Language abilities in monolingual- and bilingual- exposed children with autism or other developmental disorders
Introduction
The use of a language other than English in United States homes increased by 148 percent between 1980 and 2009, and growth in the diversity of children’s language-learning environments is projected to continue (Ortman & Shin, 2011). It is important to understand the impact of this language diversity on children’s language learning. The existing literature comparing language skills of typically developing (TD) children with simultaneous bilingual exposure (BE) (i.e., exposure to two languages at the same time) to their monolingual-exposed (ME) peers is inconsistent. Some studies suggest that BE children achieve language milestones at rates similar to their ME peers (Genesee, Paradis, & Crago, 2004; Kay-Raining Bird, Genesee, & Verhoeven, 2016), whereas others report language delays in BE compared with ME children (Oller, Pearson, & Cobo-Lewis, 2007; Paradis, 2016). TD children who acquire a second language sequentially (i.e., relatively soon after their first language) initially perform developmentally ‘behind’ in their second language relative to ME children, yet they catch up to their ME peers on this language after a few years of exposure (Paradis, 2016).
Several factors impact the rate and degree of language acquisition in TD children with simultaneous or sequential BE. Specifically, the age at which the child was first exposed to an additional language (Hammer et al., 2012; Paradis, 2016), the richness of the language environment (Paradis, 2016), the duration of exposure to the language (Blom & Paradis, 2015; Hammer et al., 2012), maternal education (Hammer et al., 2012), socioeconomic status (Hoff, 2006), maternal immigration status (Winsler et al., 2014), and maternal language proficiency (Hammer et al., 2012) influence children’s language abilities. However, research consistently demonstrates that even when TD children experience delays in language acquisition, these disappear by late primary school (Uljarević, Katsos, Hudry, & Gibson, 2016).
The potential effects of BE on language skills in children with autism spectrum disorder (ASD) and other developmental disorders (DD; i.e., cognitive and language disorders) are particularly important as children with these diagnoses, even those exposed to only one language, exhibit impaired language acquisition and functioning. Many parents of young children with developmental delays believe that BE would be advantageous to their children. For example, parents claim that BE would likely have positive influences on their children’s intellectual development, social and family involvement, and future employment (Beauchamp & MacLeod, 2017; Hampton, Rabagliati, Sorace, & Fletcher-Watson, 2017; Iarocci, Hutchison, & O’Toole, 2017).
Despite believing that BE is likely to result in several benefits for children with ASD and other DD, bilingual parents also worry that exposure to multiple languages will further disrupt language development in these children (Beauchamp & MacLeod, 2017; Drysdale, van der Meer, & Kagohara, 2015; Hampton et al., 2017; Ijalba, 2016; Kay-Raining Bird, Lamond & Holden, 2012; Kremer-Sadlik, 2005; Uljarević et al., 2016). Childcare providers from a wide range of disciplines share this belief and recommend that parents of children with neurodevelopmental disorders speak only one language when communicating with their children (Beauchamp & MacLeod, 2017; Ijalba, 2016; Kay-Raining Bird et al., 2012; Kremer-Sadlik, 2005; Yu, 2013).
Bilingual parents, either independently or through internalizing this message from providers, often believe that learning more than one language is too difficult for their child (Ijalba, 2016; Kay-Raining Bird et al., 2012). Therefore, parents of children with developmental delays may believe that they must decide between their child mastering one language, or learning two languages less proficiently (Kay-Raining Bird et al., 2012). In most cases, parents decide to speak to their child in the culture’s dominant language (e.g., English in the United States), even when this language is not the parents’ native or most proficient language (Hampton et al., 2017; Kremer-Sadlik, 2005; Yu, 2013). This decision is further influenced by the limited availability of early intervention services in languages other than the culture’s dominant language, and the fact that subsequent school-based instruction and other societal demands likely will also be in the culture’s dominant language (Hampton et al., 2017; Kay-Raining Bird et al., 2012; Yu, 2013).
Several consequences emerge when parents communicate with their children exclusively in the cultural majority language. Parents provide their children’s earliest and initially most important language input (Baron-Cohen & Staunton, 1994; Kremer-Sadlik, 2005). Speaking frequently, directly, and responsively to children significantly improves their language development (Hoff & Core, 2013; Hoff, 2006; Weisleder & Fernald, 2013). However, if a child’s input comes primarily from the parent’s non-dominant, less-proficient language, the child is likely to hear fewer words, inconsistent morphology, and significantly fewer complex grammatical structures (Altan & Hoff, 2018). Therefore, relying on communication in a language in which a parent is not fully fluent may have negative consequences for a child’s language acquisition (Place & Hoff, 2011; Ross & Newport, 1996). In an extreme example, one parent reported that she stopped communicating with her children for a year after a speech-language pathologist advised that she only speak to them in English, because she felt unable to communicate effectively in English (Ijalba, 2016). Instead, the mother relied on intervention services and television to promote English language development in her children. Additionally, language is a major avenue of socialization. Children with developmental disorders are often already excluded from family conversations and interactions because of their unique interests and communication deficits (Kremer-Sadlik, 2005). If children are not taught one of the household languages by parents or by intervention providers, they will inevitably be further excluded from the opportunities that engaged dialogue provides for the enhancement of their social skills (Kremer-Sadlik, 2005; Uljarević et al., 2016). Such a decrease in communication reduces the quality of parent-child interactions, which can then cascade into social communication impairments with other communicative partners (Beauchamp & MacLeod, 2017; Charman, 2003; Kremer-Sadlik, 2005).
