Coaching Caregivers To Implement Naturalistic Communication

Strategies In Home and Community Settings

Kathy Supple, LSW, EIS
Kent State University, Early Childhood Special Education Program
Discussion
Methods Introduction
Children with autism often lack eye contact and social communication skills.
Simple interventions can be taught to caregivers to help children have meaningful
communication.
Prelinguistic Milieu Teaching strategies are easily embedded within ongoing social
interactions that take place in the childs natural environment (Fey et. al. 2006).
Parents play a critical role in their childs early communication development since
they are their childs first teacher (Kaiser & Roberts, 2013).
The early language environment impacts long lasting communication and
language outcomes:
Hart and Risleys book, Meaningful Differences in the Everyday Experience of
Young American Children describes tremendous differences in the amount of
language children hear at home.
Important to train parents and caregivers in positive strategies to foster optimal
outcomes in the natural environment

The current study examined the effects of coaching and feedback on the parent
implemented naturalistic communication strategies on the child expressive
communication.

























Participants
2-year-old with suspected autism
Makes very little eye contact
Not using words
First-time mother & father
Parents are both Caucasian, in their early 20s
Parents live with dads parents
Setting
Home
Routines targeted were playtime and mealtime


Intervention Strategies
Following the Childs Lead: parent attends to the childs interest by commenting, asking questions about it,
or joining in play with the goal being maintaining joint attention
*if the child is stacking blocks the caregiver stacks blocks
*if the child is reading a book, the adult asks about it and tries to read with the child.
Commenting & Labeling: parent comments about and/or labels people, things, and objects that the child is
interested in, or things the child is doing
*if the child is playing with a toy, the parent can describe it (it is red, it has 4 wheels, its moving!)
*if the child is looking at the Reeces, parent says, Oh, you want a Reeces Peanut Butter Cup.
Arranging the Environment: structuring the environment in a way that promotes opportunities for children
to communicate more frequently throughout the day
*place objects of interest in sight of the child but out of her reach to encourage communication
*make a picture book with familiar people/objects to encourage the child to talk about it, or share it
Imitating: repeating a childs words or vocalizations
*this should be an exact repetition (if the child says ahh, the parent then makes eye contact and
repeats, ahh.)
Turn-taking: parent waits for the child to say or do something
*parent sticks out tongue and waits for child to do the same
*parent starts to tell a story and waits for the child to fill in the blank (the itsy bitsy_____).

Giving Positive Feedback: parent praises child or states what the child did well
* way to go putting toys away, good job asking, you look great with those shoes on or simply
giving a thumbs up, high five, or eye wink
Asking Questions: parent asks questions to encourage communication: what book do you want to read?
Providing Choices: parent asks, would you like a banana or an apple?, would you like to wear your blue
shirt or your red shirt?
Expanding: parent adds additional words to what the child says (child says baa and parents says, oh,
you want your bottle.)

Child Target Behavior (DV)
Eye contact, vocalizations, gestures, words, sentences and tantrums

Coaching Strategies
1. Talk to caregivers about the intervention
2. Model the intervention
3. Observe caregivers doing the intervention
4. Ongoing Support and Feedback to parents


Data Collection
10 Minute play sessions with adult and child at home in Baseline and Intervention Conditions (AB design)





Baseline: Child is making very little eye contact, has no words, and has just started to take parents hands
to lead them to what she wants
Intervention: Adult implementation of the Communication Strategies and subsequent increases in the
childs eye contact, communication, and social interactions & decreases in tantrums
Citation Purpose Results
Fey, M., Warren, S., Brady, N.,
Finestack, L., Bredin-Oja, S.,
Fairchild, M., Sokol, S., & Yoder, P.
(2006).
To teach parents to implement
some easy language strategies with
their children.
Childrens rate of requesting (how
often they gestured to ask for
something) increased when their
parents implemented the suggested
strategies.
Fey, M., Yoder, P., Warren, S., &
Bredin-Oja, S. (2013).
To find out if implementing more
language intervention would work
better.
Children who have meaningful play
skills may benefit from more
intervention weekly, however
children who do not have
meaningful play skills did not.
Hancock, T. & Kaiser, A. (1996).
Siblings use of milieu teaching at
home..
To teach older siblings some
strategies they can implement with
their younger siblings who have
language delays.
Younger siblings responded more
and talked more.
Kaiser, A., & Roberts, M. (2013). To teach parents to implement
naturalistic language interventions
to their children with intellectual
disabilities.
Parents of young children with
intellectual disabilities can learn
and maintain naturalistic teaching
strategies with their children.
Togram, B. & Erbas, D. (2010). To teach mand-model (requesting)
procedure in a classroom.
All participants showed progress
following training.



Current project aligns with past research on the effects of coaching
for promoting caregiver skills and confidence
The importance of positive adult-child interactions and the quality and
quantity of language interactions
Early Intervention professionals need practical strategies that can be
embedded in the natural environment with no special tools/materials
Coaching the caregiver is important because it allows the EIS to
strengthen the familys ability to support and enhance their childs
development
Coaching by the EIS is sharing information and resources, suggesting
and demonstrating intervention strategies with caregiver, supporting
the caregiver by stepping back and watching them practice the
intervention, providing feedback to the caregiver, and facilitating
problem-solving.

Future Directions
More intense research on prelinguistic milieu teaching is needed to
address the following:
Generalization of trained behaviors after intervention (across
settings and adults)
Larger sample sizes
Intervention dosage, setting, and implementer (interventionists)

More research on coaching caregivers is needed to find out:
Strategies or combination of strategies that impact caregivers
behaviors that promote their childs language
Methods
Results