Report of the Recommendations, Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 years)
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Clinical Practice Guideline: Report of the Recommendations, Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 years) |
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INTERVENTION METHODS
SUMMARY CONCLUSIONS
Parent training involves a formal program in which a therapist instructs parents in strategies and methods for enhancing their child's speech and/or language development.
Articles screened for this topic: 372
Articles meeting criteria for evidence: 11 (7 studies)
Research studies have shown that formal parent training programs can be effective in changing maternal language behavior and also in improving child language.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Parent training can be effective in modifying maternal language behavior and in improving child language.
Parents as primary intervention agents can be successful when they receive adequate training, regular monitoring, and feedback from the therapist.
Parent training can be combined with other individual and/or group intervention approaches. When parents are not the primary intervention agents, training can still be useful in allowing parents to help with interventions.
Limitations
Not all parents have the time or the ability to be involved in formal parent training sessions.
Parent training requires a commitment by the parents and therapist to allocate adequate time for the training sessions, follow-up, and monitoring of child progress.
SUMMARY CONCLUSIONS
Group speech/language interventions are defined as interventions that involve a professional working with two or more children.
Articles screened for this topic: 372
Articles meeting criteria for evidence: 5 (4 studies)
Group speech/language intervention (either as a sole intervention or in combination with individual therapy) may be useful in treating young children with communication disorders. In group intervention programs for young children with communication disorders, it may be useful to include typically developing peers as part of the group. Interaction with other children who have language skills above and below the child with a communication disorder may support language development.
Placement in a developmentally appropriate group may be helpful in facilitating language development. Depending on the child, this placement may or may not also involve formal speech/language intervention.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Group speech and language programs can be effective in improving child language and communication skills.
Working with children in groups may result in more generalization of target vocabulary words to other settings such as the home.
Having children with communication disorders interact in developmentally appropriate play settings with normal language peers, in conjunction with other approaches, can be an effective form of intervention.
Limitations
Group programs may not be practical for all children.
SUMMARY CONCLUSIONS
Individual speech/language therapy involves having a professional working one-on-one with the child.
Articles screened for this topic: 372
Articles meeting criteria for evidence: 1
Some type of individual speech/language therapy (either as a sole intervention or in combination with group interventions) may be useful in treating young children with communication disorders. However, use of individual speech/language therapy as the sole intervention method may produce less generalization to other situations than group interventions that involve multiple conversational partners.
Individual speech/language therapy may be especially important at the beginning stages of treatment as specific targets are established and as the child becomes accustomed to the use of particular techniques.
The choice of setting for individual speech/language therapy sessions for a specific child will depend on a variety of factors relating to the individual child and family situation. These might include the child's chronological age and developmental level; the type and severity of the child's communication disorder; other developmental deficits or medical problems; other therapies the child is receiving; the family's interest in and ability to participate in the intervention; and the cultural context of the child and family.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Individual speech / language therapy may be more readily adapted to the specific child and family than group interventions or formal parent training programs.
Individual speech / language therapy may be especially important at the beginning stages of treatment as specific targets are established and as the child becomes accustomed to the therapists and to the use of particular techniques.
Individual speech / language therapy may be readily combined with other treatment components, such as formal or informal parent training and group programs.
Individual speech / language therapy can occur in a variety of settings including the home, daycare, toddler group, other community centers and professional offices.
Limitations
Use of individual speech / language therapy as the sole intervention method may produce less generalization to other situations than group interventions that involve multiple conversational partners.
SUMMARY CONCLUSIONS
In directive interventions, the professional providing the intervention controls the antecedents and consequences presented to the child. Directive approaches use specific techniques such as modeling and prompting to elicit targeted language structures from the child. Naturalistic interventions use specific techniques that create opportunities for the child to use targeted language structures.
Articles screened for this topic: 372
Articles meeting criteria for evidence: 6
Because no one type of speech/language intervention is best for all young children, it is important to determine certain characteristics of the individual child before selecting an intervention approach. It is particularly important to assess the child's pre-treatment developmental and language levels. It is often useful to consider a child's conversational skills and verbal interaction style when deciding whether to use an imitation-based (directive) or a conversation-based (more naturalistic) intervention approach.
Directive approaches can be effective in eliciting initial structures of speech and language. For children with higher levels of language and/or cognitive functioning, more directive interventions may be appropriate and important at the beginning stages of treatment.
