147: Play On: Evidenced-Based Strategies in Early Intervention Treatment [Podcourse]

TRANSCRIPTION

[00:01:00]

Venita Litvack: Today, I'm joined by Cara Tambellini. Cara is an early [00:02:00] intervention expert speech language pathologist, and she has over a decade of experience working with young children under the age of three.

She holds a master's degree in speech language pathology from Northwestern university, and she is licensed to practice in California as well as registered by the college of speech and hearing professionals in British Columbia. In addition, Cara is clinically certified by speech language, audiology, Canada, and she holds her certification of clinical competence from the American speech language hearing association.

Now that we've got all that covered, let's get started. Hey Kara, thank you so much for coming today.

Cara Tambellini: Thanks so much for having me Benita.

Venita Litvack: I am so excited to learn about all things early intervention today. So let's start by having you tell the listeners who you are and where you are today.

Cara Tambellini: Yeah, so, um, like you said, I've been a speech language pathologist for over 13 years and right now I'm, um, outside of Vancouver, right outside of Vancouver in a [00:03:00] small town. Um, called port moody. And, uh, so I came here about two and a half years ago. And, um, and before that I was kind of all over the states.

I grew up in Pittsburgh, Pennsylvania, and then, um, went to Northwestern for undergrad and grad. And then went to New York city to do, um, my clinical fellowship at Blake Dell children's hospital. And I was there for two years and then I was in Los Angeles for nine years doing, um, a private practice, early intervention and working in this schools before I moved here.

So here I'm doing, um, my private practice and working in the schools and all throughout that time, I always worked in early intervention either after work or, um, in my private practice. So that's, um, one of my favorite areas. Um, and I recently, um, released a course helping parents help [00:04:00] their children.

So I teach, um, strategies to parents to help their children, um, say first word. That's

Venita Litvack: amazing.

Cara Tambellini: I can't wait

Venita Litvack: to hear more about your course. So what drew you to early intervention?

Cara Tambellini: Um, I just always enjoyed working with young children. I was a babysitter ever since I was 12 years old. There were a lot of kids on my street and I just really enjoy working with young children.

Um, and then one of my first classes in undergrad was, uh, language development. And that just fascinated me how kids learn language and, uh, the research behind that, um, I was really into Noam Chomsky, so I just, was it just always really interested me and I love seeing kids kind of start talking or learning their first words, um, or helping them communicate, uh, [00:05:00] you know, if they need other, other modes like AAC, which, you know, you're an expert in, but, um, yeah.

Yeah, it's just one of my favorite areas. I just love young kids. And when my daughter was learning how to talk, I employed all of these strategies that I teach to parents and it was so fun to see. And I'm actually, in my course, a lot of the videos, examples are of me with my daughter, that at the time that I took the videos, I didn't realize that, um, you know, I didn't know I was doing a course, so it was just, um, naturally interacting with my daughter using these strategies.

So it was fun when I decided to do this course, kind of to look back and find all the videos that I wanted to use. That's

Venita Litvack: awesome. That's like a nice real life example to, you know, true. Tried and tested. Yeah. So why don't we start by talking about the developmental milestones, you know, what are they, what [00:06:00] should, um, SLPs be looking out for parents be looking out for?

Cara Tambellini: Yeah, so I know, um, like on Instagram there's been a real talk about like milestones versus averages. So milestone is what you want your child to have at a certain age. And averages are what the average child has at that age. So around 12 months you want, you're starting to see about one to three words and then 18 months you want, the average is about 50.

And the expressive vocabulary. So kids are seeing about 50 words. Um, but the milestone is, you know, about 10 to 18 words. And then, um, by 24 months, uh, the average is about 200 words in a child's expressive vocabulary, but the milestone is, um, it used to be 50 words, but now I'm seeing more and more people use a hundred.

Uh, so those [00:07:00] are the expressive language milestones. And even before that, um, with babbling at around five months, you start to see a lot of resonant bowel sounds like, ah, Ooh, ah, and maybe some continents emerging. And then at six months, um, canonical babbling starts to emerge. That's when a syllable is repeated, like Baba mama, dada, and then, um, around nine months as when varia gated babbling starts to emerge.

And so that's when the consonant sounds are intermixed together. So, ah, ah, ah, Baba, uh, so you're intermixing, those consonant sounds and that's a good indicator. That first words are on the horizon. And then with, um, and then just with that. So I talked a lot about expressive language and with receptive language.

Um, I really like Emily Cohen's, um, 1, 2, 3 rule, [00:08:00] and she is her Instagram is tandem speech and she wrote the book playing with purpose, but I like her 1, 2, 3 rule because it's easy to for clinicians and parents to remember, but it's at one, you want your child, you, you want to start seeing one word and one step directions at two, two words and two step directions and that three, three words and three step directions.

Um, and another thing I always recommend to parents is, um, the CDC milestone guide, you can Google it and it's free and it has a lot of great, um, Things to look out for at the different ages. And it goes all the way up until five and it starts at three months, zero to three months. And then, um, I tell parents to download the milestone tracker app, which is also by the CDC.

And I really like this app because it gives the video examples of different milestones. So sometimes parents will read a milestone. They won't [00:09:00] quite understand what their child is supposed to be doing, but I really like this app because it gives video examples.

Venita Litvack: Oh, that's awesome. I have that app. I don't know that I've saw that they have videos.

I'm going to have to check that out. Yeah. I love the suggestions that you gave as well. Can you actually talk a little bit more about the milestones versus averages? Because like you, I've also seen that come up recently and I think it is so important for people to know about. And I think there's also like that expected range that has, um, been introduced recently as well too.

