JCPSLP Vol 22 No 2 2020

Journal of Clinical Practice in Speech-Language Pathology Journal of Clinical ractic i Spe ch-L l

Volume 13 , Number 1 2011 Volume 22 , Number 2 2020

Learning from our clients

In this issue:

Parent perspectives on enhancing parent– child interactions Shared book reading between parents and siblings with ASD

Information accessibility and health literacy

Comparative analysis of stuttering severity rating scales

Working with toddlers with cleft palate

A case report of cryptococcal laryngitis

Low technology audit methods of pre- packaged thickened fluids

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Listening to our clients in a pandemic

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Kathryn McKinley Brooke Sanderson Alison Smith Bronwyn Sutton

JCPSLP Editor Editor Dr Leigha Dark c/- Speech Pathology Australia

Editorial Committee Emma Finch Rachael Unicomb Laurelie Wishart Cori Williams Shaun Ziegenfusz

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Learning from our clients

From the editor Leigha Dark

Contents

W elcome to the final issue of JCPSLP for 2020. And, oh what a year it has been. It seems fitting that we end on an issue that, rather than dwelling on challenges and barriers, celebrates the opportunities afforded for continuous listening, reflection and learning from others. Our theme for November 2020, is “Learning from our clients”. This theme acknowledges and explores the importance of seeking, prioritising, and responding to the experiences, perspectives, insights and expertise of the diverse client groups to whom speech pathologists offer service, not only during unexpected and unprecedented events, but as an integral part of practice. The articles included in this issue are complemented by a suite of standard journal

74 Parent perspectives on receiving support for enhancing parent– child interactions – Estelle Pretorius, Sally Clendon, and Tara McLaughlin 79 Shared book reading between parents and child siblings with autism spectrum disorder – Natalia Henderson-Faranda and Joanne Arciuli 85 The readers, the writers and the documents: A scoping review of the information accessibility and health literacy demands of allied health reports – Harmony Turnbull, Leigha Dark, Ian Skinner, and Bronwyn Hemsley 95 Comparative analysis of paper vs online stuttering severity rating scales used in the Lidcombe Program: A pilot study at a Regional Community Health Centre – Karen Missen, Addrienne Robinson and Amy Tucker 101 Working with toddlers with cleft palate: Learning from clients and families – Anna Cronin, Sarah Verdon, and Sharynne McLeod 111 Cryptococcal laryngitis: A case report of rare clinical manifestations of dysphagia and dysphonia – Rebecca Sexton, Sarah Fulton, and Bena Brown 116 Low technology audit methods of pre-packaged thickened fluids using the Bostwick Consistometer, the Line Spread Test and the Flow Test: A comparison of compliance – Jane Ross, Maria Schwarz, Marnie Seabrook, and Anne Coccetti 122 Ethical conversations: Listening to our clients in a pandemic – Trish Johnson and Nadia Marussinszky 124 Around the journals 125 Viewpoints: Learning from our clients – Rosalie Martin 126 Resource review 127 Top 10: Privileging client voices – A nne Breaks

columns, and each offers unique insight into how learning from clients occurs in different settings and contexts. In the first article, Estelle Pretorius, Sally Clendon, and Tara McLaughlin present feedback from parents regarding their experience of a training and coaching intervention. The findings reflect how parents acquire new knowledge and skill, the value of having space and time to plan and reflect, the importance of individualised coaching and support, and the impact of collaborative practice on positive family outcomes. In their paper, Natalia Henderson-Faranda and Joanne Arciuli explore the nature of shared book reading between parents and their children with autism spectrum disorder, and what can be learned about parental reading support from analysis of utterances within dyadic interactions. In the third article, Harmony Turnbull and colleagues present the findings of a scoping review exploring the accessibility of written allied health reports with a focus on the characteristics of the writers, the readers and the documents themselves. In the next article, Karen Missen, Addrienne Robinson, and Amy Tucker report on the findings of a comparative analysis of traditional paper-based stuttering rating systems, versus an online version. Seeking the perspectives of caregivers as to the clinical utility, accuracy and efficiency of each method, the authors describe how learnings from their clients will continue to inform service enhancements in their service setting. Our fifth article is a Clinical insights paper authored by Anna Cronin and colleagues, intended for SLPs new to working with young children with cleft palate. In their paper, the team translate findings from the international multiphase Toddlers with Cleft Palate Study into practice, and reflect on how different clinical and methodological approaches supported the prioritisation of client voices during their research and knowledge translation process. Rebecca Sexton, Sarah Fulton, and Bena Brown next present a case study of a rare clinical presentation of dysphagia and dysphonia, as a result of cryptococcal laryngitis. Through detailed description, this team share their own learnings from managing the case, and reflect on the importance of raising awareness among clinicians of this rare condition, its unusual clinical manifestation, and the speech-language pathologists’ role in the differential diagnosis and management of swallowing and voice sequelae for this patient population. In the final article of the issue, Jane Ross and colleagues present the findings of a pilot study in which three low technology audit methods were used to test compliance of pre-packaged thickened fluids. Reflecting on the levels of agreement between the methods, the team considers important clinical implications, not the least of which is, the impact of access to reliable and valid low technology audit methods on patient safety and satisfaction. I’d like to end this editorial by again extending my appreciation to all the authors who contributed their work to the journal, and to the Editorial Committee and the publications team who bring this publication together so ably. Next year we look forward to curating many more interesting and topical themes. Wishing everyone happiness, wellness, safety and peace. See you in 2021!

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Learning from our clients

Parent perspectives on receiving support for enhancing parent–child interactions Estelle Pretorius, Sally Clendon, and Tara McLaughlin

Capacity-building practices actively promote the skills and abilities of parents to provide development-enhancing learning opportunities for their child. Speech-language pathologists (SLPs) use parent-implemented interventions to enhance parent–child interactions, often using a training and coaching approach. In this article, we present feedback from three New Zealand parents of young children on the autism spectrum regarding their experience of a training and coaching intervention offered by an SLP. Parent feedback stems from a broader research project that explored the impact of an intervention targeting parents’ implementation of interaction promoting strategies and embedded naturalistic interaction practices. This article describes the significance of coaching parents to use more systematic and precise practices in their interactions with their child and how this approach could be applied in the context of speech-language services. E xperts in the field of early intervention for children on the autism spectrum advocate for the provision of naturalistic and responsive learning opportunities (Salisbury et al., 2018; Sandall, McLean, & Smith, 2000; Snyder, Hemmeter, Sandall, McLean, & McLaughlin, 2013; Snyder, Rakap, Hemmeter, McLaughlin, Sandall, & McLean, 2015). Naturalistic interventions address functional skills, offer targeted learning opportunities embedded in naturally occurring activities, and promote contextually meaningful learning (Snyder, McLaughlin, & Bishop, 2018). Sandall et al. (2000) concur that children learn essential skills in social communication and language when they participate in naturally occurring routines and activities. As parents are often referred to as children’s first teachers (McConachie & Diggle, 2007; Stephan & Manning, 2017), they can play an essential part in providing these targeted learning opportunities. The promotion of parents as capable communication partners has gained significant interest and support from speech-language pathologists (SLPs) and early intervention practitioners (Kemp & Turnbull, 2014; Meadan, Ostrosky,

Zaghlawan, & Yu, 2009; Roberts & Kaiser, 2011; Salisbury et al., 2018; Stephan & Manning, 2017). Ideally, families of young children on the autism spectrum engage in speech-language pathology services early on, as these services have been shown to be effective in improving the child’s social communication and language outcomes through active and meaningful parent engagement (Sandall et al., 2000; Wetherby & Woods, 2006). Furthermore, parent-led or parent-implemented interventions endorse the principles of family-centred practice, by engaging parents as collaborative partners in the delivery of early intervention services (Division for Early Childhood (DEC), 2014; Dunst, Boyd, Trivett, & Hamby, 2002; Dunst & Dempsey, 2007; Fitzgerald, 2004; Salisbury et al., 2018; Sandall et al., 2000; Woods, Wilcox, Frieman, & Murch, 2011). In the field of early intervention for young children on the autism spectrum, training and coaching interventions are promoted as opportunities for parent capacity-building and individualised support (McConachie & Diggle, 2007; Meadan et al., 2009; Ministry of Health and Education, 2016; Wetherby & Woods, 2006). Training and coaching support offered in naturally occurring family settings not only extends knowledge and promotes skill acquisition, but it also impacts on parents’ sense of empowerment and confidence (Dunst et al., 2002; Dunst & Dempsey, 2007). Salisbury and colleagues (2018) concur that individualised planning support and feedback from an early intervention specialist can be valuable when supporting parents in developing embedded practices. In response to the growing demand for effective and individualised support for parents of young children on the autism spectrum, there has been an increase in training and coaching interventions targeting parents as the agents of change (Fitzgerald, 2004; Stephan & Manning, 2017; Woods et al., 2011). Internationally recognised parent education programs such as the Hanen More Than Words Program (Weitzman, 2013), the Early Start Denver Model (Rogers and Dawson, 2010), and the DIRFloortime approach (Greenspan & Wieder, 2006) are widely used and have ecological validity. Furthermore, training and coaching programs that offer parents support through individualised planning, focused observation and practice, individualised feedback using video, and joint problem-solving have been shown to be effective in promoting the development and generalisation of skills (Rush, Shelden, & Hanft, 2003; Salisbury et al., 2018; Stephan, 2015; Stephan & Manning, 2017). Given that parents are encouraged to play such an important role in their child’s early intervention journey, it is

KEYWORDS AUTISM

SPECTRUM DISORDER EARLY INTERVENTION EMBEDDED INTERVENTIONS INTERACTION SUPPORT PARENT PERSPECTIVES TRAINING AND COACHING THIS ARTICLE HAS BEEN PEER- REVIEWED

