Article1 AComparisonofDevelopmentalSocialPragmaticandNaturalisticBehavioral

InterventionsonLanguageUseandSocial
EngagementinChildrenWithAutism
Author/Citation Ingersoll, B., Meyer, K., Bonter, N., Jelineka, S. (2012).Comparison of
developmental socialpragmatic and naturalistic behavioral interventions on
language use and social engagement in children with autism. Journal of Speech,
Language, and Hearing Research, 55, 13011313.

Participants Fiveyoungchildrenwithautismparticipatedinthisstudy.Lucas:36monthsoldat
intake.HemetthecriteriaforautismontheADOS.Hisnonverbalmentalagewas
19monthsontheBayley,andhisverbalmentalagewas17monthsonthePLS4.
Payton66monthsoldatintake.HemetthecriteriaforanASDontheADOS.His
nonverbalmentalagewas27monthsontheBayley,andhisverbalmentalagewas
21monthsonthePLS4,withascoreof20monthsforauditorycomprehensionand
23monthsforexpressivecommunication.Mark46monthsoldatintake.Hemet
criteriaforautismontheADOS.Markhadanonverbalmentalageof16months
ontheBayleyandaverbalmentalageof18monthsonthePLS4.Hisreceptive
andexpressivelanguageageequivalentsonthePLS4were15and22months,
respectively.Jared54monthsoldatintake.Hemetthecriteriaforautismonthe
ADOS.Jaredhadanonverbalmentalageof27monthsontheBayleyandaverbal
mentalageof30monthsonthePLS4(29monthsforauditorycomprehensionand
31monthsforexpressivecommunication).Jason53monthsoldandmetthecriteria
foranASDontheADOSatintake.Hisnonverbalmentalagewas27monthsonthe
Bayley.Hisverbalmentalagewas25monthsforauditorycomprehension,35
monthsforexpressivecommunication,and28monthsfortotallanguageonthe
PLS4.
Setting Sessionswereconductedinasmalltreatmentroomataresearchlaboratory
specializinginASDs.Motivatingtoyswereavailableduringeachtreatmentsession,
andthetoysavailablewereswitchedduringeachofthethree20mintreatment
sessions,whichwereconductedbacktobackinasingleday.Inaddition,eachchild
wastreatedbyseveraldifferenttherapistsduringeachphaseoftreatment,oftentimes
withmultipletherapiststreatingthechildduringdifferent20minsessions
conductedduringasinglevisit,topromotechildgeneralizationofskillsacross
adults.
Implementer Therapistsweretrainedtoconductbaselineaswellasalltreatmentconditionsin
training ordertoruleouttherapisteffects.Priortoworkingwiththechildren,therapistswere
trainedto90%correctimplementationofallthreeinterventionsduringroleplay
sessionswiththeleadtherapist,amasterslevelclinician.Therapistsreceivedin
sessioncoachingandfeedbackfromtheleadtherapistduringtheirfirstfew
sessionswiththeparticipants,untiltheywereabletomaintain80%fidelityacross
threesessions
Independent Baseline:freeplaywiththerapist
Variable Responsiveinteraction:languagemodelingandexpansionoflanguage
Milieuteaching:directelicitationoflanguagetargetsthroughprompting
combinedcondition:bothresponsiveinteractionandmilieuteachingstrategiesto
addressthechildrenslanguagetargets.
DependentVariable ChildLanguage:childproductionoflanguagetargets(i.e.,singlewordsand
 approximationsforLucas,singlewordsforMarkandPayton,twoword
combinationsforJared,andthreewordcombinationsforJason)
socialEngagement:Trainedundergraduateratersscoredeachsessionforthechilds
levelofengagementwiththetherapistusinga5pointLikerttyperatingscalethat
wasmodifiedfromtheSocialsubscalesoftheChildBehaviorRatingScale
(Mahoney&Wheeden,1999;seeAppendixB).
Results TotalLanguage:Allfivechildrenexhibitedhigherratesoftotallanguagetargetsin
atleastoneofthetreatmentconditionsthanatbaseline.Twoofthefivechildren
(PaytonandMark)exhibitedthispatternacrossallthreeinterventionconditions
LanguageTypeandFunction:
Promptedrequest,Allfivechildrenusedmorepromptedrequestsinthemilieu
teachingandcombinedcondition,
Spontaneousrequests.Allchildrenshowedsomeimprovementinspontaneous
requestsduringtreatment.
Promptedcomments.Allchildrenshowedsomeimprovementinprompted
commentsinatleastonetreatmentconditioncomparedwithatbaseline;however,
overallratesofpromptedcommentswerelowacrossconditions.Spontaneous
comments.Ratesofspontaneouscommentswerelowacrossconditionsforall
childrenwiththeexceptionofJason
SocialValidity Thesestrategieswereusedbyundergradandgraduatestudents,yetIbelieveif
taughttoaparenttheparentwouldbeabletoimplementthestrategiestoencourage
communication

Article2 SigninterventiononexpressivelanguageusingEMTstrategies
Author/Citation Wright, C.A., Kaiser, A.P., Reikowsky, D.I., Roberts, M. Y. (2013) Effects of a
naturalistic sign intervention on expressive language of toddlers with down
syndrome. Journal of Speech, Language, and Hearing Research, 56, 9941008

PurposeofResearch Inthisstudy,theauthorsevaluatedtheeffects
Participants Fourtoddlers(ages2329months)withDownsyndromewereenrolledinastudy
requirements(a)adiagnosisofDS;(b)age18and36months;(c)visionwithin
normallimits;(d)atleastoneandfewerthan15spokenwordsormanualsigns(e)
abilitytoimitateplacementandactionofhandmovements(f)Englishasthe
primarylanguage(g)parentalconsentforthechildsParticipationinthestudy
Setting Baselineandinterventionsessionswereconductedina
roomatapediatrictherapyclinicfurnishedwithachildsizedtableandoneRifton
chair;however,thechildparticipantsandtheinterventionistsatonthefloorduring
eachsession.
Implementers theinterventionistsimplementedtheEMTstrategiesalongwithJointattention,
symbolicplayandemotionalregulationtoteachspokenwordsandsignstochildren
withDownsyndrome
Implementer Theinterventionistknewsignlanguagebutwerenotfluentinit.theyalsoknewhow
training toimplementtheEMTstrategies(respondingtochild,expandingchildlanguage,
modeling,etc.)
Independent TheEMTstrategiesincluded
Variable (a)Followingthechildsleadjoiningchildsactivityandplayinghowtheyare.
(b)Respondingtothechildscommunicationtalktothechildattherelevel
(c)mirroringthechildsplayactionsandmappingdescribingsharedactions
withtargetwordsandsigns
(d)Expandingthechildscommunicationexpandchild'sgesturesandwordby
addingtargetwords
(e)Modelingtargetsigns
(f)Usingtimedelaytopromotechildcommunicationprovidechoicesthenwait
forresponse
(g)Incorporatingmilieupromptingepisodestopromotechildpracticeof
communicationtargetspoint,show,give
DependentVariable Baselinesessionsoccurredtwotimesperweek,2030min.Eachbaselinesession
involvedinteractiveplay.Theinterventionistprovidedinterestingtoysandengaged
inplaywithtoysselectedbythechild.

InterventionInterventionsessionsalsooccurredtwotimesperweek,2030min.
onthebasisofchildinterestintoysandcontinuedengagementintheinteraction.
TheinterventionistengagedinchilddirectedplayandusedEMTandJASPER
strategiestoteach32signspairedwithspokenwords.
Results Ryan.Ryanusedonespontaneoussignduringbaseline.Withintervention,histotal
useofsignsincreased.Hesignedbetween0and11differentwords.
Erinaboutninedifferentsignspersession
Jayusedfewerthantwosignspersessionduringbaseline,afterinterventionhe
usedanaverageof17signs
Gretchendidnotsignduringthebaselinebutincreasedsigngraduallythroughout
theintervention.

