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The Impact of Bilingual Environments on Language Development in Children

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J Autism Dev Disord (2012) 42:1342–1352
DOI 10.1007/s10803-011-1365-z
ORIGINAL PAPER
The Impact of Bilingual Environments on Language Development
in Children with Autism Spectrum Disorders
Catherine Hambly • Eric Fombonne
Published online: 22 September 2011
Ó Springer Science+Business Media, LLC 2011
Abstract The impact of bilingual exposure on language
learning has not been systematically studied in children
with Autism Spectrum Disorders. This study compared the
social abilities and language levels of children (mean
age = 56 months) with ASDs from bilingual (n = 45) and
monolingual (n = 30) environments. Bilingually-exposed
children were subgrouped based on simultaneous bilingual
exposure from infancy (SIM, n = 24) versus sequential
post-infancy bilingual exposure (SEQ, n = 21). Despite
significantly different amounts of bilingual exposure across
all groups (p = \0.001) and significantly stronger social
interaction scores in the SIM group compared to the SEQ
group on the Vineland Adaptive Behavior Scales-II Inter-
personal subdomain (p = 0.025), there were no significant
group differences in language level. Bilingually-exposed
children with ASDs did not experience additional delays in
language development.
Keywords Bilingualism
Children
Autism spectrum
disorders
Language
Socialization
Introduction
There is an urgent need to understand the impact of bilingual
exposure on the language development of young children
with Autism Spectrum Disorders (ASDs) since there is a
prevalent belief in clinical settings that bilingually-exposed
children with ASDs may experience additional delays in
C. Hambly (&)
E. Fombonne
Department of Psychiatry, Montreal Children’s Hospital, McGill
University, c/o Dr. E. Fombonne, 4018 Ste-Catherine West,
Montreal, QC H3Z 1P2, Canada
e-mail: catherine.hambly@mail.mcgill.ca
123
language development. There is little data to support or
refute this assumption since early bilingual exposure in
young children with autism has only been explored in pre-
sentations (Hambly and Fombonne 2009; Leadbitter et al.
2009; Kremer-Sadlik 2005; Yu 2007), a manuscript cur-
rently under review (Petersen et al. personal communication)
and a case report (Seung et al. 2006).
There is no evidence that bilingual exposure causes
additional language delays for children with language
impairments. Research on bilingual exposure in children
with specific language impairment (Gutierrez-Clellen et al.
2008; Paradis et al. 2003) and Down Syndrome (Feltmate
and Kay-Raining Bird 2008; Kay-Raining Bird et al. 2005)
found no additional language delays in bilingually-exposed
participants. These studies had small numbers of partici-
pants in the language-impaired bilingual exposure groups
(e.g., 4–11), and participation was generally limited to
children with ‘intensive’ bilingual exposure and productive
expressive bilingual abilities. To paraphrase Genesee
(2006, p. 51), these kinds of studies indicate that some
children with language impairments and bilingual exposure
acquire language to the same level as monolinguals, but
they do not suggest that all bilingually-exposed children
with language impairments do.
Children with ASDs have severe social impairments that
are not present in children with specific language impair-
ment or Down Syndrome. The social impairments associ-
ated with ASDs include deficits in attention to voices and
joint attention: these core skills are so critical to language
learning that these deficits could potentially limit the
ability of children with ASDs to learn language in bilingual
environments at the same rate or to the same level as
children with ASDs in monolingual environments.
First, a preference for non-speech over speech sounds
reduces automatic orienting to speakers in the environment
J Autism Dev Disord (2012) 42:1342–1352
(Kuhl et al. 2005) resulting in fewer opportunities for
children with ASDs to analyze and sort the bilingual
auditory input. Along with reduced auditory input, children
with ASDs may also not attend to facial movements during
speech that provide important visual cues for sorting lan-
guages (Weikum et al. 2007). There may also be a min-
gling of environmental noises with the speech signal that
could mask the contrastive phonemes and stress patterns
needed to sort languages and parse input within each lan-
guage (Russo et al. 2009). These additional auditory pro-
cessing demands can have an impact on language
development in infancy: experimental studies have dem-
onstrated that typically-developing bilingually-exposed
infants are slower than monolingual infants to encode and
retrieve the phonetic details that help them make novel
object-word associations (Fennell et al. 2007). Word and
eventually sentence comprehension and production could
be affected if bilingual input cannot be readily or accu-
rately perceived or processed. Although bilingually-
exposed infants may display enhanced cognitive control
abilities in bilingual processing tasks compared to mono-
lingual infants (Kovács and Mehler 2009), it is not known
if any cognitive advantages related to bilingual exposure
during infancy would also be present in infants who are
later diagnosed with ASDs.
