Purpose

To investigate whether It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents.

Method

Eleven children aged 19–36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion.

Results

Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers' linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers' views of parenting did not change.

Conclusions

It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.

References

  • Australian Bureau of Statistics (2006). An introduction to socio-economic indexes for areas (SEIFA) [Information Paper 2039].Retrieved March 29, 2008, from www.abs.gov
  • Barrera, M. E., & Vella, D. M. (1987). Disabled and nondisabled infants' interactions with their mothers.American Journal of Occupational Therapy, 4, 168–172.
  • Basil, C. (1992). Social interaction and learned helplessness in severely disabled children.Augmentative and Alternative Communication, 8, 188–199.
  • Boucher, J., & Lewis, V. (1997). Preschool Language Scale—3 UK edition (PLS–3 UK). London: Harcourt Assessment.
  • Brady, N. C. (2000). Improved comprehension of object names following voice output communication aid use: Two case studies.Augmentative and Alternative Communication, 16, 197–204.
  • Brinker, R. P., Seifer, R., & Sameroff, A. J. (1994). Relations among maternal stress, cognitive development, and early intervention in middle- and low-SES infants with developmental disabilities.American Journal on Mental Retardation, 98, 463–480.
  • Buzolich, M. J., King, J., & Baroody, S. M. (1991). Acquisition of the commenting function among system users.Augmentative and Alternative Communication, 7, 88–99.
  • Clarke, M., & Kirton, A. (2003). Patterns of interaction between children with physical disabilities using augmentative and alternative communication systems and their peers.Child Language Teaching and Therapy, 19, 133–148.
  • Clarke, M., & Wilkinson, R. (2007). Interaction between children with cerebral palsy and their peers. 1: Organizing and understanding VOCA use.Augmentative and Alternative Communication, 23, 336–348.
  • Cohen, J. (1960). A coefficient of agreement for nominal scales.Educational and Psychological Measurement, 20, 37–46.
  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
  • Cross, T. (1981). Parental speech as primary linguistic data: Some complexities in the study of the effect of the input on language acquisition.In P. S. Dale, & D. Ingram (Eds.), Child language: An interactional perspective (pp. 213–228). Baltimore: University Park Press.
  • Dickinson, H. O., Parkinson, K. N., Ravens-Sieberer, U., Schirripa, G., Thyen, U., & Arnaud, C. (2007). Self-reported quality of life of 8- to 12-year-old children with cerebral palsy: A cross-sectional European study.The Lancet, 369, 2171–2178.
  • Dunst, C. J. (1985). Communicative competence and deficits: Effects on early social interactions.In E. T. McDonald, & D. L. Gallagher (Eds.), Facilitating social-emotional development in multiply handicapped children (pp. 93–140). Philadelphia: Home for the Merciful Savior for Crippled Children.
  • Dunst, C. J. (1999). Responses to Mahoney et al.: Placing parent education in conceptual and empirical context.Topics in Early Childhood Special Education, 19, 141–172.
  • Ferm, U., Ahlsen, E., & Bjorck-Akesson, E. (2005). Conversation topics between a child with complex communication needs and her caregiver at mealtime.Augmentative and Alternative Communication, 21, 19–40.
  • Fey, M. E., Warren, S. F., Brady, N., Finestack, L. H., Bredin-Oja, S. L., & Fairchild, M. (2006). Early effects of responsivity education/prelinguistic milieu teaching for children with developmental delays and their parents.Journal of Speech, Language, and Hearing Research, 49, 526–547.
  • Fox, C. (2004). Intensive voice treatment (LSVT) for children with spastic cerebral palsy. Unpublished doctoral dissertation, University of Arizona
