Amanda and I met while working at a special education charter school as an Assistive Technology specialist and special education teacher. Somehow, several years later, we have both ended up working in EI. Amanda currently works as a Speech-Language Pathologist providing EI services and AAC evaluations in DC and I am a Developmental Therapist in Arlington County.

As EI providers, we know that communication creates the opportunity to learn about and understand the world around us. Yet, often children wait until they receive school services before they have consistent access to robust AAC (Augmentative and Alternative Communication) systems. When working with toddlers who are not using verbal language to communicate functionally throughout their day, it is important to offer information and have conversations about the benefits of AAC with the family.

Figuring out your role in these conversations as an EI provider, as well as how to support a family with their AAC journey, can be challenging. Below, we have listed a few common myths and misconceptions about AAC as well as examples of toddlers we know who have started their journeys with AAC. We hope you can use this as a resource as you continue to expand your knowledge about AAC as a primary provider.   

Myth #1: Toddlers Are Too Young  

We are never too young for language exposure. Most AAC relies on a different language system than what we are exposed to from birth. If children are going to use AAC functionally, they need to hear everyone in their lives use the same system to talk to them. Waiting to provide children with the opportunity to use AAC until they are “old enough” can deprive them of months and years of language input that is necessary when learning to effectively communicate. The earlier a child has access to language, the faster he or she will learn to use it and be able to engage more with the world (American Speech and Hearing Association, n.d.). There are no prerequisites to begin using AAC. While there are considerations as to the mode of access and system used, these are determined as part of an evaluation.   

Amanda: Earlier this year, I had a conversation with the parents of a 15-month-old with limited vocalizations.  We had an honest discussion about his diagnosis and the likelihood that he may not verbally speak for a while.  Within the month, several low tech AAC systems (paper-based choice boards) and a GoTalk32 (recordable, fixed 32 cell device) were introduced.  Before he was two, he started using a high-tech dynamic display (digitized display changes based on user actions) device and by two he was using phrases to communicate.  By providing AAC from an early age, this child has the chance to continue his expressive language development at a rate similar to his typically developing peers.  

Myth #2: AAC is for Speech Language Pathologists (SLPs)  

While it is always challenging to talk about something that feels like it’s out of your area of expertise, the conversation about language development and ACC can come from any knowledgeable provider! SLPs are great resources about AAC, but remember that all providers can talk about communication. This is especially important when we think about babies and toddlers with complex bodies, who may also have complex communication needs. These children are much more likely to see a motor therapist as their primary service provider due to family priorities. Within their role, the PT or OT is also engaging in discussions and ongoing assessment in all areas of development with a family. This is the perfect opportunity to offer information about options for communication for a child who may not begin to develop verbal language in the same way as their peers.   

Lauren: A few years ago, I began as a secondary service provider for a family, when the PT working with them began this very discussion. Due to his diagnosis, this child was not likely to begin speaking within his toddler years. Although his parents were concerned about his future communication, they did not know that there were options for him to begin using words at the same time as his peers. This PT provided the family with information about an AAC clinic hosted by the local infant and toddler program. Through this process, insurance covered a high-tech device that allowed the child to communicate using eye-gaze.   

Myth #3: High-Tech Comes at High Cost  

This statement is both true and false. Dedicated, high-tech AAC devices (those with digitized displays that change based on user actions) can cost tens of thousands of dollars. It is false that these devices always come at a high out-of-pocket cost. In fact, public and private insurance will cover a variety of devices. It is important to have a knowledgeable specialist provide a thorough AAC evaluation and report.  This website from a device company provides some additional information about funding.

Amanda: I’ve been doing AAC evaluations for EI in Washington, DC for the past three years and have had many AAC devices covered by insurance including mid tech, high tech, eye gaze, and mounting accessories.  Though coverage varies by insurance plan (some private insurances require a copay or deductible, but Medicaid and Medicare typically cover AAC at 100%), there are also grants and programs available to help cover the cost of AAC. 

Lauren: Just this month, one of the toddlers I see received a device through insurance just in time to use it on his family trip to Disney World! 

What Next?   

You do not need to know everything about AAC to begin the conversation. Before you talk with families, though, make sure you have some knowledge of AAC. If you are interested in learning more general information about AAC, there is a fantastic Talks on Tuesday as well as a free AAC 101 Course to get you started.  We have only covered a few of the myths and misconceptions about AAC here. You can find more information and the supporting research through the American Speech-Language-Hearing Association.  Another great step is becoming knowledgeable about the resources for ACC evaluation in your area. Begin by reaching out to local children’s hospitals, rehab centers, and speech therapy clinics in your area to find out if they offer AAC evaluations. Where are they? How can a family contact them? What public or private insurances do they accept?  With this information, you’ll be better prepared to help families begin to explore AAC options and boost communication. 

What are some of the strategies or resources you have used in your professional journey with AAC?  

Share your strategies in the comments below!

References:

American Speech-Language-Hearing Association. (n.d.) Key Issues, AAC Myths and Realities.

Lauren Lamore-Chen has worked in EI in the Northern Virginia area since 2016 and currently works as a Developmental Therapist with the Arlington Parent-Infant Education Program. She has a master’s degree in special education and worked as an instructional coach and special education teacher where she developed her passion for all things AAC. You can reach Lauren at llamore-chen@arlingtonva.us

Amanda Soper specializes in working with individuals with complex communication needs who use AAC systems. She works at a special education school and for the early intervention program in DC. Amanda is an adjunct professor at Gallaudet University and has a private practice, providing therapy services for children using AAC. You can reach Amanda at AmandaSoperSLP@gmail.com

The post AAC in EI: Debunking Common Myths and Misconceptions appeared first on Early Intervention Strategies for Success.

