Practitioner Review: Multilingualism and neurodevelopmental disorders - an overview of recent research and discussion of clinical implications

The impact of educational and medical systems on autistic children from multilingual American homes: A systematic review

LAY ABSTRACT

Research has found that autistic children can navigate multilingual schools and communities without harming their language skills or school success. However, they may encounter specific challenges within the United States, where educational and healthcare systems are insufficiently equipped to meet their needs. This review examined 46 US-based studies on the topic and findings reveal persistent deficit-based ideas about multilingualism and autism (e.g., professionals recommending that autistic students only speak and learn in English) accompanied by patterns of unequal identification of autism among multilingual children. These findings highlight issues of disproportionality and inadequate access to educational and healthcare resources. However, recent studies indicate that incorporating a child's native language in education not only enhances learning and behavioral outcomes but also boosts cognitive functions like problem-solving and planning. Taken as a whole, current research suggests that intentionally addressing linguistic diversity will allow educational and medical systems to better serve autistic children.

`It's not just linguistically, there's much more going on': The experiences and practices of bilingual paediatric speech and language therapists in the UK

BACKGROUND

Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession.

AIMS

To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability.

METHODS

In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework.

RESULTS

Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession.

CONCLUSION & IMPLICATIONS

This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027.

WHAT THIS PAPER ADDS

What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism.

Autism and bilingualism: A thematic analysis of practitioner perspectives in the United Kingdom

BACKGROUND

At least 25% of autistic children worldwide have the potential to grow up in a bilingual environment. However, many autistic children are being denied opportunities to access additional languages and the cultural, familial and community connections that come with this. There is little evidence identifying the barriers to language learning and access, and no research addressing the perspectives of speech and language therapists (SLTs), who are crucial in supporting parents to make informed choices about bilingualism with their child.

AIMS

The aim of this research was to understand the experiences of SLTs working with autistic bilingual children, to understand the main considerations when working with families, and the opportunities and barriers for training, including the sources of information that current practice is based on.

METHODS AND PROCEDURES

Twelve SLTs from across the United Kingdom were recruited for this study. All participants were experienced in working with autistic bilingual children and their families (M = 7 years, range 4-23 years). Semi-structured interviews were conducted and focused on the experiences of SLTs regarding familial bilingual experiences, the effect of sociocultural factors of practice, and the extent to which practice is based on current research.

OUTCOMES AND RESULTS

Data were analysed using reflexive thematic analysis. Three central themes were identified from the interviews: (1) participants discussed parental uncertainties as to whether they were doing the right thing for their child, (2) while participants were in support of bilingualism, they were not always confident that they were providing the right advice and found it difficult to in keep up to date with relevant, evidence-based research, and (3) participants highlighted a need to shift towards a more inclusive and culturally diverse practice.

CONCLUSIONS AND IMPLICATIONS

This is the first qualitative study to understand the perspectives of SLTs working with autistic bilingual children. We identify several key difficulties in supporting access to language learning, and these findings have immediate and longer-term implications for supporting SLTs, and in turn, the children and families they support.

WHAT THIS PAPER ADDS

What is already known on the subject Research suggests that autistic children currently have fewer opportunities to maintain bilingualism compared to neurotypical peers. Despite the lack of evidence, many families remain concerned that bilingualism will have a negative impact on their child's development. To date, little is known about the perspectives of speech and language therapists (SLTs) who play a significant role in supporting the development of autistic bilingual children. This is the first study to provide an in-depth qualitative analysis of the experiences of SLTs working with autistic bilingual children and their families in the United Kingdom. What this study adds The results highlight a number of reoccurring barriers in providing optimal support: first, frequently cited concerns about bilingualism from parents that link to a lack of understanding about autism and the role of SLTs more generally. Second, SLTs do not have confidence in the assessments and tools available and described a lack of emphasis on cultural factors in practice. Many SLTs were concerned about the limited options for resources and interventions available in other languages, which could be challenging for parents who were less proficient or confident communicating in English. Third, SLTs reported having limited opportunities to keep up to date with relevant research to support their decision-making processes. What are the clinical implications of this work? These results have several important implications for practice-they highlight the need for more inclusive practices where possible, a need for more diversity within the profession and further opportunities to be provided with evidence-based advice around good practice. The results also suggest a benefit of providing accessible, evidence-based resources for parents about autism and bilingualism, to ensure that research key findings are reaching families.

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.

A survey of speech and language therapists' opinions of bilingualism and the advice they give to bilingual families of children with speech, language and communication needs - a comparative study between the UK and Singapore

There is emerging evidence that bilingualism is advantageous to children with speech, language and communication needs (SLCN), reflected in recommendations to promote maintenance of the home language. However, little is known about Speech and Language Therapists (SLTs)' opinions on bilingualism and practices with bilingual families. To survey the opinions and practices of SLTs on this topic, a questionnaire was developed and delivered as an anonymous web-based survey. We recruited SLTs from Singapore, where bilingualism is the norm amongst the general population and enshrined in government policies, and the UK, where bilingualism is less prevalent and not embedded in government policy. Questions probed SLTs' opinions, advice given to parents/carers, personal and professional experience of bilingualism, and knowledge of and opinions on official guidelines from the Royal College of Speech and Language Therapy (RCSLT). The survey revealed variability in opinions and practices of SLTs working with bilingual families. Amongst the UK-based respondents, the RCSLT bilingualism guidance was generally perceived positively, however, many were unfamiliar with its content, or found barriers to its implementation. Most SLTs reported recommending bilingualism to families of children with SLCN and suggesting that parents/carers speak in all languages they are proficient in, but a minority reported views and practice based on outdated assumptions: practitioners who believed bilingualism can cause or contribute to SLCN were less likely to recommend that parents/carers speak languages they are proficient in. These findings can help identify areas to target within training and continuing professional development to increase evidence-based advice given to bilingual families.

