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by Rhea Paul and Amy Wetherby
The National Institute on Deafness and Other Communication Disorders (NIDCD) and the National Alliance for Autism Research (NAAR) have teamed up to bring together scholars in child language development and disorders and clinical researchers in communication in autism. Their aim is to increase collaborations and formulate recommended practices for speech-language pathologists who work with childr en with autism spectrum disorders (ASD).
In April 2004, NIDCD and NAAR, a private, parent-run foundation that raises funds and provides support for research on ASD, jointly sponsored a conference in Atlanta, GA. Psychologists, special educators, and SLPs, all of whom shared an interest in normal language development and language disorders in children with ASD, met to exchange research findings and identify goals for the group. One outcome of this conference was the creation of a subcommittee charged with establishing guidelines for recommended practices in evaluating communication in ASD. Members of this committee include Rhea Paul and Amy Wetherby (co-chairs), Paul Yoder, Sally Rogers, Helen Tager-Flusberg, Mabel Rice, and Larry Leonard, as well as NIDCD representative Judith Cooper and NAAR representative Andy Shih.
Assessment
Autism is a serious neuropsychiatric disorder characterized by significant deficits in communication and social interaction, as well as stereotyped and repetitive behaviors. Once thought to be relatively rare, autism is now diagnosed more frequently for reasons including refinements in criteria, more active efforts to locate, identify, and provide early intervention for very young children with disorders, and a broadening of the definition to include a spectrum of related conditions (i.e., ASD). These changes have resulted in larger numbers of these children finding their way onto the caseloads of SLPs in both early intervention and educational settings.
Unfortunately, not all graduate education programs that provide pre-service training for SLPs have been able to keep pace with the rapid expansion of knowledge about ASD. Consequently, many SLPs who work with children feel inadequately prepared to participate in the diagnosis of autism, assess the unique communication profiles seen in this population, and to plan and implement educational programs.
Treating the communication disorders of children with autism is clearly a daunting task. Because communication deficits are at the core of the autistic syndrome, these deficits affect all aspects of the child's functioning. As such, communication treatment for children with ASD, as for other communication disorders, requires close collaboration among teachers, SLPs, special educators, other service providers, and family members.
The assessment of the communication skills of these children, however, is the primary responsibility of the SLP. What makes this task so difficult is that:
- The standard tests usually used to assess speech and language disorders in young children do not focus on social communication skills that are the core deficits present in children with ASD at early levels of functioning. This limits both the ability to identify children with ASD early and the information needed to understand core deficits such as joint attention and shared affect. Young children with ASD who do not speak often have impaired receptive language as well. They may appear simply "untestable" on standard measures. As the best practice, the SLP needs to select other options for gathering information about the children's level of communication development.
- Some speakers with autism have well-developed vocabulary and syntax, and may score at or above the normal range on tests of language function. Language sampling procedures, which provide quantitative measures of semantics and syntax, may fail to show significant differences between these speakers with ASD and age-mates. Even measures that purport to test pragmatics frequently fail to identify deficits in these high-functioning individuals because some children with autism have strong cognitive skills that allow them to "psych out" the tests. These speakers frequently have difficulty in ordinary social interactions and in functioning in classroom settings, yet they may fail to qualify for speech and language services.
Guidance
The NIDCD/NAAR committee, in addition to fostering research and collaboration among participants, also felt a need to provide information to SLPs who are facing these challenges, often with little support from other professionals, and with limited experience or knowledge from their pre-service education.
The committee decided to target as one of our first activities the task of providing guidance to SLPs in the assessment of their clients with ASD. To achieve this goal, we divided our task into two sections: one that would address communication assessment in prelinguistic children, and the other that would discuss issues in the assessment of children with autism who speak. Amy Wetherby agreed to chair the prelinguistic committee, with members Rhea Paul, Sally Rogers, and Paul Yoder. Rhea Paul chairs the second group, with members Larry Leonard, Mabel Rice, and Helen Tager-Flusberg. Judith Cooper of NIDCD and Andy Shih, chief science officer of NAAR, serve as ex officio members.
The committee defined its tasks as:
- Identifying critical challenges in the evaluation of communication in children with ASD
- Reviewing methods for earlier detection and the process for referral of children suspected of ASD for further assessment
- Providing guidelines for evaluation and establishing eligibility for SLP services
- Reviewing available tests and other assessment methods to identify those that address core areas of deficit in this population
- Describing informal methods of assessment that would assist in establishing baseline function, developing educational plans, and monitoring progress in communication intervention for children with ASD
- Identifying research needed to improve assessment practice
Over the next few months we plan to formulate these guidelines and disseminate them to practicing SLPs. We encourage SLPs who work with children with ASD to watch for these guidelines, and to communicate with us if you have any wisdom to share with your colleagues on solving the difficult problem of assessing communication in ASD.
Rhea Paul is professor of Communication Disorders at Southern Connecticut State University and a principal investigator at the Yale Child Study Center. Contact her at rhea.paul@yale.edu.
Amy Wetherby is the Laurel Schendel Professor in the Department of Communication Disorders at Florida State University and is executive director of the Florida State University Center for Autism and Related Disabilities. Contact her at awetherb@garnet.acns.fsu.edu.
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