It Takes Two to Talk--The Hanen Program and families of children with motor disorders: a UK perspective

"They aren't waiting for an SLP, they think 'what can I as a parent do now?'" course leaders' perceptions of AAC interventions targeting parents

Parental interventions can help parents use strategies to support their child's language and communication development. The ComAlong courses are parental interventions that focus on responsive communication, enhanced milieu teaching, and augmentative and alternative communication. This interview study aimed to investigate the course leaders' perceptions of the three ComAlong courses, ComAlong Habilitation, ComAlong Developmental Language Disorder, and ComAlong Toddler, and to evaluate their experiences of the implementation of the courses. Qualitative content analysis was used to analyze the interview data. Thereafter, three categories resulted from the findings: Impact on the Family, A Great Course Concept, and Accessibility of the Courses. The results indicate that participants perceived that the courses had positive effects on both parents and themself. Furthermore, it was described that parents gained knowledge about communication and strategies in how to develop their child's communication; however, the courses were not accessible to all parents. The collaboration between the parents and course leaders improved, and course leaders viewed the courses as an important part of their work. The following factors had an impact on the implementation: several course leaders in the same workplace, support from colleagues and management, and recruitment of parents to the courses.

Semantic Contingency of Maternal Verbal Input Directed at Very Preterm and Full-Term Children

Several studies have testified to the importance of a responsive linguistic input for children’s language acquisition and development. In particular, maternal use of expansions, imitations, interpretations, and labels has been shown to promote both children’s language comprehension and production. From this perspective, the present study examined the semantically contingent linguistic input addressed to very preterm children’s comparing it to that directed to full-term children observed during a semi-structured play session when the children were 24 months of age. The relationships between maternal contingent utterances and children’s communicative repertoires were also investigated. The main results showed that mothers of full-term children produced a higher proportion of semantically contingent utterances than those of very preterm children; moreover, this variable was associated with children’s more advanced communicative-linguistic outcomes. Overall, this study supports the interdependence between mothers’ use of certain linguistic strategies and children’s communicative-linguistic repertoire, extending this evidence to children born very preterm and suggesting the importance of considering the semantic contingency aspect of child-directed speech to support the communicative and linguistic development of these children.

The Effects of a Parent-Implemented Language Intervention on Late-Talkers' Expressive Skills: The Mediational Role of Parental Speech Contingency and Dialogic Reading Abilities

Several qualitative and quantitative features of parental speech input support children’s language development and may play a critical role in improving such process in late talkers. Parent-implemented interventions targeting late-talkers have been developed to promote children’s language outcomes by enhancing their linguistic environment, i.e., parental speech input. This study investigated the effect of a parent-implemented intervention in increasing late talkers’ expressive skills through modifications in structural and functional features of parental speech input. Forty-six thirty-one-month-old late talkers differing in their birth condition (either low-risk preterm or full-term) participated in the study with a parent; 24 parent-child dyads received a parent-implemented intervention centered on dialogic reading and focused stimulation techniques, whereas the other 22 dyads constituted the control group. At pre- and post-intervention, dyads took part in a parent-child shared book-reading session and both parental and child’s speech measures were collected and examined. Results showed that the intervention positively affected parents’ use of responses and expansions of children’s verbal initiatives, as well as the parental amount of talking over reading, whereas no structural features of parental input resulted modified. Mediation analyses pointed out that the intervention indirectly enhanced late-talkers’ use of verbal types and tokens through changes in parental use of expansions and amount of talking over reading. As birth status was entered as a covariate in the analysis, these findings can be extended to children with different gestational age. We conclude that the parent-implemented intervention was effective in supporting late-talkers’ gains in language development as a cascade result of the improvements in parental contingency and dialogic reading abilities. These promising findings suggest to examine not only children and parental outcomes but also the intervention mechanisms promoting changes in late-talkers’ language development as a clearer view on such process can inform the development of feasible, ecological and effective programs.

Early Intervention with Parents of Children with Autism Spectrum Disorders: A Review of Programs

The aim of this article was to analyze the evidence regarding the effectiveness of intervention programs for children with autism based on the participation of their parents. To obtain the data, a systematic search was carried out in four databases (PsycARTICLES (ProQuest), ERIC (ProQuest), PubMed (ProQuest), and Scopus). The retrieved documents were refined under the inclusion/exclusion criteria, and a total of 51 empirical studies were selected. These studies were first classified according to the function of the intervention objective and, later, by the methodology applied (19 studies were based on comprehensive interventions, 11 focused on the nuclear symptoms of autism spectrum disorder (ASD), 12 focused on the promotion of positive parenting, and nine interactions focused on child play). Once all of the documents had been analyzed, the evidence indicated scientific efficacy in most studies, mainly in those based on child development and the application of behavioral analysis principles. Moreover, the positive influence of parent participation in such programs was demonstrated.

