int. j. language & communication disorders, 1998, vol. 33, no. 3, 281–303
EYcacy of a parent-implemented early
language intervention based on
collaborative consultation
Teresa A. Iacono†, JeV B. Chan‡ and Rebecca E. Waring§
† Macquarie University, Sydney, Australia
‡ The Spastic Centre of NSW, Sydney, Australia
§ La Trobe University, Melbourne, Australia
(Received April 1997, accepted August 1997)
Abstract
A group of Ž ve preschool children with developmental disability and their
mothers participated in a study into the eYcacy of a parent-implemented
language intervention. Each parent was included in the team as a consultee,
with a speech pathologist and special educator acting as consultants within a
collaborative consultation process. Treatment for each child was developed
using this process, with speciŽ c strategies to increase language production skills
decided by the team. Strategies were used within an interactive model of early
language intervention. The eVectiveness of treatment was determined within a
multiple baseline design. For three children, the impact of treatment was evident,
but the results were not replicated for the other two children. Descriptive
analysis of mothers’ communicative behaviours indicated that, following treatment, they tended to direct more utterances to their children, used more models,
fewer questions and directives, and more (although limited) teaching strategies.
Keywords: collaborative consultation, developmental disability, language intervention, mother–child interaction.
Introduction
A number of advantages have been proVered for teaching parents to implement
their children’s language intervention. Kaiser (1993), for example, argued that this
practice is likely to enhance generalization of newly learned skills through the
continuation of intervention into a child’s daily activities. This consideration has
particular relevance if skills are taught in artiŽ cial settings, such as clinics, from
which generalization can be problematic (Fey 1986). Kaiser (1993) also suggested
that parent-implemented interventions are likely to facilitate children’s social communication skills because the speciŽ c techniques are often based on characteristics
of normal mother–child interactions (e.g. Cross 1977, Snow 1984). Finally, Kaiser
(1993) argued that parent involvement may have lasting eVects beyond the immediate
goal of improving the child’s communication skills because ‘diVerent and more
Address correspondence to: Teresa Iacono PhD, School of English, Linguistics and Media, Macquarie
University, Sydney, Australia 2109.
1368-2822/98 $12·00
© 1998 Royal College of Speech & Language Therapists
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T. A. Iacono et al.
positive social communication interaction patterns may be established’ (p. 64);
however, she did not discuss the nature of these eVects. Some disadvantages of
parent training also have been noted. Hemmeter and Kaiser (1994), for example,
reported that training parents, in particular to use didactic techniques, has been
criticized for disrupting the parent–child relationship by placing the parent in the
role of instructor.
Despite criticisms, a review of research into early language intervention indicates
a strong interest in involving parents as direct intervention agents. In particular,
two approaches have been the focus of research: these are the ‘interactive model’
(Tannock and Girolametto 1992) and ‘milieu teaching’ (Kaiser et al. 1992). Both
approaches use naturalistic strategies, thereby sharing features such as following a
child’s lead, organizing the environment to provide communication opportunities,
focusing on the child–adult conversational dyad, and providing linguistic models.
There are, however, important features diVerentiating the approaches. Milieu teaching incorporates direct behavioural techniques, whereby linguistic forms are directly
elicited from the child and followed by natural consequences (Kaiser et al. 1992).
In contrast, within the interactive model, no operant procedures are used (Tannock
and Girolametto 1992). The targeting of speciŽ c communication or language skills
occurs in one version of this model, focused stimulation, but not in the general stimulation
version (Girolametto et al. 1996). Hemmeter and Kaiser (1994) noted that the
diVerences in milieu teaching and the general stimulation version of the interactive
model centre on their outcome foci. Interactive procedures (referred to as ‘responsive interaction’ by these authors) are used with the aim of increasing adults’
responsiveness to a child’s communication, thereby increasing opportunities for
providing models appropriate to the child’s focus of attention. In comparison,
milieu procedures are used to target spontaneous use of new language in functional
contexts.
The interactive model appears to have emerged from concern that parents of
children with disabilities tend to be directive and non-responsive, causing them to
ignore their children’s communicative attempts (Mahoney and Powell 1988). The
long term eVect of this style is thought to be delayed communication development.
Operating within the interactive model, Mahoney and Powell (1988) taught a large
group of parents (41) to use a more responsive style, discouraging the use of
didactic techniques, with their children with varied disabilities whose ages ranged
from 2 to 32 months. They demonstrated that, after the intervention (which lasted
between 5 and 41 months), parents had reduced their interactional dominance and
directiveness while increasing their responsiveness. Based on the results of correlational analyses of their data, they also claimed that the changes in the parents’ styles
were related to the children’s developmental gains. However, the nature of these
gains could not be speciŽ ed because a fairly global measure of development was
used. Girolametto (1988) criticized attempts to claim gains in child communication
as a result of teaching parents to implement interactive procedures since most
research in the area had failed to employ control groups, relying instead on
correlations amongst measures or simple comparisons of pre- and post-assessments.
In an attempt to redress this shortcoming, Girolametto (1988) compared control
and experimental groups of children with developmental disability in a study utilizing
interactive procedures. He demonstrated treatment eVects for the mothers of
children in the experimental group as evidenced by their increased responsiveness.
However, improvements in the children’s social communication skills varied, with
Parent-implemented intervention
283
some initiating and responding more in conversational interactions with their
mothers than others, whereas no signiŽ cant diVerences from control group children
were obtained for language measures. In a further study, Tannock et al. (1992)
taught mothers of children with developmental delays to use interactive procedures.
They failed to Ž nd diVerences in either social communication or language measures
between children in the treatment and control groups.
According to Tannock et al. (1992), interactive model procedures may enhance
children’s use of behaviours already in their repertoires, but they have not been
demonstrated to be eVective in teaching new language forms. It may be that
children, at least at very early stages of language development (prelinguistic to single
words), may beneŽ t from a more directive approach (Girolametto 1988, Tannock
and Giromaletto 1992, Tannock et al. 1992), such as focused stimulation, whereby
parents are taught to use ‘frequent, highly concentrated presentations of preselected
language targets’ (Girolametto et al. 1996, p. 1275). The eVectiveness of this version
of the interactive model was investigated by Girolametto et al. (1996). Parents were
trained to use focused stimulation to target vocabulary with their young children
with expressive language delays. The children demonstrated gains in both targeted
and non-targeted vocabulary, and in the use of multiword utterances, which were
not evident in a group of control children.
The interactive model is reportedly well-suited to parents’ natural styles
(Mahoney and Powell 1988, Yoder and Davies 1990). However, in an eVort to
maximize the potential for teaching new language structures, researchers have
incorporated more didactic procedures as used in milieu teaching. Such procedures
have been demonstrated to be eVective in teaching semantic combinations (e.g.
Warren and Bambara 1989, Warren and Gazdag 1990), prelinguistic skills (Warren
et al. 1993), and general productive language and communication (Alpert and Kaiser
1992, Kaiser and Hester 1994). In addition, studies using milieu teaching have
demonstrated generalization to untrained targets (Warren and Gazdag 1990) and
use of new language skills with new interactants, settings and materials (Kaiser and
Hester 1994, Warren et al. 1994).