We all have times when we leave visits feeling like it went great because we were able to successfully engage the caregiver. Other times, we leave visits feeling defeated and wondering what we could have done differently or if the caregiver may not be completely on board with early intervention yet. Honestly, there are a multitude of reasons we make this assumption and it may be far from the truth. Maybe we need to listen better, build a stronger rapport, or simply do a better job providing information by being more intentional and reflective with the caregiver about his or her beliefs and interactions with the child. Caregivers are equipped with their own knowledge and expectations of the world (and early intervention) and we have to respect that as we provide support. With that said, we also want to help caregivers learn so that they can use intervention strategies successfully with their children. This can be a careful dance.

Creating Cognitive Dissonance

This is where we bring in our secret weapon as we help caregivers reflect on (and possibly change) how they promote their child’s development. One strategy we can use to facilitate this reflection is called creating cognitive dissonance.

Learn more about cognitive dissonance. The article states:

“According to cognitive dissonance theory, there is a tendency for individuals to seek consistency among their cognitions (i.e., beliefs, opinions). When there is an inconsistency between attitudes or behaviors (dissonance), something must change to eliminate the dissonance. In the case of a discrepancy between attitudes and behavior, it is most likely that the attitude will change to accommodate the behavior.”

In other words, cognitive dissonance creates a conflict in your brain where you engage in a behavior that does not reflect your actual beliefs. When people are in a state of cognitive dissonance, there is an urge to resolve the conflict. This happens quite frequently when people are faced with making decisions.

How You Can Create Cognitive Dissonance to Help Caregivers Learn

Let’s visit Natasha to see how she implements this strategy in practice. 

Natasha provides services to Christine (mother) and Sebastian (father) and their two-year-old, Isaiah. Isaiah has very few words. He tends to get frustrated frequently which really upsets his parents. Isaiah’s parents have both have expressed the stress it places on them as a family. Natasha has observed Isaiah becoming emotionally overwhelmed when he wants to communicate a message to his parents, but they do not understand him. 

Natasha has approached Christine and Sebastian about using sign language. When she brought it up initially, they were adamant against sign language because they want him talking. Natasha wanted to discuss using sign language again, but decided to be more intentional and reflective with Christine and Sebastian. Here is how the conversation went:

Natasha: How are Isaiah’s tantrums today?

Christine: It has been really bad. I know he is trying to tell me something, but it takes me so long to figure out what he wants. By the time I do, he has already spiraled out of control. 

Sebastian: Today, he wanted more cereal and we thought he wanted a drink. 

Natasha: What do you think is causing these outbursts?

Christine: It is definitely when we do not understand. When I can figure it out right away, he is fine. 

Sebastian: It is like he is frustrated when he cannot talk.

Natasha: Tell me if I understand you correctly. He is getting frustrated when you do not understand him.

Christine and Sebastian (simultaneously): Yes!

Natasha: I wonder what we can do to help eliminate some of that frustration while he is building his vocabulary.

Sebastian: I am not sure anymore.

Natasha: I know previously, we talked about using some signs and you were not sure if it would help. Sign language can be a bridge to using words. It is used as a strategy to help reduce frustration so you can understand what Isaiah wants and model the appropriate words. I want to be clear, though, that sign language is always used with words. Once Isaiah is confident using his words, he will stop using the signs because he will replace them with words. It sounds like you really want to reduce his frustration (parent belief?). What would you think about trying a couple signs and seeing how it goes (behavior)?

Christine (pausing in thought): …..I do want to help Isaiah learn to talk. 

Sebastian: I guess we were worried he would never talk and only sign. 

Christine: I see what you are saying. I think we can try sign language if it will help him.

Natasha: It is something to try. If it does not help, we can try something else.

I am sure many of you have encountered a situation like this. Natasha created cognitive dissonance in her discussion with Christine and Sebastian by having them reflect on their beliefs versus behavior. When we create cognitive dissonance, caregivers must reflect on their beliefs and decide whether or not they will change their behavior. 

What are some other situations where creating cognitive dissonance may be helpful?

Add your ideas in the comments below!

The post Creating Cognitive Dissonance as a Learning Strategy appeared first on Early Intervention Strategies for Success.

So far in this series, you’ve learned about the importance of two interventions associated with positive outcomes for children and families. In Part 1, we explored strategies that emphasize caregivers’ awareness and interpretation of their own actions. In Part 2, you learned how to help caregivers identify and use everyday learning opportunities to enhance child development. Now, let’s focus on the third intervention: supporting caregivers’ responsiveness to their children (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). For some caregivers, responsiveness comes naturally, especially when there is naturally a good fit between how the child interacts and communicates and how the caregiver parents. When it doesn’t come naturally or the caregiver struggles with responsiveness, it can have a significant impact on the parent-child relationship and the child’s development. Let’s think more about what this looks like and what you can do to support responsive interactions.

Supporting Caregivers’ Responsiveness to their Children

Responsiveness – how a parent or caregiver responds to and meets the needs of a child – has been found to have significant connections to communication and social-emotional development during early childhood (Mahoney, 2009). Responsiveness is one of those concepts that we know when we see it. We know it when we see a mother who reads her child’s cues, even the subtle ones, like when he shifts his gaze to make a choice about which book he wants her to read. We see it when a father hears his baby cry and immediately picks her up, bounces her and pats her back while soothing her with his voice. We see it when a childcare provider uses a warm expression and voice to calm a toddler then invite him into a turn-taking game of blowing bubbles. All of these interactions teach young children that they are important, that adults care, and that their attempts to communicate and engage with others and the environment have meaning.   

