1. Parents and therapists were trained to respond to children’s communication attempts in a non-threatening, child-centred and responsive manner. The success of the intervention suggests that using this interaction style with Bangladeshi children with autism and language delay leads to improvements in their speech. Thus, interventions for speech development should include steps that enhance responsive interactions between children with autism and those working with them. Child development centres in any setting can potentially use this intervention approach if families and autism professionals are made aware of the basic principles of this applied intervention. Communication deficits are one of the three broad diagnostic criteria that define autism spectrum disorders 1 and spoken language is one of the most important factors predicting better outcomes for children with autism in later childhood and adulthood 2. Mothers of non-verbal children with autism are more stressed than mothers of verbal children 3 and children’s speech delay also exerts an influence on parent-child interaction and parental behaviour 4. Because of their poor communicative skills children with disabilities are exposed to a higher degree of directive parent interaction than are typically developing children 5. However, parental interaction and responsiveness was shown as a major contributor to speech development in young children with Down syndrome 6. Relatively little is known about autism in developing countries 7 and there are no published intervention studies for children with autism in Bangladesh. Thus evidence supporting speech interventions applicable to Bangladeshi children with autism is lacking. Objective: To assess a language intervention which emphasised stimulating children’s speech by focussing on the interaction styles of the parents and therapists of children with autism. OPE AUTISM CENTER 46 B Lake Circus, Kalabagan, Dhaka 1205, Bangladesh Background & Objective Results Conclusions Intervention Focussing on the Interaction Styles of Parents and Therapists of Children with Autism and Limited Speech: Case Studies From Bangladesh. Nusrat Ahmed 1 and Amanda Richdale 2 1 Hope Autism Center, Dhaka, Bangladesh; 2 Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Australia Participants: Eight children with a clinical diagnosis of speech disorder and suspected autism (cases A, D, E, F, H) or autism (cases B, C, G) who were referred to the autism centre by psychiatrists. Seven children received daily intervention from the centre and one (case H) continued at his regular nursery school with a support teacher. See Table 1 for age and sex of children. Intervention Prior to the intervention a detailed child and family history, including children’s language development, was taken using a semi-structured interview. Each child was also observed during a 1-hr play session with their parent, on the floor with a bag of toys. Intervention was based on the parents’ and therapists’ interaction styles with each child. All families and therapists were trained to follow common principles that centred on the child’s communication. The intervention emphasised stimulating children’s speech, both at home and at school, in a child-directed way focussing on responsive interaction and encouraging children’s speech without emphasising that speech was the focus of the interaction. Methods Data were collected after the 1st, 2nd, 3rd and 4th month of the intervention via play observation and semi- structured interview, as previously. Initial Assessment (Table 1) 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. After Intervention (Table 2) All children started using at least one word within 2 to 3 months of intervention and within 4 months they were expressing their needs verbally instead of throwing temper tantrums. One child was using full sentences in proper context after 4 months Children who were speaking very softly started speaking louder than before and the clarity of their speech improved. With their speech development, children also seemed to be much happier than before. 1. American Psychological Association (2000). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington DC: Author. 2. Howlin, P., et al. (2004). Adult outcome for children with autism. J Child Psych & Psychiatry, 45, 212-229. 3. Konstantareas M.M., & Papageorgiou, V. (2006). Effects of temperament, symptom severity and level of functioning on maternal stress in Greek children and youth with ASD. Autism,10, 593-607. 4. Crowell, J.A., & Shirley, S. (1998). Mothers’ internal models of relationships and children’s behavioural and developmental status: A study of mother child interaction. Child Dev, 59, 1273- 1285. 5. Cress, C.J., et al. (2008). Parent directiveness in free play with young children with physical impairments. Communicat Disord Quarterly, 29, 99-108. 6. Crawley, S.B.,& Spiker, D. (1983). Mother-child interactions involving two-year-olds with Down syndrome: A look at individual differences. Child Dev, 54, 1312-23. 7. Saleh, M.A., & Elham, H.A. (2009). Autism in Saudi Arabia: Presentation, clinical correlates and comorbidity. Transcult Psychiat, 46, 340-347. References ChildAge (mths) SexSpeech LevelCommun- icative Speech Speech and VoiceMoodMeans of Communication A34FFew wordsNoNot clear - very low voice IrritatedScreamed, cried B58FRequested for songsNoNot clear – articulation problem Anxious look, irritated, did not smile Cried, pulled others’ hair and her own to express needs C46MNo wordsN/A Irritated, rigid about what he needed Screamed, cried D55MLines of rhymes, echolalia NoSoft speechAnxious, froze when direct eye contact given or when there was any discussion about him, even when his name was called Pointed, screamed when did not get item or when unable to express needs E33F2 - 3 words, rarely used NoSoft speechIrritatedScreamed or tried to take adult’s hand F30MKnew some words, rarely used NoSoft speechIrritatedCried and took adult’s hand G84MSang songsNoSongs were clearAnxious lookTried to get by himself, if couldn’t, hit others or threw things H39MSingle words, did not answer questions RarelyNot clear - soft speechIrritated, rigidScreamed Table 1 Speech and Mood Status at the Initial Assessment ChildIntervention (months) Speech LevelCommunicationMoodEcholaliaSpontaneous Language Speech and voice A23 words togetherVerbalHappy, cheerfulRareYesNormal B3Mostly used 2 - 3 wordsVerbalHappy and confidentOccasionalYesImproved, still articulation problem. Some peculiar intonation C42 wordsVerbalHappyOccasionalYesPeculiar Intonation D4Full sentences, appropriate context. VerbalHappy, still looked concerned when he was being observed RareYesClear speech, appropriate voice level E42 wordsVerbalHappy, cheerfulOccasionalYesNormal F32 - 3 wordsVerbalHappyOccasionalYesNormal, volume increased G42 - 3 wordsVerbal/picture together Much more relaxed than before OccasionalYesPeculiar intonation, clear speech H22 words, occasional 3 words VerbalHappyAbsentYesNormal Table 2. Speech Development After 2 to 4 Months of Intervention