Article3 Enhancedgeneralizedteachingwithdailyroutines
Author/Citation Kasinath,S.,Woods,J.,&Goldstein,H.(2006).Enhancinggeneralizedteaching
strategyuseindailyroutinesbyparentsofchildrenwithautism.Journalof
Speech,Language,andHearingResearch,49,466485.
PurposeofResearch Thepurposeofthisstudywastoexaminetheeffectsoffacilitatinggeneralizeduse
ofteachingstrategiesbyparentsofchildrenwithautismwithindailyroutines
Participants Fivepreschoolchildrenwithautismparticipatedininterventionwithaparentwithin
dailyroutinesinthefamilyshome.Parentslearnedtoinclude2teachingstrategies
intargetroutinestoaddresstheirchildscommunicationobjectives.Parentchild
interactionsinroutineswerevideotapedfordatacodingandanalysis.
Setting Thefamilyshomewastheinterventionsettingforeachparentchilddyad.The
interventionistmetwitheachfamilyforapproximately6090mintwiceaweek
dependingonthefamilysschedule.Theinterventionist,studentassistant,mother,
andchildwithautismspectrumdisorder(ASD)werepresentduringeachsession.
Mostinterventionsessionsoccurredintheafternoonorearlyeveningto
accommodatefamilypreferencesandwork/schoolschedules.
Implementers Theinteventionalistprovidedstrategiesfortheparenttoimplementwiththeirchild.
Parentsimplemented2teachingstrategieswiththeirchildrenwithinnatural
environments,thesestrategieswerechosentotargetindividualizedcommunication
goals.
Implementer 1.parentsweregivenfriendlyhandoutsaboutstrategiesandexamplesofhowtouse
training them.
2.Parentsweregivenvideosofotherparentsimplementingstrategies.
3.theintervetnionalitmodeledthestrategywiththechildinanaturalcontext.
4.parentspracticedstrategywhileinthesameroutineasthevideoobserved.
5.Theparentandinterventionistdiscussedstrategyuse,possiblebarriersto
implementingtheintervention,andadditionalinstancesofpotentialstrategyuse
acrossroutines.
6.theinterventionistobservedandvideotapedtheparentimplementingstrategies.
7.thentheparentandinterventionalisttalkedaboutotherroutinesthattheparent
couldimplementthestrategies.8.thengeneralizationdatawascollected
Independent 1.Arrangingtheenvironment.Parentarrangesormodifiestheenvironmentto
Variable promoteinteraction,suchasputtingpreferredtoysoutofreachbutinsight,
requiringchildrentorequestassistance
2.Usingnaturalreinforcement.Parentverballyacknowledgesachilds
communicationattemptsandprovidesaccesstoobjectsoreventsinresponseto
childsrequests.
3.Usingtimedelay.Parentpresentsanobjectofinteresttothechild(e.g.,an
unopenedtoy)andwaitsbriefly(35s)beforegivingthechildaverbalpromptto
respond.
4.Imitatingcontingently.Parentimitatesthechildsactionswithinthechildsfield
ofvisionimmediatelyfollowingthechildsactions.
5.Modeling.Parentprovidesverbalmodelsdescribingtheactivityorlabelingthe
objectsthatthechildisinterestedinbutdoesnotaskthechildtoimitate.
6.Gestural/visualcuing.Parentusesgesturesandvisualpromptstopromptthe
childsparticipationinaroutine..
DependentVariable
Parentscanlearntoincludetwonewteachingstrategieswithintheirdaily
routines
Thisstudydemonstratedthattheinterventionsuccessfullyenhanced
generalizedparentstrategyuseacrossdailyroutinesandhadpositiveeffectson
childcommunicationoutcomes.
Results
Thisstudydemonstratedthattheinterventionsuccessfullyenhancedgeneralized
parentstrategyuseacrossdailyroutinesandhadpositiveeffectsonchild
communicationoutcomes.

Article4 AcquisitionandGeneralizationofkeywordsigningbythreechildrenwithAutism
Author/Citation Tan, X.Y., Trembath, D., Bloomberg, K., Iacono, T., & Caithness, T. (2014)
Acquisition and generalization of key word signing by three children with autism.
Developmental Neurorehabilitation, 17(2), 125-136. DOI:
 10.3109/17518423.2013.863236

PurposeofResearch ThepurposeofthisstudywastoobservetheeffectofKeyWordSign(KWS)
interventionontheacquisitionandgeneralizationofmanualsigningamongthree
childrenwithAutism,andtomeasurethechangesintheirproductionofspoken
wordsandgesturesfollowingintervention
Participants Threemalechildrenaged34years,withaformalclinicaldiagnosisofASD
confirmedbytheresearchteamusingtheAutismDiagnosticObservational
Schedule

John:3years2months,communicatesusingvocalizations,eyegaze,pointing,and
actions

Kenneth:Kennethwas3yearsand11monthsoldandalsocommunicatedmostly
throughhisvocalizations,occasionalpointing,andactions,includingtakinganadult
bythehand.Heoccasionallysaidnotorejectanobjectoranotherpersons
approach,butusuallycommunicatedrejectionbypushingtheobjectormoving
away.

