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.

arrow2
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.

The ABCs of ABA in the SLP World

Literacy Stations: ABC Order

Photo by Chrissy Johnson1

We speech-language therapists have a lot of acronyms in our little speechy world. We are SLPs (speech-language pathologists) who have our CCCs (Certificates of Clinical Competence) from ASHA (the American Speech-Language and Hearing Association). When I graduated with my M.S. (okay, you all know that one) in speech-language pathology, I was pretty sure I’d mastered the alphabet soup of our profession.

Until I fell in love with kids with autism, that is. That’s when I was introduced to the world of ABA. If you’ve loved a child with autism, you’ve no doubt run smack into this term, too, and probably very early along the journey you took. Despite the fact that this word swirls around the autism world with great furiosity, it is often misused and a bit misunderstood. Some people love it with a passion; others hate it with the same intensity. Me? I think it both extremely valuable and sometimes overused.

But I’m getting ahead of myself. My goal today is to begin to define the term for those who don’t know it well. Later, when I’ve laid the groundwork just a bit, we’ll delve into the true complexities that exist with what appears, at first glance, to be a very simple concept.

ABA stands for Applied Behavioral Analysis.  It’s based on the work of B.F. Skinner, a psychologist who focused on operant conditioning, or the study of observable behaviors and the events that cause and reinforce those behaviors. The applied part of ABA means that we take this system of looking at the way behaviors are shaped and apply it to everyday life; we use it to shape behaviors that are important to the lives we lead. When we peer at the world through the eyes of ABA, we find ourselves looking at three main things.

The Antecedent: What happened in the environment before the behavior occurred?

The Behavior: This part involves describing the overt behavior that you see or want to see. Not the motives, not the intent, not the feelings behind the behavior. Simply the behavior as you can observe it in front of you. Those who study and use the principles of ABA believe in describing the behavior as clearly and objectively as possible. For example, instead of saying “Sally got mad,” a behavior analyst would say “Sally screamed and hit the door with her fist.”

Consequence: What happens after the behavior? Does this thing that occurs after the behavior (the consequence) increase the chances the behavior will occur again, making it a reinforcement? Or does it decrease the chances the behavior will occur again, making it a punishment?

To help explain, let me share a couple examples.

Say you are teaching a child to say “cookie.” The steps behind teaching the word might go a little something like this:

Antecedent:  You hold up a cookie and say, “cookie”
Behavior: The child imitates “cookie”
Consequence: You give the child the cookie. (This would be positive reinforcement, assuming that giving the child the cookie increases the chances he will say the word again in the presence of the the cookie. Or, in plain English, assuming the child actually wants the cookie–although behavior analysts would probably shy away from describing it this way, as it reflects the child’s internal state, rather than his behavior).

Or, perhaps you are teaching your child to walk. 

Antecedent: You hold out your hands and say “come here!”
Behavior: Your child takes his first step toward you.
Consequence: You cheer and throw your child in the air as he giggles. (Again, this is only reinforcement if it actually increases the chances your child will take a step toward you the next time you hold out your hands and say, “come here!” It wouldn’t be a reinforcement if he hated being thrown in the air- in this case, it might decrease the chances that he’d come to you and would, then, become a  punishment*. Consequences are different for different people- the exact same action that is a reinforcement for one person can be a punishment for another).

These three things- the antecedent, behavior and consequence (Or ABCs of ABA, if you will…yes, another acronym), make up the core of ABA. Those who live in the world of ABA focus very carefully on the ABCs behind any and all behaviors. They graph and chart and study these elements of life and plan interactions around them.

ABA is much more complex than this, of course; I took four full graduate level classes about ABA when I completed my graduate certificate in Behavioral Intervention in Autism.  There are those that study ABA all their life and still don’t have all the answers, and there are entire, complex, and well-graphed treatments for autism that are based the concepts behind ABA.  It is not nearly as simple as I am making it at the moment. And yet, if you understand the ABCs behind ABA, you can begin to understand the world through the eyes of an applied behavior analyst.

