American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Ohio Developmental Disabilities Council; Ohio Department of Health; Monarch Services
Service Guidelines for Individuals with Autism Spectrum Disorder/ Pervasive Developmental Disorder (ASD/PDD): Birth through Twenty-One

Autism Task Force. (Undated).
(OH): Ohio Developmental Disabilities Council, 105 pages.

AGREE Rating: Recommended with Provisos

Description:

This guideline is intended to help families and professionals in assessing, treating, and developing educational and community transition programs for people with autism spectrum disorder (ASD) from birth to 21. The target audience of this guideline includes families, educators, medical professionals, and other service providers.

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Swallowing
        • Individuals with behavioral disorders (e.g. pica, coprophagia or obsessive-compulsive symptomatology) should be referred for feeding/swallowing evaluation.
        • Parents "should consult with a professional (SLP, OT, psychologist, registered dietitian, nutritionist, etc.) who has experience working with feeding issues in these children" (p. 18).
      • Cognition/Language
        • Assessment of the following domains is required by federal and state guidelines:
          • cognitive,
          • social/emotional,
          • academics,
          • communication,
          • vocational/occupational, and
          • adaptive behavior (p. 24).
        • The assessment of social competence should include considerations for:
          • age,
          • sensory motor processing challenges,
          • imitation skills,
          • language skills,
          • cognitive abilities,
          • skills and interests, and
          • social environments (p. 43).
      • Hearing - This guideline recommends that all children receive a hearing screening (p. 14).
    • Assessment Instruments
      • Diagnosis
        • “Assessments/evaluations should include information from the parent(s); data from previous interventions; criterion-referenced assessments; curriculum-based assessments; standardized, norm-referenced tests; structured interviews; and structured observations” (p. 24).
        • The following instruments are suggested for diagnosis of children with ASD or pervasive developmental disorder:
          • the Childhood Autism Rating Scale (CARS);
          • Autism Diagnostic Interview- Revised (ADI-R);
          • Autism Diagnostic Observation Scale (ADOS);
          • Gilliam Autism Rating Scale (GARS);
          • Asperger Syndrome Diagnostic Scale (ASDS) (pp. 15-16).
        • The Real Life Rating Scale is suggested as a functional assessment of 47 different behaviors in individuals with ASD or pervasive developmental disorder (p. 17).
      • Screening
        • The following instruments are suggested to screen for ASD or pervasive developmental disorder:
          • Autism Behavior Checklist (ABC);
          • Autism Screening Instrument of Educational Planning (Second Edition, ASIEP-2);
          • Checklist for Autism in Toddlers (CHAT);
          • Modified Checklist for Autism in Toddlers (M-CHAT);
          • Parents Evaluation of Developmental Status (PEDS);
          • Ages and Stages Questionnaire (ASQ);
          • Communication and Symbolic Behavior Scales;
          • Developmental Profile Infant-Toddler Checklist;
          • Pervasive Developmental Disorder Screening Test (PDDST);
          • Psychoeducational Profile- Revised; and
          • Adolescent and Adult Psychoeducational Profile (AAPEP) (pp. 16-17).
  • Treatment
    • Cognition/Language
      • General Findings
        • “Teachers who are most effective in the communication process use multiple strategies simultaneously such as visual, auditory, written, symbolic, etc.” (p. 23).
        • “Instructional strategies should be based on individual learning styles and should take into consideration and capitalize upon the aspects of unique learning styles” (p. 23).
        • The focus of intervention should include: attention; imitation; communication; socialization, life skills, leisure and play, etc. (pp. 24-27).
        • To enhance play, leisure, academic, and vocational activities, multiple modalities and assistive technology are suggested (p. 30).
        • To foster generalization of skills, skills should be taught in a variety of settings, should be naturally occurring, and be positively rewarding. Features of the everyday environment should be brought into treatment sessions and rewards should be given intermittently after the behavior has been learned to maintain the skill (p. 31).
        • Support should be given to all forms of communication, including verbal, signing, pictorial, and augmentative devices (p. 36).
        • The following modifications and strategies may be implemented to enhance communication:
          • decrease question asking and increase comments and descriptions during activities;
          • understand situations that create stress for the individual with ASD;
          • modify the language and provide visual supports if no response is obtained;
          • allow sufficient time for auditory processing;
          • develop a protocol for initiation of joint attention;
          • encourage meaningful imitation;
          • use vocabulary and grammar that is at the individual’s comprehension level; and
          • teach turn-taking (p. 37).
      • Auditory/Sensory Integration Training - “While anecdotal reports of benefit from specific interventions such as sensory integration therapy or a 'sensory diet' are widespread, available study results are limited by the small sample size and further research is warranted” (p. 19).
      • Augmentative-Alternative Communication (AAC) - “Inclusion of 'low tech,' as well as 'high tech' tools should be considered” (p. 39).
      • Peer Mediated/Implemented - Strategies to consider to increase social understanding include: scripting, modeling, role play, social curriculums, social skills manuals, visual supports, and peer supports (p. 44).
      • Pragmatic/Social Skills
        • To teach social skills to develop environmental awareness the following is recommended:
          • define the “rules of the room”;
          • provide social awareness with skill development activities;
          • teach “body language” and gestures;
          • teach empathy and humor; and
          • teach recognition of emotions and emotional situations (p. 30).
          • Social goals should be developed in consideration of:
          • imitation and joint attention,
          • personal space needs,
          • environmental barriers,
          • others’ emotions,
          • requests for assistance,
          • sarcasm, slang, joking, and teasing,
          • social interactions,
          • potential for rejection,
          • game playing,
          • turn-taking,
          • body language,
          • behavior with individuals of the opposite sex,
          • peers’ understanding, and
          • workplace behavior (p. 43).
        • Strategies to consider to increase social understanding include: scripting, modeling, role play, social curriculums, social skills manuals, visual supports, and peer supports (p. 44).
      • Scripts - Strategies to consider to increase social understanding include: scripting, modeling, role play, social curriculums, social skills manuals, visual supports, and peer supports (p. 44).
  • Service Delivery
    • Dosage
      • “…[M]ore intense quality intervention generally results in better outcomes and… the intensity of interventions is determined by the unique needs of each family and individual” (p. 29).
    • Setting
      • “Any instruction must include a carefully planned environment that is predictable, structured and appropriate for the sensory motor needs of the individual… Learning and behavior may be enhanced by physical space modifications that include visual barriers, reduced visual or sound distractions, temperature adjustments, preferential seating, and visual organization of material” (p. 24).
      • The educational environment for children with ASD should be inclusive and in the least restrictive environment to the extent that the individual is able to benefit from instruction (p. 63). 

Keywords: Autism Spectrum Disorders

Access the Guideline

Added to Compendium: November 2011

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