The enhanced milieu teaching (EMT) approach, developed by Kaiser (1993),
utilizes key features of the interactive model and milieu teaching, in particular the
use of environmental arrangement and incidental teaching, within a responsive
conversational style (Kaiser and Hester 1994). In two studies using this approach
within multiple baseline designs (Hemmeter and Kaiser 1994, Kaiser and Hester
1994), parents of children with language delays were taught to implement the three
components of EMT to criterion levels. The parents’ use of EMT was found to be
associated with children’s gains in target language skills (e.g. semantic combinations
and speciŽ c morphemes), intentional communication and number of words used.
In addition, Hemmeter and Kaiser (1994) demonstrated increases in the children’s
MLUs (a Ž nding not obtained by Alpert and Kaiser 1992), maintenance of the
children’s gains and generalization across interactants and settings. These parent
and child gains were obtained in relatively brief periods of intervention (e.g. 17–24
sessions in the Hemmeter and Kaiser (1994) study). Finally, Hemmeter and Kaiser
(1994) found that parents reported high levels of satisfaction with the intervention
procedures and their children’s gains.
Involvement of parents in their children’s intervention is thought to oVer
parents some sense of empowerment, since they become an integral part of the
intervention team. However, the use of parents as intervention agents has been
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T. A. Iacono et al.
criticized for failing to take into account parental needs or desires and for ignoring
the functioning of the child with a language delay within the family unit (Barber
et al. 1988). In addition, approaches such as milieu teaching and the interactive
model would seem to be based on an implicit assumption that the interactive styles
of parents are problematic, at least in terms of failing to facilitate their children’s
communication development. There are a number of problems with this assumption.
First, variations both within and across parents (Price 1989) in their interaction
styles would suggest that the identiŽ cation of the exact behaviours that may require
modiŽ cation could prove a diY cult task. Second, although responsiveness and
directiveness have been speciŽ c behaviours most frequently targeted, Tannock and
Girolametto (1992) noted a lack of information on what might be appropriate levels
of these behaviours. In relation to this last point, early suggestions that parents of
children with disabilities may be ‘overly’ directive, to the detriment of their children’s
language development, have been criticized in light of research suggesting that this
style is appropriate with prelinguistic children (see Price 1989, Marfo 1992, Tannock
and Girolametto 1992).
Unlike the previous studies reviewed, the present study was based on the
premiss that the participating parents were using strategies facilitative of their child’s
communication, requiring simply more speciŽ c strategies or ‘Ž ne tuning’ of those
used. To this end, speciŽ c strategies already used by parents were identiŽ ed and
encouraged if they were those described in the literature as being facilitative of
children’s communication. In addition, the study aimed to evaluate an intervention
that utilized parent training within an approach that aVorded the parents a sense
of equal partnership with professionals. It was felt that true empowerment was
possible only if the parents were included as equal participants with professionals
on their child’s intervention team. This principle was based on family-centred
practices (Bailey and McWilliam 1993), which incorporate a collaborative consultation approach to intervention. Using collaborative consultation, professionals and
parents work together as equal participants on problem-solving activities relating
to their concerns about a target child’s problem (Coufal 1993).
Coufal (1993) described collaborative consultation as ‘a systematic process of
planning and problem solving that involves team members from diverse backgrounds’ (p. 1). Research into this approach has focused on services provided by
specialists to school-aged children (Friend and Cook 1992, Coufal 1993). Language
intervention involving collaboration between speech pathologists, teachers and
parents has been advocated for a number of years as being an eVective way of
delivering speech pathology services and utilizing naturalistic procedures that focus
on the interactions between children and the adults with whom they have daily
contact (Coufal 1993). Wilcox et al. (1991) demonstrated that classroom interventions
based on consultation and co-operation between a clinician and teacher is at least
as eVective as clinician-delivered individual therapy outside the classroom in promoting lexical acquisition in preschool children with language delays. The advantage of
the classroom-based approach was that it was more likely to lead to immediate
generalization of skills to the home setting. Unfortunately, no research to date has
attempted to implement a more collaborative approach to consultation, utilizing
discussions focusing on problem solving (Friend and Cook 1992), either with
parents or teachers of children with language delays.
The present study evolved as a result of problems experienced within an early
intervention programme in accessing what parents believed to be eVective speech
Parent-implemented intervention
285
pathology services. These services were limited to infrequent input by a speech
pathologist using a consultative approach and, sometimes, individual treatment for
a few children. The parents in this programme believed that intensive individual
therapy was necessary to eVect gains in their children’s communication skills. This
belief was also given as a rationale motivating the study of Wilcox et al. (1991) and
has been noted by other early intervention researchers (McWilliam 1993). Although
a comparison of classroom and individual intervention was not possible in light of
available resources and practical limitations of the present study, the aim was to
demonstrate the eYcacy of an intervention that was both classroom-based and,
ultimately, parent-implemented, a combination that has not been evaluated in the
literature. The intervention was based on two approaches:
(1) Collaborative consultation with the parents as the direct change agents
(Friend and Cook 1992).
(2) The use of naturalistic strategies, based on principles of both the interactive
model and milieu teaching, as characterises EMT (Kaiser 1993), which was
already in use within the general early intervention programme in which
the children and parents participated.
The speciŽ c hypothesis was that children would increase their productive
language as a result of the treatment. The hypothesis was general as a result of the
collaborative consultation model, since the speciŽ c structures taught to each child
would be determined by a parent–teacher–clinician team. An additional aim of the
study was to describe parent-child behaviours during interactions and to determine
if changes, particularly in speciŽ c teaching strategies, occurred across pretreatment
and treatment sessions.
Method
Subjects
All subjects were involved in a university-based early intervention programme
(details are provided below). All children and parents attending a morning group
were included in the study. The group consisted of four males and one female aged
from 254 to 357 (mean=254), with diagnoses of Down syndrome (three subjects)
and developmental disability (two subjects). Developmental age was obtained by
administering the Vineland Adaptive Behaviour Scale (VABS) (Sparrow et al. 1984) and
ranged from 155 to 158 (mean=156). The VABS also yielded Adaptive Behaviour Composite Standard Scores, which ranged from 50 to 65 (mean=59·2).
Comprehension was assessed by use of the Reynell Developmental Language Scales—
Revised (RDLS-R) (Reynell and Huntley 1987) and indicated that language comprehension ages ranged from 158 to 250 (mean=1510) and standard scores ranged
from Õ 3·0 to Õ 1·1 (mean=Õ 1·9). In addition, the MacArthur Communicative
Developmental Inventory (CDI) (1989) was completed by a parent and indicated that
comprehension vocabularies ranged from 206 to 279 words (mean=230), and
production vocabularies ranged from 14 to 72 words (mean=33) (production
represented spoken and signed words).
The children also participated as subjects in a study investigating the eYcacy
of the use of structured ‘communication temptation’ procedures (Wetherby et al.
