KidTalk Speech: Naturalistic Communication Intervention Strategies for Parents and Children with Cleft Palate

1. KidTalk Speech: Naturalistic Communication Intervention Strategies for Parents and Children with Cleft Palate Nancy Scherer, Ph.D., Ann Kaiser, Ph.D; Megan Roberts, Ph.D.; Kristin Mullins, MS, CCC-SLP; Sarah Boyce, BS; Lila Totino, BS

2. Setting the Foundation for Communication Enhanced Milieu Teaching (EMT/PE): Part 1

3. EMT is an evidence-based intervention with 20 years of research. EMT is a naturalistic, conversation-based intervention that uses child interests and initiations as opportunities to model and prompt language in everyday contexts. EMT can be used throughout the day as part of the everyday interactions. EMT is aneffectiveintervention. What is Enhanced Milieu Teaching? Clips: Jack’s Progress Handout: “Enhanced Milieu Teaching”Clips: Jack’s Progress Handout: “Enhanced Milieu Teaching”

4. EMT’s Positive Effects Increases child use of language targets Vocabulary (Kaiser et al, 1993; Scherer & Kaiser, 2008) Early syntactic forms (Kaiser & Hester, 1994) Moderately complex syntax (Warren & Kaiser, 1986) Increases child frequency of communication (Warren et al, 1994; Kaiser et al, 1993) Results in generalization across settings, people, and language concepts(Warren &Bambara, 1989; Goldstein &Mousetis, 1989) Results in maintenance of newly learned targets (Warren & Kaiser, 1986) Is more effective than drill-practice methods for early languagelearners (Yoder, Kaiser et Alpert, 1991; Kaiser, Yoder, et al., 1996)

5. Children receiving parent-implemented EMT show more language growth over time than children receiving EMT from a therapist only EMT’s Positive Effects This Graph shows longitudinal outcomes for the three treatment groups. Six months is Post 1, 12 months is Post 2. At the end of treatment, children in the parent implemented RI group were actually doing better on the combined measure of productive syntax than children in the two EMT groups, although this difference was only marginally significant (.08). AT the end of the 6 month follow up, children in the two parent groups were both doing significantly better than the trainer implemented group, but did not differ from each other.This Graph shows longitudinal outcomes for the three treatment groups. Six months is Post 1, 12 months is Post 2. At the end of treatment, children in the parent implemented RI group were actually doing better on the combined measure of productive syntax than children in the two EMT groups, although this difference was only marginally significant (.08). AT the end of the 6 month follow up, children in the two parent groups were both doing significantly better than the trainer implemented group, but did not differ from each other.

6. Hancock, T.B., & Kaiser, A.P. (in press). Implementing Enhanced Milieu Teaching with Children Who Have Autism Spectrum Disorders. In P. Prelock & R. McCauley (Eds.), Treatment of autism spectrum disorders: evidence-based intervention strategies for communication & social interaction. Baltimore: Paul Brookes Kaiser, A.P., & Trent, J. A. (2007). Communication intervention for young children with disabilities: Naturalistic approaches to promoting development. In S. Odom, R. Horner, M. Snell & J. Blacher (Eds.), Handbook of Developmental Disabilities, (pp. 224-246). New York: Guilford Press. Hancock, T. B., & Kaiser, A. P. (2006). Enhanced Milieu Teaching. In R. McCauley & M. Fey (Eds.), Treatment of Language Disorders in Children, (pp. 203-233). Baltimore: Paul Brookes. Kaiser, A. P., & Grim, J. C. (2005). Teaching functional communication skills. In M. Snell & F. Brown (Eds.), Instruction of Students with Severe Disabilities, (pp. 447-488). Upper Saddle River, NJ: Pearson.  Kaiser, A. P., Yoder, P. J., & Keetz, A. (1992). Evaluating milieu teaching. In S. F. Warren & J. Reichle (Eds.), Causes and effects in communication and language interventionVol. 1, (pp. 9-47). Baltimore: Paul H. Brookes.     Systematic Reviews of EMT Studies