So what does that look like? I know it's a little bit hard to present that in audio format, but maybe you can do it and I can kind of expand on that for people.

Cara Tambellini: I think it's just, um, a milestone is, is things that doctors look out for pediatricians and, and it's, you know what we want to see to say that, okay, the child is on its way, has some, some words.

And, um, [00:10:00] the average is kind of the statistics looking at everything like, okay, we looked at 300 children and this is. Average like the middle of where everybody was. So there's a lot, especially when you're talking about language acquisition, there's a wide range of what is in that average range, you know, in the bell curve thing.

and the milestones sort of at the left of the bell curve, and the average is more in the middle of there. So average, you're going to get more words than the milestone. So, um, a lot of times when people see milestone, they think it's average the average, but it's not.

So does that make sense, Benito?

Venita Litvack: Yeah, that was perfect. I'm glad that you like illustrated as a bell curve as well. I think that's helpful for people who are listening and then they expect to the milestone is probably at the bottom of that expected range, where that goes up to the average. Right. And then above average or above [00:11:00] expected range would be from the average on, correct?

Cara Tambellini: Yes. Or, well, the average, the middle average line is, um, there's always like that one standard deviation to the left and the right. So yeah. So yeah, it's hard with, it's so hard with first words. Cause there is such a huge range, but I remember when, um, my daughter, I took her to her 18 month appointment and she had a lot of words by that.

And the doctor was like, wow, that's great. I'd be happy if she had just three words. And I thought to myself, well, I wouldn't be because that's not really even a milestone to 18 months. So I think a lot of doctors, um, have, uh, different information on what is, um, a milestone versus average and what they would recommend early intervention for or what they would recommend to parents like seek out more strategies.

Um, but, and that's why I did my course, to be honest, because I have a lot of [00:12:00] parents reach out to me, you know, when their child's 18 months. And they're saying, they're not saying any words, I'm really worried. And, um, I don't have room in my schedule to see extra private clients right now. So I wanted a way for them to kind of see these strategies and implement these strategies to try to, um, make a difference themselves.

Parents aren't, you know, the agents of change in their child's life and not the speech therapist, especially if the early intervention age and speech therapist is more the coach and telling them how to implement these strategies in their daily routines.

Venita Litvack: Yeah. No, I'm sure that's so helpful for parents.

That's awesome. And I'm excited to learn more about the strategies that you use in the course, or you talk about in the course. So what are your favorite early intervention strategies?

Cara Tambellini: Yeah, so, um, the first strategy I usually teach to parents is, um, attending. And this is kind of, um, an umbrella term for a lot of [00:13:00] different strategies, all wrapped into one.

So it's, um, it's been studied a lot, um, like the response of interaction style, and a lot of researchers look at how parents interact with their child and how that, how that impacts our language develop. And it is a positive impact. So the more apparent is responsive to their child. Um, the more, the better their language outcomes are.

So there are different things in this. So one is responsive labeling. So, uh, when you're with your child, if your child is looking at something or pointing at something, um, I always coach the parents to kind of tap, like talk for the child label, what label, what they're looking at. So if they're pointing to about, oh, you see a ball, or if they're looking up at the lights, the lights are going off, oh, the lights just went off.

The lights went on and off. So kind of just becoming your child's [00:14:00] narrator and not, and it's interesting because a lot of parents think, or the media kind of says, like talk to your children, talk to. But it's not really about just like talking to your children, just having them hear a bunch of language it's about talking about what your child is most interested in.

Um, that makes the difference. So, um, so that responsive labeling is something I teach parallel talk. So talk about your child is what your child is doing in the moment. And some people call this like sports casting. Like you're just kind of like giving their child a lot of information, um, about, for what they're doing in the moment like, oh, you're stacking blocks, you're eating pasta, you're sheeting that rattle, or just a lot, like just kind of talking about what they're doing and letting them explore their world.

And kind of just talking about what they're looking at, what they're touching, what they're feeling. Um, and that's different than me just talking about what I'm doing. Like I'm in the kitchen, I'm making a snack, I'm putting this on. [00:15:00] It's more talking about giving the child the language. For what they're seeing and doing and touching.

Does that make sense?

Venita Litvack: Yeah. I love that. That's a really important distinction to make as well. Um, and then when do you recommend starting that? I think your course starts at a certain age, is that because you feel like it's more effective at that age? Or can it be done earlier? The reason I'm asking is because one of the things that like, you know, I have a five month old right now and she is making a lot of sounds, but we don't really know and she's, um, do not pointing yet.

So we don't really know like what it is that she's talking about. Like, let's say she's sitting on the changing table and she's like, you know, making all of these sounds with us. Well, we're not sure to say like, oh yeah, you are, you know, talking about the wall or you're talking about this, unless it's very clear that that's what she's looking at and we can kind of narrate that for her.

But, um, yeah. So when would you [00:16:00] recommend like doing this

Cara Tambellini: honestly? From births. And I think like with your daughter, like when you don't really know what she's trying to tell you, or what she's saying is she's just babbling, just kind of talking about what's in front of her, like, oh, you're on the changing table.

We're gonna change your diaper and like holding out the diaper. This is your diaper. Like if she's looking at it, okay, we're going to put it on. And, um, yeah, I think that five months is such an amazing age cause they're just on the cost of, um, starting to make a lot of different sounds and trying to get that back and forth going and in the video.

