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CLT30110.1177/0265659013507296Child Language Teaching and TherapyColmar


A parent-based book-reading
intervention for disadvantaged
children with language difficulties

Child Language Teaching and Therapy

2014, Vol. 30(1) 7990
The Author(s) 2013
Reprints and permissions:
DOI: 10.1177/0265659013507296

Susan Hilary Colmar

The University of Sydney, Australia

Children with delayed language skills, who were from a socio-economic area defined as
disadvantaged, made significant improvements in language skills after their parents were trained
in easily learned strategies, enabling them to make simple changes in the way they interacted
with their children. The 36 children, mean age five years, were allocated into three groups:
an Experimental group and a Control group, where all the children had language delays and/
or difficulties, and a second Control group of children whose language was measured within
the average range. Parents of children in the Experimental group were trained and asked to
implement the strategies. The intervention strategies used during book reading and during
everyday conversations included: pausing and encouraging the child to talk more on their chosen
topic, over a four-month period. Using an ANCOVA on difference scores with childrens preintervention language scores for each variable as the covariate, significant results were obtained
at post testing. Further, large effect sizes were measured using Cohens d. In addition, a Student
NewmanKeuls test on difference scores confirmed that the significant changes were obtained
for the Experimental group, as predicted.
Book reading, disadvantage, language difficulties, language intervention, parent training

I Introduction and literature review

For a young child, the failure to make typically observed progress in learning a first language is
likely to curtail the childs capacity to communicate effectively, as well as having a major pervasive negative effect on other areas of development and learning (Aarts et al., 2011; Bishop and
Leonard, 2000), with concomitant links to problems in social and emotional behaviour (Law et al.,
2012). Young children with language delays typically experience less engagement with
their linguistic and social environments, both of which are critical sources of teachinglearning
Corresponding author:
Susan Hilary Colmar, The University of Sydney, Manning Road, Sydney, New South Wales 2006, Australia.
Email: susan.colmar@sydney.edu.au


Child Language Teaching and Therapy 30(1)

interactions (Kaiser and Roberts, 2011). Children from backgrounds described as disadvantaged
(low socio-economic status [SES]) are specifically considered to be at risk of making poor progress in early language learning, with negative impact on their later academic progress, particularly
in literacy (Hart and Risley, 1995, 1999; Vinson, 2006; Zevenbergen et al., 2003). Further, the
effect of low SES was found to have additional negative impact when comparing parental reading
practices with children with developmental difficulties and typically developing children, from
different socioeconomic environments (Butz et al., 2009).
Considerable research confirms that parents are able to work successfully with their own young
child who is experiencing difficulties with language learning (Colmar, 1999; Hancock and Kaiser,
2002; Law et al., 2004). Evidence of parents natural conversations with their child confirms their
use of child directed speech (CDS), which appears dynamically and progressively optimal for child
language learning (Hoff and Tian, 2005; van Kleeck et al., 2010). Professionals often incorporate
the training of parents as a key element in a consultative approach (Schooling et al., 2010). Direct
parental involvement in language intervention programs acknowledges that parents, if successfully
trained, are able to (1) increase the likelihood of many more opportunities for learning being available compared to the typical 30-minute weekly session offered by a professional (Justice and
Pence, 2004), and (2) ensure the generalization of specific skills (Vilaseca and Del Rio, 2004).
Parents can maximize the communicative opportunities, often of a functionally relevant nature,
that arise within naturalistic contexts necessitating child comprehension and responding, particularly when responsive support is provided by the parent to encourage the child to respond more
fully by talking more and with greater complexity (Reese et al., 2010; Weiss and Theadore, 2011).
In addition, the existing social-emotional relationship between the parent and child may be an asset
in this process, with this relationship being further enhanced by successful communicative interactions. Typically parents are motivated and respond well to training aiming to improve their own
childs language and communication skills.
There has been evidence in the literature over several decades of the successful implementation
by caregivers of naturalistic language strategies subsumed within milieu teaching (e.g. Yoder and
Warren, 1999), including the seminal research leading to the concept of milieu teaching, which was
incidental teaching (Hart and Risley, 1974, 1980), and including mand-model (e.g. Alpert and
Kaiser, 1992) and time delay (Halle et al., 1981). Incidental teaching was originally conceptualized
as language teaching in preschool contexts, using naturally occurring opportunities during play and
activities, specifically asking questions in response to child initiations to develop communicative
interactions. Initial studies of incidental teaching were with children described as disadvantaged,
with later work in milieu teaching focused more on children with serious language and cognitive
difficulties. In milieu teaching, the caregiver is trained to implement the strategies with a focus on
engaging the child in naturally occurring conversations, aiming to increase child language skills
(Kaiser and Roberts, 2011). Colmar (2011) has reported findings successfully training parents by
combining milieu strategies within the structure of a book-reading context, with children with a
range of language and cognitive difficulties.
The core strategies within milieu teaching are (1) initial responsiveness, typified by being present
and alert, providing visual attention, listening and acknowledging the childs focus of attention, or
initiated topic of conversation, and (2) using communicative strategies, such as child topic relevant
questioning to engage the child in an interactive conversation. Frequently cited adult techniques, aiming to develop a short communicative exchange involving turn-taking with the young child, include:
1. commenting (Hockenberger et al., 1999; Kang et al., 2009);
2. questioning: generally (e.g. Ard and Beverly, 2004) and functional questioning as in
Whitehursts dialogic reading (Elias et al., 2006; Whitehurst et al., 1988);