7. Adaptation for children with clefts: Enhanced Milieu Teaching with Phonological Emphasis

8. Target words chosen based on both vocabulary and speech goals Speech recasting added to the prompt strategies Repeating target words the child uses while emphasizing a target sound in the word Phonetic awareness activities to facilitate place of articulation pracitice EMT/PE

9. A set of tools to help facilitate a child’s communication growth: Setting up an interactive context between the adult and child through play Noticing and responding to child communication; balancing turns Modeling and expanding play Modeling and expanding communication Using environmental arrangement (ea) strategies Using prompting strategies EMT Strategies During this session we will cover these core strategies of EMT. During this section, I will focus on the first two: setting up an interactive context through play and noticing and responding to child communication and balancing turnsDuring this session we will cover these core strategies of EMT. During this section, I will focus on the first two: setting up an interactive context through play and noticing and responding to child communication and balancing turns

10. The first goal is to set up an interactive context between the adult and child. Communication develops on a platform of shared joint attention and engagement. Social interaction between child and adult Play with objects and partner Everyday routines where communication is functional Strategy 1: Play and Engage

11. Children learn best when they are engaged and interacting with a communication partner. Play helps engagement and interaction Children are more likely to be engaged and learn language while doing activities they enjoy. When the adult plays with the child at his or her level, the adult optimizes the opportunity for communication to occur. Why Play and Engage?

12. Be at the child’s level. Do whatever the child is doing . Follow the child’s lead. Avoid directions and let the child lead the play. Avoid questions and let the child initiate the communication. Choose toys that are interesting and engaging. Put away toys that aren’t being used. Substitute undesired activities with desired activities . How to play and engage? In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Following the child’s lead: notice how the adult is playing with the child. Example 1: Is the adult following his/her lead? _______________________________________________ How does the adult behavior impact engagement and communication? ______ Example 2: Is the adult following his/her lead? _______________________________________________ How does the adult behavior impact engagement and communication? _______  Avoiding directions: notice how many directions the adult uses. Example 1 How many directions does the adult give? _______________________________________ How do these directions impact engagement and communication? ___________ Example 2 How many directions does the adult give? _______________________________________ How do these directions impact engagement and communication? ___________  Avoiding questions: notice how many questions the adult uses. Example 1 How many questions does the adult give? _______________________________________ How do these questions impact engagement and communication? ____________ Example 2 How many questions does the adult give? _______________________________________ How do these question impact engagement and communication? _____________  Simplifying the environment: notice how the adult arranges the environment. Example 1 How many toys are out? ____________________________________________________________ What types of toys? ____________________________________________________________ How does the environment impact engagement and communication? _________ Example 2 How many toys are out? ____________________________________________________________ What types of toys? ____________________________________________________________ How does the environment impact engagement and communication? _________  Substituting activities: notice how the adult responds to undesired activities. Example 1 What was the undesired action? ___________________________________________________ What could have been substituted? ________________________________________________ Example 2 What was the undesired action? ___________________________________________________ What was the substituted action? _________________________________________________In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Following the child’s lead: notice how the adult is playing with the child. Example 1: Is the adult following his/her lead? _______________________________________________ How does the adult behavior impact engagement and communication? ______ Example 2: Is the adult following his/her lead? _______________________________________________ How does the adult behavior impact engagement and communication? _______  Avoiding directions: notice how many directions the adult uses. Example 1 How many directions does the adult give? _______________________________________ How do these directions impact engagement and communication? ___________ Example 2 How many directions does the adult give? _______________________________________ How do these directions impact engagement and communication? ___________  Avoiding questions: notice how many questions the adult uses. Example 1 How many questions does the adult give? _______________________________________ How do these questions impact engagement and communication? ____________ Example 2 How many questions does the adult give? _______________________________________ How do these question impact engagement and communication? _____________  Simplifying the environment: notice how the adult arranges the environment. Example 1 How many toys are out? ____________________________________________________________ What types of toys? ____________________________________________________________ How does the environment impact engagement and communication? _________ Example 2 How many toys are out? ____________________________________________________________ What types of toys? ____________________________________________________________ How does the environment impact engagement and communication? _________  Substituting activities: notice how the adult responds to undesired activities. Example 1 What was the undesired action? ___________________________________________________ What could have been substituted? ________________________________________________ Example 2 What was the undesired action? ___________________________________________________ What was the substituted action? _________________________________________________