Estelle Pretorius (top) and Sally Clendon

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necessary to investigate whether the training and coaching opportunities that are offered are viewed as supportive and helpful; not only to master the practices that are taught, but also to embed these practices successfully. Parent perspectives and experiences can yield valuable insights for practitioners such as SLPs. Leko (2014) explains that interventions that are perceived as useful, meaningful, and contextually appropriate, are likely to be implemented with accuracy and offer positive outcomes. Information that would be beneficial when offering interventions for young children on the autism spectrum include understanding the knowledge that parents gain through formal learning opportunities, and the impact of the individualised support they receive to implement and embed these strategies with precision in naturally occurring routines and activities. In this paper, we describe parents’ experiences with an embedded and naturalistic social communication intervention utilising a training and coaching approach. This was conducted as part of a broader practitioner-based research project (Pretorius, 2018) which explored three dimensions: (a) the impact of the training plus coaching intervention on parents’ use of naturalistic interaction practices with preschoolers on the autism spectrum, (b) the effect of parent-implemented naturalistic instruction on the acquisition of children’s early social communication skills, and (c) parents’ experiences and perceptions of the intervention and the use of naturalistic interaction practices. This paper focuses on informal parent narratives which were captured as part of the third dimension. A brief description of the methodology is provided. The overarching themes from the parent narratives are then described and supported by quotes. We then conclude with a discussion of the relevance of gathering and listening to parents’ perspectives and experiences, within the context of family- centred and capacity building practices in speech-language services for families of young children on the autism spectrum. Methodology Ethical considerations Ethical approval for the larger study, from which this data was drawn, was obtained from Massey University Human Research Ethics Committee. Participants Three parents and their preschool children ranging in age between 3 years, 2 months and 4 years, 8 months, were recruited from a waiting list at an early intervention centre in New Zealand. All child participants presented with a formal diagnosis of autism spectrum disorder, had English as the language medium at home, presented with normal hearing and vision, and presented with limited functional social communication skills, as per parent report. Details of the intervention The parent participants attended four 2-hour workshops plus received eight in-home coaching sessions with an emphasis on developing their competency in the use of interaction promoting strategies and naturalistic interaction practices, to encourage their child’s social communication skills. Interaction promoting strategies include the use of intentional pausing, tuning in to the child’s communication attempts and copying or matching the child’s interests, actions, sounds or words. These strategies were combined with naturalistic interaction practices whereby parents received support to create embedded learning opportunities (ELOs) and engage in complete learning trials

(CLTs) (Snyder et al., 2013; Snyder et al., 2015; Snyder et al., 2018) within daily routines and interest-based activities using a project-developed interaction plan. CLTs generally involve the use of planned or naturally occurring antecedents to elicit a target response from the child (target behaviour). The target behaviour is followed by either the parent providing a naturally occurring consequence (when the child uses the targeted skill) or additional help in the form of a prompt or cue and feedback (when the child does not use the targeted skill). During the workshops, parents learned how to individualise these strategies, plan for, and create development-enhancing interactions, while targeting the social communication goals they selected before the intervention started. Examples of child goals selected by parents at the start of the study included an increase in (a) the use of single words, (b) the functional use of spoken language or gestures, (c) social turn-taking, and (d) intelligible speech. Home coaching visits generally followed a sequence of steps based on the broader literature on coaching (Friedman, Woods, & Salisbury, 2012; Kemp & Turnbull, 2014; Stephan, 2015; Stephan & Manning, 2017). Strategies included the use of information sharing, focused observation, individualised feedback including video feedback, demonstration, problem-solving, reflection, and personalised action planning (Brown & Woods, 2016; Rush et al., 2003). Data collection and analysis The data collected relevant to the present article consisted of informal feedback received from parents after completing the training plus coaching intervention. A prompt-sheet with open-ended questions was used to collect narratives related to parents’ perspectives and experience with (a) embedded instruction practices, (b) the training and coaching intervention, and (c) changes in their interactive behaviour with their child. Parent responses were audio-recorded, transcribed, and then analysed using a general inductive approach to identify overarching themes (Thomas, 2006). Results The analysis of the parent narratives revealed themes related to knowledge and skill acquisition, having space and time to plan and reflect, receiving support for strategy use through coaching, and positive family outcomes. These themes will be discussed below with examples of parent voice. Knowledge and skill acquisition Parents reported that the workshops provided them with the knowledge they required regarding useful strategies to support their child’s use of spoken language. They also noted that the workshops offered them insights into the value of engaging their child in interest-based and naturally occurring activities. Parents confirmed that the training workshops equipped them with knowledge of what was required to create and plan for more naturalistic play opportunities. They felt inspired to take a more active interest in their child’s play by joining in and extending their child’s play ideas. One parent mentioned this: Knowing ways to speak to him, get down and play with him instead of trying to talk to him from a distance. Actually, sitting down and playing with him. I never really used to do that, sit down, and play with him that much, because I always thought he was happy on his own; just sort of left him to it. Parents talked about gaining knowledge in using meaningful language that reflected their child’s interest,

Tara McLaughlin

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more manageable. One parent pointed out a positive outcome from combining group training with personalised coaching was that they have seen “significant improvement in a short time as a result”. Although there were comments that the “techniques sound[ed] very complex at the beginning”, parents reflected on the competency they gained through regular practice and that it became “quite normal to do it”, and at that point, they saw improvement. One parent described the experience of integrating new knowledge in this way: The workshops were quite overwhelming in a sense that I was not able to integrate that [knowledge of naturalistic interaction practices i.e., ELOs and CLTs] into action, but you [SLP] coming here, and coaching me to do the stuff, has become a lot easier for me to understand. It is always the theory; interacting it and converting it into action [that] was a bit challenging, but as soon as I got there, it was quite an easy-flowing process. Parent reflections were supported through discussions based on the SLP’s observations of the parent–child interaction and through video feedback. Parents reported that watching the video of their planned interactions with their child provided them with opportunities for self-discovery and experience sharing, which they regarded as useful in gaining confidence. They felt that video feedback and focused observations were effective strategies to evaluate what they did well and to consider which strategies or skills they could target. Although two parents reported the video feedback as being overwhelming at the start, the general feedback from all parents was that it was beneficial in reflecting on how their use of interaction promoting strategies and naturalistic interaction practices enhanced their interactions with their child. One parent said: When I am playing, sometimes I don’t remember what I’ve said or what I am doing. But having the videos and looking back on them and actually seeing. I remember at the start of this; I was asking a lot of questions – closed kind of questions, either yes or no answers. It has been good to see it, knowing that is what I do and that is not really helping him. Coaching conversations naturally created opportunities for planning, reflection, and problem-solving of ways to embed naturalistic interaction practices into everyday activities and routines. One parent explained how the support from the SLP during home visits, equipped them to consider how they could apply CLTs during mealtimes and everyday conversations. The parent stated: I try and do the whole ABC thing, like “would you like chips or a biscuit?” and anything he is trying to do, I’ll try and make it, so it is a complete learning trial, even into everyday things to try and get him talking more. Positive family outcomes Parents reported seeing improvements in the child’s participation in everyday routines, increased understanding of spoken language, progress towards their child’s social communication goals, and improved behaviour. They also referred to improvements in family quality of life, which included a reduction in stress in their home, and feeling that their family life was more relaxed. Parents noticed changes in how they managed challenging behaviours at home, communicated expectations, and had a shared understanding of what to do. Families reported feeling more confident in participating in community activities and seeing

which involved the use of more descriptive and specific vocabulary, as well as learning that “the skill to describe things, encourages conversation”. They described how they learned about the benefits of engaging in interactions that were initiated by the child. One parent explained that they learned “to do what he [the child] is interested in, rather than trying to start something that is not really what he wants to do, because he is interested for longer when it is something he wants to do”. Parents shared how they discovered a variety of ways to interact and play with their child. By attending the workshops, they received valuable guidance on how to support their child’s use of targeted skills, using ELOs and CLTs. It was evident in parents’ comments that they had developed an understanding of the benefits of using embedded and naturalistic interaction practices. Here is an example of one parent explaining how they were using a CLT: I am talking about the ABC [complete learning trial], like when I make a comment [provide an antecedent] and he [child] repeats what I am saying [uses words, but does not use the targeted word], and then I affirm what he says, and then we go over it [provide additional help or a prompt], and when he doesn’t [no response from the child], I have that in the back of my mind that okay, we have to exit now [provide feedback] because obviously, he is not responding, so we will try it again later. Parent feedback about learning how to create CLTs and introduce ELOs, was overwhelmingly positive, reflected in their description of the intervention as being “amazing” and “incredible”. One parent commented, “I have loved it” and affirmed the usefulness of CLTs by stating, “just knowing how to try and start something and to keep it going, and the benefits of closing it off and giving praise at the end definitely helps.” Space and time to plan and reflect Parents shared that the training workshops not only provided them with the opportunity to acquire new skills but also offered them space and time to plan for and create an individualised plan while reflecting on how they would apply their skills in interactions with their child at home. They described the importance of a personalised intervention plan, but also mentioned that having devoted time to consider how they would embed these strategies within interest-based play activities at home, was very valuable. One parent mentioned: So, the Tuesday nights were great for actually thinking about what I do away from him as well, which was good and thinking about what I can do. Thinking about what we were discussing and then how it relates to my son. Another parent stated that: “It kind of gets you to do it; gets you to make time to play, to do different things, and a variety of things as well, not just do the same thing. I think if you plan it, you do it”. Support for strategy use through coaching Parents commented on the value of the home visits, as providing them with opportunities to put theory into practice. They reflected on how important it was for them to gain a better understanding of the concepts they learned formally, through practice and individualised guidance from the SLP. They recognised the value of receiving systematic guidance in the use of interaction promoting strategies and the implementation of ELOs and CLTs during the home visits. Specifically, the opportunity to receive individualised coaching from an SLP made strategy application at home

