Teaching Paraeducators to Support the Communication of Young Children With Complex Communication Needs

Abstract

Paraeducators are frequent communication partners for young children with complex communication needs (CCN) in early childhood settings. This study examined the impact of instruction to paraeducators in two communication interaction strategies (IPLAN [Identify activities for communication, Provide means for communication, Locate and provide vocabulary, Arrange environment, use iNteraction strategies] and MORE [Model AAC, Offer opportunities for communication, Respond to communication, Extend communication]) on the number of communication opportunities provided by paraeducators during play activities with young children with CCN. Results of the study provide evidence that after 2 hr of one-on-one training, paraeducators increased the number of communication opportunities they provided for children with CCN, and children with CCN took an increased number of communication turns. In addition, paraeducators reported that they found the training beneficial, and the supervising teachers noted improvements in the communication support provided by the paraeducators. Limitations and future research directions are discussed.

Keywords

augmentative and alternative communication paraeducators training complex communication needs early intervention

Nearly half of all children in early childhood special education programs experience difficulty with communication and qualify for speech language services (Dunlap, 2009). For children with disabilities such as autism, cerebral palsy, and Down’s syndrome, speech may not be sufficient to support full participation in daily activities (Clarke et al., 2012). For these children with complex communication needs (CCN), the use of augmentative and alternative communication (AAC) can have important benefits (Douglas, 2012; Light & McNaughton, 2012). AAC includes the use of sign language, picture symbols, speech-generating devices, and gestures to augment speech (Kaiser, Hester, & McDuffie, 2001).

Use of AAC can help individuals meet their immediate communication needs and support development of new language and communication skills (Kaiser et al., 2001; Simeonsson, Bjorck-Akesson, & Lollar, 2012). However, children with CCN require assistance from communication partners as they learn to communicate effectively using AAC (Binger, Kent-Walsh, Ewing, & Taylor, 2010; Broberg, Ferm, & Thunberg, in press). Unfortunately, research indicates that communication partners often engage in behaviors that restrict the communication of individuals with CCN (J. Kent-Walsh & McNaughton, 2005; Raghavendra, Olsson, Sampson, McInerney, & Connell, 2012). However, there is evidence that training can provide communication partners with strategies (e.g., providing opportunities for communication) that can increase the frequency and quality of communication by children with CCN (see Binger et al., 2010).

Communication Partner Strategies

There are many ways that communication partners can provide appropriate supports as children learn to communicate using AAC (Douglas, 2012). First, partners should identify activities that are motivating to the child, developmentally appropriate, and provide many communication opportunities (Light, 1997b; Sigafoos, 1999). Partners should also ensure the child has access to appropriate AAC (Cress & Marvin, 2003). Communication partners should ensure that the vocabulary is fun, functional, and appropriate to the child’s development, culture, and personality (Beukelman, McGinnis, & Morrow, 1991; McCarthy & Light, 2001). During interactions, the child and partner should be facing each other with the child positioned to maximize motor skills (Costigan & Light, 2010). Finally, the AAC system and activity should be accessible to the child (Light, 1997b).

Communication partners should also use appropriate interaction skills during the activity. First, the partner should model the use of AAC (Binger et al., 2010) and provide many communication opportunities (Sigafoos, 1999). When partners model AAC and provide many communication opportunities, children with CCN are more likely to increase the number of communication turns taken (see Binger et al., 2010). Next, after providing an opportunity to communicate, partners should wait for the child to participate (Binger et al., 2010). Providing wait time signals to the child that it is their turn allows the child to “process” the message and provides the child time to formulate a response (Light, Collier, & Parnes, 1985a). Next, the communication partner should respond to the child’s communication (Cress & Marvin, 2003; Light, Dattilo, English, Gutierrez, & Hartz, 1992). When partners respond, they encourage communication and participation (Mirenda, 1997).

