American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

State of New Hampshire, Department of Health and Human Services
The New Hampshire Task Force on Autism: Part I Assessment and Interventions

New Hampshire Task Force on Autism. (2001).
(NH): Department of Health and Human Services, 69 pages.

AGREE Rating: Recommended with Provisos

Description:

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

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Hearing - Children identified as potentially having ASD from screening and surveillance should receive an audiologic evaluation to determine the presence or absence of a hearing impairment (p. 17).
    • Assessment Instruments
      • Diagnosis
        • The diagnostic assessment for autism should include an instrument with recognized sensitivity and specificity. Instruments recommended for this purpose include the Childhood Autism Rating Scale (CARS), the Autism Behavior Checklist, the Gilliam Autism Rating Scale (GARS), the Autism Diagnostic Interview-Revised (ADI-R), and the Autism Diagnostic Observation Schedule (ADOS-G) (p. 19).
      • Screening
        • “The Communication and Symbolic Behavior Scales Developmental Profile (CSBS/DP)… may detect a wider range of early language disorders including autism, PDD-NOS, and Asperger syndrome” (p. 18).
        • The CHAT is one tool that is intended to identify children who may have an autism spectrum disorder. While the CHAT “will not easily distinguish children with ASD from children with global developmental delays” (p. 18), it will determine which children need further assessment. The authors also note that the CHAT may not identify children with high-functioning autism or Asperger syndrome (p. 18).
  • Treatment
    • Cognition/Language
      • General Findings
        • The guideline provides several components of effective interventions that have been identified from research findings including but not limited to: beginning services as early as possible, engaging children in active goal-directed activities, ensuring intervention is developmentally appropriate and purposeful, and involving the family (p. 24).
        • “There are numerous approaches to the treatment of ASD and strong opinions about the efficacy of each” (p. 8). “In reviewing the literature and research on ASD, it is clear that there is no one treatment or intervention that works well for all people. However, there are many approaches that are effective and work well for specific individuals” (p. 23).
        • If a developmental or social pragmatic intervention (e.g., floor time/DIR, SCERTS, or the Denver Model) is decided upon, some implementation considerations are suggested such as ensuring that the program is not implemented in the midst of other activities, using these interventions in conjunction with other intervention if direct, skill-based instruction is needed, ensuring adequate provision of training and oversight (p. 30).
      • Applied Behavioral Analysis/Discrete Trial Training - If an applied behavioral analysis intervention is decided upon, the authors provide several implementation considerations including but not limited to ensuring that there is adequate training, time, oversight, and rigor for the program, avoiding punishment that caused pain or shame, ensuring generalization of skills, and focusing on the child’s quality of life (p. 28).
      • Augmentative and Alternative Communication (AAC) - If augmentative and alternative communication (AAC) intervention is decided upon, the authors suggest that the device or system be used in a trial evaluation prior to purchase, recommendations from other users are considered, members of the evaluating team have appropriate knowledge and skills, and the individual receiving AAC is motivated to engage in communication, or that the device is being used to foster interest in communication skills and social interaction (p. 42).
      • Auditory/Sensory Integration Training - When considering auditory integration therapy as an intervention, the following should be considered:
        • the treatment has been recommended for several populations including children with ASD despite insufficient efficacy data;
        • practitioners must be properly trained;
        • parent should be wary of claims that AIT may cure a child from an ASD;
        • there is some evidence that positive effects of AIT are not maintained (p. 40).
        • If the use of sensory integration is decided upon, it is recommended that professionals implementing SI:
        • conduct evaluations in natural environments;
        • be cautious of overstimulation; and
        • ensure a base understanding of theory and adequate training and supervision for all therapists utilizing SI treatment (p. 49).
      • Facilitated Communication - If a decision is made to pursue the use of facilitated communication (FC), it is recommended that:
        • adequate training and supervision be given to FC facilitators;
        • FC guidelines are observed;
        • proof of literacy not be required prior to FC attempts; and
        • FC is not the only communication modality used (p. 44).
      • Gentle Teaching - Considerations for the implementation of Gentle Teaching include directly teaching and supervising caregivers, conducting observations over several months rather than days, and using self-assessment via video review for evaluation (p. 32).
      • Positive Behavior Support - If a Positive Behavioral Supports approach is being considered, the authors provide several recommendations including but not limited to:
        • methods and techniques should not be over-emphasized, rather the individual’s quality of life should be the focus;
        • consideration should be given not only to the individual, but also changes in the individual’s support system;
        • supports should be provided in the home and other natural environments; and
        • adjustments to the plan may be required if results are not evident fairly soon after implementation (p. 34).
      • SCERTS - When considering use of the SCERTS Model, the following recommendations are suggested:
        • adequate provision of the positive supports component of the model;
        • adequate time is allotted to building relationships;
        • those providing the intervention receive appropriate training; and
        • assessment of the individual’s strengths and weaknesses is conducted prior to intervention (p. 36).
      • SON-RISE/OPTIONS - Families considering the use of the Son Rise/Option Program should not plan to use this as a singular approach to intervention and should be fully aware of the cost of intervention and ongoing consultation fees (p. 59).
      • TEACCH - If the TEACCH model is decided upon, the authors recommend that all team members involved in assessment or intervention receive adequate training and supervision, and that data collection is sufficient (p. 38).

Keywords: Autism Spectrum Disorders

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Added to Compendium: November 2011

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