Responsive Teaching Parent-Mediated Developmental Intervention

1. Responsive TeachingParent-Mediated Developmental Intervention Gerald Mahoney, Ph.D. Frida Perales, M.Ed. Mandel School of Applied Social Sciences Case Western Reserve University gjm14@po.cwru.edu

2. Goal for Today’s Presentations • Introduction to Responsive Teaching Curriculum • Rationale • Instructional Strategies For Working With • Children – Responsive Teaching Strategies • Parents-Intervention Topics • Intervention Procedures • Planning And Tracking • Research Findings On The Impact Of RT On • Socio-Emotional • Developmental Functioning

3. Responsive Teaching-A Different Approach Intervention Goals & Objectives • Intervention Topics • Cognition • Communication • Socio-Emotional • Motivation • Motor Responsive Teaching Strategies Reciprocity Contingency Control Affect Match Family Action Plans Responsive Parental Interactions Pivotal Behaviors Child Development

4. #1 Reason to Use Responsive Teaching:IT WORKS!!! • 50 Children with Developmental Disabilities Including 20 Children with Autism/PDD • MCA = 26 Months • One Year of Weekly Parent-Child Intervention Sessions

5. RT Derived From Research on Parental Influences on Children’s Development • Responsive Parent-Child Interaction is the most consistent predictor of early developmental outcomes for • Children At-Risk • Variability from Above Normal to Problem/Disability Range • IQ • Verbal Ability • Mental Health /Behavioral Problems • Children with Disabilities • Variability from Low Normal Problem/Disability Range • IQ • Verbal Ability • Mental Health /Behavioral Problems • All Children – Including Children From Different Cultural and Racial backgrounds

6. RT Has Evolved From Relationship-Focused Intervention • Encourage parents to use patterns of interaction which developmental research has found to be related to children’s development • INREEL, Hanen • ECO Model – MacDonald TRIP/ High\Scope Infant Toddler • Greenspan – Floor Time • Designed to Address Problems Encountered With Previous Approaches • More Focused on Child Outcomes • Clearly Defined Intervention Strategies • Better Integration with Contemporary Developmental Theories From Across Domains • Simplified Procedures For Intervention Planning and Tracking • Designed to Be Compatible with EI Best Practice Guidelines • Family Centered Practice /Natural Environments

7. Key to the Effectiveness of Responsive Teaching • Mothers Learned to Use Responsive Teaching Strategies During Daily Routines with Their Children • Responsive Teaching Strategies Helped Mothers Engage in More Responsive Interactions with their Children

8. What Is Responsiveness • Parents’ Style of Interaction • How Parents Typically Interact with their Children Across Daily Routines • Determined by a Complex Set of Factors • Beliefs About Child Development • Beliefs about the role they play in their child’s development • Understanding of their child’s disability • Affected by multiple psychosocial factors

9. Using The Maternal Behavior Scale to Identify Differences in Mothers’ Interaction Responsiveness Awareness and understanding of child’s activity or play interests Appropriateness and consistency of parent’s responses to the child’s behaviors Ability of the parent to engage the child in the play interaction. • Sensitivity to Interest • Responsivity • Effectiveness

10. Using The Maternal Behavior Scale to Identify Differences in Mothers’ Interaction Directiveness • Pace • Directiveness The parent’s rate of behavior considered independently of the child’s behavior. The frequency and intensity of parent requests, commands, or other manners to direct the child’s behavior

11. Characteristics Associated with Responsiveness DIMENSION STRATEGIES Engagement , Balance Joint Action Routines Reciprocity Sensitivity, Timing Intent, Frequency Contingency Moderate Direction Facilitation Control Animation, Enjoyment Warmth, Acceptance Affect Developmental Match Interest Match Behavioral Style Match Match

12. Responsive Teaching Strategies

13. How Do You Promote Responsiveness? • Talk about the importance of responsiveness • Model interacting Responsively with the child throughout a session • Help parents deal with stress and other problems that may interfere with their interactions with their children • Teach parents to use Responsive Teaching strategies • Learn by doing!!

14. Responsive Teaching Strategies • RT strategies help adults think about, monitor and modify the way they interact with their children during routine encounters or play activities • 66 Strategies • Organized according to the component of responsiveness that a strategy encourages parents to develop • Provide interventionists a variety of alternatives for helping parents interact more responsively with their children

15. Components of Responsiveness DIMENSION STRATEGIES Engagement , Balance Joint Action Routines Reciprocity Sensitivity, Timing Intent, Frequency Contingency Moderate Direction Facilitation Control Animation, Enjoyment Warmth, Acceptance Affect Developmental Match Interest Match Behavioral Style Match Match

16. Responsive Teaching Strategies • Engagement • Be physically available and interactive • Balance • Take one turn and wait • Joint Action Routines • Sustain repetitive play or action sequences • Awareness • Take the child’s perspective • Timing • Respond quickly to your child’s signals, cries or nonverbal requests • Intent • Respond to unintentional vocalizations, facial displays and gestures “as if” they were meaningful • Frequency • Encourage multiple caregivers to use responsive strategies • Moderate Direction • Give your child frequent opportunities to make choices • Facilitation • Expand to show the child the next developmental step