Importance of Paraeducator Supports During Play

A young child encounters many different communication partners throughout the day, including parents, siblings, peers, and educational staff. In the school environment, paraeducators are important and frequent communication partners for children with CCN. Paraeducators are defined as adults who support children with disabilities in educational settings and work under the supervision of teachers or professional practitioners (No Child Left Behind Act of 2001). There has been a dramatic increase in the use of paraeducator supports in early childhood special education settings (Hadadian & Yssel, 1998). One benefit of paraeducator supports is the provision of one-on-one instruction for the child. However, paraeducators often work with the most difficult to serve children (Mueller, 2002) and receive only limited training (Giangreco, Broer, & Edelman, 2002).

For young children, play would appear to be an especially important time to provide communication supports. By definition, children enjoy play, and there should be multiple opportunities for communication (Odom, Peterson, McConnell, & Ostrosky, 1990). Yet, there is evidence that even communication partners who are very familiar with a child may struggle to provide appropriate communication supports during play activities (Light, Collier, & Parnes, 1985b). However, with the support of adults, children with disabilities have shown improvements in both play and communication skills (Frey & Kaiser, 2010).

A literature review conducted by Douglas (2012) indicated that when paraeducators were taught behaviors to support communication, paraeducators and individuals with CCN demonstrated improvement in the quantity and quality of communication. However, despite the benefits of communication partner training, only seven studies met the inclusion criteria of the review by Douglas (2012), with only one study involving young children (Binger et al., 2010) and no studies focused on play.

Research Questions

Although paraeducators are recognized as key communication partners (Binger et al., 2010), and play activities are widely viewed as important opportunities for developing communication skills with young children (Gray, 1997; Patterson & Westby, 1994), to date there has been no research examining the impact of training on the performance of paraeducators during play activities with young children with CCN. Therefore, in this study, paraeducators were provided with instruction to support the communication of young children with CCN, and as a first step to determine the effectiveness of the training program, the communication behavior of paraeducators was measured as they interacted with young children with CCN in a focused (one-on-one) interaction. Data were also collected on the communication behavior of children. A single-subject multiple baseline probe design across dyads was used to answer the following research questions:

Research Question 1: What is the effect of paraeducator training on the number of communication opportunities provided by paraeducators to children with CCN during play interactions?

Research Question 2: What is the effect of paraeducator training on the number of communication turns taken by children with CCN during play interactions?

Social validity measures also were conducted to determine the perceived benefit of training by paraeducators and the value of training by teachers.

Method

Research Design

This study used a single-participant multiple baseline probe design (Gast, 2010) across three dyads. Dyads consisted of a paraeducator and the child they supported with CCN. The study included data collected concurrently during baseline, training, and maintenance phases. First, data were collected during baseline play sessions and analyzed to establish baseline levels of performance on the primary and secondary dependent variables (i.e., communication opportunities provided by the paraeducator, communication turns by the child with CCN). After a stable baseline was established for the first paraeducator (i.e., low variability for at least the final three consecutive data points, descending or stable trend), training was provided. During this time, other paraeducators remained in baseline. Instruction for paraeducators was staggered across dyads. When the first paraeducator completed all training sessions and demonstrated a change in the target behavior (i.e., at least a 25% mean increase over the baseline mean for three sessions, see J. E. Kent-Walsh, 2003), the next paraeducator entered training following the same procedures. This pattern continued until all paraeducators completed training.

Setting

The study was conducted at an early childhood setting in the mid-Atlantic region of the United States. The center provided a variety of early childhood services for children with and without disabilities from infancy to preschool. Classrooms within the center included typical peers (50% of the students) who served as peer models, and children with disabilities (50% of the students). Data for the study were collected in therapy rooms used regularly at the center by the paraeducators and children to promote a focused interaction between paraeducator and child, and to limit distractions and background noise.

