The incidence of autism spectrum disorder (ASD) refers to the number of new cases identified in a specified time period. The prevalence of ASD refers to the number of individuals who are living with ASD in a given time period.

In 2020, the estimated ASD prevalence was 2.76% (1 in 36) of children 8 years of age (Maenner et al., 2023). The 2021 National Survey of Children’s Health (NSCH; Maternal and Child Health Bureau, 2022) estimated the parent-reported ASD prevalence to be 3.1% of children aged 3–17 years (Wang et al., 2023).

The percentage of the population ages 5–21 years served under Part B of the Individuals with Disabilities Education Improvement Act of 2004 under the category of autism was 1.2% (U.S. Department of Education, 2023).

The prevalence of autism among Medicaid-enrolled adults was 0.95% in 2019 (Rubenstein et al., 2023).

According to data from the Centers for Disease Control and Prevention, ASD prevalence was significantly higher in boys (4.3%) than in girls (1.14%), with an overall prevalence ratio of 3:8 (male:female). Results were reported based on gender; however, there were no indications as to whether the data collected were based on sex assigned at birth and/or gender identity (Maenner et al., 2023). The pooled prevalence of autism in gender-diverse individuals was 11% (Kallitsounaki & Williams, 2023).

The estimated ASD prevalence for non-Hispanic White children (24.3 per 1,000) and children of two or more races (22.9 per 1,000) was lower than that for non-Hispanic Black children (29.3 per 1,000); Hispanic children (31.6 per 1,000); and non-Hispanic Asian/Pacific Islander children (33.4 per 1,000). The prevalence of ASD among non-Hispanic American Indian or Alaska Native children (26.5 per 1,000) was similar to that of other racial and ethnic groups. This report found no consistent association between ASD and socioeconomic status (Maenner et al., 2023).

The prevalence of autism among individuals diagnosed with a variety of conditions was as follows (Richards et al., 2015):

• 54% in individuals with Cohen syndrome
• 43% in individuals with Cornelia de Lange syndrome
• 36% in individuals with tuberous sclerosis complex
• 34% in individuals with Angelman syndrome
• 30% in individuals with CHARGE syndrome
• 22% in individuals with fragile X syndrome
• 18% in individuals with neurofibromatosis type 1
• 16% in individuals with Down syndrome
• 15% in individuals with Noonan syndrome
• 12% in individuals with Williams syndrome
• 11% in individuals with 22q11.2 deletion syndrome

The estimated global prevalence of autism by region was as follows (Olusanya et al., 2023):

• 0% in Africa
• 6% in Oceana
• 3% in the Americas
• 7% in Europe
• 3% in Asia

Additional Reasons Why Prevalence Varies

Views of neurodivergence influence motivation to seek services. Some autistic people may not wish to pursue diagnosis and/or treatment, whereas some seek support. Completely accurate numbers are difficult to obtain due to possible under- or overidentification, lack of a biological marker, variations in the quality and quantity of behavioral information in records, and other factors (Mulvihill et al., 2009). Individuals with autism and other co-occurring developmental conditions may be underdiagnosed, as having multiple conditions may lead to a misdiagnosis or delay in autism diagnosis. There is also a need to improve diagnostic tools to recognize autism in adults who may have been misdiagnosed or previously unidentified (Interagency Autism Coordinating Committee, 2023).

To date, diagnostic tools have typically been developed in studies where the participants were predominantly assigned male at birth, leading to underdiagnosis in individuals assigned female at birth. Diagnostic bias may account for the variations in reported incidence and prevalence pertaining to sex assigned at birth (McCrossin, 2022). Significant variations exist in social communication norms across cultures in the United States. These social norms may not be reflected in screening and diagnostic tools, potentially resulting in over- and underidentification in marginalized groups.

In addition, access to services influences disparities. A cross-sectional study mapped resource allocation to marginalized populations along with prevalence data to analyze access to services as a factor in prevalence. Findings revealed that Black and Hispanic children experienced more disparities in access to services as compared to White children (Liu et al., 2023).

Common Characteristics

The core features of autism spectrum disorder (ASD) are observed in the areas of

• social communication,
• language and related cognitive skills, and
• behaviors and emotions.

These core features are significantly influenced by (a) the developmental level of language acquisition (e.g., pre-symbolic language, emerging language, and conversational language) and (b) the severity level of the disorder. In addition to these core features, sensory and feeding challenges may also be present.

People with autism have a wide range of abilities and experiences. Abilities range from significant cognitive and language impairments to above-average cognitive and language abilities. However, regardless of these differences, the core characteristics and challenges associated with autism will have an impact on the development of social communication skills. The lack of community awareness of autism and the absence of opportunities to interact with people on the autism spectrum may result in miscommunication and misperceptions of behaviors. Misperceptions of behaviors, misdiagnosis, and lack of proper supports for children might place them at risk for becoming part of the “school-to-confinement pipeline” population (Stanford, 2020).

Below are common characteristics based on domain. Specific areas of deficit will vary. No one person will be the same. Skilled interventions may require adaptations to the environment, accommodations to make activities accessible, and/or the development of treatment goals.

Social Communication

Social communication includes joint attention, social reciprocity, and social cognition.

Joint attention is the shared focus of two or more individuals on the same object or event.

People with ASD and their neurotypical communication partners frequently experience social communication breakdowns due to what Milton (2012) describes as the double empathy problem— framed as the neurotypical person and the autistic person communicating from different perspectives, world views, and social perceptions. Society misunderstands autistic behavior and continues the stereotype which asserts that autistic people lack empathy. Autistic people do have empathy but may show unconventional ways of caring (DeThorne, 2020). Autistic communication is more apparent to other people when interacting with a non-autistic person than with an autistic person (Crompton et al., 2020). Non-autistic peers may avoid that person or may react to social overtures in a negative way (e.g., by teasing or bullying).

Joint attention might look like

• preferring to engage in solitary play when others are engaged in group activities but remaining in the room;
• attending to shared objects or activities rather than making eye contact (e.g., swinging a jump rope near girls playing jump rope); and
• demonstrating pleasure during an activity and body movement or changing one’s facial expression in response to continued stimulation.

Joint attention deficits that could require skilled services include the following:

• difficulty orienting toward people in a social environment when orienting is necessary
• limited frequency of directing another’s attention to share an item or event when sharing the event or item is desired
• restricted range of communicative functions to seek engagement and comfort from others that impact access to preferred communication partners
• limitations in recognizing and describing another’s emotional state, intention, and perspective that reduce the quality and quantity of communicative engagement and
• difficulty determining causal factors for emotional states of self and others that impact relationships with preferred communication partners

Social reciprocity is the back-and-forth interaction between people, during which the behavior of each person influences the behavior of the other person.

Social reciprocity might look like

• engaging in a monologue or in conversation about a favorite topic;
• using preferred phrases or scripts to engage in oral or nonoral communicative exchanges, including melodies, gestures, and augmentative and alternative communication (AAC); and
• using intentional body movements or engaging in scripted responses to communication attempts by a familiar communication partner.

Social reciprocity deficits that might require skilled services include the following:

• difficulty consistently initiating bids for interaction across settings or preferred communication partners
• problems responding to bids for interaction initiated by others in their social circles
• difficulty initiating and maintaining conversations that are sensitive to social context and the interests of others
• difficulty transitioning between conversation topics
• limitations with maintaining turn-taking in interactions that might result in undesired outcomes (i.e., unable to interview for a job, unable to adequately gain enough information to participate in a preferred activity)
• difficulty recognizing and repairing breakdowns in communication that could negatively impact continued relationships or engagement

Social cognition refers to the mental processes involved in perceiving, attending to, remembering, thinking about, and making sense of the people in our social world (Moskowitz, 2005).

