Delivering Early Intervention to Children With Down Syndrome
Condition: Down Syndrome
MeSH terms: Down Syndrome; Syndrome
Study type: Interventional

Summary: 
      Children with Down syndrome (DS) are at risk for significant language and communication
      impairments. Enhancing the service delivery of early intervention for children with DS is a
      key research and policy issue given the prevalence and detrimental effects of persistent
      language impairments. Using a telemedicine approach allows clinicians to provide
      evidence-based treatment to families from a wide geographic area in Oregon who may not
      otherwise have access to a language intervention specialized for children with DS. Our
      innovative project involves the creation of a new treatment optimized for children with DS,
      as it will be the first study that translates an existing evidence-based language
      intervention-Enhanced Milieu Teaching (EMT) into a telemedicine model. The goal of this study
      is to examine whether a telemedicine approach is effective for training parents to implement
      EMT language support strategies and whether changes in parent behavior are associated with
      child communication and language growth. The investigators will pilot the telemedicine
      initiative to provide early intervention services to ten children with DS (aged 18- 48
      months) and their families who live in rural and /or under-served areas of Oregon. The
      investigators will use single-case research design methodology to pilot this intervention
      research. The investigators will use secure video-teleconferencing technology to provide EMT.
      Clinicians will provide EMT to parents through interactive coaching, teaching them how to
      foster their children's social communication and language skills. Outcomes will focus on
      parents' use of language support strategies and children's social communication and language
      skills. Delivering early intervention to children with DS and providing parent-training at a
      distance using a telemedicine approach has the potential to transform the delivery of early
      language interventions for children with DS. Results of this study will directly inform the
      development and refinement of language interventions for young children with DS.
    

Detailed description: 
      1. Aim 1: To examine the effect of using a telemedicine service delivery model to teach
           parents of children with DS to use EMT language support strategies. The investigators
           hypothesize that parents will learn to use EMT language support strategies from the
           personalized instruction provided during 36 intervention sessions.

        2. Aim 2: To examine the effect of delivering EMT using a telemedicine service delivery
           model to improve the spoken language and social communication skills of children with
           DS. The investigators hypothesize that improvements in child communication and language
           skills will result from increasing parents' use of EMT language support strategies
           during everyday parent-child interactions such as play with toys, singing songs, book
           reading, and mealtimes.
    

Intervention name(s): Enhanced Milieu teaching
Intervention type(s): Behavioral
Intervention description(s): Enhanced Milieu Teaching (EMT) an evidence-based, naturalistic language intervention that has been optimized to address the specific language and communication deficits associated with DS. EMT is a parent-implemented intervention that involves home-visits during which clinicians teach parents to support their child learning language during typical parent-child interactions at home (play with toys, music, book reading, and snack time). Clinicians follow an evidence-based instructional framework called "Teach-Model-Coach-Review" to teach parents language support strategies.
Intervention model: Single Group Assignment
Intervention model description: A single case multiple-baseline across behaviors (i.e., EMT strategies) design-replicated across ten caregiver-child dyads will be used to evaluate the effect of implementing EMT via telepractice on parent's EMT strategy usage and concomitant increases in child communication. Within each design there will be three potential demonstrations of effect and three potential replications across participants
Masking: None (Open Label)
Primary purpose: Treatment