1988) in comparison with unstructured play to sample pragmatic and language skills
(Iacono et al. 1996). The pre-intervention assessment was administered at the same
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T. A. Iacono et al.
time as the structured and unstructured procedures. The results (with information
from the structured and unstructured conditions collapsed) are included here to
provide additional information on the children’s communication skills.
All subjects produced requests and comments, using mostly gestures and vocalizations, with some use of spoken words and signs. Individual subject data is
presented in table 1. Inspection of this table indicates that the subjects demonstrated
comprehension skills on the RDLS-R (Reynell and Huntley 1987) that exceeded
their developmental levels as measured on the VABS (Sparrow et al. 1984). Despite these comprehension skills and, in some cases, sizeable vocabulary in sign or
speech as reported on the CDI (1989), the subjects demonstrated a tendency
to use prelinguistic levels of communication when spontaneously requesting and
commenting.
The mothers of the children who attended the early intervention programme
participated in the study with their children. Demographic information in the
records of the early intervention programme indicate that the families were from
middle to upper middle class backgrounds.
General early intervention programme
The children and their mothers attended the general early intervention programme
two mornings per week (Tuesdays and Wednesdays). Fathers were also welcome to
attend sessions, but were rarely available to do so. The morning programme ran
for 2·5 hours, during which time the children were involved in group indoor and
outdoor activities (including free play and structured teacher-directed activities),
some individual work with teachers (on Ž ne motor, gross motor and communication
skills), and enjoyed a snack. Parents joined the children in the classroom for some
activities and observed via a one-way window at other times. Teachers utilized both
didactic (during individual sessions) as well as incidental teaching strategies (during
less structured activities). Parents were also encouraged to use incidental teaching
strategies with their children.
Table 1. Details of subjects performance on assessment measures
MCDI
Subject
CA
VABS
RDLS-R
Comp
Prod
Request
Comments
Bob
357
155
159
206
20
28
10
Nell
258
158
250
215
14
6
7
Brian
Jon
257
350
156
157
158
1510
211
279
18
43
8
22
13
16
Tim
254
156
159
241
72
1
7
Predominant
modality†
gestures,
vocal
gestures,
vocal
vocal, sign
gestures,
vocal
gestures,
vocal, sign
CA = Chronological age; VABS = Vineland Adaptive Behavior Scales (Sparrow et al. 1984); DA =
Developmental age; MCDI = MacArthur Communicative Developmental Inventory (1989); Comp=comprehension; Prod=production; Vocal=vocalizations.
†Predominant modality was based on the modalities used during sampling of pragmatic behaviours.
Parent-implemented intervention
287
Design
A multiple baseline design across three subjects, with repetition across two subjects,
was used to determine treatment eVects. All children received three baseline sessions minimally, with the beginning of intervention staggered across the children.
Following baseline, intervention continued over a maximum of 14 weeks (two
sessions per week). The independent variable was the parent-focused treatment,
and the dependent variable was the number of linguistic units (words, signs or
symbols) produced by the children. In addition, parent behaviours during baseline
and treatment conditions were analysed descriptively.
Procedures
Setting and materials
All baseline and treatment sessions were conducted within the early intervention
programme. Sessions were videotaped using a Panasonic VHS M7 movie camera
operated by a research assistant who followed the participants as they moved
between activities within the indoor or outdoor areas.
Pre-baseline assessment
Each mother and child dyad was videotaped during 15 minutes of free play activity.
The mothers were instructed to interact with their children as they would usually
during free activity time. These sessions were videotaped and transcribed. Each
transcription was then reviewed by the Ž rst investigator who coded both mother
and child behaviours in an eVort to determine each participant’s interaction
strategies and styles.
Baseline
During baseline, each mother and child was videotaped during 10 minutes’ interaction during their attendance in the early intervention programme. The mothers
were asked to interact with their children during free play. No other instructions
were given.
Treatment
The treatment combined a collaborative consultation approach and elements of
interactive and milieu teaching procedures, implemented across three stages. The
Ž rst stage was a collaborative consultation meeting between each mother (i.e.
separate meetings occurred for each mother–child dyad), who acted as the consultee
and therefore the direct change agent, a speech pathologist (second investigator)
and the child’s early intervention teacher, both of whom acted as consultants.
During this meeting, which occurred after the third baseline session and before the
Ž rst intervention session, the results of the child’s assessment (as detailed above)
were provided in a written summary and discussed by the team. The written
summary also detailed the type of learning strategies used by the child as determined
from analyses of data collected during all assessments. The mother’s style was also
discussed in terms of the strategies she appeared to be using with her child. A list
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T. A. Iacono et al.
of strategies was included at the end of the summary which aimed to build on the
child’s learning style and to Ž ne-tune strategies used by the mother. As an example,
one mother was found to comment frequently on her child’s activities, thereby
providing language models. However, she had a tendency to use ‘indeŽ nite’ terms
(e.g. ‘you put that one over here’). One strategy for this mother was to include more
speciŽ c terms (e.g. ‘you put the big truck next to the bridge’) in her comments.
The team members then discussed their concerns about the child’s communication and listed possible target goals. For each child, the general goal was to increase
language use, in particular vocabulary. However, no speciŽ c structures were targeted.
Methods used to increase language production, including augmentative and alternative communication (AAC) strategies (Reichle et al. 1991, Beukelman and Mirenda
1992) (e.g. the use of signs or symbols to provide linguistic models related to the
child’s activity or focus of attention), were discussed. The team then decided on
speciŽ c aims (e.g. increasing signs, use of symbols or spoken words) and potentially
useful strategies; here, the parent’s belief about what was most appropriate for her
child and what she was most comfortable with was of primary consideration. The
types of strategies used across parents included those described by Price (1989) as
based on the ‘responsiveness’ hypothesis and included: following the child’s lead,
creating opportunities for the child to take turns within ongoing activities that had
become part of the routine in the programme, and providing language models
relating to the child’s focus of attention (Tannock and Girolametto 1992).
In the second stage of treatment, which occurred over the Ž rst to Ž fth treatment
session for each child, sessions were conducted involving the child, mother, speech
pathologist and teacher. Only one adult interacted with the child at a time, with
the other two adults observing and providing occasional suggestions. The speech
pathologist used these sessions to demonstrate teaching strategies, as requested by
either the mother or teacher. His direct involvement was reduced over the Ž ve
sessions, until Ž nally, he observed only, providing feedback upon the mother’s
request.
The third stage of treatment was implemented following the third treatment
session (and therefore overlapped with the second stage by two sessions). Another
collaborative consultation session was held, during which a videotape of one of the
previous treatment sessions was observed. Here the team used the video to discuss
(a) strategies that appeared to be useful in facilitating the child’s communication,
in particular the use of words (in speech, sign or symbol modalities); and (b)
methods of further facilitating the child’s communication. This session was also
used to discuss concerns of any member of the team.
