1. The Effects of Enhanced Milieu Teaching on Children with Down Syndrome
Kelly Windsor, Megan Y. Roberts & Ann P. Kaiser
Department of Special Education, Vanderbilt University, Nashville, TN
Introduction
Children with Down Syndrome
Children with DS are characterized by deficits in their overall rate of verbal communication, the complexity and length of their utterances, their pragmatic skills in social interactions, and the quality of their speech (Roberts, Price & Malkin, 2007).
Deficits in expressive language development exceed those predicted by cognitive development (Chapman, Seung, Schwartz & Kay-Raining Bird, 1998).
Previous research has reported positive communication outcomes for children with DS, but no studies reported an observed effect on children’s spoken language or long-term productive language use (e.g., Girolametto, 1988; Fey, 2006).
Purpose of the Current Study
Extend previous research by examining the effects of Enhanced Milieu Teaching (EMT) on vocabulary and syntax when implemented with children with DS.
Research Questions
Do children with DS participating in EMT language intervention make gains in expressive vocabulary, receptive vocabulary, and syntax?
Do children with DS make greater gains when receiving the intervention from a parent?
Does change in one measure predict growth in other areas?
Methods
Research Design
Data were analyzed for 21 children with DS who participated in a randomized control trial (n=58) of EMT comparing the effects of EMT implemented by (a) therapists only, (b) parents only and (c) parents and therapists. Observations and assessments were conducted at four time points: prior to intervention (T0), at the end of intervention (T1), after 6 months (T2), and 12 months (T3).
Treatment Groups
Parent training included the therapist:
Reviewing the target strategy (didactic teaching, modeling, role playing)
Providing live coaching while the parent practiced with their child
Summarizing the session
Participants
21 children with DS between 30 and 62 months
Mean age: 48 months (SD 8.47)
Mean nonverbal IQ: 64 (SD 13.31)
62% male, 38% female
90% Caucasian, 10% African American
Mean parent education: years (SD 3.02)
Measures
Peabody Picture Vocabulary Test-III (PPVT)
Expressive Vocabulary Test (EVT)
Observations of language averaged across 3 clinic sessions (40 minutes) and 2 home generalization sessions (30 min)
Number of different words (NDW)
Mean length of utterance (MLUw)
Results
T0 to T3 Growth Across Groups
Children in all groups experienced significant growth from T0 to T3
EVT* standard score: increase of 7.8 pts
PPVT** standard score: increase of 9.8 pts
NDW** average: increase of 29 words
MLU*** average: increase of .5 words per utterance *p < .017; **p < .001; ***p < .004
Between Group Analyses
No significant between groups differences were found. Effect sizes were smallest between PT and T groups, and largest between the P and T groups. Parents in the PT group received 24 training sessions. Those children whose parents received 36 training sessions (P) demonstrated the highest improvement in language skills compared to children who only received therapist intervention (T) and those whose parents received fewer (24) sessions (PT).
Increase in NDW predicts growth in MLU
A secondary analysis was conducted to examine how increases in NDW during the study related to later utterance length (MLUw).
Gain in NDW from T0 to T1 predicted MLU at T1, T2, and T3: t=5.961(p=.00), 2.712(p=.02), and 1.856(p=.08)
These results indicate that for every 100 NDW gained during 6 months of intervention, a child gained 1 word in MLU in 6 months
Predictors of Child NDW
Conclusions
While effect size appeared to be large for the parent group compared to the therapist only group, the difference between groups was not significant, possibly due to the small sample size (7 children per group).
Children in all groups experienced significant growth in vocabulary and syntax measures, but without a nontreatment group, this must be interpreted cautiously.
Growth in NDW from T0 to T1 predicted MLU 6 months and a year following intervention.
PT v. T*
P v. PT*
P v. T*
PPVT
.05
.65
.69
EVT
.31
.37
.93
NDW
.02
.53
.52
MLU
-.08
.54
.34
* considered comparison group
Condition N
Clinic Sessions
Home Sessions
Therapist 7
36 30-minute sessions
None
Parent
30 60-minute sessions
6 60-minute sessions
Parent + Therapist
12 30-minute therapist sessions
18 60-minute parent sessions
6 60-minute parent sessions
Implications for Practice
Including parents as interventionists may have positive effects on the language skills of their children with DS, if parents are well-trained.
Participation in an EMT intervention may result in improvement in both vocabulary and syntax for children with DS; however, large gains in vocabulary may be needed to impact MLU.
Intervention should target building expressive vocabulary and number of different words used by the child in order to increase MLU.
References
Chapman, R.S., Seung, H., Schwartz, S.E., & Kay-Raining Bird, E. (1998). Language skills of children and adolescents with Down syndrome: II. Production deficits. Journal of Speech, Language, and Hearing Research, 41,
Fey, M.E., Warren, S.F., Brady, N., Finestack, L.H., Bredin-Oja, S.L., Fairchild, M., Sokol, S., & Yoder, P. J. (2006). Early effects of responsivity education/ prelinguistic milieu teaching for children with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 49(3),
Girolametto, L.E. (1988). Improving the social-conversation skills of developmentally delayed children: an intervention study. Journal of Speech and Hearing Disorders, 53,
Roberts, J. E., Price, J., & Malkin, C. (2007). Language communication development in Down syndrome. Mental Retardation and Developmental Disabilities, 13,
Enhanced Milieu Teaching Strategies
Create a context for communication (interesting activities, following the child’s lead, on child’s level, face to face)
Match communicative turns with child
Notice and respond to all child communication
Model language at the child’s “target level”
Expand child’s communication by repeating and adding only 1-2 new words
Teach in response to child requests using milieu teaching procedures: time delay, open question, choice question, and “say” prompt
More Information
This work was supported in part by NIH grant number P50 DC03282 and DOE grant number H325D The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.