=Paper=
{{Paper
|id=Vol-3099/paper13
|storemode=property
|title=The Effectiveness of an Executive Functions Program on Reducing Sociolinguistic Communicative Disorders in Children With Autism
|pdfUrl=https://ceur-ws.org/Vol-3099/paper13.pdf
|volume=Vol-3099
|authors= Ahmed Mohamed Atef Azazzy
}}
==The Effectiveness of an Executive Functions Program on Reducing Sociolinguistic Communicative Disorders in Children With Autism==
https://ceur-ws.org/Vol-3099/paper13.pdf
The Effectiveness of an Executive Functions Program on
Reducing Sociolinguistic Communicative Disorders in
Children With Autism
Ahmed Mohamed Atef Azazzy 1[0000-0003-3364-2002]
1Prince Sattam Bin Abdulaziz University, KSA and Beni Suef University, BS 62511, Egypt
ahmedazazzy@ssn.bsu.edu.eg
Abstract. Autism is a common developmental disorder that leads to Sociolin-
guistic communicative disorders among autistic children. This study aimed to
reduce Sociolinguistic communicative disorders in a sample of autistic children
by using an executive functions program. The sample consisted of 10 children
with autism spectrum disorders whose ages range between 6-9 years, divided into
two groups of 5 children each (an experimental group and a control group). For
data collection, the researcher utilized the Stanford-Binet intelligence scale 5th
edition, the autistic child scale, the Sociolinguistic communicative disorders
scale, and the executive functions program (by the researcher). The results of the
study revealed that there were differences between the means of degrees ranks of
the experimental group before and after applying for the executive functions pro-
gram in reducing Sociolinguistic communicative disorders in favor of the post-
application, there were differences between the means of degrees ranks of two
groups after applying for the executive functions program in reducing Sociolin-
guistic communicative disorders in favor of the experimental group, and there
were no differences between the means of degrees ranks of the experimental
group in the post and follow-up application in reducing Sociolinguistic commu-
nicative disorders. it was concluded that Sociolinguistic communication is a key
to reduce many symptoms of autism.
Keywords: Executive Functions, Sociolinguistic Communicative Disorders,
Autism Disorder.
1 Introduction
Autism is a pervasive, complex, and a neurological developmental disorder that a child
is exposed to by the age of three associated with him throughout his life and negatively
affects his developmental aspects [1]. Mainly, it appears in the form of difficulties in
interaction and social communication and is accompanied by stereotyped and repetitive
behaviors and interests [2]. It may be associated with attention deficit disorder [3]. Dif-
ferent definitions of autism can be found in the literature. DSM-V (2013) defined it as
a developmental disorder that affects the children in early childhood before the age of
eight with symptoms appear only in two areas, namely social communication disorder
and stereotypical repetitive behaviors [4].
Copyright © 2020 for this paper by its authors. Use permitted under Creative Commons
License Attribution 4.0 International (CC BY 4.0).
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The deficits of children with autism extend to include social communication disor-
ders, which affect social skills, verbal and non-verbal communication skills (for exam-
ple, eye contact and facial expressions, as well as difficulty making new friends. One
of the most prominent symptoms of autism is that the autistic child characterizes by
quantitative and qualitative deficits in the social communication process, a tendency
towards isolation, and joining others is only under insistence. This child also has a de-
ficiency in verbal and non-verbal communication, difficulty in understanding emotions,
insistence on routine, and resistance to any change in the surrounding environment, and
he suffers from challenges in language development [5]. Numerous studies agreed upon
the correlative relationship between language development and executive functions, es-
pecially in meta-representations and syntactic awareness aspects among children with
autism [6].
ASD More recently, autism and autistic children have become like the iceberg idea,
that we only see the tip of it although the underneath is hidden. In this context, most
literature confirmed their social failure, their inability to speak in general, and that they
practice stereotyped behaviors and many other things, but we always differ in perspec-
tives when talking about the causes that lead to autism disorder as illustrated by [7]
study. [8] defined Sociolinguistic as the communicative verbal language usage and
other expressive ways of communication such as non-verbal linguistic modalities as
facial expressions in a specific context.
