Exploring the Cultural Validity of Parent-Implemented Naturalistic Language Intervention Procedures for Families From Spanish-Speaking Latinx Homes

Designing Cultural Adaptations of Caregiver-Implemented Interventions for Latinx Caregivers of Children Who Use Augmentative and Alternative Communication: Key Considerations

PURPOSE

Caregivers play a critical role in their children's development and serve as their primary communication partners. Family interactions provide the most naturally occurring opportunities for children with complex communication needs to learn language in the context of family routines. A growing body of research suggests that caregivers can effectively support their children's use of augmentative and alternative communication (AAC) systems when provided with appropriate training and coaching through caregiver-implemented interventions (CIIs). However, the efficacy of these interventions remains untested among culturally and linguistically diverse caregivers. Given the increasing diversity in the United States, there is a pressing need to develop CIIs that align with the cultural and linguistic preferences of diverse families.

METHOD

Using the Ecological Validity Framework and the Checklist for Cultural Adaptations, this tutorial explores considerations for culturally adapting caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. The aim is to ensure that interventions are relevant, meaningful, and respectful of cultural and linguistic practices. Through carefully crafted cultural adaptations, interventions can achieve greater acceptance by caregivers.

RESULTS AND DISCUSSION

This tutorial suggests a series of cultural adaptations to ensure accessibility, sustainability, and success of caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. By incorporating cultural and linguistic considerations into the intervention design, we can enhance its acceptability among Latinx caregivers. This, in turn, can lead to improved outcomes in AAC implementation within the home environment.

Diversity of Research Participant Gender, Race, and Ethnicity in Communication Sciences and Disorders: A Systematic Review and Quantitative Synthesis of American Speech-Language-Hearing Association Publications in 2020

Purpose

One manifestation of systemic inequities in communication sciences and disorders (CSD) is the chronic underreporting and underrepresentation of sex, gender, race, and ethnicity in research. The present study characterized recent demographic reporting practices and representation of participants across CSD research.

Methods

We systematically reviewed and extracted key reporting and participant data from empirical studies conducted in the United States (US) with human participants published in the year 2020 in journals by the American Speech-Language-Hearing Association (ASHA; k = 407 articles comprising a total n = 80,058 research participants, search completed November 2021). Sex, gender, race, and ethnicity were operationalized per National Institutes of Health guidelines (National Institutes of Health, 2015a, 2015b).

Results

Sex or gender was reported in 85.5% of included studies; race was reported in 33.7%; and ethnicity was reported in 13.8%. Sex and gender were clearly differentiated in 3.4% of relevant studies. Where reported, median proportions for race and ethnicity were significantly different from the US population, with underrepresentation noted for all non-White racial groups and Hispanic participants. Moreover, 64.7% of studies that reported sex or gender and 67.2% of studies that reported race or ethnicity did not consider these respective variables in analyses or discussion.

Conclusion

At present, research published in ASHA journals frequently fails to report key demographic data summarizing the characteristics of participants. Moreover, apparent gaps in representation of minoritized racial and ethnic groups threaten the external validity of CSD research and broader health care equity endeavors in the US. Although our study is limited to a single year and publisher, our results point to several steps for readers that may bring greater accountability, consistency, and diversity to the discipline.

Native American Caregiver-Child Shared Book Reading Interactions: A Descriptive Study and Integrative Review

PURPOSE

This study included two parts: a descriptive study followed by an integrative review. The purpose of the study was to converge finding from the descriptive study and summarize relevant findings from existent literature to identify potential culturally responsive early language and literacy intervention strategies for Native American caregivers and their children.

METHOD

This study included a nonexperimental descriptive design and integrative review. The descriptive study analyzed the language behaviors and shared book interactions of Native American caregivers with their young children (N = 21) and included results from a caregiver teaching questionnaire. The integrative review evaluated relevant literature and identified strategies that were described in these sources. These findings were combined with the descriptive study findings to identify promising culturally consistent language and literacy strategies.

RESULTS

Caregivers' shared book behaviors were associated with caregivers' vocabulary usage and children's shared book behaviors. Caregivers reported a number of language and teaching strategies they frequently employed; this information was integrated with other sources to identify promising approaches. A total of 20 potential strategies were identified.

CONCLUSIONS

The purpose of this study was to describe potential early language and literacy strategies for Native American families. It would be impossible to develop early language interventions to meet the needs of all Native American families and children; thus, this study is a preliminary step in identifying strategies that may be culturally responsive for some families. The integrative review supported the use of shared book reading with young Native American children. Promising language and early literacy strategies included play-based strategies, teaching new words, questioning strategies, using descriptive language, and other language and interaction enhancements. The effectiveness of these strategies should be further evaluated in future research or treatment studies.

