Persian Adaptation of Enhanced Milieu Teaching for Iranian Children With Expressive Language Delay

Objectives: This study aimed at adapting and examining the applicability of the Teach-Model-Coach-Review model of the enhanced milieu teaching (EMT) approach for improving Iranian mothers’ language strategies while interacting with their toddlers with expressive language delay. Methods: In a single-subject multiple-baseline across-behavior study, the mothers of 3 toddlers with expressive language delay attended a series of intervention sessions to be taught how to modify their interaction strategies/behaviors, including noticing and responding, turn-taking, and expanding. Their behaviors were video-recorded, and the percentages of mother’s behaviors were calculated. Visual analysis and an improvement rate difference (IRD) metric were provided to document the mothers’ progress. Fidelity was checked, using a checklist of items taught by the clinician, as well as a quality check of the sessions. Results: Mothers indicated the improved levels of strategy usage after receiving EMT and maintained their skills at criterion levels after the termination of the intervention. IRD for notice-respond, turn-taking, and expanding was 0.88, 0.91, and 0.88 for FA’s mother, respectively. IRD was 0.92 and 1 for AM’s mother. The two strategies of notice-response and turn-taking showed IRDs of 1 and 0.66 for KA’s mother. Discussion: Iranian speech therapists employ a Persian-adapted edition of the Teach-Model-Coach-Review model of EMT with confidence to follow the improvement of parents’ strategies usage within an early intervention course of management of child language delay. The model provides a systematic education of parents to address the communication needs of their children.