CDC Kerala 7: Effect of Early Language Intervention Among Children 0–3 y with Speech and Language Delay

Abstract

Objective

To assess the effect of systematic clinic and home based early language intervention program in children reporting to the early language intervention clinic with full partnership of specially trained developmental therapist and the parents.

Methods

All babies between 0 and 3 y referred to Child Development Centre (CDC) Kerala for suspected speech/language delay were assessed and those without hearing impairment were screened first using Language Evaluation Scale Trivandrum (LEST) and assessed in detail using Receptive Expressive Emergent Language Scale (REELS). Those having language delay are enrolled into the early language intervention program for a period of 6 mo, 1 h at the CDC clinic once every month followed by home stimulation for rest of the month by the mother trained at CDC.

Results

Out of the total 455 children between 0 and 3 y, who successfully completed 6 mo intervention, the mean pre and post intervention language quotient (LQ) were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant. The developmental diagnosis included developmental delay (62.4 %), global developmental delay (18.5 %), Trisomy and other chromosomal abnormalities (10.5 %), microcephaly and other brain problems (9.9 %), misarticulation (8.4 %), autistic features (5.3 %) and cleft palate and lip (3.3 %) in the descending order.

Conclusions

In the present study among 455 children between 0 and 3 y without hearing impairment, who successfully completed 6 mo early language intervention, the mean pre and post intervention LQ were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant.

Appendix. CDC Kerala: Early Language Intervention Package

I. General Guidelines for Mothers of Babies
Touch the baby:	General principle: It is now well known that premature infants, who were massaged, grew faster, cried less and were released earlier from the hospital than those who weren’t. Activity: Keep on talking to the baby while you are doing the massage
Give unconditional love:	General principle: Remember that love and affection is the basic need of the baby and this creates a strong self-esteem and increased development of brain circuitry. Activity: Keep looking into the face of the baby with so much affection that only a mother can give (creating a positive response in herself)
Talk to the baby often:	General principle: Keep on talking with a kind voice, a wide range of vocabulary and a lot of expression on face. The parents’ voice is the baby’s favourite sound as she has heard it for long, even before she was born. Activity: While talking to young children, one must change both the manner and the content of our speech and simplify the way of construction of sentences, using a special but limited vocabulary of ‘baby words’, and using names instead of pronouns. Also exaggerate the intonation of such sentences, speak more slowly and use more repetition in our speech to young children
Respond to babies:	General principle: Responding to baby’s request without hesitation teaches her that she can communicate with other people and gives her a strong sense of trust. Activity: Try to understand the cues from your baby and quickly respond appropriately
Encourage imitation:	General principle: The baby is constantly analysing the parents and figuring out, ways to mimic their voice and facial expressions. Activity: Talk to the baby with clear voice and lot of facial expressions.
Experiencing different sounds:	General principle: Letting the baby experience different surroundings and sounds improve not only the overall development, but also language development. Activity: Go for walks, take her to different places and show her the exciting world around, take turns making sounds or saying words with infant or toddler, make the same sound the infant or toddler is making (ba-ba), make a sound that is like the infant or toddler’s sound (ga-ga), make sounds of familiar animals (dog, cat), make sounds of familiar objects (car, water, wind).
Explore different textures and temperatures:	General principle: Provide a safe environment for the baby to explore as she needs time, to discover things for herself. Activity: Let the baby touch and feel different textures and temperatures using mothers body, clothing and simple home utensils, while the mother is talking about it.
Read books to the baby:	General principle: Even though the baby can’t follow the story, she loves the pictures and the sound of the parent’s voice. Activity: Read simple story books to the baby with lot of exaggeration and expression.
Play music for the baby:	General principle: Soft music is always soothing to the baby. Activity: Let the mother keep singing simple baby songs at every opportunity.
Always communicate with your child:	General principle: Frequent and regular communication with parents can advance the child’s learning, as they exert a major influence on their children. Activity: Parents must use every opportunity to encourage their child’s learning in the home, through discussion and home-based activities that utilize lot of communication.
Read out to the child:	General principle: Parents must have relevant and age appropriate children’s literature. Activity: Parents should read aloud and discuss with their child, even if you feel that he/she is not following everything that you are trying to say.
II. Promoting Articulation
Mouth Strengthening	General principle: Encouraging kids to chew a few things that are harder to chew every day improves articulation skills. Activity: Sucking through a straw can help strengthen mouth muscles, encourage kids to drink through straws of varying widths as often as possible
Talk in Front of a Mirror	General principle: Imitation always help learning Activity: The mother should articulate each sound correctly to give her an example of what her mouth should look like and point out differences in the way she’s moving her own mouth.
Flash Cards	General principle: Parents can make flash cards more entertaining by providing an activity for kids Activity: Hide and seek- to do along with them like hiding the cards, the child finds them and says about them each using good articulation
III. Promoting Voice Production
Create an environment	General principle: The following activities can minimise the chances of acquiring voice disorders. Activity: Create an environment that is more communication friendly and help to avoid voice abuse and misuse.
Vocal hygiene strategies	General principle: Help the child to follow vocal hygiene strategies/good habits given below, which helps to keep voice healthy. Activity: Keep airway hydrated by drinking enough water, eat foods containing plenty of water, humidify the environment and limit dust, eliminate throat clearing, control vocal loudness and don’t shout, give voice rest and reduce the speed of speech, sing within your range, avoid eating spicy foods, caffeine and alcohol.
Implement a reward system	General principle: It is important to reward the child’s good vocal behaviors not only for improving the voice but also to improve self-esteem and motivation. Activity: Parents should speak to the child using positive language; e.g.,: -excellent, good work, fantastic, your voice box remembered. Reward the child with gifts for good work; e.g.,: -stickers, stamps, books, games, special outings.
IV. Promoting Fluency
Talk at child’s level only	General principle: Parents should be aware of simple tips that are useful to prevent fluency issues. Activity: Look at the child and get your face on the same physical level, try not to use very adult language—keep it at a child’s level, slow down your rate of talking to enable the child to speak back more slow, talk about the present and things that can be seen, reduce the number of questions you ask and allow the child plenty of time to answer.
Allow child own pace	General principle: Praising the child for things he has done well will help to increase his confidence in himself. Activity: Allow the child to choose when to tell you things, give the child time and show that you are interested and listening, never be tempted to complete the child’s sentences for him or fill in what you think he is trying to say, rhymes and singing may help a child to achieve fluency—many children do not stammer when they sing.
V. Promoting Language Development
Talking while playing	General principle: Language learning in your child can be promoted by parents. Activity: Start talking to your child at birth (even newborns benefit from hearing speech), respond to your baby’s coos and babbling, play simple games with your baby, like peek-a-boo and pat-a-cake, listen to your child, look at her when she talks to you, give her time to respond, sing to your child (learning new songs helps your child learn new words and uses memory skills, listening skills and expression of ideas with words)
Ask questions	General principle: Using everyday situations to reinforce your child’s speech and language would pay dividends in the long run Activity: Expand on what your child says, for example, if your child says “car!” you can say, “You want car!”, spend a lot of time communicating with your child, even during infancy; talk, sing and encourage imitation of sounds and gestures, use age-appropriate soft or board books or picture books that encourage kids to look while you name the pictures,, ask questions and acknowledge your child’s responses (even when they’re hard to understand), keep things simple, but never use “baby talk”, encourage storytelling and sharing information.
Suggestions for play school teachers	General principle: Be a good speech model emphasizing the target sound to the child prolonging and exaggerating the target sound in all positions of words as they occur in your conversation. Activity: Read a story to the child exaggerating the sound the student is saying incorrectly; talk with the child about how you make the sound, think about where your tongue, lips and teeth are as you make the sound. play games with the child and have the child find objects around the room which have their target sound in them, never tease, embarrass or make fun of a child with an articulation disorder, drill words with the target sound in them, make a list of 20 words and practice them daily.
Handling children with language delay	General principle: Accept the fact that language delay exists because not acknowledging the fact is not acknowledging the person. Activity: Speak directly to the child with language delay as you would to any other child, encourage classmates to accept the child with communication problems, be a good speech model, an atmosphere conductive to easy and good interactive communication should be established and maintained in the classroom.