Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021

PARENT-IMPLEMENTED STRATEGIES FOR

CHILDREN WHO ARE DIFFICULT TO ENGAGE
Observe Assess Implement

Parent- Early Start Pivotal Response Reciprocal Enhanced

Denver Model Training Imitation Training Milieu Teaching
(P-EDSM) (PRT) (PIT) (EMT)

Joint Attention, Symbolic

Play, Engagement, and JASP-EMT Social Communication
Regulation Facilitation
(JASPER)
combination

These intervention strategies are shown to be effective in increasing parent-child

communication when implemented by parents taught through a coaching
approach. To determine which intervention would be the best fit for the family,
you must:
OBSERVE the parents and child within the child’s natural setting, completing the routine the family wishes to receive support for.
ASSESS which strategies the parents would like to try and would be a good fit for the child’s communication.
IMPLEMENT the chosen strategies within daily routines through parent coaching and observation.
 PARENT- EARLY START DENVER MODEL
*GOOD FOR INCREASING SOCIAL ENGAGEMENT
THROUGH JOINT ACTIVITIES AND PLAY
*MUST BE CERTIFIED IN ESDM TO USE THIS
STRATEGY NAME DESCRIPTION
gaining child’s attention and
ATTENTION AND MOTIVATION encouraging participation
creating routines that facilitate
SENSORY SOCIAL ROUTINES sensory based interactions
creating routines that involve joint
JOINT ACTIVITY ROUTINES attention
increasing response to nonverbal
NONVERBAL communication and providing
COMMUNICATION models
increasing imitation by following
IMITATION child’s lead
increasing joint engagement
JOINT ATTENTION between parent and child
increasing vocalizations and
SPEECH DEVELOPMENT speech by providing models
increasing time spent playing with
FUNCTIONAL AND SYMBOLIC toys by modeling and parallel
PLAY SKILLS playing with child
Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
EXAMPLES
Saying child’s name, ringing a bell, banging toys together,
making play sounds while holding preferred toys/objects
Incorporate daily “people” games (no toys- peek-a-boo,
tossing games, etc.), add narration to established routines,
adding songs to daily activities- point is to make it repetitive
Same as above- include more “people” games (involving
more physical touch and NO TOYS), reading books, getting
dressed, bath time games
When child uses gestures, eye contact or physical touch to
communicate; for example, child grabs parent’s hand and
pulls toward favorite snack, provide verbal model
Child chooses to play with ball, parent can narrate by saying
“bounce, bounce, bounce:” child playing with toy cars,
parents can add sound effects
Using preferred toys or objects, parent initiates preferred
game between them and child (like hide and seek, peek-a-
boo, etc.)
Expand on child’s vocalizations by providing model of next
step (e.g., if child say “da” for dog, respond with “dog”),
provide models of words when responding to child’s
gestures and nonverbal communication
Child is playing with dolls, parent starts playing with doll by
modeling (brushing doll’s hair, feeding doll, etc.) next to the
child
 PIVOTAL RESPONSE TRAINING
*GOOD FOR PARENTS WANTING TO INCREASE VERBAL COMMUNICATION
*MUST BE CERTIFIED IN PRT TO USE THIS
STRATEGY NAME DESCRIPTION
child is paying attention before
CHILD ATTENDING parent presents opportunity
parent’s prompt is simple, clear
CLEAR OPPORTUNITY and appropriate
CHILD CHOICE following child’s lead
parents vary activities during
TASK VARIATION session
reinforcement from parent is
CONTINGENCY contingent upon child’s verbal
requests
reinforcer is logically/directly
NATURAL REINFORCEMENT related to child’s requests
parent accepts vocalizations and
REINFORCED ATTEMPTS approximations
parents vary prompts to balance
MAINTENANCE/ACQUISITION child motivation and skill
TASKS
acquisition
Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
EXAMPLES
Saying child’s name, ringing a bell, banging toys together,
making play sounds while holding preferred toys/objects to
gain their attention
Prompts are at or just above child’s current level of
communication (e.g., if child is using only gestures, parent may
ONLY gesture to activity or gesture to activity AND use a
single verbal prompt)
Parent allows child to choose toys/activities and play with them
the way they want to, instead of parent choosing activity and
playing with toys “appropriately” (e.g., if child is lining up cars
in a row, parents copy instead of driving cars around)
Parent provides choices for toys or objects, switches game as
soon as child loses interest (e.g., has blocks and cars
available, switches from toys to “people” games like peek-a-
boo)
Reinforcement is only provided when child gives response to
parent- otherwise parent corrects or provides appropriate
model of correct response before providing reinforcer
Objects and toys chosen for child relates to their interests (i.e.,
if a child communicates that they want a drink, parent give
them a drink)
If a child uses babbling or word approximations (e.g., says “da”
for “dog) parent still provides reinforcer/response
Parents vary between 50/50 easy and difficult prompts when
presenting opportunities to the child; prompts can include
gestural/play models, questions, facial expressions, verbal
models, commands, or narratives on child or parent actions
(e.g., parent says “doll” and waits with eyebrows up and
looking at child for response)
 RECIPROCAL IMITATION TRAINING
*GOOD FOR INCREASING JOINT ATTENTION