The remainder of the treatment consisted of having the speech pathologist
available to provide feedback and model strategies, but only if requested to do so
by the parent. By this stage, the teacher’s participation had become less frequent
as she became more involved in earlier treatment stages of other children in the
study. All treatment sessions were of 10 minutes’ duration and were videotaped by
a research assistant, or during the latter stages of each child’s treatment, by the
speech pathologist. As with baseline sessions, all treatment sessions (and the collaborative consultation meetings) occurred during the mother and child’s scheduled
time in the early intervention programme. The mothers were encouraged to utilize
the treatment procedures outside the actual treatment sessions (although it was not
possible to obtain data on the extent to which this occurred). The teachers were
instructed not to utilize any treatment strategies that they had not used with each
Parent-implemented intervention
289
child prior to the study outside the treatment sessions, until a child had reached
the intervention phase of the study. However, each teacher’s opportunity to interact
with each child was limited to the actual intervention sessions, since at other times
they were involved in group activities or other children’s interventions.
Data analysis and coding
All baseline and treatment sessions were fully transcribed by the speech pathologist
(second investigator). Child vocalizations and spoken words were transcribed phonetically and gestures and use of signs and symbols were indicated. Linguistic units,
deŽ ned as the use of spoken words, signs or symbols (produced spontaneously or
imitated), were tallied for each session. Word combinations, which occurred infrequently, were counted according to the number of individual words contained,
unless there was evidence to suggest that the combination was a routine phrase.
The latter was determined by examining whether the words used in the phrase
occurred on their own or in combination with other words. The number of linguistic
units constituted the dependent variable. In addition, each child’s gestures and
vocalizations were tallied for each session to provide further information on
communicative behaviour.
For the Ž rst three baseline sessions and Ž nal three treatment sessions, utterances
produced by each mother, which were directed to the subject, were coded and
tallied. These sessions were chosen to ensure that comparisons could be made
according to an equivalent number of sessions, given that the length of baseline
and treatments varied across subjects according to the multiple baseline (MBL)
design. In an attempt to describe parent behaviours as completely as possible,
categories obtained from a review of literature on mother–child interaction (for
children with and without disabilities) were used to code mothers’ utterances (see
the Appendix). These categories were as follows:
E
E
E
E
E
Total questions, which were also categorized according to type (yes/no,
‘Wh’, tag, intonation) and then according to their function (requests for
conŽ rmation, requests for information, request for a choice, requests for
speciŽ c structures, models, mand-models).
Models (i.e. those not in a question form).
Directives.
Redirectives.
Total use of speciŽ c teaching strategies.
These were then further categorized (imitation of child, cross-modal imitation
of child, imitation with expansion, expectant pause, closure, sign/symbol prompt,
gesture prompt, sound prompt). The deŽ nition of these categories and literature
sources, where relevant, are presented in the Appendix.
Reliability
Approximately 2–3-minute samples from randomly selected tapes of baseline and
treatment sessions for each subject (15% of tapes) were transcribed (for word
glosses or, in the case of word approximations and vocalizations, phonetic transcriptions, and gestures) and coded for child productions and categories for mothers’
utterances by the Ž rst researcher. Agreements with the original transcriber (the
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T. A. Iacono et al.
second researcher) and coder were tallied, divided by agreements plus disagreements
and multiplied by 100 to determine percentage agreement. For transcription of
mother’s utterances and children’s word and word approximations (based on phonetic transcriptions) and gestures, agreement ranged from 72% to 91·0% (mean
82·5%). For coding, agreement ranged from 72.2% to 88·9% (mean 82·8%).
Results
A major problem encountered when conducting the study was that it was not
possible to collect data as frequently as desired within a single-case design (Barlow
et al. 1984). Since the early intervention sessions were only of 2 hours duration, 2
days per week, there were often large gaps between individual subject sessions.
Long intervals between sessions were also caused by students becoming ill or
families taking holidays. In addition, since it was necessary to complete the study
within a 14-week period (as a result of funding limitations and changes that were
to occur within the programme), it was not possible to continue with subjects who
had received relatively few treatment sessions. Short of excluding certain subjects
from the study, there appeared to be no solution to this problem if the study was
to be completed during the school year. Consideration of the potential for this
methodological problem results in variability in the data attributable to extraneous
variables (Barlow et al. 1984) and is therefore warranted when interpreting the data.
Child productions
The results for Bob, Nell and Brian, are presented in Ž gure 1 and for Jon and Tim
in Ž gure 2. Overall, treatment eVectiveness in terms of more frequent production
of linguistic units was demonstrated with Bob, Nell and Brian (Ž gure 1), but this
was not replicated for Jon and Tim (Ž gure 2). Inspection of Ž gure 1 indicates that
Bob and Nell demonstrated zero or near zero production of linguistic units during
baseline, but signiŽ cant improvement (though somewhat variable for Bob) was
demonstrated during treatment. For Brian, the pattern was less clear, since levels at
14 and 9 productions, which occurred early in baseline, dropped somewhat and
remained low during the remainder of baseline, increasing (though as with Bob,
not consistently) during treatment. Inspection of Ž gure 2 indicates that the failure
to duplicate treatment eVects was evident in Jon’s production of words remaining
similar to baseline levels during treatment (except for one session, in which productions were at an extremely high level) and Tim’s increases in productions beginning
in baseline and continuing to some extent in treatment. Since no increases in the
dependent variable was discernible for these two subjects, a post hoc decision was
made to examine Jon and Tim’s vocalizations and gestures (Ž gure 3) to determine
potential treatment eVects on the frequency of their non-linguistic communicative
behaviours. It is apparent from Ž gure 3 that Jon’s gestural productions did increase
over baseline levels during the latter part of treatment, but that vocalizations
remained similar to baseline levels. In light of the large gap between treatment
sessions (occurring because of the problems noted above and Jon’s absence from
the programme for a number of days), it is impossible to exclude factors such as
maturation as reasons for Jon’s increased vocalizations. Tim’s pattern of steadily
increasing productions observed with linguistic units also were evident in his use
of vocalizations and gestures.
Parent-implemented intervention
Figure 1. Frequency of linguistic unit productions for Bob, Nell and Brian.
291
292
T. A. Iacono et al.
Figure 2. Frequency of linguistic unit productions for Jon and Tim.
The interventions used with the subjects included AAC systems, in particular
signs and, for Bob and Jon, symbols. However, most of the mothers indicated their
priority was for their children to use speech, and that they saw AAC as providing
temporary modalities. The modalities used for the production of linguistic units
(words) was analysed, with the results presented in Ž gure 4 (Bob, Nell and Brian)
and Ž gure 5 ( Jon and Tim). Inspection of these Ž gures indicates that, for Bob, Nell
and Tim, speech became the dominant modality by the end of treatment, whereas
for Brian and Jon, sign was the dominant modality both during and at the end of
treatment.