3. expanding the childs utterance by adding a word/s (Fletcher et al., 2008);

4. responsiveness to initiations with contingent questioning (Hart and Risley, 1980); and
5. generic responsiveness to the childs language in a book-reading context (Roberts et al.,
These adult techniques have been reported in use with children with normally developing language
and children with language delays and difficulties.
Child engagement and attention focus are key precursors to successful communicative interactions (Kang et al., 2009). A key indicator of engagement is child initiations, which are spontaneous
verbal utterances, or vocalizations, which begin a conversational sequence, by introducing a new
topic. Initiations are typically rare when children have language difficulties (Pennington et al.,
2009), with adults initiating at higher levels (Colmar, 1999). In a study of spontaneous utterances
in a book-reading context, Young-Suk et al. (2011) noted that these findings suggest that childrens propensity for spontaneous verbal participation during joint book reading may have a direct
relationship with their retelling skills (p. 402), thus demonstrating greater quality in their use of
language. A second indicator of active engagement is a childs responsiveness to adult comments
and questions in developing a conversational interchange. Typically responsiveness involves preestablished joint attention (White et al., 2011), as would be indicated by a child initiation, with the
resulting adult response encouraging a further child response (Hart and Risley, 1974).
Previous research using within-subject design methodology (Colmar, 1999) found that adult
pausing is an appropriate strategy allowing children with language difficulties an opportunity to
initiate a conversation. Pausing meant that the adults did not speak or communicate at all. Pausing
proved to be an unexpectedly powerful intervention technique on its own, leading to a number of
additional positive changes in child and adult language use in an interactive context, including
increases in child initiations and utterances, coupled with reductions in adult utterances, and
increases in child turn-taking with decreases for adults (Colmar, 1999). When adults were trained
to speak less, children were able to speak more. The implementation of the pausing strategy, coupled with the key conversation building strategy of incidental teaching, which is open questioning
in response to and contingently linked to the content of a child initiation, appeared to be sufficient
to alter the original non-interactive, adult-controlled conversational style into a shared interactive
pattern in which the child partner in the dyad could initiate more frequently and respond more by
contributing more language in conversational contexts (Colmar, 1999). However, although the
findings from this study were important in demonstrating that interactive communicative sequences
could be changed, there was no evidence that these changes resulted in improvements in child
language skills.
Colmars work utilized book reading, such that childrens picture books were used as a structured base for communication and language use. Importantly the use of naturalistic strategies, such
as pausing and open questioning, has only rarely been combined within a book-reading context
(Colmar, 1999). Only three studies (Colmar, 1999, 2011; McNeill and Fowler, 1999) have combined books as the stimulus for language with specified naturalistic language intervention techniques. Positive changes in child and adult language and communication behaviours were
demonstrated in all three studies. Whitehurst and his colleagues research on dialogic reading also
aims to facilitate language skills using book reading in children described as disadvantaged, with
good evidence of success (Whitehurst et al., 1988); however, the functional questioning technique
was not derived from the naturalistic milieu tradition, nor is pausing emphasized.
Book reading is used in home and early childhood settings by parents and teachers, often implicitly for language and literacy facilitation, or explicitly when using a technique such as dialogic
reading (Zevenbergen et al., 2003), or when developing early reading skills (Justice and Pullen,


