Teaching Spanish-Speaking Caregivers to Implement EMT en Español: A Small Randomized Trial

The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America

PURPOSE

The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L.

METHOD

This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13-35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20-34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais-Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics.

RESULT

The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country.

CONCLUSION

The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.

EMT en Español Para Autismo: A Collaborative Communication Intervention Approach and Single Case Design Pilot Study

The primary purpose of the current pilot study was to test the effects of an adapted and collaborative intervention model with a systematic teaching approach on Latina Spanish-speaking caregivers' use of EMT en Español Para Autismo strategies with their young children on the autism spectrum. A multiple baseline across behaviors single case design was replicated across two dyads. A series of family interviews and a direct therapist-child intervention phase supported individualization of the intervention. Families were provided speech generating devices as part of their children's intervention protocol. Caregivers were taught to use EMT en Español Para Autismo strategies with aided language input. Strategies included contingent target-level and proximal target-level language modeling, linguistic expansions, and communication elicitations. Secondary variables measured included generalization of strategy use to unsupported interactions and at a 2-month follow-up, child communication outcomes, and social validity. There was a strong functional relation for one dyad between the adapted and collaborative intervention and caregiver use of EMT strategies. The functional relation was weakened by behavioral covariation for the other dyad. Children increased the quantity and diversity of their communication during the study. Caregivers generalized their use of most EMT strategies and reported most aspects of the approach to be socially valid. The current study provides an initial demonstration of an effective model for adaptation and individualization of naturalistic developmental behavioral interventions for Latino Spanish-speaking families with children on the autism spectrum.

Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines

BACKGROUND

 Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting.

OBJECTIVES

 To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit.

METHOD

 We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components.

RESULTS

 Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa.

CONCLUSION

 Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger: Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance

Children with speech and language difficulties are at risk for learning and behavioral problems.

Objective

To review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force.

Data Sources

PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.

Study Selection

English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.

Data Extraction and Synthesis

Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.

Main Outcomes and Measures

Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.

Results

Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions.

Conclusions and Relevance

No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.

Partnering With Latino/a Caregivers and Community Stakeholders to Understand Priorities and Needs Prior to Implementing an Early Literacy Program

PURPOSE

Latino/a children disproportionately experience academic vulnerabilities, including in reading. Caregiver-mediated interventions can be leveraged to support the bilingual language development of young Latino/a children to prevent these well-documented disparities in reading. However, in leveraging these programs, it is important to weigh Latino cultural values surrounding education, family connection, and learning alongside the barriers and inequities experienced by Latino families. In response to this need, this study used a community-partnered approach to (a) understand caregivers' needs related to the language and literacy development of their young children and (b) understand perspectives for how best to implement a culturally adapted and culturally responsive caregiver-mediated program.

METHOD

A total of 101 caregivers completed a needs assessment of sociodemographic information, child development and needs, and family needs. Subsequently, nonprofit staff and caregivers completed semistructured interviews or focus groups about the development and implementation of a birth-to-5 program supporting early language development.

RESULTS

Thirty-five percent of families reported having at least one child with delayed language. Furthermore, 60.3% of respondents reported desiring strategies to support their child's early reading. Deductive content analysis revealed that both staff and caregivers desired a birth-to-5, caregiver-mediated program. Staff described family-level characteristics to consider for an early language program, community strengths, specific inequities faced by Latino families, and suggestions about culturally responsive early language and literacy program content and structure. Caregivers described barriers and inequities that they have faced related to their children's learning and development and how a birth-to-5 program could be responsive to their needs and values.

CONCLUSIONS

Staff and caregiver emphasized the resilience of Latino families and their strong values surrounding educational involvement. At the same time, participants also reported barriers and inequities rooted in systemic racism that have prevented families from being involved in certain aspects of the children's education. Together, these results revealed the importance of an early literacy program that is responsive to the structural inequities experienced by families.

Teaching Caregivers to Implement the Caregivers Optimizing Achievement of Children With Hearing Loss (COACH) Intervention

PURPOSE

This study examined the effectiveness of Caregivers Optimizing Achievement of Children With Hearing Loss (COACH), an intervention in which parents were taught naturalistic interaction strategies that addressed the unique linguistic input needs of their young children with hearing loss.

METHOD

A single-subject multiple-baseline across-behaviors design was used with four caregiver-child dyads to determine the effects of COACH training on caregivers' use of the COACH language facilitation strategies and on their children's language abilities.

RESULTS

A functional relation was demonstrated between teaching of strategies and caregivers' use of the strategies across three dyads with slower, consistent changes observed in a fourth dyad. Improvements in children's use of target-level language were observed for children in three dyads.

CONCLUSIONS

Caregivers were able to implement COACH language facilitation strategies, although the pace of caregivers' learning differed across dyads. Caregivers reported high satisfaction with participating in the intervention. Future research using a randomized design and a longer intervention condition is needed for a more complete assessment of the effects of the intervention on children's language abilities.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22290082.

Caregiver-Implemented Communication Interventions for Children Identified as Having Language Impairment 0 Through 48 Months of Age: A Scoping Review

PURPOSE

Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions.

METHOD

We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies (N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence).

RESULTS

We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures.

CONCLUSION

Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20289195.