  • Francis, G., & Hunston, S. (1992). Analysing everyday conversation.In M. Coulthard (Ed.), Advances in spoken discourse analysis (pp. 123–161). London: Routledge.
  • Gallagher, T. M. (1981). Contingent query sequences within adult–child discourse.Journal of Child Language, 8, 51–62.
  • Gibaud-Wallston, J., & Wandersman, L. P. (1978, August–September). Development and utility of the Parenting Sense of Competence Scale. Paper presented at the 86th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada.
  • Girolametto, L. (1988a). Developmental dialogue skills: The effects of a conversational model of language intervention.In K. Marfo (Ed.), Parent–child interaction and developmental disabilities (pp. 145–162). New York: Praeger.
  • Girolametto, L. (1988b). Improving the social-conversational skills of developmentally delayed children: An intervention study.Journal of Speech and Hearing Disorders, 53, 156–167.
  • Girolametto, L., Greenberg, J., & Manolson, H. A. (1986). Developing dialogue skills: The Hanen early language parent program.Seminars in Speech and Language, 7, 367–382.
  • Girolametto, L., Pearce, P. S., & Weitzman, E. (1996). Interactive focused stimulation for toddlers with expressive vocabulary delays.Journal of Speech and Hearing Research, 39, 1274–1283.
  • Girolametto, L., & Weitzman, E. (2007). It takes two to talk—The Hanen program for parents: Early language intervention through caregiver training.In R. J. McCauley, & M. E. Fey (Eds.), Treatment of language disorders in children (pp. 77–103). Baltimore: Brookes.
  • Halle, J., Brady, N. C., & Drasgow, E. (2004). Enhancing socially adaptive communicative repairs of beginning communicators with disabilities.American Journal of Speech-Language Pathology, 13, 43–54.
  • Hancock, T. B., Kaiser, A. P., & Delaney, E. M. (2002). Teaching parents of preschoolers at high risk: Strategies to support language and positive behavior.Topics in Early Childhood Special Education, 22, 191–212.
  • Hanzlik, J. R. (1990). Nonverbal interaction patterns of mothers and their infants with cerebral palsy.Education and Training in Mental Retardation, 25, 333–343.
  • Harris, M., Jones, D., Brookes, S., & Grant, J. (1986). Relations between the non-verbal context of maternal speech and rate of language development.British Journal of Developmental Psychology, 4, 261–268.
  • Hassall, R., Rose, J., & McDonald, J. (2005). Parenting stress in mothers of children with an intellectual disability: The effects of parental cognitions in relation to child characteristics and family support.Journal of Intellectual Disability Research, 49, 405–418.
  • Hemmeter, M. L., & Kaiser, A. P. (1994). Enhanced milieu teaching: Effects of parent-implemented language intervention.Journal of Early Intervention, 18, 269–289.
  • Hjelmquist, E., & Dahlgren-Sandberg, A. (1996). Sounds of silence: Interaction in aided language use.In S. Von Tetzchner, & M. H. Jensen (Eds.), Augmentative and alternative communication: A European perspective (pp. 137–152). London: Whurr.
  • Johnston, C., & Mash, E. J. (1989). A measure of parenting satisfaction and efficacy.Journal of Clinical Child Psychology, 18, 167–175.
  • Johnston, S. S., McDonnell, A. P., Nelson, C., & Magnavito, A. (2003). Teaching functional communication skills using augmentative and alternative communication in inclusive settings.Journal of Early Intervention, 25, 263–280.
  • Jolleff, N., McConachie, H., Winyard, S., Jones, S., Wisbeach, A., & Clayton, C. (1992). Communication aids for children: Procedures and problems.Developmental Medicine & Child Neurology, 34, 719–730.
  • Jones, S. R. G. (1992). Was there a Hawthorne Effect?.American Journal of Sociology, 98, 451–468.
  • Kaiser, A. P., Alpert, C. L., Hemmeter, M. L., & Ostrosky, M. M. (1987). Milieu teaching manual. Nashville, TN: Vanderbilt University Press.
  • Kaiser, A. P., Hemmeter, M. L., Ostrosky, M. M., Alpert, C. L., & Hancock, T. B. (1995). The effects of group training and individual feedback on parent use of milieu teaching.Journal of Childhood Communication Disorders, 16, 39–48.