Child Language Teaching and Therapy 30(1)

2003). Book reading has been evaluated quantitatively (Roberts et al., 2005; Rodriguez et al.,
2009) and also qualitatively, both descriptively with typical and atypical populations (Barachetti
and Lavelli, 2011; Senechal and LeFevre, 2001), and experimentally (Wasik et al., 2006). Different
types of book-reading approaches to language and literacy facilitation and intervention exist, with
the range of specifics beyond the scope of this article. The present studys strategies fall within the
scope of interactive shared book reading (Institute of Education Sciences, 2007), defined as an
adult reading with a child, aiming to enhance their language and/or literacy skills by ensuring text
engagement. The analyses carried out by the Institutes researchers found that effects were mixed
for spoken language and, whilst interactive shared book reading was not effective for print knowledge, it had some impact on initial reading and writing.
Only one previous experimental study has combined elements of incidental teaching; specifically, pausing and responsive open questioning, in a book-reading context with parents implementing the program (Colmar, 2011). The study was with children who had major language difficulties
(and most also had additional difficulties), and language outcomes were measured before and after
the intervention, with significant results for the intervention group for expressive and overall language, and effect sizes (Cohens d) ranging from .86 to 1.25. The present study was with children
described as disadvantaged, with major language delays and difficulties but no additional difficulties, and included two control groups, one of children also with language difficulties and one of
children with normally developing language. Based on previous research (Colmar, 2011), it seemed
likely that the intervention would be effective, both compared with the two Control groups receiving no intervention, and at levels indicating important gains for the children with language difficulties as measured by effect size using Cohens d. The inclusion of children with typically developing
language, who were still described as disadvantaged, strengthened the design by exploring a predicted acceleration of the Experimental groups trajectory of progress when compared with a group
of children with normal language, predicted to be making age typical progress, and a group of
children with similar language difficulties, making slow progress in learning language skills.
The key research question examined in the present study is: what is the impact of the bookreading intervention program on socio-economically disadvantaged children with language difficulties, including expressive, receptive and overall language measures. The hypotheses are that:
1. Following the intervention the Experimental (Language Difficulties) group will perform
significantly better than the Control (Language Difficulties) group and the Control
(Language Normal) group on measures of expressive, receptive, and overall language.
2. The effect size, measured with Cohens d, will be over .50 (medium) on all dependent

Ethics approval for the study was sought and successfully obtained from The University of Sydney
Human Ethics Committee and from the State Education Research Assessment Procedure.

The study involved 36 children and their parents, divided into three groups, with two groups of
children with language delays and difficulties, an Experimental Language Difficulties (ELD)
group and a Control Language Difficulties (CLD) group, and one Control Language Normal (CLN)
group. Child participants in the study were selected from three separate preschools comprising
seven classes. Child mean age was 5:0 years, with a range from 4:3 years to 5:7 years. All children


Table 1. Child participants numbers, gender and ages at pre-testing.




Mean age

Age range

Mean Spoken Language

Quotients (SLQ) (mean
100, SD 15)

(language difficulties)
Control (language
Control (language













attended special preschool centres for children from backgrounds designated as disadvantaged,
funded by the State Education system. The geographic area was designated in the lowest 5% in
New South Wales, Australia, based on multiple indicators of disadvantage across five broad headings of social distress, health, community safety, economics and education. Informed parental consent was obtained for all participants: child and adult. The numbers of children, the gender balance,
and the mean ages and range are presented in Table 1.
Children were assigned to the ELD or CLD group according to the preschool they attended to
ensure that the CLD group parents were not aware of the intervention techniques prior to training.
All children in the ELD group attended one preschool with two classes, whilst the CLD group was
selected from five classes in two other preschools. The CLN group was drawn from children with
normally developing language who attended all seven classes at the three preschools.