Social cognition might look like

• taking someone at their word rather than drawing inference from facial expressions or body language,
• synthesizing information and recalling skills for a single setting or situation,
• using expert-level knowledge and vocabulary related to a single person or situation, and
• showing differences in the interpretation of figurative language.

Social cognition deficits that might require skilled services include the following:

• Challenges in social and emotional learning, including difficulty
• understanding and regulating emotions;
• appreciating others’ perspectives;
• developing prosocial goals; and
• using interpersonal skills to handle developmentally appropriate tasks
  (Payton et al., 2000).
• Difficulty differentiating one’s own feelings from the feelings of others, taking another person’s perspective, and modifying language accordingly (i.e., theory of mind).
• Difficulty integrating diverse information to construct meaning in context (i.e., central coherence; Frith & Happé, 1994).
• Difficulty identifying feelings or socially acceptable activities outside of familiar experiences (e.g., saying “My ear hurts” to indicate feeling overstimulated).

Language and Related Cognitive Skills

Language and related cognitive skills might look like

• engaging in narratives that reveal increased use of scripts or echolalia rather than self-generated utterances;
• inconsistently using nonoral and oral communication to communicate feelings or ideas;
• using unique ways of connecting with preferred communication partners to communicate needs;
• using well-developed vocabulary in one specific topic that does not consistently transfer to other related topics;
• showing a preference for familiar sounds and prosody;
• engaging in styles of play that others cannot easily identify as familiar or enjoyable but that provide a source of joy and comfort;
• being able to read preferred and familiar text but being unable to decode unfamiliar words; and
• being able to intensely focus on an activity to completion without interruption but having difficulty or refusing to attend to nonpreferred or unscheduled tasks.

Language and related cognitive skills that might require skilled services in one or more of the following seven areas:

1. Delayed or impaired acquisition of words, word combinations, and syntax, including the following:
   • Loss of earlier learned words.
   • Delayed acquisition of words representing social stimuli such as actions and people’s names even when provided multimodal communication like AAC or manual signs (initial words are often nouns and attributes).
   • Use of echolalia—that is, when someone repeats utterances produced by others (e.g., repeating sounds, words, phrases, or songs) in order to communicate. Autistic children who are deaf and hard of hearing may demonstrate manual echolalia (Shield et al., 2017). There are two types of echolalia:
     • Immediate echolalia refers to utterances that are repeated immediately or after a few seconds or minutes.
     • Delayed echolalia refers to utterances that are repeated after a significant delay (Prizant & Rydell, 1984). Echolalia is prevalent among autistic individuals who use speech, and echolalia may remain a characteristic of their spoken language for some time (Fay, 1969).
2. Deficits in consistent use and understanding of nonverbal and verbal communication, including the following:
   • Delayed use of facial expressions, body language, and gestures as forms of communication in the latter part of the first year of life, remaining unconventional throughout development.
   • Emergence of the use of unconventional gestures (e.g., pulling a caregiver’s hand toward an item) prior to or in place of more conventional gestures (e.g., giving, pointing, and head nods/headshakes).
   • Limited understanding of gaze shifting, distal gestures, facial expressions, and rules of proximity and body language.
   • More delayed receptive language than expressive language
   • Inconsistent expressive communication influenced by environmental stimuli and the person’s internal sensory system.
3. Vocal development deficits, including the following:
   • Atypical response to caregiver’s vocalizations.
   • Atypical vocal productions.
   • Abnormal prosody once speech emerges (speech may sound robotic or may have exaggerated intonation).
4. Symbolic play deficits, including the following:
   • Delayed acquisition of functional and conventional use of objects.
   • Preference for symbolic play that follows preferred routines and repetitions.
   • Limited cooperative play in interactive situations.
   • Use of a play style whose meaning and value might not be expected by—or immediately apparent to—outside observers.
5. Conversation deficits, including the following:
   • Limitations in understanding and applying neurotypical social norms of conversation (e.g., turn-taking, vocal volume, proximity, prosody, and conversational timing).
   • Difficulty understanding how much information and context to provide their conversation partners.
   • Challenges in understanding when and how to take turns in conversation.
   • Difficulty initiating topics of shared interest.
   • Preference for topics of special interest.
   • Difficulty recognizing the need for clarification.
   • Challenges in adequately repairing miscommunications.
   • Problems understanding figurative language—including idioms, multiple meanings, and sarcasm.
   • Lack of or limited question asking in conversation.
6. Literacy deficits, including difficulty with the following:
   • Reading for comprehension despite an above-average decoding ability.
   • Understanding narratives and expository text genres that require multiple perspectives (e.g., persuasive and comparative/contrastive).
   • Understanding the main idea and summarizing.
   • Providing sufficient information for the reader when writing.
7. Executive functioning deficits, including the following:
   • Lack of or limited flexibility.
   • Poor problem solving.
   • Poor planning and organization.
   • Lack of inhibition.

Behaviors and Emotions

Behaviors and emotions might look like

• seeing a peer cry and pretending to cry with them;
• engaging in repetitive patterns of behavior, interests, or activities that could be considered stimming or perseveration—does not include self-injurious behaviors (Kapp et al., 2019);
• not using oral language when a response is expected or required;
• engaging in part-time use of AAC when experiencing a loss of oral language; and
• independently initiating a preferred regulation activity when experiencing strong emotions.

Behavioral and emotional challenges that might require skilled services include the following:

• problems dealing with changes in routine and/or changing from one activity to the next
• problems generalizing learned skills
• use of objects in unusual ways and demonstration of uncommon attachments to objects
• difficulty sleeping
• certain behaviors—for example, crying, becoming angry, or laughing—that occur for reasons that are difficult to determine and/or at seemingly inappropriate times
• anxiety and/or social withdrawal (possibly due to factors such as misinterpretation of social events, failure to identify salient or irrelevant information, and challenges with socialization)
• depression (possibly due to challenges with socialization)
• use of unconventional behavioral strategies and emotional expressions (e.g., aggression, tantrums, bolting from situations)
• repetitive patterns of behavior, interests, or activities that restrict opportunities, contribute to distress or discomfort, or impact self-management

Sensory and Feeding Challenges

Sensory and feeding may look like

• showing a preference for favorite dishes, textures, or colors of food;
• enjoying meals while standing;
• having the ability to identify small changes in food textures or tastes; and
• consistently using restricted tools for feeding.

Sensory and feeding challenges that might require skilled services include the following:

• sensory modality difficulties, including over-responsiveness, under-responsiveness, or mixed responsiveness patterns to environmental sounds, smells, light, tactile stimulation, movement, visual clutter, and social stimuli (e.g., social touch, proximity of others, voices)
• a preference for nonsocial stimuli—which leads to intense interest in the sensory aspects of objects and events;
• patterns of food acceptance or rejection based on manner of presentation or food texture; and
• consumption of a smaller variety of foods than the variety consumed by other family members.

Early Detection

Diagnostic features of ASD are present in very young children. Most families and caregivers report observing symptoms within the first 2 years of life and typically express concern by the time the child reaches 18 months of age.

