The impact of bilingualism on the narrative ability and the executive functions of children with autism spectrum disorders

The Effects of Bilingualism on the Executive Control Abilities of the Prader-Willi Syndrome Population

Unlike with the typically developing population, non-typically developing individuals, especially those with intellectual disabilities, have usually been recommended to learn and use only one language, despite perhaps coming from bilingual families or living in multilingual environments. This common practice, however, is not backed by empirical evidence; previous research, although limited, has systematically shown that bilingualism does not have negative effects. This study investigates how bilingualism shapes the executive control abilities of individuals with genetic disorders. Specifically, we compare the interference suppression abilities of Spanish-Catalan bilinguals and Spanish monolinguals with Prader-Willi syndrome. Fifteen participants with Prader-Willi syndrome were recruited in Spain. The bilingual group consisted of seven Spanish-Catalan bilinguals from Catalonia-an officially bilingual territory of Spain-, while the monolingual group was formed by eight Spanish speaking individuals from Madrid-an officially monolingual territory. Participants were administered two widely used psychological tasks: the Flanker Task (a non-language-based task) and the Stroop Task (a language-based task). Three experimental conditions were included in each task: neutral, congruent, and incongruent. Both accuracy and reaction time data were collected and analyzed. The results obtained are consistent between both tasks in showing (i) no detrimental effects of bilingualism; (ii) a high answer accuracy rate; (iii) a practice effect (the more familiar participants became with the tasks the faster their answers became); (iv) sensitivity to an interference effect (higher reaction times for incongruent trials than neutral trials) but not to a clear facilitation effect (lower reaction times for congruent trials than neutral trials). These results, far from being anecdotal, are in line with results from previous research investigating the effects of bilingualism among typically developing individuals as well as non-typically developing individuals with and without genetic disorders. This study not only evidences that Prader-Willi individuals can become bilingual if they are exposed to more than one language, but also that they can do so without showing negative effects at the cognitive level. In fact, taking into account the trend in the descriptive data, if an effect of bilingualism were in place, it would be a positive one. Bilingualism has repetitively been proven to neither be a burden nor to have negative effects for the typically or the non-typically developing population. Thus, as previous researchers have pointed out, there seems to be a clear incongruity between what the research is showing and the actual advice that these individuals and their families are receiving, and this should be amended without further delay.

Bilingualism Effects in Metaphor and Simile Comprehension and Production in Children With Autism Spectrum Disorder

Figurative language, including metaphors and similes, is a crucial component of communication; yet, it presents significant challenges for individuals with autism spectrum disorder (ASD). A critical gap in existing research is the impact of bilingualism on the ability of children with ASD to understand and produce non-literal speech. This study addresses this gap by examining the comprehension and production of metaphors and similes in monolingual and bilingual Greek-speaking children with high-functioning ASD. To the best of our knowledge, this is the first study to investigate these abilities in bilingual children with ASD. Thirty-three monolingual and 18 bilingual children participated in tasks designed to assess comprehension, production, and error patterns for metaphors and similes. The study has also investigated the roles of non-verbal intelligence, language skills (expressive vocabulary), and executive functions (working memory) in the children's performance in the metaphor and simile tasks. Results showed that the two groups did not differ in metaphor comprehension; however, bilingual autistic children with higher non-verbal intelligence appeared to have superior performance in metaphor comprehension compared to their bilingual peers with lower non-verbal intelligence. The bilingual autistic children outperformed their monolingual peers in metaphor production, likely due to their higher non-verbal intelligence ability, despite the fact that the bilingual group had lower expressive vocabulary scores than the monolingual children. Simile comprehension, on the other hand, favored monolingual children, while no significant group differences were observed in simile production. Regarding errors, both groups exhibited similar error patterns, with literal interpretations being the dominant error type across both groups, suggesting that pragmatic language difficulty is a hallmark feature in ASD. The findings challenge the misconception that bilingualism hinders language development in children with ASD and highlight its potential to provide benefits in the realm of non-literal language processing.

Linguistic Markers of Autism Spectrum Disorder in Narrative Production: Evidence From the Monkey Cartoon Storytelling Task of the Autism Diagnostic Observation Schedule

Background and aims

The Autism Diagnostic Observation Schedule (ADOS-2) is considered a "gold standard" diagnostic instrument in the assessment of autism spectrum disorder (ASD). The Monkey Cartoon task is an optional pictured storytelling task in ADOS-2, which has been designed to assess gestural and verbal communication in autistic children while telling a story. It is well established that storytelling is challenging for autistic children, particularly for the content and coherent organization of the story, also known as narrative macrostructure. Existing evidence on the efficacy of the Monkey Cartoon task to pinpoint differences between autistic and neurotypical individuals in narrative macrostructure is scant. In this study, we used a version of the Monkey Cartoon task with modified scoring to analyze the narrative macrostructural skills of two groups of children with and without ASD. We also investigated the relations between narrative macrostructure and language ability in each group.

