Assignment: Expressive communication delays

Assignment: Expressive communication delays
Assignment: Expressive communication delays
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Assignment: Expressive communication delays
Description of Program
Participants
Thirteen parents and their toddlers with expressive com- munication delays participated in LAPE across three ses- sions. However, only eight parent?child dyads attended all sessions and complete all assessment; thus, only these eight were included in these analyses. Five additional parent?child dyads participated in LAPE sessions, but did not complete all assessments or missed sessions. Parents were recruited from a local EI agency and local early child- hood programs (seven mothers and one father participated). LAPE was a voluntary program. Six of the eight children were receiving additional EI services (see Table 2). Parents
Moore et al. 215
Assignment: Expressive communication delays
varied in age (i.e., ages ranged from 29 to 41 years), educa- tion (i.e., two reported “some college,” one reported “com- munity college degree,” four reported “Bachelor’s degree,” and one reported “master’s degree”), and income level (i.e., four reported an income level between “US$20,000-US$50,000” and four reported an income level between “US$50,000-US$80,000”). Inclusion crite- ria for children were (a) chronological age between 24 and 36 months, (b) verbal vocabulary between 10 and 50 words as measured by the MacArthur-Bates Communicative Development Inventory (Words and Sentences Form; CDI-II; Fenson et al., 2007), and (c) had parents who attended all sessions and completed all assessments.
Training Structure and Settings
The LAPE program consisted of group and individual ses- sions across three cohorts of parents and toddlers. The cohorts were conducted sequentially over 1 year. Two or three parent?child dyads were included in these analyses from each cohort (Cohort 1 included three of four parent?child dyads, Cohort 2 included two of five parent?child dyads, and Cohort 3 included three of four parent?child dyads). The group sessions occurred in a classroom at a community school and the individual ses- sions occurred in the families’ homes. Individual sessions were 1 hr and group sessions ranged from 90 min to 2 hr based on group preferences (i.e., Cohorts 1 and 3 requested 2-hr sessions and Cohort 2 requested 90-min sessions). For the first two cohorts, the group and individual sessions were staggered across 7 weeks (i.e., two group sessions, one indi- vidual session, two group sessions, one individual session, and a final group session). Because the parents in Cohorts 1 and 2 did not maintain use of LAPE strategies at follow-up, the authors decided to stagger Cohort 3’s sessions and
embed a 6-week break after the first individual session. Moreover, they replaced the final group session with an individual session. Thus, for cohort 3, the total session length was 15 weeks. This was intended to promote mainte- nance of parent use of LAPE strategies and individualize the final session to the needs of the dyad. Although there were variations in the format, the curriculum was identical across cohorts.
Interventionists
The first author, a speech-language pathologist, led all group sessions and graduate students in Early Intervention/ Early Childhood Special Education (EI/ECSE) and Communication Disorders Sciences (CDS) were the pri- mary interventionists. They received practicum course credit for participating. Across the three cohorts, a total of 12 graduate students participated in LAPE. Each parent was paired with a student who served as his or her “coach” for the duration of LAPE. The students also administered the initial assessment tests, participated in the group sessions, and led individual sessions. The first and second author, an early childhood special educator, taught the students the treatment protocol, oversaw their individual session plans, and closely supervised them during all assessment and coaching activities.
Parent Strategies
LAPE followed a family coaching approach to teach par- ents to use naturalistic language teaching strategies (see Tables 1 and 3). LAPE strategies were chosen because they were empirically supported, easily embedded into daily routines, and appropriate given the needs of toddlers. Moreover, several studies have demonstrated parents can
Table 2. Child Demographic Characteristics.
PLS-IVb VABS-IIc
Dyad Disability statusa Chronological age (months) Race of child Other community services AC EC DLS SS Motor
1 DD 31 White/Caucasian EI toddler group 85 74 83 87 114 2 DD 31 Multiracial EI toddler group 77 69 98 89 72 3 SELD 25 White/Caucasian No other services 128 83 117 89 90 4 DD 25 White/Caucasian EI toddler group 81 79 105 95 111 5 SD 32 White/Caucasian SLP services 81 77 95 93 93 6d SD 24 White/Caucasian SLP services 81 (67) 96 (79) 77 82 90 7e SELD 28 White/Caucasian No other services 78 73 87 78 88 8 DD 32 White/Caucasian EI toddler group 50 50 73 78 79
aDD = developmental disability; SELD = specific expressive language delay; SD = structural disability (e.g., cleft lip/palate). bPLS-IV = Preschool Language Scale (4th ed.); AC = Auditory Comprehension subtest; EC = Expressive Communication subtest. cVABS-II = Vineland Adaptive Behavior Scales (2nd ed.); DLS = Daily Living Skills domain; SS = Socialization domain; Motor = Motor Skills domain. dThis child was 7 days away from turning 24 months at the time of testing. The PLS-IV scores in parentheses are after rounding up his age to 24 months. eOnly father–child dyad.
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implement these strategies with training and support (see Roberts & Kaiser, 2011, for a meta-analysis of this research).
Parent Training Components
LAPE consisted of three major components: group parent support sessions, individual sessions in homes, and practice in-between sessions. This was intentionally designed to give parents opportunities to interact with other parents of toddlers with communication delays; deliver content and model strategies in a supportive, cost-effective manner; dis- cuss opportunities to practice the strategies during daily routines in-between sessions; and provide individualized, routine-based coaching. The following sections describe the LAPE program components.
Group support sessions. Table 4 outlines the content of the parent support sessions. The goals of the first session were to: (a) allow the parents to meet and learn more about each other, (b) introduce basic communication and play concepts (e.g., early language and play milestones), and (c) help par- ents identify their toddler’s current communication skills. Parents also worked individual with their coaches to iden- tify goals for their toddlers and themselves. For example,
toddler goals included: “[Child] will use 25 new words by the end of LAPE.” Examples of parent goals were “I will learn the best strategies to use,” and “I will get tips to help my child talk.”
Subsequent group sessions started with a group discus- sion about progress. Each parent reported on her toddler’s progress and how she was utilizing previously taught strate- gies at home (not included in the second session). The first author encouraged parents to reflect on, comment, and sup- port each other’s progress and offer suggestions as needed. Then parents were separated and met individually with their coaches to more specifically discuss and document progress at home. After the individual coaching activity, the first author provided an overview of new strategies (see Table 4). Parents also met individually with coaches at the end of every session to plan their use of the strategies at home (new and previously taught).
Individual sessions. Each family also received individual ses- sions in their home 2 to 3 times during their participation in LAPE (see Table 4). The coaches used the family coaching strategies described in Table 1. During the first home ses- sion, parents and coaches watched the parent?toddler video sample collected prior to intervention and rated the parent’s use of each of the LAPE strategies already introduced in the