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Autism Intervention with Bilingual Children

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Josephine Bartolome

on 5 December 2015

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Transcript of Autism Intervention with Bilingual Children

Autism Intervention with Bilingual Children
Created By: Josephine Bartolome, Karen Garcia & Diana Tello
What is Autism?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the term autism spectrum disorder (ASD) to categorize individuals prior to the age of 3:0 who demonstrate two basic symptoms such as:
Persistent deficits in social communication and interaction
Demonstrate restricted repetitive behaviors, interests, and activities (RRBs) that affect daily functioning
Bilingualism & Autism
Treatment Considerations
Unprecedented increase in the prevalence of ASD in the U.S population has encouraged a strong demand for information on EBP regarding this group of individuals.
Concluding Remarks
Early intervention is KEY
Evidence suggests that therapy is proven to be more effective when started as soon as possible.
Overall, it leads to better outcomes.
Occurs in about 1 in 68 children (CDC, 2014)

Reported to occur in all racial, ethnic, and socioeconomic groups
Tend to occur more in boys (5 times) than girls (CDC, 2014)
1 in 42 for boys
1 in 189 for girls

Largest increase was with Hispanic children (CDC, 2014)

Average age of identification of ASD is 4.7 years (CDC, 2014)

Characteristics of ASD
Also known as Autism Spectrum Disorders (ASD)
Developmental Issues
Struggle with peer relationships (detrimental once they reach their teenage years)
Anxious in new situations
Narrow and rigid interests
Problems with pragmatics
PLAY (symbolic and pretend play are affected)
Joint Visual Attention

Social Communication
Hand leading
Using another's body to communicate
e.g. moving the mother's hand toward an object
Often replaces pointing
Language Impairments
Restricted/Repetitive Behaviors, Interests, & Activities
Learning Differences
68% of children with ASD have a cognitive impairment
Child imitates the communication partner's utterance
In delayed echolalia, the child produces a previously heard sentence or phrase.
Difficulty with peer relationships
Children with ASD use fewer eye gaze shifts
e.g. lack of alternating gaze between object and partner
Have less positive emotional affect
e.g. less smiling or laughing with partner
Demonstrate infrequent use of conventional gestures and communication strategies during interactions
Many are nonverbal
Motor & Perceptual Differences
Delayed motor development
Toe walking
Body placement difficulty
Motor deficits affect self-help skills
e.g. dressing, feeding, toileting
Impairment in memory for meaningful information
Rote memory may be relatively intact
Lack of Theory of Mind (TOM)
Describes the ability to perceive a person's motives or thoughts and the ability to understand how another might feel in a particular situation.
Etiology/Risk Factors
There is no single or agreed upon cause for autism, however, multiple etiologies do exist
Genetics (CDC, 2014)
For identical twins: “If one child has an ASD, then the other will be affected about 36-95% of the time.”
For non-identical twins: “If one child has an ASD, then the other is affected 0-31% of the times.”
Children born to older parents
Children with parents or siblings who have ASD
Environmental Factors
Exposure to environmental toxins during pregnancy (ASHA, n.d.)
e.g. heavy metals such as mercury
Limited prenatal vitamin intake (Autism Speaks, 2015)
Mother who take folic acid are less likely to have a child with ASD
NOT caused by vaccines (CDC, 2013)
Hypersensitivity to sensory stimulation
Children with ASD are generally hypersensitive to sensory stimulation and exhibit discomfort in response to noise, touch, smell, or visual stimulation.
Hypersensitivity can make children with ASD anxious in new situations or environments.
Potentially resulting in an increase in self-stimulatory behaviors such as rocking back and forth, pacing, or hand waving.
Narrow, rigid interests
Interests become a fixation thus limiting the child's ability to interact with others.
Oftentimes, children with ASD fail to acquire spoken language, exhibiting significant language comprehension and production problems.
For children with ASD who are verbal, their use of language is often inappropriate and out of context.
Poor topic maintenance during conversations
Irrelevant responses to requests/questions
Notable feature characteristic is pronoun reversal
e.g. "You want juice" rather than "I want juice"
Proper nouns are used to refer to oneself
e.g. "John wants juice" rather than " I want juice"
Three Major Groups of "Core Deficits"
1) Persistent failure to develop effective social communication
2) Language Impairments
3) Restricted/repetitive patterns of attention, interest, and behaviors
Myths & Facts
Due to social deficits, it is not necessary for children with autism to become bilingual, as they will not benefit from the social advantages that are often gained from being bilingual.
Parents of children with autism will experience limited success in raising their child to be bilingual.
Exposing a child with autism to two or more languages will cause him or her to develop communication difficulties that would not have otherwise developed if the child had been exposed to only one language.
Parents who speak a language in which they are not fluent to their child with autism (e.g., a parent whose primary language is French who speaks English to their child) may negatively impact their child’s language development.
Incorporating both the child’s primary language and the majority language in intervention for children with autism from bilingual families can reduce parent stress levels.
Although the research is sparse, the available evidence has revealed that children with autism who are exposed to two languages do not demonstrate more significant language difficulties than those who are exposed to only one language. In a study that examined issues of bilingualism in children with autism spectrum disorders (ASD), children being raised monolingually and bilingually did not differ on their language comprehension, production, reading, or writing abilities (Kay-Raining Bird, Lamond, & Holden, 2012). These conclusions should be interpreted with caution, however, as the authors based their analysis on data gathered through parent report; there was no direct testing of language abilities.
“Many children with language and/or intellectual disabilities, including those with autism, need to learn two languages in order to participate fully in their important life contexts and to communicate with people who are important to them. Bilingualism therefore is not a choice but a necessity for these individuals” (de Houwer, 1999). Many parents of children with autism who are members of a bilingual family expressed that raising their child to be bilingual was important for several reasons, including (1) communication with family members, neighbors, and people in school, (2) they live in a bilingual city/country, (3) it provides more life opportunities, and (4) it is important in the job market (Kay-Raining Bird et al., 2012).
Communication deficits are a hallmark of autism. In fact, a ‘qualitative impairment in communication’ is one of the diagnostic criteria of the disorder. This impairment may be manifested in a variety of ways, such as by one or more of the following: (a) delay in, or total lack of, the development of spoken language, (b) marked impairment in the ability to initiate or sustain a conversation with others, (c) stereotyped and repetitive use of language or idiosyncratic language, (d) lack of varied, spontaneous make-believe or social imitative play (American Psychiatric Association, 2000). Children with ASD will exhibit communication difficulties to some degree, regardless of whether they are exposed to one or more than one language (Kay-Raining Bird et al., 2012).