Communication Modes and Functions in Children With Cerebral Palsy

Purpose This study seeks to determine how speech-language impairments relate to the frequency and diversity of communication modes and functions produced by children with cerebral palsy (CP) during interactions with their mothers. Method We studied 40 children with CP (M age = 62 months) comprising three groups: those who were unable to speak and had anarthria (n = 15), those with speech motor impairment and language comprehension impairment (SMI-LCI; n = 15), and those with speech motor impairment and typical language comprehension (SMI-LCT; n = 10). Mother-child play interactions were coded for child modes and functions. Generalized linear regression models were used to examine the relationship between profile group and frequencies of communication modes and functions. Results Results indicated groups SMI-LCI and SMI-LCT had significantly higher mean frequencies of vocalizations, vocalizations + gestures, comments, initiations, and requests than the group of those who were unable to speak and had anarthria. All children used vocalizations primarily, though these vocalizations were often not understood. SMI-LCI and SMI-LCT differed on two measures: frequency of gestures and frequency of initiations. The majority of children in this sample did not have access to augmentative and alternative communication devices. Conclusion Results of this study highlight the need for parent-mediated interventions for children with CP that emphasize multimodal communication tailored to impairment profiles. Supplemental Material https://doi.org/10.23641/asha.12354704.

An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders

PURPOSE

The temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children's stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes.

METHODS

This study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment.

RESULTS

Stuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only.

CONCLUSION

Results demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.

Feasibility of parent communication training with remote coaching using smartphone apps

BACKGROUND

Communication training for parents of young children with neurodisability is often delivered in groups and includes video coaching. Group teaching is problematic when there is wide variation in the characteristics and needs amongst participants.

AIMS

To assess the potential feasibility and acceptability of delivering one-to-one parent training supported by remote coaching using smartphone apps and of conducting further trials of the intervention.

METHODS & PROCEDURES

We aimed to recruit eight children aged 12-48 months with motor disorders and communication difficulties and to provide families with individual parent training in six weekly home visits supplemented by remote coaching via smartphone apps. For outcome measurement, parents recorded their interaction with their child thrice weekly during baseline (3 weeks), intervention, post-intervention (3 weeks) and follow-up (1 week). Measures comprised parent responsiveness and counts of children's communication and vocalization. Research design feasibility was measured through rates of recruitment, attrition, outcome measure completion and agreement between raters on outcome measurement. Intervention feasibility was assessed through the proportion of therapy sessions received, the number of videos and text messages shared using the apps in remote coaching, and message content. Parents were interviewed about the acceptability of the intervention and trial design. Interviews were transcribed and analyzed using inductive thematic analysis.

OUTCOMES & RESULTS

Nine children were recruited over 16 weeks. All fitted the inclusion criteria. Four families withdrew from the study. Five families completed the intervention. No family submitted the target number of video recordings for outcome measurement. Interrater agreement was moderate for child communication (K = 0.46) and vocalization (K = 0.60) and high for The Responsive Augmentative and Alternative Communication Style scale (RAACS) (r_s = 0.96). Parents who completed the intervention reported positive experiences of the programme and remote coaching via the apps. Therapist messages via the app contained comments on parent and child behaviour and requests for parental reflection/action; parental messages contained reflections on children's communication.

CONCLUSIONS & IMPLICATIONS

The intervention and study design demanded high levels of parental involvement and was not suitable for all families. Recording shorter periods of interaction via mobile phones or using alternative methods of data collection may increase feasibility of outcome measurement.

Uncovering the theoretical underpinnings of an interprofessional preschool intervention program: Tumbling Together

BACKGROUND

Intervention programs are rarely tailored for children with self-regulation and communication challenges. Therefore, clinicians develop their own programs as is the case with the preschool program Tumbling Together. This program combines occupational therapy, speech-language therapy, and gymnastics.

PURPOSE

The aim of this study was to take an in-depth look at the program to answer the following questions: (a) What are the fundamental concepts of the program? and (b) What is the underlying theoretical model that illustrates the relationships between concepts?

METHOD

The qualitative research method of grounded theorizing using situational analysis was employed.

FINDINGS

Fourteen main concepts of the program were identified and informed the development of a theoretical model.