Uh, some of the videos, examples in my course are of my daughter when she was about four months when she's making a lot of cool. And I'll talk about that another strategy later, but, um, like responding to her. So like, if she is going, like you're going to go and try to get like a back and forth. So imitating them a lot is [00:17:00] such a great strategy at this age because it's showing them like, wow, this sounds I'm making a really important, because, they're making my mom say things back to me and it pay attention to me.

So that's, um, that's something I recommend, like at, you know, starting at birth, like with your child, but, um, the need, I, I meant to talk about one more strategy in this attending umbrella. So, um, we talked about responsive labeling and parallel talk. And you were a strategy, um, by the researcher Hadley, if you want to Google, um, that, and I know we're going to provide some re some, um, references.

It attached to this pod course, but, um, so she talks about, um, doing ToyTalk. So there are two kind of directions to parents for choice talks. You're going to talk about the toy and give a toy its name. So this is an interesting strategy because it puts the noun phrase in the [00:18:00] subject position for kids. So for example, the tower is red or the tower is falling or, uh, the baby doll is hungry.

So see how it's like putting that now, like the baby doll is hungry. So we're putting that. So a lot of times in the research, she talks about how this is important for parents because, um, they usually don't talk to their kids like this. Most parents are more talking about what the child is doing and putting non-specific nouns.

Like it's, it's going up or it's down or that, um, or doing, uh, pronouns. Like he. They, but when you're putting the noun phrase and the subject position that, um, the research is showing, but that's helping kids better understand grammar rules and the kids whose parents did this a lot, they had a growth in sentence diversity and grammatical structures.

So does that make sense to explain that?

Venita Litvack: Yeah. I love how you gave the two [00:19:00] examples. It's so fascinating. And I mean, I'm a speech pathologist, but it's like, some of this is intuitive, but some of it's just like, wow, like I didn't know that, and this would be one of them. So I really appreciate you sharing

Cara Tambellini: that.

Well, to be honest, a lot of my, um, when I'm attending to young kids, like doing responsive, labeling and parallel talk, I do talk about the twice. I'm more like, oh, you're putting the block on top or you're holding the baby or the bait. And I will do something like the baby doll likes the food. But, um, I think this, this specific instruction is interesting because it does kind of get your attention, um, to talking in a different way.

Uh, and it's, I like her, if you Google Hadley instructional reference, there is a free reference page that you can give to parents. And it's pretty specific. And it gives some, some pictures [00:20:00] about how to do this strategy. So, and she just gives two simple, two simple tips, like talk about the toys and give the toy its name.

So you're not going to put itch that or it cause you're going to label it because the kids tend to learn. The nouns more too, if they're at the beginning. So it's still interesting, but that's, that's a newer strategy that came out kind of in the last five, seven years.

Venita Litvack: That is so cool. I'm even thinking, like, how does that relate to individuals who are like learning a C and, you know, the language structures through AAC, just really fascinating.

So thank you for sharing that. Yeah. Um, so are there other techniques that you like for early intervention?

Cara Tambellini: Yeah. So, um, the next, and this is kind of what we were talking about with your daughter before. So usually I typically talk a lot about attending at first with the parents, because it's easier for them to do. Um, and it's kind of an it's a good first [00:21:00] strategy. The next one is responding. So responding to your child when they make a sound like when your child is starting to babble, responding to them, by giving them a touch or a look or, or talking to them after they make babbling sounds, because this is going to reinforce that babbling and your child's going to say, wow, like my mom or dad, or, or care caretakers, really, uh, giving you a lot of tension for doing this.

So I might as well do more of it. And it's interesting because there's, um, research by Goldstein in 2008, social feedback to infants, babbling facilitates, rapid phonological learning. And in this study, what he did was he took parents in a room with their child and he instructed them to like touch their children or give them, or look at them or say something.

If they're, if they're baby young babies, I think it was like 10 month old babies if they babbled. Um, and then, uh, what he [00:22:00] found was that after 10 minutes of the parents doing this, the child, um, increased and the complexity of their Babel and, um, increase the amount of their babbling just after 10 minutes.

So the baby really responded to the cue, to the parent's feedback after they babbled. So then there's a new study that I was just looking at recently and that, um, it's called adult responses to infant pre linguistic vocalizations are associated with infant vocabulary. So this was an observational study done in 2020, where they, um, video recorded parents in their home.

With their children talking and the, the parents who were the most responsive to their baby's vocalizations, their babies had a higher vocabulary. So I thought that was pretty interesting.

Venita Litvack: Yeah. That's amazing. And who was the authors on that last one that you just said?

Cara Tambellini: I [00:23:00] know it was a Lopez at all, but I'll provide you with that

Venita Litvack: reference.

Okay, awesome. Yeah. We'll definitely include this in the podcast handout for anybody that's interested.

Cara Tambellini: Yeah. So, so I think that's it. That's a cool and just kind of responding to your baby. And in my course, I. I have a lot of, uh, video examples of me with my daughter. So when she would start babbling, like I, or I would vocalize after her and then she would vocalize, and then I went to, it's such a good turn-taking, um, activity to do with, with your baby.

Um, and young child, who's just learning, uh, you know, how to make sounds. And it really does kind of help them to form new sounds because, um, another type of therapy that, um, that I have reviewed and that I incorporate into my therapy with, um, early intervention is called imitation therapy. And so this is [00:24:00] another, um, research article that you know, that you can put with this podcast, but it's called imitation therapy for non-verbal toddlers by Zaida Z E D E R.

And he, um, Okay. He'd studied children who are 18 to 19 months old who were not yet talking and not imitating, and he was trying to get them to imitate. And so he, and, and so in this, in this therapy, this imitation therapy, every child in this study, it was really small. It was only five children. They increase their imitation skills by the end of the nine week therapies sessions.

