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.

The development and psychometric assessment of communication skills checklist for 6- to 24-month-old Persian children.

Prelinguistic skills play an important role in children's communication development. These skills are considered as significant bases for language acquisition and function conductive to later social development. Means of communication, communicative functions, skills with cognitive bases, and language comprehension are important prelinguistic skills. There is a critical period for acquiring prelinguistic skills and early identification of communication deficits is an important issue to be considered. The present study aimed to develop a communication skills checklist for Persian children aged 6- to 24-month-old and evaluate its psychometric properties. Parents of 277 Persian children aged 6- to 24-month-old participated in the current study. A checklist was first developed after an extensive literature review and various psychometric analyses in addition to regression analyses were carried out to determine its validity and reliability. The final checklist contained 36 items with high face validity and content validity (CVI > 0.62, CVR > 0.79). Also, the checklist demonstrated a high association with the CNCS (Pearson's correlation coefficient = 0.85, p < 0.001), and the construct validity showed significant differences between the four age groups (F-test = 197.881, p < 0.001). The results of the internal consistency measurement (Cronbach's alpha coefficient = 0.952) and the test-retest reliability test (ICC = 0.933, p < 0.001) revealed excellent reliability of the checklist. In conclusion, based on the psychometric assessment, this checklist is a promising tool for assessing communication skills in Persian children aged 6 to 24 months.

Sequential Associations Between Communication Acts of Children With and Without Autism Spectrum Disorder and Maternal Verbal Responses.

In this study, the sequential associations between child communication acts, including spontaneous communication (SC) and elicited communication (EC), and the types of verbal responses of Iranian mothers (follow-in nondirective, follow-in directive, and redirective responses) were compared between children with autism spectrum disorder (ASD) and young typically developing (TD) children. Participants were 29 children with ASD aged 3-6 years and 40 TD children aged 13-18 months, matched on expressive vocabulary. Using time-window sequential analysis, maternal verbal responses within a time interval of 3 sec following child communication were examined during 15 min of video-recorded mother-child free play interaction. Mothers in the two groups had broadly similar patterns of response to child communication acts, but some differences in responding to child EC. Across both groups, sequential associations were stronger for maternal follow-in nondirective responses to child SC than for this type of response to child EC, and were stronger for follow-in directive responses to child EC than for follow-in directive responses to child SC. Child EC and SC acts were less likely to be followed by redirective responses than other maternal responses, again across both groups. Finally, mothers of children with ASD were more likely than mothers of TD children to follow-in to child EC with both nondirective and directive responses. Our findings suggest that mothers of children with ASD synchronize their responses with their child's SC acts to the same extent as mothers of TD children, and are more synchronous in responding to their child's EC acts. LAY SUMMARY: This observational study examined how Iranian mothers verbally responded to their children's communication acts, based on whether the children's communication was spontaneous (unprompted) or elicited (prompted by the mother). Mothers of children with autism spectrum disorder or typical development responded to their children's spontaneous communication acts in similar ways, but showed some differences in responding to children's elicited communication. By prompting their children to communicate, mothers create opportunities to give additional verbal responses to their children, which may help to support children's further language development.

A look at the normal development of Pointing and Reaching Gestures in 12-16-Month-Old Farsi-Speaking Children: A Longitudinal Study.

OBJECTIVES: Human beings can use gestures such as pointing and reaching to communicate with others before they have the ability to use verbal communication to produce speech. Given the importance of children's communication development and the key role of gestures development in communicating, the main purpose of this study was to analyze the normal development of pointing and reaching gestures and their relationship in 12-16-month-old children speaking Farsi. MATERIALS & METHODS: In this prospective, observational and longitudinal study the gestures of 11 monolingual Farsi-speaking children (7 boys and 4 girls, from Oct 2015 to Jan 2017 in the homes of participants across Tehran, Iran) were evaluated via non-randomized sampling method. Child-mother interactions were videotaped monthly in a semi-structured context to capture the emergence and consistent use of targeted gestures. Afterward, the data were coded and statistically analyzed for this purpose Repetitive measured; independent t-test and Pearson correlation were used. RESULTS: The mean of the pointing gesture increased significantly from 12 to 16 months (P<0.05). However, this was not significant for the reaching gesture. Moreover, there was no relationship between pointing and reaching gestures. CONCLUSION: Pointing gestures increase with age from 12-16 months in Farsi-speaking children. However, reaching gestures stay the same between 12-16 months of age. The study provided rich details of common gestures that children use to signal their intentions before verbal communication.