***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The purpose of this study was to compare the effects of enhanced milieu teaching ( EMT ) implemented by parents and therapists versus therapists only on the language skills of preschool children with intellectual disabilities ( IDs ) , including children with Down syndrome and children with autism spectrum disorders . METHOD Seventy-seven children were r and omly assigned to 2 treatments ( parent + therapist EMT or therapist-only EMT ) and received 36 intervention sessions . Children were assessed before , immediately after , 6 months after , and 12 months after intervention . Separate linear regressions were conducted for each st and ardized and observational measure at each time point . RESULTS Parents in the parent + therapist group demonstrated greater use of EMT strategies at home than untrained parents in the therapist-only group , and these effects maintained over time . Effect sizes for observational measures ranged from d = 0.10 to d = 1.32 favoring the parent + therapist group , with the largest effect sizes found 12 months after intervention . CONCLUSION Findings from this study indicate generally that there are benefits to training parents to implement naturalistic language intervention strategies with preschool children who have ID and significant language impairments The outcomes of a r and omized clinical trial of a new behavioral family intervention , Stepping Stones Triple P , for preschoolers with developmental and behavior problems are presented . Forty-eight children with developmental disabilities participated , 27 r and omly allocated to an intervention group and 20 to a wait-list control group .  Parents completed measures of parenting style and stress  , and independent observers assessed parent-child interactions . The intervention was associated with fewer child behavior problems reported by mothers and independent observers , improved maternal and paternal parenting style , and decreased maternal stress . All effects were maintained at 6-month follow-up OBJECTIVE : Early interventions for toddlers with expressive and receptive language delays have not result ed in positive expressive language outcomes . This r and omized controlled trial tested the effects on language outcomes of a caregiver-implemented communication intervention targeting toddlers at risk for persistent language delays . METHODS : Participants included 97 toddlers , who were between 24 and 42 months with language scores at least 1.33 SDs below the normative mean and no other developmental delays , and their caregivers . Toddlers were r and omly assigned to the caregiver-implemented intervention or a usual-care control group . Caregivers and children participated in 28 sessions in which caregivers were taught to implement the intervention . The primary outcome was the Preschool Language Scale , Fourth Edition , a broad-based measure of language . Outcome measurement was not blinded . RESULTS : Caregivers in the intervention improved their use of all language facilitation strategies , such as matched turns ( adjusted mean difference , intervention-control , 40 ; 95 % confidence interval 34 to 46 ; P < .01 ) . Children in the intervention group had significantly better receptive language skills ( 5.3 ; 95 % confidence interval 0.15 to 10.4 ) , but not broad-based expressive language skills ( 0.37 , 95 % confidence interval −4.5 to 5.3 ; P = .88 ) . CONCLUSIONS : This trial provides preliminary evidence of the short-term effects of systematic caregiver instruction on caregiver use of language facilitation strategies and subsequent changes in children ’s language skills . Future research should investigate the ideal dosage levels for optimizing child outcomes and determine which language facilitation strategies are associated with specific child outcomes . Research on adaptations for families from culturally and linguistically diverse background s is needed PURPOSE The authors examined ( a ) whether dose frequency of milieu communication teaching ( MCT ) affects children 's canonical syllabic communication and ( b ) whether the relation between early canonical syllabic communication and later spoken vocabulary is mediated by parental linguistic mapping in children with intellectual disabilities ( ID ) . METHOD The authors drew on extant data from a recent differential treatment intensity study in which 63 toddlers with ID were r and omly assigned to receive either five 1-hr MCT sessions per week ( i.e. , daily treatment ) or one 1-hr MCT session per week ( i.e. , weekly treatment ) for 9 months . Children 's early canonical syllabic communication was measured after 3 months of treatment , and later spoken vocabulary was measured at posttreatment . Midpoint parental linguistic mapping was measured after 6 months of treatment . RESULTS A moderate-sized effect in favor of daily treatment was observed on canonical syllabic communication . The significant relation between canonical syllabic communication and spoken vocabulary was partially mediated by linguistic mapping . CONCLUSIONS These results suggest that canonical syllabic communication may elicit parental linguistic mapping , which may in turn support spoken vocabulary development in children with ID . More frequent early intervention boosted canonical syllabic communication , which may jump-start this transactional language -learning mechanism . Implication s for theory , research , and practice are discussed Parents of children with a developmental disability require tailored parenting support , as their families have special needs and are at risk of increased burden . The aim of this study was to evaluate the efficacy of the Stepping Stones Triple P seminars , a brief group intervention for parents of a child with a disability . There were two seminars that presented parenting strategies to improve both child behavior and parenting variables implicated in the development and maintenance of child problem behavior . Fifty-three parents participated in this r and omized controlled trial . Each had a child , aged two to ten , with a disability . The results indicated significant reductions in child behavior problems , the use of dysfunctional parenting styles , and parental conflict reported by parents in the intervention group compared to a waitlist group . The results were maintained at 3-month follow-up and there was evidence of a sleeper effect for parenting confidence . This study demonstrated that the seminars provide a promising intervention for parents of children with a disability . Limitations and implication s for future research are also discussed Routines-based early intervention ( RBEI ) for children with or at risk for developmental delay encourages collaboration between professionals and families to enhance children 's participation in family routines with family-selected goals . We conducted the first single-blinded r and omized control trial to examine the effectiveness of a 6-month RBEI vs. traditional home visiting ( THV ) , which uses a curriculum focused on children 's developmental domains . Thirty-one families with children aged 5 - 30 months ( mean age 17.4 months ) with or at risk for developmental delay were r and omly assigned to an RBEI group ( n=15 ) or a THV group ( n=16 ) . The enrolled children were evaluated using the Chinese version of Pediatric Evaluation of Disability Inventory ( PEDI-C ) and the Comprehensive Development Inventory for Infants and Toddlers ( CDIIT ) at 5 time points . Two-way mixed analysis of variance ( ANOVA ) was used to examine the group by stage interactions . Goal Attainment Scaling ( GAS ) and the Canadian Occupational Performance Measure ( COPM ) were applied to explore between-group differences on individualized goal achievement . PEDI-C showed that the RBEI group had a faster progress rate in self-care functions and independence in social functions in the first 3 months of intervention and at the 6-month follow-up . The RBEI group also scored higher on the GAS in the first 3 months of intervention . However , between-group differences in changes in the developmental domains on the CDIIT were not significant . Thus , RBEI was more effective than THV in promoting functional outcomes and reaching family-selected goals , while both interventions allowed equal improvement in developmental domains The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Family systems theory posits that the relative effectiveness of early interventions will vary depending on various aspects of the family . This study tested whether maternal responsivity would predict the extent to which Prelinguistic Milieu Teaching ( PMT ) facilitated generalized intentional communication better than a contrast treatment that was conducted in a small group by a responsive adult ( i.e. , Responsive Small Group , RSG ) . Fifty-eight children with developmental disabilities in the prelinguistic communication period of development were r and omly assigned to one of the two staff-implemented treatment groups . Thirty were assigned to RSG ; 28 were assigned to PMT .  Mothers were kept naive to the intervention methods , hypotheses , and measures . In families with mothers who responded to a high percentage of the children 's communication acts at the pre-treatment period , the children in the PMT group used more frequent intentional communication in post-treatment generalization sessions with a trainer and mothers than did children in the RSG group . In the families with mothers who responded to fewer than 39 % of their children 's communication acts , children in the RSG intervention used more frequent intentional communication in post-treatment generalization sessions with the mothers than did children in the PMT intervention . Other family variables and no child variables that we measured could account for these findings AIM This study aim ed to evaluate the efficacy of a parent education program , the Happy Parenting program , for Chinese preschool children with developmental disabilities . METHODS This study adopted r and omized controlled trial design without blinding . Participants were r and omized into intervention group ( n=62 ) who were offered the Happy Parenting program delivered by educational psychologists and trainee educational psychologists , and a control group ( n=57 ) who were offered a parent talk after the intervention group had completed treatment .  