Raising bilingual autistic children in the UK: at the intersection between neurological and language diversity

Introduction

While research shows no negative effects of bilingualism on autistic children's development, due to misconceptions around both autism and bilingualism, bilingual parents and educational/clinical practitioners who advise them often express unfounded concerns that exposing autistic children to more than one language will cause confusion and developmental delays. To understand the reasons that drive these misconceptions, this study focuses on: identifying factors that impact family decisions about (not) raising autistic children bilingually; attitudes toward bilingualism expressed by the community, doctors, family members, and teachers; sources of information about bilingualism and autism available to families.

Methods

Through a mixed-method online survey, we explored these questions in 31 UK-based bilingual families with 34 autistic children (age M = 10.6 years; SD = 7.1).

Results

The families reported choosing bilingualism for their autistic child primarily so that the child can communicate with family and community members. Attitudes toward bilingualism in their networks were predominantly positive, with a large portion of individuals not having opinions possibly due to lack of information. Only about 1/3 of parents had access to information on bilingualism and autism, mostly found on the internet.

Discussion

We discuss these findings and offer future directions for research, practice, and battling stigmas around bilingualism and autism.

Assessing the speech production of multilingual children: A survey of speech-language therapists in French-speaking Belgium

BACKGROUND

Assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs) around the world. Scientific recommendations to improve clinical practice are available, but their implementation has mostly been described in studies from English-speaking countries.

AIMS

This survey aimed to describe the perspectives and practices of SLTs in assessing the speech production of multilingual children in French-speaking Belgium.

METHODS & PROCEDURES

An online survey was completed by 134 SLTs in French-speaking Belgium.

OUTCOMES & RESULTS

SLTs predominantly used norm-referenced assessment approaches, which are not recommended for use with multilingual children, and lacked necessary training and resources to implement recommended practices in the assessment of speech production of multilingual children. The shift towards more appropriate practices with multilingual children seems to be in its infancy among SLTs in French-speaking Belgium. Some challenges identified by the SLTs were common to those in other countries and languages, such as the difficulty to distinguish between speech differences and speech disorders. Other challenges were specific to the French language and/or the Belgian context, such as the lack of appropriate tools in French.

CONCLUSIONS & IMPLICATIONS

Action is required to improve clinical practice in assessing the speech production of multilingual children in French-speaking contexts: better training for SLTs regarding linguistic diversity, more implementation research in the field of SLT, and advocacy for linguistic diversity with decision makers.

WHAT THIS PAPER ADDS

What is already known on this subject Existing research indicates that assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs). Scientific recommendations for best practices have been published, and the shift to more appropriate assessment practices may be progressing differently across countries. SLTs' practices have been described in surveys, mostly conducted in English-speaking countries. Although French is the fifth most spoken language in the world, data about SLTs' perspectives and practices in French-speaking regions are scarce. What this study adds The implementation of recommended practices in assessing multilingual children's speech production was limited among SLTs in French-speaking Belgium. The norm-referenced approach to assessment was predominant and few SLTs used recommended practices (e.g., criterion-referenced measures, dynamic assessment, assessment of the child's speech production in the home language). Some challenges were identified that related specifically to practices in French-speaking contexts (e.g., lack of French tools) and Belgian context (e.g., health policies unfavourable to multilingualism). These findings confirm that specific understanding of a situation is needed to develop context- and/or language-specific solutions-and ultimately improve clinical practice. What are the clinical implications of this work? SLTs in French-speaking Belgium require specific training and support to provide appropriate assessment of speech production in multilingual children. Efforts to improve practices in French-speaking contexts should focus on increasing understanding and consideration of cultural and linguistic diversity at all levels of the child's environment. Evidence-based knowledge, assessment tools and multilingual resources are available to SLTs on websites in French and in English.

The effects of bilingualism on cognition and behaviour in individuals with attention deficits: A scoping review

Background

Weaknesses in executive function have persistently been found to be associated with Attention Deficit Hyperactivity Disorder (ADHD), while bilinguals have been argued to show advantages in executive functions. While there has been some research into how bilingualism affects cognitive skills and behaviour in individuals with attention deficits, the question is still very much open. The aim of this systematic review is to gather, synthesise and evaluate existing evidence on how bilingual language experience and attention deficits affect executive function performance and ADHD-related symptoms in children and adults.

Methods

Following PRISMA guidelines, a comprehensive literature search in relevant databases (PsycInfo, PubMed, Scopus, ERIC, Web of Science, EMBASE, MEDLINE, LLBA) was performed using search strings related to attention difficulties/ADHD and bilingualism. All quantitative studies were included that presented original empirical data on the combined effects of bilingualism and attention levels, regardless of age group and methodology. The screening procedure revealed nine relevant studies.

