Perspectives of the ASHA Special Interest Groups

SIG 1, Vol. 2(Part 4), 2017, Copyright © 2017 American Speech-Language-Hearing Association

Language of Intervention in Bilingual Children

With Autism Spectrum Disorders
Connie Summers
Speech-Language Pathology Program, Department of Rehabilitation Sciences,
University of Texas at El Paso
El Paso, TX

Vannesa Smith
Speech-Language Pathology Program, Department of Rehabilitation Sciences,
University of Texas at El Paso
El Paso, TX

Vannesa Mueller
Speech-Language Pathology Program, Department of Rehabilitation Sciences,
University of Texas at El Paso
El Paso, TX

Victoria Alexander
Early Childhood Intervention, Paso del Norte Children’s Development Center
El Paso, TX

Amelie Muzza
Department of Speech-Language Pathology, Magical Kids Therapy
Laredo, TX
Disclosures
Financial: Connie Summers has no relevant financial interests to disclose. Vannesa Smith has
no relevant financial interests to disclose. Victoria Alexander has no relevant financial interests
to disclose. Amelie Muzza has no relevant financial interests to disclose.
Nonfinancial: Connie Summers has no relevant nonfinancial interests to disclose. Vannesa Smith
has no relevant nonfinancial interests to disclose. Victoria Alexander has no relevant nonfinancial
interests to disclose. Amelie Muzza has no relevant nonfinancial interests to disclose.

Abstract
Selecting the appropriate language of intervention for bilingual children with language
impairment is difficult, especially for bilingual children with autism spectrum disorders
(ASD) as their families are often encouraged by professionals to select one language
only for communication. The limited evidence supports the use of bilingual language
interventions when working with bilingual children with ASD. The current study sought to
expand this limited work by presenting preliminary data of the effects of a bilingual and
monolingual treatment condition on the language skills of two bilingual children with ASD
(ages 3 and 5) using an alternating treatment, single-subject design. The two treatment
conditions, a monolingual English condition and a bilingual English/Spanish condition,
were alternated across 14 treatment sessions. Both participants improved in each condition.
The treatment conditions were highly effective for one participant and minimally effective
for the other participant. Within each participant, effect sizes were similar across the two
treatment conditions. There were differences in the maintenance patterns of the two

203

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 participants. These results support the available evidence that bilingual treatments do
not have negative effects on bilingual children with ASD.

Language of Intervention in Bilingual Children

With Autism Spectrum Disorders
The number of bilingual children is increasing in the United States where 21% of people
report speaking a language other than English (U.S. Census Bureau, 2013). This means that
speech-language pathologists (SLPs) are treating more bilingual children diagnosed with
developmental disabilities such as autism spectrum disorder (ASD; Mueller, Singer, & Grace, 2004).
Currently, there is limited research guiding decision making regarding the language of intervention
for these children (Kay-Raining Bird, Genesse, & Verhoeven, 2016; Kay-Raining-Bird, Lamond,
& Holden, 2012). In spite of the limited evidence, children with significant language disorders,
including ASD, are often treated in one language (Mueller et al., 2004). These decisions may be
due to the misconception that bilingual children with language impairments have additional
delays compared to monolingual children with language impairments because delays are seen
in two languages (Kay-Raining-Bird et al., 2012; Yu, 2013). Many professionals, including SLPs,
believe that bilingual environments increase the cognitive load required of children with language
impairments and lead to greater difficulty in language acquisition. In fact, parents are often advised
to limit language exposure to one language for children with ASD, and the language recommended
is often the majority language of the community (Yu, 2013).
Yu (2013) completed phenomenological interviews with the parents of 10 Mandarin Chinese-
English bilinguals diagnosed with ASD. The majority of parents had been advised by one or more
professionals, including SLPs, to use English only when speaking to their children. Parents
reported heightened concerns that bilingualism would cause more deficits in language acquisition.
Yu (2013) concluded that professionals like SLPs are one of the most common sources of
information for parents and need to have a better understanding of bilingualism and heritage
language maintenance in order to make evidence-based recommendations to families.
Although evidence regarding bilingual children with ASD is scarce, work in the area of
language impairment is useful to this population. Studies examining bilingual and monolingual
children with language impairment have found that bilingual exposure does not lead to additional
delays (Guttiérrez-Clellen, Simon-Cereijido, & Wagner, 2008; Paradis, Crago, Genesee, & Rice,
2003), even in children with ASD (Drysdale, van der Meer, & Kagohara, 2015). Hambly and
Fombonne (2012) examined language levels and social abilities in bilingual children diagnosed
with ASD as compared to monolingual children with ASD and found no significant differences
between groups. They concluded that bilingual exposure did not lead to additional delays in
language. Similarly, English-Chinese bilingual children with ASD function successfully as bilinguals
(Petersen, Marinova-Todd, & Mirenda, 2012). Valincenti-McDermott et al. (2013) compared the
expressive and receptive language skills of 40 bilingual English-Spanish toddlers with ASD to
40 monolingual English toddlers with ASD. Language skills were similar between the two groups
even though the authors noted that the bilingual children with ASD were more likely to vocalize
and utilize gestures.
Ohashi et al. (2012) found no statistically significant differences between bilingually exposed
children with ASD to their monolingual counterparts in a variety of language measures and
concluded that bilingual environments are not a disadvantage for children with ASD. Reetzke,
Zou, Sheng, and Katsos (2015) examined pragmatic abilities and structural language in 54 children
with ASD exposed to either one or two languages in China. There were no differences between
groups and bilingual exposure did not negatively impact children with ASD from non-Western

