SOCIO-COMMUNICATION SKILL DEFICITS IN AUTISM SPECTRUM DISORDER IN EARLY CHILDHOOD: A THEMATIC LITERATURE REVIEW AND EVIDENCE-BASED INTERVENTION STRATEGIES FOR SPEECH-LANGUAGE THERAPISTS AND CAREGIVERS IN MULTILINGUAL AND LOW-RESOURCE CONTEXTS

George Morara Anyona, Jeniffer Nduku Kioko, Mary Mukami Waithaka, George Mathenge Wairungu

Abstract


Autism spectrum disorder is a lifelong neurological condition that interferes with socio-communication skills of an individual. It is also characterized by repetitive and restrictive activities or/and interests. Socio-communication deficits are a hallmark feature of the condition and are particularly consequential during early childhood, a critical period for language and social development. This systematic thematic review synthesizes empirical evidence from over 35 peer-reviewed studies published in high-impact international journals to examine common socio-communication skill deficits in young children with ASD and evidence-based intervention strategies appropriate for speech-language therapists and caregivers, with specific attention to multilingual and low-resource contexts. Drawing on diagnostic frameworks from DSM-IV-TR and DSM-5, the review highlights deficits in joint attention, social reciprocity, pragmatic language, nonverbal communication, and social cognition. Intervention approaches reviewed include Naturalistic Developmental Behavioral Interventions, pragmatic language therapy, caregiver-mediated interventions, peer-mediated approaches, and augmentative and alternative communication. Critical synthesis identifies areas of consensus, methodological limitations, research gaps in African and multilingual settings, and implications for clinical practice and future research. Findings underscore the need for culturally responsive, family-centered, and contextually adaptable socio-communication interventions in early childhood.

Keywords


Autism spectrum disorder; socio-communication deficits; early childhood; speech-language therapy; caregiver-mediated intervention; multilingual contexts

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References


Alzrayer, N. M., Aldabas, R., Alhossein, A., & Alharthi, H. (2021). Naturalistic teaching approach to develop spontaneous vocalizations and augmented communication in children with autism spectrum disorder. Augmentative and alternative communication (Baltimore, Md. : 1985), 37(1), 14–24. https://doi.org/10.1080/07434618.2021.1881825

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.; DSM–IV–TR).Retrieved from https://img3.reoveme.com/m/2ab8dabd068b16a5.pdf

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). Retrieved from https://apastyle.apa.org/products/publication-manual-7th-edition

American Speech-Language-Hearing Association. (2020). Roles and responsibilities of speech-language pathologists in early intervention. ASHA.

Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21(1), 37–46. https://doi.org/10.1016/0010-0277(85)90022-8

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Buttery, S. C., Philip, K. E. J., Alghamdi, S. M., Williams, P. J., Quint, J. K., & Hopkinson, N. S. (2022). Reporting of data on participant ethnicity and socioeconomic status in high-impact medical journals: A targeted literature review. BMJ Open, 12(8), e064276. https://doi.org/10.1136/bmjopen-2022-064276

Cao, Y., Chen, R. C., & Katz, A. J. (2024). Why is a small sample size not enough? The Oncologist, 29(9), 761–763. https://doi.org/10.1093/oncolo/oyae162

Chang, Y. C., & Locke, J. (2016). A systematic review of peer-mediated interventions for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 27, 1–10. https://doi.org/10.1016/j.rasd.2016.03.010

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Sciences, 16(4), 231–239. https://doi.org/10.1016/j.tics.2012.02.007

Cisneros-Franco, J. M., Voss, P., Thomas, M. E., & de Villers-Sidani, E. (2020). Critical periods of brain development. In Handbook of Clinical Neurology (Vol. 173, pp. 75–88). Elsevier. https://doi.org/10.1016/B978-0-444-64150-2.00009-5

Constantino, J. N., et al. (2018). Autism-related variation in reciprocal social behavior: Longitudinal stability and change from childhood through early adulthood. Child Development, 89(5), 2003–2018. https://doi.org/10.1111/cdev.13170

Davenport, M., Mazurek, M., Brown, A., & McCollom, E. (2018). A systematic review of cultural considerations and adaptation of social skills interventions for individuals with autism spectrum disorder. Research in Autism Spectrum Disorders, 52, 23–33. https://doi.org/10.1016/j.rasd.2018.05.003

Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23. Retrieved from https://doi.org/10.1542/peds.2009-0958

Montagut, M., Crespo S., Pastor, G., & D'Ocon A. (2022). Joint Attention and Its Relationship w.ith Autism Risk Markers at 18 Months of Age. Children (Basel). 13;9(4):556. doi: 10.3390/children9040556. PMID: 35455600; PMCID: PMC9027970.