The Role of Naturalistic Developmental Behavioral Interventions in Early Intervention for Autistic Toddlers: An Observational Study

PURPOSE

Naturalistic developmental behavioral interventions (NDBIs) have demonstrated initial promise in facilitating social communication development for autistic toddlers, but their highly structured protocols may be a barrier toward their use by early intervention (EI) providers who must individualize intervention according to family-centered principles. This study aimed to characterize the extent to which EI speech-language pathologists (SLPs) use NDBI strategies, and the range of skills and behaviors addressed during their EI sessions, to contextualize the role of NDBIs within the scope of needs of families with autistic children in EI.

METHOD

This observational study included 25 families with an autistic toddler and their EI SLP. One home-based session was recorded for each family, and an observational measure was used to describe SLPs' NDBI strategy use. Qualitative content analyses were also used to characterize the strategies SLPs recommended to families, and the child skills and behaviors they discussed.

RESULTS

SLPs did not implement NDBI strategies with high quality, but they implemented developmental NDBI strategies with significantly higher quality than behavioral NDBI strategies. SLPs discussed many strategies and skills across disciplines within the session.

CONCLUSIONS

SLPs may require further training to implement NDBI strategies, but given the breadth and depth of skills addressed during sessions, researchers should investigate and report on the impact of NDBIs on a wider range of communication skills and developmental domains. This will facilitate clinical decision making and make these interventions better aligned with family-centered EI principles.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21834480.

Vocabulary Acquisition and Usage for Late Talkers: The Feasibility of a Caregiver-Implemented Telehealth Model

PURPOSE

This feasibility study examined a caregiver-implemented telehealth model of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) protocol. We asked whether caregivers could reach fidelity on VAULT, if the protocol was socially and ecologically valid, and if late-talking toddlers could learn new words with this model.

METHOD

Five late-talking monolingual and bilingual toddlers and four caregivers participated. The caregiver-related research questions involved measurements taken at multiple time points and replication across subjects but did not follow a specific research design. The toddler-related research questions included elements of a single-case design. Caregivers completed self-paced online training modules and then provided 8 weeks of VAULT to their children with remote coaching. Fidelity data were collected during coached sessions and through rating scales. Social and ecological validity data were collected via surveys and interviews. Children's word learning was measured before, during, and after treatment via production of targets and controls and via standardized vocabulary inventories.

RESULTS

Caregivers demonstrated high fidelity to VAULT throughout treatment. They reported being comfortable with many aspects of VAULT. Feedback was mixed regarding the time required. Many reported their child was talking more as a result of the program. Visual analysis revealed that toddlers learned more target than control words, which was corroborated by Tau-U and d effect size analyses.

CONCLUSION

A caregiver-implemented telehealth model of VAULT was feasible, was socially and ecologically valid, and benefited toddlers, making this a worthwhile model for future studies to examine.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21753872.

Involving Caregivers of Autistic Toddlers in Early Intervention: Common Practice or Exception to the Norm?

PURPOSE

Family-centered practice (FCP) is a core component of early intervention (EI) associated with improved child and family outcomes, but little is known about community-based speech-language pathologists' (SLPs') inclusion of families in EI. Many caregivers of autistic children experience caregiving-related stress, making these intervention principles especially critical to the provision of optimal services. This study aimed to characterize EI SLPs' use of FCP coaching strategies and the quality of caregiver-SLP relationships.

METHOD

Participants included 25 families with an autistic toddler and their EI SLP. One intervention session for each SLP-family dyad was recorded and coded for the SLP's use of FCP coaching strategies. Caregivers and SLPs completed surveys about their working alliance, caregiver perceptions of family-centered care, and SLPs' approach to FCP.

RESULTS

SLPs primarily use child-directed strategies without caregiver involvement. When involving caregivers, SLPs infrequently use coaching strategies that are important for caregiver learning and collaboration (e.g., joint planning and guided practice with feedback). However, caregivers perceived their child's services to be highly family-centered, and caregivers and SLPs rated their working alliance to be of high quality.

CONCLUSIONS

The presence of strong caregiver-SLP working alliances alongside infrequent usage of effective coaching strategies indicates that SLPs may engage caregivers in ways that are perceived to be highly collaborative but are not optimal for caregiver involvement in all aspects of their child's services (goal setting and implementation of intervention). Consideration of family preferences and SLP beliefs about FCP will inform ways to disseminate FCPs needed to optimize families' capacities to support their child's development.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20113550.

Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching

PURPOSE

Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties.

METHOD

A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers.

RESULTS

Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic).

CONCLUSION

Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17774819.

A Randomized Controlled Trial Assessing the Effectiveness of the Háblame Bebé Mobile Application With Spanish-Speaking Mothers Experiencing Economic Hardship

PURPOSE

This study examined the effectiveness of a standalone mobile application (app), Háblame Bebé, for use in real-world settings without supplemental human interaction to promote Spanish-speaking mothers' language interactions with their young children and associated child bilingual (Spanish-English) language development.

METHOD

Thirty-seven Spanish-speaking Latina mothers with lower incomes and their children were randomly assigned to experimental and wait-list control groups for 12 weeks. The experimental group was introduced to the app to learn how to provide language-promoting strategies in the home language and encouraged to use the app to track child vocabulary growth and overall development. Mother and child outcomes were measured before and after intervention via standardized assessments, direct observations, and parent report. Engagement and social validity data were also gathered.

