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Autism

See the Treatment section of the Autism Spectrum Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Consistent with the WHO (2001) framework, treatment is designed to

  • capitalize on strengths and address weaknesses related to the core features of ASD;
  • facilitate activities and participation by helping the individual acquire new communication skills and strategies or modify existing skills; and
  • modify contextual factors to reduce barriers and enhance facilitators of successful communication and participation, including identification and use of appropriate accommodations.

See ASHA's resource on the International Classification of Functioning, Disability and Health (ICF) for examples of ICF handouts specific to selected disorders.

The goal of treatment is to improve social communication and other language skills and to modify behaviors so that the individual is better able to develop relationships, function effectively in social settings, and actively participate in everyday life. SLPs often collaborate with other professionals to design and implement effective treatment plans.

Goals target core challenges of ASD and focus on

  • initiating spontaneous communication in functional activities;
  • engaging in reciprocal communication interactions; and
  • generalizing skills across activities, environments, and communication partners.

Developmental sequences and processes of language development provide a framework for determining treatment baselines, adjusting goals, and tracking progress. Core challenges of ASD take different forms as an individual responds to intervention and progresses through developmental stages from prelinguistic to emerging language and advanced language stages. (See sample intervention goals associated with core challenges [PDF].)

The mode of communication used during treatment (e.g., spoken language, gestures, sign language, picture communication, speech-generating devices [SGDs], and/or written language) can vary, and more than one mode can be used. Multimodal communication systems are individualized according to the person's abilities and the context of communication.

Family-Centered Practice

The goal of family-centered practice is to create a partnership so that the family fully participates in all aspects of the individual's care. Participation of families in services for the individual with autism can help reduce the stress experienced by family members (National Research Council [NRC], 2001).

Support may take different forms at different times and may include coordinating services for the family, procuring resources and information, teaching the family or other significant communication partners specific skills and strategies, providing learning opportunities, and advocating for or with the family. See ASHA's resources on family-centered practice and person- and family-centered care.

Cultural and Linguistic Considerations

It is important that goals embrace the priorities and preferences of the individual and family. Cultural, linguistic, and personal values should be incorporated into therapeutic activities. Clinicians also need to recognize that cultural, linguistic, and socioeconomic factors can affect a family's access to—as well as selection and use of—services (Yu, 2013). See ASHA's Practice Portal page on Cultural Competence.

Advancements have been made in research on bilingual individuals with ASD. Research indicates that children with ASD who are being raised in bilingual language environments are not more likely to have language delays than their monolingual counterparts (Drysdale et al., 2015; Hambly & Fombonne, 2012). In fact, there is no evidence to show that bilingualism has a negative impact on language development in children with ASD.

When determining the language of treatment for a child with ASD, SLPs should carefully consider the child's linguistic environments. Treatment is provided either by a bilingual SLP or through the use of trained interpreters, when necessary. See ASHA's Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators.

Treatment Modes and Modalities

Treatment modes and modalities are technologies or other support systems that the SLP can use in conjunction with, or during implementation of, various treatments. For example, the SLP can use video-based instruction in peer-mediated interventions to address social skills and other target behaviors.

A number of treatment modes and modalities are described below. When selecting a mode or modality, the SLP considers the intervention goal and the individual's developmental stage. For example, a mode or modality that is appropriate for an individual who is at the emerging language stage may not be appropriate for an individual who is at the prelinguistic stage. The list below is not exhaustive, and inclusion does not imply an endorsement from ASHA.

Augmentative and Alternative Communication (AAC)

An AAC system is an integrated group of components—including symbols, selection techniques, and strategies—used to enhance communication. AAC uses a variety of techniques and tools—including picture communication systems, line drawings, photographs, video clips, speech-generating devices (SGDs), tangible objects, manual signs, gestures, and finger spelling—to help the individual express thoughts, ideas, wants, needs, and feelings. AAC can be used to supplement existing expressive verbal communication or with individuals who are unsuccessful at learning expressive verbal communication.

For more information on SGDs for children with ASD, see van der Meer and Rispoli (2010). For more information about AAC, see ASHA's Practice Portal page on Augmentative and Alternative Communication.

Activity Schedule and Visual Supports

Activity schedules and visual supports include objects, photographs, drawings, or written words that act as cues or prompts to help individuals complete a sequence of tasks or activities, attend to tasks, transition from one task to another, or maintain emotional regulation in various settings. Written and/or visual prompts that initiate or sustain interaction are called scripts. Scripts are often used to promote social interaction but can also be used in a classroom setting to facilitate academic interactions and to promote academic engagement (Hart & Whalon, 2008).

Computer-Based Instruction

Computer-based instruction involves the use of computer technology (e.g., iPads) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving (see, e.g., Khowaja & Salim, 2013; Weng et al., 2014).

Video-Based Instruction

Video-based instruction (also called "video modeling") is an observational mode of teaching that uses video recordings to provide a model of the target behavior or skill. The individual observes and then imitates video recordings of desired behaviors. Video modeling procedures can be implemented in three ways: (a) using a video of the behavior to be targeted with another person as a model, (b) using a video of the behavior to be targeted without a model (usually called "point of view modeling"), or (c) using videos of the learner as a model (known as "self-modeling"). In all cases, the SLP works with the learner to provide practice and feedback. As recording devices become more portable and easier to use, video-based techniques are more frequently being used in treatment (see, e.g., Wilson, 2013). Videos with integrated AAC visual scene displays may enhance participate in community and vocational settings for individuals with ASD (O'Neill, Light, & McNaughton, 2017).

Treatment Approaches

Treatment approaches differ in the method used to address goals—they range from discrete trial, traditional behavioral approaches to social-pragmatic, developmental approaches (Prizant & Wetherby, 1998).

Approaches also differ in how goals are prioritized and addressed. Focused interventions rely heavily on individual strategies—used alone or in combination—to target specific skills or behaviors (e.g., to increase verbalization). Comprehensive interventions use multiple strategies to target a broad range of skills or behaviors (e.g., to enhance learning).

The selection of specific approaches takes into consideration the level of social and linguistic development, cultural background and values, personal preferences, family resources, learning style, behavior repertoire, and communication needs.

Treatment Options

Below are brief descriptions of general and specific treatment options for addressing ASD. Some attempt has been made to organize them into broader categories, recognizing that some approaches have components of more than one broad category (e.g., the Early Start Denver model [Rogers & Dawson, 2010] combines developmental approaches with behavioral teaching strategies).

This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA. For a more comprehensive list of treatment options, see the Treatment section of the Autism Spectrum Disorders Evidence Map.

Behavioral Interventions and Techniques

Behavioral interventions and techniques are designed to reduce challenging behaviors and teach functional alternative behaviors using the basic principles of behavior change. These methods are based on behavioral/operant principles of learning. They involve examining the antecedents that elicit a certain behavior, along with the consequences that follow that behavior, and then making adjustments in this chain to increase desired behaviors and/or decrease inappropriate ones.

Behavioral interventions for ASD range from one-on-one discrete trial instruction to naturalistic approaches that focus on communication, on communication and other aspects of educational programming, or on modifying ineffective communication behaviors.

Examples include the following:

Applied Behavior Analysis (ABA)—a behavioral intervention that focuses on bringing about meaningful and positive change in behavior. ABA techniques have been developed for individuals with autism to help build a variety of skills (e.g., communication, social skills, self-control, and self-monitoring) and to help generalize these skills to other situations. The techniques can be used in both structured (e.g., classroom) and everyday (e.g., family dinnertime) settings and in one-on-one or group instruction.

Intervention is customized on the basis of the individual's needs, interests, and family situation. ABA techniques are often used in intensive, early intervention (below age 4 years) programs to address a full range of life skills. Intensive programs total 25–40 hours per week for 1–3 years. Qualifications for providing ABA therapy to individuals with autism may vary by state; check with your state, as this may affect reimbursement.

