Nancy J. Scherer A. Lynn Williams East Tennessee State University Ann Kaiser, Megan Roberts, Jennifer Frey, Kristin Mullins Vanderbilt University Carol Stoel-Gammon University of Washington 14 th ICPLA Conference June 27-30, Cork Ireland

 Delayed in onset of canonical babbling  Composition of babbling is less complex  Smaller consonant inventories  Poorer speech accuracy (Percent Consonants Correct)  Delayed onset and acquisition of words  Lexical selectivity ◦ Produce more words beginning with the sounds they can produce (nasals, glides, vowels) & fewer beginning with high pressure consonants ◦ Preference for sounds at the extremes of the vocal tract (labials, velars, and glottals)

 Targets both speech and vocabulary simultaneously  Is delivered in interactions that promote functional language use in meaningful contexts  Provides strategies to facilitate speech  Increases the child’s communication attempts

1. Prelinguistic Stage (birth to 1 year) 2. First Words Stage (1 year to 18 months)  Early words learned as whole units (not sequence of segments)  Consonant production variable  Active selection and avoidance strategies used 3. Phonemic Development Stage (18 months to 4 years) 4. Stabilization of the Phonological System Stage (4 to 8 years) 5. Stoel-Gammon & Dunn, 1985

Limited sound Inventory Limits vocabulary acquisition Reduces intelligibility Reduces communication attempts Reduces feedback

 Selecting specific language and speech targets appropriate to the child’s level  Arranging the environment to increase likelihood of child initiations  Prompting the child’s engagement through mirroring and mapping  Responding to the child’s initiations with prompts for elaborated language and speech accuracy  Functionally rewarding the child’s communicative attempts by providing access to desired events  Providing focused feedback regarding the form of the child’s utterance

 Time delay Least Support  Open questions  Choice questions  Model and expansions  Speech recasting Most Support  Repeating target words the child uses while emphasizing a target sound in the word

 Behavioral ◦ Prompting strategies ◦ Imitation and production practice ◦ Contingencies for child’s communicative attempts  Developmental-Social Interactionist ◦ Language learned in meaningful contexts ◦ Responsiveness of the caregiver  Parents as speech-language facilitators

Expand sound Inventory Increase vocabulary Improved intelligibility Increase communication attempts Increase and Focus feedback Target Selection EMT/PE Responsive interaction & Environmental arrangement Child Outcome

 To assess the efficacy of an early intervention “Enhanced Milieu Teaching with Phonological Emphasis (EMT/PE)” on the speech and language development of children with CLP under 3 years of age. ◦ 48 children were randomly assigned to the EMT/PE intervention or a “business as usual” control

 Speech and language measures pre and post intervention ◦ 27 children with CLP who have completed the intervention  14 children in the EMT/PE intervention  13 children in the BAU  Compare to normative speech measures ◦ 40 noncleft children at 18, 24, 30 and 36 months

 months of age  Non syndromic cleft lip and/or palate  Palate repair <13 months  Absence of sensorineural hearing loss  English is the language of the home  At least 5 words reported by parent  Able to imitate words  Recruited from 3 sites in middle and east Tennessee

EMT/PEBAU Gender Male Female Cleft Type Cleft Palate CLP Mother’s Education HS Some College College Grad Grad School

EMT/PE Mean EMT/PE SD EMT/PE Range BAU Mean BAU SD BAU Range Age Pre-TX24.3 M7.114, M7.216, 32 Age Post-TX33.4 M7.023, M7.723, 36 Mother’s Age29.5 Y4.222, Y5.221, 37 Age of Palate Repair11.5 M1.09, M1.09, 13

 Pre-Post Assessment ◦ Profiles of Early Expressive Phonological Skills (PEEPS) ◦ Preschool Language Scale-4 ◦ Language sample  Clinician-child (Play)  Parent-child (Play, book, snack) ◦ Communicative Development Inventory ◦ LENA (Weekday, weekend) ◦ Bayley Scales of Infant Development ◦ Parenting Stress Inventory ◦ Hearing screen

 EMT/PE Intervention ◦ Clinician implemented ◦ 48 sessions ◦ 5 speech targets identified from single word naming test (PEEPS) embedded in language goals ◦ 5 play activities with at least 2 targets in each session ◦ Criteria for exposure: At least 10 presentations of the targets in each play activity

 BAU Control ◦ Clinician implemented ◦ 48 sessions  Characteristics of BAU Interventions Total Children Oral Motor/ Massage SpeechLanguageOther

 Pre and post intervention assessments were compared using OLS regression models controlling for age, study group and pre intervention performance.

Outcome Measure tpEffect Size PLS4-AC *0.39 PLS4-EC *0.43 MCDI Total Words # Different Words *0.45 Word per minute MLUm LENA voc

 The EMT/PE intervention group showed significantly greater gains in ◦ Global language comprehension scores ◦ Global expressive language scores ◦ Number of different words used in conversation ◦ Greater vocabulary size rated by parents  EMT/PE intervention group used 95.8 more words

 Assesses developmentally appropriate sound production in single words ◦ consonant inventory ◦ place/manner of articulation ◦ syllable structure ◦ accuracy ◦ error patterns  months of age  Elicited with objects

 40 words  The words were selected based on ◦ age of acquisition (AOA) based on vocabulary words from the MacArthur Communicative Development Inventories ◦ phonetic characteristics to elicit target English consonants across all place, voice, and manner categories of production, as well as in different syllable structures and word position.

 Consonant Inventory ◦ Initial ◦ Medial/Final  Percent Consonants Correct  Error Types ◦ Substitutions ◦ Omissions ◦ Compensatory substitutions

Expand sound Inventory Increase vocabulary Improved intelligibility Increase communication attempts Increase and Focus feedback Consonant inventory Speech accuracy Reduced compensatory articulation Percent intelligibility # Different words Vocabulary size

 Significant changes were found in both speech and vocabulary ◦ Coherence with typical acquisition

 Our families who participated in the research  Our Vanderbilt and ETSU research teams  Our funding agency: NIDCD