Methods

A group of 16 Greek-speaking autistic children and 16 age- and IQ-matched neurotypical children were administered the Monkey Cartoon storytelling task. Children's vocabulary and syntactic skills were also measured. Narratives were analyzed in terms of macrostructural features, including story completeness and story grammar, as well as units denoting the setting, internal responses and added details.

Results

The autistic children had lower scores in communicating the story content rather than story grammar. Moreover, the autistic group tended to include less information on the story's setting and more off-topic utterances than their neurotypical peers. Regarding the relations between narrative macrostructure and language ability, the two groups dissociated since the autistic children tended to rely on vocabulary at the expense of including irrelevant information in their narratives, while neurotypical children relied on both lexical and syntactic skills, especially when instantiating references to the story characters' mental states and the setting of the story, respectively.

Conclusions

The Monkey Cartoon storytelling task seems to be efficient at revealing pragmatic weaknesses mainly at the thematic content level in autistic children. Also, the frequent use of semantically- and pragmatically-irrelevant information in storytelling differentiated autistic from neurotypical children, and may thus be treated as a distinguishing feature of ASD in narrative production.

Implications

The findings demonstrate the viability of the Monkey Cartoon task in highlighting language markers of ASD in narrative macrostructure, with clinical implications for enhancing clinical practice in countries like Greece that face a shortage of narrative assessment tools for autistic children.

Effects of bilingual language exposure on toddlers with autism spectrum disorder

Research analyzing the effects of bilingual language exposure on children with autism spectrum disorder (ASD) has increased in frequency. Utilizing the Bayley Scales of Infant and Toddler Development-Third Edition, the current study analyzed the effects of bilingual language exposure and age on language development, cognitive development, and social emotional development in toddlers with ASD. Older children demonstrated higher language scores than younger children. The interaction between ASD and bilingualism did not yield statistical significance for language, cognitive, or social emotional scores; however, the interaction between age and bilingualism was found to be significant. Age may have more of an influence on language development than ASD. Children with ASD can be raised in bilingual homes without affecting long-term development.

The Acquisition of Relative Clauses in Autism: The Role of Executive Functions and Language

PURPOSE

Relative clauses present a well-known processing asymmetry between object-extracted and subject-extracted dependencies across both typical and atypical populations. The present study aimed at exploring the comprehension of object and subject relative clauses as conceptualized by the Relativized Minimality framework in autistic children and in a group of age- and IQ-matched typically-developing children. The study also explored the way performance in relative clauses would be affected by the children's language and executive function skills.

METHOD

Relative clause comprehension was tested through a sentence-picture matching task and language was tested with a receptive vocabulary task. Executive functions were assessed through backward digit recall and a Flanker test.

RESULTS

Object relative clauses were harder to parse for both groups than subject relatives, while number mismatch between the moved object Noun Phrase and the intervening subject Noun Phrase in object relatives boosted both groups' performances. Typically-developing children's performance in object relatives was predicted by both language and executive functions, while autistic children failed to use language and did not systematically draw on their executive functions in object relative clause comprehension.

CONCLUSION

The findings suggest that relative clause processing in autism follows a normal developmental trajectory, and that difficulty with parsing object relative clauses stems from reduced language and executive functions rather than deficits in the children's morphosyntactic skills.

Metaphor comprehension and production in verbally able children with Autism Spectrum Disorder