204

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 cultures. The available evidence points to the position that being bilingual is not additionally
detrimental to children with language impairments including ASD.
An additional difficulty in clinical decision making when serving bilingual children with
ASD is that few intervention studies have looked specifically at the question of language of
intervention. Again, empirical data in the area of bilingual children with language impairment is
helpful. What little data there is supports the use of both languages during intervention (Perozzi
& Sanchez, 1992; Thordardottir, Weismer, & Smith, 1997; Thordardottir, 2010). As for bilingual
children, we found only two intervention studies for bilingual children with ASD, both utilizing
single-subject designs to examine language of intervention effects for increasing communication
skills.
First, Seung, Siddiqi, and Elder (2006) examined the treatment of a three-year-old bilingual
Korean-English child attending an English preschool across two years. The treatment was
conducted in Korean only by a Korean-English bilingual SLP during the first year of treatment.
After that year, English was introduced slowly for the next six months. During the final six months
of intervention, treatment was conducted exclusively in English. The child made gains in
expressive and receptive language in both languages and the authors concluded that the child
benefitted from treatment in his first language.
In the second study, Lang et al. (2011) used an alternating treatment design with a four-
year-old English-Spanish bilingual girl with ASD. They found the child was more accurate in
her responses to discrete trials when presented with treatment in Spanish even though the initial
assessment indicated balanced language abilities in English and Spanish. The authors recommended
treating in both languages and using the treatment data to guide decision making regarding the
language of intervention.
Although very limited, current evidence supports the use of bilingual language interventions
when working with bilingual children with ASD (Kay-Raining-Bird et al., 2016; Thordardottir,
2010). It is clear that more intervention research is needed in this area. Single-subject design
research can be beneficial for both adding to the literature base and in clinical decision making
and is appropriate for this population (Lang et al., 2011). With the purpose of expanding the
literature base for bilingual children with ASD, we present preliminary data on two single-subject,
alternating treatment design studies. These preliminary data also provide examples for clinical
researchers and clinicians of how single subject design can be used in language of intervention
decisions for bilingual children with ASD. We explored the effects of bilingual and monolingual
treatment conditions in two young bilingual children diagnosed with ASD.

Method
Participants
Two bilingual children with ASD, one male (Diego) and one female (Lilia), participated in
the study. A language evaluation was administered to each participant by two bilingual graduate
students in order to select appropriate language targets for intervention. Evaluations consisted
of a case history, language history questionnaire from the Bilingual English Spanish Assessment
(BESA; Peña, Gutiérrez-Clellen, Iglesias, Goldstein, & Bedore, 2014), hearing screening, Preschool
Language Scales, Fifth Edition Spanish (PLS-5 Spanish; Zimmerman, Steiner, & Pond, 2011),
Childhood Autism Rating Scale-Second Edition (CARS-2; Schopler, Van Bourgondien, Wellman,
& Love, 2010), and language samples. Results of the evaluations are summarized in Table 1. The
questionnaire from the BESA was used to describe the participants’ language use at home. The
PLS-5 was conducted to examine language comprehension and production in young children and
the CARS-2 to provide a severity rating of autism symptoms.