a Initial assessment. All children were pre-tested using two standardized tests, both of which have
parallel forms, yielding four measures of language. The tests were the Test of Early Language
Development (TELD3, Hresko et al., 1999, 3rd edition), and the Peabody Picture Vocabulary Test
(PPVT3, Dunn and Dunn, 1997, 3rd edition). The TELD3 and the PPVT3 have test means of 100
with standard deviations (SDs) of 15. The TELD3 has testretest reliability ranging from .85 to .94
across the three quotients, and the PPVT3 has testretest reliability of .91. The TELD3 yields three
scores: Expressive Language Quotient (ELQ), Receptive Language Quotient (RLQ) and Spoken
Language Quotient (SLQ), with the SLQ representing a total language score. The PPVT3 is also a
measure of Receptive Language but of single word vocabulary, whereas the TELD3 RLQ measures instruction following, more complex grammatical understanding and some interpretation, as
well as single word understanding.
The summary pre-testing findings are shown in Table 1. For the Experimental Language
Difficulties (ELD) group and the Control Language Difficulties (CLD) group, the mean SLQ was
used as the criteria for inclusion in both Language Difficulties groups. An SLQ standard score
below 70, which is more than two standard deviations (SD) below the mean, and named as very
poor in the tests descriptors, confirmed that all children in the ELD and CLD groups had difficulties in language. Conversely the mean SLQ for the children in the CLN group was 101.8, defined
as average.
b Parent training and intervention programme. One of the childs parents, usually the mother (noting that two fathers participated), of children in the ELD group were individually trained within a


Child Language Teaching and Therapy 30(1)

single hour session to use the strategies of pausing and open questioning during interactive joint
book reading (see details later). A short demonstration using the key strategies was conducted with
each child by the author, with the parent observing, and suitable picture books were shown and
discussed. Each parent was provided with personalized written guidelines, including a simplified
summary of the four elements of the program. A spoken version of the strategies was also available
on CD if required by parents with low literacy levels. Parents were encouraged to implement the
strategies in a book-reading context for 515 minutes per day with their child for the next four
months, and to use the strategies during daily activities when suitable opportunities arose. Parents
were supplied with record books to record the books used, time spent and dates on which they
implemented the book-reading intervention program. They were given contact details to follow up
on any concerns. In addition, all available parents were contacted once during the intervention
period to discuss how they were managing implementing the program.
The four key components of the intervention program were:
1. pausing (not talking or communicating) at each page turn to allow the child an opportunity
to talk first, that is, to choose or initiate a topic of interest to them;
2. asking an open question related to the childs chosen topic, encouraging the child to say
more and to use more complex language, thus giving the child an opportunity to respond or
to talk more on their chosen topic;
3. using childrens picture books as a stimulus for language teaching and learning in regular
book-reading sessions; and
4. using the same strategies of pausing and conversation building in everyday settings.
Examples of the childrens picture books were selected on the basis of the attractiveness of the
pictures and story, with a limited amount of text on each page. Parents were encouraged to obtain
similar books, with a collection made available at the preschool. A full list of the books is available
on request.
c Post intervention assessment. All 36 children in the three groups were re-tested four months later
using the parallel forms of the TELD3 and PPVT3. A short follow-up interview was completed
with each available trained parent in the ELD group following their four months of intervention,
eliciting their views on the training, the implementation of the techniques, and their opinion of their
childs progress in language and other areas. When their formal involvement was completed, every
child in the three groups was presented with a certificate and a childrens picture book to thank
them for their participation. Further, a report was sent to parents of children in the ELD group.

3 Design and analysis

The design of the study was experimental with three groups: Experimental Language Difficulties
(ELD) group, Control Language Difficulties (CLD) group, and Control Language Normal
(CLN) group. The CLN group was included to allow comparison of the ELD and CLD groups
results with those of a normally developing group over the four months of intervention; thus,
Time 1, pre-testing and Time 2, post-testing. Parents of the children in the CLD and CLN
groups were given the option of being trained in the intervention strategies upon completion of
the research.
Every child was tested by one of two assessors, with pre- and post-testing of all children.
ANCOVA analyses were conducted using difference scores. To investigate where the group differences lay, further post-hoc analyses, specifically using the StudentNewmanKeuls (SNK) test,



were performed to determine which groups differed from each other. The SNK analyses are posthoc pairwise comparisons that are conducted in one follow-up procedure (thus obviating the need
for piecemeal post-hoc tests). All alpha levels were set at p < 0.05. A separate measure of effect size
was calculated using Cohens d.