Research in the field of figurative language processing in Autism Spectrum Disorders (ASD) has demonstrated that autistic individuals experience systematic difficulties in the comprehension of different types of metaphors. However, there is scarce evidence regarding metaphor production skills in ASD. Importantly, the exact source of metaphor processing difficulties in ASD remains largely controversial. The debate has mainly focused on the mediating role of structural language skills (i.e., lexical knowledge) and cognitive abilities (i.e., Theory of Mind and executive functions) in ASD individuals' ability to comprehend and generate metaphors. The present study examines metaphor comprehension and production in 18 Greek-speaking verbally able children with ASD and 31 typically-developing (TD) controls. Participants completed two tasks, namely, a low-verbal multiple-choice sentence-picture matching task that tested their ability to comprehend conventional predicate metaphors, and a sentence continuation task that assessed their ability to generate metaphors. The study also included measures of fluid intelligence, expressive vocabulary, and working memory within the sample. The results show that the ASD group had significantly lower performance than the TD group in both metaphor comprehension and production. The findings also reveal that expressive vocabulary skills were a key factor in the metaphor comprehension and production performance of the children with ASD. Working memory capacity was also found to correlate significantly with metaphor comprehension performance in the ASD group. Conversely, no correlations were found in the TD group with neither of the above factors. Of note, children with ASD generated significantly more inappropriate responses and no-responses to the metaphor production task compared with the control group. The overall results reveal that children with ASD had difficulty with both comprehending and using metaphorical language. The findings also indicate that TD children may employ diverse cognitive strategies or rely on different underlying skills when processing metaphors compared with children with ASD.

Bilingualism and second-order theory of mind development in autistic children over time: Longitudinal relations with language, executive functions, and intelligence

Theory of Mind has long been studied as a core weakness in autism spectrum disorder due to its relationship with social reciprocity, while bilingualism has been shown to compensate for autistic individuals' mentalizing weaknesses. However, our knowledge of the Theory of Mind developmental trajectories of bilingual and monolingual autistic children, as well as of the factors related to Theory of Mind development in autism spectrum disorder is still limited. The current study has examined first- and second-order Theory of Mind skills in 21 monolingual and 21 bilingual autistic children longitudinally across three time points, specifically at ages 6, 9, and 12, and also investigated associations between Theory of Mind trajectories and trajectories of the children's language, intelligence and executive function skills. The results reveal that bilingual autistic children outperformed their monolingual peers in second-order Theory of Mind at ages 9 and 12, and that intelligence and, especially, expressive vocabulary skills played a pivotal role in advancing bilingual autistic children's second-order Theory of Mind development. On the other hand, monolingual autistic children only managed to capitalize on their language and intelligence resources at age 12. The findings highlight the importance of investigating bilingualism effects on autistic children's advanced cognitive abilities longitudinally.

What Silent Pauses Can 'Tell' Us About the Storytelling Skills of Autistic Children: Relations Between Pausing, Language Skills and Executive Functions

Silent pauses may serve communicative purposes such as demarcating boundaries between discourse units in language production. Previous research has shown that autistic children differ in their pausing behavior from typically-developing (TD) peers, however, the factors behind this difference remain underexplored. The current study was aimed at comparing the use of silent pauses in the narrative production of autistic children and age-matched TD children, and also to identify possible relations between pausing behavior and the children's language and executive function abilities. According to the study's findings, the autistic children did not differ from their TD peers in the use of grammatical pauses, however, the former tended to produce significantly less syntactically complex narratives than the TD group, which increased the likelihood that the autistic group would pause appropriately at phrasal boundaries. Though we have found low rates of ungrammatical silent pauses and omitted pauses in obligatory discourse contexts across both groups, autistic children with lower cognitive flexibility tended to use more ungrammatical pauses than their peers with higher cognitive flexibility scores. Also, the autistic group tended to omit obligatory silent pauses more often as their narration became more complex. The results demonstrate that syntactic complexity in narrative production modulated autistic children's pausing behavior, and that structurally simple narrations boosted the autistic group's appropriate use of grammatical pauses. The overall findings also demonstrate the importance of studying silent pauses in the narrative discourse of autistic children, and also highlight the links between silent pauses and the children's syntactic and cognitive skills.

Bilingual exposure might enhance L1 development in Cantonese-English bilingual autistic children: Evidence from the production of focus

LAY ABSTRACT

It is commonly believed among professionals and parents that exposure to two languages imposes an additional burden on children with autism spectrum disorder. However, there is a lack of empirical evidence to support or reject this belief. With the prevalence of autism and an increasing number of children growing up bilingual, it is urgent to understand how bilingual exposure interacts with autism. Bilingual autistic children from Hong Kong, with Cantonese as their first language and English as their second language, took part in the study. We used a production game to test how bilingual autistic children use different levels of linguistic knowledge to produce contrastive information in real conversations, compared to their monolingual autistic peers and typically developing children matched in language abilities, nonverbal IQ, working memory and maternal education. We found that bilingual autistic children performed as good as typically developing children in general, and they even performed better than monolingual autistic children. Our findings suggest a bilingual advantage in autistic children in conveying constative information in sentences. We thus encourage parents to engage their children in rich bilingual environments. Clinicians, educators and other professionals may also consider adding bilingual aspects in training programmes to support families raising bilingual autistic children.