13. Whenever possible At least once a day for at least 15 minutes of concentrated and individualized adult-child time When to Play and Engage?

14. All children are communicating now How? Why? Strategy 2: Notice and Respond to all Communication

15. Notice and respond every time the child communicates. Respond by talking about what the child is doing. Language is most meaningful when it’s related to what the child is doing OR in response to what the child is communicating. Notice and Respond to Communication In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Respond to all child communication: notice if the adult responds to child communication.  How did adult responsiveness impact child engagement and communication?    Respond by talking about what the child is saying or doing: notice if the adult’s language is related to what the child is doing or saying. Example 1 Is the adult talking about what the child is doing or saying? ___________________ How does what the adult says impact engagement and communication? Example 2 Is the adult talking about what the child is doing or saying? ___________________ How does what the adult says impact engagement and communication? In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Respond to all child communication: notice if the adult responds to child communication.  How did adult responsiveness impact child engagement and communication?    Respond by talking about what the child is saying or doing: notice if the adult’s language is related to what the child is doing or saying. Example 1 Is the adult talking about what the child is doing or saying? ___________________ How does what the adult says impact engagement and communication? Example 2 Is the adult talking about what the child is doing or saying? ___________________ How does what the adult says impact engagement and communication?

16. As much as possible In all contexts throughout the day Play Meals Routines (bath, car, dressing) When to notice and respond?

17. Responsiveness: you should respond to 90% or more of the child’s communication. Goal 1: Responding to Communication

18. Take turns communicating with the child. Allow time for the child to communicate. Play a game of “communication catch” Child communicates Adult responds (and waits) Child communicates Adult responds (and waits) Only say something after the child communicates. Strategy 3: Take Turns In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Take Turns: Count how many communication turns the adult and the child take. Example 1 Adult: ________________________ Child: ______________________ How does turn taking impact engagement and communication? _________ Example 2 Adult: ________________________ Child: ______________________ How does turn taking impact engagement and communication? _________ Wait for Communication: count how many seconds the adult gives the child to respond. Example 1 Number of seconds? ________________________________________________________________ How does this impact engagement and communication? ________________________ Example 2 Number of seconds? ________________________________________________________________ How does this impact engagement and communication? ________________________ In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Take Turns: Count how many communication turns the adult and the child take. Example 1 Adult: ________________________ Child: ______________________ How does turn taking impact engagement and communication? _________ Example 2 Adult: ________________________ Child: ______________________ How does turn taking impact engagement and communication? _________ Wait for Communication: count how many seconds the adult gives the child to respond. Example 1 Number of seconds? ________________________________________________________________ How does this impact engagement and communication? ________________________ Example 2 Number of seconds? ________________________________________________________________ How does this impact engagement and communication? ________________________

19. It allows the child more opportunities to communicate. More opportunities = more practice = more opportunities to recast speech. Why Take Turns?

20. Matched turns > 75% (75% of what you say should be “matched” or in response to the child’s communication). Goal: Matched Turns

21. Mirroring: adult imitates the child’s nonverbal behaviors. Mapping: adult “maps” language onto these actions, by describing these actions. Strategy 4: Mirror and Map

22. Mirroring allows the adult to join in the interaction with the child. Mapping provides the child with a language rich description of the activity. Mirroring and mapping allows the adult to have balanced turns when the child is not communicating. What the adult says is more meaningful since the adult and child are doing the same action and language is “mapped” right on top of what the child is doing. Why use mirroring and mapping?