Studies of children with ASD found the following:

• Parents of children with ASD reported first noticing abnormalities in their children’s development—particularly in language development and social relatedness—at about 14 months of age, on average (Chawarska et al., 2007).
• Infants at risk for—and later diagnosed with—ASD showed a decline (from previous normative levels) in eye fixation within the first 2–6 months of age. This pattern was not observed in typically developing infants (Jones & Klin, 2013).
• By 12 months of age, infants at risk for—and later diagnosed with—ASD demonstrated atypical eye gaze, social smiling passivity, decreased positive affect, and delayed language (Zwaigenbaum et al., 2005).
• Children with autism used fewer communicative gestures and behaviors (e.g., pointing) as infants and toddlers (based on early home videos) than neurotypical age-matched peers (Watson et al., 2013; Werner & Dawson, 2005).
• Children with autism showed subtle differences in sensory–motor and social behavior at 9–12 months of age (based on early home videos) when compared with typically developing peers (Baranek, 1999).
• Children with autism showed lower rates of canonical babbling and fewer speechlike vocalizations across the 6- to 24-month age range (based on early home videos) than did typically developing peers (Patten et al., 2014).
• Infants at risk for—and later diagnosed with—ASD used significantly more distress vocalizations (e.g., cries, whines, screams, and squeals) than did children who were typically developing and children who were developmentally delayed; this may reflect the difficulties that children with ASD have with emotional regulation (Plumb & Wetherby, 2013).

Gender-Based Differences in Characteristics

It is well documented that more boys than girls are diagnosed with ASD (e.g., Baio et al., 2018). A diagnostic bias toward characteristic ASD traits as they present in boys makes it easy to miss ASD traits as they present in girls (Dworzynski et al., 2012). Autistic girls demonstrate more neurotypical social interaction and communication skills compared to autistic boys (Wood-Downie et al., 2021). In addition, girls also tend to have fewer and less unusual repetitive, stereotyped behaviors than boys (Mandy et al., 2012). Gender stereotypes and expectation bias may also add to the underdiagnosis of girls (Whitlock et al., 2020). Girls who do meet the diagnostic criteria for ASD during early childhood tend to have additional challenges (lower cognitive ability and/or additional behavioral problems). This is not the case for boys (e.g., Dworzynski et al., 2012; Lord & Schopler, 1985). See the Assessment section for information about autism in transgender and gender-non binary people.

Co-Occurring Conditions

Autistic people and people with a medical diagnosis of autism frequently have co-occurring conditions. For example, 97% of children with public health insurance and autism, or ASD, were reported to have at least one co-occurring health condition (Center for Medicaid and CHIP Services, 2024). Such co-occurring conditions are not necessarily present in every person.

These co-occurring conditions could include

• epilepsy,
• gastrointestinal conditions,
• immune/metabolic conditions,
• neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD),
• psychiatric disorders, and
• sleep disorders.

Speech- and language-related disorders can also co-occur with ASD. These disorders include the following:

• 1% for food selectivity (Babinska et al., 2020)
• 6% for childhood apraxia of speech (Tierney et al., 2015)
• 8% for ADHD (Rau et al., 2020)
• 42% for hyperacusis (Z. J. Williams et al., 2021)
• 6%–63.4% for language disorder (Levy at al., 2010; Rubenstein et al., 2018)
• 0%–25.0% for stuttering (Pirinen et al., 2023)
• 5%–13.0% for hearing loss (Rosenhall et al., 1999; Trudeau et al., 2021)

Autism spectrum disorder (ASD) is medically diagnosed based on differences in communication development and other signs and symptoms resulting from differences in brain structure. Researchers have devoted considerable efforts to investigating etiological factors. Understanding the biomarkers of autism can lead to more efficient screening and diagnosis/identification, which would then connect people to services sooner (Interagency Autism Coordinating Committee [IACC], 2023). Although no single cause has been identified, the available data suggest that autism results from different sets of causal factors—including genetic, neurobiological, and environmental factors.

Genetic Factors

Researchers largely agree that ASD is the result of hereditable genetic differences and/or mutations. For example, ASD is most likely linked to genetic differences associated with the X chromosome (Chakrabarti & Fombonne, 2005). People with a medical diagnosis of autism may also be more likely to have a younger sibling with an autism diagnosis (Ozonoff et al., 2011).

Neurobiological Factors

A genetic code may result in different brain development—which can lead to differences in structure and function, cognition and neurobiology, and behaviors (D. Williams, 2012). These behaviors demonstrate how the brain may respond differently to the environment, such as a different neural response to eye gaze (Elsabbagh et al., 2012).

Environmental Factors

Researchers have begun to investigate how pre- and postnatal environmental factors (e.g., dietary factors, exposure to drugs, environmental toxicants, parental factors) might influence autism.

More research is needed to fully understand potential environmental factors, including specific exposures and gene–environment interactions (IACC, 2023).

For more information on the potential causes of autism, see Question 2 and Question 3 of the 2021–2023 IACC Strategic Plan for Autism Research, Services, and Policy (IACC, 2023).

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with autism spectrum disorder (ASD). The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

The role of the SLP, often on an interprofessional team, is to provide skilled services to people who have been diagnosed with ASD and are developing communication skills based on their unique needs. There are autistic traits that may help with diagnosis but that do not require intervention or change.

SLPs provide skilled interventions that are either medically necessary or educationally necessary to support a person with a diagnosis of ASD in achieving their communication or feeding goals. The Code of Ethics (ASHA, 2023) states that the clinician must serve the best needs of the client using evidence-based practices.

The combination of (a) evidence-based, peer-reviewed research, (b) clinical experience, and (c) autistic voices can help clinicians determine how to develop and implement culturally responsive and neurodiversity-affirming treatment plans.

Appropriate roles for SLPs are as follows.

Education

• Provide information to individuals and groups known to have an increased likelihood of autism, to their family members, and to people working with those with autism.
• Educate other professionals on the communication or feeding needs of persons with ASD and the role of SLPs in diagnosing and managing ASD.
• Provide parent education so that families may continue to provide intervention beyond the sessions.
• Remain informed of research in the area of ASD and help advance the knowledge base related to the nature and treatment of ASD—including the importance of neurodiversity-affirming strategies to provide quality care.

Screening and Assessment

• Screen individuals who present with language and communication difficulties, and determine the need for further assessment and/or referral for other services.
• Conduct a culturally and linguistically relevant comprehensive assessment of language and communication, including social communication skills.
• Assess the need for and requirements for using augmentative and alternative communication (AAC) devices as a mode of communication.
• Assess and treat feeding issues, if present (e.g., patterns of food acceptance or rejection based on food texture, consumption of a limited variety of foods).
• Diagnose the presence or absence of ASD (typically as part of a diagnostic team or in other interdisciplinary collaborations).
• Partner with families in assessment and intervention with individuals who have ASD. See ASHA’s resource on person- and family-centered care.

Intervention and Support

• Refer to other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services.
• Make decisions about the management of ASD. Decisions include neurodiversity-affirming care and keeping up to date with information from autistic self-advocates.
• Participate as a member of the individualized education program, multi-tiered systems of support, and 504 teams to determine appropriate educational services.
• Develop speech and language goals focused on social language and literacy, and assist the student with self-regulatory and social interactive functions so that they can participate in the mainstream curriculum as much as possible.
• Provide treatment, document progress, and determine appropriate dismissal criteria.
• Provide training in the use of AAC systems to persons with ASD as well as their families, caregivers, care partners, and educators.
• Counsel people with ASD and their families regarding communication-related issues, and provide education aimed at preventing further complications related to ASD (see ASHA’s Practice Portal page on Counseling in Audiology and Speech-Language Pathology).
• Consult and collaborate with the individual, family members, caregivers, care partners, and the interprofessional team to facilitate program development, support transition planning, and/or provide expert testimony (see ASHA’s resources on interprofessional education/interprofessional practice [IPE/IPP], collaboration and teaming, and person- and family-centered care).
• Advocate for individuals with ASD and their families at the local, state, and national levels.

As indicated in the Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so.

