Co-Principal Investigators: Meadan, Hedda; Stoner, Julia

Purpose: Many young children who have been identified with developmental disabilities including mental retardation, Down syndrome, and autism spectrum disorders, exhibit speech-language delays along with other impairments inherent in their diagnosed disabilities. Various interventions cited in the literature target the communicative and social behavior of school-aged children with developmental delays; however, there is limited information about these types of interventions for very young children with delays. Given that there are about one million infants and children through age five receiving early intervention and early childhood special education services under the Individuals with Disabilities Education Improvement Act, and that the number of young children identified with autism spectrum disorders is rising, there is a clear need to develop interventions that can be used with this age group.

The purpose of this project is to develop and document the feasibility of an intervention to improve the social-pragmatic communication skills of young children with developmental delays. Social-pragmatic communication skills involve the ability to interpret and send appropriate verbal and nonverbal messages (e.g., eye contact, facial expressions, and body language) for successful communication exchanges in social environments. This intervention will be naturalistic, using the social context of naturally occurring interactions within everyday family activities. Because individuals with developmental delays often exhibit difficulty with generalization, strategies that promote skill generalization to untrained settings, people, and conditions (e.g., beyond the home) will be targeted.

Project Activities: In the first year, the development team will recruit, meet with, and observe participating families to develop individualized objectives, materials, and training and coaching plans. The team will develop intervention materials that will include handouts with definitions and examples for each strategy, an action plan guide, and descriptions of various intervention scenarios for discussion. In the second and third years, training materials and procedures will be refined and improved based on input from participants and consultants. When parents have successfully completed the training sessions, one member of the development team will coach the parents in the use of the specific strategies in their home environments. Researchers will code videotaped training and implementation sessions for fidelity.

Throughout the project period, researchers will interview and survey both parent participants and project consultants about the feasibility, appropriateness, and importance of the intervention strategies. Performance data on both parents' and children's behavior will be collected throughout the project to evaluate the feasibility and outcomes of the social-pragmatic skills intervention program. Researchers will also assess generalization and maintenance of the behaviors for parents and children.

Products: At the end of the project, this intervention involving parent-implemented social-pragmatic communication skills will be fully developed. It will include prototypes of all materials needed for the implementation of the intervention in home settings and strategies for implementing the intervention with diverse families. Outcome data as well as data on participants' perceptions of the feasibility, appropriateness, and importance of the strategies will be available to assess the promise of the intervention for improving social-pragmatic communication skills of young children with developmental delays.

Structured Abstract

Setting: The developing intervention will be implemented by parents in their homes in three counties in Illinois. The households will be socioeconomically, culturally, and linguistically diverse.

Population: Six to eight children, aged two to five who have developmental disabilities with limited expressive language and their parents, will be selected to participate in each of the three study years, for a total of 18 to 24 children and their parents.

Intervention: Parents will be trained in four naturalistic strategies: (1) Modeling, in which parents present verbal cues or models for their child to imitate, and provide corrective or positive reinforcement; (2) Mand-modeling, in which parents present verbal prompts in the form of a question (e.g., "What do you want?") or choice (e.g., ". . . this or that?"), or mand (e.g., "Tell me what you want"); (3) Naturalistic time delay procedures, in which parents establish joint attention with their children and then wait for their children to initiate requests, responses, or comments. Parent follow-up is prescribed, depending on their child's response (e.g., parent provides child with the desired object) or non-response (e.g., parents model request); and (4) Incidental teaching strategies, in which parents arrange children's natural environments to encourage their child to request objects, activities, or assistance. Parents respond to their child's requests with models, mands, or delays for more elaborated responses or for a target level response.

Parents will also be trained in five visual strategies that may provide cues to prompt or remind children to engage in a behavior or prepare them for an activity. These strategies include: (1) Visual schedules, such as those used to represent the order of activities during an afternoon; (2) Visuals to structure the environment, such as those that represent the place of a specific item or the task to be completed in a specific location; (3) Visual scripts, for example, scripts a child may use to calm down or ask for help; (4) Rule reminder cards, which represent rules such as putting a book back on a shelf after reading it; and (5) Visual task analysis, which involves the use of visuals that demonstrate each step of a procedure (e.g., hand washing).

Researchers will first assess parents' use of these naturalistic and visual strategies. In collaboration with parents, social-communication objectives appropriate for their children's home routines (e.g., meal time, free play) will be identified. The intervention and related materials will be individualized to meet the needs of each participating family. Parents will receive training only on those strategies for which they did not reach the mastery performance criterion in the baseline assessment.

Research Design and Methods: Researchers will use single case research methodologies. A multiple baseline design across families will be used to assess the feasibility and promise of the intervention. In addition, a multiple probe design will be used within each family with a new strategy being introduced after the prior one has been mastered. Independent and dependent variables will be recorded throughout the baseline, intervention, and post intervention phases. Observers will record the number and types of behaviors occurring within 15-second intervals.

Control Condition: There is no control condition.

Key Measures: Data on the intervention materials and procedures will be collected throughout the 3-year project from both parent participants and project consultants via qualitative interviews and surveys. In addition, observation data on both parents' and children's behavior will be collected to evaluate the feasibility and outcomes of the developed social-pragmatics skills intervention program. Standardized measures of communication and symbolic skills of young children will be administered pre-, mid-, and post-intervention. A measure of family life quality will also be administered pre-, mid-, and post-intervention.

Data Analytic Strategy: Data related to the appropriateness and importance of the strategies will be collected and analyzed qualitatively by asking parents and professionals to view intervention sessions and to give feedback on their perspective of the feasibility of intervention implementation. Interviews with these parents and professionals will be audio taped and analyzed for emergent themes.

All data collected within the multiple probe design will be analyzed using visual inspection of the graphed data. Mean, trend, magnitude, latency, and stability will be considered when analyzing change in adjacent phases as well as across all phases.

Time series analyses and effect size calculations will be conducted to compare the data from each phase of the project for each individual participant as well as the group of participants to identify changes in behavior over the course of the intervention.

Products and Publications

Journal article, monograph, or newsletter

Angell, M.E., Meadan, H., and Stoner, J.B. (2012). The Experiences of Siblings of Individuals With Autism Spectrum Disorders. Autism Research and Treatment, 2012: 1–11. doi:10.1155/2012/949586 Full text

Meadan, H., and Daczewitz, M. (2014). Internet-Based Intervention Training for Parents of Young Children With Disabilities: A Promising Service-Delivery Model. Early Child Development and Care: 1–15. doi:10.1080/03004430.2014.908866

Meadan, H., Angell, M.E., Stoner, J.B., and Daczewitz, M. (2014). Parent-Implemented Social-Pragmatic Communication Intervention: A Pilot Study. Focus on Autism and Other Developmental Disabilities , 29(2): 95–110. doi:10.1177/1088357613517504

Meadan, H., Stoner, J.B., and Angell, M.E. (2010). Review of Literature Related to the Social, Emotional, and Behavioral Adjustment of Siblings of Individuals With Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, 22(1): 83–100. doi:10.1007/s10882–009–9171–7

Meadan, H., Stoner, J.B., Angell, M.E., Daczewitz, M., Cheema, J., and Rugutt, J.K. (2014). Do You See a Difference? Evaluating Outcomes of a Parent-Implemented Intervention. Journal of Developmental and Physical Disabilities, 26(4): 415–430. doi:10.1007/s10882–014–9376–2

Stoner, J.B., Meadan, H., and Angell, M.E. (2013). A Model for Coaching Parents to Implement Teaching Strategies With Their Young Children With Language Delay or Developmental Disabilities. Perspectives on Language Learning and Education, 20(3): 112–119. doi:10.1044/lle20.3.112

Stoner, J.B., Meadan, H., and Angell, M.E. (in press). Parent Perspectives on Home-Based Intervention for Young Children With Developmental Disabilities: The Parent-Implemented Communication Strategies (PiCS) Project in Illinois, USA. Journal of the American Association of Special Education Professionals.

Stoner, J.B., Meadan, H., Angell, M.E., and Daczewitz, M. (2012). Evaluation of the Parent-Implemented Communication Strategies (PiCS) Project Using the Multiattribute Utility (MAU) Approach. Educational Assessment, Evaluation and Accountability, 24: 57–73. doi:10.1007/s11092–011–9136–0