Liam:was4yearsand1montholdandhadthemostadvancedcommunication
skillsofthethreechildren,asreflectedinhisscoresonthereceptiveandexpressive
scalesoftheMSEL(seeTableI).Heusedacombinationofwords,gestures,eye
gaze,andactionstoexpresshisneedsandwants,togreet,andtoshareinformation.

Setting Thestudywasconductedinaclinicroommeasuring?4m?4minaUniversity
clinic.Threecupboardswereusedtohousethreeseparatesetsoftoys(sixineach).
These18toyswerechosenonthebasisofbeingcommoninpreschoolsettingsand
toencourageimaginative,constructiveandsensoryplay.Therewasachildsized
tablewithtwochairsintheroomthatwereusedfortabletopplayactivities.

Baselineand Baseline:Duringthebaselinesessions,theclinicianfollowedthechildrenand
Intervention respondedtotheircommunicativeattempts,butdidnotmodeltheuseofKWS.The
clinicianalsocreatednaturalopportunitiesforthechildrentocommunicateand
respondedtohispotentiallycommunicativeactsinameaningfulway.Thechildren
wereexposedtoall18toysduringbaselinesessionstoensurethattheyhadan
opportunitytodemonstrateanypriorlearningofsignsassociatedwithparticular
toys.

Intervention:TheKWSinterventionwasintroducedinastaggeredfashioninthree
phases.

PhaseI,thestructureofsessionswasthesameasforbaseline,exceptthatthe
clinicianmodeledtheuseofKWSduringplaywithtoysfromCupboardA
duringthefirst10minsegment.Toillustrate,insteadofthecliniciansaying
Doyouwantmore?usingwordsalone,shesaidDoyouwantmore?
andsignedMOREconcurrently.Duringtheremainingtwo10minsegments
(playingwithtoysfromCupboardsBandC),KWSwasnotusedasper
 baselineconditions.
PhaseII,theclinicianmodeledKWSduringplaywithtoysfromCupboards
AandB.NomodelingofKWSwasprovidedduringplaywithtoysfrom
CupboardC,whichwasconsistentwithbaselineconditions.
PhaseIII,theclinicianmodeledKWSduringplaywithtoysfromallthree
cupboards.

At2weekpostintervention,childrenattendedafollowupsessionwhichinvolved
two15minactivities.Duringthefirstactivity,theclinicianinstitutedbaseline
conditions.Duringthesecondactivity,shemodeledKWS.Thisprovidedan
opportunitytoobservethechildrensmaintenanceinsignfreeenvironment
followedbyasigningenvironment,thusenablingustoconsiderthepossibilitythat
childrenmaybemorelikelytosigninthepresenceofanadultusing(andthus
validating)thesamecommunicationmode.

Baselinesessionswereofanaveragedurationof36minforeachchildand
interventionof34minforJohnand36minforbothKennethandLiam.

Implementers Thetreatmentwasdeliveredbyaspeechpathologist(5thauthor),blindtothe
childrenspretreatmentassessmentresults

Tohelpensuretreatmentfidelity,asetofplayscriptsrelatingtotoysinthethree
cupboardsweredeveloped.Thescriptcontainedexamplesof:(a)keywordssigned
inasentence,(b)descriptionsofdirectionalityandplacementusedinsigns,(c)
interactiveturntakingand(d)ideasforcreatingcommunicativeopportunities.

Independent KeyWordSignisanunaidedformofAACcommonlyusedinclinicalpracticeto
Variable supportthecomprehensionandexpressionofchildrenwithASD

DependentVariable Productionofspokenwordsandgestures(includessigns)
Resultsand Results:Followingtheintervention,Johnbeganusingcoresignsduringtheplay
Conclusion activities,whereasKennethandLiambeganusingbothcoreandfringesigns.John
producedatotalofsixdifferentsigns,Kennethproducedfourdifferentsigns,and
Liamproduced34differentsignsoverthecourseofthestudy.

