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Article Excerpt
This longitudinal case study examined a child who was initially diagnosed with language delay at age 3 and subsequently diagnosed with autism at age 3 years 6 months. This case study is particularly interesting because it followed the child for 24 months and evaluated the efficacy of a unique Korean-English bilingual speech-language intervention. Speech-language intervention was provided twice weekly in his primary language, Korean, for the first 12 months by a Korean-English bilingual speech-language clinician. During the next 6 months, the intervention was gradually introduced in English; and by the final 6 months, the intervention was provided almost entirely in English. This study also incorporated information regarding parent interventions that was implemented by the parents at home. The child in this report made notable gains in expressive and receptive language development in both languages over the study period as well as decreases in aberrant behaviors. At the 24-month follow-up, he was able to respond to testing that was done completely in English. The results of this study support the practice of providing services in the primary language when English is not the language used at home to establish linguistic foundation of the primary language. As the child makes gains in the primary language, a gradual transition can be made to intervention in English. Results of this study have important implications for future research and clinical decision making for assisting families of children from a variety of cultural and ethnic backgrounds.
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Autism spectrum disorders that include "classic" autism as well as pervasive developmental disorders not otherwise specified, have become increasingly more common in recent years (Alexander, Cowdry, Hall, & Snow, 1996; American Psychiatric Association, 2002; Filipeck et al., 1999). The prevalence of autism is estimated between 30 to 60 per 10,000 children based on recent surveys (Fombonne, 2003). Core clinical symptoms include deficits in verbal and nonverbal communication, socialization, and stereotypic or repetitive behaviors. The deficit in communication, including delays in speech-language development (Lord & Paul, 1997; Rapin & Dunn, 2003), can pose special challenges for children with autism who reside in bilingual homes. To date, little has been reported regarding how to design interventions addressing these concerns.
There is little understanding of the process of language development in children with autism. Recently, a study that examined early vocabulary development in this population found delays in receptive vocabulary and phrase understanding as well as expressive vocabulary (Charman, Drew, Baird, & Baird, 2003). This study also validated the use of a parent report, MacArthur Communicative Development Inventory (Fenson et al., 1993), for assessing the language level of children with autism who demonstrated language delay.
Although autism spectrum disorders have lifelong consequences, intervention has been shown to improve communication outcomes (Drew et al., 2002). Another study reported that children who were taught communication skills showed fewer challenging behaviors (e.g., aggression, opposition, tantrums, and destruction; Durrand & Carr, 1992). It was also suggested that communication intervention to manage challenging behaviors had implications for broader outcomes (i.e., academic, vocational, and social; Goldstein, 2002).
Many children with autism receive speech-language intervention through early intervention programs (before age 3), in public schools, and/or privately. However, the therapy is usually limited both in frequency and duration compared to intensive applied behavior analysis types of intervention (which usually include between 20 to 40 hours per week). Thus, it has been suggested by several researchers that current practice in speech-language and early developmental intervention should be supplemented by in-home intervention to currently available clinic-based programs (Koegel, Bimbela, & Schreibman, 1996; Moes, & Frea, 2002; Ozonoff & Cathcart, 1998; Seung, Ashwell, Elder, & Valcante, in press).
Training the parents or family members to implement intervention in a natural living environment (i.e., the home) can be a tremendously efficient way to supplement the clinic-based intervention. Ozonoff and Cathcart (1998) reported the effectiveness of a home program on the development of children with autism in a study that examined cognitive functioning change. Seung et al. (in press) found that parents trained in social reciprocity had positive effects on their children's communication outcomes. Investigators have also emphasized the necessity for future research in autism and emphasized the need to systematically evaluate intervention efficacy (Tager-Flusberg, Joseph, & Folstein, 2001).
Some investigators have raised questions about the prevalence of autism and differences in perception of autism and developmental disabilities by families in various ethnic groups (Dyches, Wilder, Sudweeks, Obiakor, & Algozzine, 2004). When children with autism from a bilingual family receive speech-language intervention, it also raises the issue of the language that should be used for the intervention; whether the intervention should be in English or in the primary language. Current literature suggests an approach of "extending" language by allowing the child to use both primary language and English, rather than "limiting" intervention to only English (Guiterrez-Clellen, 1999).
This longitudinal case study examined a child (J) who was initially diagnosed with language delay at age 3 and subsequently diagnosed with autism at age 3 years 6 months by a developmental pediatrician, the second author. This case study is particularly interesting because it followed the child for 24 months and evaluated the efficacy of a unique bilingual speech-language intervention. This study also incorporated important information regarding proven parent interventions that could easily be implemented by parents at home (Elder, Valcante, Yarandi, Groce, & Carlton, 2002; Elder,...
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