Sampling Procedures

The director of the early childhood center was asked to nominate paraeducators who worked with children with CCN for this study. She was instructed to select paraeducators who (a) were currently providing one-on-one assistance to a child aged 2 or older with CCN and (b) had been paired with that child for at least 1 month. The nominated paraeducators were then approached in person and invited to participate in the study. After consent from paraeducators was obtained, a letter was sent to parents of the children with CCN who were supported by paraeducators to request permission for their child to participate in the study. Only dyads for whom consent was obtained for both the paraeducator and child were eligible for participation in the study. All dyads for whom consent was obtained participated in the study.

Participants

Three paraeducators and three children participated in this study.

Dyad A

Ann, age 59, had 4 years of experience supporting children with disabilities at the early childhood center and held a bachelor’s degree in rehabilitation services. Prior to the study, Ann had received approximately 20 hr of training in the classroom duties of a paraeducator, including data collection techniques, working with therapists, and play-based learning.

Aaron was 4 years 11 months at the start of the study. He was diagnosed with Down syndrome, and vision and hearing were reported to be within normal limits. He used a variety of means to communicate, including sign language, gestures, pointing, speech, and speech approximations. He typically communicated using one to two word phrases with gestures, pointing, and/or a single sign. His Individualized Education Plan (IEP) goals included learning to count by rote from 1 to 10, identify colors, identify attributes of objects (e.g., larger, smaller), and take turns with peers.

Dyad B

Ben, age 23, had 3 years of experience supporting children with disabilities and was enrolled in the last year of a bachelor’s program in psychology and neuroscience during the study. Prior to the study, Ben had participated in approximately 20 hr of training in the duties of a paraeducator, including data collection techniques, working with therapists, and play-based learning.

Becca was 3 years 4 months at the start of the study. She had a diagnosis of developmental delay and was hard of hearing. She wore hearing aids, which were reported to correct her hearing so that she could hear at 30 dB (mild impairment). She also used an FM system at school to help her hear the teacher and/or paraeducator. Her vision was reported to be within normal limits. Her parents reported that she communicated using sign language and gestures. She used approximately three signs regularly (i.e., eat, more, up) and signed most frequently during mealtimes. Her IEP goals included developing sound object correspondence (e.g., selecting duck when she hears “quack”), using sign during play activities, playing functionally with toys, and increasing intentional communication (e.g., pointing, gaining attention, signing, and gesturing).

Dyad C

Cathy, age 26, had been supporting Courtney at the early childhood center for a year and was a licensed practical nurse (LPN). She had not received formal training about paraeducator duties; however, she talked informally with therapists to learn how to address educational goals for Courtney.

Courtney was 2 years 5 months at the start of the study. She was diagnosed with bilateral schizencephaly, a neurological disorder affecting cognitive, motor, and speech language functioning (Chen, 2006). In addition, she also was diagnosed with spastic quadriplegic cerebral palsy. Courtney’s educational records indicated her hearing was within normal limits. She also had a pair of prescription glasses to correct mild hyperopia; however, she resisted wearing the glasses and did not wear them during this study. According to her parents, she communicated using a simple voice output communication device that was preprogrammed with up to four messages, a picture communication board, facial expressions, and gestures. Educational reports indicated that Courtney looked at the speaker when her name was called, smiled regularly at peers, tracked objects with her eyes, and could match colors. Educational goals for Courtney included improving fine motor skills during play, following and participating in classroom routines, and using AAC to gain attention, greet, request, and interact with others.

Procedures

The study was conducted in three phases: baseline, training, and maintenance. All dyads were videotaped during play sessions at each phase of the study. Play sessions were approximately 15 min in length and ended at a natural break in play. The data collection schedule was set based on the class and therapy schedules of the children. Paraeducators selected classroom play materials for each play session.

Baseline

During baseline play sessions, paraeducators were instructed to play as they normally would with the child using toys and materials from the classroom.

