The Effectiveness of Language Facilitation



natural talk

A while back, I posted on the ABCs of ABA. Within that post, I described the basics of ABA, a method of therapy that I believe is often a bit misunderstood. I also promised to follow that post with a more thorough description of the shades of grey that exist within the broader field of ABA.

Before I do that, though, I want to touch on the effectiveness of an approach that often seems to be the very opposite of ABA: indirect language stimulation. And before I do that (hang with me here), I’m going to briefly explain the idea of a continuum of naturalness that exists within the field of speech-language pathology. This term was first coined by Marc Fey in 1986 in “Language intervention with young children,” and I think it is a wonderful way to help us wrap our minds around the variables that exist when we think about the various methods of therapy.

The ends of this continuum represent the relative naturalness of a treatment context. On one end of the continuum, we have indirect language stimulation approaches. These are highly natural, often embedded within the child’s daily routine, tend to be unstructured, and are built on the idea of being responsive to the child. On the other end of the continuum, we have highly structured ABA approaches, which tend to be highly decontextualized (*not* in the context of daily activities and play), very structured, and highly adult-directed.

In this post, I’m going to cover the left hand side of this continuum: indirect language stimulation. In a nutshell, this approach to language intervention involves describing what a little one is seeing, doing, and feeling. I’ve described different techniques within this broader method before, in various posts such as All Kinds of Talk, Self Talk & Parallel Talk, and Expansion and Extension. As you use these techniques, you are providing models of language that are a match for the child’s language level. So, if a baby mainly points and vocalizes, you use one and two word phrases; if toddler uses one and two word phrases, you use three and four; if a preschooler uses short sentences without grammar, you respond with longer sentences with appropriate grammar (you get the idea, right?).

These techniques are generally used in the context of on-going activities that happen every day, and are used in a way that is responsive to the child. In other words, you watch what the child is doing, listen to what she is saying, observe what she is watching, and then you respond to that. Watch. Listen. Observe. Describe. Put it all together, and general language stimulation looks a little something like this.

It pretty much looks like nothing is happening, right? Just a mom and her child having a snack. This is what it should look like! It’s natural- that’s why it’s on the far left hand side of the continuum of naturalness. But there is more going on than meets the eye. Notice how the language is simple, and related to the activity at hand. Also notice mom’s responsiveness–language models are provided in response to the child’s utterances (Child: “Please?” Mom: “You want apple.” “Apple please!”). And when the little one tries to get mom’s attention by saying “mmm,” again, mom responds with another “mmmm.” They go back and forth a few times–this is turn-taking, and within it lies the beginnings of conversation. Eventually, mom uses a language model directly related to the “mmmm”: “Yummy apple.”

One more example. This activity is a little more structured, but the approach used is the same. Notice how mom’s language is in response to the child’s language (Child: “Ride…” Adult: “You’re riding the bike!”) and take note of the fact what mom says is just slightly longer than the toddler’s language. And, as an additional bonus, observe how the child’s language changes– from one word sentences at the beginning, to a two-word phrase at the end of the clip. Indirect language stimulation doesn’t always work immediately in the moment like this…but it’s pretty cool when it does!

Despite the fact that indirect language stimulation looks quite simple, research shows that it can be very effective. As I described in All Kinds of Talk, research indicates that the more parents use conversational talk with their typically developing child, the larger that child’s vocabulary will be. When parents are responsive in their conversational interactions with their child, their child’s language grows.

Indirect language stimulation approaches have been shown to be effective for late talkers, too. In their article, Evidence-Based Language Intervention Approaches for Young Talkers, Finestack and Fey summarize the evidence in support of both general language stimulation and focused language stimulation. General language stimulation involves the techniques I just described in, well, a very general way. This means that there are no specific language targets (say, increasing verbs, or increasing nouns, or getting a child to use a specific type of two-word phrase). Instead, the goal is broad in nature: increase overall language skills. Finestack and Fey describe a randomized controlled trial (in other words, a well designed, scientific study) of a 12 week program that used general language stimulation (Robertson & Ellis Weismer, in Finestack and Fey, 2013). The researchers compared late-talking children who received general language stimulation to late-talkers who received no intervention and found that, compared to the children who received no intervention, children who received the intervention made more gains in vocabulary, intelligibility, and socialization. Importantly, the parents of the children who received intervention felt less stress. And who doesn’t want less stress in their life?!

Focused language stimulation is very similar to the general language stimulation except that it’s (you guessed it…) focused. The language models that are provided by adults are chosen specifically for that particular child. So, an adult might model mainly verbs if these are lacking in a child’s language. Or, the adult might model specific nouns. Or, the adult might model a specific type of early grammar marker, such as -ing (one of the earliest ways that children start marking verbs). This type of language stimulation, too, has been shown to be effective. Girolametto, et al, 1996 (in Finestack and Fey, 2013), taught parents to use focused language stimulation with their children. They compared the gains made the children of these parents to the gains made by children whose parents were not trained in use of these methods (don’t worry – the non-trained parents got trained at the end of the study, too!). By the end of the study, the children whose parents were trained in focused language stimulation had significantly larger and more diverse vocabularies, used more multi-word phrases, and had better phonology.

It’s important to note that general and focused language stimulation enjoy the most research support when used with late-talkers who don’t have any other delays. The research is mixed when it comes to the efficacy of these methods with children with more significant delays and disorders, such as those with autism or cognitive disorders. Because of this, having other tools in our toolbox is very important. This is where the rest of the continuum of naturalness becomes important – and where my passion for contextualized ABA approaches begins. But, that’s a post for another day. For today, we’ll stop here, secure in the knowledge that when we surround our typically developing children and late-talkers in language models, their language grows.

Finestack, L. and Fey, M. (2013). Evidence-Based Language Intervention Approaches for Young Talkers. In Rescorla & Dale, Eds. (2013). Late Talkers: Language Development, Interventions, and Outcomes

Becca Jarzynski, M.S., CCC-SLP, is a pediatric speech-language pathologist in Wisconsin. You can follow her blog, Child Talk, and on Facebook.