Autism Detection in Children: Integrating Machine Learning and Natural Language Processing in Narrative Analysis

Despite the consensus that early identification leads to better outcomes for individuals with autism spectrum disorder (ASD), recent research reveals that the average age of diagnosis in the Greek population is approximately six years. However, this age of diagnosis is delayed by an additional two years for families from lower-income or minority backgrounds. These disparities result in adverse impacts on intervention outcomes, which are further burdened by the often time-consuming and labor-intensive language assessments for children with ASD. There is a crucial need for tools that increase access to early assessment and diagnosis that will be rigorous and objective. The current study leverages the capabilities of artificial intelligence to develop a reliable and practical model for distinguishing children with ASD from typically-developing peers based on their narrative and vocabulary skills. We applied natural language processing-based extraction techniques to automatically acquire language features (narrative and vocabulary skills) from storytelling in 68 children with ASD and 52 typically-developing children, and then trained machine learning models on the children's combined narrative and expressive vocabulary data to generate behavioral targets that effectively differentiate ASD from typically-developing children. According to the findings, the model could distinguish ASD from typically-developing children, achieving an accuracy of 96%. Specifically, out of the models used, hist gradient boosting and XGBoost showed slightly superior performance compared to the decision trees and gradient boosting models, particularly regarding accuracy and F1 score. These results bode well for the deployment of machine learning technology for children with ASD, especially those with limited access to early identification services.

Assessing the Impact of Bilingualism on the Linguistic Skills of Children with Autism Spectrum Disorder (ASD) in Greece: A Scoping Review

(1) Background and Objectives: This review aims to identify the latest literature on the possible effect of bilingualism on the linguistic skills of children with autism spectrum disorder (ASD) residing in Greece. (2) Materials and Methods: The literature was searched in the databases of Scopus and PubMed by selecting articles and by reviewing four studies published in peer-reviewed journals. This Scoping Review is based on the standards of PRISMA recommendations for scoping reviews, while the PCC framework was used as a guide to construct clear and meaningful objectives and eligibility criteria. (3) Results: The publications included in the review addressed a variety of language-related skills, including morphology, the syntax-pragmatics interface, narrative ability, as well as both receptive and expressive language skills. (4) Conclusions: Three out of four studies provide evidence that bilingual ASD children are not disadvantaged compared to monolingual peers but rather enjoy some benefits, to a certain extent, due to bilingualism. However, the number of the reviewed studies as well as the limitations of the studies themselves render this conclusion tentative. Additionally, the findings set guidelines that speech therapists, educators, psychologists, and doctors in the Greek context need to follow when treating or educating bilingual children with ASD.

Parental Survey on Spanish‑English Bilingualism in Neurotypical Development and Neurodevelopmental Disabilities in the United States

Objectives

The cognitive and social benefits of bilingualism for children, including those with neurodevelopmental disabilities (NDDs), have been documented. The present study was designed to characterize and compare English and Spanish use in Hispanic families with and without NDDs residing in the U.S. as well as to understand parental perceptions of their child's bilingualism and of community and professional support.

Methods

We conducted an online survey of 84 Spanish-speaking parents of 4- to 24-year-olds with (n = 44) and without NDDs (n = 40) who were born in and living in the U.S.

Results

We found that bilingualism was a desired goal for 95% of our families. We also found, however, that 17.1% of parents of children with NDDs have raised them as monolinguals English-speakers, as they thought there were reasons for that, while all families from the NT group raised their children in both languages. In addition, nearly 40% of the NDD children only speak English, compared to a 5% in the NT group. Finally, parents of children with NDDs cite a lack of support for bilingualism in the community (47.6% do not feel supported, compared to a 7.9% in the NT group) and recommendation from professionals as major factors for not raising their children as bilingual.

Conclusions

The results suggest a need to educate professionals from many disciplines about the benefits of bilingualism for children with NDDs and for implementation of inclusion policies that provide access to dual-language programs.