Discrete Trial Training (DTT)—a one-on-one instructional approach using behavioral methods to teach skills in small, incremental steps in a systematic, controlled fashion. The teaching opportunity is a discrete trial consisting of an antecedent (such as an instruction from the teacher), a response from the learner, and a consequence or feedback regarding the response. DTT is most often used for skills that (a) learners are not initiating on their own; (b) have a clear, correct procedure; and (c) can be taught in a one-to-one setting.

Functional Communication Training (FCT)—a behavioral intervention program that combines the assessment of the communicative functions of maladaptive behavior with the use of ABA procedures to teach alternative responses. Problem behaviors can be eliminated through extinction and replaced with alternate, more appropriate ways of communicating needs or wants. FCT can be used with children with ASD across a range of ages and regardless of cognitive level or expressive communication abilities (Carr & Durand, 1985).

Incidental Teaching—a teaching technique that uses behavioral procedures. The clinician provides naturally occurring teaching opportunities that are based on the child's interests. The clinician follows the child's lead and reinforces communication attempts as these attempts get closer to the desired communication behavior (McGee et al., 1999).

Milieu Therapy—a range of methods (including incidental teaching) that are integrated into a child's natural environment. Milieu therapy includes training in everyday environments and during activities that take place throughout the day rather than only at "therapy time" (Kaiser et al., 1992).

Pivotal Response Treatment (PRT)—a play-based, child-initiated behavioral treatment. Formerly referred to as "Natural Language Paradigm (NLP)," PRT's goals are to (a) teach speech sounds, first words, and language; (b) decrease disruptive behaviors; and (c) increase social, communication, and academic skills. Rather than target specific behaviors, PRT targets pivotal areas of development (response to multiple cues, motivation, self-regulation, initiation of social interactions, and empathy) that are central to a wide range of skills (Koegel & Koegel, 2019). PRT emphasizes natural reinforcement (e.g., the child is rewarded with an item when they make a meaningful attempt to request that item).

Positive Behavior Support (PBS)—an approach that uses positive (nonpunitive) interventions for decreasing challenging behaviors. A commonly used strategy involves (a) functionally assessing challenging behaviors to identify the relationship between these behaviors and communication and (b) replacing the challenging behaviors with appropriate functionally equivalent replacement behaviors (FERBs). Multicomponent intervention plans often include prevention strategies (i.e., antecedent packages). PBS integrates principles of behavioral analysis with person-centered values to foster skills that replace challenging behaviors. PBS can be used to support children and adults with autism who demonstrate problem behaviors (Carr et al., 2002).

Self-Management—an approach aimed at helping individuals learn to independently regulate their behaviors and behave appropriately in a variety of contexts. Individuals are taught to discriminate the difference between appropriate and inappropriate behaviors, evaluate and record their behaviors, and (when possible and appropriate) reward themselves for using appropriate behaviors. Self-management interventions can be used across a wide range of ages from early childhood through adulthood.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an intervention approach that combines cognitive and behavioral learning principles to shape and encourage desired behaviors. The underlying assumptions of CBT are that an individual's behavior is mediated by maladaptive patterns of thought or understanding, and that changes in thinking or cognitive patterns can lead to changes in behavior. CBT is used primarily to help individuals with ASD improve behavior by learning to regulate emotions and control impulses.

The most effective CBT programs for ASD tend to include a parent education component (Scarpa & Reyes, 2011). Effective interventions often include intervention in natural settings (school, home, community; Wood et. al., 2009). Because the intervention generally involves developing hierarchies and training individuals to change thought processes, the procedures are generally used with individuals who have verbal skills and who are mildly affected by core ASD symptoms. For more information about cognitive-behavioral theory, see ASHA's Practice Portal page on Counseling for Professional Service Delivery.