Responsiveness is also something that jumps right out at us when it’s not there. Think of the grandmother who ignores her grandson’s vocalizations because he “doesn’t make sense” and who swats him when he acts out from frustration. Think about the mother who misreads her daughter’s arching back and gaze aversion as a personal offense, which negatively impacts their attachment to each other. Or, consider the father whose depression makes it hard for him to respond to his child’s needs consistently or at all. There are many factors that can interfere with a caregiver’s ability to be responsive, and truthfully, we are not always able to mitigate them. We can, however, keep our eyes on responsiveness and encourage it, celebrate it, teach it, and praise it whenever we have the opportunity.

What Does This LOOK Like in Practice?

Here are a few strategies you can use to support responsive interactions between caregivers and children:

Label it when you see it – When you notice a parent being responsive, talk about it. Describe what you saw the parent do and how the child responded. Ask the parent questions to help her identify responsiveness and the impact, such as “What did you do that made Elena smile?” or “What did Elena do after you smiled at her?” Point out the delight the child showed when her parent interacted with her and praise the parent’s efforts.

Model and facilitate contingent interactions – In the context of interacting with the parent and the child together, model contingent interactions that are responsive to the child’s communication and social cues. Talk about what you are doing and why. Coach the parent to notice the child’s communication attempts, movements, or behaviors and help him/her interpret them with meaning. Point out what the child did before and after the interaction and talk about what the parent could do to respond, keep the interaction going, help the child be successful, etc. Just be careful to turn the interaction back over to the parent after modeling so he/she can practice engaging the child. You may be great at using a responsive strategy but that only matters if the parent can learn from you and use the strategy successfully with the child.

Use your voice and facial expressions – Affect is an important part of responsiveness (Mahoney, 2009). Using a warm voice and expressive facial expressions that convey that you are present, engaged, interested, and enjoying the child send an important message. Talk about the importance of affect and provide specific feedback to parents when they are using their affect in responsive ways. This is especially important when interacting with children who struggle with social-communication or who have sensory differences.

Encourage imitation and turn-taking – Use imitation and turn-taking as the vehicles for building responsiveness. When a caregiver struggles with responsiveness, help her understand the back-and-forth nature of interactions and communication. Use simple turn-taking games to entice the parent and child into interactions. Look for turn-taking games that they can enjoy and sustain (for a reasonable amount of time depending on the child’s age and developmental level). Start small, with the parent imitating the child’s actions or sounds, and shape these interactions into turn-taking. Help the parent look for ways he can take a turn whenever the child does something and vice versa. Encourage the parent to expect, wait for, and prompt the child to respond whenever there is an opportunity. Responsiveness is reciprocal but the parent sets the tone.

All three of the interventions you’ve learned about in this series have responsiveness at their core. When caregivers are more aware of how important their own actions and interactions are, understand the learning opportunities they can facilitate during daily interactions, and recognize how to engage and respond to their children to facilitate development, you increase the chances of intervention happening everyday. You also help build stronger parent-child relationships that last well beyond EI. Like I said before, that’s powerful stuff.

Now it’s your turn.

What is your favorite strategy for supporting caregiver responsiveness?

Share your ideas in the comments below!

References:

Dunst, C. J., & Trivette, C. M. (2009). Using research evidence to inform and evaluate early childhood intervention practices. Topics in Early Childhood Special Education, 29(1), 40-52.

Mahoney, G. (2009). Relationship-focused intervention (RFI): Enhancing the role of parents in children’s developmental intervention. International Journal of Early Childhood Special Education, 1(1), 79-94.

Swanson, J., Raab, M., & Dunst, C. J. (2011). Strengthening family capacity to provide young children everyday natural learning opportunities. Journal of Early Childhood Research, 9(1), 66-80.

The post 3 Interventions Every Early Interventionist Needs to Know – Part 3 appeared first on Early Intervention Strategies for Success.

Tantrums are a normal part of every young child’s life. If we are honest, we throw our own “tantrums” as adults. When working with young children, especially those with a language delay, we have to understand that tantrums are a mode of communication when emotions become overwhelming. Marci Melzer offers five steps to handle tantrums with late talkers. 

Watch the video here and we will explore each step. 

Children under three are driven by emotions and not logic (Prencipe & Zelazo, 2005). Think about this statement and what it means for the families you serve. Often, a parent’s expectations for a child’s behavior may be unrealistically high for the child’s developmental age. Further, tantrums are stressful for the caregiver and the child. In order to access the frontal lobe (top brain) to make good decisions, the reactive part of the brain (bottom brain) needs to calm to access the top functions of the brain. The caregiver needs to be calm to make good decisions on how to react and support the child. The child needs to be calm in order to learn. This is why each of the steps Marci Melzer provides can be helpful. Let’s discuss each step.

Step 1: Acknowledge and react as if the child was injured.