Training

After five baseline data points were collected and baseline was stable (i.e., final three points with descending and/or stable trend and limited variability), the first paraeducator began training. The first author delivered one-on-one training to each paraeducator. The training took place in four sessions, spaced out over approximately 2 weeks, and took approximately 2 hr to complete (see Table 1). In the training phase, one data point was collected during the fourth training session where paraeducators engaged in a practice play session.

Table 1.

Training Session Content, Format, and Instructional Procedures.

Session	Training content	Training format	Instructional procedures	Time
1	Importance of communication	Powerpoint presentation	Commitment to participate in training	1 hr
	Description of IPLAN strategy	Videos	Application of strategy to video models and target child
2	Description of MORE strategy	Powerpoint presentation	Test of IPLAN strategy mnemonic	20 min
		Videos	Application of MORE strategy to video models and target child
3	Review of IPLAN MORE strategies	Discussion to complete plan for strategy use	Test of MORE strategy mnemonic	20 min
			Application of strategies to video models and target child
			Create plan for use of strategies with target child
4	Practice play session using IPLAN MORE strategies	15-min play session	Practice play session to implement strategy plan	20 min
		Answer any questions	Completion of reflection

Abbreviations: IPLAN = Identify activities for communication, Provide means for communication, Locate and provide vocabulary, Arrange environment, use iNteraction strategies; MORE = Model AAC, Offer opportunities for communication, Respond to communication, Extend communication.

Training content

The training targeted two strategies, both of which included a mnemonic (see Table 2). The first strategy largely focused on preparing for the play activity (IPLAN [IPLAN = Identify activities for communication, Provide means for communication, Locate and provide vocabulary, Arrange environment, use iNteraction strategies]), the second focused on what to do during the play activity (MORE [Model AAC, Offer opportunities for communication, Respond to communication, Extend communication]). The strategies were developed for this study and targeted skills that were identified as important to supporting the development of communication skills (Light & Drager, 2010).

Table 2.

Strategy Steps, Description, and Example.

Strategy step	Description	Example
I—Identify activities for comm.	Choose a motivating activity and provide comm. opportunities.	Paraeducator provides comm. opportunities during motivating car activity.
P—Provide means for comm.	Provide the child’s AAC.	Picture symbols are provided during car activity.
L—Locate and provide vocabulary	Include vocabulary that the child might want to use during activity.	Appropriate picture symbols are provided for car activity (e.g., colors, types, places).
A—Arrange environment	Position child to maximize vision, hearing, and motor skills.	Child is positioned to see partner, access cars, and access AAC.
N—use iNteraction strategies	Use the MORE strategy.	See MORE strategy examples.
M—Model AAC	Use AAC as you talk.	Point to child’s picture symbols as you talk.
O—provide Opportunities for comm.	Provide choices, ask questions, and comment. Wait for child to respond.	“Which car do you want? Where is the car going? Wow that car is fast!”
R—Respond to child’s comm.	Acknowledge and respond to comm. Ask for clarification if necessary.	Child reaches for a car. Paraeducator provides car and says, “Oh, you want the car.”
E—Extend comm.	Build on child’s comm.	Paraeducator asks, “Where will the car go?”

Abbreviations: comm. = communication; AAC = augmentative and alternative communication; MORE = Model AAC, Offer opportunities for communication, Respond to communication, Extend communication.

Training format

Instructional activities were developed using the strategy instruction framework (Ellis, Deshler, Lenz, Schumaker, & Clark, 1991; J. Kent-Walsh & McNaughton, 2005). During Session 1, a commitment to participate in the training was provided by the paraeducator, and then a brief video and discussion about the importance of communication was provided (see Table 1). Next, the IPLAN strategy steps were introduced (see Table 2), and a video was shown to demonstrate the use of the strategy steps. After the video was shown, the first step of IPLAN, Identify activities for communication, was described in more detail with a brief video to demonstrate the step. Then paraeducators were asked questions about the paraeducator’s use of the strategy step with the child seen in the video clip, and to describe how that strategy step might be implemented with their target child. Finally, paraeducators were provided with a scenario and asked to describe how they would implement the strategy step for the child described in the scenario. The next three steps of IPLAN were discussed using the same format (i.e., description, video demonstration, questions, scenario to practice application of step). Finally, paraeducators were introduced to the final step, use iNteraction strategies, and told this step would be described in more detail during the second session of training. At the end of the session, paraeducators were asked to practice and memorize the strategy steps of IPLAN before the next session.