Examples include the following:

Exploring Feelings—a structured CBT program designed to encourage the cognitive control of emotions (anxiety and anger). Sessions include activities to explore specific feelings (e.g., being happy, relaxed, anxious or angry). The child completes a follow-up implementation project prior to the next session. The Explore Feelings program was designed for small groups of children between the ages of 9 and 12 years, but it can be modified for use with only one child (Attwood, 2004).

Rational Emotive Behavioral Therapy—a therapy approach that focuses on helping the individual acknowledge the problems that are upsetting them, accept emotional responsibility for these problems, and be empowered to change. The ultimate goal is to be able to lead a happier, more fulfilling life (Ellis & Dryden, 1997).

Social Thinking®—a cognitive-based treatment framework for preschool and school-age children and adults with social learning challenges (including ASD, social communication disorder, and other related diagnoses). It comprises strategies to target pragmatic language, social–emotional learning, perspective taking, and social skills. The framework teaches individuals to understand the "thinking" that underlies the production (Crooke et al., 2008; Garcia Winner & Crooke, 2009, 2011).

Denver Model

The Denver Model is a child-led, play-based treatment approach that focuses on the development of social communication skills through intensive one-on-one therapy, peer interactions in the school setting, and home-based teaching (Rogers & Dawson, 2009). The Early Start Denver Model (Rogers & Dawson, 2010) for toddlers is an extension of the Denver Model; it combines developmental approaches with behavioral teaching strategies and can be delivered in a variety of settings (e.g., by the therapist and/or parents in group or individual sessions in the clinic or at home).

Gentle Teaching

Gentle Teaching is a framework for serving individuals with special needs that focuses on providing companionship and open, loving support and guidance. Gentle teaching uses the relationship between the individual and his or her caregiver as the foundation for teaching. The aim is to develop a safe and loving environment in which the individual can develop talents and reach his or her full potential. This approach eliminates punishment as a way to control behavior; it includes errorless learning, choice making, and fading prompts (McGee, 1990; Polirstok et al., 2003).

Literacy (Written Language) Intervention

Literacy intervention approaches incorporate a variety of instructional strategies to improve word decoding, word identification, reading fluency, reading vocabulary, and reading comprehension across a variety of materials and in a number of contexts. Older children with ASD may also have difficulty with higher-level literacy skills that require theory of mind.

Depending on the student's skill level, instructional strategies might include engaging in shared book reading, teaching literacy in natural contexts, labeling objects or pictures to promote sight word reading, reading and writing about personal experiences, promoting phonological awareness, and teaching the student how to monitor comprehension while reading. For a review of strategies for promoting literacy, see Lanter and Watson (2008). See also ASHA's Practice Portal page on Written Language Disorders.

Spoken Language Intervention

The goal of spoken language intervention is to facilitate overall language development and functional, everyday communication. The selection of treatment options and approaches are based on the individual's current level of language functioning and may reflect views on language acquisition patterns in children with ASD and the role of echolalia (see, e.g., Blanc, 2012). See also ASHA's Practice Portal pages on Spoken Language Disorders for descriptions of various treatment options and approaches.

Speech Sound Intervention

Speech sound intervention addresses functional disorders such as articulation and phonology and motor speech disorders such as apraxia of speech and dysarthria. See ASHA's Practice Portal pages on Speech Sound Disorders: Articulation and Phonology and Childhood Apraxia of Speech for relevant treatment options.

Parent-Mediated or Parent-Implemented Intervention

Parent-mediated or parent-implemented intervention consists of parents' using direct, individualized intervention practices with their child to increase positive learning opportunities and acquisition of skills.

Examples include the following:

More Than Words—a Hanen Program® that offers a parent-directed approach focusing on day-to-day life, taking advantage of everyday activities to help the child improve communication and social skills (Sussman, 1999). This program is typically used for early language intervention with young children with ASD.