17. Responsive Teaching Strategies • Animation • Respond to the child in playful ways • Enjoyment • Repeat activities your child enjoys • Warmth • Comfort your child when fussy, irritable or angry • Acceptance • Value what your child is doing • Developmental Match • Interpret the child’s behavior developmentally • Interest Match • Read my child’s behavior as an indicator of interest • Behavioral Style Match • Have expectations that conform to your child’s behavioral style/Anticipate your child’s reactions

18. How Does Responsiveness Promote Development?

19. Discrete Skills • EI and Speech Pathology have a long tradition of conceptualizing competence as the discrete skills that characterize higher levels or more adaptive/appropriate functioning • Intervention (IEP/IFSP) goals are the discrete behaviors that characterize higher levels of functioning that a child needs to know • Discrete Skill intervention goals can best be promoted through directive instruction. • Children are unlikely to learn behaviors they do not know unless they are guided and directed to learn them

20. Discrete Skills Developmental Model Cognition Communication Socio-Emotional Adaptive Functioning Enhanced Child Development Modeling, Shaping Prompting Elicited Imitation Rote Repetition Directive/Didactic Teaching DEVELOPMENTAL SKILLS Cognitive Skills, Communication Skills Social Skills, Behavioral Skills Adaptive Behavior Skills Discrete Behaviors

21. Questions About Discrete Skill Intervention Objectives • If we successfully teach a discrete skill to a child with (mental retardation, developmental delays), is s/he: • Less (developmentally delayed, autistic) • Or • A child with (developmental delays/ Autism) who knows another skill? • How many skills do we have to teach children with developmental delays before we attain success? • Can we teach children with (Mental Retardation/ Developmental Delays) everything they need to know? • Why is it so hard for children with (mental retardation/developmental delays) to remember and or use the skills we teach them?

22. But Responsive Interactions Do Not Promote Discrete Skills (Kaiser, et. al., 1996)

23. How Does Responsiveness Enhance Development? • Responsive Interactions • Associated with higher levels of • Language and Cognitive Development • Socio-emotional functioning • But Ineffective at Teaching Discrete Developmental Skills • The Predominant Focus of EI • But Responsiveness Encourages Children to Become More Actively Engaged in Social and Non-Social Activities

24. Responsiveness Encourages Child Engagement:Mother/Child

25. Responsiveness Encourages Child Engagement:Teacher/Child Behavior (n=48)

26. Child Behavior Rating Scale • Attention- the extent to which a child attends to an activity • Persistence –the degree to which a child participates in activities • Involvement- the intensity with which the child is involved in an activity • Initiation – the extent to which the child initiates activities • Cooperation- the degree to which a child attempts to comply with the requests or suggestions of the adult. • Joint attention- the extent to which the child attends to the adult • Affect – the general emotional state of the child during the interaction

27. The Child Behaviors Responsiveness Promotes Are Pivotal Behaviors • Pivotal behaviors are “behaviors that are central to wide areas of functioning such that a change in the pivotal behavior will produce improvement across a number of behaviors”. (Koegel, Koegel & Carter, 1999 p. 577, School Psychology Review) • Learning Processes • Learning Habits.

28. Children’s Use of Pivotal Behaviors Are Associated with Higher Levels of Development

29. Responsive Interaction is Developmental Teaching • Adults’ (Caregivers’) style of interacting reflects their personal, cultural and religious values • BUT the way adults interact with children helps children learn the behaviors that are the foundation for development • Interactive principles are equally applicable across cultural groups • Adults promote development by TEACHING children the Pivotal Behaviors that enhance learning each time they interact with their children • Habit Formation

30. Responsive Teaching Promotes Development by Enhancing Children’s Pivotal Developmental Behaviors Responsive Teaching Pivotal Developmental Behaviors Child Development

31. Responsive Teaching Promotes Developmental Learning By Encouraging Pivotal Behaviors For Multiple Developmental Domains • Motivation • Interest/ Curiosity • Persistence • Control • Self Confidence • Enjoyment • Learning (Cognition) • Social play • Child Initiation • Exploration/ Manipulation • Problem Solving • Communication • Joint Activity • Joint Attention • Vocalization • Intentionality • Conversation • Socio-Emotional State • Trust/Attachment • Empathy • Cooperation • Self Regulation

32. Responsive Teaching Is A Holistic and Multidisciplinary Model • Responsiveness Promotes Each of The Major Developmental Domains • The Same Responsive Strategies That Promote One Area Of Development Simultaneously Promote Others Areas Of Development • When An Interventionist Targets One Area Of Development, She Is Simultaneously Supporting Other Developmental Domains

33. The Role of Parents In Responsive Teaching

34. Parents are the Key to Intervention Effectiveness • Increasing Evidence that the Effectiveness of Intervention is Directly Dependent upon Parent Involvement • Examined outcomes 7 intervention studies • Almost 800 children at-risk/ with disabilities • First Published • Mahoney, Boyce, Fewell, Spiker & Wheeden, 1998 ,TECSE • Findings • If early intervention enhances parents’ responsiveness to their children, intervention promotes children’s development • When intervention does not enhance parent responsiveness, intervention is not effective • Regardless of • Intensity of Services • Amount Services Provided to Parents • Training of Providers • Curricula or Instructional Procedures • Keys to success • Parent involvement with their children • Responsive Interaction