The Relationship between Narrative Skills and Executive Functions across Childhood: A Systematic Review and Meta-Analysis

Executive functions (EFs) and narrative competence (NC) are two important predictors of many outcomes in human development. To date, however, it is unclear whether these skills develop synergistically-supporting or opposing each other-or whether they are independent of each other. The purpose of this meta-analysis is to understand if these skills are related to over development and if the magnitude of their association changes over time; differs in typical and atypical development; and changes with EF (inhibition, working memory, flexibility, planning) and NC (oral, written; micro and macrostructural level). For this purpose, 30 studies containing 285 effect sizes were selected and combined. The results show that EFs and NC are weakly associated with each other (r = 0.236, p < 0.001) and that this association decreases with age (b(267) = -0.0144, p = 0.001). They are more associated in preschool and early elementary school grades, becoming more independent after seven years old. Between 3 and 7 years of age, the association seems stronger in atypically developing children and for macrostructural NC. Additionally, before 7 years old, the various EF domains seem to associate indistinctly with NC, and only later specific links between EFs and NC would be observed.

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.

Here's the Story: Narrative Ability and Executive Function in Autism Spectrum Disorder

Background

Difficulties with narrative have been reported in individuals diagnosed with autism spectrum disorder (ASD), but the role of executive function on narrative ability has not been examined in ASD. In this study, we aimed to (1) examine whether narrative abilities of ASD children differed from neurotypical (NT) children who did not differ in age, sex, and IQ; and (2) investigate relations between executive function and narrative ability in ASD children.

Method

Narratives were elicited from 64 ASD children and 26 NT children using a wordless picture book and coded to derive several aspects of narrative ability such as propositions, evaluative devices, and self-repairs. Executive functions (specifically, inhibition and working memory) were measured using both experimenter-administered assessment and parent-report measures.

Results

Compared to NT children, ASD children produced fewer propositions but did not differ in their use of evaluative devices and self-repairs during narrative production. Greater inhibitory challenges related to more self-repairs involving repetition of story elements, whereas working memory did not relate to any of the measures of narrative ability among ASD children.

Conclusions

This study revealed that narratives by verbally fluent ASD children were shorter and less complex than those by NT children but did not differ in the specific features of narratives. Furthermore, although ASD children did not make more self-repairs than NT children, difficulty with inhibition was related to more self-repairs, indicating more dysfluent narrative production in ASD children, which has implications for intervention.

Referential expressions in monolingual and bilingual children with and without Autism Spectrum Disorder (ASD): A study of informativeness and definiteness

The current study evaluated the separate and combined effects of bilingualism and Autism Spectrum Disorder (ASD) on informativeness and definiteness marking of referential expressions. Hebrew-speaking monolingual children (21 with ASD and 28 with typical language development) and Russian-Hebrew-speaking bilingual children (13 with ASD and 30 with typical language development) aged 4-9 years participated. Informativeness, indexed by referential contrasts, was affected by ASD, but not by bilingualism. Definiteness use was non-target-like in children with ASD and in bilingual children, and it was mainly predicted by children's morpho-syntactic abilities in Hebrew. Language-universal and language-specific properties of referential use are discussed.

Language in autism: domains, profiles and co-occurring conditions

This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.

Chinese-English speaking family perspectives of augmentative and alternative communication use with their children

INTRODUCTION

Culturally and linguistically diverse families who have children with complex communication needs (CCN) often have limited access to augmentative and alternative communication (AAC) devices and interventions due to the lack of services that acknowledge their families' cultural and linguistic needs. Despite the increasing need for culturally responsive services, little is known about Chinese-English speaking families' perspectives and experience related to AAC use and services. The objective of this study was to understand the perspectives and experiences of Chinese-English speaking family members of children who use AAC use.

METHODS

This study employs a qualitative descriptive methodology approach. The researchers conducted individual or group semi-structured interviews with 10 adult family members (mother, father, and grandparent) from four Chinese-English speaking families in the U.S. and Canada who have a child who uses AAC (ages 3-8).

RESULTS

Chinese-English speaking families have high acceptance and satisfaction with their child's AAC as long as they see the benefits of the AAC system. Mothers and siblings play unique roles in supporting home AAC practice given frequent engagement with and observed influence on the child who uses AAC. Family members indicated goals in building stronger family connections, but noted that the child's speech difficulties interfered with this goal. Chinese-English speaking families felt they can overcome limitations resulting from lower English language proficiency, but still find difficulties in obtaining resources because of the Western expectations of advocacy. Additionally, service providers' lack of responsiveness related to family goals could prevent families in obtaining AAC resources.

CONCLUSIONS

The findings suggest the need for family-centered services with cultural sensitivity and humility for those serving Chinese-English speaking families with children who use AAC. Additionally, involving family members beyond the mother within services may improve both family functioning and child communication.

