Introduction
Autism spectrum disorder (ASD) is a developmental condition that affects social communication and behavior. Children with ASD often have language delays or impairments, which can affect their academic and social outcomes. One way to support language development in children with ASD is to provide parent-mediated interventions, which involve training parents to use specific strategies to enhance their children’s language skills during everyday interactions.
However, most of the existing research on parent-mediated interventions for ASD has been conducted in Western countries, using languages such as English or Spanish. There is a lack of evidence on the effectiveness and feasibility of such interventions for children who speak other languages, especially those with different linguistic features and cultural contexts. One such language is Mandarin Chinese, which is spoken by more than a billion people worldwide, and has a large and growing population of children with ASD.
Mandarin Chinese is a tonal language, which means that the pitch of a syllable can change its meaning. For example, the syllable “ma” can mean “mother”, “hemp”, “horse”, or “scold”, depending on the tone. Mandarin Chinese also has a complex writing system, which consists of thousands of characters that represent words or morphemes (units of meaning). Learning to read and write Chinese requires a lot of memory and visual skills, which may pose additional challenges for children with ASD.
Therefore, the authors of this paper conducted a preliminary study to examine the effects of a parent coaching intervention on the language outcomes of Chinese-learning autistic preschoolers. They also explored the parents’ perceptions and experiences of the intervention, and the factors that influenced their implementation of the strategies.
Methods
The study involved 12 children with ASD, aged 3 to 5 years, and their parents. The children were diagnosed with ASD by a clinical psychologist, and had no other developmental or medical conditions. The parents were native speakers of Mandarin Chinese, and had at least a high school education. The families lived in urban areas of Taiwan, and received regular services from early intervention centers.
The intervention was based on the Hanen More Than Words program, which is a widely used parent-mediated intervention for children with ASD. The program teaches parents to use four main strategies to foster their children’s language development:
- Follow the child’s lead: This means observing and responding to the child’s interests, actions, and expressions, and joining in their play or activities.
- Use environmental arrangement: This means creating opportunities for the child to communicate by arranging the physical and social environment, such as placing toys out of reach, or using routines and rituals.
- Use responsive interaction: This means adjusting the level and type of language input to match the child’s abilities, and providing feedback and encouragement for their communication attempts.
- Use language modeling: This means using simple and clear language to label, describe, or comment on the child’s focus of attention, and expanding or recasting their utterances.
The intervention consisted of 12 weekly sessions, each lasting 2.5 hours. The sessions were conducted in small groups of three to four families, led by a certified speech-language pathologist. The sessions included three components:
- Group discussion: The parents learned about the principles and rationale of the strategies, and shared their experiences and challenges with each other.
- Video feedback: The parents watched and discussed video clips of their interactions with their children, and received feedback and suggestions from the therapist and other parents.
- Individual coaching: The parents practiced the strategies with their children in a playroom, while receiving live coaching from the therapist through an earpiece.
The parents were also asked to practice the strategies at home for at least 15 minutes per day, and to record their interactions using a video camera or a smartphone. They were given a manual and a workbook to guide their home practice and to monitor their progress.
The language outcomes of the children were measured using two standardized tests: the Preschool Language Scale – Fifth Edition (PLS-5), and the Peabody Picture Vocabulary Test – Fourth Edition (PPVT-4). The PLS-5 assesses the child’s expressive and receptive language skills, such as vocabulary, grammar, and pragmatics. The PPVT-4 assesses the child’s receptive vocabulary, or the ability to understand spoken words. The tests were administered by a trained examiner before and after the intervention, and the scores were converted to age-equivalent scores.
The parents’ perceptions and experiences of the intervention were assessed using two methods: a questionnaire and a focus group interview. The questionnaire was administered after the intervention, and asked the parents to rate their satisfaction, confidence, and perceived benefits of the intervention on a 5-point Likert scale. The focus group interview was conducted by a researcher who was not involved in the intervention, and asked the parents to share their opinions and feedback on the intervention, as well as the factors that influenced their implementation of the strategies.
Results
The results showed that the children improved significantly in their expressive and receptive language skills after the intervention, as measured by the PLS-5 and the PPVT-4. The mean age-equivalent scores of the children increased by 5.8 months for the PLS-5, and by 6.7 months for the PPVT-4. The effect sizes of the intervention were large, indicating that the improvement was not due to chance or maturation.
The parents also reported high levels of satisfaction, confidence, and perceived benefits of the intervention, as measured by the questionnaire. The mean ratings of the parents were above 4 on a 5-point scale for all the items. The parents also expressed positive feedback on the intervention, as revealed by the focus group interview. The parents appreciated the group format, the video feedback, and the individual coaching, and felt that they learned a lot from the therapist and other parents. They also noticed changes in their children’s communication and behavior, such as increased eye contact, initiation, responsiveness, and vocabulary.
However, the parents also faced some challenges and barriers in implementing the strategies, such as lack of time, energy, or motivation, difficulty in following the child’s lead, or dealing with the child’s tantrums or resistance. The parents suggested that the intervention could be improved by providing more examples, demonstrations, or practice opportunities, as well as more support or follow-up from the therapist.
Discussion
The authors concluded that the parent coaching intervention was effective and feasible for improving the language outcomes of Chinese-learning autistic preschoolers. They also highlighted the importance of considering the linguistic and cultural factors that may influence the intervention, such as the tonal and written features of Mandarin Chinese, and the parental beliefs and expectations about ASD and language development. They suggested that future research should include more rigorous designs, such as randomized controlled trials, larger and more diverse samples, longer-term follow-up, and more objective measures of the intervention fidelity and the parental implementation of the strategies.
Faq
What is the Hanen More Than Words program?
The Hanen More Than Words program is a parent-mediated intervention for children with autism spectrum disorder (ASD) that teaches parents to use specific strategies to enhance their children’s language skills during everyday interactions. The program was developed by the Hanen Centre, a Canadian non-profit organization that provides training and resources for speech-language pathologists and parents of children with communication difficulties.
How did the authors adapt the Hanen More Than Words program for Mandarin Chinese?
The authors adapted the Hanen More Than Words program for Mandarin Chinese by modifying some of the examples, activities, and materials to suit the linguistic and cultural features of the language and the context. For example, they used Chinese songs, stories, and toys that were familiar to the children and the parents, and they incorporated the tonal and written aspects of Mandarin Chinese into the language modeling strategy.
What is the theoretical framework of the study?
The theoretical framework of the study is based on the social interactionist perspective of language development, which emphasizes the role of social and communicative interactions between the child and the caregiver in facilitating language learning. The study also draws on the principles of adult learning theory, which suggests that adults learn best when they are actively involved, motivated, and supported in their learning process.
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