Training siblings to provide language intervention for autism

As clinicians we try to provide “naturalistic” language therapy as much as possible. But how natural is it really for kids to sit in a sterile closet… ahem, speech and language office... and play with toys only the therapist owns, with an adult at least three times their age? It’s soooo natural… said no one ever.  

So how can we make therapy more functional and natural for children with autism? Spector & Charlop suggest that sibling-mediated interventions could be effective. After all, siblings are present in the day-to-day life of children with ASD, and they work for free (or at least for snacks). There isn’t much research on this idea, but anecdotally, it has been reported that siblings enjoy teaching, and children with ASD are responsive to their siblings. Obviously this intervention requires that the child with ASD have a typically-developing sibling who is able and willing to learn (and the therapist also needs access to the sibling).

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In this study, the researchers trained siblings of three 6–9 year-olds with autism in the Natural Language Paradigm—a relatively simple, evidence-based language intervention that can be used to increase spontaneous language production, expand utterances, or refine grammar. The siblings were between 7 and 11 years old and learned to implement the intervention in a 25-minute training session by watching a video and role-playing with a therapist. During the intervention, the child with ASD  chose a preferred toy to play with, and the trained sibling facilitated turn-taking with the toy while repeating various target phrases.

Two of the three children with autism doubled their percentage of verbal behavior after two sessions working with their brother or sister and showed increased happiness and joint attention post-intervention. The siblings were reported to have enjoyed the interactions as well. The third child had many interfering behaviors which prevented him from fully participating.

Whether you work in a private practice and could ask a sibling to join your session, or work in a public school and could pull a sibling out of class a few times, incorporating siblings into therapy seems to show promising evidence. And the potential for some adorable, heartwarming moments? It reminds us why we do what we do.

Side note: This month, Toseeb et al. published evidence (not reviewed by TISLP but available here) that children with ASD are more likely to be bullied by (and to bully) their siblings. Pure speculation here, but maybe peer-mediated language intervention could support positive sibling relationships? Scientists, take note!

Spektor, V., & Charlop, M.H. (2018) A sibling-mediated intervention for children with autism spectrum disorder: Using the natural language paradigm (NLP). Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-017-3404-x.