Deniz, E., Francis, G., Torgerson, C., & Toseeb, U. (2022). Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol. PloS one, 17(8), e0270153. https://doi.org/10.1371/journal.pone.0270153

Divan, G., Vajaratkar, V., Desai, M. U., Strik-Lievers, L., & Patel, V. (2015). Challenges, coping strategies, and unmet needs of families with a child with autism spectrum disorder in low-resource settings: A qualitative study. Autism, 19(4), 421–428. https://doi.org/10.1177/1362361314527639

Dong, X., Burke, M. D., Ramirez, G., Xu, Z., & Bowman-Perrott, L. (2023). A meta-analysis of social skills interventions for preschoolers with or at risk of early emotional and behavioral problems. Behavioral Sciences, 13(11), 940. https://doi.org/10.3390/bs13110940

Duvall, L., May, K. E., Waltz, A., & Kana, R. K. (2023). The neurobiological map of theory of mind and pragmatic communication in autism. Social Neuroscience, 18(4), 191–204. https://doi.org/10.1080/17470919.2023.2242095

Edgar, T. C., Schlosser, R., & Koul, R. (2024). Effects of an augmentative and alternative communication intervention package on socio-communicative behaviors between minimally speaking autistic children and their peers. American Journal of Speech-Language Pathology, 33(4), 1619–1638. https://doi.org/10.1044/2024_AJSLP-23-00313

Elmquist, M., et-al (2025). Caregiver-Implemented AAC Interventions for Children with Intellectual or Developmental Disabilities: a Systematic Review. Rev J Autism Dev Disord. 12(2):290-310. doi: 10.1007/s40489-023-00394-2. Epub 2023 Jul 28. PMID: 40893926; PMCID: PMC12393822.

Falzarano, F., Moxley, J., Pillemer, K., & Czaja, S. J. (2022). Family matters: Cross-cultural differences in familism and caregiving outcomes. The Journals of Gerontology: Series B, 77(7), 1269–1279. https://doi.org/10.1093/geronb/gbab160

Franz, L., Chambers, N., von Isenburg, M., & de Vries, P. J. (2017). Autism spectrum disorder in sub-Saharan Africa: A comprehensive scoping review. Autism Research, 10(5), 723–749. https://doi.org/10.1002/aur.1766

Fuller, E. A., & Kaiser, A. P. (2020). The Effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum Disorder: A Meta-analysis. Journal of autism and developmental disorders, 50(5), 1683–1700. https://doi.org/10.1007/s10803-019-03927-z

Gibson, J. L., Pritchard, E., & de Lemos, C. (2021). Play-based interventions to support social and communication development in autistic children aged 2–8 years: A scoping review. Autism & Developmental Language Impairments, 6. https://doi.org/10.1177/23969415211015840

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26(2), 91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x

Guler, J., de Vries, P. J., Seris, N., Shabalala, N., & Franz, L. (2018). The importance of context in early autism intervention: A qualitative South African study. Autism, 22(8), 1005–1017. https://doi.org/10.1177/1362361317716604

Gulsrud, A. C., Jahromi, L. B., & Kasari, C. (2016). Longitudinal follow-up of joint attention and play intervention: JASPER in community settings. Autism Research, 9(4), 411–419. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3338205/

Gunning, C., Breathnach, Ó., Holloway, J., et al. (2019). A systematic review of peer-mediated interventions for preschool children with autism spectrum disorder in inclusive settings. Review Journal of Autism and Developmental Disorders, 6, 40–62. https://doi.org/10.1007/s40489-018-0153-5