  • Kaiser, A. P., Hemmeter, M. L., Ostrosky, M. M., Fischer, R., Yoder, P., & Keefer, M. (1996). The effects of teaching parents to use responsive interaction strategies.Topics in Early Childhood Special Education, 16, 375–406.
  • Kent-Walsh, J., & McNaughton, D. (2005). Communication partner instruction in AAC: Present practices and future directions.Augmentative and Alternative Communication, 21, 195–204.
  • Klee, T., Marr, C., Robertson, E., & Harrison, C. (1999). The MacArthur Communicative Development Inventory: Toddler (British English adaptation). Newcastle, England: Newcastle University Press.
  • Koman, L., Smith, B. P., & Shilt, J. S. (2004). Cerebral palsy.The Lancet, 363, 1619–1631.
  • Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., & Baccani, S. (2006). Teaching “yes” and “no” responses to children with multiple disabilities through a program including microswitches linked to a vocal output device.Perceptual & Motor Skills, 102, 51–61.
  • Light, J., Binger, C., Agate, T. L., & Ramsay, K. N. (1999). Teaching partner-focused questions to individuals who use augmentative and alternative communication to enhance their communicative competence.Journal of Speech, Language, and Hearing Research, 42, 241–255.
  • Light, J., Collier, B., & Parnes, P. (1985a). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part I—Discourse patterns.Augmentative and Alternative Communication, 1, 74–83.
  • Light, J., Collier, B., & Parnes, P. (1985b). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part II—Communicative function.Augmentative and Alternative Communication, 1, 98–107.
  • Light, J., Dattilo, J., English, J., Gutierrez, L., & Hartz, J. (1992). Instructing facilitators to support the communication of people who use augmentative communication systems.Journal of Speech and Hearing Research, 35, 865–875.
  • Lund, S. K., & Light, J. (2007a). Long-term outcomes for individuals who use augmentative and alternative communication: Part II—Communicative interaction.Augmentative and Alternative Communication, 23, 1–15.
  • Lund, S. K., & Light, J. (2007b). Long-term outcomes for individuals who use augmentative and alternative communication: Part III—Contributing factors.Augmentative and Alternative Communication, 23, 323–335.
  • MacDonald, J., & Gillette, Y. (1988). Communicating partners: A conversational model for building parent–child relationships with handicapped children.In K. Marfo (Ed.), Parent–child interaction and developmental disabilities: Theory, research, and intervention (pp. 220–241). New York: Praeger.
  • Mahoney, G. J., & Powell, A. (1986). Transactional intervention program: Teacher’s guide. Farmington, CT: Pediatric Research and Training Center.
  • Mahoney, G., & Powell, A. (1988). Modifying parent–child interaction: Enhancing the development of the handicapped child.Journal of Special Education, 22, 82–86.
  • Manolson, A. (1992). It takes two to talk. Toronto, Ontario, Canada: The Hanen Centre.
  • Marfo, K. (1990). Maternal directiveness in interactions with mentally handicapped children: An analytical commentary.The Journal of Child Psychology and Psychiatry, 31, 531–549.
  • McConachie, H., & Ciccognani, A. (1995). “What’s in the box?” Assessing physically disabled children’s communication skills.Child Language Teaching and Therapy, 11, 253–263.
  • McConachie, H., & Pennington, L. (1997). In-service training for schools on augmentative and alternative communication.European Journal of Disorders of Communication, 32, 277–288.
  • Miller, J. F., & Chapman, R. S. (1992). Systematic Analysis of Language Transcripts [Computer software]. Madison, WI: Waisman Center.
  • Moher, D., Pham, B., Jones, A., Cook, D. J., Jadad, A. R., & Moher, M. (1998). Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?.The Lancet, 352, 609–613.
  • Mullen, E. M. (1995). Mullen Scales of Early Learning. Circle Pines, MN: AGS.
