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A Program for Improving Toddler Communication Through Parent Coaching

Heather W. Moore, Erin E. Barton and Maria Chironis
Topics in Early Childhood Special Education 2014 33: 212 originally published online 14 August 2013
DOI: 10.1177/0271121413497520

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TECXXX10.1177/0271121413497520Topics in Early Childhood Special EducationMoore et al.

Topical Article
Topics in Early Childhood Special Education

A Program for Improving Toddler

2014, Vol. 33(4) 212­–224
© Hammill Institute on Disabilities 2013
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DOI: 10.1177/0271121413497520

Coaching tecse.sagepub.com

Heather W. Moore, PhD, CCC-SLP1, Erin E. Barton, PhD, BCBA-D2,

and Maria Chironis, MS1

Abstract
The purpose of this manuscript was to describe a community-based program, Language and Play Everyday (LAPE), aimed
at evaluating effective practices for enhancing parents’ capacity to increase their toddlers’ communication skills. LAPE was
a parent education program focused on coaching parents to embed naturalistic language-enhancing strategies within daily
routines. Participants included eight families of toddlers with expressive communication delays ranging in age from 22 to
36 months. LAPE was delivered using group and individual sessions. After participating in the program, parents increased
their responsivity and use of other language-enhancing behaviors. Social validity measures indicated that parents were
satisfied with procedures, goals, and outcomes of the project. Moreover, children improved their expressive language
skills. Implications for future research and application are discussed.

Keywords
infants and toddlers, speech and language delays, parent coaching

Language development is a primary task of the first few
years of life. Delays in language often are primary indica-
tions of developmental delays and are likely to impact
development across all domains. While there is variation in
the rate and timing of language development, the sequence
of language milestones is generally predictable among chil-
dren within cultures. Most typically developing toddlers
acquire a core vocabulary of functional words by their 2nd
year of life (Crais, 1990). However, some toddlers exhibit
delayed vocabulary acquisition associated with identified
disorders (e.g., Down syndrome) or diagnosed develop-
mental delays (American Speech-Language-Hearing
Association, 2005). In addition to children with known dis-
orders and delays, 15% of toddlers develop language at a
slower pace without any concomitant delays in other devel-
opmental domains (Desmarais, Sylvestre, Meyer, Bairati, &
Rouleau, 2008). While a subset of these toddlers will catch
up to typically developing children by the preschool years,
some will have persistent delays (Paul, 2000; Rescorla,
2002). Recent federal data indicated that the number of
infants and toddlers with delays served under Part C Early
Intervention (EI) increased from just under 190,000 (1.6%
of all infants and toddlers) in 1998 to over 320,000 (2.2%)
in 2007 (U.S. Department of Education, 2012) and sug-
gested that 8% to 12% of preschool children have language
delays (U.S. Preventive Services Task Force, 2006).
Children with language delays are more likely to experi-
ence literacy delays (van der Schuit, Peeters, Segers, van
Balkom, & Verhoeven, 2009) and social, emotional, or
behavioral problems (van Daal, Verhoeven, & van Balkom,
2007). The effects of language impairments are cumulative
and might impact later school success if not addressed
early.
Family-Centered Approach
A family-centered approach is central to the general phi-
losophy and framework of EI (McWilliam, 2010, 2012;
Powell & Dunlap, 2010). Research consistently supports EI
approaches that focus on enhancing parent and caregiver
capacity to meet the needs of infants and toddlers (Bruder &
Dunst, 2000). For example, research indicated that increased
parent responsivity is associated with enhanced child lan-
guage skills (Dunst & Trivette, 2009a) and improved devel-
opmental outcomes (Baggett et al., 2010). Several recent
1
University of Oregon, Eugene, USA
2
University of Colorado Denver, USA
Corresponding Author:
Heather W. Moore, Communication Disorders and Sciences Program,
5284 University of Oregon, Eugene, OR 97403-5284, USA.
E-mail: hbmoore@uoregon.edu

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Moore et al. 213

Table 1.  LAPE Evidence-Based Family Coaching Practices.

Evidence-based Practices LAPE example

1.  Individualized approach to family coaching
2. Focus on daily routines with the family’s
materials in natural settings
3. Focus on supporting family participation
and building family capacity and
competence
4. Identify functional child outcomes a
discussion about the family’s priorities
5. Works directly with the caregiver and
uses effective coaching strategies
6. Focus on caregiver responsivity and
caregiver–child interactions
7. Use of videos for demonstration and
reflection
8. Identify opportunities to practice across
the day and in between visits
9.  Systematic progress monitoring
The individual home sessions were structured according to the family’s needs. Parents
chose the strategies they wanted to practice.
The individual home sessions were scheduled during routines the family identified. The
coaches supported the parents in using the strategies during daily routines.
Initial group sessions focused on early language and play development and how parent
interactions can influence development. Group sessions also allowed parents to
support each other’s efforts at home. Improvements in caregiver confidence were
measured over time.
At the beginning of the training we asked parents to identify a functional goal for their
child. To meet this goal, parents identified strategies they wanted to work on and
specific words they wanted to help their children say each week.
During individual sessions, targeted strategies were reviewed and parents practiced
the strategies with their children while their coach observed. If needed, coaches
modeled strategies. After each practice activity, parents reflected on their use of the
strategies and ways they could incorporate them into daily routines. Then coaches
provided specific feedback, support, and suggestions.
Parents were taught to identify times when their children were initiating
communication. Then they were taught take conversational turns with their children
during play and daily interactions.
Parent–child interactions were recorded prior to intervention. After the responsive
strategies were introduced, parents watched the videos and rated their use of each
strategy. Then the coaches reviewed and discussed the videos again with the parents.
At the end of each group and individual training, parents identified strategies they will
use and target words they will teach in the coming week.
Parents completed a daily log to rate their use of each strategy and a weekly log to
note their child’s progress on targeted vocabulary.