1 Effectiveness of the intervention
An ANCOVA was performed on difference scores, together with a StudentNewmanKeuls posthoc analysis. The ANCOVA analyses for the Experimental Language Difficulties (ELD) groups
difference scores, compared with the Control Language Difficulties (CLD) and the Control
Language Normal (CLN) groups difference scores as a function of group membership, were completed on measures of expressive language (TELD3, F(2, 33) = 9.37, p = .001), receptive language
(TELD3, F(2, 33) = 13.81, p = .001, PPVT3, F(2, 33) = 5.29, p = .010), and the spoken language
quotient (TELD3, F(2, 33) = 18.49, p = .001). The results from the StudentNewmanKeuls posthoc analysis (p < .05) were that the ELD group scored significantly higher than the CLD and CLN
groups following the intervention, confirming that the differences occurred in favour of the ELD
group, with no significant changes in the CLD and CLN groups. Therefore, Hypothesis 1 was
proven for all measures.
Hypothesis 2 predicted that the effect size for the ELD group of children would be over .50
(medium) on all measures following the intervention. As is evident in Table 2, this hypothesis was
upheld. For expressive, receptive and the spoken language quotients, effect sizes were large (.80
and above) to very large, with 1.50 for expressive language, 1.67 for receptive language (TELD3),
.80 for receptive language (PPVT3) and 1.73 for the overall spoken language quotient.
Finally data from the parent interviews was positive, with parents enjoying the book-reading
intervention and generally maintaining the use of the strategies for the four-month experimental
period. Many provided anecdotal evidence of positive interactions with their child and observed
progress, particularly the childs use of specific vocabulary.

2 Summary of the findings

In summary, hypotheses predicted that the language of children in the Experimental Language
Difficulties (ELD) group would improve across key areas following parental implementation of
the intervention strategies. Significant differences and medium to large effect sizes were achieved
for the ELD group compared with the Control Language Difficulties (CLD) group, and the Control
Language Normal (CLN) group. Further, the results for the CLD and CLN groups of children
showed no significant change during the four-month intervention period.

The study explored the impact of training the parents of young children with language difficulties.
Parents intervened using simple strategies within a book-reading context to facilitate their childs
use of language. Changing the pattern of adultchild language interactions led to positive significant gains, with large to very large effect sizes in child language in the Experimental Language
Difficulties (ELD) group. Importantly no change was observed in either of the Control groups
(CLD and CLN) during the four-month intervention phase. Given that there were no differences
between the ELD and CLD groups of children observed at pre-test, and the pretesting scores were


Child Language Teaching and Therapy 30(1)

Table 2. ANCOVA difference scores results for experimental (LD) group versus control groups.



Difference scores
M (SD)

Difference scores

Effect size
Cohens d


Experimental (LD)
Control (LD)
Control (LN)
Experimental (LD)
Control (LD)
Control (LN)
Experimental (LD)
Control (LD)
Control (LN)
Experimental (LD)
Control (LD)
Control (LN)


12.18 (6.82)
4.75 (9.79)
1.00 (5.03)
24.55 (11.20)
5.17 (12.08)
2.62 (9.58)
22.18 (8.12)
5.58 (9.60)
2.00 (7.76)
13.64 (17.97)
0.25 (8.01)
0.62 (7.30)