But so the, the first step of the therapy was the adult was the primary imitator of the child, including actions and vocalizations. So whatever the child did that parent would do, and I do this a rotten early intervention. So if the child picks up a block, the parent will, if the child [00:25:00] throws something, the parent, well, if the child moves their body in a certain way, the parent, well, and then the child's like, whoa, this is kind of cool.

You're doing everything I'm doing. And, um, and then, uh, the parent starts doing things to. Uh, clapping. And like once this, this momentum of imitation starts happening and then the parent does something, a lot of times the kid will imitate the parent. So then that gets like, oh, okay. I imitate you. You imitate me.

So the second step is that the child is starting to imitate the parent, but the parent is still the primary imitator of the child. And then, um, once this child starts to imitate some vocalizations that the parent does, the parent is, um, instructed to then only imitate the vocalizations that the child does or, or any.

Thing with their mouth. Like, even if they're doing raspberries, the parent's going to imitate that, but not the gestures. [00:26:00] So then the child is getting reinforced for just the vocalizations. And then the parent is instructed to kind of insert something to, to entice the child, to imitate them. So like, there's that behavioral momentum everybody's imitating the child.

And then the parent does something like BA and then waits to see if the child will imitate the parent. And, um, just the goal of this therapy is to get a back and forth going and to have the child start more imitation skills. So that's that therapy. And I thought it was interesting in the, in the research article.

They really describe it. Um, very well. A lot of times in the method section, you're like, I need more information, but this one, um, gave some really nice descriptions of the. That is

Venita Litvack: so cool. And this is like so helpful and like relevant for what's going on with me right now. I'm excited to take your course too, especially, um, you know, as she's getting a little bit [00:27:00] older, but that's awesome.

Thank you for sharing that tip. That's really helpful.

Cara Tambellini: Yeah, no, and this is what I did with my daughter a lot. Um, and it's, it's nice. Cause I think a lot of times parents are like, oh, well maybe it's not talking at their, my child's not talking. I don't quite know how to interact with them. And they feel silly, almost imitating their kids, but it's really helpful and it's nice for relationship building. Yeah,

Venita Litvack: I love the turn-taking part of it too. Um, and it's funny that you said you feel really silly about that because she was making this like very guttural noise last week, like a, almost like a cough type of noise.

And we were like imitating her, not knowing that that was. Affective, or maybe I did like, just from previous training, but it was more like intuitive. Like let's just like, copy her and see what she does. Cause she thought it was like so hilarious whenever she would make this sound. Um, but it was super silly, like, [00:28:00] um, so it's funny, but there was another thing that she did and I hope people aren't like I'm taking over this by asking all these questions about my daughter, but hopefully some people will find this relevant.

Um, there's like she would imitate like sounds from us or at least we like swore that she did, um, like you, who she did that for like a good two days. Like every time we would do it, it seemed like she would too. And I have video of it and then the LA, the next one was, Hey, but then she stopped. And I wonder if it's because we didn't really reciprocate, like when she did something, we didn't like imitate it.

I don't know. But is that common?

Cara Tambellini: I think so. I think kids are constantly exploring and. Um, testing out new sounds and testing out the way that they're, you know, they can make different sounds with their throat. So I think, yeah, and, and it is true. Like if it sounds aren't reinforced, um, and they don't hear those sounds a lot, they're not going to continue to make them, but that's probably a good thing too.

Right. Because, um, [00:29:00] eventually they're trying to imitate us and imitate their models. So, um, a lot of the, these researchers, uh, they said, uh, there's a book called, um, oh, what's it called? I, I won't get it. It'll come to me. But, some of these researchers are talking in the book and they say that, um, it's important to do this, um, do these, these, this responding, but not all the time.

Cause babies kind of need some time to be in silence and to just try vocalizing by themselves without. Getting reinforcement or getting, um, or having somebody else imitate them. Cause they're just still in that exploring stage. And, uh, it's important to kind of have a mix of responding a lot to your child and then, um, and then kind of waiting and not responding for a little bit because, and then also that intermittent reinforcement is kind of the best tight reinforced, not all the [00:30:00] time, but um, some of the timer or half of the time.

So that's it. So that's a good thing for parents to hear. I think because they, then they're not thinking like, oh, I always have to be responding when my baby makes it sound or they're at daycare and people aren't responding to them. So that's, uh, a variety of different environments is really great for kids.

Unfortunately, we're in a pandemic now, so that's like, not as, um, you know, kids are kids, aren't getting that variety as much. Yeah.

Venita Litvack: Yeah, no, I'm glad that you shared that too, because I think that is like really daunting for a lot of parents, but reassuring for them to know that they don't have to do it all the time.

Cara Tambellini: And that, that book just came from, came to nature shock. And it's by Pope Bronson, I think. But, um, it's such a good read. It's an old one though, but, um, I think I read it like six or seven years ago. I'm I'm wondering if the authors have a new [00:31:00] book out, but it has a whole chapter on language development.

That's. Interesting. Yeah.

Venita Litvack: Okay. Awesome. One thing I like too is like how specific, uh, that feedback is when you are imitating, because I was another thing that we did with our daughter. And then I realized like later on like, oh, we should've been more specific. We were like, oh, good girl. Cause we were like so excited, but we could have been either imitating her back or like had made it more specific.

Um, so what are some like specific phrases that you would recommend for parents or therapists to do when a child's like either babbling or using a first word or something?

