04 SES 05 B, A Fresh View Of Research-Based Interventions With Autism
Autism is a neurodevelopmental condition interfering with the ability of communication and social interaction (Elsabbagh et al., 2012). Autism occurs throughout the world, however, most research in the field of autism has been conducted in Western societies (Kossyvaki, 2017). Conducting autism research in Western societies also means that most autism interventions are originally developed in Western cultures (Fong and Lee, 2017). This situation is problematic because culture affects how autism is perceived, diagnosed and understood and the relevant interventions which are put in place (Freeth et al., 2014). This study aimed to contribute to the building of non-Western autism research by conducting a research project in Saudi Arabia. It also aimed to adapt a Western intervention in order to provide a culturally sensitive intervention for Saudi mothers of children with autism. A good culturally sensitive intervention recognises and respects the cultural context of participants and their needs (Fong and Lee, 2017).
Reading difficulties in children with autism can start from early childhood years (Davidson and Weismer, 2014). Therefore, there is a need for providing early literacy support for children with autism in order to prevent future reading difficulties (Fleury and Lease, 2018). However, knowledge about early literacy skills and instructions for children with autism is relatively lacking (Fleury and Schwartz, 2017). Thus, this study aimed to add to literacy research by investigating the use of dialogic reading, a shared reading intervention, for children with autism. Dialogic reading is an interactive shared reading in which the adult encourages the child to participate by using specific strategies and prompts (Whitehurst et al., 1994). Research showed that dialogic reading has promising results with children with autism by increasing their participation, literacy skills, engagement and parent-child interaction (e.g., Fleury et al., 2014; Hudson et al., 2017).
Currently in Saudi Arabia, it is hard to enrol children with autism in public or private mainstream schools (Zeina et al., 2014). Children with autism usually attend special schools called autism centres. However, there is a lack of autism centres. Therefore, many children with autism (30-44%) stay at home rather than attending mainstream schools or autism centres (Alnemary et al., 2017; Athbah, 2015). Staying at home means that it is their parents’ (mostly mothers) responsibility to teach them. The challenge is that there is a lack of parental intervention awareness and support in Saudi Arabia (Alqahtani, 2012; Omar, 2014) which increases the need for providing them with parental interventions to support their children. Thus, this study aimed to support mothers with an evidence-based intervention to use with their children with autism.
In a nutshell, the study aimed to: (i) examine the effect of dialogic reading on social communication, emergent literacy and engagement of children with autism, (ii) explore mothers’ experience and perception of shared reading with their children and (iii) provide a set of guidelines to adapt dialogic reading for mothers and their children with autism in Saudi Arabia. To achieve that, the study conducted two phases. In phase one, four mothers implemented the dialogic reading intervention with their children with autism. In phase two, a wider range of mothers of children with autism were interviewed about their understanding of shared reading and their need for support to gain a better insight into the adaptations such an intervention needs in Saudi Arabia.
The study used a mixed-methods approach which uses both quantitative and qualitative data in the same research framework. In phase one, a single-case design was used to examine the effectiveness of dialogic reading. Four mothers participated with their children with autism. Children were three males and one female between the age of 4 and 9 years old. The intervention took place in a mainstream school and an autism centre for 5 weeks with 9 sessions (twice a week). Mothers were provided with five storybooks and were asked to read each storybook for two sessions. First, mothers conducted three baseline sessions in which they were asked to read to their children without providing them with any guidelines. After that, each mother received an individual guidance session in which dialogic reading was explained, modelled and practiced. Then, mothers conducted six intervention sessions using dialogic reading. All the sessions were video recorded and observed by the researcher. To assess the effect of dialogic reading on children’s participation, three participating categories were identified as dependent variables: verbal social communication acts, nonverbal social communication acts and emergent literacy acts. A structured observation sheet based on previous shared reading studies was developed to captures those acts. After each intervention session, the researcher provided mothers with performance feedback about the session to establish the fidelity of implementation. In addition to the intervention, a semi-structured interview was conducted with mothers at three different time-periods (per-intervention, post-intervention and follow-up) to examine their experiences with dialogic reading. In phase two, 12 mothers of children with autism were interviewed to assess the usefulness and acceptance of dialogic reading because shared reading is not a common practice in Arab culture. The semi-structured interview included topics about the role of shared reading and books in mothers’ and children’s lives, mothers’ understanding of shared reading, their perception of effective shared reading, their needs for shared reading support and their willingness to receiving it. Thematic analysis was used to analyse all the interviews.
The findings of phase one showed that all mothers were able to implement the dialogic reading intervention with their children, and all the children participated during the intervention condition. Also, all children were more engaged and spent more time in the dialogic reading sessions compared to the baseline sessions. However, the effect of the intervention on participation was different for each child. In addition, all mothers were satisfied with the intervention. They reported that it was easy to use, and they and their children enjoyed it. They indicated that dialogic reading affected their interaction style with their children and helped them be more sensitive to their children’s social communication. These findings support and add to dialogic reading for autism research. For phase two, the thematic analysis of the interviews with the 12 mothers indicated that dialogic reading could be an acceptable, suitable and useful intervention for Saudi mothers to use with their children with autism. When mothers were asked about their understanding of shared reading and how it could be effective, the subthemes that emerged from their responses were interaction, active engagement and enjoyment which are essential components of dialogic reading. The interview also revealed subthemes about the factors that influence mothers’ use of shared reading with their children, such as the role of siblings and the lack of Arabic children’s storybooks. Finally, both findings from phase one and two were used to provide a set of guidelines to adapt dialogic reading to meet the needs of mothers and their children with autism in Saudi Arabia.
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