Role of the SLP in the Diagnostic Process

Interdisciplinary collaboration in assessing and diagnosing ASD is important due to the complexity of the disorder, the varied aspects of functioning affected, and the need to distinguish ASD from other disorders or medical conditions (Hyman et al., 2020). Timely diagnosis allows for timely supports and skilled services, both of which facilitate positive outcomes (IACC, 2023).

Ideally, the SLP is a key member of an interdisciplinary team with expertise in diagnosing ASD. When there is no appropriate team available, an SLP—who has been trained in the clinical criteria for ASD and who is experienced in diagnosing developmental disorders—may be qualified to diagnose these disorders as an independent professional.

Additional Considerations for State Licensing Boards and School Districts

State speech-language pathology licensing boards do not always specify whether the diagnosis of ASD and other conditions is expressly within a licensee’s scope of practice. Moreover, licensing agencies—such as a state medical board—for other health professions may set rules that prohibit SLPs from diagnosing ASD independently.

School districts and employers in other settings may also have policies regarding the professionals who can establish the diagnosis. In addition, payers (Medicare, Medicaid, commercial, or private insurers) typically require a diagnosis by a physician, a psychiatrist, or another medical professional for coverage of services.

SLPs are responsible for understanding the requirements in place in their state, in their setting, and by payer so that appropriate services are not delayed. Please see ASHA’s state-by-state resources for state licensing requirements and contact information. ASHA also provides tracking of state insurance mandates for ASD. For questions regarding specific payer requirements, please contact reimbursement@asha.org.

Interdisciplinary collaboration and family involvement are essential in assessing and identifying autism. The speech-language pathologist (SLP) is a key member of an interdisciplinary team that includes the child’s pediatrician, a pediatric neurologist, a psychologist, and a developmental pediatrician. Several available algorithms and tools are available to help physicians develop a strategy for early identification of children with autism spectrum disorder (ASD; Plauché Johnson & Myers, 2007).

Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2023; WHO, 2001), assessment is conducted to identify and describe functioning, disability, and contextual factors.

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

Benefits of Early, Accurate Diagnosis and Identification

The benefits of early, accurate diagnosis of ASD are as follows:

1. It helps families and caregivers access appropriate services.
2. It provides a common language across interdisciplinary teams.
3. It establishes a framework to help families and caregivers understand the child’s difficulties.

Any diagnosis of ASD—particularly of young children—is periodically reviewed by members of the interdisciplinary team because diagnostic categories and conclusions may change as the child develops.

The identification of early behavioral indicators can help families and caregivers obtain appropriate diagnostic referrals and access early intervention services, even before a definitive diagnosis is made (Woods & Wetherby, 2003). Early intervention may improve long-term outcomes for many children (Dawson & Osterling, 1997; Dawson et al., 2010; Harris & Handleman, 2000; Landa & Kalb, 2012). There also may be benefits of providing intervention that targets prelinguistic communication to infants who may be autistic (Bradshaw et al., 2015; L. K. Koegel et al., 2014).

A diagnosis guides the team to focus supports and services that may facilitate options for functional communication development, inform social and psychosocial accommodation recommendations, and identify opportunities to connect with the autistic community to learn more about the lived experiences of autistic self-advocates. While severity rating is included in the diagnosis, it should not be used to determine eligibility for any service.

The diagnosis describes the features of autism and identifies common traits of the autistic community. Seeking a diagnosis may help an individual determine what interventions might support personal goals that improve independence and employability. Skilled services can be recommended to improve health and educational outcomes.

Considerations for Diagnosis Later in Childhood or Adulthood

Some autistic people are not diagnosed until later school age, adolescence, or even adulthood. This can happen because they appear to succeed in some or most academic subjects, particularly in their early school years. However, those who are identified later in life show challenges with social engagement and social communication. This can significantly affect their ability to adjust to social demands in later academic and community settings and in the workplace (Gilchrist et al., 2001; Mueller et al., 2003; Tsatsanis et al., 2004). Interventions may need to address the gap between cognitive potential and social adaptive functioning.

Camouflaging

Camouflaging may be another potential reason why people are diagnosed with autism later in life. Camouflaging, including masking, is a learned coping strategy that autistic people use to (a) hide their autistic behavior that might be deemed socially unacceptable or (b) “perform” neurotypical social behavior (Lai et al., 2017; Willey, 1999). Autistic people may camouflage but may not realize that they are doing it. Here are some examples of camouflaging and masking (Cook et al., 2022):

• avoiding talking about themselves or disclosing special interests or hobbies
• reducing or hiding stimming hand movements
• maintaining the appearance of eye contact (e.g., looking at the communication partner’s forehead)
• mirroring another person’s body language, accent, or facial expressions
• changing gestures to look more like conventional gestures

All genders can camouflage, but autistic females are more likely to camouflage and mask their autistic traits (Alaghband-rad et al., 2023; Lai et al., 2017). Camouflaging and masking takes a lot of cognitive energy. Higher camouflaging has been associated with excessive stress, anxiety, and depression (Adams et al., 2023; Alaghband-rad et al., 2023; Lai et al., 2017).

Adult Diagnosis

Some adults have lived with undiagnosed ASD and seek services only when they start experiencing challenges at work, in social relationships, or in academic settings (Brugha et al., 2011). Some people may find a diagnosis of ASD in adulthood as a relief. But for many, it can come as a surprise and may be difficult to accept, even if it helps explain some of the challenges that they have been experiencing. Therefore, it is essential to give the diagnosis with utmost sensitivity. See ASHA’s Practice Portal page on Counseling in Audiology and Speech-Language Pathology.

Adult diagnosis is complicated by the fact that (a) there is limited information about the developmental trajectory of adults with autism and (b) there are no standard screening and diagnostic tools for ASD in adults (Interagency Autism Coordinating Committee [IACC], 2023). There is also a lack of services and supports for adults with autism. The importance of involving professionals from multiple disciplines cannot be overstated, especially because many adults receiving an ASD diagnosis for the first time can have other related concerns (e.g., mental health; Geurts & Jansen, 2012). SLPs with expertise in assessing social communication, higher level language, conversation, and discourse are integral members of this team.

For a comprehensive discussion on autism across the lifespan, see Question 6 of the 2021–2023 IACC Strategic Plan for Autism Research, Services, and Policy (IACC, 2023).

Cultural Considerations for Autism

Understanding Variations in Cultural Norms

Social communication is influenced by the core characteristics of autism. Variations in norms for social communication exist within and across cultures. The core characteristics of ASD may be viewed through a cultural lens leading to under-, over-, or misdiagnosis (Taylor Dyches et al., 2001; Tek & Landa, 2012). Patient- and family-centered care is essential to providing culturally responsive care. Ethnographic interviewing during a case history provides an opportunity for patients, families, caregivers, and care partners to describe their daily communication and the communication norms that exist in the home. When examining the patient’s social communication, the clinician compares it to the expectations and norms that exist in the home for the family and/or caregiver. For example, direct eye contact with an adult may be considered respectful or disrespectful—depending on one’s culture. If clinicians note variations in eye contact—without knowing how the family views eye contact culturally—then the clinician would not be able to make conclusions.

Disparities in Identification

Lack of familiarity with cultural influences may contribute to the disparity in the diagnosis of ASD among some racial and ethnic groups (Begeer et al., 2009; Taylor Dyches, 2011). In studies examining the length of time that it takes a clinician to diagnose ASD in African American children, parents indicated that they shared concerns with professionals nearly 3 years prior to diagnosis (Constantino et al., 2020). African American children with ASD were more likely than Hispanic and White children to be classified with a co-occurring intellectual disability (Maenner et al., 2023). It took Latino/a/x children an average of eight visits to receive a diagnosis (Iland et al., 2012). Researchers suggested, in part, that disparities may be due to a lack of health care provider training in recognizing ASD in children of color (Aylward et al., 2021).

