As an early intervention provider, I am often asked about raising an individual with autism bilingually whereby the home language environment (the language spoken at home or the dominant heritage language) is different than the language of the broader environment (i.e., school, location). I hear multiple recommendations and would be interested in knowing the state of the research on this topic and other possible factors to consider when working with bilingual families.

Answered by

Prisca Deliperi, MA, BCBA
New Direction ABA 

Lina Slim, PhD, BCBA-D, CCC-SLP
ASAP – A Step Ahead Program, LLC

David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

What Does the Research Tell Us?
As practitioners, we are often asked if bilingualism could be beneficial for a child diagnosed with autism spectrum disorder (ASD). This is not always an easy question to answer. The question is of critical importance for the following reasons: (1) reports of over 350 languages spoken in U.S. homes (US Census Bureau, 2015); (2) reports that “more than a third of the population speaks a language other than English at home, and close to 200 different languages are spoken” (US Census Bureau, 2015); and (3) selection of the language needs will ensure effective communication, quality of care and intervention service delivery, and overall improved health and educational outcomes (IOM, 2009).

Despite the prevalence of multi-language exposure in the general population, there have been assumptions about risks that bilingualism has on the language development of neurotypical children (e.g. Rossell & Baker, 1996). As you suggest in your question, many of these continue to be held by families and professionals alike. Further complicating this topic is that bilingual exposure and its impact on the development of language learning in children diagnosed with autism has not been extensively investigated (Hambly & Fombonne, 2012). The assumption that children diagnosed with autism raised bilingually may learn two languages more slowly than if they were only learning one, while not rooted in empirical evidence (Drysdale et al., 2015), continues to prevail. Equally, more research is needed to determine whether the development and communication of a child diagnosed with autism is negatively impacted in response to parents selecting a non-home language environment (non-HLE) with which they have limited English proficiency (LEP) (Zhou et al., 2017). Given this history, many parents and professionals are not comfortable using more than one language with children with language impairments and other developmental disabilities (Yu, 2013). This sentiment may be compounded by Yu’s (2013) caution that one cannot assume that research on bilingualism in children with language impairments will apply to children diagnosed with autism. However, a growing body of research disputes and discredits these assumptions (e.g. Adesope et al., 2010; Bialystok et al., 2010; Drysdale et al., 2015; Greene, 1998; Paradis et al., 2011; & Yu, 2013). In the face of these conflicting views and the paucity of research addressing bilingualism in children diagnosed with autism, parents and practitioners find it challenging and difficult to make informed language decisions and recommendations for their children, respectively. To illustrate, the tendency of practitioners cautioning families from choosing bilingualism is noted by Kay-Raining Bird and colleagues (2012) who reported that almost half of the 49 bilingual families raising a child with autism who were surveyed had been advised to not raise their child in a bilingual environment.

To address the misperceptions and misunderstandings related to bilingualism in individuals diagnosed with autism, Drysdale et al. (2015) conducted a systematic review to help practitioners make informed language recommendations for families based on the available evidence. The authors indicated that language learning abilities are not negatively affected in bilingual children with autism when compared to monolingual children. As a matter of fact, over the last decade, a growing body of research, much of which is highlighted throughout this article, supports the benefits of raising a child diagnosed with autism in a bilingual environment. Some studies showed that there were no significant group differences in language levels between children raised in bilingual vs. monolingual homes; moreover, bilingually exposed children with autism do not experience additional delays in language development. Furthermore, growing up in bilingual homes resulted in some social and communicative advantages, and thus professionals should encourage parents to interact with their children in their preferred language (Hambly & Fombonne, 2012; & Peterson et al., 2012). Additionally, other studies have found that children with autism raised in a bilingual environment had better gestural skills (Zhou et al., 2017; Valicenti-McDermott et al., 2013) and a larger vocabulary repertoire (Peterson et al., 2012), than ones raised in a monolingual environment; furthermore, scores on receptive and expressive skill assessments as well as overall language abilities were not different between monolingual and bilingual children with autism (Dai et al., 2018; Hambly & Fombonne, 2014; Lund, et al., 2017;  Reetzke et al., 2015; & Valicenti-McDermott, et al., 2013).

Some Directions for Further Research
Although current research seems to indicate benefits for bilingualism in children diagnosed with autism, more research is needed to better understand the course and pace of language development for parents wishing to maintain a bilingual environment (Dai et al., 2018; Hambly & Fombonne, 2012). Recent research indicates that the benefits seem to outweigh the risk; however, exposing a child with autism to a second language does not necessarily lead to the functional use of this language at a proficient level (it is important to note that proficiency may not be the actual goal for many families). As highlighted by Hambly and Fombonne (2012), 62% of bilingual children with autism who participated in the study spoke words in a second language; however the vocabulary repertoire was smaller in the second non-HLE as compared to the HLE, and only a few participants were reported to speak at the phrase level in that second non-HLE. Finally, the caregiver’s proficiency and education levels, quality of the environmental variables, timing, and duration of exposure to a second language seem to impact the acquisition of this language (Dai et al., 2018; Hambly & Fombonne, 2014). This line of research may be difficult to execute as bilingual families vary widely in their proficiency, frequency, and magnitude of contact with the child; controlling these variables can be a complex undertaking, considering contextual and cultural influences. Furthermore, as for any skill, active practice and direct instruction is key and being exposed to another language passively (e.g., listening to someone speak another language but not being required/expected to respond) may not result in the acquisition of this skill.

