Intervention effects on spoken-language outcomes for children with autism: a systematic review and meta-analysis.

BACKGROUND: Although spoken-language deficits are not core to an autism spectrum disorder (ASD) diagnosis, many children with ASD do present with delays in this area. Previous meta-analyses have assessed the effects of intervention on reducing autism symptomatology, but have not determined if intervention improves spoken language. This analysis examines the effects of early interventions on spoken-language in children with ASD. METHOD: A systematic review of 1756 studies of children with ASD who participated in early intervention resulted in the inclusion of 26 studies in the current review. These studies included 1738 participants with ASD who were, on average, 3.3 years old (SD = 0.91). RESULTS: This random-effects meta-analysis of spoken-language outcomes for children with ASD who received early intervention as compared with usual treatments yielded a significant overall mean effect size of g = 0.26 (CI = 0.11 to 0.42). On average, children with ASD significantly increased their use of spoken-language following experimental early interventions. Treatments delivered simultaneously by a clinician and a parent resulted in greater gains in spoken-language than treatments delivered by a clinician or parent only. No other participant or study characteristics predicted individual-study effect sizes. CONCLUSIONS: Early intervention improves spoken-language outcomes for children with ASD, and the largest effects are found when both parent and clinician implement the intervention. Recommendations for practice include adding systematic parent training to interventions for spoken language to potentially improve outcomes. Future research should report standard language measures as well as child (cognitive ability and socio-economic status) and intervention characteristics to improve evidence related to the effects of interventions on spoken communication in children with ASD.

Supporting communication in young children with developmental disabilities.

The behavior of parents, adult caregivers, and peers comprises the critical features of community support for the development of communication in young children with developmental disabilities. In a bio-ecological model of development, communication development is the result of the interactions of individuals with specific characteristics, in particular contexts over time. From the perspective of this model, foundational findings of intervention research to current views of communication development in children with developmental disabilities are summarized. The contributions of individual child characteristics to child-caregiver interactions that support language development are illustrated based on research with children who have autism, Williams syndrome, Down syndrome, and children who use augmentative communication systems. Parent-child interaction and the quality and quantity of parent talk are discussed as factors in children's language development. The effects of young children's delayed language on their interactions with peers, the contributions of peers to children's language learning and use, and the critical features of classroom settings that support child language development are reviewed. MRDD Research Reviews 7:143-150, 2001.

Generalized effects of enhanced Milieu teaching.

The primary and generalized effects of Enhanced Milieu Teaching were examined with six preschool children with significant language delays. In a multiple baseline design across children, trainers implemented the naturalistic language intervention during play-based interaction sessions in the children's preschool classrooms. Children systematically increased their use of targeted language skills during the intervention sessions, and these changes were maintained when the treatment was discontinued. Generalized changes in children's communication resulting from the intervention were examined with untrained teachers, peers, and parents. Some generalization to untrained partners was observed for all children. Correlational analyses indicated that greater numbers of child utterances and greater diversity in vocabulary were associated with increased talking and mands for verbalization presented by partners.

Following the child's lead when teaching nouns to preschoolers with mental retardation.

The current study tested the effects of following the child's attentional lead on the efficiency of object-label teaching. Three preschoolers with mental retardation participated. An alternating-treatments design was used to test relative treatment effects. An elicited-production method of teaching object labels was used to present the words under two conditions. Two sets of 32 nonsense words and unfamiliar objects were randomly assigned to the two teaching conditions to create equivalent goal sets and to control for prior exposure to the words and objects. Under the "following-the-child's-lead" condition, teaching episodes occurred only when the child had sustained attention to a target object or intentionally communicated about the target object. Under the "recruiting-the-child's-attention" condition, the child's attention was recruited intrusively away from his or her object of interest and toward the target object before each teaching episode began. The number of teaching trials per item and per session was carefully controlled. Results indicated that object-label teaching was more efficient under the following-the-child's-lead condition for all three participants.

An exploratory study of the interaction between language teaching methods and child characteristics.

The present study examined whether the relative efficacy of two language teaching methods was predicted by pretreatment subject characteristics. Forty handicapped preschoolers were randomly assigned to two language teaching methods (i.e., Milieu Teaching and the Communication Training Program). No main effects of treatment were found. However, seven statistical interactions between pretreatment subject characteristics and language teaching method indicated that lower-functioning children benefitted more from the Milieu method and higher-functioning children benefitted more from the Communication Training Program. The results were discussed in relation to the extant literature reporting subject-by-language-teaching-method interactions. The importance of replicating the present results and specific suggestions for subject selection criteria and pretreatment subject characteristics likely to interact with language teaching methods similar to those used in this study are discussed.

Alternative explanations for the relationship between maternal verbal interaction style and child language development.

The present study analysed formerly unexamined indirect routes for relationships between time 1 maternal speech and later child language development. Ten normally developing children in Brown's early stage 1 and their mothers were the subjects. For each dyad, two free-play sessions occurring five months apart were videotaped in the subjects' homes. Mothers' pragmatic language use was coded from time 1 sessions. Child language level was coded at both sessions. Even though time 1 scores of the outcome were controlled, seven of the ten relationships involving mother speech and child language development were indirectly related through one of two time 1 child language measures. The results indicate that a mother-driven, direct influence model may be inappropriate for many mother speech-child language development relationships. We argue that child-driven and mother-driven explanatory models for the indirect relationships are equally feasible.

Mother-child transactions in families with normal and handicapped children.

This paper describes two aspects of mother-child interaction: children's contribution to early conversations and mother's tactics for eliciting verbal responses. Normal and handicapped children matched for linguistic complexity (mean length of utterance) differed in both qualitative and quantitative aspects of their verbal interactions with their mothers. Normal children talked more, responded correctly more often, and made more attempts to control the conversation than mentally retarded children. Clear differences in mother choice of tactics for eliciting child verbalizations also were evident between the two groups. Overall, mothers of handicapped children modeled responses more and frequently asked fewer and less complex questions. The differences in mother behavior appeared to be a function of the child's specific skills, and not of the child's general classification as normal or mentally retarded; patterns of mother linguistic adjustment were identical in the two groups. These findings are discussed in terms of a general model of transactional linguistic teaching in dyads with mentally retarded children.

Incidental language teaching: a critical review.

Incidental language teaching refers to interactions between an adult and a child that arise naturally in an unstructured situation and are used systematically by the adult to transmit new information or give the child practice in developing a communication skill. The purposes of this paper are to review and critique current research on incidental language teaching, briefly discuss the theoretical reasons why incidental teaching might be expected to be effective, and to discuss directions for future research on this teaching approach with children who are language impaired and mentally retarded.

Generalization of treatment effects by young language-delayed children: a longitudinal analysis.

This study investigated the generalized effects of a language intervention program on the structural aspects of 8 language-delayed preschool children's productive language. Subjects were observed in preschool free play for periods ranging from 12 to 24 months concurrent with receiving daily didactic language intervention. A total of 57 two-, three-, and four-word syntactic forms were taught to criterion. Generalized usage was determined from (verbatim) language samples collected during free play periods in the subjects' classroom. Forty-two (74%) of the treated forms generalized to the subjects' spontaneous language in free play. There was a relationship between the complexity and potential functions of the treated forms and their generalization to free play. This effect may have been related to the subjects' MLUs. Substantial changes also occurred in the subjects' MLUs, frequency of speaking, Peabody Picture Vocabulary Test scores, and Houston Test for Language Development scores over the period of instruction. These measures suggested that 4 of the 8 subjects were functioning near the normal range at the conclusion of treatment. Implications of these and other results are discussed.