News and Knowledge

In October, OAR’s Board of Directors authorized funding for six new applied autism research studies in 2018. These new grants, totaling $176,090, bring OAR’s total research funding to over $3.6 million since 2002. This is the sixth of six previews to be featured in The OARacle this year.

In South Africa, more than 7,500 children with autism spectrum disorder (ASD) are born each year. Yet there are only nine specialized autism treatment centers in the whole country. As a result, many children are not receiving specialized intervention services at all, and even those who do typically receive a limited amount of therapy. One of the key limitations is the lack of professionals to provide services. Specifically, there is a need for trained speech language therapists to serve the needs of the diverse multicultural and multilingual population.

Through her OAR-funded research study, Ann Kaiser, Ph.D., a professor of education and development at Vanderbilt University and a staff scientist and director of the Communication Development Lab at Vanderbilt, will examine a model that may help meet the need. “EMT in South Africa: Training Speech Language Therapists in Early Intervention for Children with ASD” will demonstrate how a systematic, distance collaboration between local South African professionals and experts in the United States can be used as a training model to effectively train speech language therapists in a developing country.

Study Format

Dr. Kaiser will develop, research, and implement a distance training model that so that her U.S.-based team can train a trainer in Enhanced Milieu Teaching (EMT). EMT has proven to be effective at improving communication skills in young children with ASD. It is described as a “naturalistic model of early language intervention in which children’s interests and initiations are used as opportunities to model and prompt language use in everyday contexts.”

A local doctoral-level speech language therapist will train three fourth-year speech language therapy student-clinicians who are multi-lingual in EMT. Those therapists can then train local speech therapists, teachers, and parents. Known as a cascading training model, this method supports training for culturally and linguistically diverse professionals who may otherwise not have access to training in a specific content area. The training will consist of three phases:

• Increasing matched turns: Matching language to the child’s language targets helps the child learn language more quickly.
• Expansions: Adding target words helps to connect the child’s communication to additional new language.
• Implementing EMT prompts: Prompts are signals to the child to do or say something.

The research team in South Africa will recruit six children with ASD between the ages of 3 and 7; three will participate in intervention sessions and three will participate in generalization probes. The children must exhibit limited spoken language to qualify for the study.

Each of the three phases of training, consisting of eight sessions each, will begin with a didactic workshop to explain the rationale and provide video examples of the phase-specific goal. The trainer will then use an approach known as Teach-Model-Coach-Review (TMCR) to teach the student clinicians each strategy during 30-minute one-on-one play sessions with the child participant. The trainer will review the target strategy and model that strategy directly with the child. Then, she will coach and support the student-clinicians while the clinician works directly with the child. Finally, the trainer and student-clinician will review the session together, evaluate the use of EMT and the child’s communication, and plan for the next session.

During the study, Dr. Kaiser and the project coordinator, who are both based in the United States, will exchange feedback via email after each session and weekly calls via Skype for the trainer on her use of the TMCR training approach and for the student-clinicians on their use of the EMT strategies.

Evaluation

Evaluation will occur at six levels:

1. Establishment of baseline characteristics for the trainer, student clinicians, and children will describe the populations to which the findings can be generalized.
2. Delivery of the intervention by the trainer: A checklist will be used to evaluate fidelity to TMCR procedures.
3. Continuous assessment of implementation of the EMT procedures by the student clinician and communication by the child participants with ASD will be done via coded videos of each session.
4. Pre/post measures of child language will evaluate whether the children’s communication ability improved.
5. Statistical analysis of the observational data will verify the effects reported based on the visual analysis.
6. Summary data on social validity will be collected via student-clinician questionnaires as well as through evaluation by 10 speech-language therapy students not involved in the training and blind to the hypotheses of the study.

Outcomes

The findings of this study will:

• Determine the effectiveness of a collaborative distance-training model to train speech language therapy student-clinicians in a developing country to implement an evidence-based communication intervention with children with ASD.
• Demonstrate whether a supported cascading training model is effective for these purposes.
• Potentially demonstrate that TMCR is an effective model for training speech language therapy student-clinicians locally in South Africa to use EMT and other evidence-based practices.

Alternative models of service delivery could improve the access to evidence-based intervention services for children with ASD in South Africa. Intervention approaches that can be implemented in contexts other than the hospital-based clinics may be a useful alternative. Dr. Kaiser hopes that this study will help lay the foundation for creating and implementing alternative models of service delivery for children with ASD in South Africa and other developing countries.