Intervention Focussing on the Interaction Styles of Parents and Therapists of Children with Autism and Limited Speech: Case Studies From Bangladesh

Background: Language deficit is an important criterion for the diagnosis of autism. Interactions of parents / carers and their responsiveness to the child have been proven as major contributors for speech development. Evidence supporting speech interventions applicable to Bangladeshi autistic children is scarce. This study looked at the interaction styles of parents and therapists of Bangladeshi children with autism and their ways of encouraging children’s speech.  This study reports on case studies of eight children diagnosed with speech delay and autism who received an intervention for their speech development from an autism centre in Bangladesh.

Objectives: To assess an intervention which emphasized stimulating children’s speech, focussing on the interaction styles of the parents and therapists of children with autism.  

Methods: A detailed history was taken on children’s speech development, current level of speech, ways of expressing needs, mood, parents’ strategies for speech development, their ways of interaction with the children and also on the presence of any family tension or parents’ depression regarding child’s development. The 4-month intervention emphasised stimulating children’s speech in a child directed way focussing on responsive interaction and encouraging children’s speech without emphasising that speech was the focus of the interaction. Speech was reinforced using intrinsic reinforcers. Data were collected at assessment and after 1^st month, 2^nd month, 3^rd month and 4^th month of the intervention through play observation and history taking.

Results: The case histories showed that 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 age. At some point the children had stopped talking or rarely said any words and they did not use their words communicatively. All cases started using at least one word within two to three months of the intervention and within four months they were expressing their needs verbally instead of throwing temper tantrums. One child was using full sentences in proper context after four months. Cases who were speaking very softly started speaking louder than before and the clarity of their speech was also better than before. With their speech development, children also seemed to be much happier than before.

Conclusions: This qualitative study shows improvement in speech after a 4-month intervention period. The success of the intervention suggests responsive interaction style of parents and therapists involved in the care of Bangladeshi children with autism and language delay can enhance improvement in the children’s speech. Interventions for speech development should include steps that enhance responsive interactions between parents and therapists and these children. Child development centres in any setting can potentially use the intervention applied in this study if families and autism professionals are aware of the basic principles of this applied intervention.