Love, Talk, Read: Early Intervention Strategies for Infants and Toddlers At Risk for Language Impairment

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By Celeste Roseberry-McKibbin
Author of Increasing Language Skills of Students From Low-Income Backgrounds: Practical Strategies for Professionals, Second Edition
and co-author of the forthcoming Comprehensive Intervention for Children with Developmental Delays and Disorders Practical Strategies (10 book set)

Statistics have documented the precipitous rise of children diagnosed with Autism Spectrum Disorder (ASD), language impairment, and other atypical developmental profiles. For example, according to the Centers for Disease Control and Prevention (2016), 1 in 68 children today is diagnosed with ASD. Many times, these children do not receive intervention until they are 4 years old or even older. Recent research has documented very exciting outcomes that can occur when these at-risk children receive early intervention, which can start as early as 6 months of age. Speech-language pathologists can help caregivers begin, very early in their children’s lives, to implement strategies that improve their language outcomes. The strategies can be summed up in three words:  love, talk, read. Let’s start with love.

Love

Relationships are the cradle of all learning. Babies and young children above all must feel attached to their caregivers through love, attention, and bonding. It is critical, in the early weeks and months of life, for caregivers to respond immediately and with love when a baby cries. Immediate responses help infants to bond with caregivers and trust their world. Leaving babies to “cry it out” teaches them that the world is not a safe place, and can create a shaky foundation upon which to build later language interaction. Thus, immediate responsiveness to a baby’s cries is a foundational building block of later language.

Talk

We have all heard the oft-repeated advice, “Talk to your baby.” This is true, and talking to babies and young children is crucial to their developing language. However, research has shown that it is actually parent responsiveness to the baby’s initiations that is even more predictive of early language development (Center on the Developing Child at Harvard University, 2016; Ozonoff et al., 2009; Tamis-LeMonda et al., 2001). When a baby looks at something, for example, the parent can follow his “line of regard” and establish joint attention, where the parent and baby are focusing on the same thing. So when the dog walks into the room and the baby’s eyes land on the dog, the parent can say, “Oh, you see Angel. (pointing to dog) That’s right, Angel just came in.” When the baby points, the parent can look at what the baby is pointing to and comment—“Oh, you are pointing at the red balloon. The balloon is pretty!” When babies make sounds, the parents can respond with immediate imitation and add new sounds as well.

Ozonoff et al. (2009) conducted a study with parents of infants (6–15 months of age) suspected of having ASD. Parents were coached to create pleasurable social routines to increase their children’s opportunities for interaction. Parents used toys and words to attract their babies’ attention, and also imitated their babies’ sounds and intentional actions. The treatment consisted of 12 one-hour sessions with the infant and parent, followed by a six-week maintenance period with biweekly visits and follow-up assessments at 24 and 36 months of age. The study’s results showed that in contrast to a control group whose parents did not receive coaching, the children who received the intervention had significantly more ASD symptoms at 9 months of age, but significantly lower autism severity scores at 18 and 36 months of age. By age 3, the group that received the intervention had neither ASD nor developmental delay.

When the baby begins to say words at around 12 months of age, parents can extend their utterances. Extensions have proven to be some of the most powerful ways to increase children’s language skills.  So, for example, if the child points to the dog and says “doggy!” the parent can say, “Yes, our doggy Angel just came into the room and she is wagging her tail.” If the child says “more juice,” the parent can say, “You are thirsty, and more juice is available. Here you go!” When parents add words and new meaning to children’s utterances, semantic and syntactic skills grow. The best part is that this can be done in any language, even if the caregiver is nonliterate and has little extra time. Extensions can easily be added to families’ daily routines with no extra expenditure of time or money.

Read

Parents can share books even with babies, reading and pointing out pictures. Simple books with colorful pictures are ideal. If parents do not read, they can talk about pictures on the pages. Parents can label pictures and actions in the pictures, saying things like, “Look—there is Thomas the Tank Engine! (pointing to Thomas). Why is he happy? (pause) Oh, he is happy because Percy the Train just came up to him and wants to play.” Babies and some young children will not answer questions, but parents can ask the questions, pause for a few seconds, and then answer the question themselves. This shows the developing child that, eventually, turn-taking is expected. Routines such as this help establish joint attention, reciprocity, and eventually conversational turn-taking. Daily sharing of books with babies and young children establishes pre-literacy skills, which are critical building blocks for later literacy.