Marci describes this as the “stop, drop, and roll” method. This is where a tantrum first sparks and you need to put out the fire by providing an empathetic response. “You have to give that tantrum the same kind of attention as if was an accident or illness because in your child’s heart, in their feelings, they feel the same when they want a cookie and they can’t have it as they do when they are running and skin their knee and get hurt physically.” The difference is the empathetic response given by the caregiver in both situations. The child feels the same because both situations are out of their control and they are communicating those feelings. You would give the tantrum the same response of love in both situations (cookie before dinner vs falling and getting hurt). Both instances are “bummer situations.” Once you respond and the child knows you care about the message he/she is communicating, you move to the next step. 

Step 2: Understand the message the child is trying to tell you.

In this step, the caregiver is calm and can access his/her frontal lobe to problem-solve what message the child is trying to tell him/her. Every behavior is communicating a message (hungry, too loud, attention). 

Step 3: Be a language facilitator and translate the message.

The caregiver now becomes the language facilitator for the child by helping to find the words to express the message. Supporting the caregiver to model the words the child is trying to communicate is key. “You deal with the behavior with hugs and cuddles, but you translate this communication into words” (for example, modeling “all done” instead of throwing a cup off the high chair). Marci makes a good point; most caregivers are already translating their child’s language in their heads (“Oh…he is hungry). It is a matter of modeling the language for the child, but step four takes that a bit further.

Step 4: Model the message in words the child can process.

Most children in early intervention are late talkers. This is where we want to make sure that we are modeling the language on the child’s level. This may be a single word or short phrase. It is important to make sure the child is calm and engaged or go back to step 1. After you model the message when the child can process and understand, move to the final step.

Step 5: Make sure the child is ready to move on.

This is all about empowering the child. You acknowledge the feelings and calm the child, understand and translate the message, make sure the child understands the replacement behavior, and then check in with your child and make sure he/she is ready to move on with the next thing to do (such as help make dinner). 

A big mistake many caregivers make is redirecting or distracting without going through and acknowledging all five steps. Without going through each step, children not learning how to handle the big emotions they feel inside. This type of facilitation shows it is okay to have big feelings and how to properly deal with them over time. Remember, children under three react based off their emotions. It is not until after age three where logic starts to be used and there are a lot of emotions children feel as they learn to walk, talk, and interact with others.  

How do you support caregivers in understanding their children’s behaviors in your program?

How do you communicate typical development for children to caregivers?

Share any successful strategies you have in your tool bag.

Reference: Prencipe, A. & Zelazo, P.D. (2005). Development of affective decision making for self and other: Evidence for the integration of first- and third-person perspectives. Psychological Science, 16, 501-505.

The post Overcoming Tantrums appeared first on Early Intervention Strategies for Success.

You may have seen that awesome clip in the news recently of the father having an animated conversation with his 18-month old son. (If not, click the link and it will make your day!) Not only is it completely adorable, but it’s also a perfect example of a concept called “conversational turn-taking.”

Turn-taking is one of those early, essential skills that develops in the context of caregiving relationships. We early interventionists are always watching to see if a child can engage with another person in turn-taking. We know that turn-taking is important for early cognitive, communication, and social-emotional development and that it starts with imitation. Imitation and (eventually) turn-taking happen naturally in the context of silly games, making animal sounds while looking at books, playing with toys, eating a meal, learning how to get dressed, watching TV together, etc. When it happens in the context of early conversation between a very young child and a caregiver, turn-taking can a critical building block for communication.

How critical? Let’s find out.

Source: Gilkerson, J. Richards, J. A., Warren, S. F., Oller, D. K., Russo, R., & Vohr, B. (2018). Language experience in the second year of life and language outcomes in late childhood. Pediatrics, 142(4). Retrieved from https://pediatrics.aappublications.org/content/pediatrics/142/4/e20174276.full.pdf (PDF, New Window)

Research: What Do We Know?

In this study, Gilkerson and her colleagues examined the relationship between conversational turn-taking in 146 infants and toddlers and parents and the children’s later IQ, receptive, and expressive communication. In Phase I of the study, data was initially collected when these children were mostly between the ages of 2- to 36-months of age using a recording system that captured communication in the infant’s or toddler’s environment. This system then automatically counted conversational turns (between the parent and child), adult word count (both overheard and words directed to the child), and child vocabulary. Children were evaluated to determine their expressive and receptive language abilities, and parents completed an inventory to estimate the child’s vocabulary size. In Phase II, families in the first phase were invited to have their children (ages 9-13 years old) participate in follow-up cognitive and language assessments.

Data from Phases I and II were statistically analyzed to look for correlations. The strongest relationship was found between conversational turn-taking and adult word count occurring when children were between 18-24 months old; both were predictive of child outcomes 10 years later. However, when controlling for socio-economic status, the relationship between adult word count and child outcomes was much weaker.

Here’s the big take-away: Overall, conversational turn-taking that occurred with toddlers between 18-24 months of age and their parents showed the strongest relationship to later child outcomes, specifically related to IQ, vocabulary, and language skills at ages 9-13 years old. These findings suggest that how parents engage their 18-24 month old toddlers in turn-taking may be related to the child’s cognitive and communication development 10 years down the road. Wow.

Practice: How Can You Use What You Know

So what does this really mean? The quality of how a caregiver talks with (not to) a toddler in the 18-24 month age range may have a significant impact on that child’s later IQ, his ability to comprehend language, and his overall expressive and receptive language skills. This is probably not that surprising for us in EI, but when you think about it, this impact is amazing. Not only is the amount of words a child hears important, but the opportunities for the child to engage, back-and-forth, with an adult in a conversational manner are essential, especially while toddlers are developing their early abilities to talk.