used as a covariate, it is reasonable to attribute the significant gains with large effect sizes observed
in the ELD group at post-testing to the intervention program. The findings are important and
unique, demonstrating that the gap between children making poor progress in learning language
skills can be closed, particularly as the typically developing children in the Language Normal
group made age typical, but not accelerated progress during the same time period. Only one previous study has been published combining elements of naturalistic milieu teaching within a bookreading context (Colmar, 2011) with standardized child language measures; thus, there is little
prior research to link to the present interventions effectiveness.
It is important to consider the intervention in terms of the relative simplicity of the strategies
and the consultative nature of the training. Clearly a combination of the powerfulness of pausing
to provide the child with an opportunity to initiate talk on a topic of their own interest (their chosen
focus of attention), and responsive questioning, coupled with the advantages of book reading and
using naturally occurring opportunities to communicate, was highly successful in facilitating the
childrens language progress. From qualitative comments gathered, parental motivation to help
their own child was high. Further, the simplicity of the strategies ensured parents could implement
the program and that, as they observed the positive changes in their childrens language use and
understanding, they were further encouraged to keep using the strategies. However, as it was not
practicable to collect treatment fidelity data, only parental report and records, it is the robustness
of the design controlling for the covariates and the full results presented, that suggest parents actually did implement the intervention following training.
Pausing and questioning are both single behaviours and easily described, possibly making it
easier to train than the more complex full milieu strategies (Colmar, 1999; McNeill and Fowler,
1999). It is also likely that the structured book-reading context, with pausing specified to occur
when using the books at the start of a session and at every page turn, both of which were readily
observable opportunities, made it easy to implement. However, pausing implicitly involves the
inhibition of high levels of adult talk, and this could have been initially difficult, particularly as an
inappropriate pattern of communication with children with language difficulties including talking
fairly constantly in a book-reading context, can be adopted (Colmar, 1999). Similarly, questioning
was simpler within the book-reading context as child language was generally clearly understood
with pictorial cues available to enhance the supportive context.



The book-reading context functioned as an intervention and additionally as a practice time,

both for the parent to learn the technique in a semi-structured setting and for the child to talk on a
personally chosen topic in an enjoyable, emotionally warm context. Parents in the present study
confirmed this became a special time with their child that was mutually enjoyable. In addition,
books are an excellent source of conversational topics with the advantage of picture stimuli
(Barachetti and Lavelli, 2011), potentially a range of new and varied vocabulary, contextualization,
and a storyline to enhance conversation building. Importantly, the effectiveness of book reading
per se cannot be separated out from the parents use of the specifically prescribed strategies, given
that the program was presented as an intervention package with multiple elements, and specific
treatment integrity data was not gathered. However, parents reported using the same principles of
pausing and contingent questioning in response to child initiations within naturalistic contexts to
develop turn-taking conversations; thus the intervention went beyond book reading.
Much of the research has focused on the impact of book reading on future literacy success, not
the immediate impact on language itself. In the present study, parental post-intervention interviews
suggested that the pausing and use of the open questioning were helpful in the book-reading context in encouraging the childs engaged participation and conversational turn-taking. Importantly,
the parents use of contingent open questioning based on the childs initiated topic may have been
particularly useful, as the childs meaning then becomes the focus rather than reading the print.
Research does support the relevance of assisting the child to develop meaning, which will ultimately facilitate literacy comprehension (Schickedanz and McGee, 2010).
The findings of the present research could be further explored by including an additional Control
group whose parents could be asked to read books more, thus clarifying if the training in the strategies resulted in the effectiveness of the intervention or if providing books with no instructions would
be effective. An acknowledged limitation of the study is that the two assessors of the childrens
language at all stages of testing were aware of the group to which each child had been allocated; thus
assessor bias could have occurred. Future research or replication could ensure blind testing occurred.
In summary, the parents capacity to learn and successfully use a set of simple new strategies
confirms the importance of direct parent involvement in child learning. When trained to pause,
listen and interact as a facilitator, parents allowed opportunities for child initiations and child-led
conversations, with open questioning providing the child with further opportunities to respond
using language and to develop a conversation about a topic of their own choice. Generalization of
the technique and opportunities for more conversations were created when the parents in the study
used pausing and open questioning as often as possible in their everyday conversations with their
child, as well as engaging regularly in the book-reading program.
Changing book reading from an adult controlled activity to a child centred one, with child
choice and opportunities to both initiate and respond using language ensuring child attention and
motivation, achieved significant positive changes, with medium to large effect sizes, in child language skills, vital skill enhancement for children with serious language difficulties.
I acknowledge the invaluable assistance with the data collection of Louise Davey, Psychology Student from
the University of Bath, UK, and the generous assistance with statistical procedures and explanations from
Andrew Martin, University of Sydney, Australia.

Declaration of conflicting interest

The author declares that there is no conflict of interest.


Child Language Teaching and Therapy 30(1)

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit

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