Results

Across the nine identified studies, a total of 2071 participants were tested. Of these, seven studies involved children and two adults. The studies varied considerably with respect to their design and methodology, the targeted executive function skills or behavioural symptoms, as well as their measure of bilingualism and attention levels. Most studies assessed aspects of executive function performance such as interference control, response inhibition, working memory or cognitive flexibility. Three studies looked at the effects of bilingualism on ADHD-related symptoms or ADHD diagnosis. Across the studies, no systematic advantage or disadvantage of bilingualism on cognitive performance or behaviour in people with attention deficits was observed.

Conclusion

The limited number of identified studies provide no consistent evidence that bilingualism alleviates or intensifies attention difficulties in adults or children with ADHD. Based on the current state of research, individuals with ADHD and their families should not be concerned that learning additional languages has a negative impact on functioning or cognitive performance.

Systematic review registration

https://doi.org/10.17605/OSF.IO/PK768.

Providing a parent-administered outcome measure in a bilingual family of a father and a mother of two adolescents with ASD: brief report

There is a need for psychometrically sound outcome measures for treatment studies that have a low burden for families and that are available in multiple languages. We have developed a language assessment in English and Spanish that parents can administer to their children at home via telehealth-delivered procedures. The current case study presents descriptive data on a single family of two parent-child dyads. Both the mother and father from a single family were trained in their primary language (Spanish) on how to administer the Expressive Language Sampling - Narration (ELS-N) in their secondary language (English) to their two English-speaking monolingual sons with ASD through telehealth-delivered procedures. Both parents learned to administer the procedures to a predetermined level of fidelity. Extension to a larger sample of bilingual families is needed for this home-based, parent-administered test; however, the present results suggest feasibility even when the language of training and administration differ.

Assessment of minority language skills in English-Irish-speaking bilingual children: A survey of SLT perspectives and current practices

BACKGROUND

An increasing number of children in the UK and Ireland are growing up speaking more than one language. The many advantages of bilingualism are acknowledged; however, this increased linguistic diversity presents particular challenges for speech and language therapists (SLTs). The case is often more complex with speakers of minority languages such as Welsh and Irish, which are acquired almost exclusively in bilingual contexts. Lack of appropriate standardized assessments for bilinguals is a key issue for SLTs internationally; however, little is known about the practices, personal perspectives or wider challenges faced by SLTs in assessing minority language skills. We focus on SLTs working with English-Irish bilinguals across Northern Ireland (NI) and the Republic of Ireland (ROI) where status, use and exposure to Irish differ significantly.

AIMS

To investigate the perceptions and practices of SLTs in NI and the ROI in the assessment of bilingual English-Irish-speaking children.

METHODS & PROCEDURES

A 33-item online survey was distributed to SLTs working with children in community settings in NI and the ROI.

OUTCOMES & RESULTS

A total of 181 SLTs completed the survey. The majority of respondents had bilingual English-Irish-speaking children on their caseloads; however, less than one-quarter had assessed Irish language skills. Responses indicate confusion as to whether best-practice guidelines applied in this particular context where the majority of speakers have English as their first language and limited domains of exposure to Irish outside of the education system. Resources available to assess Irish language skills were found to be limited. Informal analysis of language samples emerged as the most popular assessment tool. SLTs in the ROI had a significantly higher level of competence in the Irish language than SLTs in NI. This reduced the challenge of assessment. Many SLTs reported scoring assessments standardized on monolingual populations when assessing English language skills in bilingual English-Irish-speaking children.

CONCLUSIONS & IMPLICATIONS

Our findings highlight the challenges faced by SLTs in meeting best-practice guidelines in the assessment of speakers of minority languages such as Irish. Further work is needed to ensure clinicians and other professionals have access to information and enhanced training on bilingual language acquisition in minority language contexts and implications for assessment and diagnosis. This study underlines the need for further research on the acquisition of minority languages as well as the development of alternative assessment tools to assist SLTs in meeting the needs of this population.

WHAT THIS PAPER ADDS

What is already known on the subject Existing research indicates that SLTs face challenges in assessing bilingual clients. Lack of assessment resources is a global issue, particularly with respect to minority languages. Emerging research indicates that SLTs and other professionals are dissatisfied with current resources for assessing Irish-speaking bilinguals and are struggling to meet best-practice guidelines. What this paper adds to existing knowledge The status of the Irish language differs significantly between NI and the ROI, while English is the dominant language in both areas. This study provides the first exploration of current assessment practices for bilingual English-Irish-speaking children as reported by SLTs across both regions. The challenges of assessing bilingual clients in many other countries are mirrored by SLTs in NI and the ROI. The majority of children acquiring Irish are doing so in a specific context: the immersion education setting. This raises uncertainty for SLTs about whether the definition of bilingualism actually applies. Despite clinicians and clients sharing the same majority language, the complexity of minority language assessment remains. What are the potential or actual clinical implications of this work? SLTs require specific support and resources to help them meet the assessment needs of bilingual English-Irish-speaking children. Ongoing education and training are required for clinicians and other professionals to facilitate understanding of the complexities surrounding bilingual speakers of minority languages and the application of best-practice guidelines. A greater understanding of the context in which children are acquiring Irish and the impact this may have on their acquisition of English would further support clinicians in identifying speech, language and communication needs in this population.

