1. Why do we want to start early with children with communication delays?
2. Why should we train parents and carers to be language i t ti i t ?interventionists?
3. What is The Hanen Centre & what is the It Takes Two to Talk® Program?
4. What is involved in It Takes Two to Talk?
What is The Hanen Centre?A Not-For-Profit Charitable Organization
Service Resources
Training Membership
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Hanen Programs…
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Facilitating a Child’s Communication
Two critical components to facilitating communication
Both need to be present in order for the child to benefit
The Importance of Parent Training in Early Language Intervention:The Hanen ApproachCindy Smith • The Hanen Centre
4© Hanen Early Language Program, 2012. All rights reserved.
What’s the missing piece?
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What’s the missing piece here?
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For children’s communication to develop, they need both….
Interaction
Language Input
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The Hanen approach is based on
Social-Interactionist theory:
The child is able to process language input more easily when adult input is responsive
Responsive input facilitates language learning because it:
is more motivating for the child, thereby increasing his participation in the interaction
Is easier for the child as he doesn’t have to use cognitive energy to shift his attention from his interest to that of the adult 22
Interaction? Language? Or Both?
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Let’s look at...
1. Why do we want to start early with children with communication delays?
2. Why should we train parents and carers to be language i t ti i t ?interventionists?
3. What is The Hanen Centre & what is the It Takes Two to Talk® Program?
4. What is involved in It Takes Two to Talk?
The Importance of Parent Training in Early Language Intervention:The Hanen ApproachCindy Smith • The Hanen Centre
5© Hanen Early Language Program, 2012. All rights reserved.
Responsive Social Interaction Strategies
First…
Child-centered strategies (increase child initiations)
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OWL
Be face to face
Observe, Wait Listen(increase initiations)
Follow child’s lead
Join in
Responsive Social Interaction Strategies
Second…
Interaction-promoting
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Match turns
Imitate
Cue for a turn
Appropriate balance of questions and comments
And finally… That’s your hand. Your
hand is soooo dirty!
HandLanguage Modeling
Responsive Social Interaction Strategies
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Interpret child’s message
Label – variety of words
Highlight, use repetition
Expand
Extend topic
It Takes Two to Talk® Schedule
Group Session 1: Let Your Child LeadGroup Session 2: Follow Your Child’s Lead
Video Feedback #1
Group Session 3: Take Turns to Keep the Interaction GoingGroup Session 4: Add Language to the Interactionp g gGroup Session 5: Add Language to Build Understanding
Video Feedback #2
Group Session 6: Let’s Play!Group Session 7: Sharing Books
Video Feedback #3
Group Session 8: Moving Forward with Music & Closing28
Framework for Teaching Strategies
Hook the learner in –establish a reason for learning
Plan for homewritten
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g
Provide the information – interactive, practical, relevant
234 1
Practice, Practice, Practice!!simulated and “mental”
What do parents say?
The Importance of Parent Training in Early Language Intervention:The Hanen ApproachCindy Smith • The Hanen Centre
6© Hanen Early Language Program, 2012. All rights reserved.
What else do parents say?
Parent begins to try to apply strategies to interactions with
their child.
The Value of Videotaping
Parent starts to
Parent starts to seesome change in
child or interaction Parent starts to learn program
strategies.
child or interaction & with our help
attributes it to own change in behaviour
Parent starts tochange attitude,
beliefs Guskey 2002
What parents say about video feedback?
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How to get involved?
www.hanen.org – Online Store 3 Day training for SLPs
References
Law, Garrett & Nye (2011) The Efficacy of Treatment for Children with Developmental Speech and Language Delay/Disorder: A Meta-Analysis. Journal of Speech, Language and Hearing Research
Girolametto, L., Pearce., P., & Weitzman, E. (1996). Interactive focused stimulation for toddlers with expressive vocabulary delays. J l f S h d H i R h 39 1274 83Journal of Speech and Hearing Research, 39, 1274-83.
It Takes Two to Talk® Research Summary www.hanen.org
Roberts, M. & Kaiser, A. (2011). The Effectiveness of Parent-Implemented Language Intervention: A Meta-Analysis. American Journal of Speech-Language Pathology, 20, 180-199.
Thank you for listening! [email protected]
Program Manager for It Takes Two to Talk [email protected]
For more information on trainings, resources and tips sheets
for parents and professionals see www.hanen.orgwww.hanen.org