A child with autism spectrum disorder lacks the features of the typical child, and
suffers from primary deficits that distinguish him from others as autism affects many
different developmental aspects, and thus lead him to withdraw and introversion, as he
refuses any external contact and connection with others [9]. Edwards & Crocker
demonstrated that this is because this child lacks the ability to communicate and interact
with others; as positive social interactions and good communications with others in-
clude the ability to understand the emotions and feelings of others and the reactions
expected of them in different situations [10]. [11] explained that most autistic children
suffer from late verbal communication in one or more aspect, and at least one-third of
them will remain with this verbal deficit throughout his life, speaking few or no words.
Certainly, such linguistic challenges will affect their life areas negatively as socializa-
tion, academies, independent life, and employment.
The deficiency in social skills represents the main problem for children with autism
that refers to a lack of verbal and nonverbal communication skills and social under-
standing. Moreover, children with autism face problems in learning social interactions,
in the initiation and in achieving reciprocal social interactions, therefore the researcher's
idea of treatment with executive functions will positively affect their skills [12]. Many
theories attempt to explain the symptoms and causes of autism. For example, [13] be-
lieve that autism is not the result of a single cause, but it is due to a combination of
different factors. In general, it is usually challenging and impossible to have a single
reason responsible for a specific disorder. One of the well-documented theories in this
field is the executive dysfunction theory, which asserts that executive dysfunction can
be recognized to underlie many of the fundamental characteristics of autism, whether
in the social or non-social domains [14] and which indicates that the complex behav-
ioral manifestations of autism are consequences of weak executive processes [15].
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Consequently, executive functioning represents a useful approach to develop social
communication skills. Thus, it is necessary to assess executive function skills in young
children with autism [16]. The term executive functioning was used for the first time in
the mid-twentieth century to describe functions associated with the frontal cortex. The
executive functions (EF) refer to a group of high-level cognitive processes, emotional
and motivational skills, mediated by the prefrontal cortex of the brain [17]. Besides,
they are skills that begin to develop in childhood [16]. Executive functions are functions
that affect primary abilities such as memory, attention, and motor skills. For example,
a person who has a deficiency in some executive function is unable to find animal
names and simple words [18].
Executive functions are considered as a general goal for all adjustment essential
skills, goal-oriented behavior, which are necessary skills for success in performing
daily life tasks, solving problems, assessing the situation, and adapting to unexpected
situations and daily pressures [19]. It also helps the individual in organizing his behav-
ior and controlling his emotions and feelings to complete the task and act flexibly ac-
cording to the current circumstances in order to achieve the goal. Besides, it makes the
individual think about the consequences of his behavior before conducting it [20]. From
this standpoint, executive functions consist of a set of skills, including working memory
skills, cognitive flexibility, and inhibitory control skill [21].
The executive functions skills that can affect children with autism are defined clearly
in literature as follows: Working memory skill refers to the ability to keep the mental
representation of information in mind while simultaneously engaging in other mental
processes [20]. Cognitive flexibility skill refers to the ability to move smoothly between
situations and activities according to the requirements of the situation and the sequence
of events [14], [16]. Inhibitory control skill refers to the ability to stop the dominant
response in favor of a more adaptive response [21]. Planning skill refers to the ability
to anticipate future events for a set of objectives, establish a sequence of task execution
steps promptly, and prepare information and reorganize it [14]. Initiation skill refers to
the ability to initiate dialogue, participation, interaction, a conversation, the ability to
assist, and the ability to initiate a request or ask questions [22]. Response inhibition
skill refers to the ability to intentionally prevent and automatically control past re-
sponses from interfering with responses to the new situation, and not to interfere in the
performance of other unrelated tasks [15].
Therefore, executive functioning is widely used for children with autism. In this re-
gard, previous studies indicated the significant associations between executive func-
tioning, Sociolinguistic communicative disorders, and restrictive and repetitive behav-
iors among children with autism [15], [23]. The impaired executive function may be
one of the hypothesized factors limiting the development of the theory of mind, which
causes difficulties in the social functioning of autistic children [24]. In addition, exec-
utive function is a better indicator of Sociolinguistic communicative problems in chil-
dren with autism [25].
