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Parent'Instruction'in'Partner.Augmented'Input

Jill$E$Senner,$PhD,$CCC/SLPKathleen$Post,$MS,$CCC/SLP

Matthew$R.$Baud,$MS,$CCC/SLPBrian$Patterson,$PhD

Research(Questions1. Will(training(parents(in(PAI(using(the(Kent9Walsh(

and(McNaughton((2005)(instructional(model(increase(parent(use(of(modeling(on(a(child’s(SGDs(in(regularly(occurring(home(activities?

2. Can(parents(learn(to(model(a(variety(of(words(on(their(child’s(SGD(following(participation(in(PAI(training?(

3. Will(training(parents(in(PAI(increase(frequency(of(child(SGD(use(at(home?((

4. Will(training(parents(in(PAI(affect(children’s(language(output(using(the(SGD?(

Child&Subjects• Candidacy&Criteria– 5410&years&of&age&– Produced&fewer&than&10&intelligible&words&using&natural&speech

– Dynamic&display&SGD&loaded&with&a&commercially&available&core&vocabulary

– Direct&selection&with&a&finger&(i.e.,&physically&pointed&to&or&pressed&a&button&on&the&SGD)&to&access&the&device

– All&children&lived&with&the&parent&participating&in&the&study&100%&of&the&time.&

Child&&Demographic&InformationSubject(# Gender Age Diagnosis SGD Vocabulary Length(of(

Device(UseC1 M 6;5 Autism iPad1 LAMP1WFL2

Full<61months

C2 M 9;6 AutismDysgenesis1of1the1Corpus1Callosum

Accent 10002 Unity2 841Sequenced

>21years

C3 M 6;9 TracheostomyVocal1Fold1Paralysis

NOVA1Chat3

10

WP4 60 >21years

C4 F 5;0 DevelopmentalDelay

NOVA1Chat3

10WP4 42 Basic >21years

LAMP(WFL2 – Language(Acquisition(through(Motor(Planning(–Words(for(Life(AppUnity2 – Unity(Language(SystemWP4–WordPower(

Parent'Subjects• All'mothers'• All'married.''• No'history'of'hearing'or'learning'difficulties.''• All'had'other'children'without'disabilities'living'in'the'

home.''• Two'parents'were'stay>at>home'mothers'and'two'

worked'outside'of'the'home.''• Self>selected'to'participate'in'the'study'and'were'made'

aware'of'the'project'via'posted'announcements,'letters'to'local'therapists'providing'services'to'children'with'disabilities,'and'social'media.'

Parent'Demographic'InformationSubject(# Household(

IncomeEducation Ethnicity Employed(

outside(of(the(home

#(of(other(children(living(

at(home

Previous(PAI(training

P1 Under($46,960(

Some(College,(No(Degree

Latino,(Spanish(Origin

Yes 2 No

P2 $46,960(to($140,900(

Bachelor(Degree

White No 2 Yes

P3 $46,960(to($140,900(

Bachelor(Degree

White Yes 1 No

P4 $46,960(to($140,900(

Bachelor(Degree

White No 1 No

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Data$Collection$&$$Analysis• Evaluating$Acquired$Skills$in$Communication$– 3rd Edition$(EASIC>3)$was$

administered$to$each$subject$to$determine$the$child’s$functional$level$of$language$comprehension.$

• Language$activity$monitoring$was$activated$on$the$subjects’$SGD$at$either$the$time$of$language$testing$or$at$the$time$of$the$first$pretest$videotape,$whichever$occurred$first.$

• Prior$to$training,$pretest$data$were$collected.$$Families$were$asked$to$participate$in$three$of$the$activities$they$had$listed$as$always$or$almost$always$occurring$at$home$on$two$separate$dates$within$two$weeks$apart.$$The$sessions$were$videotaped$and$both$parent$and$child$device$use$were$analyzed$using$Communication$Sampling$Analysis$(CSA,$Buzolich,$2009).$

• Parent$models$were$transcribed$and$independent$child$utterances$were$noted.• An$implementation$fidelity$checklist$was$used$to$ensure$that$parents$complete$

each$step$of$the$training$as$designed.$• Intervention$fidelity$was$measured$via$an$observation$checklist$completed$by$a$

student$clinician.$

1.#Pretest#&#Commitment• In0home#pretest#videotapes#were#made#of#parents#interacting#with#

their#children#at#home#prior#to#intervention:– 3#activities#rated#as#“Always”#occurring#at#home– 203#pretest#sessions#per#family

• During#the#home0based#videotaping#sessions,#the#parents#were#instructed#to#play/interact#with#child#as#they#typically#would#(Woods,#Kashinath,#&#Goldstein,#2004).##The#researcher#did#not#attempt#to#influence#caregiver#behavior#in#any#way.#The#evaluator#remained#behind#the#camera#and#avoided#interaction#with#caregiver#and#child.