Parent strategies
Means for the Ž rst three baseline and Ž nal three treatment sessions, respectively,
were calculated for the behaviours coded and tallied for each mother. These means
Parent-implemented intervention
293
Figure 3. Frequency of vocalizations and gesture productions for Jon and Tim.
are presented in table 2. The data for each mother in table 2 indicates that only
one mother decreased the number of child-directed utterances produced, whereas
the other mothers increased their productions, and in some cases quite substantially
(e.g. Bob and Tim’s mothers). The proportion of utterances containing questions,
models, directives and speciŽ c teaching strategies were determined by (a) tallying
these for each session, (b) dividing the tally by the number of utterances for each
session and multiplying by 100 to obtain a percentage, and (c) determining the
mean of these percentages across the three baseline and the three treatment sessions.
As is evident from table 2, four mothers reduced their proportional use of questions
while one mother ( Jon’s) increased her use only slightly. All mothers increased
their use of models from baseline to treatment while reducing their use of directives.
Data for the use of redirectives are not presented in table 2 because they occurred
with less than 1% frequency across mothers during baseline and intervention
294
T. A. Iacono et al.
Figure 4. Modalities used for linguistic units by Bob, Nell and Brian.
Parent-implemented intervention
295
Figure 5. Modalities used for linguistic units by Jon and Tim.
Table 2. Types of utterances† used by mothers during baseline and intervention
Bob
Total utts
Questions
Models
Directives
Strategies
Nell
Brian
Jon
Tim
B
T
B
T
B
T
B
T
B
T
18
54
25
15
1
97
25
40
8
35
48
43
30
28
1
111
41
49
11
6
119
35
38
28
4
85
24
60
12
12
64
22
48
18
8
109
26
57
8
12
47
32
46
14
6
127
22
52
8
29
†Figures are for frequency data for total utterances, and percentage data for other categories.
B =baseline; T =treatment; Utts=utterances.
296
T. A. Iacono et al.
sessions. Finally, all mothers increased their overall use of speciŽ c teaching strategies,
with quite large increases evident for two mothers (Bob and Tim’s).
Further qualitative analyses of questions was conducted to determine the types
and functions of the mothers’ questions. The mean proportions of each question
type and their function are presented in table 3. These proportions were obtained
by calculating the mean percentage for each type and function of total questions
across three baseline and the Ž nal three treatment sessions, respectively, for each
mother. It is evident from table 3 that the relative use of various sentence types
was similar across baseline and treatment. Overall, intonation and ‘Wh’ questions
were used most frequently, followed by Yes/No questions, whereas Tag questions
were used relatively infrequently. In terms of the functions of questions, overall,
most questions were used as models or to request structures, followed by use of
requests for information and conŽ rmation or clariŽ cation. Questions were rarely
used as mand-models or, with the exception of Tim’s mother, to request a choice.
SpeciŽ c teaching strategies were also further analysed according to types. During
baseline, very few strategies were used (with means ranging from 0 to 0·3). During
treatment, the types of strategies used increased and varied across dyads (with
means ranging from 0 to 17·7). Bob and Tim’s mothers demonstrated similar
patterns in their predominant use of closure (treatment means=12·3 and 17·7,
respectively), followed by sound prompts (means =7 and 9, respectively) and imitation of the child (means =5 and 6·3, respectively). Closure also seemed to be used
relatively more frequently in comparison to other strategies by Jon’s mother (mean=
3·7), but she, along with Nell and Brian’s mothers used a variety of strategies and
only infrequently.
Discussion
The eVectiveness of a parent-implemented treatment within a collaborative consultation approach in increasing the frequency of the production of children’s linguistic
units was demonstrated in one multiple baseline, but was not replicated in the
Table 3. Types and functions of questions used by mothers during baseline and intervention
Bob
Types
Inton
Tag
Wh
Y/N
Functions
M/M
Model
RS
RC
RI
C/C
Nell
Brian
Jon
Bill
B
T
B
T
B
T
B
T
B
T
28
0
17·7
20·7
43·3
2
41
7
31·6
3
46
19·3
52·3
0
33·7
14
43
0
50·3
6·7
47·3
0
51·3
1·3
31·3
13
48
7·7
28
14
40
18·7
44
0
27·3
28·7
40
5
52
3
0
14·7
38·7
0
6·7
10·3
1
23
27·7
4
14·3
2
0
37
22·3
0
22·7
0
5·3
58
10·7
3
21·3
3·3
1·3
24·7
22·7
0
30
8
0
42·3
17·7
0
35
2·7
7·3
16·3
37
0
21
10
0
46·3
19·7
6
17·7
4·7
0
66
8·7
16·7
10
0
2
34·3
27·7
2·3
20·7
12·7
B =baseline; T =treatment; Inton=intonation; Y/N = Yes/No; M/M =mand-model; RS=request
structure; RC=request choice; RI=request information; C/C=conŽ rmation/clariŽ cation.
Parent-implemented intervention
297
second. However, in terms of non-linguistic communication (i.e. gestures and
vocalizations), increases above baseline performance were noted in the second MBL
with Jon and Tim. Therefore, treatment incorporating collaborative consultation
amongst a parent, teacher and clinician and the use of interactive and milieu
teaching principles did appear to result in gains at least in the children’s frequency
of productive language.
From a purely clinical perspective, the documentation of the children’s performance proved useful in demonstrating gains to members of the collaborative consultation team and in encouraging the mothers to take credit for such gains. Such an
outcome is thought to provide empowerment for the direct service provider operating within a collaborative consultation approach (Friend and Cook 1992, Coufal
1993). Although the study did not allow a comparison with a clinician-delivered
intervention, it did at least address parental concern that their children may not
have been making gains in communication performance (both in terms of rate and
movement from use of signs to speech at least for 3 children) without individual
and regular treatment from a speech pathologist.
Since the mothers were involved in speciŽ c decisions concerning treatment,
they also made decisions about the use of augmentative and alternative communication (AAC) strategies. Most mothers were happy for their children to use signs and
in 2 cases (Bob and Jon), symbols. The exception to a willingness to use AAC was
Tim’s mother, who felt this would have been a backward step, given that he had
recently discontinued the use of signs in favour of speech. The modalities used by
the subjects indicated that they all used both speech and signs or symbols to degrees
that varied as intervention proceeded. Bob, Nell and Tim primarily used speech by
the end of treatment, after having used signs or symbols to some extent. This
pattern has been observed in children with Down syndrome (Abrahamsen et al.
1985, Kouri 1988, 1989) and other disabilities (Kouri 1988). It has been suggested
that signs may function as a transition modality, facilitating the development of a
substantial vocabulary before the spoken modality is used and two word combinations emerge (e.g. Kouri 1988, 1989). Whereas Brian and Jon primarily used signs
or symbols, they did use some speech, thereby demonstrating a potential for
continued development in this modality. It is possible that, had their progress been
monitored over a further period, they too may have demonstrated a transition to
the predominant use of speech.
In contrast to the variability across the children’s performance, their mothers
showed similarity in the types and functions of their child-directed utterances.
Comparisons of baseline and treatment sessions indicated that while the mothers
did vary somewhat in the total number of child-directed utterances, all but one
mother actually directed more utterances to her child at the end of treatment. For
these mothers who showed increases (and for two mothers they were quite substantial), it could be argued that they simply occupied more conversational space.