Perspectives and Experiences of Autistic Multilingual Adults: A Qualitative Analysis

Background

The combined experience of autism and bilingualism is poorly understood, leading to poor support for autistic people in multilingual environments or those interested in languages. While most available studies focus on the language and cognitive profiles of autistic bilinguals, or on the experiences of parents, little is known about the lived experiences of autistic multilinguals.

Methods

To address this question, this study examined the impact of autism and multilingualism on the lives of 54 autistic multilingual adults who completed an online survey assessing the profiles of autistic bi- and multilinguals. We conducted a thematic analysis of responses to the survey's open-ended questions to explore motivations for learning languages and the perceived benefits of being both autistic and multilingual.

Results

There was a wide range of language profiles in the sample, with various levels of proficiency, ages of acquisition, and learning environments. Respondents felt that being autistic can both positively and negatively influence language learning. They reported various motivating factors for the acquisition of multiple languages, including social aspects and a predisposition for language learning. Respondents reported many benefits of multilingualism, such as educational, employment, or leisure opportunities; social skills and understanding of other people; self-confidence in their own abilities; and relationships with family, friends, and the worldwide autistic community.

Conclusions

Unlike previous work with autistic multilinguals involving case studies, the larger sample involved here offers valuable insight into the profiles and experiences of this overlooked population. Importantly, autistic people can experience numerous benefits from multilingualism. These findings will have implications for language education practices as well as for multilingual families and the practitioners who support them.

Lay summary

Why was this study done?: We wanted to understand what it feels like to be both autistic and multilingual, in a world where it is often assumed that both cannot go together. The combined experience of autism and bilingualism is poorly understood. This leads to poor support for autistic people in bilingual environments or for those interested in languages. Most studies available focus on the language and mental abilities of autistic bilinguals, or on the experiences of parents. However, very few studies focus on the lived experiences of autistic multilinguals themselves.What was the purpose of this study?: The purpose of this study was to understand the experiences of autistic multilingual adults. We focused on their learning motivations and the perceived benefits of being autistic and multilingual.What did the researchers do?: Fifty-four autistic multilingual adults completed an online questionnaire designed for autistic bi- and multilinguals. The questionnaire included questions about the respondents' language history and language profiles. There were also open-ended questions about the respondents' motivations for learning languages, and their general experience of being both autistic and multilingual. We analyzed and summarized the responses to these open-ended questions to understand the experience of autistic multilingual adults.What were the results of the study?: Our sample had a diverse range of language profiles and experiences. Respondents thought that autism could be both an advantage and a disadvantage for language learning. They reported a range of motivations for language learning, including a predisposition for language learning. They considered relationships as both a motivation to learn languages and a benefit of multilingualism. Respondents thought that being multilingual had brought them many opportunities for leisure, travels, education, and employment. They considered that being multilingual had improved their self-confidence. They also thought that being multilingual had increased their awareness and understanding of autism, allowing them to connect with the wider autistic population.What do these findings add to what was already known?: Previous research with autistic multilinguals involved only one or two participants. The larger group of autistic multilinguals involved in this study offers valuable insight into the lived experiences of this overlooked population.What are potential weaknesses in the study?: The online questionnaire was not originally designed to collect in-depth data on lived experiences. This means that the questions included very few prompts: respondents were able to discuss the aspects of their experience that were the most important to them. The absence of specific topics in the results does not mean that they are not experienced, but simply that the participants did not spontaneously mention them. Future research should build upon our findings and focus on specific topics, such as learning environments or opportunities.How will these findings help autistic adults now or in the future?: These findings will help autistic adults by highlighting the diversity and richness of their language profiles, abilities, and experiences. This will prompt families, educators, and practitioners to better support and include autistic people in multilingual environments or those interested in languages.

A Systematic Review of Interventions for Multilingual Preschoolers With Speech and Language Difficulties

Purpose There is a shortage of information on evidence-based interventions for supporting young multilingual children. The purpose of this review was to identify interventions that have been evaluated with preschool-age multilingual children with a speech and/or language disorder or who are at risk of poor speech, language, literacy, and/or educational outcomes. Method This review considered speech, language, and early literacy interventions evaluated with preschool-age multilingual children with a speech and/or language disorder or who have been identified as being at risk of language difficulties (PROSPERO ID: 165892). The following electronic databases were searched: EBSCO (CINAHL Plus, ERIC, PsycINFO, Medline, Education) and Linguistics, Language, and Behavior Abstracts. Data were extracted describing article, participant, methodological, and intervention variables, and effect sizes. The Council for Exceptional Children's (CEC) standards for evidence-based practice were used to examine the quality of studies. Results Fifty-six relevant studies were identified in 52 articles and these studies described 4,551 participants who had speech sound disorder (six articles), developmental language disorder (11 articles), or were considered to be at risk (36 articles). The interventions targeted speech production (seven studies), language (45 studies), and early literacy (11 studies) skills. Most studies reported positive effects. Only 15 studies met all quality indicators specified by the CEC (2014) and these described 18 interventions targeting language and literacy skills. The only intervention with sufficient evidence to be considered an evidence-based practice was Nuestros Niños [Our Children] for children's early literacy and phonological awareness skills. Conclusions A number of high-quality studies exist that describe speech, language and/or literacy interventions for preschool-age multilingual children with a speech and/or language disorder, or who have been identified as being at risk of language difficulties. However, there remains limited evidence for specific interventions as to their ability to inform evidence-based practices. Supplemental Material https://doi.org/10.23641/asha.16632649.