Session 2 began with a brief test of the steps in the IPLAN strategy. If paraeducators demonstrated recall of the IPLAN strategy mnemonic with at least 80% accuracy (i.e., four out of five steps of the strategy), they were then introduced to the MORE strategy. All paraeducators demonstrated recall of the IPLAN strategy mnemonic with at least 80% accuracy during Session 2. If a paraeducator had not achieved 80% accuracy after one session, review of the IPLAN strategy would have been provided until mastery. Paraeducators were then taught the MORE strategy using the same instructional framework as the IPLAN strategy.

The third session began with a test of the MORE strategy mnemonic. All paraeducators passed the MORE test with 100% accuracy and moved on to practice scenarios for both the IPLAN and MORE strategies. Once paraeducators successfully completed practice scenarios, they created a plan to implement the IPLAN and MORE strategies with their target child. This included selection of a motivating play activity, description of AAC to be used, vocabulary the child might need during the activity, and arrangement of the environment (IPLAN). In addition, paraeducators described how they would model AAC, provide opportunities for communication, respond, and extend communication during the activity (MORE).

The final session of training was a play session in which paraeducators were asked to implement the IPLAN and MORE strategies with their target child. After the play session, the paraeducators had the opportunity to ask the researcher questions about the strategy. Paraeducators also self-evaluated their performance by answering questions about their use of the strategy, including how they implemented the strategy, the impact of strategy use on the communication of the child, and how they might perform differently in the future.

Maintenance

After the training session was completed, play sessions were once again conducted for each dyad

Five maintenance play sessions were completed for each dyad. For Dyad A, maintenance sessions were taken 7, 11, 24, 59, and 63 days after training was completed. Maintenance sessions for Dyad B were taken 3, 6, 37, 41, and 43 days after training was completed. For Dyad C, maintenance sessions were taken 1, 6, and 7 days after training, with two data points collected on Day 1 and Day 6 (i.e., one in the morning, one in the afternoon). Data were collected twice daily for Dyad C during the beginning of maintenance because of a break in the school calendar.

Measures

Data were collected for two dependent variables. The primary dependent variable was the number of communication opportunities provided by paraeducators, and the secondary dependent variable was the number of communication turns taken by children. Data from paraeducators and children were graphed and visually inspected for level, trend, and variability (Gast, 2010). Data were also analyzed using percentage of nonoverlapping data, which helps determine treatment effectiveness by indicating the percentage of data that overlap from baseline to other phases (Scruggs & Mastropieri, 1998).

Data collection

Play interactions were video recorded in each phase of the study. Play sessions varied in length; however, the following procedures were used to standardize video length for data analysis. First, the entire play session was recorded. Second, to minimize reactivity of the video camera and researcher, the 1st minute of each video was not analyzed. Finally, the interaction that occurred the following 12 min was coded for analysis. Training sessions also were recorded and scored for treatment integrity to document that all paraeducators received the same instructional program.

Coding

Videos collected during play sessions were analyzed using Studiocode video analysis software (Sportstec Limited, 2011). Within Studiocode, a coding window was created to count the frequency of behaviors. Coders also referred to the following coding rules and behavioral definitions when coding behaviors. Paraeducators were coded as providing a communication opportunity if they performed all three of the following behaviors: (a) asked a question, commented, or provided a choice; (b) looked at the child; and (c) provided a pause of at least 5 s (or the child responded before 5 s elapsed). Children were coded as taking a communication turn if they performed both of the following behaviors: (a) made use of intelligible speech or AAC (e.g., sign, voice output communication system, picture symbols, etc.) and (b) directed communication at the partner (e.g., the child made eye contact to the partner, object, and/or activity they were engaging in with the partner).