Naturalistic interventions at the initial stages of therapy may be appropriate for children who are not yet ready to benefit from directive intervention approaches. This may include children at earlier levels of language development including children with general developmental delays. Naturalistic interventions are more effective than directive approaches in increasing spontaneous language and in promoting generalization to non-treatment settings.
Since the long-term goal for speech/language interventions is to enable children to use language functionally and in conversation, it is appropriate that intervention methods progress from more directive towards more naturalistic approaches. This progression is important because some functional aspects of language (such as social context and conversational turn-taking) cannot be established through directive intervention and need to be learned using more naturalistic approaches.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Directive interventions
For children with higher levels of language and cognitive functioning, directive interventions can be effective in eliciting initial structures of speech and language.
Naturalistic interventions
Naturalistic interventions can be effective for children who are not yet ready to benefit from direct instruction. This may be particularly the case for some children with general developmental delay.
Naturalistic interventions usually result in greater generalization to non-treatment situations than do the more directive interventions.
Naturalistic interventions can be effective for children who have produced target structures but have not yet produced them in communicative situations.
Parents and teachers can be trained to implement naturalistic interventions with ongoing monitoring, professional supervision, and support.
Children with specific language impairment who received both types of intervention seemed to enjoy the naturalistic intervention more than the directive intervention.
Limitations
Directive interventions
Children with developmental delays often do not progress as much with directive intervention approaches compared to more naturalistic approaches. This may be because these children may not understand or use general learning strategies and have trouble generalizing the information outside of the specific teaching setting.
Certain functional aspects of language (such as social context and conversational turn-taking) cannot be established through directive intervention.
Naturalistic interventions
Naturalistic approaches may not be as effective as more directive approaches in eliciting initial imitative speech and gestures.
SUMMARY CONCLUSIONS
The efficacy of specific techniques as they are used for an individual child may be evaluated using a single-subject design methodology. Single-subject design studies can provide information not only about efficacy of broader general intervention approaches but also about the efficacy of more narrow specific elements and variations of these interventions.
Articles screened for this topic: 372
Articles meeting criteria for evidence: 17
There are many specific speech/language intervention techniques for treating children with communication disorders that have been studied using a single-subject design methodology. Single-subject design studies have demonstrated that these techniques can be learned by parents, teachers, and normal language peers, who can then become effective intervention agents.
The effectiveness of any speech/language intervention for an individual child can be evaluated and documented using elements of single-subject design methodology. By incorporating ongoing monitoring of progress into the intervention process, and documenting the link between interventions and changes in communication skills, clinical decision-making can be based on measurable outcomes. Using appropriate single-subject design methods (such as multiple-baseline or other designs), it is possible to evaluate the extent to which a change in behavior is due to intervention or some other factor, such as maturation.
In effective intervention strategies, target behaviors for an individual child were clearly identified and defined, with clear criteria for mastery. It is also important to assess the extent to which speech/language skills acquired with specific techniques are generalized to non-treatment settings. A continuum of intervention strategies is important as the child progresses.
The professional providing the intervention can use information gathered according to single-subject design methods to assist in choosing or modifying intervention strategies, intensity and frequency of sessions, and the duration of the intervention.
Finally, single-subject design methodology provides a way to evaluate the effectiveness of interventions that have been individualized to a specific child's strengths and needs, style of learning, and family situation. In addition, this methodology provides a way to evaluate the effects of modifying specific techniques during the intervention process based on the child's progress.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Many different behavioral techniques have been shown to be effective in improving communication skills in children with communication disorders.
Specific techniques that will prove most effective for an individual child for a particular targeted behavior will depend on many factors, including the type of communication disorder, personality characteristics, and presence of other developmental problems.
Therapists can use a variety of behavioral techniques for enhancing communication skills. With support and training, these techniques can also be learned by parents, teachers, and normal-language peers who can then become more effective intervention agents.
Applying the methodology of single subject research designs in clinical settings provides a method for efficiently monitoring the child's progress and modifying the specific elements of intervention techniques as appropriate.
Limitations
Unless specific attention is focused on facilitating generalization, the skills acquired using a specific speech / language intervention technique may not generalize to the child's usual environment.
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Send questions or comments to: bei@health.state.ny.us |
| Revised: June 2002 | |