Note. LAPE = Language and Play Everyday.

Source. Evidence-based Practices are adapted from Dunst and Kassow (2007), McWilliam (2010), Powell and Dunlap (2010), Rush and Shelden (2011).

reviews and meta-analyses support EI approaches that focus
on enhancing parents’ responsivity and capacity to support
their children’s development. Dunst and his colleagues
identified specific essential characteristics of parent respon-
sivity related to improved child developmental outcomes.
Effective parents responded contingently, based on the
child’s focus or intent, and in mutually reinforcing ways
(Dunst & Trivette, 2009a; Trivette, Dunst, & Hamby,
2010). Moreover, approaches that promoted full participa-
tion of families in assessment and intervention were related
to improved child outcomes (Dunst, Trivette, & Hamby,
2006, 2007, 2008a).
For infants and toddlers, responsive interactions with
parents during daily routines and activities provide essential
opportunities for learning and promoting development. In
fact, the influence of parents on child development is criti-
cal; parents are the most significant facilitators of learning
for infants and toddlers (Powell & Dunlap, 2010). Thus, EI
should focus on family coaching (i.e., supporting their abil-
ity to enhance their child’s development) rather than pro-
viding direct service to the child. This focus on the family
ensures the child has multiple learning opportunities during
meaningful routines and activities (Jung, 2003; McWilliam,
2010). A family-centered approach means practitioners
focus on increasing the quality of parent−child interactions
within daily routines and activities, which is likely to
enhance family quality of life (McWilliam, 2010). Several
family coaching practices have been identified based on
family-centered practices and adult learning principles
(Powell & Dunlap, 2010; Rush & Shelden, 2011; Sandall,
Hemmeter, Smith, & McLean, 2005). These coaching prac-
tices (see Table 1) emphasize the families’ strengths and
values, identify natural learning opportunities within daily
routines and activities, and use evidence-based adult learn-
ing strategies to build parents’ capacity to enhance their
children’s development (Campbell & Sawyer, 2007).
Parent Implemented Naturalistic
Language Interventions
Early language development is largely impacted by every-
day conversations between parents and their children (Hart
& Risley, 1995; Kaiser & Roberts, 2011; Roberts & Kaiser,
2011). Language development is likely directly related to
the quality and quantity of the language input received,
which occurs within the context of social interactions and is

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214 Topics in Early Childhood Special Education 33(4)
individually determined. Parent education programs that
focus on supporting child language development can be
highly effective (Kaiser & Roberts, 2011). Naturalistic lan-
guage interventions focus on teaching parents to embed
language-enhancing strategies into daily routines and play.
Common characteristics of naturalistic teaching strategies
include: using direct and natural reinforcement, focusing on
functional skills, using a variety of materials, and following
the child’s interests and lead (McGee, Morrier, & Daly,
1999). The use of these strategies allow for authentic learn-
ing experiences and greater generalization of language
skills (Kashinath, Woods, & Goldstein, 2006). Research
indicates that naturalistic teaching strategies are feasible—
meaning parents can implement them with high fidelity,
and effective—meaning they are functionally related to
improvements in child language development (Roberts &
Kaiser, 2011).
Evidence-based naturalistic teaching approaches include
enhanced milieu teaching (EMT; Hancock & Kaiser, 2006)
and responsive education-prelinguistic milieu teaching
(RE-PMT; Warren et al., 2006). EMT is a hybrid approach
that incorporates environmental arrangement, responsive
interaction, and milieu strategies to increase expressive and
pragmatic language in children with emerging language
skills. Several studies suggest that parent-implemented
EMT is an effective and efficient intervention for late-
talking toddlers (Kaiser, Hancock, & Nietfeld, 2000;
Kashinath et al., 2006; Roberts & Kaiser, 2011). In addi-
tion, parents consistently learned the strategies and reported
feeling confident in their ability to use EMT following
training (Peterson, Carta, & Greenwood, 2005). RE-PMT
uses the same intervention strategies as EMT but focuses on
teaching prelinguistic language skills (i.e., intentional, non-
verbal communication). The research on RE-PMT indicates
it also is an effective, parent-implemented intervention for
children (Fey et al., 2006; Yoder & Warren, 2002).
Research also supports implementing these approaches
with parents during individual and group trainings. Group
training, with individualized supports, allows information
to be shared in a quick and concise format, provides space
and time for shared parent support, and might be less costly
(Carter et al., 2011; Kaiser, Hemmeter, Ostrosky, Alpert, &
Hancock, 1995). However, the most popular group training
programs (e.g., Hanen Centre, 2011) are costly for interven-
tionists, not well suited for current Part C systems, and
might not be effective for all families because they are not
easily individualized (Carter et al., 2011). Furthermore,
although there are empirically supported intervention
approaches for enhancing parents’ capacity to promote their
child’s language development, there is a significant research
to practice gap. Recent research indicates evidence-based
practices are not being implemented in EI, and the amounts
of services families receive are fewer than recommended
(Dunst & Trivette, 2009b; Hebbeler, Spiker, & Kahn, 2012;
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Stahmer & Mandell, 2007). Additional research is needed
to examine strategies for improving parent education curri-
cula that can be cost-effective and efficiently implemented
by practitioners within a variety of community settings.
The purpose of this manuscript is to describe the devel-
opment of a parent-education program, Language and Play
Everyday (LAPE). The first and second authors developed
LAPE to address a community need for an efficient and
cost-effective, community-based parent-education pro-
gram, focused on increasing parents’ use of naturalistic
language-enhancing strategies and improving communica-
tion skills in their toddlers’ with expressive communication
delays. The community need paralleled national research on
Part C EI services. That is, research has shown that the ser-
vices families receive through Part C were fewer than rec-
ommended, and not all eligible children and families were
being served (Dunst & Trivette, 2009b; Hebbeler et al.,
2012; Hume, Bellini, & Pratt, 2005). For example, the
National Early Intervention Longitudinal Study (NEILS;
Hebbeler et al., 2007) found families received an average of
1.5 hours of Part C services per week, families missed about
one fourth of their scheduled visits, and the amount of fund-
ing per child has decreased by an estimated 50% over the
last decade (Hebbeler et al., 2012). This report concluded
that overall, families received relatively few face-to-face
services. Moreover, for 44% of the families, the services
focused only on the child, rather than the family, which is
unlikely to have a larger impact on the child’s development.
LAPE was developed to address this community need by
using a cost-effective, group format to teach parents to: (a)
identify and respond to their children’s communication
attempts, (b) provide opportunities for their toddlers to
communicate, and (c) use developmentally appropriate lan-
guage. Specific strategies and supports were identified
based on the individual needs of each child and family. The
components of the program, evaluation procedures, pro-
gram outcomes, and implications for future research and
practice are described.
Description of Program
Participants
Thirteen parents and their toddlers with expressive com-
munication delays participated in LAPE across three ses-
sions. However, only eight parent−child dyads attended all
sessions and complete all assessment; thus, only these
eight were included in these analyses. Five additional
parent−child dyads participated in LAPE sessions, but did
not complete all assessments or missed sessions. Parents
were recruited from a local EI agency and local early child-
hood programs (seven mothers and one father participated).
LAPE was a voluntary program. Six of the eight children
were receiving additional EI services (see Table 2). Parents
Moore et al. 215

Table 2.  Child Demographic Characteristics.

PLS-IVb VABS-IIc
Dyad Disability statusa Chronological age (months) Race of child Other community services AC EC DLS SS Motor
1 DD 31 White/Caucasian EI toddler group 85 74 83 87 114
2 DD 31 Multiracial EI toddler group 77 69 98 89 72
3 SELD 25 White/Caucasian No other services 128 83 117 89 90
4 DD 25 White/Caucasian EI toddler group 81 79 105 95 111
5 SD 32 White/Caucasian SLP services 81 77 95 93 93
6d SD 24 White/Caucasian SLP services 81 (67) 96 (79) 77 82 90
7e SELD 28 White/Caucasian No other services 78 73 87 78 88
8 DD 32 White/Caucasian EI toddler group 50 50 73 78 79
a
DD = developmental disability; SELD = specific expressive language delay; SD = structural disability (e.g., cleft lip/palate). bPLS-IV = Preschool Language
Scale (4th ed.); AC = Auditory Comprehension subtest; EC = Expressive Communication subtest. cVABS-II = Vineland Adaptive Behavior Scales (2nd
ed.); DLS = Daily Living Skills domain; SS = Socialization domain; Motor = Motor Skills domain. dThis child was 7 days away from turning 24 months at
the time of testing. The PLS-IV scores in parentheses are after rounding up his age to 24 months. eOnly father–child dyad.

varied in age (i.e., ages ranged from 29 to 41 years), educa-
tion (i.e., two reported “some college,” one reported “com-
munity college degree,” four reported “Bachelor’s degree,”
and one reported “master’s degree”), and income level
(i.e., four reported an income level between
“US$20,000-US$50,000” and four reported an income
level between “US$50,000-US$80,000”). Inclusion crite-
ria for children were (a) chronological age between 24 and
36 months, (b) verbal vocabulary between 10 and 50 words
as measured by the MacArthur-Bates Communicative
Development Inventory (Words and Sentences Form;
CDI-II; Fenson et al., 2007), and (c) had parents who
attended all sessions and completed all assessments.
Training Structure and Settings
The LAPE program consisted of group and individual ses-
sions across three cohorts of parents and toddlers. The
cohorts were conducted sequentially over 1 year. Two or
three parent−child dyads were included in these analyses
from each cohort (Cohort 1 included three of four
parent−child dyads, Cohort 2 included two of five
parent−child dyads, and Cohort 3 included three of four
parent−child dyads). The group sessions occurred in a
classroom at a community school and the individual ses-
sions occurred in the families’ homes. Individual sessions
were 1 hr and group sessions ranged from 90 min to 2 hr
based on group preferences (i.e., Cohorts 1 and 3 requested
2-hr sessions and Cohort 2 requested 90-min sessions). For
the first two cohorts, the group and individual sessions were
staggered across 7 weeks (i.e., two group sessions, one indi-
vidual session, two group sessions, one individual session,
and a final group session). Because the parents in Cohorts 1
and 2 did not maintain use of LAPE strategies at follow-up,
the authors decided to stagger Cohort 3’s sessions and
embed a 6-week break after the first individual session.
Moreover, they replaced the final group session with an
individual session. Thus, for cohort 3, the total session
length was 15 weeks. This was intended to promote mainte-
nance of parent use of LAPE strategies and individualize
the final session to the needs of the dyad. Although there
were variations in the format, the curriculum was identical
across cohorts.
Interventionists
The first author, a speech-language pathologist, led all
group sessions and graduate students in Early Intervention/
Early Childhood Special Education (EI/ECSE) and
Communication Disorders Sciences (CDS) were the pri-
mary interventionists. They received practicum course
credit for participating. Across the three cohorts, a total of
12 graduate students participated in LAPE. Each parent was
paired with a student who served as his or her “coach” for
the duration of LAPE. The students also administered the
initial assessment tests, participated in the group sessions,
and led individual sessions. The first and second author, an
early childhood special educator, taught the students the
treatment protocol, oversaw their individual session plans,
and closely supervised them during all assessment and
coaching activities.
Parent Strategies
LAPE followed a family coaching approach to teach par-
ents to use naturalistic language teaching strategies (see
Tables 1 and 3). LAPE strategies were chosen because they
were empirically supported, easily embedded into daily
routines, and appropriate given the needs of toddlers.
Moreover, several studies have demonstrated parents can