Interrater reliability

Two independent coders analyzed the 12-min video clips for each session using the Studiocode software program (Sportstec Limited, 2011). Training was provided for the coding procedures until at least 90% agreement had been reached for two consecutive sessions. Reliability checks were randomly selected and made for 30% of play sessions for each dyad during each phase of the study. Results from interrater reliability averaged 92% (range = 84%–100%) for communication opportunities by paraeducators and 90% (range = 79%–100%) for child communication turns. Reliability was lower in sessions where fewer behaviors occurred overall, or where the child communicated using speech or sign language as these behaviors were sometimes difficult to hear/see clearly. All disagreements were discussed until agreement was reached.

Treatment fidelity

Treatment fidelity for training sessions was measured by taking the number of instructional steps correctly implemented by the researcher, divided by the number of instructional steps. Treatment fidelity ranged from 98% to 100% during training sessions.

Social validity

Two measures of social validity were taken for this study to determine the perceived impact of the intervention for the individual receiving the intervention (i.e., paraeducators) and the perceived value of the intervention by one of the stakeholder groups (e.g., teachers of the children participating in the study). First, each paraeducator completed a training evaluation form with questions about the perceived benefits and challenges of the training program. Questions included the following: (a) What were some benefits of this training program? (b) Is there anything you would change about the material presented during the training? (c) Is there anything you would change about the strategy you learned? (d) Did you notice any changes in the communication of the child? (e) Would you recommend this training to other paraeducators? Why or why not? and (f) Do you have any other comments?

A second measure of social validity was taken to determine the perceived value of the intervention by the classroom teachers of children in the study (Schlosser, 1999). The teachers supervised the paraeducators in the study. Teachers of child participants viewed three pairs of randomly selected video clips (one from baseline and maintenance phases of the study for each pair of clips). Each video clip was 3 min in length. After viewing each pair of video clips, teachers indicated the preferred video clip and were asked questions about the preferred video clip.

Results

Paraeducator Behavior

This study provides evidence that the training resulted in the paraeducators providing an increased number of communication opportunities to the children (see Figure 1). Ann had a baseline mean level of 42 (range = 34–45) communication opportunities offered to Aaron. The number of communication opportunities increased to 74 during training and to a mean of 82 during maintenance (range = 68–92). Overall 100% of the data points during training and maintenance did not overlap with those at baseline, suggesting that intervention was highly effective for Ann (Scruggs & Mastropieri, 1998). Mean gain from baseline to maintenance was +40 opportunities in 12 min of interaction. Initially, the paraeducator maintained high rates (80 opportunities or more in 12 min), but over time, a decrease was noted.

Figure 1.

Number of communication opportunities provided by paraeducators and communication turns taken by children in Dyads A, B, and C in 12-min interactions.

Ben demonstrated a baseline mean of 28 (range = 24–31) for communication opportunities offered to Becca. The number of communication opportunities increased during a single play session in training to 39. During maintenance, the mean was 35 (range = 27–39). Eighty percent of the data in maintenance were above the highest baseline point, suggesting that intervention was effective for this Ben (Scruggs & Mastropieri, 1998). Mean gain from baseline to maintenance was +7 in 12 min of interaction. Initially, the paraeducator maintained high rates, but a decrease was noted at the end of the maintenance phase (43 days after training was completed).

Cathy provided a mean of 18 (range = 15–22) communication opportunities to Courtney during baseline. During training, she provided 37 communication opportunities, and in maintenance, she offered a mean level of 30 communication opportunities (range = 27–33). One hundred percent of data points from maintenance were above the highest baseline point, suggesting that intervention was highly effective for Cathy (Scruggs & Mastropieri, 1998). Mean gain from baseline to maintenance was +12 in 12 min of interaction.