STRATEGY NAME DESCRIPTION EXAMPLES

Similar to following the child’s lead- copy how the child is

CONTINGENT imitation of child’s actions, playing; if child is playing with cars by lining them up,
IMITATION play and movements parent does the same, if child is jumping around, parent
jumps too

Parent narrates the child and their actions; if child is

describing what child is playing with dolls, parent could say “oh you’re brushing
LINGUISTIC MAPPING
doing baby’s hair, and now its time for baby to go to sleep…” and
so on

Parent can take play food and pretend to eat it, driving toy
MODELING ACTIONS modeling play with a toy cars around, putting farm animals in a barn and making
animal noises, etc.

manding child to follow Telling the child what to do- “say ‘moo,’” “put the horse in
PROMPTING
specific cue the barn,” “point to the cow,” “go find your bear,” etc.

Parents should provide specific feedback to the child when

providing praise for correct following a correct response to a prompt; “yes, good
REINFORCEMENT
responses pointing for apple!” “I like how you brushed baby’s hair,”
etc.

Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
 ENHANCED MILIEU TRAINING
*GOOD FOR INCREASING VERBAL COMMUNICATION
*SHOULD ONLY BE USED WITH CHILDREN WHO
ALREADY HAVE SOME LANGUAGE

STRATEGY NAME DESCRIPTION EXAMPLES

MILIEU TEACHING using models, mands, and Can be wh- questions, drill and skill questions (i.e. “what
positive feedback to elicit does… say?” or “Say….”), choice prompts, simple
PROMPTS communication from child directions, verbal modeling of target sounds/words

adding words to child’s If a child is using 1-word utterances, parents can expand
EXPANSIONS utterance in a grammatically them to 2 word phrases (e.g. child says “ball” and parent
correct way responds with “red ball”)

When child responds or initiates conversation, parent

taking same amount of turns responds once, and waits for child to take a turn again
BALANCED TURNS
as child (e.g., child plays peek-a-boo with parent, parent takes turn
and waits for child to play again)

FOLLOWING CHILD’S Copy how the child is playing; if child is playing with cars
imitating child’s interests and
by lining them up, parent does the same, if child is jumping
LEAD play styles
around, parent jumps too

Parent waits a set amount of time before providing a re-

prompt or model for child after giving initial prompt (parent
TIME DELAYS appropriate use of wait times
asks child “grapes or bananas” and waits 5 seconds before
asking again if child does not respond)

providing responses for Parent responds to child every time, regardless of what
RESPONSIVE FEEDBACK every communication type of communicative act is used (if child gestures, parent
attempt from child responds immediately with single word model)

Prompts and responses are at or just above child’s current

MATCHING CHILD’S talking at same or just above level of communication (e.g., if child is using only gestures,
LANGUAGE child’s level of language parent may ONLY gesture to activity or gesture to activity
AND use a single verbal prompt)

Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
 JOINT ATTENTION, SYMBOLIC PLAY, ENGAGEMENT,
AND REGULATION
*GOOD FOR INCREASING JOINT ATTENTION
*DOES NOT REQUIRE TRAINING, BUT CAN BE OFFERED AS A CEU

STRATEGY NAME DESCRIPTION EXAMPLES

Parents can reduce the number of toys and noise in one

minimizing distractions,
room to help child focus more on parent; rotating toys to
ARRANGEMENT OF THE maintaining appropriate play
keep child’s interest during daily routines; making sure toys
materials, selecting new toys
ENVIRONMENT as needed, and maintaining
are appropriate for child’s developmental level (e.g., don’t
give a 24-month-old the Candyland game); placing
the interaction child’s level
preferred items out of reach to encourage communication

Similar to following child’s lead- mirror what the child is

imitation of appropriate and doing as they play but integrate appropriate play actions
MIRRORED PACING functional play acts, timing when child’s attention has been gained (e.g., child is lining
and positioning of actions up blocks, parent copies until child looks at parent- parent
can then start stacking blocks while child is watching)

imitation and expansion of

child’s language, contingent
Parent can expand on child’s communicative acts, ask the
language models at child’s
COMMUNICATION child questions, narrate what the child is doing or add
language level, and directive
sounds/words to child’s actions (child is playing with cars
STRATEGIES (commands, question
while parent provides action sounds such as “vroom,”
asking) or nondirective
“woo,” “crash!” etc.)
(commenting, labeling)
language

E.g., Child can point to preferred objects but needs full

PROMPTING type of prompt matches verbal model to say the target word when making a
child’s needs, and use of request- as parents use the full model more and child
STRATEGIES Least-To-Most prompting starts to say target word, parents can reduce to a partial
verbal model

Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
 JASP-EMT COMBINATION
*GOOD FOR INCREASING JOINT ATTENTION AND VERBAL COMMUNICATION

STRATEGY NAME DESCRIPTION EXAMPLES

taking same interest in child’s Saying child’s name, ringing a bell, banging toys together,
FOLLOWING CHILD
interests and play styles making play sounds while holding preferred toys/objects

providing examples of new Model correct play, target sounds/words/phrases, nonverbal

MODELING
skills to child communication like eye contact and gestures, etc.

Similar to responsive feedback- Parent responds to child

responding to every every time, regardless of what type of communicative act is
RESPONSIVENESS communicative act from child used (if child gestures, parent responds immediately with
single word model)

If a child is using 1-word utterances, parents can expand

adding to child’s utterances them to 2 word phrases (e.g. child says “ball” and parent
EXPANSION
responds with “red ball”)

Parents can reduce the number of toys and noise in one

minimizing distractions,
room to help child focus more on parent; rotating toys to
maintaining appropriate play
ENVIRONMENTAL keep child’s interest during daily routines; making sure toys
materials, selecting new toys
are appropriate for child’s developmental level (e.g., don’t
ARRANGEMENT as needed, and maintaining
give a 24-month-old the Candyland game); placing preferred
the interaction child’s level
items out of reach to encourage communication

E.g., Child can point to preferred objects but needs full

PROMPTING using LTM prompting verbal model to say the target word when making a request-
hierarchy as parents use the full model more and child starts to say
target word, parents can reduce to a partial verbal model

Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
 SOCIAL COMMUNICATION FACILITATION
*GOOD FOR INCREASING JOINT ATTENTION AND VERBAL COMMUNICATION

STRATEGY NAME DESCRIPTION EXAMPLES

Copy how the child is playing; if child is playing with cars by

directing child’s gaze to
JOINT ATTENTION lining them up, parent does the same, if child is jumping
stimuli
around, parent jumps too

modeling functional or
IMITATION
symbolic play of toys
Parent can take play food and pretend to eat it, driving toy cars
around, putting farm animals in a barn and making animal
noises, etc.

Parents can reduce the number of toys and noise in one room
to help child focus more on parent; rotating toys to keep child’s
placing preferred items in
ENVIRONMENTAL interest during daily routines; making sure toys are appropriate
sight but out of reach to
for child’s developmental level (e.g., don’t give a 24-month-old
ARRANGEMENT facilitate mands
the Candyland game); placing preferred items out of reach to
encourage communication

E.g., Child can point to preferred objects but needs full verbal
PROMPTING using LTM prompting model to say the target word when making a request- as
hierarchy parents use the full model more and child starts to say target
HIERARCHY
word, parents can reduce to a partial verbal model

Written and developed by Madeline Quinn, SLP-EI Graduate Clinician at Kent State University ©2021
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