Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland.
Department of Special Education, Vanderbilt University, Nashville, TN.
Am J Speech Lang Pathol. 2024 Nov 4;33(6):2991-3011. doi: 10.1044/2024_AJSLP-23-00454. Epub 2024 Oct 7.
This pilot study investigated delivering enhanced milieu teaching tailored for children with Down Syndrome (EMT-DS) through hybrid telepractice.
In this multiple-baseline design across behaviors study, a speech-language pathologist (SLP) taught EMT-DS to three caregivers and their children with DS (22-40 months) using a hybrid service delivery model. Sessions were conducted in person and via telepractice. The SLP taught caregivers EMT-DS, emphasizing the use of (a) four target EMT strategies: matched turns, expansions, time delays, and milieu teaching episodes; (b) augmentative and alternative communication (AAC; manual signs, speech-generating device); and (c) aided AAC modeling. The SLP provided caregiver instruction following the teach-model-coach-review approach. Caregiver outcomes were the accuracy (primary) and frequency (secondary) of EMT strategy use. Child outcomes were exploratory and included the rate of symbolic communication acts, weighted number of communication acts, and number of different words (NDW).
There was a functional relation between the intervention and the accuracy and frequency of EMT strategy use for all three caregivers. All caregivers showed an increase in the accuracy for all four target strategies. Caregivers also increased the frequency of the three EMT strategies: expansions, time delays, and milieu teaching episodes. There were no changes in the frequency of matched turns. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the rate of symbolic communication acts and NDW occurred for all three children.
Results demonstrate the preliminary efficacy of using a hybrid service delivery model to teach caregivers EMT-DS.
本初步研究通过混合远程实践来研究为唐氏综合征（Down Syndrome，DS）儿童量身定制的强化环境教学（Enhanced Milieu Teaching for Down Syndrome，EMT-DS）的效果。
在这项跨行为的多项基线设计研究中，言语病理学家（speech-language pathologist，SLP）使用混合服务交付模式，亲自或通过远程实践向三位照顾者及其患有 DS 的儿童（22-40 个月）教授 EMT-DS。课程包括环境教学、回合匹配、扩展、时间延迟和教学片段等四个目标 EMT 策略，以及辅助性和替代性沟通（augmentative and alternative communication，AAC；手语、言语生成设备）和辅助性 AAC 模型。SLP 采用“教-模型-指导-复习”的方法为照顾者提供 EMT-DS 指导。照顾者的结果是 EMT 策略使用的准确性（主要结果）和频率（次要结果）。儿童的结果是探索性的，包括符号沟通行为的比率、沟通行为的加权数量和不同单词的数量（number of different words，NDW）。
干预措施与所有三位照顾者 EMT 策略使用的准确性和频率之间存在功能关系。所有照顾者的所有四个目标策略的准确性都有所提高。照顾者还增加了三种 EMT 策略的使用频率：扩展、时间延迟和环境教学片段。回合匹配的频率没有变化。干预结束后 6 周内，照顾者仍持续使用 EMT 策略。在照顾者学习 EMT 策略后，所有三个孩子的符号沟通行为比率和 NDW 都逐渐增加。
结果表明，使用混合服务交付模型教授照顾者 EMT-DS 的初步疗效。
