Bilingualism and second-order theory of mind development in autistic children over time: Longitudinal relations with language, executive functions, and intelligence.

Theory of Mind has long been studied as a core weakness in autism spectrum disorder due to its relationship with social reciprocity, while bilingualism has been shown to compensate for autistic individuals' mentalizing weaknesses. However, our knowledge of the Theory of Mind developmental trajectories of bilingual and monolingual autistic children, as well as of the factors related to Theory of Mind development in autism spectrum disorder is still limited. The current study has examined first- and second-order Theory of Mind skills in 21 monolingual and 21 bilingual autistic children longitudinally across three time points, specifically at ages 6, 9, and 12, and also investigated associations between Theory of Mind trajectories and trajectories of the children's language, intelligence and executive function skills. The results reveal that bilingual autistic children outperformed their monolingual peers in second-order Theory of Mind at ages 9 and 12, and that intelligence and, especially, expressive vocabulary skills played a pivotal role in advancing bilingual autistic children's second-order Theory of Mind development. On the other hand, monolingual autistic children only managed to capitalize on their language and intelligence resources at age 12. The findings highlight the importance of investigating bilingualism effects on autistic children's advanced cognitive abilities longitudinally.

Parent-led Communication Therapy for Young Bilingual Autistic Children: A Scoping Review.

A scoping review of the literature was undertaken using JBI guidelines to map the evidence of parent-led therapy (PLT) for young autistic children (≤ 6 years) raised in bilingual environments. Reviewers used Covidence to screen located sources. Sixteen papers met inclusion criteria. A strong acceleration of reports of PLT for young autistic children measured in bilingual environments was observed, with 93.8% of papers (n = 15) published since 2015. Reporting of participants' language environments (home language(s)/L1s and societal language(s)/L2s) was inconsistent. A large majority of these studies, 87.5% (n = 14) were conducted in North America or in collaboration with a North American institution. Diverse PLT programs and methodologies were identified. There is variation in demographic information collected and outcomes reported. Evidence gaps in the literature are identified and the value of undertaking systematic review on this topic is considered. This scoping review points to the necessity of further empirical research and practice that centres parents in early and specific support for autistic children raised in bilingual environments. Suggestions for improving reporting standards of language profiles are provided.

Acquisition of Mandarin long passives by children with developmental language disorder.

This study investigated the comprehension and production of long passives (i.e. bei-constructions with an overt agent) in Mandarin-speaking children with developmental language disorder (DLD). Seventeen preschool children with DLD (1 female; mean age: 61 months old) and 23 typically developing (TD) children (6 females; mean age: 62 months old) participated in a sentence-picture matching task (for comprehension) and an elicited production task. Their nonverbal working memory (NVWM) was measured with the fourth edition of the Wechsler Preschool and Primary Scale of Intelligence. Results showed that children with DLD were less accurate and more likely to choose the picture with reversed thematic roles than their TD peers on passives in the sentence-picture matching task; in the elicited production task, they produced fewer target responses than TD children in passives. For NVWM, although that of the DLD group was lower than that of TD children, most children in the DLD group were within the average range. Furthermore, their performance on passives in the comprehension and production tasks was significantly correlated with their NVWM, which adds to the body of work suggesting links between complex syntax and working memory. However, the fact that NVWM could be preserved in the face of difficulties with passives suggests that this link may be due to NVWM enhancing performance during tasks with a high visual component, while it may not be underlyingly responsible for syntactic impairments in children with DLD.

Acquisition of grammatical aspect by Mandarin-speaking preschool children with autism spectrum disorder.