However, in the light of the increases in the children’s communicative behaviours,
this explanation seems unlikely. Rather, the dyads, overall, appear to have become
more conversationally active. Analysis of the types of utterances directed at the
children provides greater insight into the nature of these interactions.
Most mothers decreased their relative use of questions from baseline to treatment. Nevertheless, between 20% and 50% of the mothers’ child-directed utterances
were questions, a fact that might indicate a tendency to use a directive approach
with their children, with potentially detrimental eVects on language development
(Mahoney and Powell 1988, Tannock 1988). However, research into directiveness
298
T. A. Iacono et al.
has indicated that this is a style associated with interactions with children at early
stages of development (prelinguistic and single words) (Price 1989), and that
hypothesized inhibitory eVects of questions depend on the nature or functions of
the questions asked (Olsen-Fulero and Conforti 1983, Yoder and Kaiser 1989,
Yoder and Davies 1990, Yoder et al. 1994). The mothers in the present study used
mostly intonation and ‘Wh’ questions during both baseline and treatment. The
analysis of functions indicated that mothers used questions mostly as models rather
than as real queries; for example ‘dolly is sleepy?’ as the child puts a doll to bed.
This tendency may account for the predominant use of intonation questions.
The proportional use of models, which were deŽ ned as comments on the child’s
ongoing activities, was similar to that of questions, but an increase occurred from
baseline to treatment sessions. There was a concomitant decrease in the use of
directives, which usually functioned as suggestions to the child about what to do
next in the activity in which he was engaged. There has been some suggestion that,
despite concerns about parental directiveness (Mahoney and Powell 1988), directives
can in fact facilitate language development if they are used with the intention of
sustaining and extending the child’s involvement in the conversation (Barnes et al.
1983, McCathren et al. 1995), as opposed to redirecting the child to another focus
(McCathren et al. 1995). Mothers’ use of redirectives occurred only rarely in this
study, suggesting that they were, in fact, following the child’s focus of attention
and providing responsive utterances.
In summary, the pattern that emerged was that, although the mothers in the
present study demonstrated behaviours that enabled them to control the interactions
(through frequent use of questions, models and some directives), these were based
on the children’s activities. Their questions functioned to solicit speciŽ c structures
from children through the use of structure questions, or to re ect on their activities,
through the use of intonation questions (Olsen-Conforti and Fulero 1983), models,
and as treatment continued, through the increased use of information seeking
questions. The mother’s responsivity to their children was characteristic of their
interactions even before treatment. In addition, these behaviours demonstrated the
intention to sustain and continue the children’s involvement in the conversation
(Olsen-Conforti and Fulero 1983). Bob, for example, tended to move quickly
between activities, often preventing sustained conversational interactions. His
mother used directives to keep Bob at a task long enough for her to be able to
elicit a response through the use of questions. She then provided comments or
other semantically contingent responses, and, Ž nally, would present him with choices
for other activities, using symbols, allowing him to move on only after he had
made a choice.
The most noticeable change in the mothers’ child-directed utterances was in
their use of speciŽ c teaching strategies. However, only small increases were found.
The limited use of didactic strategies may have in turn limited the children’s gains
in linguistic skills. The observed gains may have re ected only increased rate of
communication (e.g. the children were not combining words, and two children
failed to demonstrate increases in linguistic units) and, at least for three children, a
change in modality from signs/symbols to speech. This Ž nding may have re ected
the parents greater use of responsive procedures, with only limited use of the more
didactic procedures characteristic of milieu teaching.
As was evident in previous studies using predominantly interactive procedures
(Tannock et al. 1992), the need for greater use of speciŽ c strategies to teach language
forms appears evident. The strategies coded were those identiŽ ed in the literature
Parent-implemented intervention
299
as those thought to be predictive of language development in normal children (e.g.
contingent expansions and imitations) (e.g. Scherer and Olswang 1984), and found
to be eVective with children experiencing language delays (e.g. Price 1989, ContiRamsden 1990) or which have been recommended for use in intervention programmes (Price 1989, Carter 1992). In addition, while the mothers diVered in terms
of the strategies used most, it was evident that few used augmentative techniques
(such as providing a model or prompt in sign). This apparent bias against using
AAC, despite its demonstrated usefulness with children with language delays (e.g.
Kouri 1989, Iacono and Duncum 1995), may have re ected a tendency to prefer
speech-based strategies or their own limited knowledge of signs or access to symbols
appropriate to the child-directed activities.
The results of this study demonstrate that whilst mothers involved in general
early intervention programmes may be quite responsive to their children’s communication, they, and their children, may beneŽ t from learning more didactic techniques.
In addition, parents need more information on the likely beneŽ ts of continued use
of AAC. This information may best be imparted through demonstration within
intervention, education or home settings.
Conclusions
The results of the present study demonstrated the potential for implementing a
collaborative consultation model of speech pathology service delivery within an
early intervention programme. The model of intervention incorporated strategies
which have been found eVective in enhancing mothers’ responsiveness to their
children at early stages of language development and in facilitating communication.
Although the study demonstrated some level of success in terms of increases in
the frequency of children’s use of linguistic forms, methodological problems preclude conclusions about the eYcacy of the approach. In particular, gaps in the data
provide reason for caution in interpreting the results, since maturation and the
eVects of the general intervention programme cannot be ruled out as potential
confounds. Future research in which more frequent measures of target behaviours
are made, with perhaps greater control over the available activities would assist in
assessing treatment outcome. Comparisons with more traditional approaches, as
occurred in the study by Wilcox et al. (1991) are also recommended.
Analysis of mothers’ behaviours indicated that, before treatment, they were
responsive to their children’s conversational attempts and activities, and that many
of their behaviours may have been attempts to engage their children in sustained
conversations or to provide them with language models about ongoing activities.
SpeciŽ c didactic strategies increased as treatment progressed. However, greater use
of such strategies may have resulted in clearer gains across children in their
acquisition and use of language forms.
Acknowledgements
Thanks are extended to the parents and children who participated in this study and
staV of the Macquarie University Special Education Centre. This study was supported by a Small ARC grant (1992) and portions were presented at the Australian
Society for the Study of Intellectual Disability National Conference, Newcastle,
December, 1993; and The Biennial Conference of the International Society of
Augmentative and Alternative Communication, Maastricht, The Netherlands,
October, 1994.
300
T. A. Iacono et al.
References
Abrahamsen, A., Cavallo, M . and M cCluer, A., 1985, Is the sign advantage a robust phenomenon?
From gesture to sign in two modalities. Merrill-Palmer Quarterly, 31, 177–209.
Alpert, C. and Kaiser, A., 1992, Training parents as milieu language teachers. Journal of Early
Intervention, 16, 31–52.
B ailey, D. and M cWilliam, P. J., 1993, DeŽ ning and delivering quality services in early intervention:
the search for quality indicators. In P. J. McWilliam and D. Bailey (Eds) Working Together with
Children and Families: Case Studies in Early Intervention (Baltimore: Paul H. Brooks), pp. 3–20.