According to a study of children in which researchers examined self-report and parent report, there are more nonbinary and trans people who are autistic than who are not autistic (Corbett et al., 2023; Warrier et al., 2020). Most diagnostic tools were developed on the basis of cisgender norms that were determined by sex assigned at birth. This suggests that transgender and gender-nonconforming people may be more likely to have undiagnosed autism (Warrier et al., 2020).

Cultural Views of Autism

Core values and beliefs can affect the family’s views of autism and their decisions regarding services (Burkett et al., 2015; Wilder et al., 2004). For example, autism may be viewed in a negative light, and the family feels that it needs to be hidden from others. This, in turn, may influence the type of care that the family seeks. Signs and symptoms that are clearly “red flags” in the U.S. health care or educational system may not be viewed in the same way by someone from a culture that does not formally define the disorder.

See ASHA’s Practice Portal page on Cultural Responsiveness. See also Taylor Dyches (2011) for a discussion of diverse perspectives on symptoms of autism.

Screening

The goal of screening is to detect developmental delays and other factors that might signal ASD—such as a child being referred to the early intervention system or a child who is the younger sibling of someone with autism. See ASHA’s Practice Portal page on Early Intervention.

Screening tools for early identification are available. One screening tool identifies prelinguistic behavioral vulnerabilities in infants 6–18 months of age (Bryson et al., 2008). Another tool—a broadband screener—identifies communication delays (including ASD) in children 9–24 months of age (Pierce et al., 2011; Wetherby et al., 2008). Also available are questionnaire-based tools that can screen children who may have ASD as early as 12 months of age (Turner-Brown et al., 2012). Any screening tool should be culturally and linguistically appropriate and have strong psychometric features to support its accuracy.

Screening typically includes

• norm-referenced parent and teacher report measures;
• competency-based tools, such as interviews and observations; and
• hearing screening to rule out hearing loss as a contributing factor to communication and behavior difficulties.

Screening procedures evaluate the main characteristics that differentiate ASD from other developmental disorders, including difficulties in

• eye gaze,
• orienting to one’s name,
• pointing to or showing objects of interest,
• pretend play,
• imitation,
• nonverbal communication, and
• language development.

Social communication norms vary across cultures. When screening is conducted for nonlinguistic aspects of communication, it is important to recognize when differences are related to cultural variances rather than to a communication disorder. See ASHA’s Practice Portal page on Cultural Responsiveness.

Loss of language or social skills at any age should be considered grounds for screening. In cases where children are being raised in a bilingual environment, consider whether language loss is attributable to language attrition. See ASHA’s Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.

Because children with ASD are often initially suspected of having a hearing problem, audiologists play a critical role in (a) recognizing the possible signs of ASD in children whose hearing they test and (b) making appropriate referrals for screening.

Comprehensive Assessment

Individuals who may have ASD based on screening results are referred to an SLP and other professionals, as needed, for a comprehensive assessment. A comprehensive assessment is functional and is sensitive to the wide range of acceptable social norms within and across communities and cultures. It involves the collaborative efforts of families, caregivers, care partners, classroom teachers, SLPs, special educators, and psychologists, as needed.

A culturally responsive partnership between the SLP and the family facilitates the assessment process and acknowledges the diverse needs of the individual and their family and/or care partners (Pearson et al., 2018). See ASHA’s Practice Portal page on Cultural Responsiveness.

The comprehensive assessment typically includes the following components:

• Relevant case history, including information related to the child’s health, developmental and behavioral history, and current medical status.
• Medical and mental health history of the family, including history of siblings with ASD.
• Medical evaluations, including general physical and neurodevelopmental examination and vision testing.
• Formal and informal assessments by an SLP, including
• language assessment;
• language sampling and narrative analysis;
• speech assessment, including assessment of motor speech abilities;
• feeding and swallowing assessment, as needed; and
• augmentative and alternative communication (AAC) assessment (as needed) to determine the potential benefits for improving functional communication.
• Audiologic assessment by an audiologist.

The comprehensive assessment may also include two additional testing components:

• genetic testing—particularly if there is a family history of intellectual disability or genetic conditions associated with ASD (e.g., fragile X, tuberous sclerosis) or if the child exhibits physical features that suggest a possible genetic syndrome
• metabolic testing—if the child exhibits symptoms such as lethargy, cyclic vomiting, pica, or seizures.

The comprehensive assessment may result in

• a diagnosis of ASD;
• a description of the characteristics and severity of communication-related symptoms;
• recommendations for intervention, goals, and supports (e.g., environmental accommodations, assistive technology);
• a referral for AAC assessment, if not completed as part of the comprehensive assessment; and/or
• a referral to other professionals for the following reasons:
• get additional data to confirm a diagnosis of ASD
• get further testing because the person is thought to have other disorders/conditions.

Audiologic Assessment

Individuals with hearing loss may present with symptoms similar to those of ASD, particularly in the areas of communication and socialization. For example, children with hearing loss might display the following autistic-like behaviors:

• reduced social interaction with peers if they have difficulty hearing, which may lead to the kinds of social skill deficits often seen in children with ASD
• a lack of response or acknowledgment when someone is trying to get their attention or when someone calls their name
• delays in speech and language development (Szarkowski, Mood, et al., 2014)

But, it is also possible that a deaf and hard of hearing person is also autistic (Easterbrooks & Handley, 2005; Malandraki & Okalidou, 2007; Szymanski & Brice, 2008). Knowing a child’s hearing acuity prior to an ASD assessment is a fundamental step in ensuring a reliable diagnosis and in further understanding if a child has hearing loss, has ASD, or has both conditions concurrently.

The potential similarities in presentation between hearing loss and ASD (e.g., a lack of response when someone calls their name)—and the possibility that both conditions might be co-occurring—can make diagnosis challenging. Currently, no ASD screening and assessment measures are validated for use with children who have hearing loss (Szarkowski, Mood, et al., 2014). Often, there is a delay in ASD diagnosis in individuals with both ASD and hearing loss (Szarkowski, Flynn, & Clark, 2014). More research is needed on the assessment of ASD for those who use American Sign Language (ASL) as their primary language (Szarkowski, Mood, et al., 2014).

Some characteristic behaviors associated with ASD can make it challenging to obtain valid and reliable hearing assessment results. These behaviors include (a) comfort with “sameness” and an aversion to novel situations; (b) hypersensitivity and negative responses to sensory input; and (c) communication differences, such as receptive language deficits and unreliable pointing gestures (Davis & Stiegler, 2005; Stiegler & Davis, 2010).

Suggestions for assessing hearing in individuals with these and other challenging behaviors are as follows:

• Minimize distractions in the test suite.
• Use visual supports and schedules to assist with the audiological testing sequence (McTee et al., 2019).
• Partner with parents and the managing SLP, all of whom are more familiar with the individual’s behaviors, interests, and needs.
• Use the individual’s primary/preferred language form (e.g., spoken language, ASL, AAC devices, or picture symbols).
• Increase the individual’s familiarity with assessment procedures prior to testing—such as social narratives, a visual schedule, and/or practicing with a favorite doll or stuffed animal.
• Allow the individual to touch and explore, ahead of time, earphones that you will use during testing—to help them overcome tactile sensitivity and related anxiety.
• Incorporate flexibility in the assessment situation (e.g., testing order or earphone type).
• Practice appropriate motor movements in response to test stimuli.
• Know what is reinforcing to the individual (e.g., eating food, watching clips from favorite videos, playing with a favorite toy) and using these reinforcers to reward appropriate behavioral responses to test stimuli.
• Consider the use of multiple sessions to obtain complete results.
• Recognize the person’s signs of distress, and terminate testing before the situation escalates (Brueggeman, 2012; Stiegler & Davis, 2010).
• Consider using alternative behavioral stimuli—such as the child’s favorite sounds (e.g., unwrapping a candy wrapper outside of the child’s vision).
• Consider the need for objective tests, such as otoacoustic emissions and/or auditory brainstem response testing, to supplement behavioral audiometry, especially if subjective measures are incomplete or display poor test/retest reliability.