BACKGROUND: Mandarin-speaking children with autism spectrum disorder (ASD) have difficulties producing aspect markers. The difficulties were explained in terms of pragmatic deficits since these children demonstrated strength in the comprehension of aspect markers using the Intermodal Preferential Looking (IPL) task. AIMS: To verify whether this dissociation between production and comprehension could be replicated using another technique to the IPL, and if all children with ASD show difficulties in the production of aspect markers. METHODS & PROCEDURES: A total of 34 children with ASD without cognitive delay, half with language impairment (ALI; mean age = 61.25 months old) and half with normal language (ALN, mean age = 61.52 months old), as well as 17 age-matched typically developing (TD) children (mean age = 61.38 months old) participated in a sentence-picture-matching task and a priming picture-description task to investigate their comprehension and production of Mandarin aspect markers zai-, -le and -zhe. OUTCOMES & RESULTS: In the comprehension task, children in the ALN group performed similarly to their TD peers, but those in the ALI group were less accurate on zai- and -le than TD children; children in all groups received higher accuracy when zai- was combined with Activity rather than Accomplishment verbs, and those in the ALI group was also more accurate when -le occurred with Achievement verbs, in contrast to Activity verbs. In the production task, children in the ALI group produced fewer targets and more irrelevant sentences with zai- than their TD peers, and they tended to produce bare verbs for -le and -zhe than TD children; children in all groups tended to combine zai- with Activity verbs, and those in the ALN group also tended to combine -le with Achievement verbs. CONCLUSIONS & IMPLICATIONS: The comprehension and production of Mandarin aspect markers by children with ASD are linked to general language abilities, and interactions between lexical and grammatical aspect. Patterns of performance are similar to those of TD peers only for the subgroup with spared global language, while pragmatic deficits are pervasive throughout the spectrum. Therefore, training on formal language, with a specific emphasis on aspectual rather than pragmatic abilities, may be more effective at enhancing the production of aspect markers. WHAT THIS PAPER ADDS: What is already known on this subject Mandarin-speaking children with ASD have difficulties producing aspect markers but demonstrate strengths in aspectual comprehension via the IPL task. Therefore, it has been proposed that their 'specific' difficulties in aspectual production should be ascribed to their pragmatic deficits. However, pragmatic deficits are highly pervasive in children with ASD while only a subgroup of children with ASD who are impaired in language development (children with ALI) show difficulties in producing tense/aspect morphology. Pursuing this reasoning, pragmatic deficits might not be the critical factor impacting the performance of children with ASD in aspectual production. What this study adds Children with ASD were divided into one group with ALI and the other with normal language (ALN). Results of a sentence-picture-matching and a priming picture-description task illustrated that both groups preserved the comprehension of Mandarin aspect markers zai-, -le and -zhe. However, children with ALI performed worse than age-matched TD children, while children with ALN demonstrated similar performance to TD children in aspectual production. These findings, coupled with the fact that pragmatic challenges affect individuals throughout the spectrum, suggest that general language abilities rather than pragmatics better explain the performance of children with ASD on aspectual production. What are the potential or actual clinical implications of this work? Since general language abilities rather than pragmatic deficits of children with ASD determine their performance on the production of aspect markers, direct training on the use of aspect markers or more global language therapy could benefit children with ASD in the production of aspect markers.

Language in autism: domains, profiles and co-occurring conditions.

This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.

Training Syntax to Enhance Theory of Mind in Children with ASD.

Preschool children with neurotypical development (ND) trained on sentential complements ("X thinks/says that") improve their Theory of Mind (ToM) performance. Can complementation training also enhance ToM in children with Autism Spectrum Disorder (ASD)? Thirty-three children with ASD (Mage = 8;11) and 20 younger ND peers (Mage = 4;3) were trained on sentential complements (4-6 weeks, 2-3 times per week, via the DIRE i-Pad App). Pre-training and post-training comparisons show that (1) training boosted both complementation and ToM performance across groups; (2) improvements remained 4-6 weeks after training ended; (3) participants with milder ASD symptoms made most gains. Training on sentential complements thus seems beneficial for addressing ToM difficulties in children with ASD, especially those with milder symptoms.

Early years autism and bilingualism: An interpretative phenomenological analysis of parent perceptions during lockdown.