Secondly, impaired joint attention abilities (Adamson
et al. 2009) could also potentially worsen receptive and
expressive language delays for bilingually-exposed chil-
dren. Children with ASDs have reduced use of joint
attention cues such as referential pointing and eye gaze that
help them ‘map’ word labels to the appropriate referent
(Parish-Morris et al. 2007). In addition to the mapping
tasks that all children must perform, bilingual children
must also recognize that two or more different word labels
(e.g., apple/pomme) can map to a single concept or even
multiple concepts across languages. For example, the
English third person plural pronoun ‘‘they’’ maps to both
‘‘ils’’ and ‘‘elles’’ (masculine or feminine third person
plural) in French, but a child learning English and French
would also need to recognize that the French singular
pronouns ‘‘il’’ and ‘‘elle’’ sound identical to their plural
counterparts. Receptive and expressive vocabulary skills
could be delayed in both languages if word mapping is
perceived to be more inconsistent by bilingually-exposed
children with ASDs, and additional grammatical delays
could be a product of further perceived inconsistencies in
grammatical systems (e.g., differing use of verb tense and
pronoun morphemes in English vs. French) or structural
order across languages (e.g., ‘the blue car’/‘une voiture
bleue’).
The timing of bilingual exposure could also impact the
outcomes of language learning for children with ASDs.
The infant perception literature supports a general
1343
perceptual narrowing from 6 to 12 months of age as infants
tune into the specific sensory input that characterizes their
linguistic environment (Pons et al. 2009). Many studies
have demonstrated that typically-developing infants are
sensitive to acoustic contrasts across languages that older
children do not perceive; there appears to be a critical
window for heightened speech perception and discrimina-
tion during the first year of life (Werker and Byers-
Heinlein 2008; Werker et al. 2009; Werker and Tees 1984).
During this period of broad perceptual sensitivity, bilin-
gually-exposed infants differentiate and sort linguistic input
based on features including vowel contrasts (Sebastián-
Gallés and Bosch 2009; Sundara and Scutellaro 2010),
consonant contrasts (Sundara et al. 2008), and visible
articulation cues (Pons et al. 2009) to develop a foundation
in two language systems. The perceptual ‘tuning’ that
occurs before the end of the first year of life (Gervain and
Werker 2008) reflects the infants’ attention to contrasts that
are relevant in their language system(s) and has an impact
on word learning in typically-developing children: very
young monolinguals appear to use different learning
mechanisms to acquire words than their bilingually-
exposed peers (Werker et al. 2009). It is possible that per-
ceptual abilities and word-learning strategies may differ
depending on whether a child with an ASD received
bilingual or monolingual exposure during the first year of
life.
We hypothesized that the social impairments charac-
teristic of ASDs could cause additional language delays in
bilingually-exposed children with ASDs compared to
monolingually-exposed children with ASDs. These addi-
tional delays would manifest in smaller expressive vocab-
ularies, lower levels of language comprehension and
production, and later onset of early language milestones for
bilingually-exposed children with ASDs. Within this gen-
eral hypothesis, we posited that children with ASDs whose
bilingual exposure started after infancy might show greater
language delays than children who received simultaneous
bilingual exposure beginning during infancy.
Methods
Participants
Families of 75 children with ASDs aged 36–78 months
were recruited from Quebec (N = 71) and Ontario
(N = 4). 65% of the children were patients at the Montreal
Children’s Hospital (MCH) ASD clinic, recruited via
mailings or during clinical visits. 35% were recruited
from publicity in community organizations and service
providers. The participants from Quebec were diagnosed
by child psychiatrists or developmental pediatricians; the
123
1344
participants from Ontario were diagnosed at hospitals or a
university-based ASD research unit. Diagnostic reports
were available for 89% of all participants (96% of children
diagnosed at the MCH, 82% of those diagnosed elsewhere),
with the Autism Diagnostic Observation Schedule-Generic
(Lord et al. 2000) used in at least 66% of participants’
assessments. Three participants had ‘Autism Spectrum
Disorder’ listed in their reports without further classifica-
tion. However, based on information (such as ADOS
scores) within the reports, we grouped these children
within the autism category (n = 59; 56 diagnosed with
autism, 3 listed as ‘‘ASD’’). One child diagnosed with
Asperger syndrome was grouped with the Pervasive
Developmental Delay—Not Otherwise specified category
(n = 16; 15 diagnosed as PDD-NOS, 1 diagnosed with
Asperger syndrome).
Enrollment was limited to children whose spoken
vocabulary was in French, English, Chinese, Farsi,
Hebrew, Italian, Romanian, Spanish and/or Tamil, since
the expressive vocabulary questionnaire was available in
these languages. Eleven children with trilingual exposure
were included because their expressive vocabularies could
be measured using available language forms. Nonverbal
children were included since we had theorized that bilin-
gualism could be detrimental to language development in
the presence of an ASD: if true, we would have introduced
a sampling bias in the bilingually-exposed group by
excluding nonverbal children. Seven participants spoke
fewer than 10 words, but only two of these children were
nonverbal. The informant caregivers all spoke and read
English or French well.
Participants were divided into groups based on their
language exposure history (monolingual vs. bilingual) with
the bilingually-exposed children sub-grouped based on
dual-language exposure before or after 12 months of age.
This age cut-off was selected based on changes in infant
speech perception that occur around this age, and after
consideration of the various methodological approaches to
studying bilingualism in young children. There is little
consensus in the literature on how to subgroup bilingual
children: Bialystok (2001, p. 225) highlights the subjec-
tivity and methodological disputes around this issue.
One common subgrouping methodology is based on
McLaughlin (1978) who used a cutoff age of 3 years—an
age at which typically-developing children have phrase-
level expressive language abilities—to differentiate
between children who learn two languages simultaneously
and those with later exposure who learn their languages
sequentially. However, many children with ASDs have a
protracted language acquisition period compared to typi-
cally-developing peers, and some children with ASDs may
never develop spoken language, much less phrase-level
expressive language abilities. Any age cutoff based on
123
J Autism Dev Disord (2012) 42:1342–1352
expected language levels at a given age would be mean-
ingless in a population of children with significant com-
munication delays and variable expressive language
achievement, so this approach was not selected for this
study.
Another common methodological approach is to assess
current bilingual exposure and to select only children who
receive a certain percentage of bilingual input each week
(as in Gutierrez-Clellen et al. 2008). However, a major
limitation of this approach is that it does not account for
changes in language use over time. Many families in this
sample made changes in language use proportions from
year to year, so bilingual exposure was not constant across
time. Bilingual families often reduced their use of a
minority home language (e.g., from speaking it 50 to 20%
of the time, for example) or spoke it among other family
members but not directly to the child (Yu 2007) when their
children’s language delays became apparent. In this sce-
nario, the bilingual exposure was present since birth, but
the child’s exposure to the language changed from direct to
indirect exposure at home. So, grouping by current direct
language exposure levels would have masked the large
exposure changes over time that may be unique to this
population.
An additional methodological challenge to categorizing
participants based on language exposure emerges from the
presence of major language changes, which in this study
was defined as either the addition of a novel language to the
child’s environment, or conversely the complete loss of a
language in direct communication with the child. For
example, families from monolingual minority language
homes often reported adding a second language at home
after becoming aware of their child’s language delay and
subsequent need for majority-language therapy services.
Some bilingual families stopped speaking one of their
languages to their child with an ASD, or reduced a trilin-
gual home environment to a bilingual one. These changes
were tracked in this study: although the cut-off for sub-
grouping by bilingual exposure was placed at 12 months of
age, the simultaneous and sequential exposure groups
actually had far more than 12 months of exposure differ-
entiating them from each other.
Our decision to subgroup children based on infant lan-
guage exposure was ultimately guided by the research on
infant speech perception, but the use of an early cut-off
also allowed us to differentiate between families that had
an original intent to provide a bilingual environment for
their children and those families who did not. Since the cut-
off for simultaneous bilingual exposure was placed before
the age at which language delays are usually detected—an
event that can be a trigger for major language environment
changes—the chosen subgrouping methodology effectively
separated families who intended to raise their children
J Autism Dev Disord (2012) 42:1342–1352 1345

bilingually from those families who had planned for a
monolingual childhood. It acknowledges the possibility
that families who ‘begin bilingual’ may provide more
natural and fluent language and socialization models and
more indirect bilingual exposure than families who add
a second language to help their child access majority-
language therapy or schooling (Yu 2007). In other words,
the qualitative differences between the simultaneous and
sequential exposure groups may be as important as any
perceptual advantage from infant exposure or any quanti-
tative difference in levels of direct exposure between the
bilingually-exposed groups.
Table 1 displays the characteristics of the three exposure
groups.
Monolingually-exposed children (MON, n = 30) had no
history of bilingual exposure. Bilingually-exposed children
(n = 45) presented with a range of exposures, but were
sub-grouped based on whether they received simultaneous
bilingual exposure from before 12 months of age (SIM,
n = 24) or had second language exposure added sequen-
tially into the environment after 12 months of age (SEQ,
n = 21). The age of the earliest major language changes
for each group (SIM = 25.6 months, n = 14, SEQ =
31.0 months, n = 21) highlights that major alterations in
language environment were typically made after the age of
first concerns: in the SIM group, the changes included a
shifts from (a) trilingual to bilingual direct exposure and
(b) bilingual to monolingual direct exposure. The age of
earliest major language changes also documents that on
average children in the SIM group were bilingually-
exposed for the first 25 months of life, whereas children in
the SEQ group were monolingually-exposed for the first
31 months of life. So, while a cut-off of 12 months of age
was used to distinguish between the groups, the average
difference in early monolingual versus bilingual exposure
between the groups was significantly more than 12 months.
Children in the SIM group whose bilingual or trilingual
exposure was reduced or eliminated over time were
retained in the SIM group due to their significant early
bilingual exposure. Children whose first language of
exposure was completely replaced by a second language in
caregiver-child interactions remained in the SEQ group due
to the high likelihood of ongoing indirect bilingual expo-
sure (e.g. between family members) at home.
MON children were exposed to English (53% of par-
ticipants), French (43%), or Spanish (3%). SIM children
were divided between bilingual French and English expo-
sure (54%), trilingual exposure with French, English and a
minority language (33%), and bilingual exposure with
French or English and a minority language (13%). SEQ
children were divided between bilingual French and Eng-
lish exposure (48%), bilingual exposure with French or

Table 1 Sample characteristics by language-exposure groups

MON SIM SEQ p values Post hoc testing p values
n = 30 n = 24 n = 21
MON MON SEQ
SIM SEQ SIM

% Male 80 83 81 0.951
% With autism 77 83 76 0.795
Age (months) 53.9 (10.1) 57.5 (10.7) 58.3 (13.14) 0.319
Age of first concerns 16.2 (8.6) 19.3 (9.1) 20.9 (11.4) 0.221
Age of earliest major language change n/a 25.6 (14.4) 31.0 (13.4) 0.267
Age at diagnosis 38.3 (10.2) 39.2 (11.4) 35.9 (11.3) 0.583
Lifetime ratio (LR): % dominant language 100 73.7 (14.4) 88.0 (13.5) \0.001 \0.001 0.001 \0.001
exposure
LR: % last 6–12 monthsa 99.9 (0.4) 81.8 (23.1) 81.9 (24.3) \0.001 0.001 0.003 0.993
Language diary: % current exposurea 96.6 (8.0) 77.0 (21.0) 74.8 (26.1) \0.001 \0.001 0.001 0.751
% With English or French dominant exposure 97 87.5 71 0.033 0.312 0.015 0.267
Mother: % native fluency 100 71 52 \0.001 0.002 \0.001 0.233
Mother: % non-caucasian 23 36 52 0.103
Mother: % Canadian-born 67 58 57 0.738
Mother: % with some university education 57 75 62 0.368
Family income $65,800 $62,600 $59,800 0.654
($22,700) ($23,500) ($19,300)
% Received behavioral intervention 38 29 62 0.073 0.552 0.151 0.038
a
Reported for the LR dominant exposure language

123
1346
English and a minority language (38%) and trilingual
exposure with French, English and a minority language
(14%).
Instruments
Most instruments were selected to categorize general and/
or adaptive language levels with minimal to no referencing
of specific language features. Instead of standardized test
measures which have limited availability outside of Eng-
lish or Spanish and generally can only test a single lan-
guage at a time, we selected parent report measures which
are commonly used in bilingualism research with young
children. French translations of the measures were used
with French-speaking families.
All families participated in a Language Environment
Interview (LEI) that collected data on home language
environment history and generated a language exposure
estimate. The LEI questions were administered by a trained
research assistant during a 30 min phone interview with an
informant; most informants (83%) were the children’s
mothers. Questions and scoring are described in detail in
‘‘Appendix 1’’. To summarize, the informant provided a
detailed history of all caregivers’ amount and duration of
care for each 6-month period of the child’s life. The
informants also described the languages these caregivers
used with other family members and with the child.
Additional information on countries of birth, a report on
caregivers’ fluency in all languages spoken at home, and
reasons for language changes were collected for family
caregivers. Language exposure information was gathered
for daycare or school environments where relevant.
Following the interview, major language exposure
changes (e.g., languages added or dropped) were identified,
and data for each caregiver was summarized for each
6-month period of time. Each caregiver’s language input
was weighted using a scale based on the relative amounts
of direct (e.g., one-to-one) caregiver-child communication.
For example, input from a parent with a full-time job
received a lower weight than input from a parent with
primary child-care responsibilities. The input scores
resulted in a summary exposure estimate for each six-
month period since birth. The final Lifetime Ratio (LR)
represents a composite average exposure (e.g., 75%
French/25% English) in direct caregiver-child interactions;
it does not reflect the amount of passive exposure via
indirect exposure in the home. The language heard by the
child most often during their lifetime was labeled their
dominant exposure language.
Current socio-communicative levels and ages of early
language milestones were elicited using questions excerp-
ted from the Autism Diagnostic Interview-Revised (Le
Couteur et al. 2003) and included: pointing for joint
123
J Autism Dev Disord (2012) 42:1342–1352
attention initiation and response (#42), attention to voice
(#46), comprehension of simple language (#29), overall
level of language (#30), age of first words (#9), and age of
first phrases (#10). Interviewers were trained using ADI-R
guidelines, and coding procedures were followed with one
exception: question 42 was modified to separate initiation
and response levels. Scores on some ADI-R questions were
merged to facilitate statistical analyses; consult ‘‘Appendix
2’’ for details on questions and scoring.
Families completed a week-long Language Diary by
charting the child’s location (e.g., home, daycare), com-
munication partners (e.g., parents, siblings) and language
exposure estimates throughout each day for a week. Data
were summarized into a weekly average. The correlation
for bilinguals between the Language Diary and the last six-
month period assessed on the LEI was highly significant
(r = 0.773, p \ 0.001).
The Social Responsiveness Scale (SRS) measures the
severity of autism symptoms within children’s natural
environments (Constantino 2002); it is appropriate for use
in children with autism aged 4 years and older. Scoring
procedures and standardization data followed the technical
guide (Constantino and Gruber 2005).
Caregivers completed a Family Background Informa-
tion Questionnaire (FBIQ) which elicited marital status,
household income (detailed in units of $10,000 up to the
ceiling level on the questionnaire of ‘‘[$80,000’’), high-
est level of education obtained, employment status, and
ethnic/cultural heritage for parent caregivers. Educational
level was later recoded into a binary variable (education
above or below a university coursework level). Due to
the diversity of ethnicities represented, we followed
Leadbitter et al. (2009) in categorizing participants’ eth-
nic/cultural heritage responses as ‘caucasian’ versus ‘non-
caucasian’.
A ‘List of Services’ elicited treatment program histories
including intensive behavioral interventions, speech-lan-
guage, occupational, and physical therapy, and descriptions
of other therapies. Intensive behavioral service descriptions
were subsequently categorized as ‘no services’ versus
‘some services’.
The MacArthur Communicative Development Inven-
tory: Words and Sentences (MCDI) (Fenson et al. 1993) is
a well-studied parent report measure of vocabulary; it is
designed for children aged 16–30 months, but can be used
with older developmentally-delayed children. Total
expressive vocabulary on the MCDI is correlated with
observational data for children with and without language
impairment (Fenson et al. 1993), and for both monolingual
and bilingual typically-developing children (Patterson
2000). MCDI language adaptations (Dale et al. 1993) used
in this study included English (Fenson et al. 1993), Quebec
French (Frank et al. 1997), Spanish (Jackson-Maldonado
J Autism Dev Disord (2012) 42:1342–1352
et al. 2003), Italian (Caselli and Casadio 1995), Hebrew
(Maital et al. 2000), Chinese (Wu 1997), Farsi (Kazemi
et al. 2008), Romanian (Geangu and Benga 2006), and
Tamil (Sethuraman 2008). Children with bilingual expo-
sure histories during the initial screening call were sent all
relevant versions of the MCDI (e.g., English, French, and
Spanish forms if all these languages were heard in the
home).
Scoring for bilinguals followed the procedures outlined
in Pearson et al. (1993) for computing Total Conceptual
Vocabulary (TCV): concepts named in both languages are
mapped to each other so that translation-equivalent word
forms are only counted once even when used in two lan-
guages. Cross-language mappings were developed for this
study for English and French with Chinese, Hebrew, Ital-
ian, Spanish, and Romanian. A ceiling score of 680 con-
cepts (selected to match the ceiling on the English form;
other forms vary between 611 and 680 words) was applied
to the bilingual exposure groups since their TCV scores
could exceed the maximum ceiling available to the MON
group.
The Vineland Adaptive Behavior Scales-Second Edition
(Sparrow et al. 2005) measures skills exhibited in everyday
life. The Receptive and Expressive Communication sub-
domains were appropriate to administer to bilingually-
exposed participants since lower-level items do not directly
reference language-specific content and since all partici-
pants with phrase speech had English or French as their
dominant language; the measure was administered only
once. The Interpersonal subdomain of the VABS-II was
selected as a variable of interest due to its focus on inter-
personal relationships and social skills. Test–retest reli-
ability for the VABS-II has been established: subdomain
reliability coefficients are excellent with most values
exceeding 0.85 (Sparrow et al. 2005).
Procedures
All interested families were screened by phone for eligi-
bility then mailed a questionnaire package including one or
more language versions of the MCDI as well as the SRS,
Language Diary, FBIQ, List of Services, consent forms,
and return postage. In order to evaluate the reliability of the
vocabulary measure, 17 families completed the MCDI
6 weeks after the baseline measurement. The first 16
families also received the VABS-II Parent/Caregiver Rat-
ing Form (Communication and Socialization domains) in
their package. Since mailed VABS-II were often returned
with incomplete information, the remaining 59 families
were administered the VABS-II Survey form by phone by a
trained research assistant. The LEI and ADI-R questions
were administered by a trained research assistant within a
single phone interview.
1347
Statistical Analyses
Group differences on continuous variables were analyzed
using one-way analysis of variance (ANOVA). Significant
ANOVA results were subsequently assessed with post hoc
t tests on any variable with a p value of \0.1 to identify
which group pairings were significant. All categorical data
were examined using chi-square tests of independence.
Post-hoc testing employed chi-square or Fisher exact tests
to identify significant contrasts between paired groups.
Statistical significance was set at the p \ 0.05 level, but
post hoc testing was performed on any variable with a
p value of \0.1 in order to explore trends. Statistical
analyses were performed using SPSS 14.
Six-week test–retest reliability data for the MCDI was
collected and analyzed: the Pearson coefficient of [0.9
corresponded to the test–retest reliability for the same
period reported in the MCDI User’s Guide (Fenson et al.
1993) and supports the use of this measure in a bilingual
population.
Results
Sample characteristics by exposure grouping are presented
in Table 1. Children with simultaneous (SIM) versus
sequential (SEQ) bilingual exposure had significantly dif-
ferent amounts of lifetime bilingual exposure (p \ 0.001)
but similar current bilingual exposure levels on both the
language diary and the last 6–12 month subtotal of the
Lifetime Ratio (LR). SEQ children were significantly more
likely (p = 0.015) than MON to have a minority dominant-
exposure language. Maternal characteristics were similar
across groups except for a difference in mothers’ fluency:
there were significant contrasts in maternal native fluency
in child-directed language(s) between MON and both SIM
(p = 0.002) and SEQ (p = \0.001) mothers, indicating
that bilingual mothers were not always native speakers of
the languages they use with their children. There was a
difference approaching significance in receipt of intensive
behavioral services, with significantly more SEQ compared
to SIM (p = 0.038) children receiving services.
Social and language measures are presented for the
exposure grouping in Table 2.
We had hypothesized that social impairments could
negatively affect language-learning in bilingual environ-
ments for children with ASDs. Prior to examining language
results, both general and specific aspects of social abilities
were compared across groups to verify that these abilities
were evenly distributed in this sample. The only significant
difference between groups was found in the VABS-II
Interpersonal subdomain (VINTP) scale score (F (2,63) =
3.4, p = 0.038), where the SIM group had the highest
123
1348 J Autism Dev Disord (2012) 42:1342–1352

Table 2 Social and language measures by language exposure groups

MON SIM SEQ p values
n = 30 n = 24 n = 21

Current social levels

Social responsiveness scale: T-score 76.2 (13.4) 74.7 (16.1) 80.2 (14.5) 0.455
VABS-II: interpersonal v-scale 10.5 (1.9) 11.1 (2.6) 9.2 (2.5) 0.038
ADI-R 42 (modified): initiation of pointing: % at the highest level 50 54 33 0.337
ADI-R 42 (modified): response to pointing: % at the highest level 20 42 33 0.219
ADI-R 46: attention to voice: % at the highest level 27 38 38 0.909
Expressive vocabulary and language
MCDI: total conceptual vocabulary 352 (220) 407 (253) 299 (256) 0.331
MCDI: words in dominant language 352 (220) 392 (244) 287 (246) 0.326
MCDI: words in second languagea n/a 136 (170) 103 (171) 0.693
VABS-II expressive v-scale 10.7 (3.3) 10.7 (3.3) 9.5 (3.6) 0.427
ADI-R 30: % with scores of 0 73 67 62 0.680
Receptive language
VABS-II receptive v-scale 11.6 (2.8) 11.6 (4.0) 10.0 (3.4) 0.206
ADI-R 29: % with scores of 0 or 1 63 68 65 0.936
Early language milestones
Age of first wordsb 25.3 (9.4) 25.3 (10.4) 27.3 (14.0) 0.809
c
Age of first phrases 34.0 (12.9) 38.4 (11.8) 39.0 (17.0) 0.469
a
SIM n = 16, SEQ n = 12
b
SIM n = 20, SEQ n = 17: non-verbal (n = 2) and unknown age of first words (n = 6) excluded
c
Non-phrase users excluded: MON n = 22, SIM n = 19, SEQ n = 15

scores of the three exposure groups and the SEQ group had
the lowest scores. Post hoc testing revealed significantly
better performance for the SIM group compared to the SEQ
(p = 0.025) group; there was an additional group differ-
ence at the threshold of significance between the MON and
the SEQ (p = 0.052) groups.
Despite the significant group difference on the VINTP,
there were no significant differences on any language vari-
able, although a pattern of performance emerged whereby
SIM and MON consistently scored higher than SEQ chil-
dren. Neither Total Conceptual Vocabulary (TCV) nor
dominant language counts differed significantly between
groups. TCV and dominant language counts were similar
because only 66% of the SIM and 57% of the SEQ children
reported words in a second language: these bilingual children
used many translation-equivalent pairs so their TCV scores
were not raised much beyond their dominant language word
counts. There were no significant differences on the other
expressive and receptive measures. No differences were
noted in the early language milestones data.
Discussion
The results suggest that bilingually-exposed children with
ASDs do not experience additional delays in language
development compared to monolingually-exposed children
with ASDs. In addition, the timing of bilingual exposure
from infancy versus the post-infancy period did not impact
outcomes in the children’s dominant language abilities.
While there may be a perceptual advantage to bilingual
exposure during infancy, and while children with infant
bilingual exposure heard more of their second language
over their lifespan than their sequentially-exposed peers,
there was no difference between the exposure groupings in
dominant language outcomes. Second language outcomes
will be examined in a separate paper.
We had suggested theoretical reasons why children with
ASDs might react to language learning in bilingual envi-
ronments differently than children with SLI and Down
Syndrome, but it appears that children with ASDs are
capable of similar language achievements regardless of
whether their environment is monolingual or bilingual.
Impairments or differences in speech perception, joint
attention, and other foundational skills for language
learning may not produce additional vulnerabilities for
bilingually-exposed children compared to their monolin-
gually-exposed peers with ASDs.
This study documented that some bilingually-exposed
children with ASDs are acquiring bilingual vocabulary in
early childhood: 62% of the bilingually-exposed children
spoke words in a second language, but their second

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J Autism Dev Disord (2012) 42:1342–1352
language vocabularies were much smaller than their dom-
inant language vocabularies, and few children had pro-
gressed to phrase-level speech in a second language. So,
while there does not appear to be any risk related to
bilingual exposure in infancy or early childhood, the ben-
efits of this exposure may not be fully apparent in early
childhood. Parents who wish to maintain a bilingual
environment should be counseled that bilingual acquisition
is an unstudied area for children with ASDs. For example,
we do not know if children with ASDs acquire second
language vocabulary more easily than second language
phonology, morphology, or syntax, but learning across all
these language domains is necessary to become bilingual.
Longitudinal research designs will be critical to under-
standing bilingual acquisition in this population.
Finally, the variety of bilingual experiences and the
types of changes noted in this sample were more diverse
than expected. For example, while some families did dis-
play the commonly-cited pattern of switching from bilin-
gual to monolingual exposure when their children’s
language delays became apparent, many other families
introduced a second language after the age of first con-
cerns. Patterns of language changes and reasons driving
parental decisions will be explored in a separate paper.
However, families of children with language delays may
make a variety of language choices that have not been
described in the literature to date. These choices may be
influenced by parents’ own language abilities, their rights
as immigrants (e.g., French language education is manda-
tory in Quebec for immigrants, but not for families with a
Canadian-born parent whose children can attend English-
language schools), their choices for special education (e.g.,
inclusionary policies in English schools in Quebec vs.
‘exclusionary’ autism class options in French schools), or
childcare options (e.g., family caregivers vs. public child-
care). Clinicians and researchers need to be aware that
bilingual experiences are diverse.
It is important to acknowledge several limitations to this
study. First, the recruitment approach allowed families to
self-select for participation but our large sample of children
encompassed a broad and representative range of experi-
ences and language levels, and the results may be more
generalizable than results from studies which selected
participants based on restricted levels of exposure or verbal
skills. Secondly, the study was designed in order to detect a
mean vocabulary difference of 50 words between groups: it
is possible that a larger sample size would have been able
to detect smaller group differences in vocabulary size or
differences in subgroups, such as within children with
autism versus PDD-NOS. Third, the relationship between
the amount of bilingual exposure and language outcomes
was not examined in this study because most bilingual
families made multiple exposure changes that complicated
1349
quantification attempts. Fourth, we did not analyze cogni-
tive test data although intellectual functioning plays an
important role in the acquisition of language. Finally,
caution should be exerted when evaluating the direction
and causal nature of the results.
This study suggests several directions for research.
Research on bilingualism in children with ASDs must take
into account that there is a longer language acquisition period
and more variable language outcomes for children with
ASDs than for typically-developing children, and that
methodologies based on typical language development may
not be appropriate in this population. Future research on
bilingual experiences in children with special needs could
explore the methodological challenges in grouping bilin-
gually-exposed participants who have language delays.
Next, this study’s findings should be replicated using inde-
pendent assessment measures of language outcomes. Fur-
thermore, it is critical to study how factors such as parental
language fluency and family language choices could affect
children in bilingual environments and potentially influence
child language outcomes, particularly when a child has
language delays. Finally, it would be beneficial to follow
bilingually-exposed children longitudinally in order to
understand the pace and patterns of language growth.
In conclusion, the data suggest that there is no language
delay associated with bilingual exposure for children with
ASDs regardless of whether the children were exposed to
two languages from infancy or from early childhood.
Caregivers should not be discouraged from maintaining
bilingual environments or introducing a second language
where necessary for the child or family, although little is
currently known about the pace of learning or bilingual
achievements for children with ASDs.
Acknowledgments This research was supported by a grant to both
authors from Autism Speaks.
Appendix 1: Language Environment Interview: Script
and Scoring for Language Exposure Questions
The following information was collected for every adult
caregiver who regularly provided more than 5 h per week
of childcare in the home: (a) place of birth, (b) lan-
guage(s) spoken at home, (c) fluency in each language
spoken at home, (d) languages spoken to the child with an
ASD, and (e) reasons for any changes in language(s) spo-
ken to the child. For the fluency assessment (question c),
caregivers were categorized as ‘native-level’ speakers only
if they reported mastery of the language such that they
make no pronunciation, grammar, or vocabulary errors and
would be recognized as a native speaker of the language by
other native speakers. An estimate of language exposure
123
1350
(e.g., % French vs. English input) was recorded for each
6 month period. Finally, the amount of time in childcare
was recorded for each 6 month period: researchers coded
parent childcare hours using the following 3 levels based
on parental employment outside the home: parent not
employed or ‘homemaker’, parent employed 5–15 h per
week, or parent employed [15 h per week. For non-parent
caregivers, hours spent providing childcare were catego-
rized as 5–15 h per week versus [15 h per week.
The following information was collected for childcare in
a group setting or intensive therapy program where mul-
tiple individuals provided care for the child: (a) languages
spoken to the general group of children, (b) languages
spoken directly to the child with an ASD, (c) caregivers’
level of fluency in each language(s) used in the environ-
ment (e.g., ‘‘Were all the daycare workers fluent in
French?’’), and (d) reasons for any changes in lan-
guage(s) spoken to the child. For each 6 month period of
care, language exposure estimates were elicited (e.g., %
French vs. English input) as well as the amount of time the
child spent in that setting (e.g., 5–15 h per week vs. [15 h
per week).
Following the interview, data from each caregiver were
transferred onto a summary score chart for each 6-month
period. An algorithm weighted the exposure estimate data
based on how much time each caregiver likely spent with
the child in direct one-to-one interaction during each
6 month period. For example, exposure from parents with
primary childcare responsibilities (e.g., ‘homemakers’)
received the highest weight (9 points) whereas exposure
through part-time care in a group daycare setting received
the lowest weight (1 point). Points assigned to caregivers
who provided bilingual input were divided across the lan-
guages based on the estimate of usage provided. For
example, from age 36 to 41 months, child A was cared for
by:
1. his mother, who worked 10 h per week: 100% French
input: 6 French points
2. his father, who worked 40 h per week: 100% English
input: 4 English points
3. part-time (15 h per week) daycare: 75% French, 25%
English input, 1.5 French points, 0.5 English points
Points were added for each language (French:
6 ? 1.5 = 7.5 points; English: 4 ? 0.5 = 4.5 points) and
then divided by the total childcare points (12) for that
6 month period to generate a ratio of 62.5% French (7.5/
12) and 37.5% English (4.5/12) exposure. All 6 month
exposure estimates were subsequently averaged into yearly
subtotaled ratios and a summary Lifetime Ratio (LR). The
language that received the highest percentage of lifetime
exposure was designated the child’s dominant exposure
language.
123
J Autism Dev Disord (2012) 42:1342–1352
Appendix 2: Questions from the ADI-R: Scoring
and Modifications
The ADI-R is a semi-structured interview (Le Couteur
et al. 2003). Trained interviewers ask a series of questions
to elicit caregiver descriptions of target behaviors; the
interviewer categorizes each behavior using the coding
schema for each specific question. For complete question
and coding information, please consult the ADI-R manual.
The following overview summarizes the lead questions and
the coding synopses including codes that were merged due
to low cell numbers to facilitate statistical analyses.
Overall level of language (ADI-R #30):
Lead interview question: ‘‘How much speech does
the subject have now?’’
Codes of ‘0’ (functional use of phrases) were con-
trasted against merged codes of ‘1’ (no phrase use but
speech used on a daily basis) and ‘2’ (fewer than 5
words total).
Comprehension of simple language (ADI-R #29):
Lead interview question: ‘‘How much language do
you think s/he understands if you don’t gesture?’’
Codes of ‘0’ (phrase-level comprehension; able to
perform novel requests) and ‘1’ (phrase-level com-
prehension; able to perform familiar requests) were
merged, as were scores of ‘2’ (word-level compre-
hension; [50 words understood) and ‘3’ (word-level
comprehension; \50 words); three scores of ‘4’
(‘little or no word comprehension’) were excluded
from the analyses.
Questions pertaining to pointing (ADI-R #42) were divided
for the interview into separate items for pointing initiation
and response:
Initiation of pointing to express interest (variable ‘42a’):
Lead interview question: Does your child ever
spontaneously point at things around him/her?
Codes of ‘0’ (spontaneous pointing to express interest
in distant objects) were contrasted against merged
codes of ‘1’ (limited use of pointing) and ‘2’ (little to
no pointing).
Response to pointing to express interest (variable ‘42b’)
Lead interview question: When you point at an item
that interests you, does your child turn to look at what
you are pointing at?
Codes of ‘0’ (spontaneous response to pointing) were
contrasted against merged codes of ‘1’ (responds to
points when cued) and ‘2’ (little or no response).
J Autism Dev Disord (2012) 42:1342–1352
Attention to voice (ADI-R #46)
Lead interview questions: If you come into a room
and start talking to your child without calling her/his
name, what does s/he do?
Codes were analyzed in this study as follows: ‘0’
(usually looks up when spoken to), ‘1’ (inconsistent
or brief response when spoken to; may respond to a
firm voice), and merged codes ‘2’ (usually does not
look up without strong cues) and ‘3’ (rarely
responds).
Age of first single words used meaningfully (ADI-R #9)
Lead question: How old was s/he when he first used
words meaningfully, apart from ‘mama’ and ‘dada’?
Single word use was specified as repeated and con-
sistent communicative use of a word other than terms
for parents. Age in months when the milestone was
reached was elicited.
Age of first phrases used meaningfully (ADI-R #10)
Lead question: How old was s/he when s/he first said
something that involved putting words together
meaningfully (i.e., using two word phrases)?
Phrase use was specified as a two word phrase
including a verb; echoed phrases are excluded. Age in
months when the milestone was reached was elicited.
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