Getting Parents to Understand That Something Is Important

If parents aren't interested in getting their child engaged in play, should I explain why it's important? Or do I model and share just about how to do it, what to do next, etc.?


No. Family consultation has to be responsive to their perceived needs.  If you’re asking about how to get parents interested in something they’re currently not interested in, think of it as a triangle. You (a) attend to their interest (b), weave in the thing you want them to be interested in (c) as part of (b), and see if (c) becomes an interest of theirs. For example, they are interested in their child making sounds with his or her mouth. You work on that by suggesting back-and-forth games (e.g., peekaboo) involving the adult's modeling vocal sounds. You praise the parents for playing these games and ask them if they’re interested in hearing about more kinds of games. If they say yes, you’re in luck. If they say no, you find another interest of theirs into which you can weave engaged play. Adult learning and consultation theory explain why we take this approach.

Siskin Children's Institute's International Activities

http://www.chattanoogan.com/articles/article_217778.asp

McWilliam working with Tania Boavida and Cecilia Aguiar

Two-Year-Olds With Autism Having Fun? Horrors!

I just finished writing a draft of a research article that ends as follows:

In the classroom observed in this study, incidental teaching, an evidence-based method , was the primary intervention method. But perhaps it was not implemented with as much intensity as it should have been. Programs should ensure teachers receive systematic, checklist-based feedback to increase their rate of incidental teaching, and future studies should compare a variety of meaningful outcomes between intensive, one-on-one intervention sessions and well-implemented incidental teaching in inclusive environments, with 2-year-olds with autism. Because of the age of these children, it might be more effective to teach them by dispersing trials through the day than massing them in drill sessions. Furthermore, the children might have more fun—a value minimized in the desperate discourse about educating very young children with autism.

Sometimes, it's hard to tell whether a little kid with autism is having fun, but if he or she is engaged (busy, absorbed, meaningfully participating in what's going on around him or her) it's a pretty good sign. Let's not rob toddlers of what should be a fun time in their lives, just because we're too unimaginative to figure out how to teach them through play.

Systematic Incidental Teaching

We have not yet secured funding to study the effects of teaching parents to use systematic incidental teaching. So here’s where we stand on related research:

Amy Casey and I have shown that it is possible to train early childhood teachers to increase their rate of incidental teaching:

Casey, A. M., & McWilliam, R. A. (2008). Graphical feedback to increase teachers' use of incidental teaching. Journal of Early Intervention, 30, 251-268.

Ann Kaiser has shown that it’s possible to teach parents to use milieu language interventions, which include incidental teaching:
http://jei.sagepub.com/content/16/1/31.short
http://jei.sagepub.com/content/18/3/269.short

She has also shown that parent-implemented milieu teaching has a positive impact on children’s social communication:
http://www.tandfonline.com/doi/abs/10.1207/s15566935eed1104_4

These researchers have shown that it’s possible to train parent trainers in the use of milieu teaching:
http://jei.sagepub.com/content/20/1/30.short

…it goes on. You might ask Why aren’t you just teaching parents this “milieu teaching”? Because most of the training was done in a lab setting and the outcomes were communication ones only. We want to “train” parents in the home for all kinds of outcomes, across routines and domains. The essence of milieu teaching (teaching in context, following children’s interests, eliciting more sophisticated behavior) is also the essence of SIT.

Many states face the issue of therapists’ POLITICAL claims that the routines-based, family-centered approach is watering down services or even denying services to families . They might believe what they’re saying, but those beliefs are wrong and might be a consequence of cognitive dissonance: They have to believe what they believe, otherwise they lose money and professional face. Unfortunately, they don’t listen when we say that the routines-based approach actually increases the importance of therapists, because we need them to support the natural workforce (regular caregivers) and the paid workforce. It’s easy to do therapy with a child in a distraction-free environment; it’s hard as hell to figure out the right interventions to teach to lay people that fit into their lives. So weariness or laziness also must factor in to their claims.

The key about how to support families effectively lies more in the family consultation approach than in SIT, which is really content (i.e., a skill we teach families). The method for teaching families is family consultation. Although I have developed this model for early intervention specifically, the roots are found in existing research on parent-implemented early language intervention (again—sorry! http://informahealthcare.com/doi/abs/10.1080/136828298247758), variables that influence collaborative relationships (http://tec.sagepub.com/content/16/3/322.short), and vocational programming (http://eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ421457&ERICExtSearch_SearchType_0=no&accno=EJ421457). Again, we haven’t yet secured funding to study family consultation per se. It’s almost impossible to get the Institute of Education Sciences to fund studies with family behaviors as the outcomes.