Aim: This study explores how bilingual parents of autistic children made language decisions for their families, how the event of the SARS-CoV-2 pandemic and subsequent lockdown impacted the communication environment of their households, and whether these experiences affected their language habits. Method: Semi-structured interviews were conducted with five bilingual parents of autistic children who lived through lockdown in France. Data were analysed using interpretative phenomenological analysis. Demographic and background information was collected using an adapted version of the Questionnaire for Parents of Bilingual Children. Results: Participants reported conflicting advice given by a range of practitioners. Parents expressed differing beliefs about the impact of language choices on their children. Parents described active engagement with their children's home-learning as generally positive. Parents identified an increase in children's exposure to their first language during the lockdown. Parents reported an increase in children's overall communication abilities. Conclusion: Parents believed that their children's positive communication development during lockdown was related to increased exposure to their first language(s), and direct involvement in their children's learning programs.

Comprehension of Mandarin Aspect Markers by Preschool Children With and Without Developmental Language Disorder.

Children with developmental language disorder (DLD) reportedly struggle with the comprehension of aspect. However, since aspect and tense are closely entangled in the languages spoken by the children with DLD in previous studies, it is unclear whether the difficulty stems from aspect, tense, or both. Mandarin Chinese, a language without morphological manifestations of tense, is ideal to investigate whether the comprehension of aspect is specifically affected in children with DLD, yet to date work on this is scarce and presents methodological limitations. In this study, we examined whether preschool Mandarin-speaking children with DLD have difficulty in comprehending perfective aspect (represented with the aspect marker -le) compared to imperfective aspect (represented with the aspect markers zai- and -zhe), whether performance can be explained in terms of the pre- vs. post-verbal realization of the aspect markers, and the potential role played by lexical aspect in the comprehension of grammatical aspect. Fourteen preschool children with DLD (mean age: 61.11 months old) and 14 TD children (mean age: 63.4 months old) matched for age and nonverbal intelligence participated in a sentence-picture matching task. Global results showed that, similar to their TD peers, children with DLD performed better on imperfective aspect than perfective aspect. Concerning specific aspect markers, while children with DLD indeed performed similarly to TD children on imperfective -zhe, they obtained significantly lower accuracy than TD children on perfective -le and imperfective zai-. However, considering verb types combined with these aspect markers, results revealed that children with DLD scored significantly higher on the prototypical combination(s) (e.g., zai- + Activity verbs) than on the non-prototypical combination(s) (e.g., zai- + Accomplishment verbs). The performance pattern suggests that the comprehension of aspect markers by children with DLD is particularly affected by lexical aspect. As this also affects younger TD children, children with DLD are arguably at an earlier stage of aspectual development than their age and nonverbal intelligence matched TD peers. Therefore, the aspectual development of children with DLD appears to be delayed rather than deviant. Given this, language programs addressing difficulties in DLD may need to incorporate training on the use of aspect markers, especially targeting their combination with non-prototypical verbs.

Working memory training in children with developmental language disorder: Effects on complex syntax in narratives.

This study assesses the impact of a working memory training program on the syntactic complexity of the spontaneous speech of French-speaking children with Developmental Language Disorder (DLD). Thirty-nine 6- to 12-year-old children with DLD were allocated to a WM training (DLDMM, N = 20) or an active control group (DLDSQULA, N = 19). The computerized training sessions took place three times a week, yielding 12 training hours per participant. Syntactic complexity was assessed in storytelling, measuring mean length of utterances, use of embedded clauses and rate of errors in complex utterances. The performance of participants with DLD was first compared to previous spontaneous data of 40 typically-developing (TD) children of the same age. Then, intragroup (pre- vs. post-test) and intergroup (DLDMM vs. DLDSQULA) comparisons were made to assess the impact of the working memory training on the language measures. Global results confirmed syntactic impairment in children with DLD, as opposed to TD children, with large differences for the use of embedded clauses. Findings also suggested gains in the mastery of embedded clauses in children who participated in the WM training, whereas no gains were observed in the DLD control group. These findings confirm deficits in complex syntax in children with DLD, in particular in embedded clauses, and may encourage the clinical use of language sample analysis, which provides an ecological account of children's language performance. While our results should be replicated on a larger scale, they also suggest positive transfer effects of working memory training on the capacity of participants with DLD to produce embedded clauses, in line with previous studies showing a positive effect of WM training on tasks of expressive syntax. It thus seems that working memory training can yield benefits for language, which leaves open the door to new therapeutic approaches for children with DLD.

Bilingualism and creativity across development: Evidence from divergent thinking and convergent thinking.

Introduction: Numerous studies have demonstrated the benefits of creativity from bilingualism. Divergent thinking and convergent thinking are considered the two most important components of creativity. Various (although not all) studies have concluded that bilingual children outperform monolingual children in divergent thinking, however, no study on children or adolescents so far has explored the relation between bilingualism and convergent thinking, or the brain structural basis of interaction between bilingualism and creativity. This study aimed to explore the impact of bilingualism on both convergent and divergent thinking in children and adolescents based on neuropsychological assessments, and the possible structural basis of the effect of bilingualism on creativity by a whole-brain analysis of regional gray matter volume (rGMV) and cortical thickness in children and adolescents. Methods: 92 healthy children and adolescents of age 4-18 were recruited from public or private schools in the French-speaking side of Switzerland. Demographic data of the participants were collected, including gender, age, pedagogy, usage of language, and parents' socioeconomic status. Most of the participants underwent the neuropsychological assessments of divergent thinking, convergent thinking, and fluid intelligence. Structural image data of 75 participants were analyzed. Both voxel-based morphometry (VBM) and surface-based morphometry (SBM) were processed, to perform the analyses of rGMV and cortical thickness respectively. Results: The outcomes indicated that convergent thinking, but not divergent thinking benefits from bilingualism in children and adolescents. However, this bilingual advantage appears to weaken across development. Unexpectedly, no significant correlation between morphometry and bilingualism was found. Neither divergent thinking scores nor convergent thinking scores showed any significant correlation with rGMV. However, the whole brain SBM showed that the cortical thickness in the right supplementary motor area (SMA) was negatively correlated with convergent thinking scores, which suggested that the children and adolescents with higher convergent thinking abilities may have thinner, more mature, and more activated cortex in the right SMA. Discussion: Bilingualism and cortical thinness in the right SMA might facilitate convergent thinking independently, by enhancing this selective ability.

A Preliminary Examination of the Impact of Working Memory Training on Syntax and Processing Speed in Children with ASD.

In addition to deficits in pragmatics, children with autism spectrum disorders (ASD) have weaknesses in complex syntax and working memory (WM). These two deficits may be closely related. Previous work investigated the effects of WM training in developmental language disorders and showed significant improvement in both WM and syntax. The current study tests the impact of 12 h of WM training across 8 weeks in 30 children with ASD, aged 5 to 11. Results showed direct improvements on untrained WM tasks, as well as transfer effects to syntax and processing speed. Stronger WM led to better syntactic abilities. While they must be replicated, these exciting results provide impetus for further studies of WM interventions.

Syntactic Strategy Training for Theory of Mind in Deaf Children.

Children who are deaf or hard of hearing (DHH) show delays in Theory of Mind (ToM) development. Complement sentences such as "Eliane says that Santa Clause exists" influence ToM performance. Can a training program targeting sentential complements enhance ToM? Twenty-one French-speaking DHH children (Mage = 8 years 11 months) with delays in ToM and sentential complements completed a first series of tests (T0). Children were tested again to control for maturation effects (T1), after which they were included in a 6- to 8-week training program targeting complements with verbs of communication. Post-training tests (T2) assessed if the training yielded improvements on complements (direct effect) and ToM (transfer effect). While no gains were noted in the absence of training (at T1), results indicate post-training (T2) improvements in complements and ToM tasks, suggesting that the acquisition of sentential complements provides a tool to represent subjective truths and boosts ToM reasoning in DDH children.

The cognitive benefits of bilingualism in autism spectrum disorder: Is theory of mind boosted and by which underlying factors?

This study examined whether bilingualism boosts Theory of Mind as measured by a non-verbal false belief (FB) task in children with autism spectrum disorder (ASD), and how this potential boost may stem from improvements in a variety of other domains, namely executive functions (EFs), language, metalinguistic awareness skills, as well as autism severity. One hundred and three children with ASD (7- to 15-year-olds) (43 bilingual and 60 age- and IQ-matched monolingual children) were tested on a nonverbal task of attentional switching, working memory and updating task, and an online, low-verbal first-order FB task. Results showed a clear FB benefit for bilingual children with ASD as compared with their monolingual peers. There were also boosts in EF, however, there is no evidence that these EF boosts drove the FB advantage. Enhanced FB was not explained either by language, metalinguistic skills, or lower autism severity. While the results do not conclusively settle the debate on what triggers the ToM advantage in bilingual children with ASD, the empirical picture of the current study suggests that the ToM component of FB understanding in bilingual children with ASD is enhanced by the bilingual experience per se. LAY SUMMARY: The current study aimed to determine if and how bilingualism may improve the ability to understand others' beliefs in children with autism spectrum disorder (ASD). We assessed their belief reasoning alongside a series of other skills hypothesized to be beneficial for such reasoning, namely understanding, producing, and thinking about language, recalling and switching between information, and the severity of their autistic symptoms. The overall findings highlight advantages for bilingual children with ASD over their monolingual peers for grasping beliefs, thus suggesting that pursuing bilingualism may be beneficial for cognition in ASD. Other boosts were also associated with bilingualism, such as recalling and switching between information, but these boosts were not directly related to belief understanding, highlighting the beneficial role of bilingualism per se.

Training Complements for Belief Reasoning in Developmental Language Disorder.

Purpose Children with developmental language disorder (DLD) experience difficulties with an important Theory of Mind milestone, namely, false belief (FB) reasoning. Their FB success relates to mastery of a linguistic structure that is also challenging for them, namely, sentential complements (e.g., Claire says/thinks [that Santa Claus exists]). Training typically developing (TD) children on complements has been shown to boost complements and, in turn, enhance FB, but such training has never been explored with children with DLD, which is the aim of the current study. Method Fifty French-speaking children followed a novel training program: 30 with DLD (M age = 7;3) and 20 TD (M age = 4;3). They engaged in iPad applications targeting complementation with verbs of communication (e.g., say, shout, answer) during eight to 12 sessions lasting 30 min. Training commenced within 1-2 weeks of pretests and ceased 1-2 weeks before immediate posttests. After immediate posttests, the majority of children were available to be tested with follow-up tests after 4-6 weeks of no training. Results Findings revealed that both TD and DLD groups benefited from the training to significantly improve their complementation and FB scores. The gains achieved during immediate posttests were moreover maintained 6-8 weeks after training ceased, as revealed by preserved levels of performance during follow-up posttests. Conclusion This research thus suggests new avenues for therapeutic interventions for children with DLD, namely, the incorporation of a program directly training complements, which holds the promise of a double benefit, both for these structures and for Theory of Mind.

An eye-tracking study of selective trust development in children with and without autism spectrum disorder.

The purpose of this study was to explore whether children with autism display selectivity in social learning. We investigated the processing of word mappings provided by speakers who differed on previously demonstrated accuracy and on potential degree of reliability in three groups of children (children with autism spectrum disorder, children with developmental language disorder, and typically developing children) aged 4-9 years. In Task 1, one speaker consistently misnamed familiar objects and the second speaker consistently gave correct names. In Task 2, both speakers provided correct information but differed on how they could achieve this accuracy. We analyzed how the speakers' profiles influenced children's decisions to rely on them in order to learn novel words. We also examined how children attended to the speakers' testimony by tracking their eye movements and comparing children' gaze distribution across speakers' faces and objects of their choice. Results show that children rely on associative trait attribution heuristics to selectively learn from accurate speakers. In Task 1, children in all groups preferred the novel object selected by accurate speakers and directly avoided information provided by previously inaccurate speakers, as revealed by the eye-tracking data. In Task 2, where more sophisticated reasoning about speakers' reliability was required, only children in the typically developing group performed above chance. Nonverbal intelligence score emerged as a predictor of children's preference for more reliable informational sources. In addition, children with autism exhibited reduced attention to speakers' faces compared with children in the comparison groups.

The Impact of Grammar on Mentalizing: A Training Study Including Children With Autism Spectrum Disorder and Developmental Language Disorder.

Training on complements in English, German, and Mandarin has been reported to trigger improvements on both complements and Theory of Mind (ToM), with typically developing (TD) pre-schoolers on the verge of developing these skills (Hale and Tager-Flusberg, 2003; Lohmann and Tomasello, 2003; Shuliang et al., 2014). In the current study, we build on the idea that increasing mastery of complementation holds the promise of enhancing ToM, and seek (i) to replicate the positive effects observed in previous work for this effect in French-speaking TD children, and (ii) to pilot extending this to clinical children, more specifically those with Autism Spectrum Disorder (ASD) and Developmental Language Disorder (DLD), through exploring whether improvement in the latter, clinical groups follows that of the TD group. Sixty children with ToM difficulties, 16 with ASD (aged 5;6-11;8), 20 with DLD (aged 4;8-9;0) and 24 typically developing children aged (2;9-5;3 years), participated in a 4-week training program. Half received training targeting sentential complements and half received a control training targeting lexical skills. Complementation training, but not lexical training, led to a significant direct increase in complements, and also had the indirect effect of significantly boosting belief reasoning. TD and clinical groups followed the same patterns of performance. These results confirm previous findings in other languages for TD, and further suggest promising new directions for therapeutic programs addressing ToM delays in populations of different aetiologies, namely the incorporation of a motivating training on complementation.

The Effect of Working Memory Training on a Clinical Marker of French-Speaking Children With Developmental Language Disorder.

Purpose Our work investigates the production of 3rd-person accusative clitic pronouns in French-speaking typically developing (TD) children and children with developmental language disorder (DLD) following a novel working memory (WM) training program (12 hrs of effective training) that specifically targets the components of WM that have been shown to be impaired in children with DLD and to be directly related to the mastery of clitics (Delage & Frauenfelder, submitted for publication; Durrleman & Delage, 2016). Method Sixteen TD children aged 5-12 years and 26 age-matched children with DLD completed our 8-week WM training program. Furthermore, an age-matched control group of 16 TD children and 17 children with DLD followed a scholastic training regime matched for intensity and frequency. Syntax and WM were assessed prior to and following the WM/scholastic training. Results Significant posttraining WM gains were found in TD children and children with DLD who took part in the WM training, and the production rate of 3rd-person accusative clitics significantly increased in children with DLD following the WM training. No significant WM or syntax gains were observed in the control group. Conclusion These findings are noteworthy as Melby-Lervåg and Hulme's (2013) meta-analysis concluded that existing WM training programs show short-lived generalized effects to other comparable measures of WM, but that there is no evidence that such training generalizes to less directly related tasks. That our study led to gains in skills that were not trained (i.e., syntax) suggests that a WM training regime that is firmly grounded in theory and that targets the specific mechanisms shown to underpin the acquisition of syntax may indeed provide effective remediation for children with DLD.

Developmental dyslexia and specific language impairment: distinct syntactic profiles?

Recent work exploring syntax in developmental dyslexia (DD) has identified morphosyntactic deficits, striking parallelisms between children with DD and specific language impairment (SLI). The question remains open if the underlying causes for such deficits are related to difficulties in phonology, which is affected in DD, or to working memory, as has been previously reported for SLI. We focus on the production of third person accusative clitic pronouns (ACC3) and of homophonous definite determiners in French-speaking children with DD and SLI as well as typically developing (TD) controls. If syntactic complexity modulates performance of DD children, as has already been shown for SLI, we predict children with DD to perform significantly worse on ACC3 compared to definite determiners, which are homophonous but syntactically simpler. In addition, if impairment in ACC3 stems from phonology or working memory difficulties, we expect ACC3 performance in both clinical groups to relate to performance on non-word repetition or forward/backward digit spans. We studied 2 groups of 21 children and adolescents, with DD and SLI (7-15 years) and age-matched TD controls. Results reveal significant weaknesses with ACC3 in DD and SLI groups compared to TD controls, but no difficulty for homophonous definite determiners, confirming a deficit relating specifically to syntactic complexity. As for links to phonology and working memory, a single correlation emerged between ACC3 and the backward digit span in SLI, but not in DD, suggesting different underlying sources for syntactic deficits in these populations. Clinical implications of these results are discussed.