Importance of developing prelinguistic skills before speech therapy in children with autism
Autism spectrum disorder presents with difficulties involving Speech, socialization, communication, and behavior. The severity of these symptoms varies largely, with some children having minor difficulties while others have more obvious deficits. Autism is characterized by major communication difficulties, which frequently cause delays in the development of language. Early identification and treatment of these communication impairments can have a significant effect on a child’s capacity to interact with their environment.
Speech Therapy
Speech therapy is a treatment that aims to improve communication skills and support the development of language in individuals who have speech and language impairments. While speech therapy is an important intervention for individuals with autism, the efficacy of such therapies can be considerably increased when prelinguistic skills are developed before the formal start of speech therapy. These fundamental skills lay the foundations for speech therapy techniques, enhancing the chance of successful language development and communication outcomes.
Prelinguistic skills
Prelinguistic skills are the foundational abilities that develop before the development of spoken language. The foundation of verbal communication is made up of these abilities. They include a variety of behaviors and interactions, such as eye contact, joint attention, social response, gestures, imitation, turn-taking, babbling, etc. These abilities are often learned in the first few months of a child’s life, laying the foundation for later language and social communication.
Children with autism frequently experience difficulties with language and communication development when it comes to social interaction. Prelinguistic skills are crucial in determining how these kids’ language development will proceed. Therefore, it is essential to comprehend the value of prelinguistic skill development and include it in intervention strategies prior to speech therapy. During the assessment and intervention of children with ASD, one must know prelinguistic skills, the developmental hierarchy, and their impact on children’s present and future communication skills. By fostering these fundamental skills, we set the platform for more efficient and targeted speech therapy interventions, eventually helping autistic children to gain language skills and interact more effectively with their environment.
This article discusses the importance of developing these prelinguistic skills as an essential and complementary intervention for children with autism by highlighting some of the evidence and research conducted on it over the years.
Language development
There exist many theories on how the development of language takes place across childhood. Theories central to prelinguistic skills development include the social interaction theory which highlights the importance of interactions in early childhood for language development. Additionally, the principles of learning, such as association and reinforcement, observation, and imitation of people around them are also foundational in speech and language development. The gradual progression of language over time also supports the idea that children learn using imitation and reinforcement.
The prelinguistic stage is the time prior to which the child develops the ability to use language meaningfully. The child starts to use behaviors such as eye contact, gestures, and other nonverbal communication. This gradually leads to the formation of one-or-two words, further leading to the formation of phrases and sentences. This is also when they start to understand and comprehend the language to be used for successful communication. This linguistic development does not happen typically with ASD and therefore, teaching them these skills early on can predict the successful development of language and communication.
The positive impact of prelinguistic skills on communication outcomes
There exist numerous studies which have shown the effectiveness of developing prelinguistic skills in children with ASD. One such study involved interventions targeting these skills and the findings showed significant improvement in skills such as gestures, joint attention, and vocalizations in the children. The author also conducted a meta-analysis which included a systematic search to understand the relationship between vocalizations and expressive language skills. This analysis was conducted on children falling under the age of 9 years. The results of the analysis showed a strong correlation between the two, supporting the importance of developing prelinguistic skills such as vocalizations in children.
Another group of researchers conducted a study to understand the long-term outcome of a collection of prelinguistic skills measured during the second year of the children’s lives. They then measured the language outcome in the third year to understand how the latter can be predicted based on the prelinguistic skills. This study was done on typically developing children. The findings revealed a continuity between the prelinguistic and language skills later. It also demonstrated how individual differences also play a major role in the language outcome of this group.
One study followed a group of 18 children with developmental disabilities over a two-year period. The children’s ages lay between three to six years of age and their linguistic skills were assessed every 6 months. The children would primarily use gestures, some vocalizations, and one-word utterances to communicate. The researchers measured skills such as rate of prelinguistic communication, parental responsiveness, and attainment of gestures. The findings of this study were also synchronous with the fact that the prelinguistic skills measured were significant predictors of the linguistic development outcomes later.
Another study researched nonverbal communication in children with autism. They assessed the participants on certain skills such as joint attention, social response, and requesting. They found significant deficits in joint attention and the frequency of communication in these children was lower in than even typically developing children with younger mental age. This was tested on a group of 2-3-year-old children with autism. The findings implied that these younger children with autism show marked deficits in turn-taking and joint attention even during the early stages of linguistic development. We can use this for early identification and subsequently early interventions for children with autism. One such method is to focus on prelinguistic development when planning interventions.
One study studied a cohort of children with a heightened risk of developing autism as they had a sibling diagnosed with autism. They studied the social communicative behaviors of these children to understand whether the behaviors involving joint attention, vocalizations, and their coordination among the children differed across different modalities. The study found that the differences in coordination of these behaviors may have a negative effect on the development of these socio-communicative behaviors in children who were later diagnosed with ASD. This implies that the lack of coordination between these prelinguistic behaviors may delay further language development. These findings indicate the need for complementing existing interventions with strategies to improve the coordination of these communicative behaviors or prelinguistic skills.
Conclusion
The research above and the numerous studies conducted over the years have shown the importance of focusing on prelinguistic skills in interventions being used for children with autism. These observed outcomes have practical implications as therapists, teachers, special educators, and caregivers can use these strategies that focus on imitation, joint attention, social response, turn-taking, etc., and combine them with their existing approaches. These practices not only enhance language development but also improve the social relationships of children with autism.
Written by-
Manali Kene
Psychologist, Neuro Revolution International
References
Brady, N. C., Marquis, J., Fleming, K., & McLean, L. (2004). Prelinguistic predictors of language growth in children with developmental disabilities. Journal of speech, language, and hearing research: JSLHR, 47(3), 663–677. https://doi.org/10.1044/1092-4388(2004/051)
Chiang, C. H., Soong, W. T., Lin, T. L., & Rogers, S. J. (2008). Nonverbal communication skills in young children with autism. Journal of autism and developmental disorders, 38(10), 1898–1906. https://doi.org/10.1007/s10803-008-0586-2
Crais, E., & Ogletree, B. T. (2016). Prelinguistic communication development. In D. Keen, H. Meadan, N. C. Brady, & J. W. Halle (Eds.), Prelinguistic and minimally verbal communicators on the autism spectrum (pp. 9–32). Springer Science + Business Media. https://doi.org/10.1007/978-981-10-0713-2_2
Heymann, P., Northrup, J. B., West, K. L., Parladé, M. V., Leezenbaum, N. B., & Iverson, J. M. (2018). Coordination is key: Joint attention and vocalization in infant siblings of children with Autism Spectrum Disorder. International journal of language & communication disorders, 53(5), 1007–1020. https://doi.org/10.1111/1460-6984.12418
McDaniel, J., Brady, N.C. & Warren, S.F. Effectiveness of Responsivity Intervention Strategies on Prelinguistic and Language Outcomes for Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Group and Single Case Studies. J Autism Dev Disord 52, 4783–4816 (2022). https://doi.org/10.1007/s10803-021-05331-y
McDaniel, J., D’Ambrose Slaboch, K., & Yoder, P. (2018). A meta-analysis of the association between vocalizations and expressive language in children with autism spectrum disorder. Research in developmental disabilities, 72, 202–213. https://doi.org/10.1016/j.ridd.2017.11.010Watt, N., Wetherby, A., & Shumway, S. (2006). Prelinguistic predictors of language outcome at 3 years of age. Journal of speech, language, and hearing research: JSLHR, 49(6), 1224–1237. https://doi.org/10.1044/1092-4388(2006/088)