"It's Like Stealing What Should be Theirs." An Exploration of the Experiences and Perspectives of Parents and Educational Practitioners on Hebrew-English Bilingualism for Jewish Autistic Children

Parents of autistic children are routinely advised to raise them monolingually, despite potential negative effects of monolingualism and no evidence of harm from bilingualism. There is, however, limited research on this topic. This study explored experiences and perspectives of educational practitioners (‘practitioners’) and parents of Hebrew–English bilingual autistic children on bilingualism and monolingualism. Using interpretative phenomenological analysis, we explored the experiences of 22 parents and 31 practitioners using both oral and written interviews. The analysis revealed that religious continuity is a crucial factor in bilingual decision-making. Unexpectedly, both practitioners and parents felt that having to adopt a monolingual approach was unjust, in line with conceptions of forced monolingualism. This article recommends awareness training on community languages and research in other communities.

Autistic People's Access to Bilingualism and Additional Language Learning: Identifying the Barriers and Facilitators for Equal Opportunities

Bilingualism is a valuable tool that enriches and facilitates cultural, social and lived experiences for autistic and non-autistic people alike. Research consistently finds no negative effects of bilingualism and highlights the potential for positive effects across cognitive and socio-cultural domains for autistic and non-autistic children. Yet parents of autistic children remain concerned that bilingualism will cause delays in both cognitive and language development and are still frequently advised by practitioners to raise their child monolingually. Evidently, findings from research are not reflected in practice or subsequent advice, and it is essential to identify ways to ensure equal access to additional language learning. We briefly summarise the existing literature on bilingualism and autism, considering perspectives from the bilingual autistic community, and experimental research. We identify the most pertinent barriers to participation for autistic bilingual children in terms of familial, clinical and educational perspectives. We propose novel solutions to promote additional language learning and suggest changes to practice that will contribute to an evidence base for families and practitioners. This commentary makes innovative recommendations at both the individual and societal level to ensure that autistic bilingual people have equal rights and opportunities to language learning and are optimally supported in accessing them.

Bilingualism in children with a dual diagnosis of Down syndrome and Autism Spectrum Disorder

Research shows that a substantial proportion of children with Down syndrome (DS) also meet the clinical criteria for Autism Spectrum Disorder (ASD). Children with this dual diagnosis display a linguistic profile that includes significant language delays and language impairments which often differ from the impairments observed in each developmental disability (DD) separately. Given the challenges observed with language acquisition for children with DS-ASD, concerns might be raised regarding the outcomes and suitability of a bilingual environment for children with this dual diagnosis specifically. The aim of this research was to explore the language profiles of four children with DS-ASD. A multiple case-study approach was employed. Four children with a confirmed DS-ASD diagnosis who had received exposure to two languages (English and Welsh) were assessed on a range of cognitive and linguistic measures. Performance was compared to three control groups; bilinguals with DS, English monolinguals with DS and mental age-matched typically developing bilinguals. Assessments comprised of expressive and receptive language, phonological awareness, working memory and non-verbal cognitive abilities. Considerable variability was found in the cognitive and linguistic profiles of the case-study participants. Children with DS-ASD displayed similar language profiles to that of the bilingual and monolingual children with DS in the areas tested, although performance was generally lower than that of the TD bilingual children. Although substantial variability was found, participants were developing bilingual abilities in a similar trajectory to children with DS in line with the degree of exposure to each language. This research highlights the need to assess bilingual children with complex dual diagnoses with an individualistic approach and carefully consider how to appropriately assess and treat bilingual children within speech and language therapy provisions.

The Impact of Bilingualism on Everyday Executive Functions of English-Arabic Autistic Children: Through a Parent-Teacher Lens

There is evidence that autistic children may have reduced executive function skills, contributing to day-to-day difficulties, but much remains unknown regarding the influence of bilingualism. We investigated its influence on sustained attention, interference control, flexible switching and working memory, in Arabic-English autistic (n = 27) and typically developing peers (n = 53) children, aged 5 to 12 years old. Parents and teachers completed rating measures assessing children’s daily EF abilities. Results showed generalized positive effects for bilingual autistic children relative to their monolingual peers across all EF domains, but using parent ratings only. The findings indicate that bilingualism does not negatively impact the executive function skills of autistic children, and that it might mitigate difficulties faced on a day-to-day basis.

Parental Perceptions and Decisions Regarding Maintaining Bilingualism in Autism

A growing body of evidence suggests that bilingual exposure does not negatively impact children on the autism spectrum. This study sought to illuminate parents’ perceptions and choices regarding maintaining bilingualism in autism. Semi-structured interviews were conducted with 16 family members in England and Wales. Data were analysed using interpretative phenomenological analysis (IPA). Although parents expressed positive attitudes towards bilingualism, these views were not always congruent with their language practices. Instead, several factors influenced decisions about language maintenance in autism, including the severity of the child’s autism, advice received, and the importance of English as the dominant societal language. This article calls for greater support for families in making language decisions that are suitable for the individual child and their family.

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.