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216 Topics in Early Childhood Special Education 33(4)
Table 3.  LAPE Strategies and Dependent Variables.
LAPE strategy/description
Wait and respond. Wait for your child to communicate and then
respond accordingly.
Talk in short, simple sentences. When talking directly to your
child, use sentences your child would be likely to say.
Answer instead of asking. Avoid asking yes/no and “test”
questions (e.g., What color is this? How many do you have?).
Repeat and add. When your child says a word or sentence, repeat
what s/he said and add a word.
Do what your child does and talk about it. Imitate your child’s
actions, and say what s/he would say.
Say what your child would say. Respond to your child’s
spontaneous requests/comments by saying the word/words your
child might say in a way that encourages/prompts her/him to
imitate you.
Give your child a choice. Say the words for the items as you
provide choices, such as “do you want milk or juice?”
Environmental Arrangement. Give your child more
opportunities to communicate by setting up situations where your
child wants/needs to (e.g., Ask for more of something, Seek your
assistance, Comment on something new or silly).
Note. Due to low frequency of occurrence, the following related variables were combined into one variable, titled other language-enhancing behaviors
(O-LEBs) = EXP + VM + IT + FC + M / Number of total spoken adult utterances. LAPE = Language and Play Everyday.
implement these strategies with training and support
(see Roberts & Kaiser, 2011, for a meta-analysis of this
research).
Parent Training Components
LAPE consisted of three major components: group parent
support sessions, individual sessions in homes, and practice
in-between sessions. This was intentionally designed to
give parents opportunities to interact with other parents of
toddlers with communication delays; deliver content and
model strategies in a supportive, cost-effective manner; dis-
cuss opportunities to practice the strategies during daily
routines in-between sessions; and provide individualized,
routine-based coaching. The following sections describe
the LAPE program components.
Group support sessions.  Table 4 outlines the content of the
parent support sessions. The goals of the first session were
to: (a) allow the parents to meet and learn more about each
other, (b) introduce basic communication and play concepts
(e.g., early language and play milestones), and (c) help par-
ents identify their toddler’s current communication skills.
Parents also worked individual with their coaches to iden-
tify goals for their toddlers and themselves. For example,
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Corresponding dependent variable
Responsivity (RE) = Number of times the adult responded
to child’s words or actions / Number of spoken adult turns
Target Level Talk (TLT) = Number of utterances spoken
by the adult within 1–3 words of child’s identified MLU /
Number of spoken adult utterances
Questions (Q) = Number of adult yes/no questions + test
questions / Number of spoken adult utterances
Expansions (EXP) = Number of times the adult expanded
child’s utterance by adding a new and related word,
phoneme, or grammatical marker.
Verbal Mapping (VM) = Number of times the adult imitated
child’s nonverbal action and added a word or sentence.
Incidental Teaching (IT) = Number of times the adult
responded to the child’s communication attempt by saying a
word the child might say and Model (M) = Number of times
the adult modeled the name of an object or action with the
intention that the child would imitate it.
Forced Choice (FC) = number of times the adult verbally
gave a choice between 2 or more objects.
These were not coded, but were designed to create
opportunities for communicative interactions and promote
the child’s initiations.
toddler goals included: “[Child] will use 25 new words by
the end of LAPE.” Examples of parent goals were “I will
learn the best strategies to use,” and “I will get tips to help
my child talk.”
Subsequent group sessions started with a group discus-
sion about progress. Each parent reported on her toddler’s
progress and how she was utilizing previously taught strate-
gies at home (not included in the second session). The first
author encouraged parents to reflect on, comment, and sup-
port each other’s progress and offer suggestions as needed.
Then parents were separated and met individually with their
coaches to more specifically discuss and document progress
at home. After the individual coaching activity, the first
author provided an overview of new strategies (see Table 4).
Parents also met individually with coaches at the end of
every session to plan their use of the strategies at home
(new and previously taught).
Individual sessions.  Each family also received individual ses-
sions in their home 2 to 3 times during their participation in
LAPE (see Table 4). The coaches used the family coaching
strategies described in Table 1. During the first home ses-
sion, parents and coaches watched the parent−toddler video
sample collected prior to intervention and rated the parent’s
use of each of the LAPE strategies already introduced in the
Moore et al. 217

Table 4.  LAPE Parent Group Session Content.

Sessiona New content Method Review from previous session Method

1 Introductions Group Group activity  
Overview / Schedule
  Review CDI-II and Individual review with coach  
sound repertoire
results
  Language and play Group discussion  
milestones
  Identify how your child Individual activity with group  
communicates discussion
  Identify parent and Individual discussion with coach  
child goals
2 Defining and identifying Group discussion then individual Discuss home play observations Group discussion
home routines (play, discussion with coach)
social, and daily)
  Responsive strategies Group discussion, video Confirm parent and child goals Individual discussion with
examples, role-play coach
3 Teaching new Group discussion, individual Discuss child progress, Group discussion and then
vocabulary through planning with coach homework, and use of individual discussion with
responsive strategies responsive strategies at home coach
4 Environmental Group discussion, modeling with Discuss child progress, Group discussion and then
arrangement classroom examples, individual homework, and use of individual discussion with
strategies discussion and planning with responsive strategies at home coach
coach
5 Modeling Group discussion, modeling, role- Discuss child progress, Group discussion and then
play, individual discussion with homework, and use of individual discussion with
coaches responsive strategies, coach
6 Individual conferences to review child and parent progress environmental arrangement
and make recommendationsb strategies at home

Note. LAPE = Language and Play Everyday.

a
Fidelity was measured using group session checklists for each session. bCovered in final individual session for Cohort 3.

group sessions. Based on this discussion, the parent chose
two strategies to focus on during the remainder of the visit
(e.g., say what your child would say, target level talk). The
coach and parent discussed the strategies and the coach
modeled use of the strategies. Then, the parent initiated a
routine (e.g., mealtime, diapering) or a play activity (e.g.,
book reading, playing with toys) with their toddler and
practiced the strategies for 5 to 10 min. Following the activ-
ity, the coach encouraged the parent to self-reflect on her or
his use of the targeted strategies. For example, the coach
might have asked the parent to talk about what went well
during the routine and what was difficult. Then, the coach
provided specific, performance-based feedback (e.g.,
“When you used just two words to say “hat on” he imitated
you!” or “Wow. You were really responsive when he
walked into the playroom. You followed and resumed your
play there.” Or “When you waited for her to initiate pulling
on her pants, she said ‘help’!”). At the beginning of each
subsequent visit, the coach and parent had a general discus-
sion about the child’s language progress and his or her use
of the LAPE strategies at home. The parent then identified
two strategies (previously learned in group sessions) to
focus on during the visit, practiced the strategies, reflected,
and received feedback (as described above). Before the end
of the visit, the coach and parent set up a plan for practicing
all LAPE strategies during the family’s daily routines
at home.
In-between session practice.  As previously mentioned, at the
end of each group and individual session, the parents identi-
fied when and how they planned to practice the LAPE strat-
egies at home and wrote their ideas on a weekly LAPE
strategy log. After the first home coaching session, parents
were asked to practice the strategies 15 min per day during
routine and play activities with their children and rate their
progress on their weekly logs.
Evaluation Procedures
Toddler standardized measures.  To fully describe the partici-
pants before intervention, two assessments were adminis-
tered with each toddler (see Table 2). The Preschool

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218 Topics in Early Childhood Special Education 33(4)
Language Scale 4th edition (PLS-4; Zimmerman, Steiner,
& Pond, 2002) was administered to measure the child’s
receptive and expressive language. The Vineland Adaptive
Behavior Scales (VABS-II; Sparrow, Cicchetti, & Balla,
2005) was completed through parent interview and was
used to measure the child’s daily living, social, and motor
skills. In addition, the parent-completed CDI-2 measured
the child’s verbal vocabulary and was used as part of the
inclusion criteria and as an outcome measure.
Play and routine observations.  Toddler and parent progress
was measured using summative and formative measures.
Prior to the start of LAPE each parent−child dyad partici-
pated in two videotaped samples in their homes (collected
on the same day). During a 10-min play sample, parents
played with their toddlers using a standard set of toys pro-
vided by the authors. The toys included dolls, cups, plates,
books, blocks, and games (e.g., Mr. Potato HeadTM). In a
10-min routine sample, parents interacted with their chil-
dren during a parent-identified routine. Parents selected
mealtime, diapering, dressing, or getting ready for bed.
During pre-LAPE observations, parents were instructed to
interact with their children using any strategies they nor-
mally use to encourage their children to communicate. The
same play and routine activities were videotaped again
immediately after LAPE (i.e., post) and at a 3-month
follow-up. During these sessions, parents were instructed to
use LAPE strategies. Five graduate students transcribed and
coded all videos after establishing 90% interobserver agree-
ment (IOA) on nonstudy videos. Four parent variables were
coded: (a) responsivity (RE), (b) target level talk (TLT), (c)
questions (Q), and (d) other language-enhancing behaviors
(O-LEBs). These are described in Table 3. Two child vari-
ables were calculated: (a) mean length of utterance (MLU;
mean number of words per child utterance) and (b) initia-
tions (see Table 6).
Progress monitoring. Parents monitored their use of the
LAPE strategies and progress toward self-selected goals.
As described previously, the parents completed a respon-
sivity log every week. If a parent did not bring a completed
log with them to a group or individual session, the coach
asked the parent to complete it before the group session
began. During group and individual sessions, the parents
reviewed their progress as reflected on their log, and dis-
cussed with their coaches the progress toward their self-
selected goals. Following intervention, parents also
completed the LAPE Goal Questionnaire, which asked
them to indicate whether LAPE helped them meet their
goals for themselves and their children.
Interobserver agreement. Twenty-eight (58%) randomly
selected play and routine session videos (i.e., including at
least 20% of videos across dyads, sessions, time) were
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independently coded by a second coder to calculate interob-
server agreement (IOA). IOA was calculated using the
point-by-point method (Kennedy, 2005). IOA averaged
90.7% (82.0%–96.6%) across dyads, sessions, behaviors,
and time.
Fidelity.  The authors measured implementation fidelity and
intervention fidelity. Implementation fidelity refers to the
procedures used to support the parents’ use of LAPE strate-
gies; intervention fidelity refers to the parents’ use of indi-
vidual strategies with their toddlers (Dunst et al., 2008b).
Implementation fidelity was collected in three ways. First, a
checklist was created for the group sessions outlining the
planned components of the sessions (e.g., “discuss parent
and child progress at home,” “review the strategy Repeat
and Add”). Students (who were not presenting or coaching)
used the checklist designed for LAPE group sessions to
measure implementation fidelity of every group session.
This ensured the group training components were similar
across cohorts. The number of planned components for
group sessions ranged from 5 to 12. The group session
implementation fidelity averaged 93.6% (range = 78%–
100%) across sessions and cohorts. Second, the first or sec-
ond author completed fidelity checklists at all individual
sessions. These outlined the planned components of indi-
vidual sessions to ensure the coaches conducted these ses-
sions as planned and that they were similar across dyads.
The number of planned components for individual sessions
ranged from 9 to 12. The individual sessions implementa-
tion fidelity averaged 90.42% (range = 77%–100%) across
sessions, dyads, and cohorts. Occasionally a parent would
want to spend extra time working on a specific strategy or a
routine was cut short, and the coach would decide to skip or
spend less time on a component. Thus, the implementation
fidelity indicated coaches completed most of the planned
components, but were flexible and responsive to parent and
toddler needs (McWilliam, 2012). Third, attendance was
recorded at all group sessions. Two parents missed one
group session each, and missed content was reviewed dur-
ing a make-up session. Intervention fidelity was measured
using a weekly review of the parent-completed responsivity
log. All eight parents reported consistently using the LAPE
strategies at home.
Social validity.  Social validity was measured in two ways.
First, parent satisfaction with the group trainings was mea-
sured after each group session with an anonymous ques-
tionnaire. These ratings were consistently high. Second, at
the end of LAPE parents rated their satisfaction with the
goals, procedures, and outcomes with an anonymous social
validity questionnaire. The overall mean for the nine items
on the questionnaire was 5.32 (i.e., the scale ranged from
1 = strongly disagree to 6 = strongly agree), which signi-
fied strong social validity. Parents indicated LAPE was
Moore et al. 219

Table 5.  Parent Outcomes by Variable.