Parent participants were requested to complete question naires on their children 's behavior , their parenting stress , and discipline strategies . RESULTS Analysis was by intention-to-treat . The results indicated significant decrease in child problem behaviors , parenting stress and dysfunctional discipline strategies in the intervention group at post-intervention . CONCLUSION This study provided promising evidence on the effectiveness of a parent education program , the Happy Parenting program , for Chinese preschool children with developmental disabilities We design ed a parent-directed home-visiting intervention targeting socioeconomic status ( SES ) disparities in children 's early language environments . A r and omized controlled trial was used to evaluate whether the intervention improved  parents ' knowledge of child language development and increased the amount and diversity of parent talk .  Twenty-three mother-child dyads ( 12 experimental , 11 control , aged 1;5 - 3;0 ) participated in eight weekly hour-long home-visits . In the experimental group , but not the control group , parent knowledge of language development increased significantly one week and four months after the intervention . In lab-based observations , parent word types and tokens and child word types increased significantly one week , but not four months , post-intervention . In home-based observations , adult word tokens , conversational turn counts , and child vocalization counts increased significantly during the intervention , but not post-intervention . The results demonstrate the malleability of child-directed language behaviors and knowledge of child language development among low-SES parents PURPOSE To evaluate the longitudinal effects of a 6-month course of responsivity education (RE)/prelinguistic milieu teaching ( PMT ) for young children with developmental delay . METHOD Fifty-one children , age 24 - 33 months , with fewer than 10 expressive words were r and omly assigned to early-treatment/no-treatment groups . All treatment was added as a supplement to services that the children received in the community . Follow-up data were collected 6 and 12 months after the conclusion of the initial 6-month treatment/no-treatment conditions . RESULTS No effects of this treatment were detected 6 or 12 months after the conclusion of the initial treatment condition . CONCLUSIONS M. E. Fey et al. ( 2006 ) reported that 6 months of RE/PMT led to a significant treatment effect in the use of intentional communication in 1 of 2 communication sampling context s. This finding , combined with evidence from other studies , suggests that RE/PMT may be applied clinical ly at low intensity with the expectation of medium-sized effects on children 's rate of intentional communication acts over the short term . The results of the present study , however , provide no evidence for the anticipated longer term benefits of this intervention . Further investigation of the approach at higher intensity levels and for longer periods of time is warranted This article presents results of a r and omized controlled trial examining the efficacy of Parent – Child Interaction Therapy ( PCIT ) for treating  disruptive behaviors of young children ( ages 3 to 6 ) with mental retardation ( MR ) and comorbid oppositional defiant disorder . Thirty families were r and omly assigned to an immediate treatment ( IT ) or waitlist ( WL ) control group . Results indicated that IT mothers interacted more positively with their children after treatment than WL mothers , and their children were more compliant after treatment . On parent-report measures , IT mothers reported fewer disruptive behaviors at home and lower parenting stress related to difficult child behavior than WL mothers after treatment . Whether evidence -based treatments for disruptive behavior require modification before application to children with MR is discussed This study assesses the longitudinal effects of an original early intervention programme on the adaptation of  parents of children with a disability ( Down syndrome and cleft lip/palate , i.e. DS and CLP ) . Variations in the effects of the programme according to the time of measurement , the type of disability and parent 's gender are also examined . Globally , the results show a better adaptation among parents who participated in the intervention programme compared to those who did not participated in the programme . These parents had lower levels of parental stress , they had more positive perceptions and attitudes concerning their child 's disability and their parental situation , they were more confident in their own re sources and the help they could receive from others , they had lower levels of emotional distress , anxiety and depression and they perceived more emotional support from their spouse . In general , these gains were maintained throughout the year when the children were between six and 18 months of age , they were relatively similar for parents of children with DS and parents of children with CLP , as well as for mothers and fathers The interactive model of language intervention instructs parents to use techniques that promote reciprocal 
    Output:
    
There is currently insufficient evidence to determine the effects of  parent-mediated interventions for improving the language and communication of children with Down syndrome .