Talkability™—a Hanen Program® for parents of verbal children with ASD. The program teaches parents practical ways to help their child learn people skills, such as "tuning in" to others' feelings and thoughts by attending to nonverbal cues, such as body language, facial expressions, and tone of voice. The ability to consider others' point of view and to empathize are considered essential for successful conversation and for making friends (Sussman, 2006).

Peer-Mediated or Peer-Implemented Treatment

Peer-mediated or peer-implemented treatment approaches incorporate peers as communication partners for children with ASD in an effort to minimize isolation, provide effective role models, and boost communication competence. Typically developing peers are taught strategies to facilitate play and social interactions; interventions are commonly carried out in inclusive settings where play with typically developing peers naturally occurs (e.g., preschool setting).

Examples include the following:

LEAP—a multifaceted program for preschool children with ASD (Hoyson et al., 1984). LEAP utilizes a variety of strategies and methods, including ABA, peer-mediated instruction, self-management training, prompting, and parent training. LEAP is implemented in a classroom setting consisting of children with ASD and typically developing peers and is designed to support child-directed play.

Circle of Friends—a treatment approach that uses the classroom peer group to improve the social acceptance of a classmate with special needs by setting up a special group or "circle" of friends. The focus is on building behaviors that are valued in everyday settings. The application of skills to new and appropriate situations is reinforced as naturally as possible as they occur (Whitaker et al., 1998).

Integrated Play Groups—a therapy model designed to support children of different ages and abilities with ASD in mutually enjoyed play experiences with typical peers and siblings. Small groups of children play together under the guidance of an adult facilitator. The focus is on maximizing the child's potential and his or her intrinsic desire to socialize with peers (Wolfberg & Schuler, 1993).

SCERTS

SCERTS—which stands for social communication (SC), emotional regulation (ER), and transactional support (TS)—is a comprehensive framework for targeting critical intervention goals relevant to the individual's stage of social, emotional, and communication development. The supports integrated into this framework fall under the transactional support process and focus on enabling families, service providers, and community members to effectively implement evidenced-based teaching strategies in "real-world" activities. The SCERTS Model is a comprehensive educational approach used with children of various ages, from preschool through school age (Prizant et al., 2006).

Social Communication Intervention

Social communication intervention approaches and frameworks are designed to increase social skills, using social group settings and other platforms to teach peer interaction skills and promote effective communication. See ASHA's Practice Portal page on Social Communication Disorder.

There continues to be research in the development of social communication treatment approaches (Adams et al., 2012). The following is not an exhaustive list; SLPs are encouraged to research additional social communication treatment programs and approaches.

Examples include the following:

Joint Attention Symbolic Play Engagement Regulation (JASPER)—a treatment approach that combines developmental and behavioral principles. This approach targets the foundations of social communication (joint attention, imitation, play) and uses naturalistic strategies to increase the rate and complexity of social communication. The approach incorporates parents and teachers into implementation of intervention to promote generalization across settings and activities and to ensure maintenance over time (Kasari et al., 2008).

Social Scripts—a prompting strategy that teaches children to use a variety of language skills during social interactions. Scripted prompts (visual and or verbal) are gradually faded out as children use new language skills more spontaneously (Nelson, 1978).

Social Skills Groups—groups in which appropriate ways of interacting with typically developing peers are taught through direct instruction, role playing, and feedback. Groups typically consist of two to eight individuals with social communication disorders and a teacher or adult facilitator.

Social Stories™—a highly structured intervention that uses customized and carefully constructed stories to explain social situations to children and to help them learn socially appropriate behaviors and responses (Gray et al., 2002).

Relationship-Based Interventions

Relationship-based interventions are aimed at supporting parent–child relationships (Edelman, 2004; Gutstein et al., 2007).

Examples include the following:

DIR/Floortime—a model that promotes development by encouraging children to interact with parents and others through play. The model focuses on following the child's lead; challenging the child to be creative and spontaneous; and involving the child's senses, motor skills, and emotions (Greenspan & Wieder, 2007).

