Structured Communicative Play Therapy for Targeting Language in Young Children
Eisenberg, Sarita, Communication Disorders Quarterly
Although recent evidence has shown that conversational contexts may be more effective in achieving spontaneous use of language targets, many clinicians continue to employ more structured and less naturalistic contexts for their therapy. The purpose of the current article is to present a therapy approach that is structured, yet incorporates the communicative aspects of more naturalistic language therapy.
An important focus for language intervention with preschool children is to address deficits in the grammatical system of children with language impairments (LI). The importance of making grammatical skills a focus of therapy is supported by research that shows that grammatical competence is a persistent problem for children with LI (Goffman & Leonard, 2000; Watkins, 1994). In addition, certain pragmatic abilities, such as conversational repair and cohesion, depend on knowledge of grammar (Leonard & Fey, 1991; Mentis, 1994). The long-term aim of language intervention, however, is not only to have these children learn more sophisticated grammatical forms but also to have them use these newly learned aspects of grammar for a variety of purposes. To accomplish this aim, the speech-language pathologist (SLP) must design a variety of learning environments that enable the child to hear and use the relevant language structures. These learning environments may differ in a number of ways, including the number and type of models that the child hears, the degree of naturalness or structure, the number opportunities for the child to produce the target, and the adult's response to the child's correct and incorrect attempts at the target.
Although recent evidence has shown that conversational contexts may be more effective in achieving spontaneous use of language targets (Camarata & Nelson, 1992; Nelson, Camarata, Welsh, Butkovsky, & Camarata, 1996), many clinicians continue to use more structured and less naturalistic contexts for their therapy. This may be because, as reported by Shriberg and Kwiatkowski (1982) for phonological therapy, clinicians perceive drill therapy paradigms as more effective and efficient. Although children do produce trained target forms within the drill therapy context, however, these more structured therapies do not lead to spontaneous productions in conversation (Fey, 1986; Law, 1997) and thus cannot accomplish the ultimate aims of intervention.
THE CONTINUUM OF NATURALNESS
Intervention contexts vary along a continuum of naturalness on the basis of their similarity to everyday situations in which the child has frequent opportunities to communicate (Fey, 1986). At one extreme is drill therapy, in which production of the target is in response to some specific stimulus. At the other extreme are conversational activities in which use of the target behavior arises naturally as it is needed to communicate. Play has been incorporated into therapy at each of these extremes: as a context for naturalistic therapy in free play (Fey, 1986) and as a motivator and reinforcer for correct responses within structured drills (Shriberg & Kwiatkowski, 1982).
Drill therapy consists of an antecedent stimulus, child response, and consequent reinforcement. The antecedent stimulus serves as the condition for the child's response and may also include instruction, often in the form of a model of the target form. The child's responses always follow the stimulus and are constrained such that only responses that match or attempt the specific target are allowed. Response by the child is required, and the motivation for the child's response comes from a consequent reinforcer. The child's response is not, therefore, communicative, and the reinforcer is unrelated or external to the target response and activity. Prompting may be provided after incorrect attempts, and feedback is provided regarding response accuracy. Stremel and Waryas (1974) described a drill therapy program using a token reinforcer paired with social praise (e. …