205

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 Table 1. Language Evaluation Results.

Task Diego Lilia

Age 3,8 5,7

Diagnosis ASD and ADHD ASD
a
Hearing screening passed
CARS-2 Mild to Moderate Symptoms Mild to Moderate Symptoms
PLS-5 Spanish
Auditory Comprehension SS = 96 SS = 62
a
Expressive Communication SS = 61
Intervention target Increase requests Increase MLU

Note.aunable to administer due to lack of attention or child behavior; CARS-2 = Childhood Autism
Rating Scale, 2nd edition, use a mean of 100 and a standard deviation of 15; SS = standard score;
MLU = mean length of utterance, PLS-5 = Preschool Language Scales, 5th Edition;

Evaluation Results
The evaluation revealed that both children had been diagnosed with ASD at the age of
three. Diego had also been diagnosed with attention deficit hyperactivity disorder (ADHD) at that
time. Both participants’ mothers reported that the children heard more Spanish than English but
were exposed to and used both languages, which can be seen in Table 2. Both Diego and Lilia
presented with mild to moderate symptoms of ASD. Diego scored within the average range on
the Auditory Comprehension subtest of the PLS-5 but was unable to complete the Expressive
Communication portion after several attempts. It was noted during the evaluation that Diego made
few verbal requests. Lilia, scored more than two standard deviations below the mean on both
subtests of the PLS-5. During the evaluation, Lilia’s verbal productions consisted primarily of
one- and two-word productions. As seen in Table 2 she produced utterances in both English and
Spanish. Based on the evaluation results, appropriate treatment targets were selected for each
participant. Diego’s target was to increase total number of requests. Lilia’s target was to increase
her mean length of utterance (MLU) in spontaneous productions focusing on length of utterances
and not specific grammatical markers.

Table 2. Output-Input Percentages of Use of Language Based on the BESA.

Diego Lilia
Spanish English Spanish English

Input 73% 27% 62% 38%

Output 47% 53% 60% 40%

Procedures
The design of the study was a single-subject, rapid alternating treatment design with
baseline (Hegde, 2003) conducted over three phases: baseline, treatment, and maintenance. After
treatment targets were selected, baseline data was collected. Diego had three and Lilia had four
baseline points. In the treatment phase, a bilingual condition and a monolingual condition were
alternated within each session so that both conditions occurred in every session throughout
the study. Treatment sessions were conducted twice per week for a total of 14 sessions for each

206

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 participant. Sessions were approximately 60 minutes divided into two 25–30 minute blocks with
a five-minute break in between the two conditions. The order of the treatment conditions (bilingual
and monolingual) was randomized with no more than three consecutive sessions occurring with
the same order. Sessions for each participant were scheduled during the same time with the same
clinician throughout the study.
During the monolingual condition, the clinician spoke only English regardless of the
participant’s use of language. During the bilingual condition, the clinician used both English and
Spanish. If the participant did not respond to the clinician in one language, the clinician would
make the same comment or question using the other language. The final maintenance phase
probed for generalization of treatment targets as no treatment was provided during these sessions.
Diego had two and Lilia had one maintenance session.
All sessions were video recorded for later transcription and scoring. For Diego’s treatment
target, total number of requests in spontaneous speech were counted during a five-minute sample
by a graduate student clinician. Repeated requests were only counted as spontaneous if there
was a 10 second space between requests. Repetitions of clinician productions were not counted
as requests. A second student separately scored 15% of the total sessions with an average interrater
reliability of 90%. For Lilia’s treatment goal, five-minute language samples from each condition
were transcribed by a graduate student, and MLU was calculated using the Systematic Analysis
of Language Transcripts (Miller & Iglesias, 2012). Because of her frequent code-mixing during
treatment, productions in either language were accepted. A second bilingual student independently
transcribed 21.4% of Lilia’s language samples with an interrater reliability of 88%.