Pre Post Follow-up

Dyad Behavior Play Routine Play Routine Play Routine
1 RE 49.4 29.4 69.0 64.5 62.2 55.4
  TLT 64.4 72.6 93.9 91.9 94.0 89.0
  Q 35.6 22.1 13.7 12.6 17.9 23.3
  O-LEBs 4.0 2.1 24.4 24.3 16.3 7.5
2 RE 39.4 39.2 67.0 56.0 53.8 57.0
  TLT 63.6 65.1 72.0 73.0 93.3 89.9
  Q 15.5 16.8 7.0 10.7 8.9 13.5
  O-LEBs 8.6 8.7 15.9 8.7 24.4 10.1
3 RE 53.2 43.3 70.8 53.4 63.2 50.9
  TLT 55.3 33.8 95.4 78.1 84.6 66.7
  Q 39.4 36.6 5.8 8.2 3.9 17.5
  O-LEBs 10.1 7.0 27.6 30.1 5.1 14.0
4 RE 50.3 55.8 77.7 43.0 57.4 48.5
  TLT 62.0 60.0 95.4 80.5 89.8 77.2
  Q 27.7 26.2 8.3 17.0 20.5 15.0
  O-LEBs 22.9 6.9 52.8 13.6 6.3 9.5
5 RE 58.9 53.4 63.8 58.8 62.7 65.4
  TLT 66.9 70.5 95.7 79.9 78.4 64.4
  Q 43.0 31.6 10.6 6.9 16.8 28.2
  O-LEBs 5.0 6.0 16.5 12.6 13.5 12.2
6 RE 42.6 62.0 69.5 77.7 77.3 63.4
  TLT 71.3 61.8 86.8 77.7 93.5 78.0
  Q 22.1 32.0 3.5 22.3 4.7 13.4
  O-LEBs 6.6 13.4 21.1 8.5 8.4 3.7
7 RE 51.9 31.5 82.0 39.1 76.9 42.2
  TLT 38.4 35.2 86.4 44.5 88.7 54.4
  Q 45.0 16.7 15.3 4.7 13.0 17.7
  O-LEBs 17.2 1.8 24.6 11.4 28.7 10.9
8 RE 28.8 29.7 44.0 36.0 57.0 35.5
  TLT 95.0 96.2 98.4 97.5 97.6 91.5
  Q 35.7 18.4 20.8 12.2 26.2 17.0
  O-LEBs 4.0 5.0 29.6 16.3 6.2 10.3
Group M (SD) 46.9 (9.4) 42.8 (12.8) 68.0 (11.3) 53.6 (14.0) 63.8 (8.8) 52.2 (10.2)
  64.6 (15.8) 61.9 (20.3) 90.5 (8.6) 77.9 (15.7) 90.0 (6.1) 76.4 (13.6)
  33.0 (10.4) 25.1 (7.7) 10.6 (5.7) 11.8 (5.7) 14.9 (7.8) 18.2 (5.1)
  9.8 (6.9) 6.4 (3.7) 26.6 (11.7) 15.7 (7.7) 13.6 (9.0) 9.8 (3.1)

Note. RE = Responsivity: Percentage of spoken adult turns; TLT = target level talk: Percentage of total adult utterances; Q = question asking: Percent-
age of total adult utterances; O-LEBs = other language-enhancing behaviors: Percentage of total adult utterances.

effective for increasing their children’s communication
skills across daily routines (M = 5.14) and during play inter-
actions (M = 5.21). Moreover, they reported using LAPE
strategies outside of the home (M = 4.64) and stated that
they would recommend the LAPE program to other parents
with toddlers with communication delays (M = 5.86).
Program Outcomes
Multiple measures were used to evaluate parent and child
outcomes from LAPE. Initially, outcome analyses were
conducted by cohort. However, there were no differences
identified across cohorts. Thus, given the small number of
dyads, outcomes were analyzed individually and are pre-
sented as such in the subsequent sections (see Tables 5
and 6).
Parent Outcomes
Responsivity (RE). Parents demonstrated variability in RE
during pre-LAPE observations, and seven parents increased
their RE following intervention. In general, parents were

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220 Topics in Early Childhood Special Education 33(4)

Table 6.  Child Outcomes by Variable.

MLUd in play Percent child initiationse

CDIb-II—Number of
  words Pre Post F Pre Post F
Disability
Dyad statusa Pre Post Fc Play Rout Play Rout Play Rout Play Rout Play Rout Play Rout
1 DD 47 101 205 1.0 1.0 1.3 1.4 1.4 1.3 21.8 48.4 46.1 56.6 38.5 32.7
2 DD 12 35 56 1.0 1.0 1.2 1.0 1.1 1.1 1.3 3.3 5.2 3.5 22.7 10.2
3 SELD 39 139 541 1.0 1.0 1.3 1.4 3.6 1.9 20.9 14.3 41.9 38.2 73.9 31.8
4 DD 16 79 208 1.0 1.1 1.1 1.1 1.2 1.2 1.9 4.7 10.1 6.6 16.7 1158
5 SD 40 127 208 1.1 1.0 1.3 1.4 1.4 1.2 8.6 6.2 19.6 37.6 20.7 17.5
6 SD 11 205 501 1.0 1.0 1.1 1.1 1.9 2.4 13.0 11.3 20.4 18.3 48.4 0.0
7 SELD 14 306 515 0.0 1.0 1.3 1.2 1.2 1.7 0.0 5.0 33.3 13.0 31.5 10.6
8 DD 19 42 52 1.3 1.2 1.0 1.1 1.8 1.5 12.5 1.8 39.1 41.5 55.1 46.3
M 24.8 129.3 285 0.9 1.0 1.2 1.2 1.7 1.5 10.0 11.9 27.0 26.9 38.4 20.1
SD 14.7 90.2 203.6 0.4 0.1 0.2 0.2 0.8 0.5 8.6 15.3 15.3 19.1 19.7 15.4
a
Disability status: DD = developmental disability, SELD = specific expressive language delay, SD = structural disability. bCDI = MacArthur−Bates Com-
municative Development Inventory–2nd Edition (words and sentences form). cF = follow-up. dMLU = mean length of utterance (Number of words in
intelligible utterances divided by total intelligible utterances). ePercent Child Initiations = percentage of child turns that are initiated by the child (i.e.,
intelligible and unintelligible utterances and nonverbal communicative acts initiated by the child divided by total number of child turns).

more RE during play than in routines. However, at 3-month
follow-up only two parents continued to improve RE; five
did not maintain postintervention levels.
Target Level Talk (TLT). Parents demonstrated variability
during pre-LAPE observations in their TLT (i.e., the per-
centage of utterances within their child’s MLU). All eight
parents improved their use of TLT in play and routine activ-
ities following LAPE, and parents consistently used more
TLT during play. Overall, parents maintained their use of
TLT at 3-month follow-up.
Questions (Q).  Parents demonstrated a high percentage of Q
pre-LAPE. All eight parents decreased their use of Q fol-
lowing intervention and used fewer Q during play than in
routines. However, at follow-up, none of the eight parents
maintained these decreases during routines. Four of the
eight parents maintained the decreases during play.
Other Language-Enhancing Behaviors (O-LEB).  Parents dem-
onstrated variability during pre-LAPE observations in their
use of O-LEB. All participants increased their use of O-LEB
following intervention; the greatest increase occurred dur-
ing play. However, none of the eight parents maintained
these increases during routines. Three parents maintained
their increased use of O-LEB during play.
Results of the LAPE Goals Questionnaire indicated that out
of 27 LAPE goals written by the parents, 25 were met, and
2 were not addressed because they were speech production
goals.
Child Outcomes
All children increased their vocabulary following LAPE and
at follow-up, as reported by parents on the CDI-II. As
expected, progress varied by disability group. Children with
Specific Expressive Language Delays (n = 2) gained the
greatest number of words (M = 502 words, range = 501–502);
children with Developmental Delays (n = 4) gained the fewest
number of words (M = 130 words, range = 33–194). Likewise,
all children increased their mean number of words per utter-
ance (MLU) postintervention and at follow-up. Overall, chil-
dren started at a mean of 0.9 during play and 1.0 during
routines and by follow-up were at 1.7 for play and 1.5 for
routines. The average MLU for typically developing toddlers
(age 18–36 months) is 1.8 to 3.1 (Paul & Norbury, 2011). The
children varied in their use of communicative initiations prior
to the start of LAPE with a larger range of initiation in the
routine samples than the play samples. All children increased
their use of initiations post-LAPE. However, at follow-up,
children increased their use of initiations during play but not
routines.

Parent Self-Progress Monitoring Discussion

As mentioned previously, all parents reported consistently This project was designed to evaluate the effectiveness of a
using the LAPE strategies at home on a weekly log. community-based parent education program: LAPE. The

