Using the LENA System in Early Intervention

Early Intervention (EI) services are provided to infants and toddlers with documented
developmental delays in all 50 states and US territories. EI improves long-term
infant-toddler adaptation and lowers the cost of care if parents use the services. However,
depressive symptoms can reduce mothers' ability to provide the daily child
development-promoting activities recommended by EI, increasing the child's risk for
communication and behavioral problems. Indeed, repeated studies have shown that depressive
symptoms reduce mothers' consistent use of developmentally sensitive, child-centered speech
which, in turn, lead to negative child cognitive and behavioral outcomes. Previous research
showed that over one-third of mothers of children with disabilities have significant levels
of depressive symptoms, a rate higher than the population at large. Infants and toddlers of
depressed mothers have been shown to receive fewer intensive services and have been shown to
interfere with uptake of EI services through impaired mother-child interactions. A
preliminary study by the investigators found that over a third of mothers of infants and
toddlers enrolled in EI in a large North Carolina county had severe depressive symptoms and
depression histories. Fortunately, the investigators also found that when depressed mothers
were provided with concrete, attainable skills for improving interactions with their child,
the impact of depression on both mother and child was substantially reduced. Focusing on a
depressed mother's child-centered speech and reciprocal communication also improves child
outcomes, even when the child is cognitively compromised. However, none of these specialized
services are part of EI best practices. Thus, EI is an ideal setting in which to integrate
screening, referral and targeted skills for depressed mothers in order to improve
parent-child interactions and ultimately, child outcomes.

This project will develop an intervention focused on communication between infants and
toddlers with diagnosed or suspected developmental disabilities and their mothers who have
depressive symptoms. The primary aim of the study is to test the initial efficacy of
embedding a language pedometer, the Language ENhancement Assessment/intervention system
(LENA), into EI to teach mothers to increase child-centered speech and reciprocal
communication, which have been linked to positive child outcomes, and to increase parenting
efficacy in depressed mothers of children in EI. While maternal depressive symptoms can
disrupt developmentally stimulating, child-centered speech, simple tools to assess and
provide feedback to mothers can improve the child-centered speech and reciprocal language
interactions that positively impact child outcomes. Although the LENA has been used in other
studies and shown improvements in mothers' child-centered speech, the system has not been
used with mothers showing depressive symptoms or in the EI context.

Using a randomized wait-list controlled design, the investigators will examine whether use of
the LENA with feedback from a supportive EI provider has an impact on the child's language
environment, parenting efficacy and maternal depressive symptoms. The investigators will
stratify mothers by group based on depressive symptoms (mild, moderate, moderately severe)
and randomly assign them to intervention (LENA with feedback) or wait-list control (LENA no
feedback). The investigators will examine the use of the LENA system and the impact on short
term child outcomes including receptive/expressive language, functional and social
communication, and social-emotional behavior, and on maternal depressive symptoms. Positive
intervention outcomes may ultimately lead to a sustainable addition to EI programs in all 50
US states and territories.

Inclusion Criteria:

Service Coordinator and Service Provider Inclusion:

- Be a CDSA employee in Durham, Wake, Alamance or Guilford Counties, NC

- Be a service coordinators or approved Speech-Language Provider(SLP) or Community Based
Rehabilitative Service (CBRS) provider (service providers).

- Eligibility of the service providers will be determined by the agreement of a mother
to participate in the LENA portion of the study and the agreement of the service
providers to participate as well.

Mothers Inclusion criteria:

- Be 18 years or older. Mothers who are 18 years can give consent independently.

- Be the biological or adoptive mother of an infant (6 weeks - 18 months old) or toddler
(19 -32 months old) enrolled in EI at the time of recruitment; mothers must be the
primary caretaker of the child.

- EI services are offered only to infants and toddlers up to the age of 36 months; this
study caps the age of enrollment at 32 months to ensure that toddlers are continuously
enrolled in EI during the data collection period.

- Able to independently give consent. Mothers must have adequate capacity to participate
in the LENA intervention as well as understand what they will be asked to do as
participants.

- Score 8 or higher on the PHQ-9. This score is indicative of depressive symptoms.

Exclusion Criteria:

Service Coordinator and Service Provider Inclusion: none

Mothers Exclusion criteria:

- Currently pregnant by self-report.

- Child is completely deaf