Other Considerations
Family Perspectives

Despite these promising findings, practitioners may want to consider several other factors when making recommendations for bilingual language use in a family. The first relates to family perspectives on language use. Yu (2013) conducted an in-depth analysis of parental interviews about the challenges and impact of their language choice. Results reflected the following underlying variables that influenced parents’ language choice selection: (a) parental prioritization of the language of choice in terms of perceived value and status, (b) parental perceived impact of the language of choice on the intervention outcome for the non-HLE, (c) parental beliefs of the effects that adopting bilingualism has on learning and development, and (d) parental practical concerns and comfort level with using a second non-HLE. When addressing the language selection (e.g., monolingualism v. bilingualism), practitioners need to apply cultural sensitivity and humility, consider the family’s choices, and engage in a joint and shared decision-making process to select the best language of instruction that is informed by evidence-based information which is respectfully and clearly communicated.

Family Fluency with a Second Language

When addressing the language selection of instruction, practitioners need to consider the dynamics of the family and the fact that the family may only be fluent in their primary home language environment (HLE). For example, selecting the non-HLE may inadvertently limit the child’s opportunities to communicate with people in his/her environment – including parents/grandparents – who may not speak or may not be fluent in the recommended non-HLE, which may hinder participation in important family life events. Moreover, in many families, grandparents fill roles as primary caretakers and are highly involved in daily, language-rich activities such as meals, bath time, getting dressed, etc. If grandparents are not fluent in the non-HLE and asked to refrain from speaking altogether, then these activities would be devoid of natural language interactions which could be detrimental to the child’s social and communication development. It is important to keep in mind that cross-generational contact, family traditions, history, and broader cultural experiences can be a great source of joy and connection in the child’s life (e.g., holidays, foods, customs and rituals, faith practice) and one’s native language can be intertwined in all of that.  Although there is a paucity of materials about behavior analytic intervention available in other languages, practitioners should make every effort needed to provide relevant materials in the HLE.

Family-Practitioner Relationship

When a practitioner communicates to the family that their primary HLE should be avoided in favor of a non-HLE, he or she may inadvertently convey the perception of rejection and disrespect, which may be detrimental to the working therapeutic relationship between family and practitioner and harmful to the overall progress of the child (Fiske, 2017). This may also lead to some mistrust of the practitioner (Dennison et al, 2019). Barriers and challenges to a family-practitioner relationship may negatively impact treatment adherence, progress, and consistency, and may lead to treatment interruptions and possibly discontinuation.  To prevent and address these communication breakdowns, practitioners will be required to apply interpersonal skills in support of effective communication skills and collaboration, namely, active listening, empathy, respect, use of language understood by all, and joint shared decision-making processes.  Furthermore, the inclusion of an in-person or remote interpreter via videoconferencing may increase the success of both assessment and implementation efforts. Utilizing effective interpersonal and culturally sensitive collaboration skills and including an interpreter when warranted will support building positive partnerships and supportive relationships with the family. These relationships will provide a bridge that supports the practitioners’ attempts to develop and implement intervention processes that enhance the child’s skill acquisition in multiple languages and assess the benefits and possible risks. One of the processes that may improve teaching the same target in multiple languages is using multiple exemplar training while programming for generalization across stimuli, people, and settings. Using generalization probes collected by a family member speaking in the HLE will help inform on the acquisition of the skills and promote carryover.

Final Thoughts
In summary, although the benefits of bilingual education for children diagnosed with autism may be apparent, recommendations for language learning should be made on a case by case basis. Language selection, bilingual versus monolingual education, is unique to each family and practitioners need to support caregivers in helping them make an informed evidence-based decision that matches their individualized needs, cultural norms and dynamics (Dennison et al. 2019; & Yu, 2013). When making a selection for bilingual versus monolingual education, several variables should be taken into consideration, such as cultural norms, caregivers’ abilities and fluency in carrying out the recommended language of instruction, and the practitioners’ linguistic competencies. These considerations highlight the importance for practitioners to develop and practice cultural awareness and competence when working with families whose home languages and cultural norms differ from that of the non-HLE and culture (Dennison et al., 2019). The overarching goal is to ensure that the recommendations for the selection of the language of instruction would neither prevent the child from communicating with his/her family and community nor negatively impact his/her general communication abilities. In conclusion, practitioners should consider and include parents in the decision-making process for the selection of the language(s) of learning, bilingual versus monolingual education, to best meet the needs of the family and its cultural community. Recommendations should consider and be based on the available research, cultural and linguistic awareness and competence, individual factors, contextual and environmental conditions, and parental preferences and values.

References

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Citation for this article:

Deliperi, P., Slim, L., & Celiberti, D. (2020). Clinical corner: What are some language considerations when working with bilingual families? Science in Autism Treatment, 17(5).

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