Relationship Development Intervention® (RDI)—a family-based, behavioral treatment designed to address the core symptoms of ASD. It is based on the theory that dynamic intelligence (the ability to think flexibly) is the key to improving the quality of life for individuals with ASD. RDI helps individuals form personal relationships by strengthening the building blocks of social connections, including the ability to form emotional bonds and share experiences. Parents, teachers, and other caregivers can be involved in the implementation of RDI (Gutstein & Gutstein, 2009).

TEACCH

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is a university-based system of community regional centers that provides clinical services, such as diagnostic evaluations, parent training and parent support groups, social play and recreation groups, individual counseling, and supported employment (Mesibov et al., 2007). TEACCH combines developmentally appropriate practice with behavioral techniques (e.g., environmental control/structure) and family collaboration and involvement.

Treatment Considerations: ASHA's Position

Several treatment options and approaches lack scientific evidence of validity and are not endorsed by ASHA. They are Auditory Integration Training (AIT), Facilitated Communication (FC), and Rapid Prompting Method (RPM). Below are brief descriptions of these treatments, along with ASHA's position on each. Click on the hyperlinks provided to read ASHA's full position statements.

Auditory Integration Training

Auditory Integration Training (e.g., the Berard method; Berard, 1993) is a type of sensory integration treatment that involves exercising the middle ear muscles and auditory nervous system to treat a variety of auditory and nonauditory disorders, including auditory processing problems, dyslexia, learning disabilities, attention-deficit disorders, and ASD. The treatment typically involves listening to specially filtered and modulated music for two 30-minute sessions per day for 10 consecutive days. The objective is to reduce distortions in hearing and hypersensitivity to specific frequencies so that the individual will be able to perceive sounds—including speech—in a normal fashion.

According to ASHA's position statement titled, Auditory Integration Training , "The 2002 ASHA Work Group on AIT, after reviewing empirical research in the area to date, concludes that AIT has not met scientific standards for efficacy that would justify its practice by audiologists and speech-language pathologists" (ASHA, 2004, para. 1).

Facilitated Communication

Facilitated Communication (FC)—also referred to as "Assisted Typing," "Facilitated Communication Training," and "Supported Typing"—is a technique that involves a person with a disability pointing to letters, pictures, or objects on a keyboard or on a communication board, typically with physical support from a "facilitator." This physical support usually occurs on the hand, wrist, elbow, or shoulder (Biklen et al., 1992) or on other parts of the body.

According to ASHA's position statement titled Facilitated Communication , "It is the position of the American Speech-Language-Hearing Association (ASHA) that Facilitated Communication (FC) is a discredited technique that should not be used. There is no scientific evidence of the validity of FC, and there is extensive scientific evidence—produced over several decades and across several countries—that messages are authored by the ‘facilitator' rather than the person with a disability. Furthermore, there is extensive evidence of harms related to the use of FC. Information obtained through the use of FC should not be considered as the communication of the person with a disability" (ASHA 2018a, para.1).

Rapid Prompting Method (RPM)

The Rapid Prompting Method (RPM) is described on the home page of the Helping Autism Through Learning and Outreach (HALO) website (HALO, n.d.) as a teaching method "leading towards communication for persons with autism" (Mukhopadhyay, 2008). Information about RPM is available primarily through the HALO website and in books by Soma Mukhopadhyay (see, e.g., Mukhopadhyay, 2008, 2011), who developed RPM for her son. According to the HALO website (HALO, n.d.), RPM involves pointing to letters "to form words on a letter board, typing device, and/or by handwriting." Untested assertions are that RPM assists with motor planning and that "prompting is necessary in order for the student to initiate a response" (Mukhopadhyay, 2008, p. 139).

Although RPM—also known as Soma® RPM—is primarily associated with HALO-Soma and Soma Mukhopadhyay, foundationally and procedurally similar alternative forms have appeared, such as "Informative Pointing" (Iversen, 2007), "letterboarding," and "Spelling to Communicate." This position statement is applicable regardless of the name used for the technique.

