Parents and therapists were trained to respond to children’s communication attempts in a non-threatening, child-centred and responsive manner. The success of the intervention suggests that using this interaction style with Bangladeshi children with autism and language delay leads to improvements in their speech. Thus, interventions for speech development should include steps that enhance responsive interactions between children with autism and those working with them.Child development centres in any setting can potentially use this intervention approach if families and autism professionals are made aware of the basic principles of this applied intervention.

Communication deficits are one of the three broad diagnostic criteria that define autism spectrum disorders1 and spoken language is one of the most important factors predicting better outcomes for children with autism in later childhood and adulthood2. Mothers of non-verbal children with autism are more stressed than mothers of verbal children3 and children’s speech delay also exerts an influence on parent-child interaction and parental behaviour4. Because of their poor communicative skills children with disabilities are exposed to a higher degree of directive parent interaction than are typically developing children5. However, parental interaction and responsiveness was shown as a major contributor to speech development in young children with Down syndrome 6 .Relatively little is known about autism in developing countries7 and there are no published intervention studies for children with autism in Bangladesh. Thus evidence supporting speech interventions applicable to Bangladeshi children with autism is lacking.

Objective: To assess a language intervention which emphasised stimulating children’s speech by focussing on the interaction styles of the parents and therapists of children with autism.

OPE AUTISM CENTER46 B Lake Circus, Kalabagan, Dhaka 1205,

Bangladesh

Background & Objective

Results

Conclusions

Intervention Focussing on the Interaction Styles of Parents and Therapists of Children with Autism and Limited Speech: Case Studies From Bangladesh. Nusrat Ahmed 1 and Amanda Richdale 2

1 Hope Autism Center, Dhaka, Bangladesh; 2 Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Australia

Participants: Eight children with a clinical diagnosis of speech disorder and suspected autism (cases A, D, E, F, H) or autism (cases B, C, G) who were referred to the autism centre by psychiatrists. Seven children received daily intervention from the centre and one (case H) continued at his regular nursery school with a support teacher. See Table 1 for age and sex of children.

InterventionPrior to the intervention a detailed child and family history, including children’s language development, was taken using a semi-structured interview. Each child was also observed during a 1-hr play session with their parent, on the floor with a bag of toys. Intervention was based on the parents’ and therapists’ interaction styles with each child. All families and therapists were trained to follow common principles that centred on the child’s communication. The intervention emphasised stimulating children’s speech, both at home and at school, in a child-directed way focussing on responsive interaction and encouraging children’s speech without emphasising that speech was the focus of the interaction.

Methods

Data were collected after the 1st, 2nd, 3rd and 4th month of the intervention via play observation and semi-structured interview, as previously .

Initial Assessment (Table 1)All the children had developed some speech at some stage but either the amount, voice, or clarity of speech was inadequate considering the children’s ageAt some point the children had stopped talking or rarely said any words and they did not use their words communicatively.

After Intervention (Table 2)All children started using at least one word within 2 to 3 months of intervention and within 4 months they were expressing their needs verbally instead of throwing temper tantrums. One child was using full sentences in proper context after 4 monthsChildren who were speaking very softly started speaking louder than before and the clarity of their speech improved. With their speech development, children also seemed to be much happier than before.

References

Child Age (mths)

Sex Speech Level Commun-icative Speech

Speech and Voice Mood Means of Communication

A 34 F Few words No Not clear - very low voice

Irritated Screamed, cried

B 58 F Requested for songs No Not clear – articulation problem

Anxious look, irritated, did not smile

Cried, pulled others’ hair and her own to express needs

C 46 M No words N/A N/A Irritated, rigid about what he needed

Screamed, cried

D 55 M Lines of rhymes, echolalia

No Soft speech Anxious, froze when direct eye contact given or when there was any discussion about him, even when his name was called

Pointed, screamed when did not get item or when unable to express needs

E 33 F 2 - 3 words, rarely used

No Soft speech Irritated Screamed or tried to take adult’s hand

F 30 M Knew some words, rarely used

No Soft speech Irritated Cried and took adult’s hand

G 84 M Sang songs No Songs were clear Anxious look Tried to get by himself, if couldn’t, hit others or threw things

H 39 M Single words, did not answer questions

Rarely Not clear - soft speech Irritated, rigid Screamed

Table 1 Speech and Mood Status at the Initial Assessment

Child Intervention(months)

Speech Level Communication Mood Echolalia Spontaneous Language

Speech and voice

A 2 3 words together Verbal Happy, cheerful Rare Yes Normal

B 3 Mostly used 2 - 3 words Verbal Happy and confident Occasional Yes Improved, still articulation problem. Some peculiar intonation

C 4 2 words Verbal Happy Occasional Yes Peculiar Intonation

D 4 Full sentences, appropriate context.

Verbal Happy, still looked concerned when he was being observed

Rare Yes Clear speech, appropriate voice level

E 4 2 words Verbal Happy, cheerful Occasional Yes Normal

F 3 2 - 3 words Verbal Happy Occasional Yes Normal, volume increased

G 4 2 - 3 words Verbal/picture together

Much more relaxed than before

Occasional Yes Peculiar intonation, clear speech

H 2 2 words, occasional 3 words

Verbal Happy Absent Yes Normal

Table 2. Speech Development After 2 to 4 Months of Intervention