By Jenna Somers
A new study finds that a culturally sustaining treatment can help nearly half of young Spanish-speaking children with early language delays improve their skills significantly-five times more than standard care alone.
Led by researchers at Vanderbilt University Peabody College of education and human development, the study demonstrated that Enhanced Milieu Teaching en Español (EMT en Español), a language intervention tailored to Spanish-speaking toddlers with language delays, significantly improved the language status of children in the intervention group. For example, 45 percent of children receiving treatment improved their language skills to the extent that they no longer met the clinical criteria for a language disorder diagnosis at age four. In contrast, only 8 percent of children who received standard care showed similar improvement.
"These results are especially important for young Spanish-speaking children who may not be identified with language delays until they reach school age," said Ann Kaiser, Susan Gray Professor of Education and Human Development, professor of special education, and the study's principal investigator.
EMT is a naturalistic language intervention that uses daily home routines with parents, such as playing, book-sharing, and family-selected activities like hairdressing and cooking, to improve the communications skills of young children with language delays. Parents are coached on naturalistic language teaching strategies to communicate with their children during these regular routines. For example, if the child points or uses sounds to communicate, parents are coached to use specific words that seem to verbalize what the child is attempting to convey and to treat the child's response as meaningful and communicative. Responsiveness as well as modeling language at the child's level are important components.
"These children need access to earlier intervention, and teaching parents EMT may allow that access. Parents in our study learned EMT strategies and used them with enough skill and frequency to change their children's developmental trajectories. This is potentially extremely empowering for parents! Hopefully, our findings will also improve broader community understanding of the importance of home language in children's language development," Kaiser said.
In addition to reductions in language disorder diagnoses, the researchers found that children receiving treatment used more words and phrases immediately following treatment and in six- and 12-month follow-up visits. The lasting effect suggests that parents continued to use the language teaching strategies they learned during the study. Indeed, during follow-up visits, the researchers found that, even a year later, most parents continued to implement the strategies, as observed through the quantity and quality of parental linguistic input to children.
Without treatment like EMT en Español, children's communicative, social, behavioral and academic development could be hindered, and they could be at further risk for persistent language delays.
"We're pretty excited by what we've found. Children who receive the intervention score significantly better on the Bilingual English-Spanish Assessment-the gold standard for developmental language disorder diagnostic," said Tatiana Peredo, research assistant professor in the Department of Special Education and the study's co-principal investigator. "However, what we know about developmental language disorder is that it is a lifelong condition, so these children are going to need continued support. But that's why this is a big deal. High-quality intervention works."
The importance of culturally sustained treatment
This study adapted EMT for Spanish-speaking children to address the paucity of research on early language interventions serving this population. Due to these limits, Spanish-speaking children in the U.S. are often over referred or under referred for special education, depending on whether and how clinicians use English-based diagnostics.
The EMT en Español study takes the initial step toward addressing this larger problem. Spanish grammar develops differently from English and is more morphologically rich, meaning word structures are complex, explained Peredo. Spanish-speaking children need to be exposed to additional verb models and inflections when they are younger, whereas English-speaking children need to learn fewer verb forms and focus more on learning nouns.
With these differences in mind, the research team adapted EMT strategies for Spanish language development, informed by studies that examined how Spanish-speaking toddlers and parents talk to each other and what typical language development looks like in Spanish.
Beyond language differences, the research team considered cultural values. "In general, a lot of Latino families ascribe to a more directive parenting style, which uses more questions and directions and aligns with certain cultural values, such as respeto, or the idea of deferring to elders," Peredo said.
In traditional EMT, strategies are based on the child's autonomy and caregivers following the child's lead. For example, a parent might set out toys, observe what the child is interested in and then imitate what they do. In the Spanish version, activities were more adult led with the parent guiding the child on how to play and then responding to how the child expressed themselves. Keeping in practice with these cultural norms allows the child to work on their language skills in a familiar atmosphere.
What comes next: From research to community practice
Peredo is completing a similar study inspired by EMT en Español that explores a variant approach focused on even younger children-14-to-30 months old-and book-sharing as the primary intervention tool. The goal is to capture children's engagement in book-sharing earlier, since the researchers observed in the EMT en Español study that some two-and-a-half-year-olds struggled to engage. This pared-down study focuses only on coaching parents in book-sharing strategies and introducing younger children to the rich language of books.
In the future, the researchers plan to study a community implementation of EMT en Español, training clinicians and pediatric providers on supporting families with natural language teaching strategies.
The EMT en Español study was funded by a six-year, $3,285,441 grant from the Institute of Education Sciences at the U.S. Department of Education.