B arber, P., T urnbull, A., B ehr, S. and Kerns, G., 1988, A family systems perspective on early
childhood special education. In S. Odom and M. Karnes (Eds) Early Intervention for Infants and
Children with Handicaps: An Empirical Base (Baltimore: Paul H. Brookes), pp. 179–198).
B arlow, D., Hayes, S. and Nelson, R., 1984, The Scientist Practitioner: Research and Accountability in
Clinical and Educational Settings (New York: Pergamon Press).
B arnes, S., Gutfreund, M ., Satterly, D. and Wells, G., 1983, Characteristics of adult speech which
predict children’s language development. Journal of Child Language, 10, 65–84.
B eukelman, D. and M irenda, P., 1992, Augmentative and Alternative Communication: Management of Severe
Communication Disorders in Children and Adults (Baltimore: Paul H. Brooks).
B rown, R., 1973, A First Language: The Early Stages (Cambridge, MA: Harvard University Press).
Carter, M ., 1992, A review of naturalistic communication training strategies for persons with severe
handicaps: implications for the development of sponteneity. Australasian Journal of Special
Education, 15, 17–31.
Conti-Ramsden, G., 1990, Maternal recasts and other contingent replies to language-impaired children.
Journal of Speech and Hearing Disorders, 55, 262–274.
Coufal, K., 1993, Collaborative consultation for speech-language pathologists. Topics in Language
Disorders, 14, 1–14.
Cross, T ., 1977, Mothers’ speech adjustments: the contribution of selected child listener variables. In
C. Snow and A. Ferguson (Eds) Talking To Children: Language Input and Interaction (London:
Cambridge University Press), pp. 151–188.
Fey, M ., 1986, Language Intervention with Young Children (London: Taylor & Francis).
Friend, M . and Cook, L., 1992, Interactions: Collaboration Skills for School Professionals (White Plains NY:
Longman).
Girolametto, L., 1988, Improving the social-conversational skills of developmentally delayed children:
an intervention study. Journal of Speech and Hearing Disorders, 53, 156–167.
Girolametto, L., Pearce, P. and Weitzman, E., 1996, Interactive focused stimulation for toddlers
with expressive vocabulary delays. Journal of Speech and Hearing Research, 39, 1274–1283.
Haring, N., Liberty, K. and White, O., 1980, Rules for data-based strategy decisions in instructional
programmes. In W. Sailor, B. Wilcox and L. Brown (Eds) Methods of Instruction for Severely
Handicapped Students (Baltimore: Paul H. Brooks), pp. 159–192.
Hemmeter, M . L. and Kaiser, A., 1994, Enhanced milieu teaching: eVects of parent-implemented
language intervention. Journal of Early Intervention, 18, 269–289.
Iacono, T . and Duncum, J., 1995, Comparison of sign alone and in combination with an electronic
communication device in early language intervention: case study. Augmentative and Alternative
Communication, 11, 249–259.
Iacono, T ., Waring, R. and Chan, J., 1996, Sampling communicative behaviours in children with
intellectual disability in structured and unstructured situations. European Journal of Disorders of
Communication, 31, 417–431.
Kaiser, A., 1993, Parent-implemented language intervention: an environmental system perspective.
In A. Kaiser and D. Gray (Eds) Enhancing Children’s Communication: Research Foundations for
Intervention (Baltimore: Paul H. Brooks), pp. 63–84.
Kaiser, A. and Hester, P., 1994, Generalized eVect of enhanced milieu teaching. Journal of Speech and
Hearing Research, 37, 1320–1340.
Kaiser, A., Yoder, P. and Keetz, A., 1992, Evaluating milieu teaching. In S. Warren and J. Reichle
(Eds) Causes and EVects in Communication and Language Intervention (Baltimore: Paul H. Brooks),
pp. 9–47.
Kouri, T ., 1988, EVects of simultaneous communication in a child-directed treatment approach with
preschoolers with severe disabilities. Augmentative and Alternative Communication, 4, 222–232.
Kouri, T ., 1989, How manual sign acquisition relates to the development of spoken language: a case
study. Language, Speech, and Hearing Services in Schools, 20, 50–62.
The MacArthur Communicative Inventory, Infants, 1989, (San Diego, CA: The Center for Research in
Language, UCSD).
Parent-implemented intervention
301
M ahoney, G. and Powell, A., 1988, Modifying parent–child interaction: enhancing the development
of handicapped children. The Journal of Special Education, 22, 82–96.
M arfo, K., 1992, Correlates of maternal directiveness with children who are developmentally delayed.
American Journal of Orthopsychiatry, 62, 219–233.
M cCathren, R., Yoder, P. and Warren, S., 1995, The role of directives in early language intervention.
Journal of Early Intervention, 19, 91–101.
M cCormick, L. and Goldman, R., 1984, Designing an optimal learning program. In L. McCormick
and R. Schiefelbusch (Eds) Early Language Intervention (Columbus: Charles E. Merrill Publishing
Company), pp. 201–242.
M cD onald, L. and Pien, D., 1982, Mother conversational behavior as a function of interactional
intent. Journal of Child Language, 9, 337–358.
M cWilliam, P. J., 1993, DeŽ ning and delivering quality services in early intervention: Real-world
challenges to achieving quality. In P. J. McWilliam and D. Bailey (Eds) Working Together with
Children and Families: Case Studies in Early Intervention (Baltimore: Paul H. Brooks), pp. 21–32.
M oerk, E., 1977, Pragmatic and Semantic Aspects of Early Language Development (Baltimore: University
Park Press).
Olsen-Fulero, L. and Conforti, J., 1983, Child responsiveness to mother questions of varying type
and presentation. Journal of Child Language, 10, 495–520.
Price, P., 1989, Language intervention and mother–child interaction. In M. Beveridge, G. ContiRamsden and I. Leudar (Eds) Language and Communication in Mentally Handicapped People (London:
Chapman & Hall), pp. 185–217.
Reichle, J., York, J. and Sigafoos, J., 1991, Implementing Augmentative and Alternative Communication:
Strategies for Learners with Severe Disabilities (Baltimore: Paul H. Brooks).
Reynell, J. and Huntley, M ., 1987, Reynell Developmental Language Scales—Revised (3rd edition) (Windsor:
NFER-Nelson).
Scherer, N. and Olswang, L., 1984, Role of mothers’ expansions in stimulating children’s language
production. Journal of Speech and Hearing Research, 27, 387–396.
Siegel, S. and Castellan, N. J., 1988, Nonparametric Statistics for the Behavioral Sciences (New York:
McGraw-Hill).
Snow, C., 1984, Parent–child interaction and the development of communicative ability. In
R. Schiefelbusch and J. Pickar (Eds) The Acquisition of Communicative Competence (Baltimore:
University Park Press), pp. 69–107.
Sparrow, S., B alla, D. and Cicchetti, D., 1984, Vineland Adaptive Behavior Scale: Interview Edition Survey
Form Manual (Minnesota: American Guidance Service).
