Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines.

BACKGROUND:  Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting. OBJECTIVES:  To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit. METHOD:  We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components. RESULTS:  Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa. CONCLUSION:  Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

A survey of communication supports in Grade R classrooms in the Western Cape, South Africa.

BACKGROUND:  Early classroom communication supports are critical in influencing oral language development and emergent literacy skills. It is both support from peers and adults, as well as the environment that impacts the quality and efficacy of language learning. Schools in particular play a key role in communication development, which will be further explored in this article. OBJECTIVES:  To describe how communication was being supported in the classroom by teachers in the areas of language-learning environment (LLE), language-learning interactions (LLIs) and language-learning opportunities (LLOs) to focus on classroom communication supports to strengthen literacy outcomes for Grade R learners. METHOD:  A cross-sectional descriptive survey of classrooms was conducted using a structured observation method in 136 classrooms. The Communication Supporting Classroom Observation Tool was used to make 223 observations across classrooms of LLE (19 items), LLI (20 items) and LLO (5 items). A descriptive analysis of frequency of occurrence of items was conducted for each domain. RESULTS:  Language-learning environment had more frequently occurring observations, with 12 out of 19 items being observed with a frequency of occurrence greater than 65%, indicating that the environment had adequate basic resources (e.g. good light). Language-learning interactions scores indicated that 3 out of 20 items were observed frequently, while 17 out of 20 items were observed less frequently (56.5%), including interactive strategies (e.g. turn-taking). Language Learning Opportunities scores indicated that teacher-led behaviours (e.g. including children in small group activities) were infrequently observed on all items. CONCLUSION:  While the physical environment was generally supportive, the behaviours in the interactive domains of LLI and LLO were observed less frequently. There is potential for speech-language therapists to work collaboratively with teachers to develop communication supporting classrooms as a critical primary-level intervention for language-literacy learning.

Enhanced milieu teaching for children with autism spectrum disorder in South Africa.

Purpose: Efficient and effective interventions are required to meet the communication needs of children with autism spectrum disorders (ASDs). However, most children with ASD living in South Africa do not receive individualised interventions.Method: This multiple baseline study examined the effects of therapist-implemented enhanced milieu teaching (EMT) on the diversity and frequency of spoken language of three children with ASD in South Africa.Result: A moderate functional relation was demonstrated between the introduction of EMT and increases in (1) the number of different words and (2) the number of spontaneous utterances used by each participant. Some evidence of generalisation to novel partners and contexts was observed.Conclusion: Results indicated that EMT may be effective for improving communication in South African children with ASD. Implications for clinical practice and cultural and linguistic adaptations are discussed.

Parents of children with disabilities: A systematic review of parenting interventions and self-efficacy.

BACKGROUND: An increasing body of empirical evidence suggests that early intervention has positive outcomes for parents of children with neurodevelopmental disabilities. Parental self-efficacy has been used as an outcome measure in some empirical studies; however, there is a lack of evidence of the impact of parent training programmes on parenting self-efficacy beliefs. OBJECTIVES: This systematic review sought to assess the effectiveness of parenting interventions to increase parental self-efficacy levels in parents of young children with neurodevelopmental disabilities. METHOD: We conducted a broad literature search, which included grey literature, such as dissertations and unpublished conference presentations, to identify all relevant prospective studies reporting on our study objective. Articles were selected for inclusion using predefined criteria and data were extracted onto a purposely designed data extraction form. Twenty-five articles met our search criteria. We extracted parenting self-efficacy scores before, and on, completion of parenting interventions and performed a meta-analysis using standardised mean difference. We also conducted a risk of bias assessment for all the included studies. RESULTS: Parent training programmes resulted in a statistically significant increase in parental self-efficacy levels (standardised mean difference, 0.60 [95% confidence interval {CI}, 0.38-0.83]; I2, 74%) relative to baseline measurements. Parents of children younger than 5 years demonstrated the highest increase in levels of parental self-efficacy after parenting interventions. Furthermore, this review showed that psychologists and other healthcare practitioners are successfully able to implement training programmes that enhance parenting self-efficacy. CONCLUSION: Parent training programmes are effective in increasing parental self-efficacy in parents of children with neurodevelopmental disabilities.

Parents of children with disabilities: a systematic review of parenting interventions and self-efficacy

Background: An increasing body of empirical evidence suggests that early intervention has positive outcomes for parents of children with neurodevelopmental disabilities. Parental self-efficacy has been used as an outcome measure in some empirical studies; however, there is a lack of evidence of the impact of parent training programmes on parenting self-efficacy beliefs. Objectives: This systematic review sought to assess the effectiveness of parenting interventions to increase parental self-efficacy levels in parents of young children with neurodevelopmental disabilities.Method: We conducted a broad literature search, which included grey literature, such as dissertations and unpublished conference presentations, to identify all relevant prospective studies reporting on our study objective. Articles were selected for inclusion using predefined criteria and data were extracted onto a purposely designed data extraction form. Twenty-five articles met our search criteria. We extracted parenting self-efficacy scores before, and on, completion of parenting interventions and performed a meta-analysis using standardised mean difference. We also conducted a risk of bias assessment for all the included studies.Results: Parent training programmes resulted in a statistically significant increase in parental self-efficacy levels(standardised mean difference, 0.60 [95% confidence interval {CI}, 0.38­0.83]; I2, 74%) relative to baseline measurements. Parents of children younger than 5 years demonstrated the highest increase in levels of parental self-efficacy after parenting interventions. Furthermore, this review showed that psychologists and other healthcare practitioners are successfully able to implement training programmes that enhance parenting self-efficacy.Conclusion: Parent training programmes are effective in increasing parental self-efficacy in parents of children with neurodevelopmental disabilities

The attitudes of typically developing adolescents towards their sibling with autism spectrum disorder.

BACKGROUND: Understanding how the cognitive, emotional and behavioural components of sibling attitudes interact with one another at various stages of a sibling's lifespan will allow clinicians to provide better support to children with autism spectrum disorder (ASD) and their families. However, no research exists which focusses on describing the attitudes of adolescent siblings of children with ASD within the South African context towards their sibling with an ASD. The primary aim of this study was to investigate how typically developing adolescents recall their past attitudes and describe their present attitudes towards their sibling with an ASD. METHODS: Thirty typically developing adolescents who have siblings with ASD were selected to complete the survey instrument, the Lifespan Sibling Relationship Scale, using a cross-sectional design. RESULTS: Results indicate that the measure has internal consistency within this sample. Wilcoxon signed-ranks tests were used to test for significant differences between the mean values for the two self-reported time periods. Friedman analysis of variances (ANOVAs) was used to test for significant differences in the three components of attitudes, namely affect, behaviour and cognition. Results indicate that participants held more positive attitudes towards their siblings with ASD as adolescents compared with when they were younger and that adolescents rated their current emotions towards and beliefs about their sibling with ASD to be more positive than their current interaction experiences. CONCLUSION: As siblings' attitudes appear to change over time, clinicians should use a lifespan approach to sibling attitudes when designing and implementing supports for siblings of children with ASD.

Primary school teachers' opinions and attitudes towards stuttering in two South African urban education districts.

BACKGROUND: As teachers form an important part of the intervention process with childrenwho stutter in primary school, the primary aim was to describe primary school teachers'attitudes in South Africa. The secondary aim was to compare teachers' attitudes towardsstuttering in South Africa with those from a pooled group of respondents in the Public OpinionSurvey of Human Attributes-Stuttering (POSHA-S) database from different countries collectedin 2009-2014. METHOD: A quantitative, cross-sectional survey research design was used. Primary schools intwo education districts in Western Cape, South Africa, were sampled. The POSHA-S, a selfadministeredquestionnaire, was completed by a cluster sample of 469 participants. RESULTS: Overall positive attitudes towards stuttering were found, specifically related to thepotential of people who stutter, although the result should be interpreted with caution as thesample was not homogenously positive. Teachers still had misconceptions about personalitystereotypes and the cause of stuttering. The attitudes of the South African sample were slightlymore positive compared with the samples in the current POSHA-S database. CONCLUSION: When developing stuttering intervention strategies, there are a number of keyconsiderations to take into account. The study provides a basis for speech-language therapiststo think about intervention with teachers and which areas of stuttering to consider.

Translucency ratings of Blissymbols over repeated exposures by children with autism.

The use of graphic symbols forms an integral part of augmentative and alternative communication (AAC) strategies, particularly for pre-literate children. Although some studies have indicated that typically developing children and those with autism are able to learn symbol meanings with multiple exposures to graphic symbols, little is known about how children with autism rate the degree to which the symbol represents its referent (translucency) with repeated exposures. The purpose of this study was to describe the translucency ratings of children with autism over three consecutive exposures. Twenty-two children with autism participated in a Blissymbol translucency task that included 40 symbols. The Blissymbol task was modified from Bornman, Alant, and du Preez (2009) , who explored the translucency of Blissymbols with typically developing children. Findings of this study indicated statistically significant differences in total translucency ratings of the Blissymbols by the children with autism between Day 1 and Day 3 (medium effect size) with Day 3 yielding more positive ratings than Day 1. No single Blissymbol showed statistically significant differences over the days. Findings are interpreted and further implications for research are discussed.