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2 Methods
2.1 Participants
The sample of the pilot study consisted of 30 children with autism registered in some
private centers for treating autism. Parents were contacted individually through special
education centers, where their children were diagnosed with autism by licensed profes-
sionals, to ensure the psychometric competence of the study tools, and this sample was
excluded from the basic study sample.
The basic study sample consisted of 10 children with autism disorder, divided into
two groups, an experimental group and a control group of 5 children with autism spec-
trum disorder for each. The experimental group was exposed to the program and the
control group was not exposed to the application.
Table 1. Participant characteristics (N = 10) 5 Control+ 5 Experimental.
M SD Range
Age 7.8 0.894 6.4 -9
IQ 91.9 5.3 85 -100
Sociolinguistic communicative disorders 103.7 12.37 81 -114
The researcher homogenized the characteristics of the two groups in terms of age, in-
telligence, and Sociolinguistic communicative disorders using the Mann-Whitney Test
as shown in table 2.
Table 2. Mann-Whitney Test Results for the Experimental and Control Group.
Pretest Group N Mean Sum U Z P
Rank Ranks
Age Control 5 5.6 28 12 0.106 0.916
Experimental 5 5.4 27
Intelli- Control 5 5.7 28.5 11.5 0.211 0.833
gence Experimental 5 5.4 26.5
SCD Control 5 5 25 10 0.530 0.596
Experimental 5 6 30
The results of Table 2 indicate that there are no statistically significant differences be-
tween the mean scores of the experimental and control groups in age, intelligence, and
Sociolinguistic communicative disorders, thereby guaranteeing the homogeneity of the
sample.
2.2 Research methodology
This study used the experimental approach of the two-group experimental design (the
experimental group and the control group) for its relevance to the characteristics of the
study sample "children with autism". In this regard, the researcher utilized the pre and
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post-measurement for the experimental and control groups and then the follow-up
measurement for the experimental group only.
2.3 Measures
Stanford-Binet Scale 5th Edition (Prepared by [26]): It is used to measure the indi-
vidual's cognitive abilities and intelligence from the age of two to 85 years old. The
well-known use of the Stanford-Binet scale includes the diagnosis of various cases of
cognitive delay in young children, mental retardation, learning difficulties, and mental
giftedness Sample.
The Autistic Child Scale (Prepared by [27]): This scale consists of 28 items to which
the specialist or parents answer with (yes) or (no). These items manifest the symptoms
of autism.
Sociolinguistic communicative disorders Scale (Prepared by the Researcher): The
scale consists of 39 items, distributed on three sub-dimensions, which are: the social
skills disorder 12 items, verbal Language skills disorders 14 items, and Non-verbal
Language 13 items, participants have to choose one answer from three alternatives ac-
cording to Likert's three points scale method always 3 scores, sometimes 2 scores,
rarely 1 score. All statements are negative expressions, and thus the children's scores
on the scale ranged from 39:117. A higher score on the scale indicates an increased
presence of Sociolinguistic communicative disorders in children with autism, and a low
score indicates a lower presence of Sociolinguistic communicative disorders for them.
the researcher calculated the Alpha Cronbach coefficient that was 0.854 for the social
skills disorder dimension, 0.706 for the verbal Language disorders dimension, and
0.784 for the Non-verbal Language, where all values were statistically significant at the
0.01 significance level, thus the scale is reliable. Besides, the researcher verified scale
validity through inter-rater validity and internal consistency. Therefore, the scale of
Sociolinguistic communicative disorders as a whole has internal validity.
The Executive Functions program for children with autism (prepared by the re-
searcher): The executive functions program relies on brain functions to regulate other
functions of the child with autism disorder, and the ability to manage his life activities
through a set of higher cognitive processes, emotional and motivational skills that me-
diate the prefrontal cortex of the brain that aims to direct the child's behavior to achieve
the goal and regulate his behavior in order to achieve a great deal of meaningful social
communication [19]. The current program aims to Sociolinguistic communicative dis-
orders in children with autism by using an executive function program and monitoring
the extent to which individuals participating are retaining training gains after the pro-
gram ends. The number of sessions consisted of 39 sessions, and the duration of each
session was 45 minutes in which a set of techniques was used, including positive rein-
forcement, role-playing, modeling, prompting, shaping, repetition, organization, and
homework.