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Parent-implemented interventions often highlight the importance of offering regular opportunities to parents to practise using strategies, while receiving feedback on their implementation, either through direct observations or video feedback (Kemp & Turnbull, 2014; Meadan, Ostrosky, Zaghlawan & Yu 2009; Stephan, 2015; Stephan & Manning, 2017). When parents are encouraged to plan for and create learning opportunities for their child, they should also be given opportunities to practice, receive feedback, and reflect on their implementation of these practices. As parents gain confidence and competence, they are well- positioned to develop independent and generalised use of these strategies. Over the last decade, speech-language services have shifted from a therapist-led approach to an emphasis on family capacity-building practice, guiding SLPs to integrate parent-implemented interventions in their practice with families and ensure they offer built-in opportunities for training and coaching. Although embedded and naturalistic interventions are widely supported, the systematic nature of CLTs and ELOs has had limited attention in conventional speech-language services. This article highlighted that parents from this study were appreciative of the opportunity to gain knowledge and mastery in supporting their children with more systematic and precise practices, leaving them empowered and supported. Positive feedback from parents on their successful application of CLTs and ELOs in interactions with their child at home when given intensive training and individualised support has important implications for clinical use by SLPs who regularly support young children on the autism spectrum. Findings from this study suggest that parents can be supported in using more systematic practices in their interactions with their child and that SLPs are well placed to offer families these specialised training and individualised coaching interventions. This study has limitations in terms of validity and generalisability. Given that this study recruited a small sample of parent–child dyads, the results cannot be generalised to a larger population whose demographics and characteristics vary greatly. Furthermore, the informal feedback from parents in this study was collected by the primary researcher, who also implemented the intervention, which may have influenced the parents’ responses. This paper, therefore, highlights the need for more research into the impact of SLP interventions that offer parents opportunities to learn how to maximise naturally occurring activities and routines, and successfully and independently embed naturalistic interaction practices. Summary and conclusions This paper provides SLPs with unique insights into the perspectives and experiences of a small group of parents who participated in an embedded social communication intervention. Parent feedback highlighted the value of intensive training paired with individualised coaching support to not only enhance their interactions with their child, but also achieve positive child and family outcomes. For SLPs, this article has emphasised the value of integrating training and coaching opportunities for parents of young children on the autism spectrum into their practice, in particular offering parents individualised support in applying and generalising interaction promoting strategies and naturalistic instructional practices into their routines and activities at home. We have learned from parents that they value gaining knowledge of using more systematic practices, but they also value having 1:1 coaching support

improvements in the way they talked with their partners about their child’s communication needs. One parent confirmed, “I think even in my relationship with my husband; we are both calmer as well. We have more harmony; we have better communication around things.” Another parent noted that they had seen changes in their child’s behaviour in other community settings, for example, “even his Daycare has said it has been like a switch for him, overnight he is talking more.” All parents spoke about seeing positive differences in their child’s social communication skills and specifically noted increased use of spoken language within everyday activities. Discussion Data generated from informal conversations with parents offered valuable insight into how useful parents found the combined experience of gaining knowledge of embedded and naturalistic interaction practices through workshop training, and receiving individualised coaching support provided by the SLP. Parents described their experiences of learning how to plan for, and implement more systematic, and precise interaction practices during naturally occurring and interest-based interactions with their child. The intervention yielded positive child and family outcomes, as reported by parents. A core component of the intervention was to train and coach parents to use naturalistic interaction practices. Parents reflected positively on their experiences of learning to use ELOs and CLTs in their interactions with their child. They perceived that gaining knowledge and experience in creating and implementing ELOs and CLTs enabled them to capitalise on natural learning opportunities, which in turn resulted in positive outcomes for the child. This finding aligns with research evidence that children are more likely to gain targeted skills when the structure and predictability of interactions are increased (Salisbury et al., 2018; Sandall et al., 2000; Snyder et al., 2013; Snyder et al., 2015; Snyder et al., 2018). Parent feedback also suggests that they valued gaining knowledge about embedded and naturalistic interaction practices through SLP facilitated workshops paired with receiving individualised feedback in their use of more systematic and precise practices within their interactions with their child at home. Individualised planning and discussions during the workshops were reported as being helpful in supporting them to reflect on how they could use ELOs and CLTs with their child at home. Furthermore, follow-up individualised coaching from an SLP brought the knowledge to life when they received scaffolding to integrate their learned knowledge of naturalistic interaction practices such as ELOs and CLTs in their home environment. One of the insights offered by parents was that individualised coaching improved their understanding of, and confidence with using more systematic and precise practices. Parents acknowledged that the workshop content related to ELOs and CLTs were overwhelming and complicated at the beginning, but opportunities for individualised planning and coaching support including video feedback from an SLP during the home visits made it more manageable. This finding suggests that, in addition to gaining knowledge, parents need access to individualised support to become confident and develop competency in applying this knowledge. This finding is echoed in the literature on parent capacity-building practices where coaching and individualised planning are considered critical for supporting independent use of a set of skills with the end of goal of empowerment (Mataiti, van Bysterveldt, & Miller, 2016; Stephan, 2015; Stephan & Manning, 2017).

