Enhanced milieu teaching with phonological emphasis: A pilot, telepractice study for parent training in early intervention

Early Intervention for Children With Developmental Disabilities and Their Families via Telehealth: Systematic Review

BACKGROUND

Early intervention during the first 3 years of life is crucial for children with developmental disabilities to optimize developmental outcomes. However, access to such services is often limited by geographical distance and resource constraints. Telehealth can be part of a solution for overcoming these barriers, enabling the delivery of early intervention services. However, a comprehensive understanding of the efficacy and implementation of telehealth in early interventions remains elusive, particularly for children aged 0-3 years.

OBJECTIVE

This systematic review aims to synthesize existing research on the effectiveness and implementation of telehealth interventions in infants and toddlers (aged 0-3 years) who are at risk of or diagnosed with developmental disabilities. The primary objective of the study is to evaluate the ways that telehealth compares to conventional in-person interventions in improving developmental outcomes for children and supporting family well-being.

METHODS

A systematic search was conducted of 4 electronic databases (PubMed, Embase, CINAHL, and Web of Science), focusing on studies published between 2010 and 2024. The inclusion criteria were studies involving telehealth interventions for children aged 0-3 years who were at high risk or had developmental disabilities, which involved active interactions between the providers and the families. Study quality was assessed using the mixed methods appraisal tool, and a narrative synthesis was used to analyze the data.

RESULTS

Eighteen studies met the inclusion criteria: 12 single-case designs, 4 randomized controlled trials, and 2 nonequivalent control group designs. All studies involved caregiver-child dyads, with child ages ranging from 5 to 37 months and having or at risk of autistic spectrum disorder (n=10, 56%), cerebral palsy (n=4, 22%), and other conditions (n=4, 22%). Synchronous videoconferencing was the primary modality for caregiver training and coaching (n=17, 94%) while 1 intervention used an Internet of Things system. Outcomes were identified in child communication (n=9, 50%), physical (n=6, 33%), social or emotional (n=6, 33%), and adaptive behavior (n=4, 22%), as well as caregiver implementation (n=12, 66%). Telehealth demonstrated comparable or superior effectiveness to traditional in-person methods in 2 studies. However, the focus on specific conditions and limited research on cognitive development were notable gaps.

CONCLUSIONS

Telehealth can be a viable alternative to traditional in-person early interventions for young children who have developmental disabilities and their families. It enhances accessibility and interactions between families and providers at a distance while promoting family-centered care. Challenges exist, including those of technological literacy, and the lack of research on cognitive outcomes must be addressed. Future work should explore more comprehensive interventions, including multidisciplinary approaches and expanded family outcomes, to solidify the role that telehealth plays in early intervention.

TRIAL REGISTRATION

PROSPERO CRD42024551286; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=551286.

Prenatal to Adulthood: The Responsibility of the Speech-Language Pathologist on the Comprehensive Cleft Palate and Craniofacial Team

PURPOSE

Comprehensive cleft care is an important component when caring for a child with cleft palate with or without cleft lip (CP ± L). Speech-language pathologists (SLPs) serve different capacities on comprehensive cleft palate and craniofacial teams.

METHOD

This tutorial highlights the role of the SLP on the cleft palate and craniofacial team from the prenatal consultation to adulthood. This tutorial emphasizes the importance of collaboration between the cleft team SLP and other professionals on a comprehensive cleft team. Additionally, the tutorial provides education for feeding infants with CP ± L and focuses on assessment and treatment of children with CP ± L before and after the palate repair. Finally, this tutorial underscores the importance of working as part of and collaborating with interdisciplinary team members.

RESULTS

SLPs are an essential member of comprehensive cleft teams in addition to other medical providers. SLPs play a critical role on these multidisciplinary teams and are fundamental to the assessment and treatment of feeding, speech, language, and resonance disorders in children with CP ± L.

CONCLUSION

It is critical that SLPs are involved in comprehensive cleft team care from the prenatal consultation through adulthood to monitor resonance, speech, and language development and outcomes.

Systematic Review and Meta-Analysis of Enhanced Milieu Teaching

PURPOSE

Early language intervention is essential for children with indicators of language delay. Enhanced milieu teaching (EMT) is a naturalistic intervention that supports the language development of children with emerging language. We conducted a systematic review and meta-analysis of all qualifying single-case and group design studies that evaluate the experimental effects of EMT on child outcomes.

METHOD

We evaluated the risk of bias in the included studies and conducted a descriptive analysis of study quality, effect sizes, and demographics. We reviewed a total of 29 single-case and 17 group design studies in which 1,590 children participated.

RESULTS

Out of 46 studies, 39 met the What Works Clearinghouse standards without reservations, showing low levels of risk of bias. The effects were comparable when EMT was implemented alone and when it was implemented with another intervention component, and EMT was more effective when implemented by caregivers than when implemented by therapists. Most studies did not report sufficient participant demographics.

CONCLUSIONS

The EMT research literature published thus far is of high study quality; the effects across studies are comparable; and the intervention has been studied via a wide range of delivery modalities, contexts, implementers, and samples. Future research could systematically examine the effects of EMT and explore these varying intervention delivery, implementer, and learner characteristics as moderators.

The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America

PURPOSE

The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L.

METHOD

This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13-35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20-34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais-Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics.

RESULT

The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country.

CONCLUSION

The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.

Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial

BACKGROUND

Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders.

OBJECTIVE

This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention.

METHODS

A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants).

RESULTS

The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received.

CONCLUSIONS

The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54426.