Here are a few strategies to help you use what you now know:

Build parent responsiveness

Help parents recognize communication cues from infants and older toddlers who are still learning to talk. Point out the child’s attempts to communicate, whether by eye gaze, gesture, body movement, or sound. Model for parents how to respond and provide positive, specific feedback when the parent responds to the child’s communication (e.g., “Wow, when Taylor said “ka” you knew exactly what she wanted! When you said “cup” back to her, you gave her a great example of how the word sounds!”)

Build turn-taking skills with actions and sounds

Encourage parents to always pair sounds/words with actions when playing turn-taking games with their children. Rolling a ball back and forth or blowing soap bubbles could be paired with fun sounds or repetitive words like “ready, set, go!” or “your turn!” and “my turn!”

Encourage parents to have conversations with their infants and toddlers – often!

Model how this sounds and praise it when you see it happening between the parent and child. Assure them that even if they feel silly talking to a child who can’t “talk” yet, they are teaching their child about how words sound, what words mean, and how to use sounds and words to communicate with others. Conversational turn-taking also teaches the child what may be the most important lesson of all – that the child is valued and loved. Use video examples like the fantastic clip mentioned above to see these conversations in action!

My biggest take away from this article (and that amazing dad) is that it’s not always about the number of words a young child hears. What may be even more important is the quality of the interaction. Conversations matter – even and maybe especially with toddlers!

What are your favorite strategies to encourage conversational turn-taking between parents and their babies?

Share your ideas in the chat below!

The post EI Research to Practice Brief #7 – Conversational Turn-Taking between 18-24 Months Really Matters appeared first on Early Intervention Strategies for Success.

When we whittle early intervention down to its core, I think it’s all about interactions. Interactions between the child and caregiver, first and foremost…interactions between the child and the environment (toys, sofa cushions, spoons and cups, buttons on the TV remote, the family dog)…interactions between the EI practitioner and caregiver that facilitate positive interactions with the child in the natural environment. See where I’m going here? It’s all related to positive, reciprocal, contingent interactions.

Translating our Super Powers

The Division for Early Childhood (DEC) Recommended Practices provide our field with a list of five interaction practices that we can use to “promote specific child outcomes” (p 14) when working with families. As early interventionists, we often have super powers related at using these practices – we know how to use our voices and language to engage children, how to observe behavior and encourage reciprocal communication, and how to help children sustain interactions and respond to the environment. Our use of our super powers won’t ever be enough, though. We have to use what we know to help others interact with the child in ways that boost development and learning. When caregivers use recommended practices for interaction, the child has more opportunities to develop social skills, communication, cognition, and independence throughout the day. Those daily interactions are what really matter.

Helping Caregivers Use the DEC Interaction Practices

Let’s consider the first three practices, which focus on promoting social and communicative interactions.

INT1. Practitioners promote the child’s social-emotional development by observing, interpreting, and responding contingently to the range of the child’s emotional expressions.

Early interventionists are great resources for caregivers in helping them observe and interpret their child’s behavior. This is especially helpful with children who communicate in ways that are harder to understand, such as children who may have autism or those with multiple disabilities. The interventionist can help the caregiver notice the child’s attempts to engage and communicate. Then, they can figure out how the caregiver can respond in ways that help the child learn the benefits of engaging others.

Example: An educator sees a child’s tendency to stroke his mother’s hair as an attempt to engage the mother and feel close to her. The mother originally found the “hair pulling” slightly annoying, but when she sees the possibility that it represents affection from her child, she can respond to the child with a warm smile and voice, encouraging rather than discouraging the interaction.

INT2. Practitioners promote the child’s social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support.

Early interventionists can help caregivers seek out opportunities for the child to interact by observing typical routines, especially those that the caregiver and child enjoy together. By asking the caregiver open-ended questions (“What makes your child laugh? What do you like to do together? When do you do to spend time together? What would you like to do together?), the interventionist can identify activities to target for intervention.

Example: An occupational therapist (OT) observes the morning dressing routine, during which a mother plays peek-a-boo and tickle games with her infant. The OT coaches the mother to use an expectant look and extra wait time to facilitate her child’s engagement and teach her child how to take turns, make sounds, and perhaps pull the blanket from the mother’s face to keep the game going.

INT3. Practitioners promote the child’s communication development by observing, interpreting, responding contingently, and providing natural consequences for the child’s verbal and non-verbal communication and by using language to label and expand on the child’s requests, needs, preferences, or interests.

Rather than being the communication partner for the child for most of the visit, the interventionist can coach the caregiver in how to respond contingently, use words that are just above the child’s language level, and expand on what the child says. This works well during play and other routines.

Example: A speech-language pathologist coaches a father in how to expand a child’s gestural request for his cup to be filled with water. The child hands his cup to his father and walks away. Through modeling and practicing simple prompts, the father can learn to label the child’s request (“More water?”), hold the cup up near his own mouth to draw the child’s attention to the word being said, and wait before meeting the need so that the child has a chance to imitate the model. The father and child can then practice this interaction whenever this request is made, which is likely to be often – more often than if the therapist used this strategy 2-3 times on a single visit.

These are just a few examples of how we can implement the Interaction Recommended Practices through the caregiver-child interaction.  Our knowledge of how to facilitate interactions can translate into the strategies we share and practice with families. Using those parent-interventionist interactions to facilitate parent-child interactions in natural environments – that’s what it’s all about!

Next week, we’ll continue this discussion by looking at the next two practices, which focus on facilitating cognitive skills. In the meantime:

Why is it important that early interventionists translate these practices for use with families?

