Using the LENA System in Early Intervention - b
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      This project will determine whether an intervention to enhance communication between infants
      and toddlers with developmental disabilities and their depressed mothers can be integrated
      into federally-funded Early Intervention (EI) services. Participants will be mothers with
      depressive symptoms whose children are receiving EI services, along with their EI service
      providers.

      The investigators will conduct a small feasibility trial using the Language ENhancement
      Assessment/intervention system (LENA), a technology-supported language monitoring system,
      with 10 mothers and one of their child's EI service providers. The LENA uses an infant or
      toddler garment with an integrated audiotape system that records adult speech centered on the
      child, child vocalizations, and reciprocal parent-child turn-taking conversations. The LENA
      software produces visual feedback that a mother can use to focus her language interactions
      with her child. They study will follow participants in the LENA with feedback intervention
      over 6 weeks: 5 weeks of LENA data collection (with mothers running the system 1 day/week for
      16 consecutive hours). The investigators will analyze data from measures on LENA
      communication data (adult word count, child vocalizations and conversational turn-taking),
      and measures of child language, maternal depressive symptoms, and child disability profiles.
    

Detailed description: 
      Early Intervention (EI) services are provided to infants and toddlers with documented
      developmental delays in all 50 states and US territories. EI improves long-term
      infant-toddler adaptation and lowers the cost of care if parents use the services. However,
      depressive symptoms can reduce mothers' ability to provide the daily child
      development-promoting activities recommended by EI, increasing the child's risk for
      communication and behavioral problems. Indeed, repeated studies have shown that depressive
      symptoms reduce mothers' consistent use of developmentally sensitive, child-centered speech
      which, in turn, lead to negative child cognitive and behavioral outcomes. Previous research
      showed that over one-third of mothers of children with disabilities have significant levels
      of depressive symptoms, a rate higher than the population at large. Infants and toddlers of
      depressed mothers have been shown to receive fewer intensive services and have been shown to
      interfere with uptake of EI services through impaired mother-child interactions. A
      preliminary study by the investigators found that over a third of mothers of infants and
      toddlers enrolled in EI in a large North Carolina county had severe depressive symptoms and
      depression histories. Fortunately, the investigators also found that when depressed mothers
      were provided with concrete, attainable skills for improving interactions with their child,
      the impact of depression on both mother and child was substantially reduced. Focusing on a
      depressed mother's child-centered speech and reciprocal communication also improves child
      outcomes, even when the child is cognitively compromised. However, none of these specialized
      services are part of EI best practices. Thus, EI is an ideal setting in which to integrate
      screening, referral and targeted skills for depressed mothers in order to improve
      parent-child interactions and ultimately, child outcomes.

      This project will develop an intervention focused on communication between infants and
      toddlers with diagnosed or suspected developmental disabilities and their mothers who have
      depressive symptoms. The primary aim of the study is to test the feasibility and initial
      efficacy of embedding a language pedometer, the Language ENhancement Assessment/intervention
      system (LENA), into EI to teach mothers to increase child-centered speech and reciprocal
      communication, which have been linked to positive child outcomes, and to increase parenting
      efficacy in depressed mothers of children in EI.

      While maternal depressive symptoms can disrupt developmentally stimulating, child-centered
      speech, simple tools to assess and provide feedback to mothers can improve the child-centered
      speech and reciprocal language interactions that positively impact child outcomes. Although
      the LENA has been used in other studies and shown improvements in mothers' child-centered
      speech, the system has not been used with mothers showing depressive symptoms or in the EI
      context. The investigators will examine the efficacy of using LENA in a
      pre-/post-intervention design. Specifically, the investigators will examine whether mothers'
      primarily independent use of the LENA with feedback has an impact on the child's language
      environment, parenting efficacy and maternal depressive symptoms.

      The investigators will also conduct follow up data collection with participating mothers,
      which will be approximately 6 months after her last LENA recording. Follow up activities will
      involve having the mother conduct one more LENA recording and provide survey information over
      the phone, which will allow the investigators to determine residual effects of the study
      interventions, additional demographic information, and feedback for future studies.
    

Intervention name(s): Language ENhancement Assessment/intervention system
Intervention type(s): Behavioral
Intervention description(s): The LENA with Feedback intervention will involve mothers running the Language ENhancement Assessment/intervention system, an audiorecorder language pedometer that records adult speech centered on the child, child vocalizations, and parent-child reciprocal turn-taking conversations. Researchers will provide an initial feedback session to mothers, which will include reviewing the LENA visual output from the previous recording and how mothers can access the output on their own for future recordings. Mothers will independently use the LENA system and access the output on their own.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment