The Importance of Parent Training in Early Language Intervention ...

The Importance of Parent Training in Early Language Intervention:The Hanen Approach Cindy Smith • The Hanen Centre

Let’s look at... 1. Why do we want to start early with children with communication delays? 2. Why should we train parents and carers to be l language interventionists? i t ti i t ?

The Importance of Parent Training in Early Language Intervention: The Hanen Approach

3. What is The Hanen Centre & what is the It Takes Two to Talk® Program? 4. What is involved in It Takes Two to Talk?

Cindy Smith, B. App. Sc. Speech-language Pathologist Hanen Instructor and Australasian Representative

Why start early?

Why train parents to be interventionists?

 Some children we can predict will have communication delays e.g. Down Syndrome, GDD

 Need to work with the people who are closest to the child

 Studies on brain plasticity and brain development

 Know them the best

 Long term impact on academic success, social competence, behaviour

gg vested interest  Have the biggest  Spend the most time

 Savings to society in terms of long-term need for support

 Promotes family well being

Clegg, Hollis, Mawhood & Rutter, 2005 Johnson, Beitchman & Brownie, 2010 Tomblin, Zhang, Buckwalter & O’Brien, 2003 Tomblin, Zhang, Buckwalter, Catts, 2000

(Crnic & Stormshak, 1997)

What the experts say about working with families...

Kaiser and Roberts Meta Analysis (2011)  Meta-analysis - combined results of 18 studies that examined parent-implemented intervention

“Active involvement by families is critical. Without it, intervention is unlikely to be successful - any short term effects are unlikely to be long-lasting”.

 Compared experimental with control groups (control groups either non-treatment, therapist-delivered, or business as usual)

Bronfenbrenner Bronfenbrenner, 1974

 Children average 24-36 months (range: 15-77 mos) “The earlier parents of children with disabilities are involved in intervention programs, the better the outcomes”.

 All interventions were between 10-13 weeks (less than 26 hours of parent training)  All programs taught responsive strategies

Rossetti, 2001 5

© Hanen Early Language Program, 2012. All rights reserved.

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2. Do parent-implemented interventions positively affect child language outcomes?

1. Did parent training positively affect parents’ use of strategies?

YES!

YES!

Positive impact on... Positive & significant effects on: • receptive ti & expressive i language l and vocabulary • expressive morpho-syntax • rate of communication

• parent responsiveness • parent’s use of language models • rate of communication with their child

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3. Is intervention more effective when delivered by a parent?

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4. Do the effects of parent-implemented interventions differ for children with or without intellectual difficulties?

YES... for some language constructs

NO... except for expressive vocabulary

• receptive language – parents more effective • expressive syntax – parents more effective

(larger effect size for children without ID) No difference in most language constructs for these two groups

No significant difference in other constructs between intervention delivered by parent and SLP

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It Takes Two to Talk® Research Randomized Controlled Trial, JSHR,1996

Parent Changes:

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Outcomes of Study on It Takes Two to Talk (1996)

Child Changes:

 less directive; more responsive p

 social gains – increase in joint attention and turn taking

 language input slower, less complex

 had larger vocabularies and a greater variety of words

 used more focused stimulation than control group

 used more multi-word sentences  used more target words (in structured and free play situations)


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Let’s look at...

What about Malaysia?

 Approximately 3.5 million children under the age of 6

1. Why do we want to start early with children with communication delays?

 Worldwide estimate that 7% of children have a language delay, due to various etiologies

2. Why should we train parents and carers to be language i t interventionists? ti i t ?

 Number of SLPs in Malaysia

3. What is The Hanen Centre & what is the It Takes Two to Talk® Program?

 Potentially 245,000 children with communication delay

4. What is involved in It Takes Two to Talk?

What is The Hanen Centre? A Not-For-Profit Charitable Organization

Service

Resources

Training

Membership

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Facilitating a Child’s Communication

Hanen Programs…

 Two critical components to facilitating communication  Both need to be present in order for the child to benefit

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What’s the missing piece?

What’s the missing piece here?

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For children’s communication to develop, they need both….

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The Hanen approach is based on Social-Interactionist theory: The child is able to process language input more easily when adult input is responsive

Interaction

Responsive input facilitates language learning because it:  is more motivating for the child, thereby increasing his participation in the interaction

Language Input

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Interaction? Language? Or Both?

 Is easier for the child as he doesn’t have to use cognitive energy to shift his attention from his interest to that of the adult

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Let’s look at... 1. Why do we want to start early with children with communication delays? 2. Why should we train parents and carers to be language i t interventionists? ti i t ? 3. What is The Hanen Centre & what is the It Takes Two to Talk® Program? 4. What is involved in It Takes Two to Talk?

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Responsive Social Interaction Strategies

Responsive Social Interaction Strategies

Second…

First…

Interaction-promoting

Child-centered strategies (increase child initiations)

 Be face to face

 Match turns

 Observe, Wait Listen

 Imitate

(increase initiations)

 Cue for a turn

 Follow child’s lead

 Appropriate balance of questions and comments

OWL

 Join in

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It Takes Two to Talk® Schedule

Responsive Social Interaction Strategies And finally… Language Modeling

Hand

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That’s your hand. Your hand is soooo dirty!

Group Session 1: Let Your Child Lead Group Session 2: Follow Your Child’s Lead Video Feedback #1

 Interpret child’s message

Group Session 3: Take Turns to Keep the Interaction Going Group p Session 4: Add Language g g to the Interaction Group Session 5: Add Language to Build Understanding

 Label – variety of words

Video Feedback #2

 Highlight, use repetition

Group Session 6: Let’s Play! Group Session 7: Sharing Books

 Expand

Video Feedback #3

 Extend topic

Group Session 8: Moving Forward with Music & Closing 27

Framework for Teaching Strategies

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What do parents say?

Hook the learner in – g establish a reason for learning

Plan for home written 4

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3

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Practice, Practice, Practice!! Provide the information simulated and “mental” – interactive, practical, relevant

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The Value of Videotaping

What else do parents say?

Parent begins to try to apply strategies to interactions with their child.

Parent starts to see some change in child or interaction & with our help attributes it to own change in behaviour

Parent starts to learn program strategies.

Parent starts to change attitude, beliefs Guskey 2002

What parents say about video feedback?

How to get involved?

www.hanen.org – Online Store

3 Day training for SLPs

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References  Law, Garrett & Nye (2011) The Efficacy of Treatment for Children

with Developmental Speech and Language Delay/Disorder: A MetaAnalysis. Journal of Speech, Language and Hearing Research

 Girolametto, L., Pearce., P., & Weitzman, E. (1996). Interactive

focused stimulation for toddlers with expressive vocabulary delays. JJournall off S Speech h and dH Hearing i R Research, h 39 39, 1274 1274-83. 83

 It Takes Two to Talk® Research Summary www.hanen.org  Roberts, M. & Kaiser, A. (2011). The Effectiveness of Parent-

Implemented Language Intervention: A Meta-Analysis. American Journal of Speech-Language Pathology, 20, 180-199.

Thank you for listening!  [email protected]  Program Manager for It Takes Two to Talk [email protected]  For more information on trainings, resources and tips sheets for parents and professionals see www.hanen.org


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