IMPLICATIONS

A theoretical model incorporating Tumbling Togethers concepts is a first step in evaluating its efficacy. Although the concepts involved are not novel, their unique combination forms a promising intervention approach for this population.

Evaluation of the Hanen it Takes Two to Talk Intervention Programme

Introduction:

It Takes Two to Talk (ITTT) – The Hanen Programme is a family-focused programme for parents of young children with speech and language delays (SLD). It aims to equip parents with the skills to help their child learn to communicate and use language. This programme is widely used overseas, but there is little evidence about its effect on the Singapore population. The aim of this study was to investigate the effectiveness of ITTT in improving a child's speech and language abilities, and in equipping parents with the skills necessary to teach their children.

Methods:

Parents of four children aged 26–41 months with a diagnosis of SLD participated in the study. The child's language was evaluated pre- and post-ITTT by a parent report communicative development inventory. Parental perceptions were evaluated with a knowledge, attitudes and perceptions questionnaire.

Results:

Improvement was seen post-program in expressive vocabulary for all participating children, with an increase in the median vocabulary age-equivalence of the child, beyond that of the chronological time that had elapsed. All parents achieved a pass rate in scores on knowledge-based questions. While 2/3 of parents felt ill-equipped to handle their child's SLD, all were interested to attend training in this area as they saw a need to implement changes in the way they helped their children.

Conclusion:

Results suggest that ITTT may be a useful tool in helping children with SLD. However, more research needs to be done on a larger population locally to determine the effectiveness of the programme.

The applicability of normalisation process theory to speech and language therapy: a review of qualitative research on a speech and language intervention

Background

The Bercow review found a high level of public dissatisfaction with speech and language services for children. Children with speech, language, and communication needs (SLCN) often have chronic complex conditions that require provision from health, education, and community services. Speech and language therapists are a small group of Allied Health Professionals with a specialist skill-set that equips them to work with children with SLCN. They work within and across the diverse range of public service providers. The aim of this review was to explore the applicability of Normalisation Process Theory (NPT) to the case of speech and language therapy.

Methods

A review of qualitative research on a successfully embedded speech and language therapy intervention was undertaken to test the applicability of NPT. The review focused on two of the collective action elements of NPT (relational integration and interaction workability) using all previously published qualitative data from both parents and practitioners' perspectives on the intervention.

Results

The synthesis of the data based on the Normalisation Process Model (NPM) uncovered strengths in the interpersonal processes between the practitioners and parents, and weaknesses in how the accountability of the intervention is distributed in the health system.

Conclusions

The analysis based on the NPM uncovered interpersonal processes between the practitioners and parents that were likely to have given rise to successful implementation of the intervention. In previous qualitative research on this intervention where the Medical Research Council's guidance on developing a design for a complex intervention had been used as a framework, the interpersonal work within the intervention had emerged as a barrier to implementation of the intervention. It is suggested that the design of services for children and families needs to extend beyond the consideration of benefits and barriers to embrace the social processes that appear to afford success in embedding innovation in healthcare.

Irish clinicians' views of interventions for children with autistic spectrum disorders

The current study investigated clinicians' perspectives on the effectiveness of interventions designed to support the development of children with autistic spectrum disorders (ASDs). Researchers developed a semi-structured interview which was administered to 11 clinicians involved in the assessment and treatment of ASDs (5 = clinical psychologists, 6 = psychiatrists). Content analysis of qualitative data revealed that Irish clinicians typically endorse an eclectic approach to treatment, combining facets of different methods of interventions in a complementary fashion. The process that clinicians engaged in when evaluating modes of treatment was assessed. Significant variation was observed in how clinicians merge clinical experience with empirical evidence. Challenges which clinicians face in assessing individuals on the autistic spectrum, such as the proliferation of misinformation on interventions, as well as the role of parents in treatment, were also discussed within the interviews. The implications of the findings for understanding the process of selecting interventions for children with ASDs are discussed.

Effects of it takes two to talk--the hanen program for parents of preschool children with cerebral palsy: findings from an exploratory study

PURPOSE

To investigate whether It Takes Two to Talk-The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents.

METHOD

Eleven children aged 19-36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion.

RESULTS

Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers' linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers' views of parenting did not change.

CONCLUSIONS

It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.

Speech and language therapy to improve the communication skills of children with cerebral palsy

BACKGROUND

The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited.

OBJECTIVES

To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns.

SEARCH STRATEGY

Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched.

SELECTION CRITERIA

Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined.

DATA COLLECTION AND ANALYSIS

L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separate random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers.

MAIN RESULTS

Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient detail to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment.

REVIEWERS' CONCLUSIONS

Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made.