• Parents#were#sent#links#to#videos#to#watch#on#their#own.• Student#clinicians#discussed#the#videos#with#parents#and#provided#

feedback#regarding#strengths#and#weaknesses.• Parents#signed#a#written#commitment#to#the#training#program#at#an#

initial#in0service#training.##

2.#Strategy#Description

• All#parents#participated#in#a#live,#38hour#group#instruction#session.##

3.#Strategy#Demonstration

• Strategy#Demonstration#was#conducted#using#videotaped#samples#of#PAI#being#used#by#families#at#home.#

• Live#strategy#modeling#was#also#later#provided#in#the#clinic#by#the#student#clinicians#during#coaching#sessions.##

4.#Verbal#PracticeS Slow%Rate%. Speak#in#a#slow,#clearly#

articulated#mannerMo Model% . Point#to#the#symbol#on#the#

child’s#device#while#simultaneously#providing#parallel.talk#or#self.talk

R Respect%&%Reflect%%. When#the#child#communicates#something#through#gesture#or#word##approximation,#respect#the#communication#and#model#a#word#or#phrase#to#communicate#the#same#thought#or#feeling

R Repeat%. Frequently#repeat#targeted#vocabulary#words

E Expand . Build#up#utterances#by#adding#elements#to#provide#a#more#complete#expression#of#intended#meaning

S Stop . Pause#to#allow#the#child#time#to#respond

5.#Controlled#Practice• Each#parent#had#a#device#and#the#child’s#page#set.• Parents#were#asked#to#generate#a#variety#of#practice#phrases#on#the#devices#as#well#as#to#generate#phrases#to#model#based#on#scenarios#provided.#– The#scenarios#related#to#activities#at#home#and#required#parents#to#think#about#what#types#of#models#they#might#provide#in#the#situations#described#(e.g.,#“Your#child#pushes#away#a#game#you#are#playing.#What#could#you#model#on#your#child’s#device#to#reflect#his#or#her#intent?”)

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5.#Controlled#Practice• Parents#also#had#the#opportunity#to#practice#in#the#clinic#with#the#student#clinician#present.

• All#sessions#were#supervised#by#a#principal#investigator.

• Dyads#attended#8#or#9#sessions.

5.#Controlled#Practice• An#observation#checklist#was#used#to#note#performance#of#each#ingredient#to#successful#modeling.

6.#Advanced#Practice

• Parents#continued#to#practice#use#of#strategy#within#the#clinic#with#students#clinicians#present#for#coaching.##

• Verbal#feedback#was#immediately#provided.##

7.#Post(Test

• Post(test#videotapes#were#made#of#parents#interacting#with#their#children#at#home#during#the#same#three#activities#as#pretest#over#the#course#of#two#separate#days.

8.#Generalization

• An#additional#activity#was#introduced#during#the#last#weeks#of#the#study.##

Percentage)of)utterances)modeled)by)parents)on)children’s)SGDs

6.3700 5.7850

49.8250

38.5725

0.0 0

5.0 0

10 .00

15 .00

20 .00

25 .00

30 .00

35 .00

40 .00

45 .00

50 .00

Pre test)1 Pre test)2 Po stEtest)1 Po stEtest)2

Percen

tage)of)))Utteran

ces)M

odeled

Parent)Utterances)Modeled

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Parents’)Modeled)Words

• Parent)models)produced)at)post3test)were)analyzed)to)determine)percentage)of)unique)words)modeled)(i.e.,)type3token)ratio).))Unique)words)modeled)varied)by)activity)and)ranged)from)37.04%)to)74.51%)(M"=)55.91,)SD"=)13.35).

Words/Phrases+Modeled+(P1+Book)• it+is• it+is+time+for• Game• Book• I+feel• Max+is+sad+go+home• Okay• Plumber• he+is• fixing+the+sink• he+has• green+snake• I+see+a• Fish• Turn• Page• The• Toys• oh+my+gosh+no+way• Is• uh+oh

• they+need+to+call+the• he+has• Toolbox• turn+the• Page

• they+went+to+the• Basement• he+is• turning+off• turn+the

• Page• they+found• Down• I+don't+see+the

• uh+oh• it+is+got• don't+go+in• look+more• turn+the+turn

• that's+cool• I+see• came+out• Water

• uh+oh• Again• oh+my+gosh

Frequency)of)SGD)Use)at)Home

• Device)use)at)home)could)only)be)calculated)

using)three)of)the)four)subjects)due)to)data)

loss)secondary)to)device)malfunction.))

• A)paired@samples)t@test)was)conducted)to)

compare)frequency)of)device)use)at)home)

before)and)after)the)intervention.))

– This)difference)was)not)statistically)significant)(M=3.60,)SD=3.8108))and)post@test)(M=7.28,)

SD=2.01))conditions;)t(2)=2.1246,)p)=)1.731.

Raw$Data$Child$Unique$WordsSubject(# Pretest Post.Test Percentage(

Increase

C1 10 37 270%

C2 20 46 125%

C3 31 78 152%

C4 38 42 11%

ResultsPretest Post'Testbathroom,)eat,)finish,)go,)good,)help,)more,)need,)yellow,)yes

big,)blue,)bubbles,)bus,)cheese,)chips,)cold,)come,)fast,)fun,)go,)good,)guitar,)happy,)hot,)iPad,)like,)little,)more,)mom,)most,)my,)no,)open,)please,)pop,)puzzle,)red,)see,)then,)trash,)turn,)water,)yes,)you,)yum

ResultsPretest Post'Testall#done,#eat,#funny,#fruit,#Goldfish,#help,#hungry,#I,#pretty,#reading,#snack,#surprise,#taste,#thirsty,#think,#want,#water,#were,#what,#yes

all#done,#book,#can,#do,#drink,#eat,#go,#goodbye,#happy,#have,#help,#hungry,#hurt,#I,#in,#it,#juice,#mad,#Mater,#more,#mouse,#nail,#off,#oh#no,#on,#oops,#open,#out,#page,#Phineas#and#Ferb,#please,#popcorn,#put,#read,#reading,#sad,#see,#snack,#some,#stop,#take,#turn,#up,#want,#watch

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ResultsPretest Post'Testand,%banana,%book,%brachiosaurus,%chicken,%dinosaur,%Diplosaurus,%favorite,%fire%engine,%French%fries,%game,%good,%happy,%hear,%help,%hungry,%job,%my,%of,%please,%raptor,%red,%rooster,%she,%thank,%think,%train,%turn,%up,%vegetables,%you

a,%aquarium,%balloon,%bathroom,%battery,%birthday,%box,%bug,%caterpillar,%December,%different,%dog,%don’t,%down,%duck,%finish,%five,%fix,%four,%fox,%friend,%game,%give,%go,%good,%Halloween,%happy,%I,%jackAoAlantern,%July,%know,%look,%of,%maintenance%worker,%Max,%mom,%monkey,%mouse,%my,%no,%November,%now,%one,%outside,%page,%pig,%play,%plumber,%read,%red,%sad,%scared,%September,%six,%snack,%snake,%squirrel,%stop,%submarine,%Thanksgiving,%the,%three,%time,%telescope,%tools,%toy,%tractor,%turkey,%turn,%two,%yellow,%your,%uncomfortable,%upstairs,%watch,%water,%zero,%zoo

ResultsPretest Post'Testanimal&cracker,&animal&home,&apple,&baby&dolls,&bacon,&ball&ramp,&ball,&butter,&cage,&dr.&pepper,&eggs,&goldfish,&green,&hippo,&house,&juice&box,&like,&M&&&M,&muffin,&outside,&orange,&pie,&pig,&pink,&play,&purple,&purple&pillow,&read,&skunk,&three,&tiger,&tomato,&two,&Tyrannosaurus&rex,&vegetable,&waffles,&white,&Writing&center

all&done,&ambulance,&animal&crackers,&bad,&don’t,&black,&blue,&brown,&car,&finish,&fire&engine,&Five,&four,&garbage,&garbage&truck,&go,&green,&I&am&___&years&old,&I&like&to,&I&love&you,&juice&box,&like,&mail&truck,&more,&My&name&is&___,&oh&my&gosh,&one,&orange,&pink,&polar&bear,&purple,&red,&soccer,&three,&tractor,&triangle,&truck,&two,&van,&yellow,&wheel,&white

Social'Validity• 7'Questions'

– Overall,'I'believe'that'PAI'has'been'effective'in'supporting'my'child's'communication.

– I'better'understand'how'to'provide'PAI'during'regularly'occurring'activities'at'home.

– I'am'more'familiar'with'the'language'on'my'child's'device.

– I'found'this'training'useful.– I'will'continue'using'PAI'at'

home.– I'think'it'would'be'helpful'for'

other'family'members'to'attend'this'training.

– I'used'my'child's'SGD'more'frequently'at'home.

• LikertGType'Scale'– 1'='Strongly'Disagree– 2'='Somewhat'Disagree– 3='Neutral– 4'='Agree'Somewhat– 5'='Strongly'Agree

• Mean'='5.0,'SD'='0'for'all'questions.

