Vocabulary Acquisition and Usage for Late Talkers: The Feasibility of a Caregiver-Implemented Telehealth Model

Parent implementation of a treatment for late talkers based on cross-situational statistical learning principles: Treatment fidelity and acceptability

PURPOSE

Early intervention based on principles of cross-situational statistical learning (CSSL) for late-talking children has shown promise. This study explored whether parents could be trained to deliver this intervention protocol with fidelity and if they found the intervention to be acceptable.

METHOD

Mothers of four English-speaking children aged 18-30 months who scored <10th centile for expressive vocabulary were recruited to an 8-week group training program. Parents were taught principles of CSSL and asked to perform 16 home treatment sessions (30 minutes each) in total, providing auditory bombardment of target words in full sentences at high dose number and syntactic variability, using a range of physical exemplars. Home diaries and two videotaped sessions measured treatment fidelity. Pre- and post-treatment questionnaires measured acceptability.

RESULT

One parent discontinued the study after the second group training session. Three parents completed 15/16 group training sessions and reported completing 87% of home sessions. Two parents demonstrated implementing the intervention as per the target dose number by the first fidelity session (Weeks 2/3), and the third parent was very close to meeting target dose number by the second fidelity session (Weeks 7/8).

CONCLUSION

Parents can be trained to deliver an intervention based on cross-situational statistical learning principles.

Monitoring Treatment Fidelity in a Pragmatic Pediatric Rehabilitation Trial Comparing Two Physical Therapy Schedules: Analysis and Unexpected Findings

OBJECTIVE

This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity.

METHODS

Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention), and study protocol for a comparative effectiveness trial titled: "A Comparison: High Intensity periodic vs Every week therapy in children with cerebral palsy (ACHIEVE)" for children ages 2 to 8 years with cerebral palsy (CP). Therapists were instructed to record every tenth hour of treatment. A subset of recordings were used to monitor treatment fidelity so that each therapist was rated twice using the study-specific ACHIEVE Treatment Fidelity Checklist. Generalized linear mixed effects modeling and logistic regression were used to analyze child and therapist factors related to treatment fidelity.

RESULTS

Median treatment fidelity scores were high (>80%). With training, therapist's years of experience and specialty certification do not significantly impact treatment fidelity. There is a trend toward lower treatment fidelity scores for children with communication difficulties, particularly for therapist's use of multi-modal instructions to direct the child in the desired activity.

CONCLUSION

Functional, goal-directed, motor learning intervention can be delivered with high fidelity for children with CP within a busy clinical setting. Motor learning principles may be implemented differently for children with communication difficulties. More research is needed to explore optimal motor learning strategies for these children.

IMPACT

With training, physical therapists can deliver high-fidelity intervention to children with CP across all Gross Motor Function Classification System levels within a busy clinical setting. Therapists may use motor learning principles differently in children with communication delays.

Not All Planes Have Propellers: Using Context Variability to Treat Word Learning in Late Talkers With the Vocabulary Acquisition and Usage for Late Talkers Protocol

PURPOSE

The purpose of this study was to determine if the Vocabulary Acquisition and Usage for Late Talkers (VAULT) intervention could be efficaciously applied to a new treatment target: words a child neither understood nor said. We also assessed whether the type of context variability used to encourage semantic learning (i.e., action or object) would affect learning outcomes.

METHOD

Nineteen primarily English-speaking late-talking toddlers received 8 weeks of VAULT intervention. They were quasirandomly assigned to a condition that highlighted either object or action variability. Individual effect sizes were calculated for target (treated) and control (not treated) words for each child. These were combined to assess group-level comparisons of treatment efficacy and treatment conditions. Generalization of the word-learning ability was assessed by comparing rates of learning on a vocabulary checklist prior to and during intervention. Bayesian statistics (e.g., t tests, analysis of variance) were used for the analyses.

RESULTS

There was strong evidence for a treatment effect showing that children produced more target than control words and moderate evidence that they understood more target than control words. There was strong evidence for generalization. Children learned an average of 6.8 words per week during treatment. There was anecdotal evidence for no difference between treatment conditions.

CONCLUSIONS

VAULT, with a focus on context variability, can be used efficaciously to teach children to say words they do not understand at the start of treatment. The effects were most pronounced in the generalization data. Additionally, children were able to learn later-acquired words.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28200074.