How, then, does ABA fit into the world of SLP? As an experienced applied behavior analyst once told me, we all (parents, teachers, speech-therapists, all of us) use ABA in one form or another.  SLPs are no exception. We use the principles of ABA to teach children first words (Antecedent: “Say, Ball!” Child’s Behavior: “Ball!”  Consequence: Child is rolled the ball). We use ABA methods to teach children how to behave and understand language (Antecedent: “Sit down please.” Child’s behavior: sits down. Consequence: “Here’s your snack.”).  We call on ABA to help us figure why children behave in certain ways, so that we might help them find a better response and eliminate challenging behavior. For example, we might look at what comes just before a child hits another child (the antecedent), discover that it happens whenever another child obstructs the way, and then give the  child a new behavior (saying, “move please”) by teaching and reinforcing this new behavior.

So yes, we all use the concepts behind ABA, intuitively and frequently, to teach, motivate, and shape our children’s behaviors. And yet, controversy behind these methods exists. Why so? Because there are significant differences in how and when we apply these methods, in how stringently we define the behaviors we expect, in how we select and apply consequences, and in how strongly we believe that the ABA lens is the only one through which we can view the world.

That’s a post for a different day though.  For now, we’ll just be happy that we’ve learned our ABCs.

 (This post originally appeared on Child Talk)

 

Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist in Wisconsin. Her blog, Child Talk, can be found at www.talkingkids.org and on facebook at facebook.com/ChildTalk.

A Picture Is Worth 1000 Words: Using Photo Books to Increase Vocabulary, Grammar, and Narrative Skills

Photo Gear


Photo by DeusXFlorida

(This post originally appeared on Child Talk)

Making photo books with your kids is a fabulous way to help increase their language skills. It matters not if you are a mom simply looking for  creative ways to provide your toddler with a language-rich environment or a dad looking for ways to help your kindergartener learn to tell stories– photo books are a flexible tool than can be used in a huge variety of ways.
How to use picture books? The general idea goes a little something like this:

  • Take pictures during a fun event such as a trip to the zoo or the beach,
  • Capture key moments in the pictures,
  • Print the pictures that highlight the key moments from the event,
  • Spend a few afternoons gluing the pictures onto construction paper, letting your children help cut, glue and color around the pictures; if your child is old enough, help him to write captions for the pictures, and
  • Laminate the pages and have them bound into a book that can be read over and over.

One you’ve done this, you’re all set up to use the books to help increase language.  Kids love these books because they are based in experiences that they had; this makes the books both meaningful and fun. And children usually want to read the books over and over again– as annoying as this can be, it makes picture books the perfect vehicle for developing language.

With toddlers, you can use the pictures to build on language.  Most toddlers love to start looking at pictures of themselves around 12-24 months, right when they are starting to rapidly increase their vocabulary and move from one-word phrases to two-word phrases. Photo books create excellent opportunities for using parallel talk, description, and expansion to help children develop new vocabulary and help them make the jump from one to two words.

Check out the video below.  I use expansion with my daughter, who is looking at a picture of herself riding a toy motorcycle with her brother, James.  First, I wait for her to say something (“ride!”). Then I build on her words by putting them into short phrases, two different times. As a result, she comes back with a two-word phrase of her own (“James riding”)! No, it doesn’t always work this quickly….I’ve been using parallel talk, description and expansion with her for the past year and it’s only really starting to pay off now.

Toddlers aren’t the only ones who benefit from photo books, though. Using these books with preschoolers and early elementary age children can be great way to work on a whole variety of language-related skills. You can:

  • Work on sequencing by having your child lay out the pictures in the right order as you make the book,
  • Work on pre-writing and writing skills by having your child trace words you write or write his own words and sentences as you make the book,
  • Work on vocabulary by defining new words and integrating those words into the story and by using time words such as first, next, then and finally,
  • Work on language by using indirect correction, in which you correct errors in your child’s grammar by restating what he said, correctly and conversationally (e.g. Your child: “I runned really fast!” You: “You did. You ran so fast!”), and
  • Work on memory by having your child practice telling the story with and without the picture book in front of him.
Finally, photo books are a fantastic way to work on narrative (story) development. Developing an understanding of narrative structure (the typical flow of stories) is essential to being able to engage in conversations, tell others about things that have happened, and understand academic texts later in the elementary years. Enhancing narrative development is an asset for any child; I work on it with my son, often. It’s also a skill that can be very hard for children with language delays and specific diagnoses such as autism, so working on it with these children is essential. Using photo books to visually show stories in which children actually participated helps make narrative structure more concrete and easier to understand.   At first, you can use photo books to help your child understand that the story has a beginning, a middle, and an end. Later, during the early elementary age years, you can help your child form a story that has the following elements:
  • Setting (“We were at the zoo”)
  • Goal (“We wanted to see the animals,”)
  • Problem (“But Sally was scared of the lion.”)
  • Feelings (“I was so mad, because I wanted to see the lion.”)
  • Attempt to solve the problem (“So we went to see the owls instead. Then Sally was ready to see the lion. Mom just covered her eyes.”)
  • Conclusion (“After that, we had a really fun day.”)

It doesn’t have to be perfect, of course. Stories are messy, just like life. They won’t fit perfectly into those elements, nor should they. But telling stories in a way that wraps loosely around those story elements, over and over and over again, will help your child begin to internalize the flow of stories.
There is so much to do with picture books that the possibilities seem endless.  What’s more, at the end of the day, you also have a book full of memories that your children will cherish for years to come.  And that’s just priceless.

Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist in Wisconsin. Her blog, Child Talk, can be found at www.talkingkids.org and on facebook at facebook.com/ChildTalk.

Do Twins Have a Secret Language? (A.k.a. The One Where I’m Debbie Downer)

(This post originally appeared on Child Talk)

You may have already seen this very cute video of two twin boys having a grand time “talking” to each other:

These two are clearly enjoying each other and it is very sweet to watch them do so.  And, in this case, the boys look to be very early communicators who are just having fun playing around with sounds. The video does spark an intriguing question though: Do twins really communicate to each other in their own secret twin language?

The idea of a “twin language” (or “cryptophasia” if you want to get really fancy) has been around for some time now.  It’s been reported that up to 50% of young twins will have their own twin language–one which they use to communicate only with each other and one that can not be understood by others outside their little duo.  The theory behind this “twin language” goes a little something like this: twins are so close to each other and rely on each other so much that they don’t have as much of a need to communicate with the outside world, so they make up their own idiosyncratic language that develops only between the two of them. It’s a fun and almost magical idea, for sure. But does it stand up to reality?

It turns out that many researchers think it does not. Some research studies seem to indicate that what appears to be “twin language” might actually be two children with the same delay in phonology. Phonology refers to rules that children use to put speech sounds together into words.  As I’ve explained in other posts, children tend to develop speech sounds in the same general order and they often make the same types of errors in their speech.  Children with phonological delays have speech sound systems that don’t develop as we’d expect, and this makes it hard to understand their speech.  Some researchers now believe that what is often described as “twin language” is actually two children whose speech sounds are not developing as we would expect.

Researchers further theorize that these speech sound errors (the “phonological delays”) are prolonged in twins because each twin has a partner who seems to understands him and uses the same type of speech as he does.  While this does make it kind of a “twin language” (because the two twins seem to understand each other when others can not), it’s also a delay in speech sound development that might need to be addressed by speech therapy. And in fact, studies have also linked the presence of a twin language to language delays later in the school age years.

This is not to say that parents of twins who have their own language should panic. There does seem to be a small percentage of twins who have both their own language and are able to communicate effectively with their parents in the “real” English language. These twins will switch back and forth between their own language and the English language, depending on who they are talking to.  This type of “twin language” is not linked to later language delays.  It’s also, however, less likely to occur.

It’s also important to note that researchers have not found that all twins who have their own language will go on to have language delays. Twin language seems to be a risk factor, not an absolute indicator the twins will struggle with speech and language. It’s enough of a risk factor, though, that an evaluation by a speech-language therapist might be beneficial in helping decide what’s really going on.