Summary

For infants and young children who are at risk for language impairment and other developmental issues, caregivers can focus on three simple strategies: love, talk, read. Research shows that early intervention, beginning in infancy, can have exciting and dramatic results in terms of helping children achieve successful language and life outcomes.

For more information, visit http://lovetalkread.com.

 

References

Center on the Developing Child at Harvard University. (2016). Serve and return. Available at http://developingchild.harvard.edu/science/key-concepts/serve-and-return/

Centers for Disease Control and Prevention. (2016). Autism spectrum disorder. Available from https://www.cdc.gov/features/new-autism-data/index.html

Ozonoff, S. et al. (2009). How early do parent concerns predict later autism diagnosis? Journal of Developmental and Behavioral Pediatrics, 30(5), 367–375.

Roseberry-McKibbin, C. (2013). Increasing language skills of students from low-income backgrounds: Practical strategies for professionals (2nd  ed). San Diego, CA: Plural Publishing, Inc.

Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767.

Attacking Social Interaction Problems Across the Lifespan

Autism: Attacking Social Interaction Problems

Autism: Attacking Social Interaction Problems by Betholyn F. Gentry, Pamela Wiley, and Jamie Torres-Feliciano

By Pamela Wiley, Ph.D., co-author of Autism: Attacking Social Interaction Problems

In my private practice, we are often asked by our funding sources when our children with ASD will no longer need social skills instruction. I often feel a sense of “indirect or subtle” pressure to discontinue our service and declare that a child is socially competent and basically cured of what is essentially the hallmark feature of ASD: impaired social interaction. However, given what I know and have observed with this population it is difficult both ethically and morally to do so.

As professionals we know that social skills are the foundation for getting along with others. We also know that there are social skills milestones which develop along a continuum. For example, one of the early skills focused on for our young children is “how” to make friends and join groups. Many are successful and with parental support during the preschool years engage in playdates and develop friendships with their typically developing peers. However, around 8 or 9 years of age the terrain shifts and children reportedly become more discriminating and scrutinizing as they select their friends. Labels such as nerd, cool and loser become important in the selection process. Our children with ASD often fall into the category of nerd.

As a result, many of them experience rejection and bullying and are left confused and hurt when their only friends abandon them. Social skills continue but our focus evolves to include discussions and skill steps to facilitate their understanding of “who” should be their friend and “how” our friends make us feel and accepting loss and changes in life. The need for social skills training into middle school and beyond can have a profound effect on the quality of life for these children.

High school brings yet another level of complex social interactions and negotiations especially when dealing with the opposite sex, changes in hormone levels, sexual maturation, and peer pressure.

The final phase is the transition process from high school to college and the world of work. The need for continued social skills training is essential and should address core clusters of skills critical for promoting independence and fulfilling lives: vocational, independent, and personal development. Social skills taught may include relationships and how to discriminate between a friend, a colleague, and an acquaintance, the importance of good hygiene, executive functioning, workplace conversation, nonverbal communication, unwritten social rules, and workplace idioms such as “hit the ground running” to name a few.

Based on decades of working with this population and the long-term relationships experienced with many of the children and families in my practice and more importantly the positive outcomes we have achieved, in response to the question, how long should children with ASD continue with social skills treatment, my short answer is, “Across the Lifespan.”

That having been said, based on the positive comments and requests from our colleagues following several ASHA presentations on social skills, my colleague and I have developed a series of social skills workbooks, Autism: Attacking Social Interaction Problems to cover the lifespan of children with ASD from 4 years to adulthood.

Our books contain clear and concise objectives and instructions on how to introduce and implement the lessons. Our approach is fun yet structured and each unit builds on previously learned skills to assist in the generalization of information across boundaries and contexts which include home, school, and the community while incorporating parent and teacher input.

Our newest additions are the teen and prevocational books which are fresh and relevant to today’s youth and include the use of social media and issues facing young people today such as sexting, texting, and TMI. The goal is to assist our students to develop a full range of interpersonal social competencies that can help them ultimately achieve acceptance in the workplace and develop a meaningful existence.

To learn more about our series of workbooks, visit Plural Publishing at www.pluralpublishing.com or our website www.speakla.com.