35. Why Parents? • Intervention Is Difficult, Complex, Demanding • Defy processes that are dictated by biology and/or history • Intervention requires high intensity effort • Children Have the Potential to Learn During All Their Waking Moments • Children Are More Attentive and Responsive to Parents than other Adults • Parents Have Enormous Opportunities to Impact Children’s Development Throughout Their Daily Routine

36. Who Has the Greatest Impact on Children’s Development?

37. How Do How Adults Become More Responsive? • Learn to use RT strategies with child • Understand the importance of pivotal behavior to children’s development • Understand how RT encourages children’s developmental behavior. • Reconcile RT with personal beliefs

38. The Change Process

39. Procedures for Teaching Responsive Teaching Strategies • Explanation • Demonstration • Coaching • Requires a critical eye • Patience, Learn in Small Steps • Practice • Video Review • Note: The Change Process

40. Intervention Topics Link RT Strategies to Children’s Pivotal Behavior • Used as Discussion Guides • Educate parents About the Role Pivotal behaviors Play in Children’s Development • How Responsiveness promotes Children’s Use of Pivotal Behaviors • IT’s are critical to helping parents incorporate RT strategies into their routine interactions with their children

41. RESPONSIVE TEACHING Responsive Interaction Component Reciprocity Contingency Shared Control Affect Match • Engagement • Balance • Joint Activity • Routines • Sensitivity • Intent • Timing • Frequency • Moderate Direction • Facilitation • Animation • Enjoyment • Warmth • Acceptance • Developmental • Interest • Behavioral Style RT Strategies Intervention Goals COGNITION COMMUNICATION SOCIAL EMOTIONAL MOTIVATION PivotalDevelopmental Behaviors • Social Play • Initiation • Exploration • Practice • Problem Solving • Joint Activity • Joint Attention • Vocalization • Intentionality • Conversation • Attachment • Empathy • Self Regulation • Cooperation • Interest • Persistence • Enjoyment • Control • Competence Intervention Objectives Intervention Outcomes CHILD DEVELOPMENT

42. Responsive Teaching: A Structured Approach to Early Intervention • Context • Parents and Children Together • Any Place that is convenient • Components • Purpose- Pivotal Intervention Objective • 1 to 2 Intervention Topics • Rationale for Pivotal Objective • 1 to 2 Responsive Teaching Strategies • Family Action Plans • Time - 45 to 60 minutes

43. Intervention Format for Teaching Responsive Teaching Strategies • Explanation • Demonstration • Coaching • Requires a critical eye • Patience, Learn in Small Steps • Practice • Video Review • Note: The Change Process

44. Responsive Teaching Promotes Language and Communication

45. Pivotal Intervention Objectives • Derived From Contemporary Child Development Research • Communication • Bates - Communication Theory • Bruner - Role of Mother in Establishing Joint Action Routines • The Same Way Adult’s Learn a Foreign Language

46. EI Outcomes: Language and Communication Behaviors That Parents Want • “I want my child to make her needs known to me”. • “I want my child to talk/ learn words”. • “I want my child to talk in sentences • I want my child to have conversations with me”. • “I want my child to respond to what I say/pay attention to me”. • “I want my child to speak so others can understand her”.

47. Language Goalsand Pivotal Objectives • Language Goal: To support and promote children’s ability to engage in conversational exchanges in which they express their observations, feelings and needs and respond to the requests, feelings and observations of others. Joint Activity Joint Attention Intentionality Conversation Vocalization

48. Joint AttentionIntervention Topics • Children learn the meaning of language by using context and nonverbal cues to decipher the relationship to the feelings, observations, objects or actions these words refer to. • Children make eye contact with parents when parents persist at making eye contact with them. • Children attend to their parents when parents are attentive to their children’s activity • Children learn to follow their parents’ focus of attention when parents use multiple cues to direct their attention. • Children learn to direct their parents’ attention by controlling their behavior • It takes time for children to learn to develop joint attention

49. Joint AttentionResponsive Teaching Strategies • 113 Get into my child’s world • 211 Observe my child’s behavior • 312 Imitate my child’s actions and communications • Accompany communication with intonation, pointing • nonverbal gestures • 424 Repeat activities your child enjoys • 521 Read my child’s behavior as an indicator of interest • 522 Follow my child’s focus attention • 531 Be sensitive to my child’s sensations

50. Intentional CommunicationIntervention Topics • Intentional communication occurs when children get others to understand their feelings, needs and observations. • The first step toward becoming an intentional communicator is understanding that gestures and vocalizations can be used to express feelings and needs. • Children become intentional communicators to the degree that their early nonverbal behaviors have effects on others. • Children’s early communications do not have to be understood, only responded to. • Children’sfirst words describe their actions, experiences and nonverbal communications. • Children learn words and language rapidly as they discover how they help them communicate more effectively