Cara Tambellini: Um, yeah, honestly, Vinita. I think what you did is great. Like, oh wow. Like just giving attention and um, and, and so they know, so they're thinking, okay, They like this, I'm going to do more of it.

I think that's honestly the key. I think there's, I think the key is just [00:32:00] giving your child attention for trying to communicate with you, whether that's, you know, a word Ababil or, um, whatever it is. And then, and then just like, my next piece of advice is like, try and get it back and forth going, trying to get, like they say something, I say something, they say something like, because even when my daughter was younger and this there's a video example in the course of, um, my daughter's like doing a bunch of open, open vowel sounds, and then I'm saying, oh yeah, yeah, you did it.

You like that or whatever it was. And then she keeps going and then I say, oh, you're telling me, you're really telling me, so I'm not directly imitating her, but I'm, I'm saying something and she's waiting for me to finish. And then she starting and then I go again. So it's such a nice little back and forth.

And um, I try to encourage parents to do that a lot with her.

Venita Litvack: Okay. Awesome. Um, so what about like old strategies that I've like, I'm familiar with it? I'm thinking [00:33:00] a lot of SLPs are like communication temptations. Is that something that you use a lot too?

Cara Tambellini: Totally. Uh, so, um, one part of communication, communicative temptations is, um, pausing.

And so this is one that I teach parents a lot, and this is a super popular AI strategy and it's a ton of research. Um, pausing is, uh, just kind of starting something and then pausing and looking expectantly. So I do this with phrases a lot, like ready, set, go. Ready, set. Go. So once a child hears, ready, set, go.

Ready, set. Go. A bunch of times. Um, then, uh, you do it and you pause and you look at them like, okay, what are you going to do? So you go ready, set, and you look and wait. And then if they say go, or if they say, ah, or anything, then I like activate the windup toy, or I push them on the swing or I let them go down the slide.

So the important thing I think with [00:34:00] pausing as you're doing something you're waiting, and then as soon as your child makes an attempt, you do whatever the thing is. Like a lot of times I do up and down. So with brilliant young children who are light and you can lift up, you can go up and down, up and down up and, and then pause and wait and look at them.

And if they make any sort of communication, even like moving their hands to go down, then I'll say, yeah. So then they're learning like, okay, like I do something and something happens. Like I say something and something happens. So, um, that's what I do a lot with pausing and, um, Uh, my, I, I don't know if I mentioned this at the beginning of this pod chorus, but I, um, have four children's books out on Amazon.

And, um, what the first one I wrote was, uh, easy to say first words. And I got the idea after an early intervention session with the little guy and, uh, it's I wrote [00:35:00] it to, with the pausing techniques. So, uh, it has a word three times and then it has it. So it basically goes like hat, hat, hat, the owl wears that.

And then you pause and the kid says, hat or cup, cup, cup drink from, and then you pause. And the kid says it now, obviously I read this book a lot to my students or my daughter when she was young. And then, then you start the pausing. So they know kind of what to expect. So that's, um, I really love that pause technique.

And then a lot of people use the pause technique in songs too. So, um, a lot of times I just make up my own songs. So in my course, there's a song that there's a video of me doing a song that I made up with my daughter and I go dance, dance, dance, dance, dance, dance, dance, dance, dance, dance, dance, dance, Vieira likes to, and then I pause and look at her and she [00:36:00] went and I think, yeah, dance.

So she was, I think 10, nine or 10 months in that video. So it just shows that like, if you pause and look expectantly at children, they want to continue. They want to say something or do something. So I, I do really like that stress.

Venita Litvack: Yeah, I love that. I liked the song too. Very cute. I know. I think as parents, you come up with all sorts of songs to get through the like tougher things or just to make it like really fun too.

And

Cara Tambellini: speaking of songs like I, since you're a new mom, I wish I would have, um, seen Carly. Do you, do you follow? We talkers on Instagram. She has so many great songs like that are so different from the ones that we're so used to singing. Like itsy-bitsy spider wheels on the bus and there's super engaging and she, um, she's a great one to look up on

Venita Litvack: Instagram.

Thank you for sharing that because I feel like the [00:37:00] algorithm doesn't always show everyone's posts. You only see like a certain amount and that is one that I would have to actively go and search. So I'm going to do that today. Thank you. Yeah. Um, awesome. So let's talk about how SLPs can coach parents to use evidence-based strategies in daily routines.

Cara Tambellini: Okay. Yeah. Um, so routine, the routines based intervention model is extremely useful in early intervention. And, um, and it's kind of, what's recommended for early intervention. Like you want to teach parents how to use these strategies in their routines because sometimes just sitting and playing, um, is just not realistic for a lot of parents, especially if they have a lot of kids, like more than one child working full time, you know, it's, it's hard to kind of.

Say like, okay. You have to carve out this time to sit and play with your child. Um, even though [00:38:00] sitting, sitting in playing and attending to your child is great. Um, you can do all of these strategies during a child's daily routine. And, um, a lot of times I know we were talking about communicative temptations and we talked a lot about pausing.

Um, but, um, one thing that's, uh, that I tell parents to do and that I help with kids is, um, is training them or teaching them to request. So if, um, they want something like, uh, if they're happy, if they have snack and they're eating cheese say, and then you have. There, they finish their cheese and then they want more cheese.

And they're looking at you. Um, you kind of hold out the cheese and wait and give them an opportunity to say cheese or whatever. And if they don't then, um, I tell parents to, to model the word for them. So she needs an it model and wait. And if they still don't say anything, that's okay. At least you gave them that model and you built in that [00:39:00] time for them to try to request the item.

