This meta-analysis examined the effects of early interventions on social communication outcomes for young children with autism spectrum disorder. A systematic review of the literature included 1442 ...children (mean age 3.55 years) across 29 studies. The overall effect size of intervention on social communication outcomes was significant (
g
= 0.36). The age of the participants was related to the treatment effect size on social communication outcomes, with maximum benefits occurring at age 3.81 years. Results did not differ significantly depending on the person implementing the intervention. However, significantly larger effect sizes were observed in studies with context-bound outcome measures. The findings of this meta-analysis highlight the need for further research examining specific components of interventions associated with greater and more generalized gains.
Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, ...autism interventions that represent the merging of applied behavioral and developmental sciences. “Naturalistic Developmental Behavioral Interventions (NDBI)” are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.
Early interventions for toddlers with expressive and receptive language delays have not resulted in positive expressive language outcomes. This randomized controlled trial tested the effects on ...language outcomes of a caregiver-implemented communication intervention targeting toddlers at risk for persistent language delays.
Participants included 97 toddlers, who were between 24 and 42 months with language scores at least 1.33 SDs below the normative mean and no other developmental delays, and their caregivers. Toddlers were randomly assigned to the caregiver-implemented intervention or a usual-care control group. Caregivers and children participated in 28 sessions in which caregivers were taught to implement the intervention. The primary outcome was the Preschool Language Scale, Fourth Edition, a broad-based measure of language. Outcome measurement was not blinded.
Caregivers in the intervention improved their use of all language facilitation strategies, such as matched turns (adjusted mean difference, intervention-control, 40; 95% confidence interval 34 to 46; P < .01). Children in the intervention group had significantly better receptive language skills (5.3; 95% confidence interval 0.15 to 10.4), but not broad-based expressive language skills (0.37, 95% confidence interval -4.5 to 5.3; P = .88).
This trial provides preliminary evidence of the short-term effects of systematic caregiver instruction on caregiver use of language facilitation strategies and subsequent changes in children's language skills. Future research should investigate the ideal dosage levels for optimizing child outcomes and determine which language facilitation strategies are associated with specific child outcomes. Research on adaptations for families from culturally and linguistically diverse backgrounds is needed.
Purpose: The purpose of this meta-analysis was to systematically evaluate the effects of parent-implemented language interventions on the language skills of children between 18 and 60 months of age ...with primary and secondary language impairments. Method: A systematic literature search yielded 18 studies that met the predetermined inclusion and exclusion criteria. Effect sizes for each study were calculated for 7 language outcome variables and analyzed using a random effects model. Separate analyses were conducted for each language outcome and for each comparison group. Outcomes were compared for children with and without intellectual disabilities and for parent report and direct observational language measures. Results: The results indicate that parent-implemented language interventions have a significant, positive impact on receptive and expressive language skills of children with and without intellectual disabilities. Effect sizes (g) for child measures ranged from -0.15 to 0.82 depending on the outcome measure and comparison group. Conclusion: The results of this review indicate that parent-implemented language interventions are an effective approach to early language intervention for young children with language impairments. Critical features of parent-implemented interventions are discussed in terms of implications for practice and future research. (Contains 8 tables and 3 figures.)
Purpose: The purpose of this study was to compare the effects of enhanced milieu teaching (EMT) implemented by parents and therapists versus therapists only on the language skills of preschool ...children with intellectual disabilities (IDs), including children with Down syndrome and children with autism spectrum disorders. Method: Seventy-seven children were randomly assigned to 2 treatments (parent + therapist EMT or therapist-only EMT) and received 36 intervention sessions. Children were assessed before, immediately after, 6 months after, and 12 months after intervention. Separate linear regressions were conducted for each standardized and observational measure at each time point. Results: Parents in the parent + therapist group demonstrated greater use of EMT strategies at home than untrained parents in the therapist-only group, and these effects maintained over time. Effect sizes for observational measures ranged from d = 0.10 to d = 1.32 favoring the parent + therapist group, with the largest effect sizes found 12 months after intervention. Conclusion: Findings from this study indicate generally that there are benefits to training parents to implement naturalistic language intervention strategies with preschool children who have ID and significant language impairments.
•This randomized trial tested the effectiveness of EMT en Español•EMT en Español is an adapted—not simply translated—intervention•Caregivers in intervention used significantly more EMT en Español ...strategies•Children in intervention had higher receptive vocabulary outcomes•Caregivers judge the intervention effective and culturally appropriate
The primary purpose of this study was to examine the effects of using the Teach-Model-Coach-Review approach to teach Spanish-speaking caregivers from low-income households to implement EMT en Español with their young children with language delays. A secondary purpose was to explore the effects of the caregiver-implemented intervention on children's vocabulary. A final and more exploratory goal was to gain insight into caregivers’ perceptions of the intervention.
21 caregiver-child dyads participated in the intent-to-treat randomized control trial. Their children were 30-43 months old with language delays. Dyads were randomly assigned to receive 24 caregiver training sessions delivered at home in Spanish or a wait list control group. Pre, post and 3-month follow assessments included observational measures of caregiver-child interactions and child standardized vocabulary assessments. Caregivers completed surveys rating their perception of the intervention.
Caregivers in the intervention group had significantly higher percentages of matched turns, expansions, and targets at post-assessment and of expansions and targets at follow-up compared to the control group. Overall, children in the intervention condition had significantly higher receptive vocabulary scores and performed better than children in the control condition on observational measure of their lexical diversity, with moderate effect sizes for most outcomes. Caregivers perceived the intervention as effective and culturally appropriate.
Teach-Model-Coach-Review is effective in increasing Spanish-speaking caregivers’ use of EMT en Español strategies with their young children with language delays. The intervention also appears to be effective for child vocabulary outcomes and acceptable to caregivers.
Researchers examined whether a parent‐implemented language intervention improved problem behaviors 1 year after intervention. Ninety‐seven children with language delays (mean age at 12‐month ...follow‐up = 48.22 months) were randomized to receive Enhanced Milieu Teaching (EMT) language intervention or business as usual treatment. Twelve months after the intervention ended, children in the EMT intervention condition displayed lower rates of parent‐reported externalizing, internalizing, and total problem behaviors. A mediation analysis revealed that the relation between EMT and problem behaviors was partially mediated by child rate of communication for both internalizing and total problem behaviors. A developmental framework is proposed to explain the impact of EMT on problem behaviors, and future lines of research are discussed.
Purpose: This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice ...service delivery model. Method: Four caregivers and children with language delays aged 18-27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver-child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach-Model-Coach-Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words. Results: There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children. Conclusion: Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies.
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.
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.
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.
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.
https://doi.org/10.23641/asha.22290082.
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.
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