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3 Results
Table 3. The Wilcoxon signed-rank test of the two correlated samples (Pre-test & post-test)
Variables Scale N Mean-R Sum-R Z P
Social Skills Disorder Negative rank 5 3 15 2.04 0.041**
Positive rank 0 0 0
Equal 0
Verbal Language Negative rank 5 3 15 0.03 0.042**
Positive rank 0 0 0
Equal 0
Non-verbal Lang Negative rank 5 5 25 0.02 0.043**
Positive rank 0 0 0
Equal 0
** p<0.05.
Results demonstrated that there were statistically significant differences between the
pre-post measurement application scores of the experimental group in favor of the post-
application in social skills disorder (z= 2.04; p<.05), verbal Language disorder (z= 2.03;
p<.05), Non-verbal Language (z= 2.02; p<.05) indicating the strong effect of the pro-
gram used in the current study in reducing the level of Sociolinguistic communicative
disorders among children with autism- the sample under study.
Table 4. The results of the Wilcoxon Signed-Rank test of the two correlated samples (Posttest-
3wks after)
Variables Scale N Mean- R Sum-R Z P
Social Skills Disorder Negative rank 1 1.5 1.5 -0.82 0.414
Positive rank 2 2.25 4.5
Equal 2
Verbal Language Negative rank 1 2 2 0.45 0.655
Positive rank 1 1 1
Equal 3
Non-verbal Lang Negative rank 1 2.5 2.5 0.27 0.785
Positive rank 2 1.75 3.5
Equal 2
Besides, results revealed that there are no differences between the experimental group
post and follow-up measurement application (after three weeks) in the social skills dis-
order (z= -, 816; p>0.05), verbal Language (z= -, 447; p>0.05), Non-verbal Language
(z= -.272; p>0.05). This indicated the stability of the program’s effect for a period of
time among children with autism- the sample under study.
Table 5. The results of The Mann-Whitney test of two independent samples (Posttest)
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Variables Scale N Mean- R Sum-R U Z P
Social Skills Dis- Control 5 8 40 0.00 -2.65 0.008*
order Experimental 5 3 15
Verbal Language Control 5 8 40 0.00 -2.63 0.009*
Experimental 5 3 15
Non-verbal Lan- Control 5 5 40 0.00 -2.64 0.008*
guage Experimental 5 3 15
*p<0.01.
Moreover, results illustrated there were differences between the means of scores of the
experimental and control group post measurement in the social skills disorder (z= -,
2.652; p<.01), verbal Language (z= -2.627; p<.01), Non-verbal Language (z= -2.635;
p<.01), indicating the stability of the program’s effect for a period of time among chil-
dren with autism- the sample under study.
4 Discussion
The purpose of this study was to investigate the effectiveness of an executive functions
program in reducing Sociolinguistic communicative disorders in children with autism.
Previous studies have shown that executive functions can be used with children with
autism to improve a set of practices or to reduce a group of disorders, especially Soci-
olinguistic communicative disorders using effective training of executive functions.
Numerous studies agreed upon the correlative relationship between language develop-
ment and executive functions, especially in meta-representations and syntactic aware-
ness aspects among children with autism [6], [13], [28].
Analyzing results revealed that there were differences between the experimental
group in the pre and post-scale application in favor of the post-application and that there
were statistically significant differences between the experimental and control group in
the post-scale application in favor of the experimental group, indicating that the pro-
gram applied in this study that is based on using the executive functions has contributed
significantly to reduce Sociolinguistic communicative disorders among children with
autism in the experimental group compared with those in the control group. These re-
sults are inconsistent with the results of many previous studies [29-30].
In this regard, previous studies showed that children who suffer from behavioral
symptoms have executive functions impairment than their peers because they are una-
ble to direct their behaviors to achieve a specific purpose, and they do not have any
initiation to plan, organize, and develop strategies to solve a problem, this was con-
firmed by many studies as [31]. While there executive functioning is broadly related to
ASD, few studies expecting the relationship between executive functioning and autism.
In this regard [15] revealed a significant relationship between executive functioning
and restricted and repetitive behaviors. Besides, they asserted the relationship between
the two variables especially, in the social domain in children and adolescents with and
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8
without ASD. Other researchers concluded that EF dysfunctions are associated with
language deficits [32].