Hampton, S., Rabagliati, H., Sorace, A., & Fletcher-Watson, S. (2017). Autism and bilingualism: A qualitative interview study of parents’ perspectives and experiences. Journal of Speech, Language, and Hearing Research, 60(2), 435–446. https://doi.org/10.1044/2016_JSLHR-L-15-0348

Hampton, L. H., & Kaiser, A. P. (2016). Intervention effects on spoken-language outcomes for children with autism: A systematic review and meta-analysis. Journal of Intellectual Disability Research, 60(5), 444–463. https://doi.org/10.1111/jir.12283

Hariton, E., & Locascio, J. J. (2018). Randomised controlled trials—the gold standard for effectiveness research: Study design: randomised controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 125(13), 1716. https://doi.org/10.1111/1471-0528.15199

Howlin, P., Magiati, I., & Charman, T. (2014). Systematic review of early intensive behavioral interventions for children with autism. American Journal on Intellectual and Developmental Disabilities, 119(1), 23–43. https://doi.org/10.1352/1944-7558-119.1.23

Ingersoll, B., Wainer, A., Berger, N. I., Pickard, K., & Bonter, N. (2016). Toward a more scalable approach to early autism intervention: Supporting development through parent engagement. Autism, 20(2), 176–185.

Kaiser, A. P., & Roberts, M. Y. (2013). Parents as communication partners: An evidence-based strategy for improving parent support for language and communication in everyday settings. Perspectives on Language Learning and Education, 20(3), 96–111. https://doi.org/10.1044/lle20.3.96

Karp, N. A., Sharpe, A., & Phillips, B. (2024). Preclinical pilot studies: Five common pitfalls and how to avoid them. Laboratory Animals, 58(5), 481–485. https://doi.org/10.1177/00236772241244519

Kasari, C., Lawton, K., Shih, W., Barker, T. V., Landa, R., Lord, C., Orlich, F., King, B., Wetherby, A., & Senturk, D. (2014). Caregiver-mediated intervention for low-resourced preschoolers with autism: A randomized controlled trial. Pediatrics, 134(1), e72–e79. https://doi.org/10.1542/peds.2013-3229

Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2014). Long-term outcomes of joint attention intervention for children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 53(6), 623–631.

Katz, E., & Girolametto, L. (2015). Peer-mediated intervention for pre-schoolers with ASD: Effects on responses and initiations. International Journal of Speech-Language Pathology, 17(6), 565–576. https://doi.org/10.3109/17549507.2015.1024166

Koegel, R. L., Ashbaugh, K., & Koegel, L. K. (2014). Pivotal response intervention and autism. In J. Matson (Ed.), Handbook of behavioral interventions in autism spectrum disorder (pp. 135–151). Springer. https://doi.org/10.1007/978-3-319-30925-5_4

Kuhl, P. K. (2011). Early language learning and literacy: Neuroscience implications for education. Mind, Brain, and Education, 5(3), 128–142. https://doi.org/10.1111/j.1751-228X.2011.01121.x

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage. Retrieved from https://us2.sagepub.com/en-us/nam/book/naturalistic-inquiry

Maenner, M. J., Shaw, K. A., Bakian, A. V., et al. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, United States, 2020. Morbidity and Mortality Weekly Report, 72(2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1

Mahoney, G., & Perales, F. (2016). Relationship interventions for children with autism spectrum disorders: A synthesis of research from 1980–2014. Developmental Review, 39, 181–207.

Marsiglia, F. F., & Booth, J. M. (2015). Cultural adaptation of interventions in real practice settings. Research on Social Work Practice, 25(4), 423–432. https://doi.org/10.1177/1049731514535989

Milella, F., Minelli, E. A., Strozzi, F., & Croce, D. (2021). Change and innovation in healthcare: Findings from literature. ClinicoEconomics and Outcomes Research, 13, 395–408. https://doi.org/10.2147/CEOR.S301169

Mundy, P., et al. (2007). A review of joint attention and social–communication deficits in autism. Journal of Autism and Developmental Disorders.

Mundy, P., & Neal, R. (2001). Neural plasticity, joint attention, and a transactional social-orienting model of autism. In International Review of Research in Mental Retardation (Vol. 23, pp. 139–168). https://doi.org/10.1016/S0074-7750(01)80006-9

Muthiga, M., Mbwayo, A., Kang’ethe, R., et al. (2025). Pathways and delays in the diagnosis of autism spectrum disorder in Kenya: A cross-sectional study from tertiary hospitals in Nairobi. Child and Adolescent Psychiatry and Mental Health, 19, 114. https://doi.org/10.1186/s13034-025-00916-2

Nevill, R. E., Lecavalier, L., & Stratis, E. A. (2018). Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder. Autism, 22(2), 84–98. https://doi.org/10.1177/1362361316677838

Nyström, P., Thorup, E., Bölte, S., & Falck-Ytter, T. (2019). Joint attention in infancy and the emergence of autism. Biological Psychiatry, 86(8), 631–638. https://doi.org/10.1016/j.biopsych.2019.05.006

Newton, C. R. (2020). Research and open access from low- and middle-income countries. Developmental Medicine & Child Neurology, 62(5), 537. https://doi.org/10.1111/dmcn.14513

Norbury, C. F., & Sparks, A. (2013). Difference or disorder? Cultural issues in understanding neurodevelopmental disorders. Developmental Psychology, 49(1), 45–58. https://doi.org/10.1037/a0027446

O’Dwyer, C., Twomey, C., Davis, B., Sharry, J., Brosnan, E., & Carr, A. (2025). Parents Plus systemic, solution-focused parent training programs: An updated systematic review and meta-analysis. Family Process, 64(2), e70049. https://doi.org/10.1111/famp.70049

Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), 89. https://doi.org/10.1186/s13643-021-01626-4

Parsons, L., Cordier, R., Munro, N., & Joosten, A. (2019). A Randomized Controlled Trial of a Play-Based, Peer-Mediated Pragmatic Language Intervention for Children With Autism. Frontiers in psychology, 10, 1960. https://doi.org/10.3389/fpsyg.2019.01960

Parsons, L., Cordier, R., Munro, N., & Joosten, A. (2020). Peer's pragmatic language outcomes following a peer-mediated intervention for children with autism: A randomised controlled trial. Research in developmental disabilities, 99, 103591. https://doi.org/10.1016/j.ridd.2020.103591

Parsons, L., Cordier, R., Munro, N., Joosten, A., & Speyer, R. (2017). A systematic review of pragmatic language interventions for children with autism spectrum disorder. PLOS ONE, 12(4), e0172242. https://doi.org/10.1371/journal.pone.0172242

Pickles, A., Le Couteur, A., Leadbitter, K., et al. (2016). Parent-mediated social communication therapy for young children with autism (PACT): Long-term follow-up of a randomised controlled trial. The Lancet, 388(10059), 2501–2509. https://doi.org/10.1016/S0140-6736(16)31229-6

Polónyiová, K., Kruyt, J., & Ostatníková, D. (2024). To the roots of theory of mind deficits in autism spectrum disorder: A narrative review. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-024-00457-y

Presnyakova, Y. V., & Men, E. E. (2025). Peer-mediated interventions in autism: Methodology for developing social-communication groups. Autism and Developmental Disorders, 23(3), 44–52. https://doi.org/10.17759/autdd.2025230305

Quinde-Zlibut, J., et al. (2021). Empathy and prosociality in young children with ASD: The role of social interactions and early psychopathology. Journal of Autism and Developmental Disorders.

Rinaldi, S., Caselli, M. C., Cofelice, V., et al. (2021). Efficacy of the treatment of developmental language disorder: A systematic review. Brain Sciences, 11(3), 407. https://doi.org/10.3390/brainsci11030407

Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta-analysis. American Journal of Speech-Language Pathology, 20(3), 180–199. https://doi.org/10.1044/1058-0360(2011/10-0055)

Rogers, S., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement (1st ed.). Guilford Press. Retrieved from https://psycnet.apa.org/record/2010-03916-000

Roselló, B., Berenguer, C., Baixauli, I., García, R., & Miranda, A. (2020). Theory of mind profiles in children with autism spectrum disorder: Adaptive/social skills and pragmatic competence. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.567401

Roth, F. P., & Worthington, C. K. (2016). Treatment resource manual for speech-language pathology (5th ed.). Cengage Learning. Retrieved from https://www.pluralpublishing.com/publications/treatment-resource-manual-for-speech-language-pathology-1

Saban, R., Avni, E., Ben, E., Zachor, D. A. (2023) Relationship between Parental Concerns about Social-Emotional Reciprocity Deficits and Their Children's Final ASD Diagnosis. Children (Basel). 6;10(11):1786. doi: 10.3390/children10111786. PMID: 38002877; PMCID: PMC10670729.

Sanjuán, M., Navarro, E., & Calero, M. D. (2023). Caregiver training: Evidence of its effectiveness for cognitive and functional improvement in older adults. Journal of Clinical Nursing, 32(5–6), 736–748. https://doi.org/10.1111/jocn.16301

Saul, J., Griffiths, S., & Norbury, C. F. (2023). Prevalence and functional impact of social (pragmatic) communication disorders. Journal of Child Psychology and Psychiatry, 64(3), 376–387. https://doi.org/10.1111/jcpp.13705

Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism. American Journal of Speech-Language Pathology, 17(3), 212–230. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK76412/

Schreibman, L., Dawson, G., Stahmer, A. C., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8

Shic, F., Bradshaw, J., & Klin, A. (2021). Early social communication development in infants with autism spectrum disorder. Child Development, 92(6), 2224–2239. https://doi.org/10.1111/cdev.13606

Sigman, M., Mundy, P., Sherman, T., & Ungerer, J. (2004). Social interactions, joint attention, and developmental outcomes in autism. Journal of Autism and Developmental Disorders, 24(2), 115–135.

Siller, M., & Sigman, M. (2008). Model of parent–child engagement as a predictor of language development in children with autism. Journal of Autism and Developmental Disorders, 38(8), 1403–1414.

Silva, C. C., Presseau, J., van Allen, Z., et al. (2024). Effectiveness of interventions for changing more than one behavior at a time to manage chronic conditions: A systematic review and meta-analysis. Annals of Behavioral Medicine, 58(6), 432–444. https://doi.org/10.1093/abm/kaae021

Tager-Flusberg, H., Paul, R., & Lord, C. (2020). Language and communication in autism. In F. R. Volkmar (Ed.), Autism and pervasive developmental disorders (3rd ed., pp. 335–364). Cambridge University Press. https://doi.org/10.1017/9781108339513

Turner, A., Langley, K., & Jones, C. R. G. (2022). Understanding stigma in autism: A narrative review and theoretical model. Autism in Adulthood, 4(1), 76–91. https://doi.org/10.1089/aut.2021.0005

Witherow, M. A., Diawara, N., Keener, J., Harrington, J. W., & Iftekharuddin, K. M. (2024). Pilot study to discover candidate biomarkers for autism based on perception and production of facial expressions. arXiv. https://arxiv.org/abs/2404.16040

Wong, C., et al. (2016). Joint attention interventions for children with autism spectrum disorder: A systematic review and meta-analysis. Autism Research, 9(2), 239–250.

Wong, C., Odom, S. L., Hume, K. A., et al. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. https://doi.org/10.1007/s10803-014-2351-z

Ye, L., Liu, L., Lv, et al. (2021). The gestures in 2–4-year-old children with autism spectrum disorder. [Journal not provided]. https://pmc.ncbi.nlm.nih.gov/articles/PMC7875888/

Zajac, D. M., et al. (2020). Pragmatic language in children and adolescents with autism spectrum disorder: Mediating role of theory of mind and executive functions. [Journal details not provided].

Zhang, B., Liang, S., Chen, J., et al. (2022). Effectiveness of peer-mediated intervention on social skills for children with autism spectrum disorder: A randomized controlled trial. Translational Pediatrics, 11(5), 663–675.

Zhou, P. S., & Matlakala, F. K. (2024). Challenges faced by caregivers raising children left by deported migrant parents in Johannesburg, South Africa. Cogent Social Sciences, 10(1). https://doi.org/10.1080/23311886.2024.2358152

Zsiga, E. C., Boyer, O. T., & Kramer, R. (Eds.). (2014). Languages in Africa: Multilingualism, language policy, and education. Georgetown University Press. http://www.jstor.org/stable/j.ctt13x0dmp




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