American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

American Speech-Language-Hearing Association
Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders across the Life Span

Wetherby, A., Diehl, S., et al. (2006).
Rockville (MD): American Speech-Language-Hearing Association, 46 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for screening, diagnosis, assessment and treatment of children and adults with autism spectrum disorder (ASD). The target audience of this guideline is speech-language pathologists.  

Recommendations:

  • Assessment/Diagnosis
    • General Findings
      • SLPs are involved in the screening and early identification of children at risk for ASD and must make appropriate referrals to professionals for diagnosis and treatment needs.
      • As mandated by the IDEA (2004), SLPs should determine eligibility for services on an individualized basis, as opposed to using a priori criteria. SLPs in public school settings must determine service eligibility as a team and eligibility should be based on clinical judgment and observational measures (p. 15).
    • Assessment Areas
      • Cognition/Language
        • Children and adults with ASD may require speech-language pathology services to address social communication impairments regardless of age, cognition, and results of formal testing.
        • “SLPs should assess and enhance (a) the initiation of spontaneous communication in functional activities across social partners and settings; (b) the comprehension of verbal and nonverbal discourse in social, academic, and community settings; (c) communication for a range of social functions that are reciprocal and promote the development of friendships and social networks; (d) verbal and nonverbal means of communication, including natural gestures, speech, signs, pictures, written words, as well as other AAC systems; and (e) access to literacy and academic instruction, as well as curricular, extracurricular, and vocational activities” (p. 21).
  • Treatment
    • Cognition
      • General Findings
        • SLPs should work together with families throughout assessment and intervention and should provide counseling, education, training, service coordination, and advocacy to families. It is important for the SLP to consider the impact of cultural, linguistic, and socioeconomic factors that may affect families’ access to and use of services (p. 6).
        • The [National Research Council] (2001) reviewed the empirical research on ASD intervention. They concluded that there are several “critical features” that are active ingredients in effective interventions. SLPs should work collaboratively to integrate these ingredients into educational programs (p. 18). They include:
          • “entry into intervention programs as soon as ASD is suspected” (p. 17);
          • “active engagement in intensive instructional programming for a minimum of 5 hours per day, 5 days per week” (p. 17);
          • “repeated, planned teaching opportunities” (p. 17);
          • “inclusion of a family component, including parent training” (p. 17);
          • “low student: teacher ratios” (p. 17);
          • “mechanisms for ongoing assessment and program evaluation with corresponding adjustments in programming” (p. 17);
          • “six kinds of instruction [listed on p. 17] should take priority for individuals with ASD” (p. 17).
  • Service Delivery
    • Dosage
      • The [National Research Council] (2001) reviewed the empirical research on ASD intervention. They concluded that there are several “critical features” that are active ingredients in effective interventions. SLPs should work collaboratively to integrate these ingredients into educational programs (p. 18). They include:
        • “entry into intervention programs as soon as ASD is suspected” (p. 17);
        • “active engagement in intensive instructional programming for a minimum of 5 hours per day, 5 days per week” (p. 17);
        • “repeated, planned teaching opportunities” (p. 17);
        • “inclusion of a family component, including parent training” (p. 17);
        • “low student: teacher ratios” (p. 17);
        • “mechanisms for ongoing assessment and program evaluation with corresponding adjustments in programming” (p. 17);
        • “six kinds of instruction [listed on p. 17] should take priority for individuals with ASD” (p. 17).
    • Setting
      • “SLPs should provide services in natural learning environments that are connected with functional and meaningful outcomes and only provide pull-out services when repeated opportunities do not occur in the natural environment or to work on functional skills in more focused environments. Because of the limited impact of pull-out services focused on discrete skills, SLPs should ensure that any pull-out services are tied to meaningful, functional outcomes and incorporate activities that relate to the natural environment” (p. 32).
    • Provider
      • SLPs with sufficient knowledge and skills can diagnose ASD independently; however, typically work as members of multidisciplinary diagnostic teams. 

Keywords: Autism Spectrum Disorders

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Added to Compendium: November 2010

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