According to ASHA's position statement titled Rapid Prompting Method , "use of the Rapid Prompting Method (RPM) is not recommended because of prompt dependency and the lack of scientific validity. Furthermore, information obtained through the use of RPM should not be assumed to be the communication of the person with a disability" (ASHA, 2018b, para. 1).

Treatment Considerations: Transitioning Youth and Adults

The core challenges associated with ASD can have an impact on the ability to succeed in postsecondary educational programs, employment, and social relationships, and to acquire the skills needed to live independently (Howlin & Moss, 2012; Zager & Alpern, 2010).

Individuals with ASD who are transitioning to young adulthood experience high rates of unemployment and underemployment (Lounds Taylor & Seltzer, 2011; Shattuck et al., 2012) and may have difficulty maintaining employment once secured (Lounds Taylor et al., 2015; Wei et al., 2015). Socially, they may discontinue friendships, participate in fewer social activities (Orsmond et al., 2013), and experience social isolation (Lounds Taylor et al., 2017; Myers et al., 2015).

These findings highlight the need for continued support to facilitate a successful transition to adulthood. SLPs are involved in transition planning in high school and may be involved, to varying degrees, in other support services beyond high school.

Transition planning for individuals with ASD may include

  • determining the need for continued therapy, if appropriate;
  • identifying career goals and educational needs;
  • providing academic or career counseling;
  • providing opportunities for work experience;
  • discussing housing options; and
  • facilitating community networking (see, e.g., Hendricks, 2010; Van Bourgondien & Woods, 1992; Lawrence et al., 2010).

Effective transition planning involves the student as an active and respected member of the team (Wehman, 2006) as well as their family, who can provide valuable information about the student's needs. See ASHA's resource on transitioning youth.

Individuals with ASD who pursue postsecondary education will benefit from disability support services. However, they may need supports that are not typically provided; these include supports to help them live independently, to self-advocate, and to communicate effectively inside and outside the classroom (Ellison et al., 2013).

Those who pursue employment following high school will benefit from job-related supports such as training to improve interview skills (Morgan et al., 2014; Smith et al., 2014), interventions to improve social communication (Koegel et al., 2013, 2015, 2016), and customized employment that incorporates career assessment, job search, on-site training, and teaching job retention techniques (Wehman et al., 2016).

For a comprehensive discussion of individuals with ASD as they transition into and through adulthood, see IACC (2017). For a review and discussion of research on environmental supports and barriers to participation in adolescents with ASD, see Krieger et al. (2018).

Service Delivery Options

See the Service Delivery section of the Autism Spectrum Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

In addition to determining the type of speech and language treatment that is optimal for children with social communication disorders, SLPs consider other service delivery variables—including format, provider, dosage, and timing—that may impact treatment outcomes.

  • Format—whether a person is seen for treatment one-on-one (i.e., individual) or as part of a group
  • Provider—the person providing treatment (e.g., SLP, trained volunteer, caregiver)
  • Dosage—the frequency, intensity, and duration of service
  • Timing—the timing of intervention relative to the diagnosis
  • Setting—the location of treatment (e.g., home, community-based, school)

Given the challenges experienced by communication partners, treatment considers a range of service delivery models, including traditional pull-out; home-, classroom-, and community-based models; and collaborative consultation models.

Service delivery focuses on natural learning environments and includes education and training of family members, teachers, peers, and other professionals. Learning in natural learning environments invite higher rates of initiation and generalization and enhance the ecological validity of the intervention (NRC, 2001).

Service Delivery: Adults

Access to state-funded ASD programs may be limited for adults who are newly diagnosed because documentation of a developmental disability prior to the age of 22 years is typically required. However, some funding for services may be available; services include counseling, vocational supports, and speech-language services to address core social communication challenges. Community support programs and various online support groups are also available.

For a discussion of service delivery for adults with ASD, see IACC (2017).

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.