Child Behavior

All children showed an increase in communication turns during the training phase of the study when compared with baseline (see Figure 1). Aaron had a mean of 28 (range = 25–32) communication turns during baseline. During the single training play session, his communication turns increased to 70. In maintenance, the mean for communication turns was 77 (range = 52–98). One hundred percent of data from maintenance did not overlap with baseline data, suggesting that intervention was highly effective for Aaron (Scruggs & Mastropieri, 1998). Mean gain from baseline to maintenance was +49 in 12 min of interaction. Initially, Aaron demonstrated significant gains during the maintenance phase, but a decline was noted at the end of maintenance, although rates remained above baseline.

Becca had a mean of 3 (range = 1–6) communication turns per session during baseline. During the single training play session, the number of communication turns rose to 16. During maintenance, Becca had a mean of 10 communication turns (range = 2–18). Eighty percent of data from maintenance was above the highest baseline data point for Becca, suggesting that the intervention was effective for Becca (Scruggs & Mastropieri, 1998). Mean gain from baseline to maintenance was +7. Performance was variable in maintenance with an initial drop, but an upward trend was noted.

Courtney had a mean of 13 communication turns during baseline (range = 13–14). The number of communication turns by Courtney rose to 20 during training, with a mean of 18 (range = 13–20) communication turns during maintenance. Eighty percent of maintenance points did not overlap with baseline data points, suggesting the intervention was effective for Courtney (Scruggs & Mastropieri, 1998). Mean gain from baseline to maintenance was +5 communication turns in 12 min of interaction.

Social Validity

Results from social validation measures provide evidence that paraeducators were satisfied with the training provided. First, all paraeducators indicated that they would recommend the training to other paraeducators. In addition, each paraeducator indicated positive changes in both their skills and the communication skills of the child. When asked whether they would make any changes to the material presented, all paraeducators indicated they would not change the materials. However, when asked about the strategy, one paraeducator felt the mnemonic was not needed to support strategy use.

Results from the video review by classroom teachers indicate that training was seen as beneficial for the paraeducators. Two teachers (i.e., teachers for children in Dyads A and B) reviewed videos for the study (the third teacher could not be reached due to a change in employment at the early childhood center). The teacher reviewing Dyad A videos identified all postinstruction videos for the paraeducator as preferable to the preinstruction clips. Specifically, the teacher noted that in the postinstruction videos, the paraeducator described what the child was doing, asked open-ended questions, and provided items when the child made a request. The teacher reviewing the videos for Dyad B identified two of three postinstruction videos for the paraeducator as preferable. She noted that in the two preferred postinstruction videos, the paraeducator provided more choices and encouraged participation by the child. In the preinstruction video that was preferred by the teacher, the Dyad was playing with toy animals. The teacher noted that Ben provided a larger variety of objects, signs, and sounds about the animals when compared with the postinstruction video in which the dyad played with cars.

Discussion

This study provides initial evidence that a 2-hr, one-on-one paraeducator training targeting best practices to support communication of young children (Light, 1997a), and taught through a strategy instruction model (Ellis et al., 1991; J. Kent-Walsh & McNaughton, 2005), had a positive impact on the communicative interaction between paraeducators and children with CCN during play activities. Following training, paraeducators increased the number of communication opportunities, and children took a greater number of turns.

These results compare favorably with other interventions to support the communication of young children with CCN. For example, Binger and colleagues (2010) reported that communication training to paraeducators resulted in an increase in the use of multisymbol messages by children with CCN during story reading activities, and improvements seen in communication by children with CCN closely followed the use of communication strategies by paraeducators. The study by Binger and colleagues (2010) also utilized principles of strategy instruction as outlined by J. Kent-Walsh and McNaughton (2005), and included key communication supports (e.g., model AAC use, ask questions).