How have you use these practices on visits? With child care providers?

Share your thoughts and examples of implementing these practices by leaving a comment below!

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

The post DEC Recommended Practices – Interaction (Part 1) appeared first on Early Intervention Strategies for Success.

In Part 1 of this series, we met Phoebe, a service coordinator, and Wyatt’s family. Wyatt had just been referred to early intervention, and his family was eager to begin services but feeling overwhelmed by the process and their son’s new diagnosis of cerebral palsy. We began the discussion about the DEC Recommended Practices (2014) under the Family strand, illustrating how Phoebe used them when supporting Wyatt’s family from intake through service delivery. Take a moment now and review the Part 1 blog post to catch up.

Now, let’s consider how Phoebe and Noelle, the physical therapist, implemented the last five family practices.

DEC Recommended Practices: Family (continued)

F5. Practitioners support family functioning, promote family confidence and competence, and strengthen family-child relationships by acting in ways that recognize and build on family strengths and capacities.

When Phoebe joined a visit, she was happy to see Noelle coaching Wyatt’s mother in how to help Wyatt learn to support himself in sitting. Wyatt’s older sister was keeping Wyatt entertained by holding his favorite musical toy in front of him and singing songs. Wyatt was smiling and working hard to keep his head in mid-line so he could see his sister. Wyatt’s sister loved helping him learn and was his greatest cheerleader. One of his family’s biggest goals was helping Wyatt learn to sit so that he could more easily participate in playtime, bath time, and meals which were social, fun times for the family.

F6. Practitioners engage the family in opportunities that support and strengthen parenting knowledge and skills and parenting competence and confidence in ways that are flexible, individualized, and tailored to the family’s preferences.

Two weeks later, Wyatt’s mother called Phoebe, asking for ideas on how to help Wyatt participate in the local baby gym program. She’d taken Wyatt to a free class but was disheartened that he struggled with many activities. Phoebe suggested that they hold an IFSP review meeting to revisit Wyatt’s outcomes and goals and discuss how to help him at the baby gym. Phoebe called Noelle to update her and schedule the meeting in the early evening so that Wyatt’s father can attend, as he also wanted  to take Wyatt to weekend classes. During the meeting, the baby gym is added as a location for physical therapy and goals are reviewed. After the IFSP review was completed, Noelle discussed the activities at the baby gym class with Wyatt’s parents and they came up with several ideas to help Wyatt have fun.

F7. Practitioners work with the family to identify, access, and use formal and informal resources and supports to achieve family-identified outcomes or goals.

Noelle attended the next two baby gym classes to help Wyatt’s family access and use the play equipment. She helped Wyatt’s parents and the baby gym instructor problem-solve how to encourage Wyatt’s motor development while he played and interacted with the other children. He especially enjoyed playing with the parachute and popping bubbles, but needed assistance sitting upright during these activities. Wyatt’s parents used the strategies they practiced at home to help him with sitting, and determined that the bolsters at the gym could provide him with support when sitting or lying on his tummy. After these visits, Wyatt’s parents felt much more comfortable in the class. 

F8. Practitioners provide the family of a young child who has or is at risk for developmental delay/disability, and who is a dual language learner, with information about the benefits of learning in multiple languages for the child’s growth and development.

One day, Wyatt’s mother called Phoebe to tell her that she would begin working full-time soon. Her mother would be providing childcare and primarily spoke Spanish when at home, though she was bilingual. Wyatt’s mother was concerned that hearing both languages would interfere with his language development. Phoebe discussed the benefits of Wyatt learning a second language, and offered to email his mother information about encouraging Wyatt’s learning of both languages. She assured Wyatt’s mother that Noelle would continue to monitor all areas of Wyatt’s development too. Phoebe called Noelle to fill her in, and services began alternating between the grandmother’s home and periodic visits in the early evening with Wyatt’s parents.

F9. Practitioners help families know and understand their rights.

When it was time for Wyatt’s annual IFSP review, Phoebe reviewed the family rights and procedural safeguards again to ensure that Wyatt’s parents were aware of their rights.  She offered a document explaining these rights, and completed documentation of the discussion.  By then, Wyatt’s parents were very familiar with this information, as Phoebe had discussed rights often throughout the past year, especially at IFSP reviews. 

F10. Practitioners inform families about leadership and advocacy skill-building opportunities and encourage those who are interested to participate.

Phoebe has been pleased to see how Wyatt’s family has grown from being overwhelmed with the process to feeling confident in their role on the IFSP team. This growth led her to ask Wyatt’s mother if she would be interested in being a resource to new families as they enter the program. Wyatt’s mother happily agreed. When an opportunity to serve on a local board that oversees community services for children with disabilities became available, Phoebe also asked Wyatt’s family about their interest, and his father decided to volunteer. Where they were once eager to get services started, Wyatt’s parents are now eager to help other families and participate in community activities that build strong supports for their son and other children.

As you’ve just read, the DEC Family Practices can be used as a guide for supporting families throughout the EI process. These practices help service coordinators and service providers build family confidence and competence from the first contacts throughout service delivery.  What we do in early intervention matters…but it is HOW we do it, how we support families, that really makes the difference.

Be sure to check out these Family Practice Guides for Practitioners from the ECTA Center:

Family Capacity Building in Early Childhood Intervention (PDF, New Window)

Supporting Family Member Informed Decision Making (PDF, New Window)

Now, pick one practice guide and forward it on to your colleagues/staff.

How have YOU implemented these practices today? 