See Scope of Practice in Audiology (ASHA, 2018c).

Speech and Language Assessment

To obtain the most true and accurate assessment results, the clinician confirms a person’s hearing status before assessing them. SLPs can use both formal and informal assessment approaches. Formal testing may be required if a diagnosis or eligibility for services has yet to be determined. Informal testing may be most useful for determining whether the person has met specific communication milestones or for assessing communication skills in everyday settings. See ASHA’s resource on assessment tools, techniques, and data sources, which SLPs can use in a comprehensive communication assessment.

The SLP might use dynamic assessment to identify nonsymbolic and symbolic communication behaviors and to evaluate individual learning potential (Pea, 1996; Snell, 2002). Conversation analysis (Yu & Sterponi, 2022) is an additional option for dynamic assessment. It is a form of spontaneous language sampling that provides a realistic picture of an autistic person’s language—including echolalia—and social communication without the assumptions that come with structured questionnaires, interviews, and tests (Yu & Sterponi, 2022).

A comprehensive speech and language assessment includes testing of skills in language, speech, feeding and swallowing, and AAC.

Expressive language. Assessment of spoken language includes language expression and language comprehension (see ASHA’s Practice Portal page on Spoken Language Disorders). The clinician assesses all means of expressive language—verbal (including echolalia) and nonverbal (including gestures)—for communicative function and intent (see, e.g., Cohn et al., 2022; Watson et al., 2013). Language sampling and narrative analysis are essential pieces to the comprehensive assessment, especially if the child uses forms of echolalia.

Communicative functions of echolalia. Historically, echolalia has been described as meaningless and without communicative function. However, a growing body of research has identified various communicative functions of echolalia (e.g., turn-taking, labeling, requesting, affirming, and protesting) and has suggested its role in gestalt language acquisition (Prizant, 1982, 1983; Prizant & Duchan, 1981; Prizant & Rydell, 1984; Stiegler, 2015). SLPs can consider the theory of gestalt language acquisition and the role of echolalia in assessment procedures (e.g., assessing communicative function of echolalia) and treatment approaches to language intervention (see, e.g., Blanc et al., 2023; Luyster et al., 2022). However, clinicians may need to be cautious of overgeneralizing gestalt language acquisition to autistic language development (Hutchins et al., 2024).

Written language. This includes reading decoding, reading comprehension, written expression, and writing for varied audiences. See ASHA’s Practice Portal page on Written Language Disorders.

Social communication. Assessment of social communication may vary based on familial and cultural norms. Components of social communication assessment may include the following:

• use of gaze
• joint attention
• sharing affect
• initiation of communication
• social reciprocity and the range of communicative functions
• behaviors during play
• understanding and use of facial expressions
• use of gestures
• speech prosody (using stress and intonation to effectively convey meaning)
• conversational skills
  • topic management (initiating, maintaining, and terminating relevant, shared topics)
  • turn-taking
  • providing appropriate amounts of information in conversational contexts

Speech. A speech sound disorder, including a motor speech disorder, can result in a person having significant difficulty producing speech or, possibly, an inability to speak. Motor speech disorder in autistic people who use part-time oral speech can be characterized by reduced intelligibility, decreased precision, and difficulty with speech coordination (Maffei et al., 2024).

Speech difficulties are not the same as language and social communication problems. For example, when a speech sound disorder results in lack of speech or highly unintelligible speech, someone might assume that the individual is nonverbal. However, they may have average to above-average language and communication abilities (see, e.g., Tierney et al., 2015). See ASHA’s Practice Portal pages on Speech Sound Disorders: Articulation and Phonology and Childhood Apraxia of Speech.

Feeding and swallowing. See ASHA’s Practice Portal page on Pediatric Feeding and Swallowing.

AAC. See ASHA’s Practice Portal page on Augmentative and Alternative Communication (AAC).

Following a diagnosis of ASD, clinicians conduct ongoing assessments. Reasons may include, but are not limited to, the following:

• Measure progress on developing AAC communicative competencies.
• Determine an individual’s current profile of social communication skills.
• Identify high-priority learning objectives within natural communication contexts.
• Examine the influence of the communication partner and the environment on communication competence.

As part of the ongoing assessment process, clinicians can use alternative approaches such as dynamic assessment to identify skills that an individual has achieved, skills that may be emerging, and the contextual supports that enhance communication skills (e.g., AAC or modeling). The dynamic assessment framework uses a test–teach–retest model. This allows the clinician the opportunity to observe how quickly new skills are learned.

Considerations in the School Setting

Within a public school setting, eligibility for services under the disability category of autism is based on the definition of autism provided in the Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004):

Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences . . . . Autism does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined by IDEA . . . . a child who manifests the characteristics of autism after age three could be identified as having autism if the criteria in 300.8(c)(1) are satisfied.

Social communication challenges affect participation and progress in the general education curriculum. The pervasive nature of social communication challenges in individuals with ASD supports the eligibility criteria for services in schools.

Individuals who have been diagnosed with ASD via other sources of clinical criteria—such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR; American Psychiatric Association, 2022)—are likely to be eligible for special education services under the autism category, as defined above, due to (a) deficits in social communication functioning across severity levels and (b) the determination of educational benefit.

To determine a person’s eligibility for educational services, the clinician uses a variety of strategies for gathering information, including

• standardized and nonstandardized measures of social adaptive functioning,
• naturalistic observation across a range of settings, and
• caregiver/teacher interviews or questionnaires.

Regardless of the assessment measures or tools that they use, the clinician needs to be aware of any subtle signs and symptoms consistent with a diagnosis of ASD.

Inappropriate Exclusion of Services

IDEA (2004) requires an initial determination as outlined in Section 300.301 to inform the decision-making process regarding eligibility for special education and related services. Some possible criteria to consider are listed below, with reference to ASD as relevant.

Cognitive referencing. This practice of comparing IQ scores and language scores to determine eligibility for speech-language intervention assumes that language functioning cannot surpass cognitive levels. Consequently, if language functioning is commensurate or consistent with cognitive skills, no further gains can be made through intervention. Research had demonstrated that children with disabilities whose language and cognitive levels were commensurate nonetheless benefit from language intervention (Cole et al., 1990). See ASHA’s resource on cognitive referencing.

Chronological age. This argument suggests that individuals with disabilities are either “too young” or “too old” to benefit from communication services. However, research shows that infants, toddlers, and preschoolers with ASD do benefit from communication services and supports (Garfinkle & Schwartz, 2002; L. K. Koegel et al., 2014; Lawton & Kasari, 2012; Pierce et al., 2011). In addition, individuals with ASD can continue to develop communication abilities across their lifespan (Hamilton & Snell, 1993; Pickett et al., 2009; Watanabe & Sturmey, 2003).

Diagnostic label. The term “severe disability” is used to describe a variety of diagnostic labels that identify a significant communication impairment. However, research shows that individuals with severe disabilities—regardless of the underlying diagnosis—can learn to communicate effectively. In the case of ASD, social communication impairment is a core feature (Baron-Cohen et al., 1992; DiLavore et al., 1995; Lord & Corsello, 2005). Therefore, a diagnosis of ASD indicates the inclusion of communication services. Research has indeed demonstrated the benefits of instruction and support for individuals with ASD (Hamilton & Snell, 1993; Mirenda et al., 2000; Wetherby et al., 2000).