Changes(in(Self

Using(the(respect(and(reflect(option(more.((I(believe(I(communicated(better(with(my(child(when(I(took(that(into(consideration.((We(had(great(language(exchanges(then(and(often(lead(back(to(the(task(we(were(targeting.((But(sometimes(it(didn't(but(if(it(didn't((the('conversations'(that(were(had(on(were(very(informative(and(covered(ideas/topics(that(hadn't(been(talked(about(in(the(past.Much(better(proficiency(using(the([device].

I(noticed(that(I(am(more(confident(in(using(the(device(and(getting(used(to(using(it(in(general(not(just(for(helping([child](request(but(also(in(initiating(conversations.

Changes(that(I(started(to(make(and(need(to(continue(working(on(is(providing(my(son(with(more(opportunities(to(communicate.((Over(the(years(I(have(gotten(so(used(to(speaking(for(him,(asking(yes/no(questions(and(figuring(out(what(he(needs(without(talking(that(it(is(a(change(of(mind(set(that(I(need(to(work(on.((He(has(so(much(he(can(say,(and(knows(he(can(use(his(device(it's(about(breaking(that(barrier(to(actually(have(him(use(it.

Changes(in(ChildMy(child(is(taking(in(the(modeling(in(his(own(way...it(might(not(look(like(he(is(watching(or(learning.((But(he(is...and(it(may(just(take(some(time(for(it(to(show(itself.[Child](feels(way(more(comfortable(using(the([device].That([child](is(getting(more(comfortable(using(the(talker(and([child](is(using(it(more(and(more(as(time(goes(on.(When([child](has(moments(of(frustration(because(he(is(having(a(hard(time(communicating(his(needs,(he(will(independently(reach(or(search(for(his(talker.(At(times(when(I(am(not(getting(his(attention(when(I(am(speaking(or(I(feel(he(is(not(fully(understanding,(I(will(use(the(talker(to(repeat(what(I(am(saying(and(I(will(get(a(reaction(such(as(eye(contact(so(I(feel(it(helps(him(comprehend(better.I(have(noticed(that(if(I(give(my(son(the(opportunity(with(longer(pauses(and(not(providing(yes/no(questions(he(tends(to(use(his(device(more.

Parent'LikesPositive'environment'for'learning'the'process.''I'appreciated'the'hands'on'approach'88getting'the'chance'to'see'it'and'then'jump'in'and'try'it'yourself.''I'was'able'to'learn'more'about'my'child'88 his'interests'and'dislikes.Very'thorough,'gave'everyone'a'better'understanding'on'how'to'communicate'effectively.The'breakdown'of'different'steps'in'using'my'son's'device'for'more'than'just'requesting.I'liked'the'feedback'from'sessions'that'I'have'received.''The'training'was'very'good'as'before'the'study'I'knew'we'need'to'model'the'use'of'AAC'for'my'son'but'we'focused'so'much'on'modeling'and'using'the'device'ourselves'that'we'didn't'give'him'many'opportunities'to'use'it.

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Acknowledgements

• This1project1was1partially1funded1by1a1Midwestern1University=College1of1Health1Sciences1Research1and1Facilitation1Grant,12017

• Special1thanks1to1the1graduate1students1who1participated1in1this1project:– Brianne1Bolin,1M.A.– Jazmyn1Lopez,1B.S.– Emma1Williams,1B.S.

Summary• An)eight/step)instruction)model)was)used)to)teach)four)parents)of)children)

who)use)augmentative)and)alternative)communication)(AAC))to)provide)partner/augmented)input)(PAI))on)the)core)vocabularies)on)their)children’s)speech/generating)devices)(SGDs))during)activities)frequently)occurring)at)home:)– All)parents)demonstrated)the)ability)to)perform)all)of)the)components)of)

successful)PAI)(slow)rate,)model,)respect)and)reflect,)repeat,)expand,)stop))as)determined)by)review)of)the)observation)checklists)completed)during)coaching)sessions.)

– All)parents)significantly)increased)percentage)of)utterances)modeled)on)their)children’s)speech/generating)devices)between)pretest)and)post/test)measures.)

– The)percentage)of)unique)word)modeled)(i.e.,)type/token)ratios))of)each)parent)suggests)variety)in)words,)phrases,)and)sentences)modeled)at)post/test.)

– 3)of)4)children)appeared)to)increase)the)number)of)unique)words)independently)produced)on)the)SGD)between)pretest)and)post/test.)

– Parents)perceived)the)program)as)beneficial.))

@JillESenner

@mbaud121

https://www.pinterest.com/talcaac/

https://www.facebook.com/TechnologyLanguageCenterInc/

talcaac@gmail.com

mbaud@ntdse.org

kpost@midwestern.edu

http://www.talcaac.com/

http://bit.ly/NEDSEAT

https://www.mwuclinics.com/illinois/services/specialty/speechHlanguage

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