A typical speech-language remediation session begins with a plan. The plan includes goals, or what the speech-language pathologist (SLP) wants the child to achieve; intervention procedures, or how the SLP will help the child achieve the goals; and the contexts, or the activities in which the SLP will use procedures to help the child master his or her goals (Klein & Moses, 1999). Goals, procedures, and contexts are thoughtfully chosen based on the principles of evidence-based practice, which considers the research, the SLP's expertise, and the family's values (ASHA, 2005).
For a child working on first words, strong theoretical and empirical support has been documented for a technique called focused stimulation (see Ellis Weismer & Robertson, 2006, for review). One context in which this technique can be used is when storybooks are used to facilitate the development of first words. Research supports the use of shared book reading to facilitate vocabulary development in children developing typically (Fletcher & Reese, 2005) and those with language delays (Ratner, Parker, & Gardner, 1993). The purpose of this article is to document the theoretical and empirical evidence supporting the use of focused stimulation, review the principles for choosing early vocabulary targets, and discuss the best books for facilitating early target words using focused stimulation. The article will conclude with an annotated bibliography of recommended storybooks to facilitate one or more early vocabulary targets.
Focused stimulation is a technique in which the facilitator predetermines the target word(s) and creates an environment in which the target(s) can be naturally modeled a minimum of 5-10 times (Ellis Weismer & Robertson, 2006). Classically, focused stimulation does not require evoking a response, and the research has not provided sufficient evidence that focused stimulation plus evoked response is better than focused stimulation alone (Ellis Weismer, Murray-Branch, & Miller, 1993; Kouri, 2005).
Theoretical and empirical evidence justifies the use of focused stimulation. Social learning theory (Bandura, 1977; Bruner, 1983; Vygotsky, 1978) teaches that learning takes place in context and through observation of and interaction with more competent others (especially adults and parents). Children with language delays are less responsive to input from others and sometimes, this leads to a breakdown in the communicative interaction (Yoder & Warren, 1993). Focused stimulation provides developmentally appropriate, concentrated, preselected targets that meet children where they are linguistically ready to respond, thus renewing discourse.
Another theoretical basis for focused stimulation is the information processing model of language development and disorders. In this model, it is believed that we learn through the cognitive processes of attention, organization, and storage and retrieval of information. Lahey & Bloom (1994) suggested that there is a limited capacity of cognitive resources in the child with language delays, especially working memory. As tasks get too cognitively demanding, the limited resources compete against each other and thus, learning breaks down. Since the brains of children with language delays can't hold and process as much information as the brains of their typically developing peers, these children need less complex, more salient, and more frequent presentations of models; this is the technique that underlies focused stimulation (Robertson & Ellis Weismer, 1999).
In addition to theoretical rationales for focused stimulation, there is an empirical research base as well. Focused stimulation has been proven to be an effective technique to facilitate early vocabulary development when used by parents (Giralametto, Pearce, & Weitzman, 1996), speech-language pathologists in small language stimulation groups (Lederer, 2001; Robertson & Ellis Weismer, 1999), and early childhood special educators in the classroom (Wilcox, Kouri, & Caswell, 1991).
Principles for Choosing First Words
In their seminal article, "Planning a First Lexicon: Which Words to Teach First," Lahey and Bloom (1977) provided guidelines for selecting early, single-word vocabulary targets based on a descriptive-developmental approach. They recommended a balance of substantive (i.e., object specific) and relational (i.e., not object specific) words that are easy to demonstrate, pragmatically useful (i.e., used not only as labels, but also to communicate), and developmentally early. In addition, they cautioned against targeting polar opposites (e.g., up/down, hot/cold) simultaneously. First, children must learn the concept, for example, temperature, by learning "hot" or "not hot."
Over the last 30 years, others have joined the discussion about early vocabulary targets (Girolametto, Pearce, & Weitzman, 1996; Lederer, 2001, 2002, 2007; Leonard et al., 1982; Robertson & Ellis Weismer, 1999; Wilcox, Kouri, & Caswell, 1991). These researchers further specified what Lahey & Bloom (1977) meant by "developmentally early words." With the publication of the MacArthur Communication Development Index (CDI; Fenson et al., 1993) and the data from the research (Fenson et al., 1994) that informed development of the CDI, these researchers now had information about the age when, in months, at least 50% of over 1000 children produced each of over 600 words. A second database of word acquisition by age (for children developing typically and late talkers) was provided by Rescorla and her colleagues (Rescorla, Alley, & Christine, 2001). These researchers suggested that speech production abilities be taken into account when targeting early vocabulary. They argued that target words should begin with sounds and syllable shapes already within a child's phonemic repertoire.
First Words, First Books, & Focused Language StimulationFirst Words, First Books, & Focused Language Stimulation