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collaboration on natural settings. Infants and Young Children , 16 (1), 33–47. Salisbury, C., Woods, J., Snyder, P., Moddelmog, K., Mawdsley, H., Romano, M., & Windsor, K. (2018). Caregiver and provider experiences with coaching and embedded intervention. Topics in Early Childhood Special Education , 38 (1), 17–29. Sandall, S., McLean, M. E., & Smith, B. J. (2000). DEC recommended practices in early intervention/early childhood special education . Longmont, CO: Sopris West. Snyder, P., Hemmeter, M. L., Sandall, S., McLean, M., & McLaughlin, T. (2013). Embedded instruction practices in the context of response to intervention. In V. Buysse & E. Peisner- Feinberg (Eds.), Handbook of response-to-intervention in early childhood (pp. 283–300). Baltimore, MD: Brookes. Snyder, P.A., McLaughlin, T., & Bishop, C. (2018). Maximizing contextually relevant learning opportunities through embedded instruction. In P. A. Snyder & M.L. Hemmeter (Eds.), Instruction: Effective strategies to support engagement, learning, and outcomes (DEC Recommended Snyder, P. A., Rakap, S., Hemmeter, M. L., McLaughlin, T. W., Sandall, S., & McLean, M. E. (2015). Naturalistic instructional approaches in early learning: A systematic review. Journal of Early Intervention , 37 (1), 69–97. Stephan, T. (2015). Coaching parents: Are we ready? https://www.hanen.org/SiteAssets/Articles---Printer- Friendly/Clinical---Program-Support/Printer-Friendly--- Coaching-Parents-Are-We-Ready.aspx Stephan, T., & Manning, K. (2017). Parent-implemented early language intervention: What really works. http://www. hanen.org/Helpful-Info/Presentations-and-Whitepapers. aspx Thomas, D. R. (2006). A general inductive approach for analysing qualitative evaluation data. American Journal of Evaluation , 27 (2), 237–246. Weitzman, E. (2013). More than words: – The Hanen Program for parents of children with autism spectrum disorder: A teaching model for parent-implemented language intervention. Perspectives on Language Learning and Education , 20 (3), 96–111. Wetherby, A. M., & Woods, J. J. (2006). Early social interaction project for children with autism spectrum disorder beginning in the second year of life: A preliminary study. Topics in Early Childhood Special Education , 26 (2), 67–82. Woods, J., Wilcox, M., Friedman, M., & Murch, T. (2011). Collaborative consultation in natural environments: Strategies to enhance family-centred supports and services. Language, Speech, and Hearing Services in Schools , 42(3), 379–392. Estelle Pretorius is a speech-language therapist at the McKenzie Centre and a PhD candidate in the School of Education at Massey University. Sally Clendon is a senior lecturer in speech and language therapy in the School of Education at Massey University. Tara McLaughlin is a senior lecturer in early years in the School of Education at Massey University. Practices Monograph Series No. 4, pp. 51–64). Washington, DC: Division for Early Childhood.

in applying these strategies with more precision during every day routines and activities. By offering parents such learning opportunities, SLPs are engaging in family capacity-building practices and promoting parent– practitioner partnership. References Brown, J. A., & Woods, J. J. (2016). Parent-implemented communication intervention: Sequential analysis of triadic relationships. Topics in Early Childhood Special Education , 36 (2), 115–124. Division for Early Childhood. (2014). DEC recommended practices in early intervention/early childhood special education 2014. https://www.dec-sped.org/rp-mono-base Dunst, C. J., & Dempsey, I. (2007). Family–professional partnerships and parenting competence, confidence, and enjoyment. International Journal of Disability, Development and Education , 54 (3), 305–318. Dunst, C. J., Boyd, K., Trivette, C. M. and Hamby, D. W. (2002). Family-oriented program models and professional help giving practices. Family Relations, 51 (3), 221–229. Fitzgerald, D. (2004). Parent partnerships in the early years . London, UK: Bloomsbury Publishing Friedman, M., Woods, J., & Salisbury, C. (2012). Caregiver coaching strategies for early intervention providers: Moving toward operational definitions. Infants & Young Children , 25 (1), 62–82. Greenspan, S. I., & Wieder, S. (2006). Engaging autism: Using the Floortime approach to help children relate, communicate and think . UK: De Capo Lifelong Books. Kemp, P., & Turnbull, A. P. (2014). Coaching with parents in early intervention. Infants & Young Children , 27 (4), 305–324. Leko, M. M. (2014). The value of qualitative methods in social validity research. Remedial and Special Education , 35 (5), 275–286. Mataiti, H., van Bysterveldt, A., & Miller, J. (2016). Changing roles and responsibilities: The development of coaching in early intervention education settings, in Aotearoa New Zealand. New Zealand Research in Early Childhood Education , (19), 15-31. McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice , 13 (1), 120–129. Meadan, H., Ostrosky, M. M., Zaghlawan, H. Y., & Yu, S. (2009). Promoting the social and communicative behavior of young children with autism spectrum disorders: A review of parent-implemented intervention studies. Topics in Early Childhood Special Education , 29 (2), 90–104. Ministry of Health and Education. (2016). New Zealand autism spectrum disorder guideline (2nd ed.). Wellington, New Zealand: Ministry of Health. Pretorius, E. (2018). The impact of a parent-implemented naturalistic social communication intervention for pre- schoolers on the autism spectrum: A training plus coaching approach (Master’s thesis). Massey University. Retrieved from: http://hdl.handle.net/10179/15197 Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta- analysis. American Journal of Speech-Language Pathology , 20 , 180–200. Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement . New York, NY: Guilford Press. Rush, D. D., Shelden, M. L. L. & Hanft, B. E. (2003). Coaching families and colleagues: A process for

