Novel intervention gives hope to children at risk for speech and language disorders
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Editor's note: Beate Peter and her team will receive the 2025 Editor’s Award from ASHA’s Journal of Speech, Language, and Hearing Research on Nov. 19 at the association’s convention in Washington, D.C., for the research featured in this story.
It's not uncommon for children to experience temporary delays in speech and language development. But while most will eventually catch up on their own, those who end up needing treatment typically don't get it until age 2 to 4 — when they may have already fallen behind.
What College of Health Solutions Associate Professor Beate Peter calls “vitamin P” may just be the key to improving children’s speech early on. Vitamin P — or parental involvement — is an integral part of the success of Babble Boot Camp and Play Boot Camp, research projects Peter is working on at Arizona State University.
Another unique element of the camps is the very young age at which children begin. Both are built on early intervention, working to treat the problem before difficulties arise. Babble Boot Camp participants start before they are 6 months old, while Play Boot Camp enrolls infants aged 4 to 8 months.
“If we can predict a very young child's future struggles with learning to talk, what if we do something that no one's ever done before, and that is work with parents in their daily home life, starting when the children are tiny infants instead of waiting for the difficulties to show,” Peter said.
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Current standard interventions involve weekly one-on-one meetings with a speech-language pathologist for 30 minutes or more, depending on state and local resources. In Babble Boot Camp, babies receive the intervention from their parents all day long in their daily home life.
Babble Boot Camp works by allowing a pediatric speech-language pathologist to educate parents on speech and language development. Peter’s clinical trial enrolled infants up to 6 months old with classic galactosemia, a rare metabolic disease identified in newborns prohibiting proper processing of galactose, which can be found in regular milk products and breast milk. Even though infants who test positive for this disease are immediately switched to a galactose-reduced diet, they are at risk for severe difficulties with learning to talk.
Children with classic galactosemia were randomized into two groups, one that started Babble Boot Camp before age 6 months and one that started at 15 months after receiving a motor intervention. Both groups completed Babble Boot Camp at age 2, and six months later, they participated in assessments of speech and language.
“One of the things that makes us unique is that we start not after children show that they have problems learning to talk, but long before they're ready to even say their first word,” Peter said.
After the children were enrolled, speech-language pathologists monitored their progress, meeting with parents to discuss how they were developing. From there, the speech-language pathologist determined areas to improve upon followed by a way the parents can work to achieve the goal. For example, if the goal was to increase cooing or babbling frequency, the speech-language pathologist suggested responding to any sound the baby makes.
“We're leveraging the frequency of vocalization toward building motor control that babies can then use in increasing their babble skills and, from there, their speech skills,” Peter said.
When tested at age 10 to 12 months, the participants who received the earliest intervention actually outperformed the control group.
“What should be quite clear is the children who received the earliest babble intervention outbabbled everybody else, even their typically developing peers,” Peter said of the earliest findings of her study.
When tested at age 2 1/2, the vast majority of Babble Boot Camp participants were doing well and did not show a need for additional speech therapy.
“Our children with classic galactosemia, when they were 2 1/2 years old, showed substantial increases in speech and language skills, compared to children who got conventional interventions, which often means they get no speech or language intervention until they're 2, 3 or 4 years old,” Peter said.
While the Babble Boot Camp study was wrapping up, Play Boot Camp, an expansion of Babble Boot Camp, was just getting started with a small pilot study with six infants with Down syndrome. For this study, Peter worked alongside ASU Department of Psychology Assistant Professor Kelsey Lucca, Mary Lou Fulton College for Teaching and Learning Innovation Clinical Professor Amanda Boutot, Northern Arizona University Clinical Professor Amy Armstrong-Heimsoth and Babble Boot Camp speech-language pathologist Jennifer Davis to develop an intervention that combines Babble Boot Camp speech and language strategies with motor and cognitive support.
Many children with Down syndrome experience difficulty with fine motor functions and have very low muscle tone, so when encountering a toy, they may struggle to interact with it. Without the strength or coordination to use the toy, they lose out on the opportunity to learn concepts like cause and effect from the toy.
“The very young age was selected because we think, based on our experience with the Babble Boot Camp so far, that the earlier we intervene, the more impact we can make. Because children's brains are so malleable still and so receptive to changes, how the brain builds up its connectivity, the earlier the better,” Peter said.
Over the course of 10 months, the parent and child spend 40 sessions learning from two experts, an early childhood specialist and a speech-language pathologist. The children interact with a new toy each month, and each toy has four areas of impact: communication, fine motor, gross motor, and cognitive and play skills.
The team meets with the parents via telehealth, coaching them as they play with the child in ways that touch on all of these goal areas.
“All of these together are designed to maximize the child's benefit from interaction with a toy across the board. You can do the most with this set of 10 toys, and you can also use the same toy across a child's developmental trajectory, because you can do more and more and more complex things with the same toy,” Peter said.
During this time, it’s essential to foster a sense of curiosity within the child.
“Curiosity is a really big one. Fostering a child with Down syndrome's sense of curiosity, so they keep at it. If a child gives up, then that won't build skill,” Peter said.
Using Babble Boot Camp as a foundation, Peter is able to move forward to combat apraxia of speech as it presents in other disorders. Looking ahead, Peter hopes to move toward solutions for children who face a variety of other obstacles, from Bainbridge-Ropers Syndrome and hearing loss to autism. By intervening in infancy, before symptoms have a chance to present, there is a greater window of opportunity to change the course of their development.
Babble Boot Camp training is available through Northern Speech Services, where anyone from parents to speech-language pathologists can complete a certificate. Graduate students can also complete the certificate for a reduced cost.
Those interested in contributing to this research can donate to the Babble Boot Camp fund. Play Boot Camp was made possible by a $50,000 grant from the ASU Women and Philanthropy group, while one of the Babble Boot Camp pilot studies received funding through the American Speech-Language-Hearing Foundation.
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