Nancy J. Scherer A. Lynn Williams

East Tennessee State University Ann Kaiser, Megan Roberts, Jennifer Frey,

Kristin Mullins Vanderbilt University

Carol Stoel-GammonUniversity of Washington

14th ICPLA ConferenceJune 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 used3. Phonemic Development Stage (18 months

to 4 years)4. Stabilization of the Phonological System

Stage (4 to 8 years)5. Stoel-Gammon &

Dunn, 1985

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

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

15-36 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/PE BAU

Gender Male Female

86

85

Cleft Type Cleft Palate CLP

212

211

Mother’s Education HS Some College College Grad Grad School

4631

1552

EMT/PE Mean

EMT/PESD

EMT/PERange

BAUMean

BAUSD

BAURange

Age Pre-TX 24.3 M 7.1 14, 32 26.6 M 7.2 16, 32

Age Post-TX 33.4 M 7.0 23, 35 34.7 M 7.7 23, 36

Mother’s Age

29.5 Y 4.2 22, 35 29.6 Y 5.2 21, 37

Age of Palate Repair

11.5 M 1.0 9, 12 11.1 M 1.0 9, 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

Speech Language

Other

13 12 8 2 4

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

Outcome Measure

t p Effect Size

PLS4-AC 2.02 0.043* 0.39

PLS4-EC 2.59 0.021* 0.43

MCDI Total Words 1.17 0.26 0.40

# Different Words 2.31 0.048* 0.45

Word per minute

0.88 0.40 0.32

MLUm 0.26 0.80 0.05

LENA voc 0.25 0.81 0.10

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

18-36 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

Consonant inventorySpeech accuracyReduced compensatory articulation

Percent intelligibility

# Different wordsVocabulary 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