The ICF as a common language for rehabilitation goal-setting: comparing client and professional priorities.

BACKGROUND: Joint rehabilitation goals are an important component for effective teamwork in the rehabilitation field. The activities and participation domain of the ICF provides a common language for professionals when setting these goals. Involving clients in the formulation of rehabilitation goals is gaining momentum as part of a person-centred approach to rehabilitation. However, this is particularly difficult when clients have an acquired communication disability. The expressive communication difficulties negatively affect the consensus building process. As a result, obtaining information regarding rehabilitation goals from professionals and their clients warrants further investigation for this particular population. METHODS: This comparative study investigated clients and their assigned rehabilitation professionals' perception of the importance of ICF activities and participation domains for inclusion in their rehabilitation program. Twelve clients in an acute rehabilitation centre and twenty of their corresponding rehabilitation professionals participated in an activity using the Talking Mats™ visual framework for goal setting. Each participant rated the importance of the nine activities and participation domains of the ICF for inclusion in their current rehabilitation program. RESULTS: The ICF domains which consistently appear as very important across these groups are mobility, self-care and communication. Domains which consistently appear in the lower third of the rankings include spare time, learning and thinking and domestic life. Results indicate however that no statistical significant differences exist in terms of the individual domains across each of the participant groups. Within group differences however indicated that amongst the speech-language therapists and physiotherapists there was a statistical significant difference between spare time activities and communication and mobility. CONCLUSIONS: Findings indicate that consensus is possible amongst professionals and clients even within an acute-rehabilitation setting. In addition, the Talking Mats™ visual framework appears to be a valid protocol for including clients with acquired communication disabilities in the process of obtaining consensus during goal-setting.

Which graphic symbols do 4-year-old children choose to represent each of the four basic emotions?

The purpose of this study was to investigate which graphic symbols are perceived by typically developing 4-year-old children as the best representation of four basic emotions. Participants were asked to respond to questions by using graphic symbols taken from PCS, PICSYM, and Makaton for four basic emotions: happy, sad, afraid, angry. The purpose was to determine which graphic symbol the children selected as a representation of an emotion. Frequencies of choices per symbol were obtained and the different symbols were analysed in terms of facial features that distinguish them from each other. The most preferred symbol per emotion was also identified. Results showed that children recognized the emotion happy with more ease than the emotions sad, afraid, and angry.

Comparison of the learnability and retention between Blissymbols and CyberGlyphs.

BACKGROUND: There are a variety of graphic symbol sets/systems (GSSs) currently used in the field of augmentative and alternative communication (AAC). Various characteristics of these graphic symbol systems affect learnability and should be considered in order to make a meaningful match between the user of AAC and the system. Although a variety of studies on learnability of graphic systems have been conducted in the past, all studies conducted included participants from Western countries. AIMS: To compare two symbol systems, namely Blissymbolics and CyberGlyphs in terms of learnability. To identify the overall performance between Blissymbolics and CyberGlyphs in terms of the percentage of symbols correctly identified at the various stages. METHODS AND PROCEDURES: A quasi-experimental crossover design between groups was carried out on two homogeneous groups of typically developing, Northern Sotho-speaking children. Data were obtained by teaching 80 different referents (40 from each symbol system) to 50 Northern Sotho speaking regular students from South Africa, ranging from grade 4 to 6. The participants were tested on symbol recognition at four different stages: after initial training, after a revision period, after a 7-day withdrawal period and after 30 days of withdrawal. OUTCOMES AND RESULTS: The overall results indicated that the ease of learning and memory retention of the CyberGlyphs were higher than that of Blissymbols, irrespective of the group or the sequence of exposure. Possible reasons for the differences are discussed. CyberGlyphs seem to be more accessible as the symbols in general seem to be more detailed and also are meant to be hand drawn rather than computer or stencil produced. Within this context, CyberGlyphs could be easier to access visually than Blissymbolics, especially for children who do not have extensive experience in dealing with geometric shapes, particularly for the children who do not come from rich literacy backgrounds or who do not have rich visual perceptual experiences to draw from. CONCLUSIONS: Even though initial learning might be faster for CyberGlyphs than for Blissymbolics in certain populations, there may be other factors to consider when making a choice between the two graphic symbol systems. Within the clinical setting CyberGlyphs can provide the individual who uses AAC with a more user-friendly system as an entrance to the use of other graphic symbol systems. This may be especially important in contexts where issues surrounding poverty and lack of early exposure to literacy exist.