Parents are the primary communication models for children with ASD (Baron-Cohen & Staunton, 1994). Parents who speak a non-native language and are not fluent in that second language may provide incomplete and grammatically incorrect models to their child, which may adversely affect the child's language development (Jacobson & Cairns, 2008; Ohashi et al., 2012). Research suggests that exposure to two languages does not disadvantage young children with autism in the early stages of language development (Ohashi et al., 2012; Seung et al., 2006). Thus, parents should not feel discouraged in speaking to their child in their native language, as providing complete and accurate language models to a child with ASD is important for promoting language development.
In a case study of a 3-year-old child with autism from a Korean-English household, the mother’s scores on the Parenting Stress Index (PSI; Abidin, 1995) improved as her son made gains in his language and communication abilities in both languages. As the child’s communication skills improved, his mother perceived him as less distractible and less demanding. She also felt more competent as a mother and less depressed. These findings, although limited, suggest positive effects of dual-language intervention on parent stress levels (Seung et al., 2006).
Language intervention for children with autism who are considered bilingual should be provided in one language only.
Although the research investigating bilingualism and autism is extremely limited, a case study of a 3 year-old bilingual child with mild-moderate autism demonstrated notable gains in both languages after receiving Korean-English bilingual speech-language intervention over the course of 24 months. In addition, maintenance of these advances was demonstrated 24 months post-intervention (Seung, Siddiqi, & Elder, 2006). While this provides only preliminary evidence, the findings are encouraging. The results suggest the utility and efficacy of targeting both languages in speech-language interventions with bilinguals with autism. At the very least, it does not provide reason to suspect that dual language intervention is detrimental to language development in children with autism.
Treatment Efficacy/Evidence Based Practice (EBP)
The National Professional Developmental Center (NPDC) on ASD identified 27 focused intervention practices as meeting criteria for being considered as "evidence based."
Treatment approaches should be individualized for the client.
Important to be flexible and open to different approaches because a certain method may not be appropriate nor effective for the client.
The ultimate goal is to provide bilingual children with ASD effective communicative strategies to help them function in their everyday lives.
(Roth & Worthington, 2015)
(Kaderavek, 2014)
(Roth & Worthington, 2015)
(Kaderavek, 2014)
(Kaderavek, 2014)
(Kaderavek, 2014)
According to ASHA (n.d.), autism is defined as a developmental disability in which children present with social, communication and language problems.

(Roth & Worthington, 2015)
Discrete Trial Training (DTT)
Studies have indicated that DTT is especially useful for teaching children with autism to add new forms of behavior to their repertoires and to make new discriminations between events (Smith, 2001).
Reciprocal Imitation Therapy (RIT)
Evidence of Efficacy of ABA as a Treatment for Autism
Treatment Approaches
Represents a class of interventions that apply behavioral science principles to address behavior problems and learning in children with autism and other developmental disorders.
The Assessment
SCERTS & Evidence Based Practice (EBP)
SCERTS' 3 Main Elements
Social Communication
The development of spontaneous, functional communication, emotional expression, and secure and trusting relationships with children and adults.
Treatment Approach
Applied Behavior Analysis (ABA)
Based on Skinner’s (1957) theory of operant conditioning
A stimulus, or antecedent event, is presented to elicit a target response, which is immediately followed by a consequent event (reward or punishment) to increase desired behaviors or decrease unwanted behaviors.
All ABA approaches simplify complex tasks, actions, and behaviors into smaller sequential parts in order to make it easier for the child.
Most ABA approaches are intensive, comprising of 30 to 40 hours of one-to-one therapy per week.
(Roth & Worthington, 2015)
(Lovaas et al., 1973)
Based on the learning principle that if a behavior is rewarded, it is more likely to be repeated (Roth & Worthington, 2015)
1) Cue
When an adult presents instruction or a question
E.g. “Do this” or “What is it?”

2) Prompt
Adult assists the child in responding correctly to the cue

3) Response
Child gives correct or incorrect answer to the adult’s cue

4) Consequence
Depending on the child’s response, the adult may reinforce the response or say “no” if incorrect.

5) Intertrial Interval
After giving the consequence, the adult pauses before presenting the cue for the next trial.
DTT has 5 Components
DTT Limitations
Child is only responding to cues from the adult and may not learn to initiate behaviors when the cues are not present.

Child may not transfer skills acquired in DTT to other environments (e.g. family settings, classrooms).

DTT must be combined with other interventions to enable children to initiate the use of their skills and display these skills across settings.

DTT is highly labor intensive in the sense that adults work individually with a child and continually provide cues.
(Smith, 2001)
“Behavioral Treatment and Normal Education and Intellectual Functioning in Young Autistic Children”
Examined the impact of intensive behavioral intervention (ABA).

Compared an experimental group of 19 children who received 40 hours of ABA per week for two years to comparison groups.

Findings showed that 9 out of 19 children in the ABA group attained average cognitive functioning and were able to perform in school with minimal supports compared to only 1 of 40 children in the control group.
“ Long-term Outcomes of Toddlers with Autism Spectrum Disorder Exposes to Short-term Intervention”
Forty-eight patients with autism received a 6-month applied behavior analysis based intervention starting at age 2:0.

Cognitive (IQ) and communication ability, as well as severity of autism symptoms, were assessed by using standardized measures.

Findings revealed significant gains in IQ and Vineland Communication domain standard scores as well as a decrease in ASD severity were achieved.
“Behavioral Interventions In Children and Adolescents with Autism Spectrum Disorder: A Review of Recent Findings”
Reviewed and summarized 27 studies published in peer-reviewed literature since January 2010 on behavioral interventions for children and adolescents with autism spectrum disorder (ASD).

Findings suggest that behavioral interventions are effective for improving language, cognitive abilities, adaptive behavior, social skills, and reducing anxiety and aggression.
(Lovaas, 1987)
Peer-Reviewed Literature
(Dawson, 2011)
(Landa, 2012)
Social-Communication, Emotional Regulation, & Transactional Support (SCERTS)
Emotional Regulation
The development of the ability to maintain a well-regulated emotional state to cope with everyday stress, and to be most available to learning and interacting.
Transactional Support
The development and implemenation of supports to help partners to respond to the child's needs and interests, modify and adapt the environment, and provide tools to enhance learning.
SCERTS needs to be integrated in a comprehensive manner across all settings and all partners.
(Prizant, Wetherby, Rubin & Laurent, 2007)
The SCERTS Model includes a well-coordinated assessment process that helps a team measure the child’s progress, and determine the necessary supports to be used by the child’s social partners (educators, peers and family members).
The assessment process ensures that:
Functional, meaningful and developmentally-appropriate goals and objectives are selected.
A child's difference in learning style, interests and their motivations are implemented.
The culture and lifestyle of the family is understood
The child is engaged in meaningful and purposeful activities throughout the day.
Supports are developed and used consistently across partners, activities, and environments.
The progress of the child is charted over time.
Program quality is frequently measured to ensure accountability.
The SCERTS model is in accordance with the National Research Council (2001) for addressing the core deficits that children with ASD face in relation to education:
Priority goals are established to address the core challenges of ASD, building on a child's capacity to initiate communication with a presymbolic and/or symbolic communication system, and to regulate attention, arousal and emotion.
Individualized intervention in provided based on a child's strengths and weaknesses and is guided by research in child development and developmentally appropriate practices.
Incorporates intervention strategies derived from empirically supported practices of developmental social- pragmatics and contemporary behavioral approaches.
Generalization is addressed through transactional supports and progress measured in functional activities with a variety of partners across a variety of settings.
(Prizant, Wetherby, Rubin, & Laurent, 2003)
Intervention planning is individualized based the strengths, natural motivations, and needs of each child and the priorities of the family (Roth & Worthington, 2015)
A research-based educational approach and multidisciplinary framework that directly addresses the core challenges faced by children and persons with ASD and related disabilities, and their families.
(Prizant, Wetherby, Rubin & Laurent, 2007)
(Prizant, Wetherby, Rubin & Laurent, 2007)
Table from (Prizant et al., 2003)
Effectiveness of SCERTS as a Treatment for Autism
Peer-Reviewed Literature
"Autism and multidisciplinary teamwork through the SCERTS Model"
(Moletini, Guldberg, & Logan, 2013)
Research investigates multidisciplinary teamwork in an English special school in the West Midlands (UK).

The findings from this research demonstrate how SCERTS can support professionals in implementing an educational plan that respects the child and his or her family, and that allows the team to listen to the voices of all the people involved in the child’s life, including the child him- or herself.

The quantitative analysis showed that 89% of the participants said they feel or would feel comfortable in using SCERTS every day with children on the autism spectrum, and the therapists indicated the SCERTS principles helped them improve their work with the child because they had the opportunity to have an exchange of experience and perspectives with the other professionals who work more regularly with the child (teachers and care staff).
Limitations to SCERTS:
Difficulty getting all the professionals together and supporting them to understand the manual and assessment.
This made the participants frustrated because the assessment cannot be attempted if key-workers are missing.
(Ingersoll & Lalonde, 2010)
Form of Pivotal Response Teaching (PRT) which teaches imitation through naturalistic social interactions with an adult (Ingersoll & Schreibman, 2006).
Specifically targets spontaneous, reciprocal imitation skills within the context of a play environment (Roth & Worthington, 2015)
The clinician facilitates imitation by imitating the child's actions, gestures, and vocalizations and then the child is rewarded for any following attempted imitative behavior (Roth & Worthington, 2015)
Efficacy of RIT on Autism
A study conducted by Carson & Wilcox (2011) determined whether Reciprocal Imitation Therapy (RIT) is effective in promoting imitation acquisition in young children (29-45 months) with ASD.
Children participated in intervention three times per week within a span of 10 weeks
Findings revealed that all participants exhibited significant increases in their object imitation skills as well as made gains in their imitative language skills (Ingersoll & Schreibman, 2006).
(Roth & Worthington, 2015)
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