RESULTS

No statistically significant differences were identified between experimental and control groups. However, looking at the magnitude of the difference between groups, child outcomes consistently favored the experimental group (d = 0.2-0.4). Mothers reported high levels of acceptance of the intervention.

CONCLUSIONS

Culturally and linguistically responsive app-based interventions have the potential to serve as a unique delivery model for speech-language pathologists and other professionals to share critical information on bilingual language development with parents of young children who are learning in a bilingual context. Clinical and research implications are discussed, including the consideration that low-intensity interventions may need to be paired with ongoing parent coaching.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18461585.

A Longitudinal Study of Language Use During Early Mother-Child Interactions in Spanish-Speaking Families Experiencing Low Income

PURPOSE

This longitudinal study assessed continuity and stability of productive language (vocabulary and grammar) and discourse features (turn-taking; asking and responding to questions) during mother-child play.

METHOD

Parent-child language use in 119 Spanish-speaking, Mexican immigrant mothers and their children at two ages (M = 2.5 and 3.6 years) was evaluated from transcriptions of interactions.

RESULTS

Child productive language significantly increased over the year, whereas mothers showed commensurate increases in vocabulary diversity but very little change in grammatical complexity. Mother-child discourse was characterized by discontinuity: Mothers decreased their turn length and asked fewer questions while children increased on both measures. Rates of responding to questions remained high for both mothers and children even as children increased and mothers decreased over time. Mothers and children showed significant rank-order stability in productive language and measures of discourse. Mothers' rate of asking questions and children's responses to questions during the first interaction predicted children's receptive vocabulary a year later.

CONCLUSIONS

As children become more sophisticated communicators, language input remains important, with discourse features growing in relevance. Children's early opportunities to respond to parents' questions in the context of play benefit their language skills. This work extends the evidence base from monolingual English-speaking families and is interpreted in the context of prior research on parenting practices in U.S. families of Mexican origin.

Cultural and Linguistic Adaptations of Early Language Interventions: Recommendations for Advancing Research and Practice

Purpose Speech-language pathologists are responsible for providing culturally and linguistically responsive early language intervention services for legal, ethical, and economic reasons. Yet, speech-language pathologists face challenges in meeting this directive when children are from racial, ethnic, or linguistic backgrounds that differ from their own. Guidance is needed to support adaptation of evidence-based interventions to account for children's home culture(s) and language(s). This review article (a) describes a systematic review of the adaptation processes applied in early language interventions delivered to culturally and linguistically diverse populations in the current literature and (b) offers a robust example of an adaptation of an early language intervention for families of Spanish-speaking Mexican immigrant origin. Method Thirty-three studies of early language interventions adapted for culturally and linguistically diverse children ages 6 years and younger were reviewed. Codes were applied to describe to what extent studies document the purpose of the adaptation, the adaptation process, the adapted components, and the evaluation of the adapted intervention. Results Most studies specified the purpose of adaptations to the intervention evaluation, content, or delivery, which typically addressed children's language(s) but not culture. Study authors provided limited information about who made the adaptations, how, and when. Few studies detailed translation processes or included pilot testing. Only one used a comprehensive framework to guide adaptation. A case study extensively documents the adaptation process of the Language and Play Every Day en español program. Conclusions Future early language intervention adaptations should focus on both linguistic and cultural factors and include detailed descriptions of intervention development, evaluation, and replication. The case study presented here may serve as an example. Increased access to such information can support research on early language interventions for diverse populations and, ultimately, responsive service provision.

Media exposure and language experience: Examining associations from home observations in Mexican immigrant families in the US

The current exploratory study describes exposure to digital media in young children from Mexican immigrant homes and its association with language input and output. Using multiple recordings of children's home environments, we report on the rate (i.e., percentage of total recording time), language (Spanish or English), and type (adult- or child-directed programming) of auditory media exposure in toddlers under three years of age (N = 30; M_age = 20;3 months). We also examine total adult words and adult-child conversational turns, as indicators of child language input, and the number of child language vocalizations as a measure of early language development. Findings showed that digital media comprised approximately 14 % of the child language environment that families selected to record, with wide variability observed. Children were more likely to be exposed to media in Spanish than English and adult-directed than child-directed programming. Children's general media exposure was negatively associated with the amount of children's vocalizations and conversational turns but not the quantity of adult words in the environment, suggesting that the relation between media exposure and child language development is likely not mediated by a general decrease in adult input in Mexican immigrant homes. Instead, media exposure may decrease opportunities for children to engage in conversation and practice language expression, both critical mechanisms for successful language acquisition. Selection of child-directed programming may encourage child vocalizations but is less likely to be in Spanish in these homes, which may reduce opportunities for engagement with Spanish-dominant adults. Together these findings provide a window into the nature of media exposure in children from Mexican immigrant homes and into the associations between media and language input and output. Directions for future research are discussed.