Effects of a naturalistic sign intervention on expressive language of toddlers with down syndrome

Courtney A. Wright, Ann P. Kaiser, Dawn I. Reikowsky, Megan Y. Roberts

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Purpose: In this study, the authors evaluated the effects of Enhanced Milieu Teaching (EMT; Hancock & Kaiser, 2006) blended with Joint Attention, Symbolic Play, and Emotional Regulation (JASPER; Kasari, Freeman, & Paparella, 2006) to teach spoken words and manual signs (Words + Signs) to young children with Down syndrome (DS). Method: Four toddlers (ages 23-29 months) with DS were enrolled in a study with a multiple-baseline, acrossparticipants design. Following baseline, 20 play-based treatment sessions (20-30 min each) occurred twice weekly. Spoken words and manual signs were modeled and prompted by a therapist who used EMT/JASPER teaching strategies. The authors assessed generalization to interactions with parents at home. Results: There was a functional relation between the therapist's implementation of EMT/JASPER Words + Signs and all 4 children's use of signs during the intervention. Gradual increases in children's use of spoken words occurred, but there was not a clear functional relation. All children generalized their use of signs to their parents at home. Conclusions: The infusion of manual signs with verbal models within a framework of play, joint attention, and naturalistic language teaching appears to facilitate development of expressive sign and word communication in young children with DS.

Original languageEnglish (US)
Pages (from-to)994-1008
Number of pages15
JournalJournal of Speech, Language, and Hearing Research
Issue number3
StatePublished - 2013


  • Down syndrome
  • Early intervention
  • Language intervention
  • Sign language
  • Simultaneous communication

ASJC Scopus subject areas

  • Speech and Hearing
  • Language and Linguistics
  • Linguistics and Language


Dive into the research topics of 'Effects of a naturalistic sign intervention on expressive language of toddlers with down syndrome'. Together they form a unique fingerprint.

Cite this