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

The post DEC Recommended Practices: Family (Part 2) appeared first on Early Intervention Strategies for Success.

You are visiting Mason at his child care center for the first time today. When you arrive, you find the classroom to be super busy, with eight toddlers and two adults. After introducing yourself to the lead teacher and the assistant, you explain how EI visits usually work and ask how you can help. You try to join the art activity and talk with the teacher more, but the teacher answers in short sentences as if it’s hard for her to concentrate on the children and on your questions. Eventually, the teacher mentions that the classroom next door is empty and asks you if you’d like to go work with Mason in there.

What do you do?

Strategies for Working with the Child Care Provider & Child IN the Classroom

So what do you do when you walk in the classroom and are told to walk right out? Asking you to pull the child out into another room could indicate several things about what the child care provider may be thinking. Here are some strategies for dealing with the possibilities:

Possibility #1 – She doesn’t understand the purpose of your visit. 

The child care provider may think that you are there to provide therapy to Mason. She may not want to get in the way or have the other children distract you or him. Take the time to reiterate your roll as a support to her. Tell her that you are there to work together with her and her assistant to find ways to encourage Mason’s development during the activities that they do everyday. Let her know that you’d like to explore what they’ve already tried and what they’d like to do with Mason. Explain that if you pull Mason out of the classroom for therapy for one hour a week, then he’s not really getting much intervention. However, if you work with her and she’s able to implement intervention strategies throughout the week, he’ll get much more intervention, which is ultimately the goal of your visit. Don’t forget to ask how this sounds to her, if it is “doable.” What she thinks really matters.

Possibility #2 – She doesn’t know what to do with you.

This is just as likely in a child care center as it is in a home. Caregivers often don’t know their role in the collaborative partnership. Describe how you can work together. Ask her if she is okay with the first few visits focusing on getting to know her classroom and how Mason behaves there. Let her know that you will spend a lot of time talking with her and helping her and her assistant try out strategies with Mason during the activities in the classroom. You’ll help her come up with ideas, try them out, then reflect on them and problem-solve so she feels confident using them when you’re not there.

Possibility #3 – She doesn’t think there is any real reason for you to be there.

Sometimes, child care providers disagree with families about the child’s development. Maybe she thinks Mason will talk when he’s ready. Maybe he talks more at school than he does at home. Before you jump into strategies, find out her thoughts on his development. Tap into her expertise. If she doesn’t think he needs intervention, then ask how his communication (or motor development, or social skills, etc.) compares to other children in the room. Ask about what goes well for Mason and what challenges him – and what challenges her during the day with Mason. Maybe she doesn’t think Mason needs to talk yet, but the fact that he drops into a tantrum ten times a day is a big challenge. Find out about her day and determine how you can help – same as you would with a parent. After that, if you still don’t have her “buy in,” talk to the service coordinator and the parent about what to do next.

Possibility #4 – This is just not a good time for your visit.

It could be as simple as art time is usually chaos with eight toddlers so is not a great time for a visitor. Ask the question. Maybe another time of day would be better. Outside play time is often a great time to see the child move about, interact with others, and still be able to snag the teacher’s attention. If she needs you to come at a certain time of day and you don’t have that available in your schedule, you may need to contact the service coordinator to discuss changing providers. Working in child care requires a great deal of flexibility – even being flexible enough to realize that you may not be the best match for the situation, and that’s okay too.

Hopefully, after you’ve explored the possibilities with the teacher and helped her understand why you are there, you’ll all be on the same page and ready to work together. The collaboration between you and the child care staff is what will keep you IN the classroom!

What are your best strategies for dealing with these possibilities?

What have you done when asked to pull the child out of the child care classroom?

Share your experiences and ideas in the comments below!

The post The Teacher Wants You to Pull Mason Out of the Classroom…What Do You Do? appeared first on Early Intervention Strategies for Success.

I have a confession…I don’t actually think we should spend so much time talking with families about their concerns. I think we should ask once, so that we have it for Section II of the IFSP, then leave it alone. Instead, I think we should focus much more on the family’s priority for their child’s development. Concerns and priorities are not the same thing, and the difference matters.

Concerns and Priorities – What’s the Difference?

Concerns are often similar from family to family. Think about the many, many toddlers who are referred to early intervention who are not talking. In fact, most of the children we see are not talking as an age-appropriate level. When you ask their parents what they are concerned about, they are likely to say something like, “He’s not talking like other kids his age.” This is a very common, very real concern. Same with children who are late walkers. These concerns are very important because they are what drive a parent to EI, and they are what keep a parent up at night, worrying about her child. We must acknowledge these concerns, and record them on the IFSP, then dig deeper to find out about priorities.

Turning to priorities reframes the discussion to become more individualized, more positive, and more functional. Priorities are the answers to questions like “What would it look like to you if she was able to talk more?” or “How would your day or your child’s day be easier if she could say more words?” Priorities are descriptions of what life would be like for a child and family if things got better. Priorities reflect the family’s vision for the child’s development. Priorities are the foundation for individualized, functional IFSP outcomes.

Why It Matters

It’s really, really hard to write a good IFSP outcome based on concerns alone. When we focus on concerns, we get outcomes that are “cookie-cutter.” You can substitute any child’s name in the body of an outcome like this: Noah will use words to express his wants and needs. All toddlers need to be able to do that – it’s not an individualized outcome. If you focus on priorities for Noah and his family, you’ll find out that life would be grand if Noah could say words to label toys and activities he likes to do when he plays with his siblings after school. Noah loves to play with his blue ball in the back yard, play in the toy kitchen with his sisters, and look at books with his dad. By digging into priorities for Noah and hus family, we learn about how the family works and what’s important to them. This rich information is where you glean what you need to know to write a good outcome. Here’s an example:

Noah will use 50 words to label his favorite toys (ball, cup, book, doggie) and activities (play, outside, kitchen, dinner, books) when playing with his siblings each afternoon after school for two weeks.

This outcome is individualized to what Noah likes to say and do, includes a context that happens frequently in his home, and includes a measurable criteria that the family can keep track of. If the professionals on Noah’s IFSP team had only focused on his family’s concerns, then they would have missed out on what they really needed to know to ensure that the IFSP was meaningful to Noah’s family. This is important because the IFSP outcomes guide service delivery, and meaningful services are based on what’s important to the family – their priorities for their child.

What do your teams typically focus on – concerns or priorities?

What challenges do you face with finding out about family priorities?

How do you guide the conversation to dig deeper into what’s important to families when writing IFSP outcomes?

Share your comments below!

The post A Priority or a Concern – What’s the Difference and Why it Matters appeared first on Early Intervention Strategies for Success.

This will come as no surprise to you as an early interventionist…findings from a new study in the online journal JAMA Pediatrics suggest that electronic toys are not so good for toddler communication development. Shocked? I knew you wouldn’t be.

Electronic Toys & Play Interactions

I often found this to be a big challenge on intervention visits – the plethora of electronic toys and books. I would try to join the family as they played with their toys, and found it hard to coach the parent in different ways to engage the child with these toys. The child would often delight in pressing the buttons (sometimes over and over again) to make the lights, sounds, or voices play, but that was about as creative as the play got. The parent would try to talk about pushing the button, ask the child to find a particular button, imitate the sound that played, or maybe praise the child after he found the button. That was often the extent of the language displayed, not because the parent wasn’t trying, but because the repertoire of activities that can be done with many electronic toys is just so limited. You might think, wait a minute, an iPad or the latest Fisher Price toy can do a ton of things…that may be true, but consider this…how can the parent interact with the child while the toy is doing all the work?

Too Many Buttons, Too Few Words

In the new study, parent-child communication was measured when the each dyad was playing with three kinds of toys: electronic toys, traditional toys (like blocks), and books. Children in the study were between 10-16 months of age. When parents and their toddlers played with electronic toys, both said fewer words. There were fewer conversational turns between them, the parent responded to the child’s utterances less often, and the parents used fewer content-specific words. This really matches what I’ve seen on visits and actually, what I’ve experienced when playing with toddlers with these toys myself. It’s just harder to communicate around electronic toys and books. I don’t necessarily thing that electronic toys are “bad” for children – in moderation. Electronic toys grab a toddler’s attention, and I think they are really well-marketed to grab ours (as adults). In moderation, a few lights and sounds toys can be fun. Too many, though, can hijack a child’s attention and make it harder for the parent and child to interact, which is so important for communication and social development. Like most things, it’s probably about balance. A few noisy, flashy toys with more traditional toys, like blocks, cars, baby dolls, rattles and (lots of!) books can go a long way, especially when there is a responsive adult playing along with the child.

A Few Suggestions

So, with this said, what’s an early interventionist to do in a home full of electronic toys? Here are a few suggestions:

Observe parent-child play – You might find that the pair are having a blast and interacting fantastically with whatever toy they have. Or, you might find that they are struggling to interact with toys that trap the child’s attention away from the parent. If a toy interferes with communication, talk to the parent about it, not in a “you bought the wrong toys” sort of way. Ask the parent what she notices about her child’s communication when he plays with his lights and sounds toy, and I bet she’ll say that he doesn’t talk much. That gives you a great lead-in to explore this topic with the parent.

Remove the batteries – I’m not suggesting that you remove them when the parent’s back is turned. Rather, if the child loves his animal farm that makes all of the animal sounds for him, ask the parent what she thinks would happen if the batteries were removed. Sure, the child might not be very happy at first, but when he figures out that interacting with his mom while she makes the silly sounds is much more fun, the parent might see how her interaction with her child, rather than the toy, can make a big difference.

Don’t play with toys – Wha? Yes, how about you suggest to the parent that on the next visit, that you do something else. Ask her what they like to do, what’s fun for them. Ask what they would be doing if you weren’t coming and plan to do that. Early intervention can be immensely successful without toys. Try it and you’ll be amazed. Don’t go in and automatically plop on the floor near the toy box. Afterall, parents really don’t spend most of their day playing with toys of any kind with their toddlers. Instead, they are running errands, fixing meals, doing laundry, cleaning the house, taking walks, getting the mail, etc. Join those activities on your next visit and help the parent seize the natural learning opportunities as they happen.

This is a fascinating subject to me. I love toy play, but I think this study reminds us that there are so many other fun and effective ways to interact with children that have nothing to do with batteries or lights and sounds. Sometimes parents need that reminder, and sometimes early interventionists do too.

Okay, now I am officially stepping down off of my soapbox, dismounting from my high horse. 🙂

What are your thoughts about electronic toys and infant/toddler development?

What do you do in a home full of electronic toys?

Share your thoughts and ideas in the comments below!

Reference

Sosa, A. V. (2016). Association of the type of toy used during play with the quantity and quality of parent-infant communication. JAMA Pediatrics, 170(2), 132-137.

The post The Challenge of Electronic Toys on Visits appeared first on Early Intervention Strategies for Success.