Brain Mechanisms Supporting Flexible Cognition and Behavior in Adolescents With Autism Spectrum Disorder

Cognitive flexibility enables appropriate responses to a changing environment and is associated with positive life outcomes. Adolescence, with its increased focus on transitioning to independent living, presents particular challenges for youths with autism spectrum disorder (ASD) who often struggle to behave in a flexible way when faced with challenges. This review focuses on brain mechanisms underlying the development of flexible cognition during adolescence and how these neural systems are affected in ASD. Neuroimaging studies of task switching and set-shifting provide evidence for atypical lateral frontoparietal and midcingulo-insular network activation during cognitive flexibility task performance in individuals with ASD. Recent work also examines how intrinsic brain network dynamics support flexible cognition. These dynamic functional connectivity studies provide evidence for alterations in the number of transitions between brain states, as well as hypervariability of functional connections in adolescents with ASD. Future directions for the field include addressing issues related to measurement of cognitive flexibility using a combination of metrics with ecological and construct validity. Heterogeneity of executive function ability in ASD must also be parsed to determine which individuals will benefit most from targeted training to improve flexibility. The influence of pubertal hormones on brain network development and cognitive maturation in adolescents with ASD is another area requiring further exploration. Finally, the intriguing possibility that bilingualism might be associated with preserved cognitive flexibility in ASD should be further examined. Addressing these open questions will be critical for future translational neuroscience investigations of cognitive and behavioral flexibility in adolescents with ASD.

Developmental Risks in Vulnerable Children from a Low-Income South African Community

OBJECTIVE

To describe the developmental risks, and its influence, in young children from a low-income South African community.

METHOD

An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42 months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes.

RESULTS

Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ² (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2-12.4) most indicative of potential developmental delay. Older children (19-42 months) were also more at risk of developmental delay (p < 0.001) than younger children (0-18 months).

CONCLUSIONS FOR PRACTICE

Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development.

Professionals' Perspectives on Supporting Deaf Multilingual Learners and Their Families

Parents frequently report that advice from professionals is important in making decisions about how their child with hearing loss will communicate. Little is currently known about how professionals support parents raising children with hearing loss in spoken language multilingual environments, children who are described as d/Deaf multilingual learners (DMLs). The purpose of this phenomenological study was to gain insight into professionals' perspectives and experiences working with such families, particularly in relation to supporting parents in decision-making about multilingualism and language choice. Nineteen professionals discussed their experiences working with DMLs and their families, the role of professionals in decision-making about multilingualism and language choice, and the factors that they considered were important when supporting DMLs and their families. Inductive thematic analysis yielded three themes: child characteristics (language, development), negotiating and supporting language (information, parents' language, role of language, timing, leadership, language management), and professional issues (knowledge, resources). This paper provides an important insight into professional considerations in supporting DMLs and their families, such as the role and functioning of evidence-based practice.

Autism Spectrum and Other Neurodevelopmental Disorders in Children of Immigrants: A Brief Review of Current Evidence and Implications for Clinical Practice

Children of immigrants may have higher neurodevelopmental risks than those of non-immigrant populations. Yet, some evidence suggests that this group may receive late diagnosis, and therefore miss beneficial early interventions. Clinicians may misattribute symptoms of disorders to other social, behavioral or language problems. Likewise, there might be cultural differences in parents' likelihood of perceiving or reporting first developmental concerns to clinicians. Population-based standardized screening may play an important role in addressing ethnic inequalities in the age at diagnosis, although further research focusing on cross-cultural use is necessary. Once children are diagnosed, clinicians may rely on culturally sensitive procedures (translation services, cultural mediators) to increase the accessibility of interventions and improve adherence among immigrant families. In this brief review, we provide an overview about what is currently known about the epidemiology and risk factors of neurodevelopmental disorders, paying special attention to autism spectrum disorder (ASD), in children of immigrants and suggest the necessity of population-based screening and culturally sensitive care.

The Impact of Bilingualism on the Executive Functions of Autistic Children: A Study of English-Arabic Children

There is evidence to suggest that certain executive functions are impaired in autistic children, contributing to many daily challenges. Regular use of two languages has the potential to positively influence executive functions, though evidence is mixed. Little is known about the impact of bilingualism on the executive functions of autistic children, with only a handful of studies published worldwide to date. This study investigated the impact of bilingualism on sustained attention, interference control, flexible switching and working memory, in Arabic-English autistic children (n = 27) and their typically developing peers (n = 66), aged 5-12 years old. Groups were matched on age, nonverbal IQ and socioeconomic status, and completed a battery of computerized tests. Results showed an advantage for bilingual autistic children relative to their monolingual peers in sustained attention, and equivalent performance between bilingual and monolingual autistic children on all other executive functions. There were no generalized positive effects of bilingualism, and typically-developing children performed better than autistic children on all measures. The findings indicate that bilingualism does not negatively impact the executive function skills of autistic children, and that it might mitigate difficulties in sustained attention. LAY SUMMARY: Contrary to widespread belief, but in line with previous research, this study showed that speaking two languages did not harm thinking skills in autistic children. The thinking skills evaluated in this study included the ability to focus over a period of time, the ability to resist distractions, the ability to move back and forth between tasks, and the ability to use short-term memory. In fact, speaking two languages might help reduce difficulties that autistic children might face when focusing over a period of time.

Bilingualism in autism: Language learning profiles and social experiences

LAY ABSTRACT

Bilingualism changes the way people relate to others. This is particularly interesting in the case of autism, where social interaction presents many challenges. A better understanding of the overlap between the social variations of bilingualism and autism could unveil new ways to support the social experiences of autistic people. This research aims to understand the language learning and social experiences of autistic people who speak one, two or more languages. A total of 297 autistic adults (aged between 16 and 80 years) completed an online questionnaire that included general demographic questions, social life quality self-rating questions, language history questions, and open questions about the respondents' bilingualism experience. Respondents had a wide range of language experiences: there were 89 monolingual English speakers, 98 bilinguals, 110 respondents knew three languages or more, all with a wide range of abilities in their languages. In the full group, younger respondents were more satisfied with their social life, and respondents with many languages were more satisfied with their social life than respondents with few languages. In the multilingual group, younger respondents were more satisfied with their social life, and the more skilled in their third language the more satisfied with their social life. This is the first study describing the language history and social experiences of a large group of bilingual and multilingual autistic adults. It highlights how autistic people can encounter a new language, learn it and use it in their daily life, and how their bilingualism experiences shape their social life.

Assessment of a neuro-developmental screening tool in children in Bhutan

Background: Developmental screening tools are designed to fit the cultural context in which they are utilized, yet often find a wider international audience. This study evaluates the efficacy of one such tool, the Parental Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), developed in the United States and tested in the lower income Asian country of Bhutan. We aimed to test the PEDS:DM instrument to measure neurodevelopmental delay in children in Bhutan.

Methods: In total, 96 community-dwelling Bhutanese children (3-7 years old) without diagnosed neurocognitive conditions were recruited from ambulatory clinics in urban Bhutan in 2016 as part of a larger study on retinal imaging and cognitive and growth parameters. Scoring was based on neurocognitive domains (gross and fine motor, receptive and expressive speech, self-help, social-emotional). Rates of failure (meant to indicate delay) within domains were calculated.

Results: Modifications of some standard questions were deemed necessary by the study staff to suit the cultural context, such as replacing kickball with football in a question regarding games played with rules to maintain local relevance. In a modified PEDS:DM test with these improvised modifications, the mean percentage of age-appropriate domains failed was 58.8% and the mean percent delay was 12.3% (range 0-41.4%, available in n=83). The highest prevalence of failures was 59.4% for receptive language and 76.3% for expressive language, much higher than the lowest rate of failure seen in self-help (5.4%). 

Conclusions: The PEDS:DM requires further modifications and validation studies before it can be reliably implemented to assess developmental delay in children in Bhutan. In this pilot study, the rate of delay as reported by the PEDS:DM would be scored as markedly elevated, especially when compared to available epidemiologic studies in the region.

Relations Between Bilingualism and Autistic-Like Traits in a General Population Sample of Primary School Children

Some evidence suggests that bilingualism improves communication and cognitive skills which are often impaired in autism. However, diagnosing autism in bilinguals may suffer a cultural bias, which can affect the investigation of bilingualism and autism. Therefore, the current study investigates relations between autistic-like traits (ALTs) and bilingualism in a general population sample of 394 children (M age = 8;3). Within the high-scoring group on the ALT measure, monolinguals had significantly higher ALT scores than bilinguals. There were no differences between monolinguals and bilinguals in the low-scoring group. Across the whole sample, age and structural language skills accounted for 35% variance in ALTs, while bilingualism had no effect on ALTs. Furthermore, structural language skills explained more variance in ALTs among bilinguals than among monolinguals.

Maternal immigrant status and signs of neurodevelopmental problems in early childhood: The French representative ELFE birth cohort

A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of 2-year-old children using standardized parent-report instruments. We used data from the French representative Étude Longitudinale Française depuis l'Enfance birth cohort, initiated in 2011. The study sample included 9,900 children of nonimmigrant French, 1,403 children of second, and 1,171 children of first generation immigrant women followed-up to age 2 years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI). In fully adjusted linear regression models, maternal immigrant status was associated with M-CHAT scores, with stronger associations in children of first (β-coefficient: 0.19; 95% CI 0.08-0.29) than second generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of first generation immigrant mothers native of North Africa (vs. nonimmigrant French: 0.33; 0.16-0.49) and French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of first generation immigrant mothers, particularly from mostly non-francophone regions. Children of first generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores. Our findings suggest that maternal immigrant status is associated with early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Further research is necessary to test whether these associations persist and to determine the underlying mechanisms. Autism Res 2019, 12: 1845-1859. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We asked immigrant and nonimmigrant mothers in France about early signs of neurodevelopmental problems in their 2-year-old children. Overall, we found that children of immigrants may be at higher risk of showing these early warning signs, as compared to children of nonimmigrants. This is in line with previous studies, which were based on doctors' diagnoses at later ages. However, our results differed depending on the mothers' regions of origin. We found the highest risks in children of first generation immigrants from North and French-speaking Sub-Saharan Africa, who also seemed especially at risk of neurodevelopmental problems combined with low language development.

The school experiences of bilingual children on the autism spectrum: An interpretative phenomenological analysis

BACKGROUND

With growing numbers of bilingual children on the autism spectrum in UK classrooms, the interaction between autism and bilingualism is becoming a pressing issue for practitioners, researchers and families. In this study, we report the school experiences of bilingual, autistic children in the UK through their own voice with focus on five aspects of their school life.

METHOD

Using interpretative phenomenological analysis (IPA) as a methodological framework, semi-structured, computer-assisted interviews were conducted with 11 children aged 7 to 14 from across England and Wales. Interviews were carried out in English and took place in mainstream schools or the children's home, depending on their preference.

RESULTS

Results indicate that, while children's school experiences vary widely, there were commonalities in this population's identity formation, including being bilingual, and their classroom experiences. Most notably, children educated in more multilingual environments (i.e. in schools with larger multilingual populations) expressed more positive views about multilingualism than those in more monolingual settings. In line with previous studies, limited social circles and classroom anxiety were present in participants' school experiences.

IMPLICATIONS

The findings of this paper suggest that giving autistic children from bilingual backgrounds opportunities to explore their linguistic identities in the classroom may enhance their experiences of school. Further research should focus on parents' and practitioners' attitudes and perspectives towards the support available for this population.

Linguistic Skills in Bilingual Children With Developmental Language Disorders: A Pilot Study

The current pilot study compared the linguistic characteristics of a cohort of simultaneous bilingual children (Italian, L1; German L2) with developmental language disorders (DLDs) and those of bilingual peers with typical language development (TLD). Importantly, the two groups were balanced for a number of environmental variables (e.g., age of first exposure to the L2, acquisition contexts, degree of exposure to both languages) known to affect linguistic development in both TLD and DLDs. The analyses included the assessment of the participants' phonological short-term memory. Their lexical, grammatical and narrative abilities were analyzed in both languages by administering the Italian and German equivalent forms of the Battery for the assessment of language in children aged 4 to 12 - BVL_4-12 (Marini et al., 2015). The children with DLDs had reduced phonological short-term memory and lexical skills that, in turn, contributed to the reduced levels of local coherence and informativeness of their narratives. Such difficulties were found at similar levels in their two languages. These results suggest that reduced phonological short-term memory and lexical selection skills may reflect a core symptom in both mono- and bilingual children with developmental language disorders.

Language Abilities in Monolingual- and Bilingual- Exposed Children with Autism or Other Developmental Disorders

BACKGROUND

Parents and providers are sometimes concerned that exposure to two languages will impair language acquisition in children with autism spectrum disorder (ASD) or other developmental disorders (DD). However, research to date suggests that language milestones and abilities are unaffected by this exposure. The current study explored language abilities in toddlers with ASD or DD exposed to one versus multiple languages, prior to intervention. To our knowledge, this is the largest investigation of language learning in bilingual-exposed (BE) children with ASD.

METHODS

Participants were 388 children evaluated as part of a larger study on the early detection of ASD. Parents were asked to list all languages that primary caretakers use to communicate with their child. One hundred six BE children (57 ASD, 49 DD) were compared to 282 monolingual-exposed (ME) children (176 ASD, 106 DD). The Mullen Scales of Early Learning assessed nonverbal and verbal abilities. Multiple regression was used to evaluate the relationship of BE to language abilities, beyond the influence of nonverbal cognitive abilities, diagnosis, and socioeconomic status.

RESULTS

Results showed greater language impairment in ASD than DD, but no main effect for language exposure group nor any interaction of language group by diagnosis. Results remained consistent after controlling for socioeconomic status.

CONCLUSION

This study suggests that bilingual caregivers can communicate with their children in both languages without adverse effects on their children's language functioning.

Mehrsprachiges Aufwachsen und Sprachentwicklungsstörungen. Eine Übersichtsarbeit

Zusammenfassung. Für viele Kinder mit Migrationshintergrund ist das Erlernen der Zweitsprache im Aufnahmeland eine bedeutende Hürde für den Bildungserfolg. Durch die Vielzahl der Sprachen, die noch nicht detailliert linguistisch beschrieben sind, ist die Entwicklung von entsprechenden validen und reliablen Diagnoseinstrumenten und Screeningverfahren äußerst erschwert. Daraus entsteht ein diagnostisches Dilemma, da Kinder mit Erwerbsproblemen der Zweitsprache mit sprachentwicklungsgestörten Kindern (engl. Specific language impairment [SLI]) verwechselt werden können. Kinder mit Migrationshintergrund können linguistische Profile aufweisen, die oberflächlich an Kinder mit Sprachentwicklungsstörung erinnern. Der vorliegende Übersichtsartikel stellt ein selektives Review der relevanten Literatur dar und bietet Vorschläge für den Umgang mit den entsprechenden Herausforderungen. Es wird davon ausgegangen, dass die Prävalenz für die Sprachentwicklungsstörung bei mehrsprachig aufwachsenden Kindern nicht höher ist als bei einsprachig aufwachsenden Kindern und mehrsprachig aufwachsende Kinder ebenfalls subtile kognitive Schwächen zeigen können. Die Bedeutung von Sprachentwicklungsstörungen bei psychiatrisch erkrankten einsprachig und mehrsprachig aufwachsenden Kindern ist hinreichend belegt und muss bei der umfassenden Diagnostik mitbedacht werden. Eine essenzielle Maßnahme für jene Kinder mit Migrationshintergrund, die größere Probleme beim Erwerb der Zweitsprache haben, ist eine Sprachdiagnostik in der jeweiligen Muttersprache.