Language and communication skills in multilingual children on the autism spectrum: A systematic review

LAY ABSTRACT

Both parents and service providers have voiced concerns about the potential negative impact of exposure to multiple languages on the language and communication skills of autistic children. The current literature review summarized research that assessed the language and communication skills of multilingual autistic children in comparison with their autistic and nonautistic peers. After a comprehensive search, 22 relevant publications were identified that met the inclusion criteria of the current review. Thirteen studies used both direct (directly administered screening/diagnostic tools) and indirect language assessments (e.g. parent questionnaires). Receptive and expressive vocabulary was the most frequently assessed language skill. Available research does not support the assumption that bilingualism has negative effects on the language and communication skills of autistic children. The language and communication skills of multilingual autistic children frequently resembled their monolingual autistic peers in both strengths and areas of growth. Preliminary findings indicate that multilingual autistic children may share some advantages of multilingualism with their multilingual nonautistic peers. Studies often excluded participants with intellectual disabilities or complex communication needs, which means that a large population of autistic children is not yet represented in research about the effects of multilingualism.

Often Encountered but Rarely Reported: Challenges in Selecting Language(s) for Intervention in Bi/Multilingual Children with Autism Spectrum Disorder

India is a socioculturally and linguistically diverse country. Most often individuals grow up exposed to more than one language. Apart from exposure to native and community languages, there is a growing preference for English as the language of formal education and employment. Previous studies demonstrated that bilingual children with autism spectrum disorder (ASD) develop language similar to their monolingual nonverbal IQ-matched ASD peers. However, most of these studies have been conducted in countries in which English is the primary language for majority of the population. Although existing studies support a bilingual environment for children with ASD, professionals still seem to advise families' use of a monolingual approach. This paper reviews and discusses factors that influence the selection of language(s) for intervention in young children with ASD in bi/multilingual environments. These are discussed under three areas namely, (1) language environment of the child, (2) parent/caregivers' perspectives regarding bi/multilingual exposure, and (3) medium of education and availability of intervention services. This paper also highlights the complexities involved in the language selection process for intervention using four case vignettes. Based on the review and findings from the case vignettes, it is evident that there is a need for (1) sensitizing fellow professionals regarding the increasing shift toward a bi/multilingual approach, (2) formulating guidelines for this decision-making process, and (3) continuing to develop an evidence base for adopting multilingual approach for intervention in a socioculturally and linguistically diverse country like India.

Longitudinal Social and Communication Outcomes in Children with Autism Raised in Bi/Multilingual Environments

Globally, there are more bilingual speakers than monolingual speakers; however, scant research evidence exists regarding social communication development and outcomes for bilingual children with autism spectrum disorder (ASD). A stronger evidence base will facilitate health professionals and educators providing accurate recommendations regarding language use. This study employed a longitudinal cohort design to compare social and communication skills, at baseline and over 12 months, for 60 monolingual and 60 bilingual children with ASD receiving community based early intervention. We found few differences at intake, and no difference in the magnitude of change over 12 months for this cohort. Findings support the notion that there is no basis on which to discourage home language use with bilingual children with ASD.

Looking back and moving forward: A scoping review of research on preschool autism interventions in the field of speech-language pathology

Background & Aims

Speech-language pathology services are frequently accessed by families of children who have suspected or diagnosed autism. This is expected given that social communication differences are a core feature of autism. This review looked broadly at the state of research in the field of speech-language pathology and preschool autism interventions in order to identify the types of studies that could be used to inform the practices of speech-language pathologists (SLPs), and to identify gaps in the field so they can be addressed in future research. Specifically, we examined the extent of research conducted on interventions delivered (at least in part) by SLPs to preschool children with suspected or diagnosed autism, identified the range of skill development areas targeted within the studies, and explored the characteristics of the interventions (i.e., theoretical models underlying the programs, service delivery models, treatment dosage).

Methods

A scoping review of articles published between 1980 and 2019 was conducted using the five phases outlined by the Arksey and O'Malley framework: (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results.

Main Contribution/Results

A total of 114 studies met inclusion criteria with most published since 2010 and conducted within North America. Case study or single-subject study designs were the most frequently used. Interventions delivered solely by SLPs and by multiprofessional teams that included SLPs were relatively equally represented. Across the included studies, nine skill development areas were targeted, but interventions targeting social communication, language, and augmentative communication skills made up the vast majority of studies. There was relatively even distribution of interventions informed by child-centered, clinician-directed, and hybrid models. Explicit information detailing intervention characteristics (e.g., treatment dosage, professional training of clinicians delivering the intervention) was poorly reported in many studies. For those studies providing details, there was a great deal of variability in the nature of interventions (e.g., service delivery models, SLPs' role, dosage).

Conclusions

This review revealed that research in the area of autism interventions delivered, at least in part, by SLPs has markedly increased over the past 10 years. Still, there remains a need for more research, and greater transparency detailing the nature of the interventions being investigated. The research conducted to date captures the versatility of the SLP's role within preschool autism intervention. Improved reporting and studies with strong methodological rigor focused on capturing the complex and individualized nature of interventions are needed, as are intervention studies aligned with real-world community practice.

Implications

This review provides a comprehensive examination of the status of research on preschool interventions delivered to children with suspected or diagnosed autism within the field of speech-language pathology. Several directions for future research are provided, as are suggestions for improving the clinical applicability of results to further the development of effective, evidence-informed policy and practice in speech-language pathology.

Bilingual Versus Monolingual Vocabulary Instruction for Bilingual Children with Hearing Loss

Effective vocabulary interventions for children with hearing loss, including children who are bilingual, are needed because of persistent vocabulary deficits in this population. Current instructional practices for children with hearing loss who are bilingual vary in the degree to which they incorporate the language the child uses at home. Unfortunately, there is little direct evidence as to whether bilingual or monolingual instructional practices yield greater benefits for these children. Three Spanish-English-speaking children participated in this single case adapted alternating treatments design study that evaluated the effectiveness and efficiency of bilingual and monolingual teaching procedures for an expressive vocabulary intervention. Contrary to predictions from a monolingual instruction perspective, no evidence of an inhibitory effect of bilingual instruction on English performance was identified. Participants exhibited gains in Spanish for words in the bilingual condition only. Findings suggest more efficient word learning in the bilingual condition as measured by conceptual vocabulary.