Caregiver Experiences With Oral Bilingualism in Children Who Are Deaf and Hard of Hearing in the United States: Impact on Child Language Proficiency

PURPOSE

Best practices recommend promoting the use of the home language and allowing caregivers to choose the language(s) that they want to use with their child who is deaf or hard of hearing (DHH). We examined whether Spanish-speaking caregivers of children who are DHH receive professional recommendations on oral bilingualism that follow best practices. We also assessed whether professional recommendations, caregiver beliefs, and language practices had an impact on child language(s) proficiency.

METHOD

Sixty caregivers completed a questionnaire on demographic questions, language(s) use and recommendations, beliefs on bilingualism, and child language proficiency measures in English, Spanish, and American Sign Language (ASL). Professional recommendations on oral bilingualism were reported descriptively, and linear regression was used to identify the predictors of child language(s) proficiency.

RESULTS

We found that only 23.3% of the caregivers were actively encouraged to raise their child orally bilingual. Language practices predicted child proficiency in each language (English, Spanish, and ASL), but professional recommendations and caregiver beliefs did not.

CONCLUSIONS

Our results revealed that most caregivers received recommendations that do not follow current best practices. Professional training is still needed to promote bilingualism and increase cultural competence when providing services to caregivers who speak languages different from English.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21644846.

Cognitive flexibility in autism: Evidence from young autistic children

We examined the cognitive flexibility performance of young autistic children and a group of neurotypical peers. Thirty-six autistic children (72-83 months) and 200 age-matched typically-developing children were assessed on the Children's Color Trails Test (CCTT), a semantic and a phonemic verbal fluency task. The results showed that the autistic children performed worse than their neurotypical peers in the switching component of the CCTT. In the fluency tests, the autistic group generated overall fewer word items than their neurotypical peers, however, their poorer performance was driven by specific linguistic stimuli in the fluency tasks. The findings suggest that cognitive flexibility for the autistic children was affected in the nonverbal CCTT only, while poor performance in semantic and phonemic fluency seemed to be inherent to the language properties of the verbal fluency tasks.

Bilingualism effects on cognition in autistic children are not all-or-nothing: The role of socioeconomic status in intellectual skills in bilingual autistic children

LAY ABSTRACT

Previous research has suggested that bilingualism may improve cognition in children with autism, and that this boost may stem from improvement in executive functions. The Wechsler Intelligence Scales for Children are considered to be reliable and valid measures of intelligence when administered to autistic children. These measures have so far revealed unusual psychometric properties in monolingual autistic children, notably distinctive patterns of strengths and weaknesses and low inter-correlation among verbal and nonverbal IQ subtests. The way bilingualism affects the intellectual functioning of autistic children has not been explored yet. Nor has there been a satisfactory factor structure that explains monolingual and bilingual autistic children's IQ performance in terms of individual factors, such as age and socioeconomic status. The current study examined the intelligence profiles of 316 bilingual and age- and gender-matched monolingual children with autism using the Wechsler Intelligence Scales for Children-Third Edition. The study applied clustering models to extract intelligence subtypes of autism, and mediation analyses to examine potential mediation effects of age and socioeconomic status on the children's verbal and nonverbal IQ performance. The results support the mediational role of the children's socioeconomic status in the association between bilingualism and intelligence. Low-socioeconomic status bilingual autistic children outperformed their monolingual peers on both verbal and nonverbal subtests, while the differences faded in medium-socioeconomic status and high-socioeconomic status children. The findings emphasize the positive effects of bilingualism on low-socioeconomic status autistic children's intelligence and also highlight high-socioeconomic status as a factor that may mitigate discrepant patterns of strengths and weaknesses in monolingual children's IQ performance.

Bilingualism Effects on the Cognitive Flexibility of Autistic Children: Evidence From Verbal Dual-Task Paradigms

The deficit in cognitive flexibility (i.e., the ability to adapt cognitive behavior to changing contexts) is one of the most prominent characteristics of autistic individuals. Inflexibility may manifest in restricted interests and increased susceptibility to the effects of misinformation either through inefficient inhibition of non-target information or deficient recall of correct information. Bilingualism has been shown to enhance executive functions in both typically developing children and autistic children; yet, the effect of bilingualism on cognitive flexibility in autism remains underexplored. In this study, we used verbal dual-tasks to compare cognitive flexibility across 50 monolingual autistic and 50 bilingual autistic children, and 50 monolingual and 50 bilingual typically developing children. The children were also administered language ability tests and a nonverbal global-local cognitive flexibility task, in order to investigate whether performance in the dual-tasks would be modulated by the children's language and executive function skills. The bilingual autistic children outperformed their monolingual autistic peers in the dual-tasks. The strength of the bilingualism effect, however, was modulated by the type of language processing that interfered with the target information in each dual-task, which suggests that the bilingual autistic children calibrated their processing resources and efficiently adapted them to the changing demands of the dual-task only to the extent that the task did not exceed their language abilities. Bilingual autistic children relied on their executive functions rather than on their language abilities while performing in the dual-tasks. The overall results show that bilingualism compensates for the reduced cognitive flexibility in autism.