Correspondence to: Estelle Pretorius McKenzie Centre Hamilton, New Zealand email: Estelle.Pretorius.1@uni.massey.ac.nz

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Learning from our clients

Shared book reading between parent and child siblings with autism spectrum disorder Natalia Henderson-Faranda and Joanne Arciuli

The development of literacy skills in children with autism spectrum disorder (ASD) is an area of growing interest for educators and speech-language pathologists (SLPs). This study explored the nature of shared book reading (SBR) between parent–child dyads in two families, each of which had two primary school age siblings with ASD. Mothers’ utterances during dyadic SBR with each child were analysed in terms of utterance type: praise, error correction or book-related. Results indicated that, within each family, parents of children with ASD use different proportions of utterance types with each of their children during SBR interactions. Implications for educators and clinicians working on literacy development with this population, and further avenues for research, are discussed. L iteracy skills are important for educational and vocational achievement (Torgesen, 2002), and are increasingly necessary in the social sphere, for example, with the proliferation of social media platforms, emails and texting. Reading is a core literacy skill that requires explicit instruction and can be an area of weakness for many children with developmental disorders such as autism spectrum disorder (ASD; Arciuli, Villar, Colmar, Evans, Einfeld & Parmenter, 2013; Brown , Oram-Cardy, & Johnson, 2013; Nation, Clarke, Wright & Robinson, 2006). Shared reading (SR) is an activity involving a child and partner (usually parent or teacher) reading a book together. The benefits of SBR for children’s literacy development have been well documented (Bus, van IJzendoorn, & Pellegrini, 1995; Piasta, Justice, McGinty, & Kaderavek, 2012), and encompass positive impacts on children’s ability to decode and comprehend written text. The Simple View of Reading model suggests that decoding and comprehension are the two fundamental components of reading ability (Gough & Tunmer, 1986). SBR has been shown to enhance decoding (e.g., phonological awareness) and comprehension (e.g., vocabulary) skills in children (Swanson et al., 2011), setting them up for later reading success (see review by Sénéchal & LeFevre, 2001). Language and literacy are also known to be closely related, with strong oral language skills

providing an important foundation for both decoding and comprehension in reading (Nation & Snowling, 2004). Feedback (including praise, clarification questions, error correction, etc.) has been shown to promote children’s learning when appropriately balanced and paired with effective instruction (Hattie & Timperley, 2007), and SBR is a naturalistic setting in which parents can provide feedback to their children. Praise as an element of parent behaviour has been a subject of interest in the research on reading instruction for several decades. Specific, contingent, and timely praise can promote improvement in reading skill for children with reading difficulties. The Pause, Prompt, Praise (PPP) procedure is aimed at parents, teachers, and peers of struggling readers (McNaughton, Glynn & Robinson, 1987) and features provision of reading material at an appropriate level for the reader and increased positive feedback given to the child during reading. Given the involvement of parents in shared reading activities with their children, researchers have been interested in the nature of parent behaviours during SBR and the impact on literacy development of neurotypical preschool children (Hammett, van Kleeck, & Huberty, 2003; van Kleeck & Beckley-McCall, 2002), and more recently children with ASD (Fleury & Hugh, 2018; Tipton, Blacher, & Eisenhower, 2017; Westerveld, Paynter, & Wicks, 2020). Hammett et al. (2003) analysed the nature of parent utterances during SBR interactions in 96 middle-income parent–child dyads. Child participants were aged between three years and four months and four years and one month. Participants were provided with unfamiliar books and parents were asked to read to their child as they would in a normal reading interaction at home. Interactions were video-recorded, then parent extra textual utterances were categorised into print and book convention utterances (e.g., “What letter does this word start with?”), behaviour management and feedback utterances (e.g., “Come and sit back down”) and story content related utterances (e.g., “He tried”). This latter category was further categorised into four groups according to the level of abstraction (discussion extending beyond the text). This categorisation was adapted from Blank’s levels of questions (Blank, Rose & Berlin, 1978), with low level abstraction utterances such as “Who did X?” and high level abstraction utterances such as “Can the bear really fly?”. The largest group of parents ( n = 60) demonstrated a limited number of utterances across all categories, although they used utterances at both low and high levels of abstraction. The findings indicate that SBR in some families may not be as interactive as the activity’s

KEYWORDS AUTISM AUTISM SPECTRUM DISORDER (ASD) HOME-BASED

LITERACY LITERACY READING SIBLINGS

THIS ARTICLE HAS BEEN PEER- REVIEWED

Natalia Henderson- Faranda (top) and Joanne Arciuli

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name suggests, and that opportunities for likely benefits to child language development may be missed. An exploratory study by van Kleeck and Beckley-McCall (2002) examined parent–child SBR interactions with five families, each with two neurotypical different-aged preschoolers. Two conditions were observed: individual (parent–child dyads) and simultaneous reading (parent and both children). Parent behaviours during SBR (mediation strategies where guidance was provided while the child read) were coded according to a four-level coding scheme, and linguistic complexity of the text and time spent were recorded. Results indicated that book complexity, time spent and level of abstraction of parent utterances were all higher in the dyadic interactions with older children. The number of mediation strategies per minute and attempts to get and maintain attention (e.g., parent directing the child’s attention to the book, by saying “Look!”) were higher in dyadic interactions with the younger children. The simultaneous condition varied between families, with some parents showing a similar approach to the interaction with their older or younger child, while others used a combination of strategies. This suggests that the approach parents adopt during SBR is likely to differ between families. Previous studies of SBR have also revealed a relationship between a child’s reading skills and the type and frequency of feedback provided. For example, Tracey and Young (2002) analysed the SBR interactions of 76 third grade students and their parents. Findings indicated that children with poorer reading skills received more corrective feedback from their parents. In light of other research (Baker, Mackler, Sonnenschein, & Serpell, 2001), it is likely that an excess of corrective feedback may lead to a less enjoyable reading experience for the child. In addition, a gender pattern emerged: there were a greater number of verbal contributions in interactions between mothers and daughters than those between mothers and sons. This potentially places girls at an advantage in terms of benefiting from SBR in vocabulary, comprehension, oral language and syntactic development. Parent use of praise and error correction are therefore worthwhile avenues for investigation in SBR research in primary school age children with ASD. ASD and reading Within the ASD population there is a wide diversity of oral language abilities (Kjelgaard & Tager-Flusberg, 2001) and reading abilities (Bailey & Arciuli, 2020; Nation et al., 2006; Norbury & Nation, 2011). Some children with ASD present with weak oral language skills which puts them at risk of literacy difficulties (e.g., Bishop & Snowling, 2004; Clarke, Snowling, Truelove, & Hulme, 2010). In some cases, children may present with stronger decoding skills relative to their comprehension skills (Arciuli et al., 2013; Nation et al., 2006). In addition to oral language ability, poorer reading comprehension skills in children with ASD are also likely to be influenced by the social and communication challenges that characterise the condition (Ricketts, 2011). Despite the relatively high rate of literacy difficulties (between 7–10%; Lucas & Norbury, 2014) in children with ASD, little is known about the impact of different parental strategies on supporting and expanding their child’s literacy development through SBR interactions. This is especially the case in children of primary school age who have commenced formal reading instruction. Some recent studies have explored SBR with preschoolers with ASD. Tipton and colleagues (2017) investigated the nature of parent behaviours during an

adapted SBR activity with children with ASD in a clinic setting. Participants were 111 children (aged between 4 and 7 years 3 months) and their parents. Parent–child dyads were observed sharing four wordless books (selected to accommodate a range of child verbal and reading abilities), and parent feedback (comments/ questions) was coded and analysed for use of language elicitation strategies. These results were then compared with various developmental domains for each child based on standardised assessments: social skills, IQ, and behaviour. The authors found positive correlations between parent use of clarification techniques during SBR and a child’s social skills, and negative correlations between child IQ and amount of parent feedback during SBR (lower IQ was associated with greater parent feedback). Tipton et al. (2017) proposed a possible link between certain types of parent feedback and child social communication development, as well as a need for greater scaffolding investigating SBR practices between caregivers and their children, with a group of children with ASD as well as a neurotypical control group (aged between 3 and 5 years). The authors found that children on the autism spectrum presented with lower levels of passive engagement such as looking at the book, and higher levels of non-engaged behaviours (such as the child not attending to the book or exhibiting behaviour that impacts their ability to attend to reading) in comparison to the neurotypical group. Participants with ASD demonstrated the highest levels of joint engagement when reading familiar books. Westerveld et al. (2020) examined SBR interactions between 47 preschoolers (aged between 48 and 70 months) with ASD and their parents using two unfamiliar books. These authors extended the research base by analysing parent feedback and strategies used during SBR as well as child utterances. Findings suggested that parents used a range of print- and meaning-based feedback with their children, not favouring one approach over the other. Parents’ use of explicit teaching of story grammar and questioning was associated with greater verbal participation from the child. Although mostly involving preschool age participants, the studies described above indicate that SBR is an activity that families are likely already engaging in with their children, making it an ideal two-way avenue for a rich language exposure to take place. The results from these studies together support existing research that parents of children with ASD play a vital role in social, language, and literacy development. However, despite the recent research in SBR with this population, an area that remains largely unexplored is the way in which SBR might be similar or different for primary school aged children with ASD within the same family (e.g., siblings) in the home environment. Although there have been some recent studies of SBR in preschool children with ASD, a review of the literature revealed a dearth of evidence in the area in primary school aged children with ASD. While there has been some investigation of SBR interactions in families with neurotypical siblings (e.g., van Kleeck & Beckley-McCall, 2002) and with preschool children with ASD (Westerveld et al., 2020), as far as we are aware no previous study has examined the differences in SBR interactions between parent–child dyads that include primary school aged children who are siblings with ASD within the same family. during SBR for children with ASD and lower IQ. In 2018, Fleury and Hugh conducted a study

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