  • Palisano, R. J., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy.Developmental Medicine & Child Neurology, 39, 214–223.
  • Pennington, L., Goldbart, J., & Marshall, J. (2004). Speech and language therapy to improve the communication skills of children with cerebral palsy.Cochrane Database of Systematic Reviews, Issue 2, Article No. CD003466. DOI: 10.1002/14651858.CD003466.pub2.
  • Pennington, L., & McConachie, H. (1996). Evaluating My Turn to Speak, an in-service training programme for schools.European Journal of Special Needs Education, 11, 167–180.
  • Pennington, L., & McConachie, H. (1999). Mother–child interaction revisited: Communication with nonspeaking physically disabled children.International Journal of Language & Communication Disorders, 34, 391–416.
  • Pennington, L., & McConachie, H. (2001a). Interaction between children with cerebral palsy and their mothers: The effects of speech intelligibility.International Journal of Language and Communication Disorders, 36, 371–394.
  • Pennington, L., & McConachie, H. (2001b). Predicting patterns of interaction between children with cerebral palsy and their mothers.Developmental Medicine & Child Neurology, 43, 83–90.
  • Pennington, L., Smallman, C. E., & Farrier, F. (2006). Intensive dysarthria therapy for older children with cerebral palsy: Findings from six cases.Child Language Teaching and Therapy, 22, 255–273.
  • Pennington, L., & Thomson, K. (2007). It Takes Two to Talk—The Hanen Program and families of children with cerebral palsy: A UK perspective.Child: Care, Health and Development, 33, 691–702.
  • Pepper, J., & Weitzman, E. (2004). It Takes Two to Talk: A practical guide for parents of children with language delays. Toronto, Ontario, Canada: The Hanen Centre.
  • Pepper, J., Weitzman, E., & McDade, A. (2004). Making Hanen happen: It Takes Two to Talk—The Hanen Program for Parents. Leader’s guide for certified speech-language pathologists. Toronto, Ontario, Canada: The Hanen Centre.
  • Pinder, G. L., & Olswang, L. B. (1995). Development of communicative intent in young children with cerebral palsy: A treatment efficacy study.Infant-Toddler Intervention, 5, 51–69.
  • Robertson, S. B., & Weismer, S. E. (1999). Effects of treatment on linguistic and social skills in toddlers with delayed language development.Journal of Speech, Language, and Hearing Research, 42, 1234–1248.
  • Robey, R. R., & Schultz, M. C. (1998). A model for conducting clinical-outcome research: An adaptation of the standard protocol for use in aphasiology.Aphasiology, 12, 787–810.
  • Rocissano, L., & Yatchmink, Y. (1983). Joint attention in mother–toddler interaction.Merrill–Palmer Quarterly, 30, 11–31.
  • Romski, M. A., Sevcik, R. A., Reumann, R., & Pate, J. L. (1989). Youngsters with moderate or severe mental retardation and severe spoken language impairments. I: Extant communicative patterns.Journal of Speech and Hearing Disorders, 54, 366–373.
  • Sameroff, A. J., & Fiese, B. H. (2000). Models of development and developmental risk.In C. H. J. Zeanah (Ed.), Handbook of infant mental health (pp. 3–19). New York: Guilford Press.
  • Sankoh, A. J., D’Agostino, R. B., & Huque, M. F. (2003). Efficacy endpoint selection and multiplicity adjustment methods in clinical trials with inherent multiple endpoints.Statistics in Medicine, 22, 3133–3150.
  • Schepis, M. M., & Reid, D. (1995). Effects of voice output communication aid on interactions between support personnel and an individual with multiple disabilities.Journal of Applied Behaviour Analysis, 28, 73–77.
  • Schlosser, R. W., & Sigafoos, J. (2002). Selecting graphic symbols for an initial request lexicon: An integrative review.Augmentative and Alternative Communication, 18, 102–123.
  • Schulz, K. F., & Grimes, D. A. (2005). Multiplicity in randomised trials. I: Endpoints and treatments.The Lancet, 365, 1591–1595.
  • Sevcik, R. A., Romski, M. A., & Adamson, L. B. (2004). Research directions in augmentative and alternative communication for preschool children.Disability & Rehabilitation, 26, 1323–1329.
