***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 Objective : The aim of this r and omised controlled trial was to evaluate the effectiveness of a short , highly structured parent based language intervention group programme for 2-year-old children with specific expressive language delay ( SELD , without deficits in receptive language ) . Methods : 61 children with SELD ( mean age 24.7 months , SD 0.9 ) were selected between October 2003 and February 2006 during routine developmental check-ups in general paediatric practice s , using a German parent-report screening question naire ( adapted from the MacArthur Communicative Development Inventories ) . St and ardised instruments were used to assess the language and non-verbal cognitive abilities of these children and of 36 other children with normal language development ( reference group ; mean age 24.6 months , SD 0.8 ) . 58 children with SELD were sequentially r and omly assigned to an intervention group ( n = 29 ) or a 12-month waiting group ( n = 29 ) . In the intervention group , mothers participated in the 3-month Heidelberg Parent-based Language Intervention ( HPLI ) . All children were reassessed 6 and 12 months after pretest . Assessors were blind to allocation and previous results . Results : 47 children were included in the analysis . At the age of 3 years , 75 % of the children in the intervention group showed normal expressive language abilities in contrast to 44 % in the waiting group . Only 8 % of the children in the intervention group versus 26 % in the waiting group met the criteria for specific language impairment ( t score ⩽35 ) . Conclusions : By applying the short , highly structured HPLI in children with SELD , the rate of treatment for language impairment at the age of 3 years can be significantly reduced 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 This study was conducted to examine the impact of Relationship Focused Intervention ( RFI ) on a sample of Korean mothers and their preschool-aged children with disabilities . Subjects were 18 mothers of children with developmental problems ( ages 3 - 8 years ) . Ten of these mothers were assigned to an RFI Treatment group and eight to a No RFI Control group . The RFI was adopted from the Family/Child Curriculum ( Mahoney , G. ( 1999 ; Family/Child Curriculum : A relationship focused approach to parent education/early intervention . Tallmadge , OH : Family Child Learning Center ) . This intervention focused on teaching mothers to use responsive interactive strategies through a process of modeling , coaching , role-playing and video feedback . It was implemented with parents during weekly group and individual intervention sessions that were conducted over three months period . Comparison of pre- and post-intervention assessment s of parent-child interaction indicated that RFI was effective at encouraging parents to become more responsive , affective and achievement oriented with their children . These changes in mothers ' interactional style were associated with an 18 % increase in children 's interactive behaviors . Regression analyses indicated that increases in children 's behavior were associated positively with maternal responsiveness and negatively with maternal achievement orientation . Results from this study are discussed in terms of ( a ) implementing RFI with Korean mothers and ( b ) the mechanisms by which RFI promotes children 's development A r and omized clinical trail ( RCT ) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury . The control group infants received the State-funded follow-up program provided by the Los Angeles ( LA ) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System ( CAMS ) taught by public health nurses ( PHNs ) . The developmental assessment s and outcome measures were performed at 6 , 12 and 18 months corrected age and included the Bayley motor and mental development , the Home , mother-infant interaction ( Nursing Child Assessment Feeding Scale ( NCAFS ) and Nursing Child Assessment Teaching Scale ( NCATS ) ) , parental stress and social support . At 18 months , 43 infants remained in the study . The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group . Likewise , the intervention did not contribute to less stress or better mother-infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months . There was a significant trend , however , for the control group to have a significant decrease over time on the Bayley mental scores . Although the sample was not large and attrition was at 31 % , this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome Background Children with cerebral palsy ( CP ) have life-long motor disorders , and they are typically subjected to extensive treatment throughout their childhood . Despite this , there is a lack of evidence supporting the effectiveness of early interventions aim ing at improving motor function , activity , and participation in daily life . The study will evaluate the effectiveness of the newly developed Small Step Program , which is introduced to children at risk of developing CP during their first year of life . The intervention is based upon theories of early learning-induced brain plasticity and comprises important components of evidence -based intervention approaches used with older children with CP . Method and design A two-group r and omised control trial will be conducted . Invited infants at risk of developing CP due to a neonatal event affecting the brain will be r and omised to either the Small Step Program or to usual care . They will be recruited from Astrid Lindgren Children ’s Hospital at regular check-up and included at age 3–8 months . The Small Step Program was design ed to provide individualized , goal directed , and intensive intervention focusing on h and use , mobility , and communication in the child ’s own home environment and carried out by their parents who have been trained and coached by therapists . The primary endpoint will be approximately 35 weeks after