Very Early Communication

Intervention for Infants Born with NAS & Their

Mothers

CHI RP

THE COMMUNI CATI ON OF HI GH-RI SK

I NFANTS RESEARCH PROGRAM

Thanks!

• ETSU, Research Development Committee Grant: 15-026M• Collaborative support from Families

Free, especially Lisa Tipton & Judy Clark• Graduate Assistants:• Kristi Moore• Kaitlyn Turney• Kara Costner

CHI RP

THE COMMUNI CATI ON OF HI GH-RI SK

I NFANTS RESEARCH PROGRAM

Purpose• To pilot a very early communication intervention program with 8

babies who were born with NAS, aged 4-10 mos, and their mothers.

Specific Aims• To develop supplementary materials and modify the Hanen

Program, It Takes Two to Talk® (Manolson, 1983) to specifically

target communication and interaction between the babies and their mothers

• To measure and analyze mothers’ facilitating communication behaviors

• To measure and analyze babies’ prelinguistic communication behaviors

• To measure and analyze frequency and duration of turn-taking between mothers and their babies

• To measure and analyze mother-baby attachment and temperament

The Basic Intervention Program

• 2 Assessment Sessions• 12 Responsive Education/Prelinguistic Milieu Treatment

Sessions (Yoder & Warren, 2002)• 2 Final Assessment Sessions• Responsive Education • Based on the It Takes Two to Talk® program (Manolson,1983). • Being modified in consultation with the developer and

publisher, the Hanen Centre, to focus more intensely on prelinguistic communication.

• Prelinguistic Milieu Treatment• It focuses on establishing foundational communication skills

that develop before babies start talking (e.g., Fey et al., 2006; Warren et al., 2008; Yoder & Warren, 2002)

Responsive Education with Mothers

• First half-hour, SLP works with mom individually• Videos, role-play, handouts and

worksheets• Examples of the topics includes: • Observing how and why your child

communicates• You make the difference• Allow your baby to lead• Adapt to share the moment• Add language to the interaction• Daily routine talk• Play the 3A way• Moving forward with music, rhythm &

rhyme

Prelinguistic Milieu Treatment with Babies• First half-hour, graduate students trained in PMT

work with the baby individually on selected goals• Examples of communication targets:• To communicate for a purpose• To use gaze, gestures and vocalization to communicate• To pay attention to people and toys with someone else• To take turns in play routines• To imitate sounds & gestures• To babble

Coaching and Practicing All Together

• In the last half hour of the session, the speech-language pathologist coaches the mother while she practices the techniques and strategies taught earlier in the session.• Model, offer suggestions during the interaction,

reinforce correct use of techniques, use video-feedback, debrief, set “homework”.

Recruitment & Research Design• Mothers and their babies are referred to the basic intervention

program through Families Free based on their counsellors’ judgment about their readiness for the program• All mothers receive the intervention regardless of their

choice to participate in the research component• Babies must be 10 months of age or less at the beginning of

the intervention• Early exploratory single subject multiple baseline design• 2 sessions/weeks of pre-intervention baseline testing• 12 sessions/weeks of intervention• 2 sessions/weeks of post-intervention baseline testing• 2 sessions/weeks of maintenance testing, 12 weeks after

the final intervention session

Data Collection• Infant Social and Communication Behavior Scales (Cress, 2014)• MacArthur-Bates Communication Development Inventory (Fenson

et al., 1993)*• Mullen Scales of Early Learning (Mullen, 1995)• Mini-MBQS (Moran, 2009)*• Infant Behavior Questionnaire (Rothbart, 1981)* • Adult Temperament Questionnaire (Derryberry & Rothbart, 1988)*• 10-15 minute mother-baby videos of daily living and play

activities: Pre-intervention, During Intervention*, Post-Intervention, Maintenance*

• Mothers’ and babies’ demographic, health, and developmental histories

* Additionally collected for the research study

Independent Variables

Mothers• Age, education, SES, prenatal & current substance use,

temperament

Babies• Age, gestation, birth weight, NAS recovery history,

neurodevelopmental diagnosis, temperament

Dependent VariablesMothers• Communication and Interaction:• Overt interpretation of infants’ behaviors, linguistic mapping,

directiveness, responsiveness, use of questions, wait time, and prompting• Attachment and BondingBabies• Communication and Interaction• Rates of potential and actual protoimperatives, protodeclaratives,

communicative acts, gestures, gaze shifts, joint attention, vocalizations, reciprocal vocalizations, and canonical vocalizations

• Receptive and expressive vocabulary size • General Developmental LevelsMothers & Babies • Interaction• Frequency, duration of reciprocal turn-taking during daily & play routines

ReferencesCress, C. (2014) Infant Social and Communication Behavior Scales). In development.Derryberry , D. & Rothbart, M. K. (1988). Arousal, affect, and attention as components of temperament.

Journal of Personality and Social Psychology, 55, 958-966.Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates ,E., Hartung, J. P., et al. (1993). MacArthur Communicative

Development Inventories. San Diego, CA: Singular Publishing Group.Fey, M. E., Warren, S. F., Brady, N., Finestack, L. H., Bredin-Oja, S. L., Fairchild, M., et al. (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, 526-548.Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An

intervention study. Journal of Speech and Hearing Disorders,53,156-167Girolametto, L., Pearce, P. & Weitzman, E. (1996).The effects of focused stimulation for promoting vocabulary in

children with delays: A plot study. Journal of Childhood Communication Development, 17, 39-49.Manolson, A. (1983) It Takes Two to Talk. Toronto, ON: The Hanen Program.Moran, G. (October, 2009) Mini-MBQS . Retrieved http://Works.bepress.com/gregmoran/49 Mullen, E. M. (1995).Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Services, Inc., Rothbart, M. K.(1981). Measurement of temperament in infancy. Child Development, 52, 569- 578. Tannock, R., Girolametto, L., & Siegel, L. (1992). Language intervention with children who have developmental delays: Effects on an interactive approach. American Journal of Mental Retardation, 97, 145-160 Warren, S. F., Fey, M. E., Finestack, L. H., Brady, N. C., Bredin-Oja, S. L., & Fleming, K. K. (2008) A randomized

trial of longitudinal effects of low-intensity responsivity education/prelinguistic milieu treatment. Journal of Speech, Language, and Hearing Research, 51, 451-470.

Yoder, P. & Warren, S.F. (2002). Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 45, 1158-1174.