  • Shonkoff, J. P., Hauser-Cram, P., Krauss, M. W., & Upshur, C. C. (1992). Development of infants with disabilities and their families: Implications for theory and service development.Monographs of the Society for Research in Child Development, 57(6, Serial No. 230)
  • Sigafoos, J. (1999). Creating opportunities for augmentative and alternative communication: Strategies for involving people with developmental disabilities.Augmentative and Alternative Communication, 15, 183–190.
  • Sigafoos, J., & Roberts-Pennell, D. (1999). Wrong-item format: A promising intervention for teaching socially appropriate forms of rejecting to children with developmental disabilities?.Augmentative and Alternative Communication, 15, 135–141.
  • Sinclair, J., & Coulthard, M. (1992). Towards an analysis of discourse.In M. Coulthard (Ed.), Advances in spoken discourse analysis (pp. 1–34). London: Routledge.
  • Snow, C. E., & Ferguson, C. (1978). Talking to children. London: Cambridge University Press.
  • Tannock, R., & Girolametto, L. (1992). Reassessing parent-focused language interventions.In S. F. Warren, & J. Reichle (Eds.), Communication and language intervention series: Vol. 1. Causes and effects in language intervention (pp. 49–79). Baltimore: Brookes.
  • Tannock, R., Girolametto, L., & Siegel, L. S. (1992). Language intervention with children who have developmental delays: Effects of an interactive approach.American Journal of Mental Retardation, 97, 145–160.
  • Thomas-Stonell, N., Rosenbaum, P., Oddson, B., & Robertson, B. (2007). Development of a new communication outcome measure for preschool children—FOCUS.Developmental Medicine & Child Neurology, 111Suppl.. 49, 78
  • Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality in the North. London: Croom Helm.
  • U.K. Medical Research Council. (2000). A framework for development and evaluation of RCTs for complex interventions to improve health. London: Author.
  • von Tetzchner, S., & Martinsen, H. (1996). Words and strategies: Conversations with young children who use aided language.In S. von Tetzchner, & M. H. Jensen (Eds.), Augmentative and alternative communication: European perspectives (pp. 65–88). London: Whurr.
  • Walker, L. S., Van Slyke, D. A., & Newbrough, J. R. (1992). Family resources and stress: A comparison of families of children with cystic fibrosis, diabetes, and mental retardation.Journal of Pediatric Psychology, 17, 327–343.
  • L. Wei (Ed.), 2000). The bilingualism reader. London: Routledge.
  • Wetherby, A. M., Cain, D. H., Yonclas, D. G., & Walker, V. G. (1988). Analysis of intentional communication of normal children from the prelinguistic to the multiword stage.Journal of Speech and Hearing Research, 31, 240–252.
  • Wright, M. G., Hunt, L. P., & Stanley, O. H. (2001). Quantification of object manipulation in children with cerebral palsy.Pediatric Rehabilitation, 4, 187–195.
  • Yoder, P. J., & Warren, S. F. (1998). Maternal responsivity predicts the prelinguistic communication intervention that facilitates generalized intentional communication.Journal of Speech, Language, and Hearing Research, 41, 1207–1219.
  • Yoder, P. J., & Warren, S. F. (2001). Relative treatment effects of two prelinguistic communication interventions on language development in toddlers with developmental delays vary by maternal characteristics.Journal of Speech, Language, and Hearing Research, 44, 224–237.
  • Yoder, P. J., & Warren, S. F. (2002). Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with intellectual disabilities.Journal of Speech, Language, and Hearing Research, 45, 1297–1310.
  • Yont, K. M., Snow, C. E., & Vernon-Feagans, L. (2003). The role of context in mother–child interactions: An analysis of communicative intents expressed during toy play and book reading with 12-month-olds.Journal of Pragmatics, 35, 435–454.

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