In addition to the adverse impacts of this decision on children, parental emotions are also affected. First, parents express sadness and a sense of personal loss when they cannot speak with their children in their native language (Fernandez y Garcia, Breslau, Hansen, & Miller, 2012). Second, speaking English is difficult for some bilingual parents, and they worry that channels of communication with their children will be further disrupted if their children do not learn the family’s native language (Yu, 2013). Even if parents are capable of speaking English, many bilingual parents report feeling uncomfortable speaking English at home, and they feel that their conversations in English are not as personal and casual as those in their dominant language (Hampton et al., 2017; Yu, 2013). Indeed, bilingual parents with greater language competence in their non-native language reported feeling more comfortable interacting with their child in this language, relative to parents with lower non-native language competence (Hudry, Rumney, Pitt, Barbaro, & Vivanti, 2017). Similarly, adolescents who were not taught the family’s native language reported a worse relationship with their parents than peers who learned their parents’ native language (Tseng & Fuligni, 2000). Finally, parents of children with developmental disorders report high levels of stress (Estes et al., 2009), and advising them to avoid speaking their primary language to their children (and to find caregivers who only speak English) is likely to further compound parental stress. This may be particularly true when grandparents partake in childcare, or are perhaps excluded from doing so because they speak the family’s native language exclusively.
Despite the pervasive notion that children with ASD or DD should only be exposed to one language, there is no empirical evidence to support this recommendation. Few studies have explored language development in young bilingual children with ASD; these studies unanimously reported that ME and BE children show similar timing of language milestone acquisition (Beauchamp & MacLeod, 2017; Ohashi et al., 2012) and comparable receptive and expressive language abilities when tested in either English or in their dominant household language (Drysdale et al., 2015; Hambly & Fombonne, 2012; Lund, Kohlmeier, & Durán, 2017; Ohashi et al., 2012; Petersen, Marinova-Todd, & Mirenda, 2012; Reetzke, Zou, Sheng, & Katsos, 2015; Valicenti-McDermott et al., 2013). ME and BE children also exhibit similar conceptual language abilities (Hambly & Fombonne, 2012; Petersen et al., 2012). As well, parent reports suggest that older ME and BE children and adolescents with ASD do not differ in functional communication (Iarocci et al., 2017). Interestingly, children who have a diagnosis of ASD, with simultaneous or sequential BE, demonstrate language skills that are comparable to their ME peers (Ohashi et al., 2012; Petersen et al., 2012; Reetzke et al., 2015; Uljarević et al., 2016; Valicenti-McDermott et al., 2013).
The literature examining the impact of BE on language learning in young children with global developmental delays (i.e., delays in several areas of intellectual functioning, including both verbal and nonverbal skills) is more limited, and most of this research has focused on children with Down syndrome. As with findings for children with ASD, these studies do not show adverse effects of simultaneous exposure to a second language (Beauchamp & MacLeod, 2017). Indeed, ME and BE children with Down syndrome show comparable language abilities in their dominant language (Burgoyne, Duff, Nielsen, Ulicheva, & Snowling, 2016; Feltmate, & Kay-Raining Bird, 2008; Kay-Raining Bird et al., 2016; Uljarević et al., 2016).
Similarly, among children with language disorders and delays (i.e., delays in language functioning only), simultaneous BE children perform similarly to their ME peers on tasks assessing their abilities in both of their languages (Gultierrez-Clellen, Simon-Cereijido, & Wagner, 2008; Korkman et al., 2012; Paradis, 2016; Paradis, Crago, Genesee, & Rice, 2003; Paradis, Crago, & Genesee, 2006; Uljarević et al., 2016). However, with respect to second-language proficiency, sequential BE children with language delays exhibit deficits in their second language when compared to their language delayed ME peers (Kay-Raining Bird et al., 2016; Paradis, Emmerzael, & Duncan, 2010). Yet, like TD children, after a few years of exposure to the additional language, language delayed children with sequential BE demonstrate language performance similar to ME children (Paradis, 2016; Paradis, Gavruseva, & Haznedar, 2008).
