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a Department
of Physical Therapy, Speech-Language Pathology and Audiology, and Occupational Therapy, School
of Medicine, Universidade de São Paulo (FMUSP), São Paulo, Brazil; b Universidade Paulista (UNIP), Santos, Brazil
Keywords there were differences between the children’s pre- and post-
Autism · Language · Pragmatics · Cognition · Executive test performance. Significantly different performances were
function observed in the areas of occupation of communication
space, proportion of communicative interactivity, and so-
cial-cognitive performance. Conclusion: The inclusion of ac-
Abstract tivities to stimulate executive function abilities in language
Aims: Identifying effective methods for stimulating lan- intervention for children with ASD warrants further investi-
guage and communication of children with autism spec- gation. © 2017 S. Karger AG, Basel
trum disorder (ASD) is fundamental to the effective use of
available resources to support these children. This pilot
study was designed to explore the potential benefits of a
program of stimulation of executive functions (SEF) on the Introduction
functional aspects of language and communication through
the assessment of the functional communicative profile and Throughout the years, despite variations in diagnostic
social-cognitive performance. Methods: Twenty children, criteria and classification, descriptions of autism spec-
aged 5–12 years, with a diagnosis of ASD participated in the trum disorder (ASD) include impairments in language
study. Two stimulation programs were offered over a 10- to and communication [1]. Identifying effective methods
12-week period as part of the regular services offered to for stimulating language and communication in children
these children through a University’s speech and language with ASD is fundamental to the adequate use of resourc-
therapy outpatient clinic in São Paulo, Brazil. Children either es, such as specialized intervention and education, espe-
received SEF intervention in their home implemented by cially in regions of the world where this population is un-
their parent/s, with close monitoring by the speech-lan- derserved or where geographic distances impede access
guage pathologist (SLP) (group 1), or they received SEF by to appropriate intervention.
the SLP during regular speech-language therapy individual The close association between language development
sessions (group 2). Results: The findings suggested that and executive functions (EFs) has been studied for de-
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© 2017 S. Karger AG, Basel Ingrid Ya I. Sun, Department of Physical Therapy, Speech-Language
Pathology and Audiology, and Occupational Therapy
School of Medicine, FMUSP, Rua Cipotânea, 51
E-Mail karger@karger.com
Cidade Universitária, São Paulo, SP 05360-160 (Brazil)
www.karger.com/fpl
Univ.of Adelaide
Downloaded by:
Participants
A convenience sample was used. There were 24 students with
ASD enrolled in an outpatient language service, but 4 children did Table 2. Average number of areas with progress per participant in
not complete the intervention, so the data presented are for 20 FCP and SCP
children who completed the planned intervention. The children
had received a diagnosis of ASD by a neurologist or psychiatrist n FCP SCP Average per Average per
and were aged between 5 and 12 years. They received language subject in FCP subject in SCP
therapy for at least 6 months before the onset of this study and were
able to engage in cooperative play activities. Their parents were Group 1 6 15 12 2.5 2
able and willing to participate in the intervention and maintained Group 2 14 48 17 3.4 2.1
regular contact with the SLP by phone or digital means.
Since each participant was his/her own control, the inclusion cri- FCP, functional communicative profile; SCP, social-cognitive
teria were defined so as to be as broad as possible. A score above 70% performance.
in the SCP assessment was required to obtain some homogeneity
among the participants. In addition, the child’s behavior in play ac-
tivities during the semester prior to the study was observed. Verbal
and nonverbal children were included. The same criteria were used
with both groups. The study did not change the routine of therapeu- The SCP assessment identified the child’s best performance in
tic intervention procedures at the service where it was conducted. 7 different areas: gestural communicative intent, vocal communi-
cative intent, gestural imitation, vocal imitation, tool use, combi-
Procedures natory play, and symbolic play.
All participants were assessed regarding the FCP and the SCP The children attending the outpatient clinic formed 2 groups.
[36] in the pre- and postintervention periods implemented. In the In group 1, 6 children received stimulation of executive functions
FCP, 15-min samples of child and SLP interactive play sessions (SEF) exclusively conducted by their parents, at home, over a 10-
were video recorded and transcribed to specific protocols. The week period. During this period, parents and therapists made sys-
SLP’s transcription and marking were checked by another exam- tematic contact (by phone, WhatsApp, or Skype) to report the chil-
iner, and any differences in the transcription were resolved through dren’s progress, solve problems, or discuss necessary small chang-
discussion and repeated listening to the video recordings. es in the activities proposed. In group 2, 14 children received SEF
The data used in this study referred to: during individual weekly language therapy sessions with the SLP
• the number of communicative acts expressed per minute, for a 12-week period. Parents were asked to engage in follow-up
• occupation of the communicative space (identified by the pro- activities demonstrated by the SLP at home.
portion of communication initiated by each participant of the The SEF program involved the use of game activities to facili-
interaction), tate the child’s cognitive flexibility, operational memory, inhibi-
• percentage of interactivity (determined by the proportion of tory control, and central coherence. These therapeutic activities
communicative acts with interactive functions), and could be managed at home by the parents in low-stress situations.
• the use of different communicative means (verbal, vocal, or Table 1 presents examples of the activities proposed and their
gestural) [37]. goals.
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AM, communicative acts per minute; OCS, occupation of communicative space; % inter, proportion of
interactivity; SCP, social-cognitive performance.
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