Effects of a Naturalistic Sign Intervention on
Expressive Language of Toddlers with Down Syndrome
Courtney Wright, Ann Kaiser, Dawn Reikowsky, Megan Roberts
Department of Special Education, Vanderbilt University, Nashville, TN
Introduction
Procedures
Children with DS have specific phenotypic strengths and
weaknesses based on their diagnosis (Chapman &
Hesketh, 2000; Kumin, 1996; Roberts, Price, & Malkin,
2007; Stoel-Gammon, 2001).
Baseline:
• Adult directed play with toys.
• Moderately responsive
• No EMT/JASPER strategies used
• No signs modeled
Two appropriate interventions:
• Naturalistic interventions target strengths in social
engagement (Adamson, Bakeman, Deckner, &
Romski, 2009) and weaknesses in requesting (Mundy,
Sigman, Kasari, & Yirmiya, 1988), persistence (Kasari
& Freeman, 2001), and object play (Adamson, et al.,
2009).
• Sign language interventions target strengths in
gesturing (Caselli et al., 1998; Franco & Wishart, 1995)
and weaknesses infusing symbols into joint
engagement (Adamson et al., 2009).
Purpose
1. Does EMT/JASPER Words + Signs increase use of
expressive signs and spoken communication in
young children with DS?
2. Do children generalize newly learned words and
signs to use with their parents at home?
Intervention:
• 20 sessions, 20-30 minutes
• Child directed play with toys
• Fully responsive
• All EMT/JASPER strategies used
• Signs modeled with >90% of
spoken words
Generalization:
• 10 minutes of standardized set of
toys and books
• Conducted every 5 sessions
• At home with untrained parent
EMT and JASPER Intervention Components
Component
Specific Strategies
 Sit face to face with the child
 Follow the child’s lead
Setting a
 Respond to all child communication
context for communication
 Imitate the child’s non-verbal actions (mirror)
and map (model) language
Modeling and
expanding play
Examples
 Adult reorients in front of the child when the child when the
child moves from blocks to cars
 Child vocalizes while playing with the baby and the adult
responds by saying “baby”
 Child rolls ball, adult rolls ball and says “ball”
 Choose interesting and engaging toys
 Choosing toys according to play level
 Teach target level play actions and sequences  Modeling stacking the blocks
Modeling and
 Model target signs or words
expanding communication  Expanding child communication
 Pointing to the apple and saying “apple”
 Child signs “baby” and the adult signs/says, “baby eats.”
 Model point, show and give gestures in
conjunction with target language
 Points to car rolling down track and says “down the slide”
 Shows baby bottle and says and signs “bottle”
Time delay strategies
 Assistance
 Choices
 Waiting with routine/cue
 Inadequate portions
 Adult gives the child a juice box, waits for the child to ask
for help, and expands communication
 Adult holds up two choices, waits for the child to indicate a
choice., and expands communication
Prompting strategies
 Open questions
 Choice questions
 “Say” prompt
 Child reaches for the ball and the adult says “say: ‘ball,”
 Adult holds up “juice” and “milk” and says “juice or milk?”
Modeling
joint attention skills
Results
Frequency of Total Signs and Spontaneous Novel Signs
Frequency of Total Words and Spontaneous Novel Words
Discussion
Cumulative Words & Signs Used Spontaneously
Participants
Age at entry (months)
Gender
Ethnicity
Ryan
29
Male
Caucasian
Erin
25
Female
Caucasian
Jay
23
Male
Caucasian
Gretchen
23
Female
Caucasian
58
80%
69
80%
77
40%
72
0%
Screening
Mullen SS
Imitation
Testing
PLS AC SS
PLS EC SS
MCDI # of
signs produced
MCDI # of
words produced
Pre
61
73
Post
57
72
Pre
67
73
Post
71
83
Pre
74
73
Post
75
75
Pre
67
81
Post
61
89
0
27
1
30
0
21
0
7
11
33
7
33
10
43
2
26
Observational Measures
• Twenty minutes video recorded and coded
• Spontaneous, imitated, and prompted
• If a child used a sign and a word simultaneously, both
the word and sign were tallied.
Reliability was coded for 30% of sessions and averaged
91% (SD=.19, range=0-100, 87% sessions over 80%)
 New application of
EMT to sign mode
 Children still use
words when learning
to sign
 Children learned
between 10 and 21
signs and generalized
their use to untrained
partner at home
Future research
During baseline, all children used fewer Three of the four participants used zero
than five signs. Upon introducing the
words during baseline sessions. Erin
intervention, use of signs increased to said five (three unique) words. After the
varying degrees ranging from 0-78 signs. introduction of the intervention, each
Spontaneous number of different words
participant demonstrated different
increased for 3 of the 4 participants.
patterns of word usage. Participants
Children generalized their skills to
used between zero and 32 total words
untrained parents.
during intervention sessions.
A word or sign was included when the
child used it spontaneously during a
single session. Participants used few
spontaneous words or signs during
baseline. All children acquired words
and signs throughout intervention,
although at different rates. Children
learned more signs than words.
 Replicate findings in
group and single
subject designs
 Expand target words,
environments partners
 Explore EMT/JASPER
with other AAC modes
 Continue developing
interventions targeting
strengths and
weaknesses of young
children with DS