Generalizations:allthreechildrenappearedtogeneralizetheiruseofcoresigns
fromplayactivitiesinvolvingtoysinCupboardA(forwhichKWSmodelinghad
beenprovided)totoysinCupboardsBandCforwhichnomodelinghadyetbeen
provided.

Conclusion:effectofacquisitionandgeneralizationofcoresignsacrossplay
activitiesfollowingintroductionoftheKWSintervention.Theresultsareconsistent
withpreviousstudiesofsignedbasedinterventions,suggestingthepossibleutility
ofKWSforasubsetofchildrenwithASDwhouselittleornofunctionalspeech.

Article5 ParentimplementedEnhancedMilieuTeachingwithPreschoolchildrenwhohave
 intellectualdisabilities
Author/Citation Kaiser, A., & Roberts, M. (2013). Parent-implemented enhanced milieu teaching
with preschool children with intellectual disabilities. Journal of Speech, Language,
and Hearing Research, 56, 295309.

PurposeofResearch ComparetheeffectsofEMTimplementedbyparentsandtherapistversustherapist
onlyonlanguageskills

Participants 77children,2treatments(Parent+therapistortherapistonly)36sessions,children
assessed,after,6monthslater,12monthslater

Implementers ForhalfofthechildrenParentsworkedwiththerapisttoimplementEMT,andfor
theotherhalftherapistimplementedEMTstrategies

Implementer Parentsparticipatedinaninteractiveworkshopthatincludedindividualized
training informationaboutlanguagedevelopment,behavior,play,environmental
arrangement,androutinesthatarefoundationaltotheEMTintervention.The
workshopslastedbetween2and3hr,andtheparentsreceivedanotebookofin
formationabouteachtopicandhandoutsthatprovidedspecific,individualized
informationabouttheirchildslanguagedevelopment

Independent ahybridnaturalisticteachingprocedurethatincludesfourcomponents:
Variable 1.environmentalarrangementarrangeenvironmenttosetthestageforadultchild
interaction2.responsiveinteractionmodellanguagetargetsappropriateforchildin
responsetochildscommunicationinconnectiontotheirinterests.3.specific
languagemodelingandexpansionsexpandchildswordsbyaddingwordsto
childsutterances4.milieuteachingpromptsrespondtochildsrequestwitha
promptsforelaborativelanguage

DependentVariable
Measurescollectedforchildrenandparentsincluded(a)observationalchildand
parentmeasuresathome,(b)normreferencedstandardizedmeasuresofchild
language,and(c)parentreports.Eachoutcomemeasurewasassessedatthestart
ofthestudy(pretest),immediatelyfollowingintervention,6monthsafter,and12
monthsafter

Results ParentsinthisstudywhoreceivedtraininginEMTincreasedtheiruseofresponsive
 interaction,expansions,languagemodeling,andmilieuteachingpromptsintrained
anduntrainedplaysettings

Article 6 Trainer Implemented EMT on social communication

M
Author/Citation Hancock, T. B., & Kaiser, A. P. (2002). The effects of trainer- implemented enhanced milieu
teaching on the social communication of children who have autism. Topics in Early
Childhood Special Education, 22, 3954.

Purpose of Examine the effects of trainer-implemented EMT on language performance of preschool

Research children with Autism

Participants Four children with autism and their mothers. The children were between 2 1/2 years to 5 years
old, has a 6 month delay in language, child verbally imitative, had at least 10 expressive
words and hearing was in normal range

Setting The training took place in a small playroom in a clinical setting. The room contained two
adult chairs, a kid table and chairs, cabinets with toys and a video camera.

Implementers The trainers implemented the Enhanced milieu teaching strategies

Implementer Trainers knew how to implement the EMT strategies (expansion, turn taking, following
training childs lead, pause errors, responsive feedback, talk at child target level)

Independent The intervention included:

Variable 1.Environmental Arrangement-Arranging environment for interaction
2.Responsive Interaction-Turn taking, following child's lead
3.Milieu Teaching Procedures
(a) Modeling-demonstrate behavior you want the still to follow
(b) Mand modeling-give a child a directive as you model what you want them to do
(c) Time delay-wait for child to engage
(d) Incidental teaching-teach with there toys of interest

Dependent Frequency of total utterances, spontaneous utterances, total use of targets, spontaneous use of
Variable targets.

Results Children demonstrated positive changes in social communication, these strategies

were generalized and the children were able to use them with their parents.