the start of the intervention , and the secondary endpoint will be at 2 years of age . The primary outcome measure will be the Peabody Developmental Motor Scale ( second edition ) . Secondary assessment s will measure and describe the children ’s general and specific development and brain pathology . In addition , the parents ’ perspective of the program will be evaluated . General linear models will be used to compare outcomes between groups . Discussion This paper presents the background and rationale for developing the Small-Step Program and the design and protocol of a r and omized controlled trial . The aim of the Small Step Program is to influence development by enabling children to function on a higher level than if not treated by the program and to evaluate whether the program will affect parent ’s ability to cope with stress and anxiety related to having a child at risk of developing CP.Trial registration Clinical Trials.gov Identifier NCT02166801 . Registered June 12 , 2014 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 PURPOSE This study compared the language performance of young children with developmental delays who were r and omly assigned to 1 of 3 parent-coached language interventions .  Differences in performance on augmented and spoken word size and use , vocabulary size , and communication interaction skills were examined . METHOD Sixty-eight toddlers with fewer than 10 spoken words were r and omly assigned to augmented communication input ( AC-I ) , augmented communication output ( AC-O ) , or spoken communication ( SC ) interventions ;  62 children completed the intervention . This trial assessed the children 's symbolic language performance using communication measures from the language transcripts of the 18th and 24th intervention sessions and coding of target vocabulary use . RESULTS All children in the AC-O and AC-I intervention groups used augmented and spoken words for the target vocabulary items , whereas children in the SC intervention produced a very small number of spoken words . Vocabulary size was substantially larger for AC-O and AC-I than for SC groups . CONCLUSIONS This study found that augmented language interventions that include parent coaching have a positive communication effect on young children with developmental delays who begin with fewer than 10 spoken words . Clinical implication s suggest that augmented communication does not hinder , and actually aids , speech production abilities in young children with developmental delays Objectives To evaluate how  involvement in life situations ( participation )  in children with cerebral palsy varies with type and severity of impairment and to investigate geographical variation in participation . Design Cross sectional study . Trained interviewers visited parents of children with cerebral palsy ; multilevel multivariable regression related participation to impairments , pain , and sociodemographic characteristics . Setting Eight European regions with population registers of children with cerebral palsy ; one further region recruited children from multiple sources . Participants 1174 children aged 8 - 12 with cerebral palsy r and omly selected from the population registers , 743 ( 63 % ) joined in the study ; the further region recruited 75 children . Main outcome measure Children ’s participation assessed by the Life-H question naire covering 10 main areas of daily life . Scoring ignored adaptations or assistance required for participation . Results Children with pain and those with more severely impaired walking , fine motor skills , communication , and intellectual abilities had lower participation across most domains . Type of cerebral palsy and problems with feeding and vision were associated with lower participation for specific domains , but the sociodemographic factors examined were not . Impairment and pain accounted for up to a sixth of the variation in participation . Participation on all domains varied substantially between regions : children in east Denmark had consistently higher participation than children in other regions . For most participation domains , about a third of the unexplained variation could be ascribed to variation between regions and about two thirds to variation between individuals . Conclusions Participation in children with cerebral palsy should be assessed in clinical practice to guide intervention and assess its effect . Pain should be carefully assessed . Some European countries facilitate participation better than others , implying some countries could make better provision . Legislation and regulation should be directed to ensuring this happens BACKGROUND Little is known about the quality of life ( QoL ) of disabled children . We describe self-reported QoL of children with cerebral palsy , factors that influence it , and how it compares with QoL of the general population . METHODS 1174 children aged 8 - 12 years were r and omly selected from eight population -based registers of children with cerebral palsy in six European countries and 743 ( 63 % ) agreed 
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There was no evidence of an effect of training for children 's initiation of conversation or engagement in joint attention during interaction with their mothers .
Mothers who received training became more responsive to their children 's communication , but there were no differences in the extent to which they controlled conversation by directing their children .
There were no effects on maternal stress .
We found no reports of the effects of parent training on children 's use of individual communication skills , such as asking questions or providing information , on their generic participation or adverse outcomes .
Neither did we find reports of mothers ' satisfaction with treatment , its acceptability or their compliance with it .
There is only limited , very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders .
It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication .