Managing interactional breakdowns with children with ASD: Therapists' practices when directives face challenges in therapeutic interactions.

This study watched how speech therapists work with autistic children during therapy sessions. Researchers recorded over 200 hours of real therapy sessions with seven children. They found that therapy works better when therapists: notice and use the child's own way of communicating (like repeated words or sounds), change how they give instructions based on what works for each child, and pay attention to timing when taking turns in conversation. The research suggests therapists should learn about each child's unique communication style to make therapy more effective.

This conversation analysis study examined how speech and language therapists manage interactional breakdowns when working with children with autism spectrum disorder (ASD). Researchers analyzed over 200 hours of naturally occurring therapeutic interactions between seven Mandarin-speaking children with ASD and their therapists, focusing on 1062 directive turns and subsequent responses. The study identified three key therapeutic strategies: recognizing and utilizing children's unique interactive modes including repetitive utterances and prosodic patterns; flexibly adapting directive formats through verbal iteration and embodied solicitation; and strategic timing to enhance turn-taking opportunities. The findings suggest that incorporating interaction profiling into assessments and interventions, while adapting approaches to align with children's unique communication patterns, can enhance therapeutic effectiveness.

Speech and language therapists should incorporate interaction profiling into assessments and interventions. Practitioners should adapt their directive approaches to align with each child's unique communication patterns, including recognizing repetitive utterances as meaningful communication. Strategic timing and flexible adaptation of instruction formats may enhance therapeutic engagement and outcomes for children with ASD.

The study focused on Mandarin-speaking children, which may limit generalizability to other languages and cultures. Sample size details were not provided in the abstract. The observational nature of conversation analysis, while providing rich qualitative data, may limit statistical generalizability of findings.

Effective interventions to promote language competence, cognitive abilities and integrate these skills into daily activities for children with autism spectrum disorder (ASD) often involve providing guidance and training through specific tasks, typically delivered by speech and language therapists through directive interactions. However, engaging children with ASD in such activities is not straightforward and often fraught with challenges. Yet we know very little about how practitioners cope when the interaction breaks down, for example, due to misunderstandings or failures to engage. This study employs a conversation analytic approach to uncover therapists' intricate practices for managing breakdowns in therapeutic interactions.

Over 200 hours of naturally occurring interactions between seven Mandarin-speaking children and their therapists were recorded and analysed. Using Conversation Analysis, we identified and analysed 1062 directive turns issued by therapists and subsequent responses of the children. The findings are in three aspects: 1) A crucial and effective premise for increasing engagement and improving the quality of therapeutic interactions lies in recognising, ascribing and utilising the specific interactive modes of children with ASD, including their repeated utterances and prosodic resources. 2) Therapists' strategies are successful when they flexibly address and adapt the format of directives through tailored verbal iteration and embodied solicitation. 3) The importance of timing underscores the increased opportunities to positively influence turn-taking in children with ASD. It is proposed that practitioners can enhance their understanding of children with ASD by incorporating the profiling of interaction into their assessments and interventions, adapting ways to align with the unique patterns of children with ASD.