Bilingualism effects in pronoun comprehension: Evidence from children with autism

The prevalence of autism worldwide has risen steadily in the last two decades, while bilingualism is also becoming increasingly prevalent in today's rapidly globalizing world. The current study aimed to investigate bilingualism effects in the pronoun resolution skills of children with autism in comparison to age-matched monolingual children with autism, as well as monolingual and bilingual children of typical development (Ν = 20 participants per group). Results showed that autistic children had general difficulty anchoring ambiguous pronouns to entities that were linguistically expressed in discourse, yet, the bilingual children with autism were more sensitive to the topicality of the entities in syntactic subject position and more prone to identify them as suitable referents of ambiguous null pronouns as compared to their monolingual peers. The findings suggest that bilingualism is not detrimental to autistic children's pronoun resolution skills. The current study aimed at determining how bilingualism influences ambiguous pronoun comprehension in children with autism as compared to bilingual and monolingual children of typical development. The findings show that bilingualism was not detrimental to the autistic children's pronoun resolution skills, further suggesting that having acquired more than one language does not exacerbate autistic children's deficits in the comprehension of pronouns.

Measuring the Impact of Bilingualism on Executive Functioning Via Inhibitory Control Abilities in Autistic Children

One factor that may influence how executive functions develop is exposure to more than one language in childhood. This study explored the impact of bilingualism on inhibitory control in autistic (n = 38) and non-autistic children (n = 51). Bilingualism was measured on a continuum of exposure to investigate the effects of language environment on two facets of inhibitory control. Behavioural control of motor impulses was modulated positively through increased bilingual exposure, irrespective of diagnostic status, but bilingual exposure did not significantly affect inhibition involving visual attention. The results partially support the hypothesis that bilingual exposure differentially affects components of inhibitory control and provides important evidence for families that bilingualism is not detrimental to their development.

The cognitive benefits of bilingualism in autism spectrum disorder: Is theory of mind boosted and by which underlying factors?

This study examined whether bilingualism boosts Theory of Mind as measured by a non-verbal false belief (FB) task in children with autism spectrum disorder (ASD), and how this potential boost may stem from improvements in a variety of other domains, namely executive functions (EFs), language, metalinguistic awareness skills, as well as autism severity. One hundred and three children with ASD (7- to 15-year-olds) (43 bilingual and 60 age- and IQ-matched monolingual children) were tested on a nonverbal task of attentional switching, working memory and updating task, and an online, low-verbal first-order FB task. Results showed a clear FB benefit for bilingual children with ASD as compared with their monolingual peers. There were also boosts in EF, however, there is no evidence that these EF boosts drove the FB advantage. Enhanced FB was not explained either by language, metalinguistic skills, or lower autism severity. While the results do not conclusively settle the debate on what triggers the ToM advantage in bilingual children with ASD, the empirical picture of the current study suggests that the ToM component of FB understanding in bilingual children with ASD is enhanced by the bilingual experience per se. LAY SUMMARY: The current study aimed to determine if and how bilingualism may improve the ability to understand others' beliefs in children with autism spectrum disorder (ASD). We assessed their belief reasoning alongside a series of other skills hypothesized to be beneficial for such reasoning, namely understanding, producing, and thinking about language, recalling and switching between information, and the severity of their autistic symptoms. The overall findings highlight advantages for bilingual children with ASD over their monolingual peers for grasping beliefs, thus suggesting that pursuing bilingualism may be beneficial for cognition in ASD. Other boosts were also associated with bilingualism, such as recalling and switching between information, but these boosts were not directly related to belief understanding, highlighting the beneficial role of bilingualism per se.

Ad-hoc and scalar implicatures in children with autism spectrum disorder

BACKGROUND

Previous studies found that people with Autism Spectrum Disorder (ASD) perform well on pragmatic inference tests that require the use of the linguistic scale <some, all>. The present study extends previous research by testing two types of implicature: scalar implicatures, based on lexical scales, and ad-hoc implicatures, based on contextual scales.

