STIMULATION OF EXECUTIVE FUNCTIONS AS PART OF THE

LANGUAGE INTERVENTION PROCESS IN CHILDREN WITH

AUTISM SPECTRUM DISORDER

DIVISI TUMBUH KEMBANG – PEDIATRI SOSIAL

VERLY HOSEA
AIMS
Identifying effective methods for stimulating language
and communication of children with autism spectrum
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
functional aspects of language and communication through
the assessment of the functional communicative profile and
social-cognitive performance
METHODS
Twenty children, aged 5–12 years, with a diagnosis of ASD
participated in the study. Two stimulation programs were
offered over a 10- to 12-week period as part of the regular
services offered to these children through a University’s
speech and language therapy outpatient clinic in São Paulo,
Brazil. Children either received SEF intervention in their
home implemented by their parent/s, with close monitoring
by the speech-language pathologist (SLP) (group 1), or they
received SEF by the SLP during regular speech-language
therapy individual sessions (group 2)
RESULTS

The findings suggested that there were differences between

the children’s pre- and posttest performance. Significantly
different performances were observed in the areas of
occupation of communication space, proportion of
communicative interactivity, and social-cognitive
performance.
CONCLUSION

The inclusion of activities to stimulate executive function

abilities in language intervention for children with ASD
warrants further investigation.
INTRODUCTION
• Identifying effective methods for stimulating language
and communication in children with ASD is fundamental
• The close association between language development and
executive functions (EFs) has been studied for decades
regarding specific aspects, such as meta-representation
and syntactic awareness in children with ASD and
Asperger syndrome. However, it is still not clear if there is
a causal relationship between them.
INTRODUCTION
• EFs are understood as the ability to manage the mental
processes that organize, control, program, and monitor
perceptual and motor information already stored in
memory
Specifically, we aimed to observe if the inclusion of tasks
• involving
StemmerEFs andinWhitaker suggest
the language that EFs include
intervention processthe
with
abilities
children of
withself-control,
autism mayworking memory,
be beneficial cognitiveby
as observed
flexibility,
improved and centralincoherence
performance areas of functional communicati
on and SCP planning, executing
• The abilities of goal identification,
goal-directed plans, and effective performance are
components of Efs
• Other researchers have found that EF impairments are
associated with language deficits intrinsic to ASD
METHODS
• The study was conducted at the Communication Sciences
and Disorders Program of the School of Medicine,
Universidade de São Paulo, Brazil.
• The research was approved by the institution’s ethics
committee, and a parent or caretaker of each participant
signed the approved consent form.
• The research used a quasi-experimental design, where
each participant was his/her own control, by comparing
different “moments” (pre- and postintervention
assessments) of the intervention process within the same
participants
PARTICIPANTS

• There were 24 students between 5 and 12 years with ASD

enrolled in an outpatient language service, but 4 children
did not complete the intervention, so the data presented
are for 20 children who completed the planned
intervention.
PROCEDURES
• All participants were assessed regarding the FCP
(functional communicative profile)
The SCP assessment and
identified thethe SCPbest
child’s (social-
cognitive performance) in the pre- and postintervention
performance in 7 different areas: gestural commu
periods implemented.
nicative intent, vocal communicative intent, gestu
ral imitation, vocal imitation, tool use,
combinatory play, and symbolic play
PROCEDURES
Group 1: Group 2:
6 children received stimulation 14 children received SEF during
• The children attending
of executive functions (SEF) the outpatient clinic formed 2
individual weekly language
groups.
exclusively conducted by their therapy sessions with the SLP for
parents, at home, over a 10- a 12-week period. Parents were
week period. During this period, asked to engage in follow-up
parents and therapists made activities demonstrated by the
systematic contact (by phone, SLP at home
WhatsApp, or Skype) to report
the children’s progress, solve
problems, or discuss necessary
small changes in the activities
proposed
PROCEDURES

• The SEF program involved the use of game activities to

facilitate the child’s cognitive flexibility, operational
memory, inhibitory control, and central coherence.
RESULTS
• The statistical analysis focused on the interaction of data
between pretest and posttest assessments
• The aim was not to focus on comparing the effects of the
2 interventions on the children. Rather, the focus was on
exploring the effect of an individual intervention in each
one of the groups
RESULTS

Improvement in FCP was identified as an increase in the number of

communicative acts expressed per minute, change toward balance in the
occupation of the communicative space, proportion of communication
interactivity, and increase in the use of verbal communicative means.
Regarding the SCP, the improvement was identified by the increased scores in
each of the 7 areas observed.
RESULTS

Regarding the performance of participants in group 1, the results of ANOVA

(confirmed by the Tukey-Test) show different performances before and after the
intervention period in the proportion of communication interactivity (p = 0.03)
and in total SCP (p = 0.01).
RESULTS

In group 2, a significant difference was observed only for the variable of

occupation of communicative space (p = 0.001).
These results were also confirmed by the Tukey test.
RESULTS

The nonparametric analysis of both groups combined identified significant

differences between both groups before and after intervention in the proportion
of communication interactivity.
DISCUSSION
• This study explored the potential benefit of SEF interven
tion for children with ASD
• Exploring intervention alternatives with children with ASD
that include parents, caretakers, and/or other familiar
adults has been shown to be an effective method to
improve the quality of the language and social interaction
abilities
• In the present study, all parents reported that they
observed that their children’s communication skills
improved in the areas of communication intentionality
and turn taking in conversations and increased in their
oral vocabulary
CONCLUSION
• The results show that SEF had a positive effect on skills
measured by the FCP and SCP
• One of the most relevant limitations of this study is the
small number of participants, particularly in the
intervention that required parents to be more actively
involved in the home intervention
• This continues to be a challenge for future studies to
address
 Telaah kritis jurnal :
STIMULATION OF EXECUTIVE FUNCTIONS AS PART OF THE LANGUAGE INTERVENTION
PROCESS IN CHILDREN WITH AUTISM SPECTRUM DISORder
I. UMUM
No HAL YANG CHECK LIST PENILAIAN YA TIDAK
DINILAI

1 Judul Makalah a. Apakah judul tidak terlalu panjang atau 

pendek?
b. Apakah judul menggambarkan isi 
utama penilaian?
c. Apakah judul cukup menarik?
d. Apakah judul menggunakan singkatan 
selain yang baku? 

2 Abstrak a. Apakah merupakan abstrak satu  Satu paragraf

paragraf, atau abstrak terstruktur?
b. Apakah sudah tercakup komponen
IMRAC (Introduction, methods, Results,

Conclusion?)
c. Apakah secara keseluruhan abstrak
informatif? 
d. Apakah abstrak lebih dari 250 kata?

225 kata
3 Pendahuluan a. Apakah mengemukakan alasan dilakukannya 
penelitian?

b. Apakah menyatakan hipotesis atau tujuan

Hipotesis tidak
penelitian?
ada,
Tujuan ada
c. Apakah pendahuluan didukung oleh pustaka 
yang kuat & relevan?
4 Metode a. Apakah disebutkan desain, tempat & waktu  ( kecuali waktu
penelitian? penelitian)

b. Apakah disebutkan populasi sumber

(populasi terjangkau)?

c. Apakah kriteria pemilihan (inklusi & eksklusi)
dijelaskan?

d. Apakah cara pemilihan subjek (teknik
sampling) disebutkan? 
e. Apakah perkiraan besar sampel disebutkan &
disebut pula alasannya? 

f. Apakah perkiraan besar sampel dihitung

dengan meggunakan rumus yang sesuai?

 g. Apakah observasi, pengukuran, serta 
intervensi dirinci sehingga orang lain
dapat mengulanginya?
h. Bila teknik pengukuran tidak dirinci,
apakah disebutkan rujukannya?
i. Apakah definisi istilah & variabel penting 
dikemukakan?
j. Apakah ethical clearance diperoleh? 
k. Apakah disebutkan rencana analisis,
batas kemaknaan & power penelitian?


5 Hasil a. Apakah disertakan tabel deskripsi subjek 

penelitian?
b. Apakah karakteristik subjek yang penting
(data awal) dibandingkan

kesetaraannya?
c. Apakah dilakukan uji hipotesis untuk
kesetaraan ini? 
d. Apakah disebutkan jumlah subjek yang
diteliti? 
 e. Apakah dijelaskan subyek yang drop 
out dengan alasannya?
f. Apakah semua hasil di dalam tabel 
disebutkan dalam naskah?
g. Apakah semua outcome yang penting
disebutkan dalam hasil? 
h. Apakah subyek yang drop out 
diikutkan dalam analisis?
i. Apakah disertakan hasil uji statistik 
(x2,t) derajat kebebasan (degree of
freedom), dan nilai p?
j. Apakah dalam hasil disertakan

komentar & pendapat?

6 Diskusi a. Apakah semua hal yang relevan

dibahas? 
b. Apakah dibahas keterbatasan
penelitian, dan kemungkinan

dampaknya terhadap hasil?
c. Apakah disebutkan kesulitan penelitian,
penyimpangan dari protokol, dan 
kemungkinan dampaknya terhadap hasil?

d. Apakah pembahasan dilakukan dengan

meghubungkannya dengan teori dan hasil
penelitian terdahulu? 

e, Apakah dibahas hubungan hasil dengan

praktek klinis?

f. Apakah disertakan kesimpulan utama
penelitian?

g. Apakah kesimpulan didasarkan pada data 

penelitian?

h. Apakah efek samping dikemukakan dan
dibahas?

c. Apakah disebutkan hasil tambahan 

selama diobservasi?

d. Apakah disebutkan generalisasi hasil 

penelitian?

e. Apakah disertakan saran penelitian
selanjutnya, dengan anjuran metodologis
yang tepat?

 II. KHUSUS
VIA (Validity, Important, Aplicability)
I. Validity

1. Apakah awal penelitian didefinisikan dengan jelas ? ya dikatakan

bahwa untuk mengidentifikasi metode yang efektif untuk menstimulasi
kemampuan komunikasi dan bahasa pada anak yang menderita
gangguan spectrum autism (GSA)

2. Apakah menyatakan desain penelitian dengan jelas ? Desain studi kuasi

-eksperimental terhadap 24 anak dengan usia 5-12 tahun yang
menderita GSA.

3. Apakah pembanding dinyatakan dengan jelas ? Ya, Penelitian ini memb

andingkan hasil Stimulation of Executive Function (SEF) dimana pada k
elompok 1 dilakukan oleh orang tua dengan pemantauan ketat oleh ahli
patologi bahasa-wicara dan pada kelompok 2 dilakukan oleh ajli patolog
i bahawa-wicara pada saat di klinik rawat jalan.
 II. KHUSUS
VIA (Validity, Important, Aplicability)

4. Apakah kelompok-kelompok yang dibandingkan sebanding pada tahap

awal penelitian ? Ya sebanding dimana kelompok yang dibandingkan m
erupakan anak-anak usia 5-12 tahun yang menderita GSA.

5. Apakah follow up dilakukan secara memadai ? Ya, Follow up dilakukan

untuk menilai adanya keberhasilan dalam stimulasi terhadap kemampu
an bicara
 II. KHUSUS
VIA (Validity, Important, Aplicability)
II. Important
1. Apakah outcome /hasil dipaparkan secara jelas (hasil uji statistic denga
n hasil nilai P)? Ya, dikatakan bahwa adanya peningkatan perkembanga
n pada grup 1 dan grup 2 dilihat dari Functional Communicative Profile (
FCP) dan Social-Cognitive Performance (SCP) dimana grup 2 memiliki s
kor yang lebih tinggi.
 II. KHUSUS
VIA (Validity, Important, Aplicability)

Pada grup 1 terdapat perbedaan bermakna dari kemampuan komunikasi yang

interaktif dengan (p=0,03) dan total SCP (p = 0,01).
Pada grup 2 terdapat perbedaan pada komunikasi okupasi (p = 0.001).
Pada grup 1 dan 2 terdapat perbedaan bermakna dari kemampuan komunikasi
yang interaktif
 II. KHUSUS
VIA (Validity, Important, Aplicability)
III. Aplicability

1. Apakah karakteristik pasien kita mirip dengan subyek yang diteliti ? Ya

dimana anak dengan GSA memiliki karakteristis yang sama dengan
yang diteliti

2. Apakah metode pemeriksaan tersedia dan terjangkau oleh pasien kita?

Tidak, dimana terapi wicara yang dilakukan di RSWS dengan metode
play-therapi dan mengatasi kelemahan organ-organ articular.
TERIMAKASIH