23. Use mirroring and mapping when the child is not communicating. Mapping must come after mirroring. First imitate the action and then label the action with words. Child: {feeds baby} Adult: {feeds baby} eat. How and When to Mirror and Map? In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET WORKSHEET: notice the child action that the adult imitates, the language the adult maps and how the child responds. Fill in the child action, the adult action, the adult language and the child language for each of these examples. In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET WORKSHEET: notice the child action that the adult imitates, the language the adult maps and how the child responds. Fill in the child action, the adult action, the adult language and the child language for each of these examples.

25. Mirror (imitate) close to the child’s actions to make language more obvious. Avoid mirroring behaviors that are unacceptable (e.g., throwing toys, hitting). Balance mapping and playing (e.g., don’t over map). How and When to Mirror and Map?

26. Do what the child does, following his lead. Make statements (no questions, no directions). Respond when the child communicates. Talk about what the child is doing. Wait for communication. Only talk after the child talks. Mirror and map when the child is not communicating. Let’s Review

27. Modeling and Expanding Play and Communication Enhanced Milieu Teaching (EMT): Part 2

28. A set of tools to help facilitate a child’s communication growth: Setting up an interactive context between the adult and child through play Noticing and responding to child communication; balancing turns Modeling and expanding play Modeling and expanding communication Using environmental arrangement (EA) strategies Using prompting strategies EMT Strategies SAY: We’ve learned about setting up an interactive context through play, noticing and responding, and balancing turns. Now we are going to focus on modeling and expanding play and communication. SAY: We’ve learned about setting up an interactive context through play, noticing and responding, and balancing turns. Now we are going to focus on modeling and expanding play and communication.

29. Extend the time the child plays with a toy. Expand the different actions the child does with the same toy. Expand the types of different toys the child uses. Play Goals Discuss: More time with a toy = more opportunities for language learning More actions with the toy = more opportunities for language learning More types of toys = more opportunities for language learning Discuss: More time with a toy = more opportunities for language learning More actions with the toy = more opportunities for language learning More types of toys = more opportunities for language learning

30. Linking words with engaging activities maximizes opportunities for teaching language. Choosing toys that are interesting keeps the child engaged. Expanding play activities allows more language modeling and facilitates language learning. Why do we teach play ?

31. Manipulative play: basic exploration of materials, taking apart and combining objects, and combining items because they go together Pre-symbolic play: manipulating objects to themselves, extending play actions/objects to others, and the first sequence type play. Symbolic play:substituting objects, using an agent as if it is alive, and complex sequences of play. Play at your child’s level Just like EMT and language targets, we need to interact at a level where the child is, reduces the “load.” So first we need to learn about play so we can play where the child is and model at or slightly above that level. Video clips: at versus above level. In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Play at the child’s level: notice how the adult’s play impacts engagement and communication. Example 1 Is the adult playing at the child’s level? ___________________ How does the adult’s play level impact engagement and communication? _________________________________________________________________________________________ Example 2 Is the adult talking about what the child is doing or saying? ___________________ How does the adult’s play level impact engagement and communication? _________________________________________________________________________________________ Just like EMT and language targets, we need to interact at a level where the child is, reduces the “load.” So first we need to learn about play so we can play where the child is and model at or slightly above that level. Video clips: at versus above level. In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Play at the child’s level: notice how the adult’s play impacts engagement and communication. Example 1 Is the adult playing at the child’s level? ___________________ How does the adult’s play level impact engagement and communication? _________________________________________________________________________________________ Example 2 Is the adult talking about what the child is doing or saying? ___________________ How does the adult’s play level impact engagement and communication? _________________________________________________________________________________________

32. Continue to follow the child’s lead. Set a new toy object in sight or model a new action and WAIT to see if the child shows interest. Do what the child does and try to add a different action. If the child shows interest, model a new play action with the object. As always, follow the child’s lead and if the child is not interested, try again later with a different object or action. How to model new play actions?

33. Routines are a predictable sequence that have a beginning, middle and end. Children learn language during small routines in play because they know what actions (and words) will come next. Examples Scoop beans, pour beans, dump beans. Person in car, drive car, get out of car Video Using Routines in Play In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Using Play worksheet 2 – last part to write down the action, and the target word. (build, in, dump).In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Using Play worksheet 2 – last part to write down the action, and the target word. (build, in, dump).

34. When the child is doing the same action with the same object multiple times. When the child is doing an undesired action with the toy (e.g., eating play-doh, hitting the baby, mouthing pretend food). When to model new play?

35. Increase the rate at which the child communicates. Increase the diversity of communication. Increase the child’s independence. Increase spontaneous communication Decrease the dependence on adult cues Increase consonant inventory Increase place of articulation features Language and Speech Goals Connect play with language: Now that we have a good foundation for language learning we are going to talk about what to say during play to teach ___ new language. Before you focused on responding to ___’s communication in any way. Now we are going to focus on using specific language targets. Connect play with language: Now that we have a good foundation for language learning we are going to talk about what to say during play to teach ___ new language. Before you focused on responding to ___’s communication in any way. Now we are going to focus on using specific language targets.

36. Children learn language through modeling. Contingent modeling that is in response to a child’ s communication is the most powerful form of modeling. Simplifying language to match the child’s language targets helps the child learn language more quickly. Easier to imitate, easier to understand Why model language? In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Model language at the child’s target level: notice what type of language the adult is using and how this impacts child communication. Example 1 Is the adult talking at the child’s level? ___________________ How does the adult’s language level impact engagement and communication? _________________________________________________________________________________________ Example 2 Is the adult talking about what the child is doing or saying? ___________________ How does the adult’s language level impact engagement and communication? _________________________________________________________________________________________ In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Model language at the child’s target level: notice what type of language the adult is using and how this impacts child communication. Example 1 Is the adult talking at the child’s level? ___________________ How does the adult’s language level impact engagement and communication? _________________________________________________________________________________________ Example 2 Is the adult talking about what the child is doing or saying? ___________________ How does the adult’s language level impact engagement and communication? _________________________________________________________________________________________

37. We pick targets based on the language the child is already using and what the child should learn next. How does the child communicate now? Gestures, vocalizations Single words 2 words 3 words 4 words How to model language?

38. Choosing Communication Targets

39. 50% of what you say should be one of the child’s targets: 50% should be slightly higher than the child’s current targets 1-2 words above his/her level All words should be teaching words (nouns, verbs, modifiers) Goal: Targets Discuss: By simplifying the input (down to ___’s target level), he/she is more likely to spontaneously imitate the language model. Simplifying input helps the child understand language easier. Give example: If you’re driving a car and you say “drive” it is more likely that ___ will learn that drive means we roll the car along the table than if you had said “we drive the car fast.” Which word means rolling the car along the table (we, drive, car, fast)?Discuss: By simplifying the input (down to ___’s target level), he/she is more likely to spontaneously imitate the language model. Simplifying input helps the child understand language easier. Give example: If you’re driving a car and you say “drive” it is more likely that ___ will learn that drive means we roll the car along the table than if you had said “we drive the car fast.” Which word means rolling the car along the table (we, drive, car, fast)?

40. After the child communicates. Respond with a language target When you are doing the same action or have the same object as the child. Child: {drives car}. Adult: {drives car} drive. While taking communication turns. When to model new language?

41. An expansion is imitating what the child communicated and then adding more words. The most powerful expansion includes one of the child’s communication targets. Expanding Communication

42. Expansions immediately connect the child’s communication to additional new communication. The more the child hears and practices language that is more complex, the better his/her language skills become. Expansions help the child learn new vocabulary and talk in more complex sentences. Why expand communication?