Absence of cognitive or other prerequisite skills. This practice presumes that certain skills and performance criteria are necessary to benefit from communication services and supports, based on the interpretation shared by some research findings (Miller & Chapman, 1980; Shane & Bashir, 1980). However, subsequent research shows that individuals (including those with ASD) who do not demonstrate supposed prerequisites can benefit from appropriate communication services and supports (Amato et al., 1999; Bondy & Frost, 1998; Moes & Frea, 2002).

Failure to benefit from previous communication services. Lack of progress in therapy is often attributed to a lack of “potential” to benefit from services. But lack of progress can be tied to other factors—including inappropriate goals, unsuitable intervention methods, failure to incorporate assistive technology, or insufficient methods in measuring outcomes (National Joint Committee for the Communication Needs of Persons With Severe Disabilities, 2003). Access to communication services and supports should not be denied because of failure to progress as a function of these other factors. Rather, previously unsuccessful therapy experiences should be examined to help determine ways in which communication services and supports can be better tailored to meet the individual’s unique communication needs.

Lack of funding or adequately trained professionals. A lack of funding and expertise often fuels exclusionary practices. If trained professionals are not available, then there is an obligation either to find trained professionals or to train existing professionals (Timothy W. v. Rochester, New Hampshire School District, 1989). Similarly, lack of funding does not constitute a reason for exclusion from communication services and supports. IDEA (2004) mandates that identified needs must be met.

Differential Diagnosis

SLPs are instrumental in differentiating between autism, social communication disorder, and other neurodevelopmental disorders or conditions. Accurate diagnosis ensures that individuals with ASD and those with social communication disorder gain access to services. See ASHA’s Practice Portal page on Social Communication Disorder.

Diagnostic features also differ by gender. Differences in the social landscape of girls may make it easier for them to camouflage or mask their social differences. For example, the social groups that girls form on the playground are “fluid.” Girls with autism stay near peer groups and, to an observer, look similar to non-autistic girls. Most boys, on the other hand, usually play structured games on the playground. Boys with ASD tend to spend more time wandering and, therefore, do not appear similar to their peers who are not on the spectrum (Dean et al., 2017).

Whether or not they have had difficulties with language acquisition, all people with an ASD diagnosis are eligible for speech-language services due to the pervasive nature of the social communication impairment. Therefore, SLPs advocate for inclusion of language intervention for individuals diagnosed with ASD and ensure that individuals with ASD also receive a diagnosis of a language disorder when they meet the criteria. See ASHA’s Practice Portal pages on Spoken Language Disorders and Written Language Disorders.

Communication Partners

At its core, communication is a social process. People with ASD and their neurotypical communication partners frequently experience social communication breakdowns. These communication breakdowns are usually due to the double empathy problem (Milton, 2012). The double empathy problem is framed as the neurotypical person and the autistic person communicating from different experiences, world views, and social perceptions. Communication breakdowns occur because the neurotypical person and the autistic person have trouble with cognitively and emotionally empathizing with each other (Gaddy & Crow, 2023).

Individuals with ASD report a desire to have friendships and relationships despite their social communication challenges. However, due to the double empathy problem, peers often feel ineffective in social exchanges with an individual with ASD. Non-autistic peers may avoid that person or may react to social overtures in a negative way (e.g., by teasing or bullying).

Family members, friends, teachers, and coworkers face the challenge of learning to recognize and respond to subtle bids for communication and to interpret the communication functions of challenging behaviors. See the National Joint Committee for the Communication Needs of Persons With Severe Disability’s resource on challenging behavior as communication.

Speech-language pathologists (SLPs) provide skilled services for people with autism spectrum disorder (ASD) across the lifespan. They work with people on the autism spectrum and their families to develop and meet their personal goals throughout their life. The goal of skilled services is to promote positive outcomes—not to force people with ASD to mask their autistic traits or to lose their identity (Interagency Autism Coordinating Committee [IACC], 2023).

SLPs also observe and document the skills of people with ASD—skills that might look different from those of their non-autistic peers. SLPs help the person build new skills using strengths to improve areas that negatively impact the autistic person’s daily functioning. Neurodiversity-affirming care, integrated with skilled services, develops skills that support the autistic child’s identity while helping them learn and develop. See Crow’s (2024) neurodiversity-affirming flowchart [PDF]. This flowchart was originally published as part of the ASHA Professional Development course, “Neurodiversity-Affirming Speech-Language Services and Early Intervention” (Crow, 2024).

Not all people will want to seek skilled services. Those who do require speech and language services aim to improve their language and social communication skills. People on the autism spectrum can learn and apply skills needed to better develop relationships, navigate and function independently in educational and work settings, and actively participate in everyday life. SLPs often collaborate with other professionals to design and implement effective treatment plans.

The mode of communication used during treatment can vary. Mode of communication can include

• spoken language;
• gestures;
• sign language;
• augmentative and alternative communication [AAC];
• speech-generating devices [SGDs]; and/or
• written language.

More than one mode of communication can be used, such as part-time use of AAC systems (Koerner et al., 2023). Different types of AAC may be necessary in differing environments. Low-tech supports may enable quick access or assist unfamiliar communication partners. High-tech assistive technologies or SGDs allow the user to communicate more detailed ideas and offer auditory features. Multimodal communication systems are individualized according to the person’s preferences and abilities and according to 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 people with autism can help reduce the stress experienced by family members (National Research Council, 2001).

Support may take different forms at different times and may include the following:

• coordinating services for the family
• procuring resources and information
• teaching the family or other significant communication partners specific skills and strategies
• providing learning opportunities
• advocating for or with the family

See ASHA’s resources on person- and family-centered care and family-centered practice.

Cultural and Linguistic Considerations

Patient-centered care encompasses gender- and neurodiversity-affirming care. It is culturally responsive and relevant. It ensures that identified 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). Surveillance data reveal persistent disparities across demographic categories. Limitations in studies, most specifically considering the intersectionality of demographic categories, make it difficult to draw conclusions (Hotez & Shea, 2023). Screening for social determinants provides a framework for allowing considerations in access to services. See ASHA’s Practice Portal page on Cultural Responsiveness and ASHA’s resource on social determinants of health.

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; Gilhuber et al., 2023; Hambly & Fombonne, 2012). Multilingual autistic children experience the same benefits of being multilingual as their multilingual non-autistic peers.

When determining the language of treatment for a child with ASD, SLPs carefully consider the child’s linguistic environments. Treatment is provided either by a multilingual SLP or by working with trained interpreters, when necessary. See ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology and Collaborating With Interpreters, Transliterators, and Translators.

Treatment Approaches

Treatment approaches differ in the method used to address goals. They range from discrete trial, traditional behavioral approaches to social-pragmatic, naturalistic developmental behavioral 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 the following factors into consideration:

• the level of social and linguistic development
• cultural background and values
• personal preferences
• family resources
• learning style
• behavior repertoire
• communication needs

Treatment Options

Below are brief descriptions of general and specific treatment options for addressing ASD. The options are organized into broader categories; however, many options can fit into more than one broad category. For example, many options combine developmental approaches and behavioral teaching strategies.

SLPs who engage in neurodiversity-affirming behavioral interventions work on identifying environmental impacts that may affect the autistic person’s successful communication. SLPs create skilled, therapeutic opportunities for meaningful engagement with the autistic person to develop autonomy, teach self-regulation strategies, promote independence, and consider the person’s autistic identity.