But I tell parents to do this kind of throughout the day, um, for example, like opening doors, so they child wants to go outside to play and then you pause and you look at them and you wait to see if they say open and if they don't, then you say, well, open, open the door. And then you wait and then they might say, oh, Ben, or, oh, and then you go, you open it right away.

So as soon as they say the word for what they want, then you immediately do it. So that's just a natural reinforcer. And so they're learning like, wow, my words are really powerful. Um, I'm going to, I'm going to imitate you more because then I get what I want. And it's, it's fun to do this. And even like, there's so many times during the day to do this, like in bath time, like during the bath, a lot of times, um, I'll tell parents like, okay, before you turn on the water pot, have your hand on the nozzle and look at your town and say, [00:40:00] aye, and wait and see if they say, oh, and if they don't, you can say, can you try it?

And then if they say, oh, then you turn on the water right away. And then, um, and then they're getting that reinforcement, like, wow. I said it and something's happening. So the more that they imitate. You doing this, then you can feed that prompt of imitation. And then you can just, all you have to do is built in that waiting and pausing time.

And then the child will, um, you know, if they're familiar with imitating, do it on their own. And, um, that's what I tell parents to do a lot. Like during meal time, bath time getting dressed, like talking about putting on shirts and let's put your foot in, let's put your foot in, in, in, in, in, in, and then you can pause and see if they'll say, and then, you know, so you can build these into daily routines, um, at the grocery store.

A lot of [00:41:00] times my daughter, when she was younger, liked putting things in the cart. So I would hold it and wait for her to name the item and then give it to her. And then she would put it in the cart. So that was like a fun game that we used to play. So, um, yeah, they're just doing these. Things creating these opportunities for your child or to talk during daily routines as super powerful.

And, um, that's what I tell parents a lot is it's, it's about creating opportunities for your child, um, to communicate throughout the day. And, and, um, we talked, we talked a bit about communicative temptations before, but, um, if there are a lot of ideas for this and it's by whether be in present, if you Google, whether it be in present 1989, communicative temptations, they give so many ideas for, um, these communicative temptations with, to do with your child, like putting things up [00:42:00] high, um, so that they have a chance to request it, putting, um, things in sealed containers that they clear theatre, sealed containers so they can see the item they want, but they have to request for it or request for you to open it.

Just things like that. Um, But there are like a ton of examples that, that you can look up or, or give to parents.

Venita Litvack: Thank you so much for sharing that article, as soon as you mentioned it. I was like, I remember that using that one a lot there be in the early days. Um, and I totally forgot about it as a parent, so I just went and Googled it and it popped up.

There's so many different like websites on it. Um, but that's super helpful.

Cara Tambellini: Yeah. Yeah. Um, but, um, a couple of other techniques that we didn't mention yet, but I talk to parents about is, um, recasting, so expansion and Repat testing. So when your child says something, then, um, you're [00:43:00] going to, Y once the child starts saying words, then you're going to give them more information for their words.

So if they're saying. Apple, you could say, yeah, that's a big red apple or you're just giving them. I always tell parents, like, think about adding like different concepts that your child doesn't yet know. Like if they say water, oh yeah, this is cold water or tree. That's a big tall tree. So you're just going to still respond to them.

And you're still responding to what they're saying, but you're just adding more information. And then, um, the same kind of technique is with recasting. So your child says something, but it's not quite grammatically correct. Or it's not, they're not using like precise articulation, but you just say it again for them just so they can hear that.

You're not telling them to crack themselves. You're not asking them to repeat after you, you're just simply repeating it in the correct way. So my daughter used to say booby booboo for blueberries. So she would say booby [00:44:00] booboo and empty blueberry. Here's a blueberry. And for water, she would say, wow. Woo.

And I was like, yeah, you're in the water. So you just say it again after they say it so they can hear the correct production. So that's like an easy strategy that I tell parents. Um, to do. And then a lot of times when I'm working in EDI and coaching parents on these strategies, um, they are like, oh, wow. I didn't think to do this.

This is super helpful. And, um, and a lot of the research on these strategies, um, shows that parents satisfaction with implementing these strategies is really high and they're easy to implement and they, um, help build the parent child relationship. Cause there's, um, especially for, uh, enhanced value teaching.

That's just like a set of strategies that is very well studied, but it's a set of all these kinds of strategies, like time delay, environmental arrangement, expansions responsive, labeling. [00:45:00] And, um, and then that mans model. And that's kind of what I was talking about before. Like you're teaching your child to request by giving them a model for the item and then waiting and letting them, um, say.

So that's called enhanced mill you teaching. And there's so much research on that and it's just kind of a collection of all these strategies and same with parent child interaction therapy. It's a similar thing, like a lot of these types of strategies in this psych umbrella term of parent child interaction therapy.

And that's very well studied too. So yeah, a lot of these strategies are pop up in different studies and, um, but they're all evidence-based and there, I think there needs to be more research on, especially like kids with, um, Lee who are late talkers or, um, are having trouble with communication, but there's a lot of research on child language acquisition, but not a lot on like kids who are having [00:46:00] trouble talking.

And what can we do?

Venita Litvack: Yeah, that's really interesting. I feel like it's one of it's like articulation and phonology, right? Like there were so many studies established and then there's like this big law. And then with articulation and phonology, we ended up getting the new standards. What was it like two years ago?

Um, and maybe like early intervention, it's like a similar type of scenario where there was a lot of research done, but there needs to be more now more updated information. Well, those were super, super helpful tips for coaching parents, um, to embed language and daily routines. So thank you for sharing.