Results
To examine the effectiveness of the treatment conditions, results were analyzed with
visual inspection (Figure 1) and effect sizes using percent non-overlapping data (PND; Table 3).
The graphs in Figure 1 represent the course of the treatment across time as indicated by session
numbers. PND was calculated by dividing the number of intervention data points that were
higher than the highest baseline point by the total number of intervention data points. An effect
size of 90% to 100% was considered highly effective, 70% to 89% moderately effective, 50% to
69% minimally effective, and less than 50% ineffective (Oliver & Franco, 2008).

Figure 1. Results for Language Targets for Diego (Right Graph) and Lilia (Left Graph).

207

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 Table 3. Percentage of Non-Overlapping Data.

Condition Diego: MLU Lilia: Total Number of Requests

PND Effectiveness PND Effectiveness

Monolingual 93% highly effective 64% minimally effective

Bilingual 100% highly effective 57% minimally effective

Note. MLU = mean length of utterance; PND = percent non-overlapping data.

Diego
Visual inspection of Diego’s performance revealed he had a stable baseline with 1–3 requests
produced during that phase (see Figure 1). His total number of requests ranged from 1 to 25 requests
during the treatment phase. Requests were highly variable but increased across time in both
conditions. Two maintenance sessions demonstrated more requests in the bilingual condition
than the monolingual condition. The PND for the monolingual condition was 92.9% and 100%
for the bilingual condition (see Table 3). The PND for both conditions was considered highly
effective.
Lilia
The visual inspection of Lilia’s MLU performance (see Figure 1) revealed an increase across
the study in both conditions. MLU in the baseline sessions ranged from 1.43 to 2.27 in the
monolingual condition and 1.63 to 2.37 in the bilingual condition. During the treatment phase,
the lowest MLU was 1.89 and the highest 3.72 in the monolingual condition, representing an
increasing but variable trend. For the bilingual condition, MLU ranged from 1.77 to 2.89. Initially,
there was little improvement observed in the bilingual condition until the fifth treatment session
when MLU started to show an increasing but still variable trend.
A comparison of monolingual and bilingual conditions showed an increase in both, but
no clear difference between the two treatment conditions. In the maintenance session, Lilia’s MLU
decreased in both conditions. But, her performance in the monolingual condition was still higher
in maintenance than during the baseline phase. Effect size calculations revealed that the PND
was 57% for the bilingual condition and 64% for the monolingual (see Table 3). These effect sizes
showed a minimally effective treatment for both treatment conditions.

Discussion
The purpose of the study was to determine whether a monolingual English treatment condition
or a bilingual English/Spanish treatment condition would yield greater language outcomes in bilingual
children with ASD. Before discussing these preliminary data, it is important to discuss potential
limitations in the single-subject design. As in prior studies of bilingual children with ASD (Lang
et al., 2011; Seung et al., 2006), the sample size is limited. We included two participants in this
design, and they differed in their ages. An additional limitation of this study may have been the
design itself. Alternating the treatment conditions may have caused treatment diffusion, where
one of the conditions affected the outcome of the other condition. Randomization of the order of
treatment conditions was implemented to control for this factor. Although treatment conditions
were alternated within each session, the bilingual outcomes could have carried over to the
monolingual conditions. In addition, requests in either language were accepted in the monolingual
English condition, which further allowed the possibility of treatment diffusion.
Despite the limitations of the single-subject design, these preliminary data add to the
existing literature and can inform clinician practice. Incorporating a second language during
intervention did not negatively affect participant performance, which is consistent with previous
studies (Hambly & Fombonne, 2012; Ohashi et al., 2012; Petersen et al., 2012; Valicenti-McDermott

208

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 et al., 2013). In fact, language outcomes in both conditions improved. Effect sizes differed by
participant as Diego’s was highly effective while Lilia’s treatment was minimally. Yet, within each
participant, similar gains were made across treatment conditions. That is, regardless of the
effectiveness of the treatment for each individual participant, these two bilingual children with
ASD responded to the monolingual and bilingual treatments similarly.
The participants also exhibited different performance patterns across the study. Lilia
had more variability in the monolingual condition with a more marked decrease in the bilingual
condition during maintenance. Diego’s performance decreased during maintenance as well, but
was still above baseline. In contrast to Lilia, he was able to maintain treatment outcomes more
in the bilingual condition than in the monolingual condition. Diego’s higher maintenance in the
bilingual condition may have been influenced by the context of the treatment that more closely
resembled the environment that he encountered on a day-to-day basis. Recall that he was
younger than Lilia and may have needed both languages to maintain a high performance.
Yu (2013) argued that exposing children to a bilingual environment was associated
with cognitive advantages. Considering that treatment outcomes were better maintained in the
bilingual condition for Diego, using both languages may have allowed him to make use of all his
available resources. Excluding a child’s home language may result in not being able to use
cognitive resources that could be available to them in that language context (Hambly & Fombonne,
2012; Ohashi et al., 2012; Petersen et al., 2012; Valicenti-McDermott et al., 2013; Yu, 2013).
Clinical Implications and Future Directions
The preliminary data suggest that providing a bilingual treatment does not have a negative
effect on the language abilities in children with ASD. This finding is important in light of professional
advice commonly given to parents (Yu, 2013). This study supports the work of other researchers
who emphasize the practice of bilingual treatment in bilingual children with language disorders
(Perozzi & Sanchez, 1992; Thordardottir et al., 1997), including children with ASD (Hambly &
Fombonne, 2012; Lang et al., 2011; Seung et al., 2006). Language of intervention choices are
difficult. Removing a child’s home language from treatment may reduce or eliminate communication
with family members, contributing to other problems (Yu, 2013). On the other hand, eliminating
English, often the language of school, might cause academic problems and create poor communication
with the community. Thus, it is recommended to consider supporting both languages of bilingual
children with ASD.
It is also recommended that clinical researchers and clinicians continue to use single-
subject design to explore the effects of language of intervention choices for children with ASD. All
clinicians should increase their understanding of the evidence in language of intervention choices
so they make appropriate recommendations for language use in the home (Hambly & Fombonne,
2012; Yu, 2013). Following these recommendations would ease the burdens of families from
culturally and linguistically diverse backgrounds who are struggling to provide an English only
environment for their child with ASD. Families would be encouraged to communicate in whatever
language is most proficient to them, providing a more naturalistic environment for effective
communication and allowing children to be included in social situations with high quality
language models.
Conclusion
Given the great lack of intervention research in bilingual children with ASD, these preliminary
data contribute to the evidence that children can and do benefit from both monolingual and bilingual
language conditions. Professionals should consider using bilingual treatment approaches when
working with bilingual children with ASD. Replication and expansion of the current study is needed
in order to generalize the results obtained to a larger population. Future research should include
other treatment designs as well as longer-term maintenance phases to determine whether the
outcomes of these treatment conditions are maintained across time.

209

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 References
Drysdale, H., van der Meer, L., & Kagohara, D. (2015). Children with autism spectrum disorder from bilingual
families: A systematic review. Review Journal of Autism and Developmental Disorders, 2(1), 26–38. https://
doi.org/10.1007/s40489-014-0032-7
Guitiérrez-Clellen, V., Simon-Cereijido, G., & Wagner, C. (2008). Bilingual children with language impairment:
A comparison with monolinguals and second language learners. Applied Psycholinguist, 29(1), 3–19. https://
doi.org/10.1017/S0142716408080016
Hambly, C., & Fombonne, E. (2012). The impact of bilingual environments on language development in
children with autism spectrum disorders. Journal of Autism & Developmental Disorders, 42, 1342–1352.
https://doi.org/10.1007/s10803-011-1365-z
Hegde, M. N. (2003). Treatment research. In M. N. Hegde (Ed.), Clinical research in communicative disorders:
Principles and strategies. Austin, TX: Pro-Ed.
Kay-Raining Bird, E., Genesee, F., & Verhoeven, L. (2016). Bilingualism in children with developmental
disorders: A narrative review. Journal of Communication Disorders, 63, 1–14. https://doi.org/10.1016/
j.jcomdis.2016.07.003
Kay-Raining Bird, E., Lamond, E., & Holden, J. (2012). Survey of bilingualism in autism spectrum disorders.
International Journal of Language and Communication Disorders, 47(1), 52–64. https://doi.org/10.1111/
j.1460-6984.2011.00071.x
Lang, R., Rispoli, M., Sigafoos, J., Lancioni, G., Andrews, A., & Ortega, L. (2011). Effects of language of
instruction on response accuracy and challenging behavior in a child with autism. Journal of Behavioral
Education, 20, 252–259. https://doi.org/10.1007/s10864-011-9130-0
Miller, J., & Iglesias, A. (2012). Systematic analysis of language transcripts (SALT), [Computer Software].
Middleton, WI: SALT Software, LLC.
Mueller, T. G., Singer, G. H. S., & Grace, E. J. (2004). The individuals with disabilities education act and
California’s proposition 227: Implications for English language learners with special needs. Bilingual Research
Journal, 28, 213–251. https://doi.org/10.1080/15235882.2004.10162815
Ohashi, J. K., Mirenda, P., Marinova-Todd, S., Hambly, C., Fombonne, E., Szatmari, P., . . . Thompson, A.
(2012). Comparing early language development in monolingual- and bilingual-exposed young children with
autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 890–897. https://doi.org/10.1016/
j.rasd.2011.12.002
Oliver, M. L., & Franco, J. H. (2008). (Effect) size matters: And so does the calculation. The Behavior Analyst
Today, 9(1), 5–10. https://doi.org/ 10.1037/h0100642
Paradis, J., Crago, M., Genesee, F., & Rice, M. (2003). French-English bilingual children with SLI: How
do they compare with their monolingual peers? Journal of Speech, Language, and Hearing Research, 46,
113–127. https://doi.org/10.1044/1092-4388(2003/009)
Peña, E. D., Gutiérrez-Clellen, V. F., Iglesias, A., Goldstein, B. A., & Bedore, L. M. (2014). Bilingual English-
Spanish assessment. San Rafael, CA: AR-Clinical Publications.
Perozzi, J. A., & Sanchez, M. L. C. (1992). The effect of instruction in L1 on receptive acquisition of L2 for
bilingual children with language delay. Language, Speech, and Hearing Services in Schools, 23, 348–352.
https://doi.org/10.1044/0161-1461.2304.348
Petersen, J. M., Marinova-Todd, S. H., & Mirenda, P. (2012). Brief report: An exploratory study of lexical
skills in bilingual children with autism spectrum disorder. Journal of Autism and Developmental Disorders,
42, 1499–1503. https://doi.org/10.1007/s10803-011-1366-y
Reetzke, R., Zou, X., Sheng, L., & Katsos, N. (2015). Communicative development in bilingually exposed
Chinese children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research,
58(3), 813–825. https://doi.org/10.1044/2015)JSLHR-L-13-0158
Schopler, E., Van Bougondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood Autism Rating Scale-
2nd edition. Los Angeles: Western Psychological Services.
Seung, H. K., Siddiqi, S., & Elder, J. H. (2006). Intervention outcomes of a bilingual child with autism.
Journal of Medical Speech-Language Pathology, 14(1), 53–63.

210

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx
 Thordardottir, E. (2010). Towards evidence-based practice in language intervention for bilingual children.
Journal of Communication Disorders, 43, 523–537. https://doi.org/10.1016/j.jcomdis.2010.06.001
Thordardottir, E. T., Weismer, S. E., & Smith, M. E. (1997). Vocabulary learning in bilingual and
monolingual clinical intervention. Child Language Teaching and Therapy, 13, 215–226. https://doi.org/
10.1177/026565909701300301
U.S. Census Bureau. (2013). Language use in the United States: 2011: American community survey reports.
Retrieved March 27, 2014 from https://www.census.gov/prod/2013pubs/acs-22.pdf
Valicenti-McDermott, M., Tarshis, N., Schouls, M., Galdston, M., Hottinger, K., Seijo, R., . . . Shinnar, S.
(2013). Language difference between monolingual English and bilingual English-Spanish young children
with autism spectrum disorders. Journal of Child Neurology, 28, 945–948. https://doi.org/10.1177/
0883073812453204
Yu, B. (2013). Issues in bilingualism and heritage language maintenance: Perspectives of minority-language
mothers of children with autism spectrum disorders. American Journal of Speech-Language Pathology, 22,
10–24. https://doi.org/10.1044/1058-0360(2012/10-0078)
Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2011). Preschool language scales (5th ed.). San Antonio, TX:
Pearson.

History:
Received June 02, 2017
Revised October 27, 2017
Accepted October 27, 2017
https://doi.org/10.1044/persp2.SIG1.203

211

Downloaded From: https://perspectives.pubs.asha.org/ by a Washington University - School of Medicine User on 05/21/2018

Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx