Professional Documents
Culture Documents
NUMBER4 (wiNm
1988,21,391-400
MARJORIE H. CHmuuop
CLAREMONT MCKENNA COLLEGE
LAURA SCHREIBMAN
UNIVERSITY OF CALIFORNIA, SAN DIEGO
Parents of four nonverbal and four echolalic autistic children were trained
to increase their children's speech by using the Natural Language
Paradigm (NLP), a loosely structured procedure conducted in a play
environment with a variety of toys. Parents were initially trained to use
the NLP in a clinic setting, with subsequent parent-child speech
sessions occurring at home. The results indicated that following training,
parents increased the frequency with which they required their children
to speak (i.e., modeled words and phrases, prompted answers to
questions). Correspondingly, all children increased the frequency of
their verbalizations in three nontraining settings. Thus, the NLP appears
to be an efficacious program for parents to learn and use in the home to
increase their children's speech.
DESCRIPTORS: parent training, natural language paradigm, autistic children, speech
Health.
The authors Chris Kimball and
thank
Jeffrey Yasuda for their graphics and Sandy
Sullivan, Julie McDonald, Nora Tann, John
One of the most debilitating and
Teeples, Joanna Kirshner, Trish Kurtz,
difficult to treat characteristics of Janice Milstein, Jerry Silliman, and Lori
autistic children is their severe Robles for their assistance in data collection
speech deficit (Rutter, 1978). and analysis.
Reprints may be obtained from Karen E.
Although researchers have reported
Laski, Affiliated Counselors &
success in increasing appropriate
Psychotherapists, 9530 E. Imperial Hwy.,
speech using clinic-based operant Suite L, Downey, California 90242, or
training proce Marjorie H. Charlop, Psy chology
dures (e.g., Lovaas, Koegel, Department, Claremont McKenna College,
Simmons, & Long, 1973), Clare mont, California 9171 1.
generalized improvement in
functional speech has been
disappointing (Fay & Schuler,
1980). One strategy used to enhance
generalization has been to train
parents to deliver the speech
therapy; however, problems still
remain. Some
391
392 al.
KAREN E. LASKI et
tocol designed to increase
of the positive features of both motivation by varying tasks
traditional operant procedures and (Dunlap, 1984), increase responding
natural language procedures. Play by pro viding direct reinforcers
sessions are specifically presented, (Koegel & Williams, 1980), and
during which massed opportunities enhance generalization through loose
are provided for the child to use structure
speech, and all verbal attempts are and multiple exemplars (Stokes &
reinforced even though they may not Baer, 1977). The present study
be as elaborate or dear as expands upon the results of Koegel
previously emitted. A rapid et al. (1987), who initially
exchange of the toys continues demonstrated the efficacy of this
between the child and therapist promising language program. Their
while a wide variety of words and data suggested that, when used in a
phrases are modeled for the child. clinic setting with trained
Thus, the NLP is a child-initiated therapists, the NLP produced more
pro generalized speech for two autistic
children than did traditional
operant procedures. The pres ent
study was designed to enhance the
effects of the NLP on increasing
generalization of speech by teaching
parents to use the procedures in the
home. In our study, parents of 8
autistic children were trained to use
the NLP, and the effects of training
on parent-child verbal interactions
were examined in three
generalization settings.
METHOD
Subjects
Participants were 7 autistic boys
and 1 autistic like girl (ages 5 to
9.6 years old) and their primary
caretakers. The children were
diagnosed by two independent
agencies according to the criteria es
tablished by National Society for
Autistic Children (Ritvo & Freeman,
1978).
The nonverbal children (Children
1 through 4) were 5.8, 5.9, 5, and
9.6 years old with mental ages of
2.7, 3.10, 1.7, and 2.9 years.
Children 1, 2, and 4 could imitate
only sounds and a few words upon
request, rarely initiated speech, and
had re
ceptive vocabularies under
approximately 15 words. Child 3 was
functionally mute and had no
receptive vocabulary. The 4
echolalic children (Children 5
sco soo
1'00 100
..s
.~~Cil
5
~~~~ ~~~~~Cd1 0Child
t
100 100
50 2 10
so so
0
free-play0settings.) ____C(ihdd7
100 *100
50 50
Child 3
Free-play Sessions
0Y Child 4
0 2 4 6 8 1O 12 14 16 18 20
Free-play Sessions
Parent verbalizations and child vocalizations (combined imitations, answers, and
Figure 1.
spontaneous speech) in the
free-play settings.
396 al.
KAREN E. LASKI et
answers, and spontaneous speech in (range,69% to 100%) and 96%
the clinic and home free-play (range,88% to 100%), respec tively,
settings), mean occurrence and non and 96% (range, 88% to 100%) and
occurrence agreement was 87% 97% (range, 89% to 100%) for
echolalia. In the break room, mean observed for Child 8 (baseline M =
occurrence and nonoccurrence reli
ability was 78% (range, 50% to =
100%) and 91% (range, 67% to 11%; posttreatment M 62%) and
100%) for parent verbalizations, 87% Child 6 (baseline M =
13%;
(range, 67% to 100%) and 90%
(range, 77% to 100%) for child posttreatment M = 65%).
vocalizations, and 96% (range, 88% Comparative Data
to 100%) and 97% (range, 89% to Parent verbalizations.
100%) for echolalia. Posttreatment increases of lower
magnitude were also observed in
RESULTS parent verbalizations with the
siblings. Baseline and post treatment
Changes in Parent and Child means and ranges were: Sibling 1,
Verbal Behavior Free-play settings.
base line M = 50% (48% to 51%)
Changes in the parents' and their
autistic child's verbal behavior are and posttreatment M = 65% (57% to
presented in Figure 1. All parents 75%); Sibling 2, baseline M = 48%
increased the percentage of intervals
(42% to 58%) and posttreatment M
in which they presented a
= 67% (57% to 77%); Sibling 3,
discriminative stimulus to which
their child could respond vocally. baseline M = 33% (30% to 35%) and
The greatest increase was seen in posttreatment M = 45% (33% to
the verbalizations 64%). This suggests that the parents
of Child 2's mother (baseline M = were also more verbal with their
other children after the NLP
34%; post treatment M = 84%) and
training.
the smallest, but still substantial,
Parent verbalizations for the
gain seen with Child 7's mother
comparison mothers of
(base line M = 48%; posttreatment nonhandicapped children were
M = 67%). generally lower and relatively stable
All children increased the across the four monthly probes, with
percentage of intervals in which means and ranges for each of 29%
they vocalized. Child 3, who was the (15% to 42%), 27% (20% to 33%),
least verbal during baseline, showed 24% (22% to 27%), 25% (13% to
the greatest gains (baseline M = 37%), 21% (18% to 27%), and 12%
(7% to 17%).
0%; posttreatment M = 27%). In
Child vocalizations. Table 1
contrast, Child 7, who was the most
presents the mean and range of each
verbal during baseline, showed only
child's vocalization by type (im
minimal gains (baseline M itation, answers, and spontaneous
= 68%; posttreatment M = 72%). speech) in the clinic free-play
Break room setting. Posttreatment setting. Data obtained in the home
increases in parent verbalizations free-play and break room settings
were observed for all but one of the are not presented; however,
caregivers (Child 4's aunt), with individual children's verbal
greatest gains seen for parents of behavior was similar across all
settings. Increases in imitations were
Child 2 (baseline M =
observed for all of the autistic
4%; posttreatment M = 47%) and children, with the greatest increases
parents of Child 6 (baseline M = observed with Children 2, 5, and 8.
4%; posttreatment M = 62%) (see Answers increased for 4 of the
autistic chil dren (Children 1, 2, 4,
Figure 2). Correspondingly,
posttreatment in creases in child and 5), remained relatively
vocalizations were observed for all unchanged for Children 6 and 7, and
children, with greatest gains decreased for Child 8. Slight
increases in spontaneous speech were relatively un
observed for Children 1, 3, 6, and 8, changed across the four probes.
whereas others remained relatively Although these data varied
stable. considerably from posttreatment
For the siblings, slight increases data in terms of frequency and
were observed in imitation for content of verbalizations, when
Sibling 2, in answers for Siblings 2 considered from a normative
and 3, and in spontaneous speech for perspective they must be considered
Sibling 3. As expected, the in the context of the purpose of our
frequency of vocalizations for the
nonhandicapped children remained
TRAINING PARENTS TO 397
INCREASE SPEECH
100-
50
100
50
Parent v
Baseline Post-utmaent SO .. -I
L .......
100-
< Child
Child I
0I
so0
AI__
So
100
s o
SO
100
100-
I
a
Baseline
Post-aunent "a
50
I
I'
I
' ~~Chid 2 . . . IsI; .
.__.J~~~~~~~~~
II
II
______________
Child 7
Child s
* *Cw
* -uix
Child 3
00-
Child 3
f'''
(with Momi
SO .C .
I
I"Al
W .I I "
- .'
o *_ _ * __ _ . . . 0
0V-a_ ChldS6
0 2 4 6 8 10
(with Dad) 0 tOO Break-room
100- o0-
Sessions
SO
Iis.~~~~~~~~~~~~
8
0 2 4 6 10
Break-room Sessions
and
Figure 2. Parent verbalizations and child vocalizations (combined imitations, answers,
in
spontaneous speech) the break room setting.
KAREN E. LASKI et al.
398
Table 1
Mean (and Range) Percentage of Intervals of Child Vocalizations in Clinic Free-Play
Setting
1 0 29 (20-37) (20-40) 7
With Mom 6
7 14 -10) (8-20) 13 23 (2-20) (2-10) 1 (0-20) 27
2 (10-37) 11 23
(2 (0-3) 0 (7-52) 26
21 66 (5. (3-19) (10-38) (0-65)
3 -23) (56-77) 0 (Not measured) 0
With Dad 3 21 (15-25) 29
(Not measured)
4 5 6 7 8 9 39 -15) (3. Siblings 1 2
(30-47) 4 (0-7) (0-5)
23
16 47 -38) (5. (0-12) 19 17 13
(10-37) 33
(37-63) 4 8 -15) (5-32) 46 (7-25) 14 (5-22) 29
(2-14) (13-53) 41
(0 (37-52) 41 (8-20) 29 (12-43) 35
6 54 -11) (0 (33-50) 43
(23-50) 40 (21-43) 12 (17-57) 27
(40-72) 13 51 -25) (33-52) 20
(25-55) (0-25) (15-33)
(2. (40-60) (15-28)
20 (26-32)
15
Comparison (30-59) 35
(18-22) 6 (7-22) 18 34 children 35 (30-40) 28
(3-7) (3-35) 4 (33-35) 38 (28-43) 29 (20-33) 45
2 3 3 (3-5) 22 (28-48) 48 (20-40) 29 (31-55)
(0-5) 29 (10-35) (43-52) 39 (22-35)
(0-3) 0 19 (11-27) 17 33 (7-60)
1 (0-3) 0 (13-22) 11 (8-18) 28 (23-35) 46
10 (5-18) 17 28 (15-42) 31 (30-57)
2 3 4 5 6
(15-22) 25 (22-28) (13-50) 30 (23-42)
14 (2-22) 1 (0-3) 1
DISCUSSION
This study presented a promising new