Early Intervention
Strategies for Children with
Speech & Language
Impairment
Nancy J. Scherer, Ph.D.
Overview of Presentation
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Rationale for early intervention
Goals for early intervention
Early intervention models
Teaching Parents
Rationale
 Much
of language development occurs
prior to three years of age
 Language functioning is requisite for
successful academic performance and
social functioning
 Early intervention may lessen risk of longterm communication impairment
Advances in Early
Language Intervention
 Focus
on teaching functional skills for
immediate use
 Attention to generalization, maintenance
of newly learned skills
 Emphasis on naturalistic approaches
rather that didactic instruction
 Empirical evidence of effective intervention
to improve communication skills
Implications of These
Advances
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Teach in everyday
contexts where
communication is needed
Teach specific
communication forms at
the moment they are
useful
Teach to promote
generalization and
maintenance
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Which teaching
strategies?
Who can teach?
What should be taught?
What evidence of
effectiveness?
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Are developmental changes
possible?
What changes in functional
communication skills?
Are there effects in other
developmental domains?
Goals for Early Intervention
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Promote pre-linguistic communication
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Communication intention (e.g.,Request, comment, protest)
Communication modalities
• Vocalizations
• Gesture
• Sign
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Early linguistic communication
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Early vocabulary development
Word combinations
Syntax/morphology
Articulation
Pragmatics
Milieu Teaching
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Naturalistic language
teaching strategy
designed to teach
communication skills
in everyday
conversational
interactions

Hart & Rogers-Warren (l978)
Principles of EMT
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Children are motivated to practice language
when there is a functional consequence.
Adults can create opportunities for functional
language by arranging the environment to
facilitate requests.
Adults model target words (Focused Stimulation)
Structured prompting procedures elicit and
model new words in response to requests.
Expansion, praise and access to requested
objects encourages practice of new words.
Provides functional, social and linguistic
consequences for child’s language production.
Milieu Teaching has positive effects on
children’s communication when implemented
by clinicians and teachers
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Increases child use of targets
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Vocabulary (Kaiser et al, l993; Scherer & Kaiser, in press)
Early syntactic/semantic forms (Kaiser & Hester, l994)
Moderately complex syntax (Warren & Kaiser, l986)
Increases child frequency of communication
(Warren et al, l994; Kaiser et al, l993)
Results in generalization across settings, people, and
language concepts (Warren & Bambara, l989; Goldstein & Mousetis, l989)
Results in maintenance of newly learned targets (Warren &
Kaiser, l986)
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Is more effective than drill-practice methods for early
language learners (Yoder, Kaiser et Alpert, l991, Kaiser, Yoder, et al,1996)
Findings From Single Subject Research on
Parent-Implemented Milieu Teaching
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Parents can learn a range of strategies to
criterion levels
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Environmental arrangement (Alpert & Kaiser, l992; Hemmeter & Kaiser
l990)
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Responsive interaction strategies (Hancock & Kaiser, 2002;Kaiser et al,
l996)
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Modeling language targets (Hancock & Kaiser, 2002)
Prompting target production using EMT techniques (Kaiser,
Hancock & Nietfeld, 2001)
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Parents can generalize these strategies to
home interactions with their children (Hancock
& Kaiser, 2002)
 Parents maintain their newly-learned skills
over 6-18 months (Kaiser, et al 2001).
Hybrid: Enhanced Milieu
Teaching (Kaiser, l993)
Environmental Arrangement
PLUS
Responsive Interaction
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Modeling
 Mand + Model
 Time Delay
 Incidental Teaching
Four Milieu
Teaching
Procedures
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BIG Environmental Arrangement
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Child preferred activities and materials
Strategies and room arrangements to promote child
engagement
Strategies and room arrangements to support positive
behavior
Routines
Little Environmental Arrangement
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Strategies to promote requesting
Choose Toys and Materials of Interest
 Developmentally appropriate
 Promote speech and language targets
 Can be structured to promote requesting
 Can be used in a play routine
 Adapt toys and activities to fit the child’s interest and
abilities
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Cause and effect (bubbles, balls on track, shape sorter)
Routines and simple schemes (cars on track, jumping
spiders, art, playdough, feeding babies)
Moderate schemes (doll house, simple games,
housekeeping, farm)
Child is engaged….but not obsessed
Sustaining Child Engagement
 Actively engage in play with child
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Mirror child actions
Exchange materials
Take turns
Talk about what child is doing
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Add parts to materials
 Praise engagement—let the child know you notice
 Be an engaging, responsive partner
 Manage time
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Anticipate when child is interest in waning
Change before she does
Use a timer
Responsive Interaction
(Adapted from Weiss, et al , 1985)
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Follow the child’s lead
(topic, play, joint attention)
Balance verbal turn taking
Treat nonverbal turns as
communicative
Contingent imitation of
child actions in play
Enter into and expand
child’s play
Provide meaningful
feedback for
communicative behavior
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Model talk at the target
level appropriate to the
communicative context
Model specific language
targets in context
Expand child utterances
(meaning and lexical
expansions at target level
and using specific
targets)
Provide meaningful
verbal feedback for
communicative behavior
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Basic EMT strategies
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Environmental Arrangement
Responsive Interaction
Milieu Teaching Strategies
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Strategies for supporting positive behavior and
engagement
 Choosing activities and routines for teaching
communication
 Ability to Individualize to fit children’s
communication needs
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Choosing targets that advance child’s skills
Teaching child’s targets
Keeping track of progress
Changing as the child changes
Basic Responsive Strategies
 Create
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Make yourself an available partner
Use routines, activities, child interest, child
action to define the topic
 Follow
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a context for conversation
the child’s lead
Join, follow, focus on the child
Maintain positive boundaries
 Imitate
child’s actions:Mirroring
Mirroring
Non-verbal Turn-taking
Definition:
Connecting and communicating with the child
without using words.