Bishop, D.V., & Bishop, S.J. (1998). “Twin language”: A risk factor for language impairment? Journal of Speech, Language, and Hearing Research, 41(1), 150-160.

 

Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist in Wisconsin. Her blog, Child Talk, can be found at www.talkingkids.org and on facebook at facebook.com/ChildTalk.

The Rest of The Story: The Changing Face of Early Intervention

About one year ago now, I started hearing some new buzz words swirling around the Early Intervention Program in my home state of Wisconsin–words like evidence-based practices and coaching, natural learning environments and primary provider. As a pediatric speech-language pathologist, I was a bit intrigued. Mostly though, I was rather annoyed and quite a bit skeptical. After all, I had been trained to look analytically at a child’s speech or language, come up with a plan to fix it, and implement that plan systematically and objectively. Suddenly, it seemed, I was being asked to take a step way back. To work through parents rather than through the child, and to train parents to be speech therapists. And I found it absurd to expect parents to learn in a few short months what I had learned in six years of higher education.

Because I’m the curious type, though, I started asking lots of questions and doing lots of research. I’ll be honest and say that my primary motivation was to prove that this approach was wrong. I dug through the research on speech and language outcomes for early intervention, looking for the “evidence” that was being touted about so loudly. I found research to support the clinician-directed ABA intervention and language facilitation in play with which I was very familiar and some research to show that parent-led intervention could improve child language and phonology as well. Yet I found not one large, well-controlled study that proved beyond a shadow of a doubt that this “new” approach—the one that called for coaching parents to responsively engage their children in the context of natural learning opportunities–was any better than what we were already doing.

A funny thing happened along the way, though. The more I read, the more I began to realize something else. In focusing so narrowly on speech sounds, vocabulary development, and two-word phrases, I was omitting a huge body of research about child development. I started to see that so much of what was being asked of us as early intervention professionals had less to do with speech and language outcomes per se, and more to do with infant and toddler mental health. I began reading research that suggested that most significant factor in a young child’s development was not the amount of time that child spent in therapy, but rather the degree to which that child’s parent was responsive and engaged. And I began to understand that my single biggest source of power as an early interventionist was not to be found in playing on the floor with the child myself, but in helping that child’s parents become more responsive and engaged with him.

This isn’t to say, of course, that I suddenly began to think that there was no value in interacting directly with a child. This is far from true. Interacting directly with children helps us to discover what does and does not work with that child and allows us to model strategies for parents. There is every place for this in our early intervention practices. But this past year, I began to understand that I needed to be much more intentional about when and how I interacted with children. I also needed to be much more careful about building up parent competence in enhancing their own child’s development, rather than giving the appearance that a child’s development was dependent on me. After all, as a weekly early intervention visitor, I was with that child less than 2% of all his waking hours. It seems so silly that I ever assumed that I was the agent of change in a young child’s life, but I did. This past year, it finally dawned on me that early intervention wasn’t about me and what I did with the child…it was about that child’s parents and what they did with him. And if I couldn’t effect change in that, I simply wasn’t doing my job.

One year later, I’ve realized that these evidence-based practices aren’t about me training parents to be speech-language therapists at all. Children under the age of three don’t need their parents to be speech therapists. They need them to be parents. I’m not being asked to give up my role. I’m being asked to take all the information I have about child development, mesh it with what I’ve learned about infant and toddler mental health, and find ways to intricately weave those practices into the fabric of that child’s relationship with his parents. I’m being asked to get into that child’s life, to know his daily routines—no matter what they are–and to work within those. I’m being asked to start where the parents are, not where the child is. It’s complicated, it’s complex, and it’s messy. And it’s my job.


Becca Jarzynski, M.S., CCC-SLP
is a pediatric speech-language pathologist in Wisconsin. Her blog, Child Talk, can be found at www.talkingkids.org and on facebook at facebook.com/ChildTalk.