In the current study, the program sessions were conducted over a period of 15 weeks.
The results indicated that executive functions helped in reducing three main areas of
Sociolinguistic communicative disorders (social skills disorder, verbal Language and
Non-verbal Language), compared to the control group whose Sociolinguistic commu-
nicative disorders remained without a decrease. The researcher attributes these results
for different reasons. Firstly, children of the experimental group received effective
training on executive function strategies that are characterized by modernity in their
approach and application and based on the scientific and methodological basis in re-
ducing communication disorders among people with autism. The effect of this program
was evident in the experimental group, and in contrast, the control group received reg-
ular training without targeting their behavior and social skills. Secondly, executive
functions are considered as one of the most important strategies used nowadays all over
the world to modify the behaviors of children with autism in particular and those with
special needs in general in integrated classrooms, or in behavior modification rooms
and centers. That this program is based on scientific foundations and theories, which
asserted in the importance of taking into consideration individual differences through
learning more about their abilities, learning styles, and intelligence preferences. This is
consistent with the scientific method and the psychological logic as asserted in the find-
ings of [25], [33] studies.
The researcher attributes the improvement in Sociolinguistic communicative disor-
ders among the children of the experimental group to the content of the training pro-
gram on the executive functions that were selected, starting with the techniques that
were used such as the technique of reinforcement, shaping, sequencing, modeling,
prompting, gradual exclusion, task analysis, feedback, and the role-playing. In addition
to the set of skills targeted in the current program such as the skill of positive commu-
nication with others through the methods of visual communication with others via ac-
tivities and play, the skill of attention, the skill of developing response inhabitation that
was done by reducing the child's movement, developing his awareness of the desired
behavior, and replacing the unwanted behavior to a desirable one. The program targeted
also the skill of initiation such as initiation of greeting others, initiation of a request to
play with others, the initiation of daily life activities, and the initiation to help others,
all of which are behaviors that develop Sociolinguistic communicative, the ability to
make new friends and increase verbal and non-verbal communication skills.
Moreover, the researcher utilized the cognitive flexibility skills such as accepting
others in play and place, and classification skills such as classifying types of food and
similar shapes, the planning skills such as arranging steps for brushing teeth, and work-
ing memory skills such as remembering the places of things and remembering the
names of games. Undoubtedly, all these skills and experiences provide an opportunity
for the trainees to arouse their strengths and try to develop their weaknesses as training
differed from one child to another and from one executive function to another. This
result id logical and consistent with study results [24].
The results also confirmed that there were no statistically significant differences be-
tween the post and follow-up measures of the experimental group in Sociolinguistic
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communicative disorders, and this indicates that the experimental group had received
training in Sociolinguistic communicative disorders such as social skills, verbal Lan-
guage of Non-verbal Language with others for children with autism. This result demon-
strated the effectiveness of the program in improving the personal, social, and perfor-
mance aspects of children with autism. We find that the development of Sociolinguistic
communicative that has become acquired and trained in it increased assistance, com-
passion, obedience, and responsibility towards others and this was a treat for many be-
havioral and social disorders, including social communication disorder that these chil-
dren suffer from. These results were consistent with study results [34] confirming that
there were no differences between the post and follow-up application of the experi-
mental group in Sociolinguistic communicative disorders for children with autism dis-
order.
5 Conclusions
From the above-mentioned, the results of the current study supported training through
executive functions in improving the Sociolinguistic communicative skills of children
with autism and developing their academic, personal, social, and interactive capabilities
which are closely related to their progress in behavioral skills and result in the use of
positive behavioral skills in interaction with life situations. Communication, attention,
response, initiation, cognitive flexibility, classification, planning, and working memory
skills should be developed because they are essential skills for these children with au-
tism disorder that helps to improve communication between the child and his surround-
ings. Besides, the use of techniques must be diversified with these children so that the
child does not become bored. So, the researcher suggests the application of the execu-
tive functions training program used in this study on other groups such as the mentally
handicapped, Asperger's, the hearing impaired ... etc., and measuring tools must be de-
veloped to identify and diagnose Sociolinguistic communicative disorders for children
of preschool age so that these disorders do not worsen in the future.
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