Although the existing research has contributed important findings about language abilities in ME and BE children with ASD, global developmental delay, and language delays, it has several limitations that may compromise generalizability. First, studies may have been underpowered to detect potential differences in language development due to small sample sizes of one to 40 participants in each BE group (Burgoyne et al., 2016; Drysdale et al., 2015; Feltmate & Bird, 2008; Gutiérrez-Clellen et al., 2008; Hambly & Fombonne, 2012; Korkman et al., 2012; Lund et al., 2017; Ohashi et al., 2012; Paradis et al., 2003; Petersen et al., 2012; Reetzke et al., 2015; Valicenti-McDermott et al., 2013). Second, some studies did not report or control for potential confounds, such as socioeconomic status (Burgoyne et al., 2016; Feltmate & Bird, 2008; Hambly & Fombonne, 2012; Petersen et al., 2012; Valicenti-McDermott et al., 2013) and nonverbal intelligence (Gutiérrez-Clellen et al., 2008; Hambly & Fombonne, 2012; Reetzke et al., 2015; Valicenti-McDermott et al., 2013), which are associated with children’s vocabulary skills (Beauchamp & MacLeod, 2017; Cobo-Lewis, Pearson, Eilers, & Umbel, 2002; Hoff, 2003; Lund et al., 2017; Rosselli, Ardila, Lalwani, & Velez-Uribe, 2016). Third, the majority of these studies assessed older children (i.e., preschool and school age rather than children under three years), who are expected to have more developed language (Burgoyne et al., 2016; Feltmate & Bird, 2008; Hambly & Fombonne, 2012; Gutiérrez-Clellen et al., 2008; Iarocci et al., 2017; Korkman et al., 2012; Ohashi et al., 2012; Paradis et al., 2003; Petersen et al., 2012; Reetzke et al., 2015). Finally, although some researchers attempted to include very young children (e.g., Valicenti-McDermott et al., 2013), or to enroll children before intervention took place, others included children who already received a diagnosis or intervention in the dominant language prior to assessment (Ohashi et al., 2012; Petersen et al., 2012; Reetzke et al., 2015). Children often receive speech/language services after receiving a diagnosis, which increases their language functioning (Kremer-Sadlik, 2005). Indeed, in these samples BE children received more speech/language intervention than ME children (Ohashi et al., 2012; Petersen et al., 2012), making it difficult to compare outcomes directly, even though the authors controlled for the amount of intervention exposure in statistical analyses.
The present study aims to enhance the limited literature on this topic by exploring language functioning in ME and BE toddlers with ASD or DD before they have experienced any intervention. We will also examine the impact of socioeconomic status and nonverbal intelligence on language development in this sample. To our knowledge, this is the largest investigation of language abilities in BE children with ASD to date. In line with the literature on language abilities in BE children with ASD and DD, we tested two hypotheses: (1) BE children with ASD or other DD will have similar Receptive Language abilities, when tested in English, to their ME peers, and (2) BE children with ASD or other DD will have similar Expressive Language abilities, in English, to ME children with ASD or other DD.
Section snippets
Participants
Participants were recruited from a larger study on the early detection of pervasive developmental disorders. Children with a parent who was able to read in English were screened using the Modified Checklist for Autism in Toddlers with Follow-Up (M−CHAT/F; Robins, Fein, & Barton, 1999) or the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M−CHAT-R/F; Robins, Fein, & Barton, 2009) during their pediatric wellness visits at either 18 or 24 months of age. Children who failed the
Results
Results of chi-square tests of independence confirmed that the language groups did not differ on gender, χ2(1, N = 388) = 0.32, p = 0.570, φ = -0.04, or diagnosis, χ2(1, N = 388) = 2.05, p = 0.152, φ = -0.08. Similarly, groups did not differ on age, t(386) = -1.38, p = 0.168, d = 0.16. Race and ethnicity differed by language group, such that Caucasian, non-Hispanic children comprised a greater portion of the ME group, while minority children were more prevalent in the BE group, with a large
Discussion
This study compared Receptive and Expressive Language functioning in ME and BE toddlers with developmental disorders who had yet to experience clinical intervention. A main effect of diagnosis was observed, such that children with ASD performed worse on all domains of cognitive functioning (MSEL Visual Reception, Fine Motor, Receptive Language, and Expressive Language) than children with DD. Within DD, children with global delays performed worse in both Expressive and Receptive language than
Conflicts of interest
Deborah Fein is part owner of M−CHAT-R, LLC, which receives royalties from companies that incorporate the M−CHAT-R into commercial products and charge for its use. Data reported in the current paper is from the freely available paper version of the M−CHAT-R. Yael Dai, Jeffrey Burke, Letitia Naigles, and Inge-Marie Eigsti declare that they have no potential or competing conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants in the study.
Acknowledgements
This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICD; R01HD039961) and the Maternal and Child Health Bureau (MCHB; R40MC00270). Neither the NICD nor the MCHB had any involvement in the study design, data collection, analysis, interpretation of data, writing of the manuscript, or in the decision to submit the article for publication. The authors also wish to thank the families and clinicians who participated in the current study, as
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