Don't forget to look at additional information at www.siskinresearch.org. 

Toy Bags Again

Banishing toy bags from home visits is both symbolic and meaningful. I have written about this issue before: http://naturalenvironments.blogspot.com/2007/10/toy-bags.html. Here's a summary:

Working from a toy bag implies that the home visitor’s interaction with the child for 1 hour a week is intervention.	The hour is better spent working with the parents, because adults can benefit from 1-hour, weekly sessions.
The toy bag implies that what the family has is inadequate.	The home visit should be, in part, about reassuring families’ of their competence.
If the toys are so important, why are they removed at the end of the visit?	The home visit should prepare the family to intervene during all the many hours between home visits.
Toy bag ladies (and gentlemen) spend 80% of the home visit on something that consumes 5-15% of a child’s time: adult-child-toy play.	Home visits should provide consultation to families on interventions that can happen in all naturally occurring routines.
Toy bag play tends to be adult-directed.	Intervention is most effective when it follows a child’ interest.

How Cognitive is Engagement?

In the early days of engagement research, engagement was measured as happening or not happening in planned activities. Our research, first with Carl Dunst and then with Don Bailey, and much since both of them, has emphasized the fact that engagement is not dichotomous variable. It is instead one that ranges from nonengagement (same as the dichotomous way of looking at it) to sophisticated behavior--a pot into which we put encoded, constructive, persistent, and symbolic). We usually array these codes in a developmental sequence, acknowledging that there is a "cognitive" component to the construct. Our studies have shown that Battelle scores were somewhat correlated with engagement levels.

In a study currently under review, conducted by the brilliant young Portuguese researcher, Cecilia Aguiar, sophisticated-engagement levels in classrooms were associated with sophisticated-engagement levels in homes. Does this mean children are carrying around their engagement trait from one setting to another?

Aguiar found that sophisticated engagement was correlated with age: Older children have more of it. Because children obviously carry around their age from one setting to another, ipso facto, engagement will look like a trait.

Engagement and developmental age are not exactly correlated, however, so we recognize that there is something of a developmental or "cognitive" dimension to engagement. But don't discount the environment. Within children who spend quite a lot of time engaged in a sophisticated manner, those in interesting environments are more likely to spend time in sophisticated engagement. Even more important, perhaps, children who spend much time nonengaged are more likely to be nonengaged in uninteresting settings.

Functionality in School-Aged Children

Question from Ireland: What in your opinion are the critical functional outcomes that apply generally to school-age children and their families?  

For children and youth with disabilities, I believe the core outcomes of engagement, independence, and social relationships (EISR) still apply—as well as quality of life for their families. My so-called expertise is limited to young children but I am the father of a person with disabilities, and other outcomes people mention for older children and adults (e.g., self-determination, feelings of belonging or membership, quality of life) in my experience are all tied to the big three. Of course, that might just be me, seeing everything through that lens.

For school-aged children, academic success is also important, but I see EISR as precursors to the ability to learn academic content. It’s just that we can’t stop at EISR. We have to ask what they will be useful for—self-fulfilment, becoming an interesting person and therefore having friends, getting a job, and so on.

I do think that self-determined satisfaction with one’s life is huge, within reason. You and I might share some common ideas about what should be a satisfactory life, based on our shared ability level and possibly some shared interests, but that doesn’t qualify us to determine what a satisfactory life is for someone else. On the other hand, we might have a responsibility to protect people. If a person likes sitting in front of a video game hour after hour, we might think this is a shallow, empty existence. The individual might think it’s a rich, interesting, exciting existence. If the person’s hours in front of the video game are during recreation time, that’s one thing. If the person doesn’t hold down a job, because of his or her obsession with video gaming, that’s another thing. We would presumably try to protect the person from penury by teaching him or her that that the decision to forego employment in favor of the video game is a bad one. A tricky issue. But the point I began with is that the variety of ways people with disabilities define their quality of life might be even bigger than the variety of definitions held by people without disabilities.