43. Point/reach: Child: {points to/reaches for baby}. Adult: {points to baby/reaches for baby} baby. Show Child: {hold up block}. Adult: {points to block} block. Give Child: {gives adult car to drive}. Adult: {takes the car} car. Expanding Gestures WORKSHEET notice how the adult expands the child’s communication Change target level if needed. Discuss: By imitating the gesture or taking/touching the object while labeling the word, you are increasing the saliency of the word and making it more likely that ____ will learn this new word.WORKSHEET notice how the adult expands the child’s communication Change target level if needed. Discuss: By imitating the gesture or taking/touching the object while labeling the word, you are increasing the saliency of the word and making it more likely that ____ will learn this new word.

44. Vocalizations referring to a specific word Child: {says “ah” and is pointing to cup}. Adult: {point to cup} cup. Vocalizations not referring to a specific word Child: {says “ah” and is walking cow}. Adult: {walk the cow} walk. Expanding Vocalizations WORKSHEET notice how the adult expands the child’s communication Discuss: The goal is to use language that ___ replaces the non-verbal form of communication. What would you want ___ to say?WORKSHEET notice how the adult expands the child’s communication Discuss: The goal is to use language that ___ replaces the non-verbal form of communication. What would you want ___ to say?

45. Whenever the child communicates, add 1 or 2 words. When to expand communication?

46. Adults should expand at least 40% of child communication. Goal: Expansions

47. Using Environmental Arrangement (EA) Strategies to Increase Communication Enhanced Milieu Teaching (EMT): Part 3

48. A set of tools to help facilitate a child’s communication growth: Setting up an interactive context between the adult and child through play Noticing and responding to child communication; balancing turns Modeling and expanding play Modeling and expanding language Using environmental arrangement (EA) strategies Using prompting strategies What is EMT? SAY: you have learned the first 4 strategies, now we are learning about environmental arrangement strategies.SAY: you have learned the first 4 strategies, now we are learning about environmental arrangement strategies.

49. What are EA strategies? Non-verbal tasks that encourage the child to communicate with you.

50. Providing small or inadequate portions of preferred materials. Creating situations in which the child needs the adult’s help. Setting up a routine in which the child expects certain actions and then waiting before doing the expected action. Using associated objects (e.g., shoe to foot) and then waiting before completing the expected action EA Strategies In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Notice what the adult does to elicit the child’s communication. How does the child respond? What language target does the adult use to expand this communication? Discuss: 3 other inadequate proportions that can be done. Examples: leggos, blocks, only one cookie, little bit of juice, one eye for potato head, small amount of play-doh. Practice: use toys to practice at least 1 inadequate portions strategy. In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Notice what the adult does to elicit the child’s communication. How does the child respond? What language target does the adult use to expand this communication? Discuss: 3 other inadequate proportions that can be done. Examples: leggos, blocks, only one cookie, little bit of juice, one eye for potato head, small amount of play-doh. Practice: use toys to practice at least 1 inadequate portions strategy.

51. The adult holds up two objects and waits for the child to communicate about choice of which item he/she wants. Sabotaging activity by not providing all of the materials the child will need to complete the task OR Preventing the child from completing a desired activity EA Strategies In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Notice what the adult does to elicit the child’s communication. How does the child respond? What language target does the adult use to expand this communication? Discuss: 3 other choice making strategies that can be done. Examples: holding up juice and milk at snack, holding up fork and spoon at snack, holding up boy and girl animal, holding up cow or horse, holding up different puzzles pieces. Practice: use toys to practice at least 1 choice making strategy. In small groups – watch the video and discuss and then write the answer on your white board. In small groups – watch the video and discuss and then write the answer on your white board. WORKSHEET Notice what the adult does to elicit the child’s communication. How does the child respond? What language target does the adult use to expand this communication? Discuss: 3 other choice making strategies that can be done. Examples: holding up juice and milk at snack, holding up fork and spoon at snack, holding up boy and girl animal, holding up cow or horse, holding up different puzzles pieces. Practice: use toys to practice at least 1 choice making strategy.

52. Provide the child with more opportunities to practice communicating. Increases the child’s rate of communication Provide you with more opportunities to reinforce and teach new language by Responding Expanding the child’s communication Why use EA strategies?