As in previous research (Light et al., 1992), a decrease in partner performance was noted after the completion of training activities. Both Dyads A and B showed a slight downward trend over time in the maintenance phase, and Dyad C showed an initial drop, then remained relatively constant in maintenance, although maintenance data were not collected for as long due to a break in school. However, all maintenance data points were above baseline for Dyads A and C; for Dyad B, four out of five data points were above baseline. There are several possible explanations for the drop in the number of communication opportunities. First, although paraeducators demonstrated initial acquisition of the strategy, they may not have been fully fluent in its use with only 2 hr of training. Additional practice in providing communication opportunities before exiting training (see McReynolds & Kearns, 1983) may help improve fluency.

Variation in performance occurred across dyads. Paraeducator education levels, years of experience working with children with disabilities, and hours of previous training varied in this study. The paraeducator who made the most growth in the study (i.e., Ann) had 4 years of experience working with children with disabilities and a 4-year degree in a field related to working with individuals with disabilities. Although this is not the traditional demographic of most paraeducators, this additional experience may have provided additional benefit for the dyad. Similarly, the initial communication turns taken by children also varied and were lower for Becca and Courtney. Initial communication turns may have been influenced by the cognitive and physical skills of the child. For example, Courtney’s diagnosis of spastic quadriplegic cerebral palsy and bilateral schizencephaly may have made it difficult for communication to occur at the same rate as Aaron.

Child communication turns also varied across dyads in the study. For the great majority of the sessions, the number of turns taken by the child was closely related to the number of opportunities provided by the paraeducator. However, on a small number of occasions, the children responded to the increased number of opportunities provided by the paraeducator and also showed an increased in initiations. In the field of AAC, a two-pronged approach to intervention has been recommended: direct intervention with the individual with CCN and instruction to communication partners (McNaughton & Light, 1989). This study, however, only addressed instruction to communication partners (i.e., paraeducators)—No instruction was provided for the child, and the intervention did not address adding vocabulary to the child’s AAC system. Different outcomes might have been noted if intervention had also directly targeted the children with CCN.

Limitations and Future Research Directions

Although positive results were observed in this study, there are a number of limitations. First, the study examined the performance of three dyads of paraeducators and children with CCN, all of whom were located in the same early childhood center. Given the small number of participants, care should be taken in making generalizations about the potential effectiveness of the treatment to other individuals. In addition, variability was seen in the performance of the participants in this study. Given these limitations, further research is needed to determine whether the addition of practice sessions, generalization measures, or training paraeducators to a specified criterion might be beneficial to the intervention. In addition, future research is needed to determine whether this intervention is generalizable to other settings, paraeducators, and children with CCN.

Several limitations were also noted in the training. Given that a multicomponent training was utilized, it is difficult to determine what aspects of the training are most important and made an impact on dependent variables. Additional research could be conducted to determine whether reducing the content covered in training would result in improved outcomes for paraeducator and child communication behaviors. In addition, this study measured the effectiveness of one-on-one training to paraeducators who support children with CCN during focused play activities (without peers). Therefore, future research should explore the application of this or similar training to paraeducators supporting peer-mediated play. In addition, given the one-on-one nature of the training, future research should explore the benefits and outcomes of training teacher/paraeducator teams, or groups of paraeducators.

Summary

This study provides evidence that a 2-hr paraeducator training package that focuses on key skills to support communication (Light, 1997a), and incorporates principles of strategy instruction (Ellis et al., 1991; J. Kent-Walsh & McNaughton, 2005), can have a positive impact on the number of communication opportunities provided by paraeducators and the number of communication turns taken by children with CCN. Future research should continue to explore the factors that will lead to enhanced communication support by paraeducators, as well as communication development and participation for children with CCN.

Footnotes

Acknowledgements

The authors would like to thank the paraeducators and children who participated in this research project.

Authors’ Note

Pseudonyms have been used to ensure confidentiality of participants.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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