T annock, R., 1988, Control and reciprocity in mothers’ interactions with Down syndrome and normal
children. In K. Marfo (Ed.) Parent–child Interaction and Developmental Disabilities: Theory, Research
and Intervention (New York: Praeger), pp. 163–180.
T annock, R. and Girolametto, L., 1992, Reassessing parent-focused language intervention programs.
In S. Warren and J. Reichle (Eds) Causes and EVects in Communication and Language Intervention
(Baltimore: Paul H. Brooks), pp. 49–79.
T annock, R., Girolametto, L. and Siegel, L., 1992, Language intervention with children who have
developmental delays: eVects of an interactive approach. American Journal on Mental Retardation,
97, 145–160.
Warren, S. and B ambara, L., 1989, An experimental analysis of milieu language intervention: teaching
the action-object form. Journal of Speech and Hearing Disorders, 54, 448–461.
Warren, S. and Gazdag, G., 1990, Facilitating early language development with milieu intervention
procedures. Journal of Early Intervention, 14, 62–86.
Warren, S., Yoder, P., Gazdag, G., Kim, K. and Jones, H., 1993, Facilitating prelinguistic communication skills in young children with developmental delay. Journal of Speech and Hearing Research,
36, 83–97.
Wetherby, A., Cain, D., Yonclas, D. and Walker, V., 1988, Analysis of intentional communication
of normal children from the prelinguistic to the multiword stage. Journal of Speech and Hearing
Research, 31, 240–252.
Wilcox, M . J., Kouri, T . and Caswell, S., 1991, Early language intervention: a comparison of
classroom and individual treatment. American Journal of Speech–Language Pathology, 1, 49–62.
Yoder, P. and Davies, B ., 1990, Do parental questions and topic continuations elicit replies from
developmentally delayed children? A sequential analysis. Journal of Speech and Hearing Research,
33, 563–573.
302
T. A. Iacono et al.
Yoder, P. and Kaiser, A., 1989, Alternative explanations for the relationship between maternal verbal
interaction style and child language development. Journal of Child Language, 16, 141–160.
Yoder, P., Davies, B ., B ishop, K. and M unson, L., 1994, EVect of adult-continuing wh-questions
on conversational participation in children with developmental disabilities. Journal of Speech and
Hearing Research, 37, 193–204.
Appendix
DeŽnitions and source of categories used for mothers’ utterances
Category
Questions
Type
Yes/No
Wh
Tag
Intonation
Function
Request for
conŽ rmation/
clariŽ cation†
Request for
information
Request for a choice
Requests for speciŽ c
structure‡
Model
Mand-model
Model§
Directive
Description
Example
Explicit request for
information
Only a yes or no
response is required
Who, what, where, why
questions
Statement followed by a
question
Marked by intonation
rather than structure
Sources
McDonald and Pien
(1982), Yoder et al.
(1994)
‘Does the bus go
there?’
‘Where’s the baby?’
(Olsen-Fulero and
Conforti 1983)
Olsen-Fulero and
Conforti (1983)
‘That’s the daddy, isn’t Olsen-Fulero and
it?’
Conforti (1983)
‘You’re making a cake?’ Olsen-Fulero and
Conforti (1983)
Attempt to ensure that
Ch: ‘cup’ Mother: ‘A
the adult has
cup?’
understood the child or
to obtain speciŽ c
information about
what was not
understood
Request for information ‘What will we do next?’
that the adult does not
have
Requires child to choose ‘Does dolly want a
between two options
drink or something to
eat?’
Functions as a test
‘What is this?’
question, used to elicit
a speciŽ c word or
structure
Re ects on the child’s
‘Is dolly is sleeping?’
activity, rather than to
elicit speciŽ c
information, but rather
act as a comment on
what the child is doing
Requests a speciŽ c
‘What is it? A giraVe.’
structure and then
provides a model
A comment on the
‘You’re making a
child’s activity
chocolate cake’
Either an imperative or ‘Now put the cake in
a suggestion for what
the oven.’
to do that relates to
the child’s focus of
interest.
Kaiser et al. (1994),
McDonald and Pien
(1982)
Kaiser et al. (1994),
McDonald and Pien
(1982)
Olsen-Fulero and
Conforti (1983)
Kaiser et al. (1994),
McDonald and Pien
(1982), Olsen-Fulero
and Conforti (1983)
McDonald and Pien
(1982)
Alpert and Kaiser
(1992)
McDonald and Pien
(1982)
McCathren et al.
(1995), McDonald and
Pien (1982), Yoder
and Kaiser, 1989)
Parent-implemented intervention
Category
Redirective††
Description
Either an imperative or
a suggestion for what
to do that does not
relate to the child’s
focus of interest
SpeciŽ c teaching
Techniques used to
strategies
focus or extend child’s
utterance and to elicit
speciŽ c word
productions
Imitation of child
Direct and immediate
imitation of all or part
of the child’s previous
utterance
Cross-modal imitation‡‡ A direct and immediate
imitation, which is
produced in a modality
diVerent to that used
by the child in the
previous utterance
Imitation with
Includes child utterance
expansion
in a semantically or
syntactically expanded
form
Expectant pause
Utterance includes a
pause before a word
the mother wishes the
child to produce, but is
then completed for the
child
Closure
An incomplete sentence,
which the child is
expected to complete
Sign/symbol prompt
Provides a sign or a
symbol to prompt a
response
Gesture prompt
Provides a gesture to
prompt a response.
Sound prompt
Provides the Ž rst sound
of a word
Attention
A device used to get the
child to attend to an
activity or the mother
Acknowledgement
Utterance providing
praise for child’s
utterance or action
303
Example
Sources
‘Come and do some
painting’
McCathren et al. (1995),
McDonald and Pien
(1982), Yoder and
Kaiser (1989)
Child: ‘car.’ Adult: ‘car’
Conti-Ramsden (1990)
Child: CAR (signed);
Adult: ‘Car’ (spoken)
Child: ‘car’ Adult: ‘A
big car.’
Yoder et al. (1994)
‘Its a big (pause) car’
Moerk (1977)
‘Its a big … ’
Moerk (1977)
‘Do you want to cook
or paint (while
showing 2 symbols)’
Points upward to elicit
the word ‘up’
‘Its a c … ’
Haring et al. (1980)
‘Look here’
‘Yes, that’s right’
Haring et al. (1980)
McCormick and
Goldman (1984)
Conti-Ramsden, (1990),
McDonald and Pien
(1982)
McDonald and Pien
(1982)
†Sources distinguish between conŽ rmation and clariŽ cation requests, but were combined here because
the latter occurred infrequently.
‡Also referred to as test questions in the sources cited.
§Referred to as comments in the source cited.
††Directives and redirectives are not distinguished in the sources cited, but are distinguished here to
provide information on whether or not the directive related to following the child’s lead in the activity.
‡‡Cross-modal imitation is a variation of child imitation and therefore does not have a separate source.