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Mirroring occurs when the adult imitates the
child’s nonverbal behaviors
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Mirroring means you wait, watch, and then
do exactly what he did if you can
Mirroring
Non-verbal Turn-taking
Examples
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Imitating/Mirroring the child’s nonverbal,
appropriate play behaviors
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Child rolls his truck on the table; the adult rolls her
own truck on the table
You can both drive cars on the table without
mirroring, but when he stops his car and you
immediately stop your car too, then you are mirroring
When he slices one piece off of the playdough and
you slice one piece off, you are mirroring
Mirroring
Verbal Turn-taking
Examples
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To balance your turns with the child, you should
respond to every child verbal utterance
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Talk only when the child talks
Be sure to pause after your response to allow the child to take
another turn
If more than 5 seconds pass without a verbal or nonverbal
behavior from the child, you should take another turn
Mirror the child’s actions and talk about the action
Map the child’s nonverbal communication with words
Example of Mirroring
C/A: (Mirroring)
A: We make music
C/A: (Mirroring)
C: (Vocalizes)
A: Say more (Model)
C: (Vocalizes)
A: Say more (Model)
C: (Vocalizes)
A: More music (Model)
C/A: Mirroring
Milieu Teaching
Procedures
 Prompt
language use in functional
communicative contexts using
•
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•
Model
Mand +Model,
Time Delay,
Incidental Teaching
 Teach
elaborated language forms
(TARGETS) in context
 Provide functional consequences for
communication including positive
feedback and expansions
Model Procedure
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Prompts child to imitate modeled language
response
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Response is functional for child
• Access to reinforcer
• Child does not yet use form spontaneously
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Model begins with “SAY”
• Make the prompt clear to the child
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Adult waits for child response
Model is repeated once if child does not respond
Approximations may be accepted
• Criteria for response are predetermined
Examples of Model Procedure
C: X
A: Say I roll (Model)
C: I roll
A: I roll marbles (Expansion)
C: (reaches for marbles)
A: Say more marbles (Model)
C: More marble
A: More marbles (Expansion)
C: (Marbles in track)
A: Marbles roll (Model)
C: Me some
A: Say marbles go (Model)
C: Marble go
Model Procedure
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Model a target word that child does not produce
spontaneously
 Two prompts—unless you lose child interest
 Focus and move fast—keep the model in the
pace of the conversation
 Expand, praise, and provide the requested
object
Mand
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A prompt for a communicative response
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Real Question
• What do you want?
• What are you painting?
An instruction to verbalize preference or give
information
• Tell me what you want
• Tell me when you are ready
An opportunity to indicate a choice
• Do you want milk or tea?
Test Questions
Example of Mand-Model
A: Which one? (Mand)
C: (Reaches)
A: Say give horse (Model)
C: Give horse
A: Give me horse (Expansion)
C: Give horse
A: Give me more horse
(Expansion)
C: Give me more
A: Say more horse
C: More horse
Time Delay …the pause that transitions
to spontaneous requesting
 Set
up environment to promote request
(routines, needs assistance)
 Look at child expectantly
 Hold up object or physically interrupt
action
 WAIT….up to 5 sec
 Reinforce child initiated responses!!!
Example of Time Delay
A: (Holds car on track)
C: Go
A: Say go cars (Model)
C: Go cars
Expansion
 Definition:
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Repeat child’s utterance and ADD new
information.
• Expansions can be lexical, “correcting” the
sentence by fixing an ending, correcting a word, or
replacing a nonspecific word with a specific word
• or meaning expansions—adding new
words/meanings to the sentence.
Expansion Example
A: Which one? (Mand)
C: X
A: Say yellow block (Model)
C: Yellow block
A: Want yellow block
(Expansion)
A: Stack blocks (Model)
C: Stack block
A: We stack blocks
(Expansion)
Summary
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Model procedure is the heart of EMT; it is always
the fall back correction procedure
 Mand-model procedure teaches choice making
and response to general instructions (“tell me)
and real questions
 Time-delay helps children transition to initiating
verbal communication at target level; its use
depends on child learning
 Expansion increases the child’s linguistic
complexity
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Incidental teaching is simply these procedures done
in response to a child request
Choosing Targets
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Each child should have:
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Vocabulary targets
• Specific words or categories with specific words
• Prelinguistic transition and one-word children will have
small set of targets with lots of repetition
• Vocabulary matches child cognitive skills and linguistic
skills
• Phonology and articulation also dictate choices
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Two semantic/ syntactic target classes above
MLU level
• One word children will not have these
• Plan multiple examples of target classes
Examples
Child’s Target Level
Potential “Target Types”
Target Examples
One word
Nouns
Verbs
Protoverbs
Requesting Words
Car, ball, barn, house
Go, push, roll, run
In, out, off, on, up, down
More, help, Mine, Want
Two word
Agent-action
Action-object
Modifier-noun
2 word requests
Girl rides; baby cries
Catch ball; drive car
Big ball, red car
Want ball; More cars; Help
me
Three word
Agent-action object
Agent-action-location
Action-modifier-noun
Agent-preposition-location
Action-preposition-location
3 word requests
The farmer drives the tractor
The girl jumps down!
Blow big bubbles!
Boy in car!
Go down the slide!
I want ____; Want more
____; Help me ____
Summary: EMT
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Hybrid model of early language intervention that
utilizes natural language teaching opportunities
Validated through evidence-based studies
Used with wide range of disabilities
Promotes speech production in addition to
language
Can be applied to prelinguistic children as well
as children using words
Parents and teachers can be trained