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Moore et al. 221
intervention was designed based on recommended family
coaching practices and incorporated empirically supported
language-enhancing strategies (e.g., environmental arrange-
ment, responsive interaction strategies). The effectiveness
of LAPE was evaluated with multiple quantitative mea-
sures. Three notable findings were identified. First, the
results from LAPE are promising. The parents increased
their use of language-enhancing strategies (i.e., RE, TLT,
modeling) and decreased their use of question asking
(which might limit child language growth) after participat-
ing in LAPE. Moreover, parents were satisfied with LAPE
and indicated that LAPE met most of the goals they wrote
for themselves and their children. Although child progress
varied substantially according to disability group, all chil-
dren increased their vocabulary, MLU, and initiations.
While causal relations cannot be determined based on the
small sample size, lack of controls, and the developmental
nature of child language, the outcomes are notable due to
the relatively small dosage of intervention (i.e., 4–5 group
sessions, 2–3 individual sessions; totaling 9.5 to 12 hr over
7 or 15 weeks) as compared with other similar parent-
training interventions, such as Hanen—It Takes Two to
Talk (i.e., 8 group sessions, 3 individual video feedback
sessions, totaling 30 hr; Girolametto & Weitzman, 2006)
and EMT (approximately 30 individual sessions contingent
on parents meeting criterion, totaling 10 hr; Hancock &
Kaiser, 2006). The current evaluation supports existing
research documenting that a hybrid approach (group train-
ing with individual support) might be effective for teaching
parents language-enhancing strategies in a short period of
time (Carter et al., 2011; Kaiser et al., 1995).
Second, with the exception of TLT, six parents did not
maintain their use of LAPE strategies at the 3-month
follow-up. Although RE, Q, and O-LEBs did not return to
pre-LAPE levels, there was a clear decrease in use over
time. Two out of three parents maintained their high levels
of RE at 3-month follow-up in the third cohort, which had a
longer treatment duration (same dosage), but Q and O-LEB
did not maintain. Previous studies also have documented
that use of language-enhancing strategies does not maintain
over time without extensive follow-up coaching and sup-
port (Peterson et al., 2005).
Third, parents consistently used more LAPE strategies
during play than routines. Play and routines were discussed
at length during the group and individual sessions and prac-
ticed during individual sessions. After analyzing data from
the first two cohorts, the authors decided to change the for-
mat of the daily responsivity log to encourage more practice
during routines and incorporated more routine examples
during group and individual sessions. However, there were
still no substantial differences between the cohorts. These
differences might indicate that it is more difficult to embed
language-enhancing strategies into routines, perhaps
because the primary focus of the routine for the parent is
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completing the routine (e.g., getting the child dressed),
rather than the child’s communication skills, whereas dur-
ing play parents can focus directly on teaching new com-
munication skills. Parents might need more support and
guidance on how to embed communication strategies into
routines while still attending to the task at hand.
Limitations and Future Research
Although multiple outcome measures were utilized, causal
relations between intervention and child outcomes could
not be deduced. As discussed previously, LAPE was devel-
oped to address a community need, so no control partici-
pants were identified. Future research should experimentally
examine the efficiency and effectiveness of the LAPE
model as it compares with “business as usual” EI across
disability groups (e.g., using a randomized wait-list control
design). Moreover, there is a dearth of information on pater-
nal use of language-enhancing strategies. Although only
one father participated in this study, the authors anecdotally
noted differences between the mothers’ and the father’s
interactions with their children. As fathers take a more
active parenting role and participate more in therapeutic
interventions with their children, research should examine
their unique interaction and communication styles.
Parents in LAPE did not maintain their use of language-
enhancing strategies at 3-month follow-up. Future studies
should examine practices that promote maintenance, includ-
ing monthly parent support sessions, web-based supports,
or individual follow-up and coaching. In fact, previous
research indicates parent education group trainings are only
effective when supplemented with intensive, individual
supports (Carter et al., 2011; Kaiser et al., 1995). However,
few cost-effective, early language intervention approaches
exist that are feasible and useful for interventionists work-
ing within Part C systems, and the few that do are not effec-
tive for all families (Carter et al., 2011) or are not flexible
enough to be implemented by a variety of EIs in authentic
settings. For example, future research might examine the
use of phone or web-based support as a supplement to
follow-up coaching to promote parents’ maintenance of
skills learned. Future studies should continue to examine
feasible, effective curricula that can be implemented within
the confines and limitations of the Part C service delivery
systems.
Implications for Practice
LAPE is an example of a parent education program devel-
oped through recommended practice guidelines and current
research. LAPE was designed as a supplemental “first level
of response” to provide brief, intensive help to parents of
toddlers exhibiting communication delays. The following
five recommendations are based on LAPE outcomes.
222 Topics in Early Childhood Special Education 33(4)
First, group training might be effective for giving par-
ents information in a short period of time. Group-based pro-
grams can be cost-effective and offer the support and
guidance of peer-parents, which might increase engage-
ment and participation. This has been shown to be true for
parent education programs focused on reducing children’s
challenging behaviors (McIntyre & Phaneuf, 2008). Groups
should be kept small (5–6 families) and allow ample time
for parents to support each other, share progress, and dis-
cuss implementation of the strategies. In LAPE, the authors
anecdotally noted that parents frequently supported each
other during group sessions.
Second, despite the advantages of group-based parent
education programs, groups alone are not effective (Kaiser
et al., 1995); individual support is necessary to support fam-
ilies. In LAPE, the purpose of the individual sessions was to
help the parents identify which specific strategies they used
well, which new strategies they wanted to start implement-
ing, and how to implement them in their homes. Moreover,
parent−child observations were important for making data-
based decisions. Thus, individual sessions should be based
on each family’s unique needs.
Third, effective family coaching practices exist and
should be implemented (Powell & Dunlap, 2010). During
home visits, early interventionists should build relation-
ships with families, model strategies, provide multiple
opportunities for practice, and give performance-based
feedback that builds on the parent’s self-reflection. Video
recordings should be used for demonstration, self-reflection,
and performance-based feedback.
Fourth, parents should be taught to embed language-
enhancing strategies during daily play and routine activities.
During group and individual sessions, early interventionists
should talk with parents about how they typically engage
with their children and then individualize examples accord-
ingly. Not all parents have the time or desire to play in tradi-
tional ways (e.g., sitting on the floor with toys) with their
children everyday. Instead early interventionists should dis-
cuss what they are already doing (e.g., playing and talking in
the car, at bath time) and which daily activities might be
most conducive to teaching new communication skills,
acknowledging that some home activities are more hectic
and task-directed than others. Once activities are identified,
early interventionists should help parents identify specific
opportunities during those activities to embed the strategies
and provide modeling and time for parents to practice during
coaching sessions (McWilliam, 2010).
Fifth, coaching should be responsive to the family’s
changing needs and the child’s language development.
Early interventionists should teach milieu strategies (e.g.,
model) if responsive and environmental arrangement strate-
gies are not producing significant outcomes for the child.
For some parents, milieu strategies might promote more
directive and fewer responsive behaviors. Thus, early
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interventionists should teach responsive and environmental
arrangement strategies first (Hancock & Kaiser, 2006).
Conclusion
The purpose of this project was to develop a parent educa-
tion model focused on enhancing parent responsivity and
improving the language skills of toddlers with expressive
communication delays. LAPE incorporated family coach-
ing and language-enhancing strategies using group and
individual sessions in a relatively brief period of time (i.e.,
7–15 weeks). After participating in LAPE, all parents
increased their use of language-enhancing strategies and
decreased their use of question asking. However, only two
parents maintained these increases after 3 months. Social
validity measures indicated parents were satisfied with pro-
cedures, goals, and outcomes of the project. This suggests
LAPE is a promising parent education program, though fur-
ther refinements are needed.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
project was funded in part by a grant from the University of
Oregon College of Education Hope Baney Fund.
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