53. Set up the opportunity to encourage the child to communicate by using an EA strategy. Wait until the child communicates (gestures, vocalizes, says a word). Expand or recast this communication with a target. How to use EA strategies?

54. When the child is not communicating frequently. Some strategies work better than others for different children. Use the ones that work best for the child. Avoid EA strategies that frustrate the child. When to use EA strategies?

55. 80% of EA strategies used correctly (e.g., waited for communication and then labeled with a target). EA Goal

56. Prompting Communication Enhanced Milieu Teaching (EMT): Part 4

57. A set of tools to help facilitate a child’s communication growth: Setting up an interactive context between the adult and child through play Noticing and responding to child communication; balancing turns Modeling and expanding play Modeling and expanding communication Using environmental arrangement (EA) strategies Using prompting strategies What is EMT?

58. A signal to the child to do or say something. There are 4 types of language and 1 speech prompt: Time delay Least Support Open questions Choice questions Model procedure Most Support Speech Recasting What is a prompt?

59. An overt non-verbal cue for the child to use language. The adult uses an expectant look and waits for the child to verbalize before performing the expected action or giving the child a desired object. Environmental arrangement strategies may be used as a time delay if used with an obvious “expectant look” Time delay offers the least language support. Video Example Time Delay

60. Example

61. Example

62. The adult asks an open question (e.g., no single correct answer). Open questions offer a little more support by verbally cueing the child to verbalize his requests. Examples: What next? Where should the car go? Tell me what you want. What should the babies do? Open Question

63. The adult asks an choice question that has no single correct answer. Choice questions offer even more support by including the answer in the question. Example: “car or truck?” Video Example Choice Question

64. The adult tells the child exactly what to say. The model procedure offers the most adult support because it tells the child exactly what to say. Example: “Say ‘car.’” Video Example Model Procedure

65. Repeating child’s word while emphasizing target sound in word Most recasts are done at the one word level at beginning of treatment May occur along with expansions in multi word utterances if accuracy is at least 50% Speech Recasting

66. Speech Recasting

67. Speech Recasting + Expansion

68. Phonetic Awareness Activities Targeted for children 2 years and older Five-ten minutes at beginning of session Simple, repetitive tasks that focus on placement for target consonants in simple CV or VC contexts Peek-a –boo (boo) Sticking hands in bowl of spaghetti (ick or eek) What if child is not adding consonants?

69. Phonetic awareness +

70. Gives the child an opportunity to practice communication targets during a highly motivating context. Gives the child functional practice and reinforcement for communication. Why Prompt Language?

71. Wait for the child to request . Use an environmental arrangement strategy (time delay) to elicit a request. Inadequate proportions Assistance Waiting as part of a routine Waiting with cue Sabotage Choice making How to Prompt Language? Insert child name hereInsert child name here

72. Stop prompting after the child says exactly what you wanted him to say. Give the child enough time to response (5 seconds) before giving another prompt. End each prompting episode by giving the child the requested object or action. After the child has said what you wanted him to say or you have given two model prompts Expand if the child says the target Repeat if the child does not say the target How To Prompt Language? Insert child name hereInsert child name here

73. Only when the child is requesting and not using a target. Only as one of the many tools (not the only tool) of Enhanced Milieu Teaching Not more than 3 times per 15 minute session Too many demands may cause the child to become frustrated. Discontinue prompting if the child loses interest. When to Prompt Language? Insert child name hereInsert child name here

74. 80% of prompting episodes used correctly (e.g., waited for request, prompted a target, used the correct prompting order, gave object/action at the end). Prompting Goal

75. A set of tools to help facilitate a child’s communication growth: Setting up an interactive context between the adult and child through play Noticing and responding to child communication; balancing turns Modeling and expanding play Modeling and expanding communication Using environmental arrangement (EA) strategies Using prompting strategies Summary: What You’ve Learned

76. Thank You