Yeah. Now you've mentioned that you have some books that you've written. That's amazing. Um, let's talk about books in general and how that's really helpful for early intervention. Because again, I'm going to have to talk about my daughter, sorry guys. And like, love obviously new mom, but, um, we like read [00:47:00] books from the very beginning.

I didn't read while I was pregnant. I just couldn't get into it. I couldn't like picture that she was in there and I'm reading to her, but we did start like right when she came out and, um, she has such a preference for books now. And I had posted like on Instagram, if question just to SLPs in general, like can babies this young, I think she was like two months be interested in books.

And a lot of people said, yeah, you know, um, I just thought it was like so fascinating that she was already like showing a preference for books. So let's talk about them and how helpful they are for early.

Cara Tambellini: Yeah, books are great. And, um, you know, some, some kids gravitate toward books more than others. And I always tell parents just to fall.

Cause a lot of times parents will say like, okay, it's time to read a book, let's read a book and they want to like read a book with their child before bed. And um, I always tell parents to follow your child's lead though. If he's here, she's interested in the book. That's great. But if not, that's okay too.

Like [00:48:00] just let them flip the pages, let them explore it, let them, um, lift it up and you know, um, you can, you can just talk about the pages that they're opening or looking at, and you can also like have them in front of you. And a lot of times I tell parents like, get face-to-face with your child while you're reading a book so they can see your face, as you're saying the words and reading it.

Um, and then, uh, in, in my books, like, especially in my first words book, I say at the beginning, Only read it. If your child's interested in it, like if they're don't force your child to finish a book, like read a few pages, if they're interested and then, um, try to entice them to be interested with like, you know, uh, excited language and, uh, excited, uh, sound effects and things like that.

But, um, but don't force for a sec. Cause that way, like your child's still going to be interested in the book and they're not going to see it as something that you're trying to make them get through. So that's my [00:49:00] recommendation with books. I think books are amazing and there's so many great books for using, um, using like the times away technique, like brown bear brown bear, where spot like so many books where you can pause and have your child fill in the word a lot of times.

When kids are really interested in books, when they're, you know, under the age of three, I tell parents like, this is a great time to like, talk about all the things in the book and practice pointing and pointing to the things in the book, and then have your child point. Can you find the dog? Can you find this?

And like, ha and if they're interested, that's a great time to work on like identifying and pointing and, um, and labeling items in a fun way.

Venita Litvack: Those are great tips. And it's interesting that you said, like, to make sure you don't force them to finish the book because we're on the cusp of. Doing sleep training.

And also like having her enjoy books and in our routine is one of the parts is like finishing a book. And just last night she like [00:50:00] loves books. The last night she was not having it. She was ready to go to bed. And I was like, can we make her finish it? Because it's part of the routine, but I don't, I don't want her to hate books.

So yeah, it's a constant struggle, but, um, I appreciate you sharing that. And then like we found, I don't know about you, but like those squishy books are like her jam because they allow her to like, you know, manipulate the book, turn the pages, but, um, they're easy enough that she can move it because she doesn't have those fine motor skills established yet.

What do you think about those books?

Cara Tambellini: Yeah, they're great. Are you talking that the squishy ones, there are some that are also like indestructable books like that won't rep and they can go in the water and there's so many cool books out there, like, especially for those young kids that are mouthing books.

And I know that there are cloth books, even. I think that I just exposing your child to a lot of different, different types of books. And, um, I think one of the reasons kids love books so much is because, [00:51:00] because it really gives them a great time to interact with their parents. Cause like usually the parents close to them, reading to them, responding to them.

So it's a great time to practice all, uh, um, all of these strategies. And actually there's a research study that I was reading about recently called parent implemented communication strategies during book reading and, um, Bye ACA Moe glue and medicine, but they teach, they taught parents to use modeling and time delay techniques with their children when they were reading young children, when they were reading books.

And they found that the parents who use these techniques, the children initiated more communicating communication apps with the parents when they use these techniques. And I think afterwards too, but, um, it just shows that like, just tweaking your reading with your child a bit, to have them be more engaged is, um, is a big help to kind of help your child learn to [00:52:00] initiate more and, and respond more and do a backup.

Venita Litvack: That's a great tip. One thing I wanted to ask you, but I didn't get to was how long do you usually give an expectant delay? Because I've seen the research for like AAC. Um, but it's really scanned. Like there's not a lot of information. I think it was like, even, it was like even a dissertation where they found that it could range from 20 seconds all the way up to like, I think two minutes, um, for children who required AAC to, to respond, um, in some capacity, but a lot of parents are only giving like three, maybe like on average three seconds before they would go ahead and like give the next prompt.

So do you have like a standard? What you typically wait?

Cara Tambellini: Honestly, I don't have a standard cause it kind of always all depends on the child's attention. If you're looking expectantly and your child is staring at you. You can, you're like, [00:53:00] there's something going on. Like they're trying to figure it out what to do.

You can just keep waiting, especially if the child is not, um, not showing signs of frustration. Cause that's another thing I wanted to mention. Like, for a lot of these techniques, especially the communicative temptations, you really want to keep it fun and light and not, uh, not a stressful thing for your child.

The last thing you want to do is stress them out and have them feel like you want them to communicate and they need to communicate right now. Like the important thing is just giving them an opportunity and, and waiting enough. But not so that they're like getting sad and frustrated and upset and they're like, why don't you just open this container?

Like, you know, but, um, but I think it all depends on the child and, and that exact moment, like if the child is happy and looking at you and waiting, like sometimes I've waited like a decent amount and then the child will say, Yeah. If we're reading brown bear or whatever. And, um, and I [00:54:00] think waiting long enough that, you know, the child's not upset, but then they're still attending to the activity sometimes.