METHODS

We tested 26 children with ASD aged 4-10 years (mean age 7.1) and 26 typically developing (TD) children - matched on chronological age and with a similar performance in non-verbal IQ and vocabulary - by means of a picture selection task for scalar and ad-hoc implicatures. We also investigated the effect of children's scores in standardized tests measuring non-verbal intelligence, lexical, and morphosyntactic abilities and Theory-of-Mind skills on their performance in the implicature tasks.

RESULTS

Although more than half of the children with ASD performed above chance on both kinds of implicatures, their performance as a group was significantly lower than the performance of their TD peers. General cognitive abilities were found to affect the performance of children with ASD on both kinds of implicatures, and Theory-of-Mind reasoning skills were found to be linked to their performance on scalar, but not ad-hoc implicatures.

CONCLUSIONS

We show that children with ASD have difficulty with both kinds of implicatures. These findings may have implications for explanatory theories of pragmatics as well as for clinical work with children with ASD.

Theory of Mind in ADHD. A Proposal to Improve Working Memory through the Stimulation of the Theory of Mind

The aim of this study was to investigate the relationships between Theory of Mind (ToM), Working Memory (WM), and Verbal Comprehension (VC). Performance of these variables was evaluated in 44 elementary students (6-12 years) diagnosed with ADHD. Their performance in all variables was collected through the Neuropsychological Battery (NEPSY-II) and the Wechsler Intelligence Scale for Children IV. The results showed that fifty percent of the participants were below the 25th percentile in ToM and that this low performance was not related to age. In addition, analyses showed statistically significant relationships between WM, VC, and ToM. Analysis of the effect of WM and VC on ToM showed that only WM explained the variance in participant performance in ToM. These results led us to raise the need to include ToM among the skills to be stimulated in programs for the treatment of ADHD, accompanying other skills related to social adaptation that are usually included in such programs. Likewise, considering that ToM implies putting into practice skills such as considering different points of view, attending to relevant aspects of the context, making decisions, inferring mental states, and predicting behaviors, we believe that through the stimulation of ToM, WM would also be stimulated.

Theory of Mind, Executive Functions, and Syntax in Bilingual Children with Autism Spectrum Disorder

Impairments in Theory of Mind (ToM) are a core feature of Autism Spectrum Disorder (ASD). ToM may be enhanced by various factors, including bilingualism, executive functions (EF), and complex syntax. This work investigates the language-cognition interface in ASD by exploring whether ToM can be enhanced by bilingualism, whether such ToM boosts would be due to EF or syntax, and whether routes to mentalizing would differ between bilinguals and monolinguals on the spectrum. Twenty-seven monolingual Greek-speaking and twenty-nine bilingual Albanian-Greek children with ASD were tested on ToM reasoning in verbal and low-verbal ToM tasks, an executive function 2-back task, and a sentence repetition task. Results revealed that bilingual children with ASD performed better than monolinguals with ASD in the low-verbal ToM and the 2-back tasks. In the sentence repetition task, bilinguals scored higher than monolinguals in complex sentences, and specifically in adverbials and relatives. Regarding the relations between ToM, EF, and sentence repetition, the monolingual group’s performance in the verbal ToM tasks was associated with complement syntax, whereas, for the bilingual children with ASD, performance in both verbal and low-verbal ToM tasks was associated with EF and adverbial clause repetition. The overall pattern of results suggests that mentalizing may follow distinct pathways across the two groups.

Behavioral and Autonomic Responses in Treating Children with High-Functioning Autism Spectrum Disorder: Clinical and Phenomenological Insights from Two Case Reports

In this study, we aimed to evaluate the process applied in subjects with Autism Spectrum Disorder (ASD) to elaborate and communicate their experiences of daily life activities, as well as to assess the autonomic nervous system response that subtend such a process. This procedure was evaluated for the first time in two eight-year-old girls with high-functioning ASDs. The subjects performed six months of training, based on the cognitive–motivational–individualized (c.m.i.^®) approach, which mainly consisted in building domestic procedures and re-elaborating acquired experiences through drawing or the use of icons made by the children. Together with behavioral observations, the response of the autonomic nervous system during such re-elaboration was recorded. A change in communicative and interactive competences was observed, moving from a condition of spontaneity to one in which the girls were engaged in relating their experiences to a parent. Autonomic response highlighted how, in communicating their own experiences, they achieved a state of cognitive activation, which enabled a greater communicative and emotional connection with the interlocutor. This is a proof-of-concept study on the application of the c.m.i.^®, which needs to be extensively validated in the clinical setting.