Like if you wait and the child's completely not paying attention and onto something else, then it's like, well, you're just, they're not, they're not with you. So kind of knowing, like, if your child's with you looking at you, they are kind of in that moment with you and you think like, okay, they might say something like just waiting a bit longer.

Can, can a lot of times be fruitful, but, um, I think it's important to. Not wait too long so that your child gets, it gets frustrated. Cause then, then that's like completely missing the point. Then they're like, whoa, this is hard. This isn't fun. I don't want to do it. You know? Yeah,

Venita Litvack: no, that's a great point. Um, I don't know if we talked about this at all, but like another thing I think that's important, like in early intervention is like, um, instead of questioning, maybe more like using, um, like you were saying [00:55:00] the, um, communicated temptations.

So can you talk about that a little bit? Cause I think that sometimes parents can get into this, um, like cycle of what's this what's that and then what should they be doing instead?

Cara Tambellini: Yeah, totally. Um, so, uh, I tell parents it's a lot, like try to get out of the quizzing because a lot of times parents are like, well, I want to interact with my child with their playing.

So I'm going to say like, oh, what did the car do? What's this, where's it going? How has it, what does it say? What is it? And, um, and a lot of times kids are like, oh my gosh, I just want to play. Like what? So, um, a lot of times I tell parents to do in that case, it's just to do, um, all those strategies from the, what we were talking about before, like responsive, labeling, parallel, talk, talk about your child, what your child's doing, talk about the toys your child's playing with.

And a lot of times [00:56:00] the child will, um, just have, say something back. Like if you're like, oh, the tower is so big, they'll say like, it's so tiny, knocked it down. And then you can say, oh, the blocks are everywhere. You knocked it down it foul. And then they'll say, let's build it again. So then it's a good. To get it back and forth, but you're not really asking them any questions.

I mean, you can ask some questions, but I would say mostly do responsive, labeling parallel talk, uh, talk about what they're doing, talk about what just happened. Um, and you can ask some questions, but definitely the ratio has to be more of the following. Your child's lead responsive, responsive talk.

Venita Litvack: Yeah, no, that's great.

Um, I'd like to end with some of like your go-to accounts, you mentioned like we talkers. Are there other ones that you recommend or resources for early intervention for SLP specifically?

Cara Tambellini: Oh my [00:57:00] goodness. Um, there are so many amazing accounts online. I can barely even, uh, like an a D SLP is great. Um, you're awesome, Carrie, uh, Cari.

Seminars. I think her name is she's amazing. And she does talks a lot about early intervention. Um, and then just for like general parenting, I really like south bay, mommy and me. Um, she talks a lot about, uh, parenting skills and curious neuron is a great one, um, for science-based parenting advice. Um, but there are so, I mean, I actually just love Instagram.

I learned so much from everyone on there. Um, but those are some of my, like some good early intervention accounts that I like. Um, but there's just, yeah, [00:58:00] there's just so many people sharing, such amazing information. On Instagram. Yeah. No,

Venita Litvack: that's super helpful. And like, what are your go-to resources? I know you said the CDC, um, you have your course for, um, is it appropriate for SLPs to you

Cara Tambellini: think?

I mean, to be honest, I do think so. Like I have had, um, SLPs, uh, a few take it, um, because to be honest, like a lot of times when, um, SLPs come out of grad school or they're starting their job, they don't have a lot of exposure to early intervention and then they don't have a lot of examples on what it looks like.

And the reason I did my course is that I have a lot of video examples on how to do these strategies because it's one thing to read about them, but it's another thing to kind of see them in action. Um, but you know, there's just, uh, as far as other resources for early intervention, um, yeah, I mean, Asher has a lot of.

You know, [00:59:00] research articles about it. And then the informed SLP, I'm a member of them formed SLP and they have a birth to three members section and they, um, I mean, you can just Google anything you want and they'll, and, and they'll have research articles about it. Cause they're just, they kind of scour the, the, um, literature to find the most relevant information for our field.

So I really like like being, um, a part of that birth to three, um, on the informed SLP. Oh yeah.

Venita Litvack: That's super helpful. Thank you for sharing that. So is there anything else you want to share before we wrap up and talk about where everybody can find and connect with you?

Cara Tambellini: Um, well, I was actually, I was just thinking like Hannon, like taking the hand in courses is very helpful.

I did that early in my career and, um, for newer speech therapists, um, or therapists who are getting into early intervention, that's a great, um, great place to start to [01:00:00] which one

Venita Litvack: that it takes

Cara Tambellini: to, to talk or, oh yeah. Um, it takes two to talk and more than words, but, um, it takes two to talk, I think is a great starting point.

You have to take that before more than words, but I think they have other programs too.

Venita Litvack: Great. All right. So let's talk about where everybody can find and connect with you, um, after this episode.

Cara Tambellini: Yeah. So my Instagram is Kara speech, C a R a speech, and, um, then my books are on Amazon and, um, it's we just Google my name, Kara tan Bellini.

I have four books geared toward early talkers and, um, my chorus is Cara speech.thinkific.com. So that's think epic T H I N K I F I C

Venita Litvack: wonderful Kara. This has been amazing. Um, I have really enjoyed this episode, you know, as a new mom, but also as an SLP who [01:01:00] needed a refresher and early intervention and you shared so much great information.

So I'm excited for the listeners to hear this. And I look forward to following along on your journey.

Cara Tambellini: Awesome. Thanks so much. We need to add, this was so much fun. I really enjoyed it. All right, until next time. Okay.

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