This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA. Many approaches have different available commercial programs. Some approaches and programs may require additional training and/or certification. This section will share general descriptions of treatment options that can support people on the spectrum. As autistic children become autistic adults, their needs change and so do the treatment approaches. For a more comprehensive list of treatment options, see the Treatment section of the Autism Evidence Map.

Behavioral Interventions and Techniques

Behavioral interventions and techniques are designed to reduce behaviors that impact effective communication or nutrition 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. Clinicians then adjust in this chain to increase desired behaviors and/or decrease inappropriate ones.

SLPs might apply behavior approaches to interventions. Many treatment approaches that target specific behaviors can fall into either traditional approaches or more contemporary behavior approaches. Intervention is customized based on the person’s needs, interests, and family situation.

Traditional Behavioral Approaches

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. Providers use techniques in one-on-one or group instruction, structured settings (e.g., classroom), and everyday settings (e.g., family dinnertime). Supporters of traditional ABA may believe that highly structured approaches should be used as the main service for people with autism. Some people who oppose traditional ABA may believe that focusing on behavior correction removes autonomy and, thus, they support more child-led treatment approaches.

Intervention is customized based on the person’s needs, interests, and family situation. ABA techniques are often used in intensive, early intervention programs (with children younger than age 4 years) to address a full range of life skills. Intensive programs total 25–40 hours per week for 1–3 years. SLPs might collaborate with Board Certified Behavioral Analysts to maximize resources and promote optimal outcomes. See ASHA’s advocacy resource about ABA and Autism Evidence Map. See also the Resources section on this page for articles about SLPs working with ABA professionals.

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).

Naturalistic Developmental Behavioral Interventions (NDBI)

Activities and treatment targets are child-led, are presented in natural settings, and use developmental and spontaneous modeling. NDBI includes play-based behavioral approaches. A wide range of acceptable antecedents exist, as do a variety of acceptable responses. See ASHA’s Autism Evidence Map for summaries on NDBI.

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 (G. G. McGee et al., 1999).

Examples of traditional and naturalistic behavioral programs are as follows:

• Denver Model (Rogers & Dawson, 2009)
• DIR/Floortime (Greenspan & Wieder, 2007)
• Early Start Denver Model (Rogers & Dawson, 2010)
• Joint Attention, Symbolic Play, Engagement and Regulation (JASPER; Kasari et al., 2008)
• Language Enrichment Arts Program (LEAP; Hoyson et al., 1984)
• Play and Language for Autistic Youngsters (PLAY) Project (Solomon et al., 2014)
• Picture Exchange Communications System (PECS; Bondy & Frost, 1998; Forbes et al., 2024) See also ASHA’s Practice Portal page on AAC for more information about PECS.
• PIVOTAL RESPONSE TREATMENT® (PRT; Forbes et al., 2020; R. L. Koegel & Koegel, 2019)

Educational and School-Based Behavior Interventions

Positive Behavior Support (PBS)—an approach that uses positive (nonpunitive) interventions for decreasing challenging behaviors. A commonly used strategy focuses on two aspects:

1. functionally assessing challenging behaviors to identify the relationship between these behaviors and communication
2. replacing the challenging behaviors with appropriate, functionally equivalent replacement behaviors

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).

Examples of educational and school-based programs are as follows:

• Social Communication, Emotional Regulation, and Transactional Support) Model (SCERTS) model; Prizant et al., 2006)
• Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH; Mesibov et al., 2007)
• Learning Style Profile for Children With Autism Spectrum Disorder (LSP©; Rydell, 2012)

Cognitive Behavioral Therapy

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 people 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 reliable oral speech and who experience fewer core ASD characteristics.

There are additional considerations for professionals implementing CBT principles or other traditional psychotherapeutic approaches to nonspeakers or people who use AAC (Noyes & Wilkinson, 2022). SLPs may need to provide communication partner training to mental health professionals. SLPs can help mental health professionals work with AAC users, such as identifying and repairing communication breakdowns.

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).

Caregiver-Mediated or Relationship-Based Interventions

Caregiver-mediated or relationship-based interventions consist of strategies that caregivers, care partners, or peers use to facilitate communication or social interaction. The caregiver can be involved in interventions even after early intervention. Relationship-based interventions can include romantic partners, family members, and friends. The SLP trains and coaches the caregiver to implement these interventions in natural settings. See ASHA’s Autism Evidence Map for summaries on caregiver-, peer-, or sibling-mediated interventions and on relationship-based interventions.

Examples of programs that include caregiver-mediated and relationship-based interventions are as follows:

• Gentle Teaching (J. J. McGee, 1990; Polirstok et al., 2003)
• Integrated Play Groups® (Wolfberg & Schuler, 1993)
• More Than Words® (Sussman, 1999)
• Relationship Development Intervention® (RDI; Gutstein & Gutstein, 2009)

Social Skills Training

Social skills training 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. Social skills may be trained individually or in groups using a variety of intervention techniques, including social scripts (Nelson, 1978). See ASHA’s Practice Portal page on Social Communication Disorder and ASHA’s Autism Evidence Map for summaries on social communication interventions.

Examples of programs that focus on social skills are as follows:

• Program for the Education and Enrichment of Relational Skills (PEERS®; Laugeson et al., 2011)
• Social Stories™ (Gray et al., 2002)
• Social Thinking® (Crooke et al., 2008; Garcia Winner & Crooke, 2009, 2011)
• TalkAbility™ (Sussman, 2006)

Speech and Language Interventions

Augmentative and Alternative Communication (AAC)

An AAC system is an integrated group of components used to enhance communication. AAC uses a variety of techniques and tools to help the individual express thoughts, ideas, wants, needs, and feelings. Examples of treatment techniques include the following:

• Augmented Input
• Descriptive Teaching Model (DTM)
• Enhanced Milieu Teaching (EMT)

AAC can supplement existing expressive spoken communication or can be an alternative to spoken language. Although people with autism, especially autistic adults, may have functional speech, they may also need AAC to fully meet their communication needs (Zisk & Dalton, 2019).

For more information about AAC interventions and communicative competence, see ASHA’s Practice Portal page on Augmentative and Alternative Communication (AAC). See ASHA’s Autism Evidence Map for summaries on AAC.

Executive Function

People with autism may have trouble with executive functioning. Speech-language pathology services might address executive functioning skills and/or recommend strategies and accommodations. See ASHA’s Practice Portal page on Executive Function Deficits.

Feeding and Swallowing

Feeding and swallowing interventions may address sensory difficulties and food acceptance. See ASHA’s Practice Portal page on Pediatric Feeding and Swallowing.

Fluency

Autistic adults may demonstrate more typical disfluencies (e.g., revisions, multisyllable word repetitions), stuttering-like disfluencies (e.g., prolongations, blocks), and atypical disfluencies (e.g., repetition of a final sound or syllable) than non-autistic peers (Pirinen et al., 2023). See ASHA’s Practice Portal page on Fluency Disorders.

Language Interventions for Deaf and Hard of Hearing Individuals

People diagnosed with ASD may also be deaf and hard of hearing. Clinicians may need to account for additional considerations for language interventions, such as nonspoken language models or referrals to audiologists and other medical professionals for hearing management options (e.g., hearing aids, cochlear implants, or other hearing assistive technology). See ASHA’s Practice Portal page on Language and Communication of Deaf and Hard of Hearing Children.

Literacy (Written Language) Intervention

Reading comprehension is a common academic struggle for people on the autism spectrum with low support needs (McIntyre et al., 2017). Literacy intervention approaches incorporate a variety of instructional strategies to improve phonological awareness, word decoding, word identification, reading fluency, reading vocabulary, and reading comprehension. Older children with autism may also have difficulty with higher level literacy skills that require theory of mind.

For a review of strategies for promoting literacy, see Lanter and Watson (2008). See also ASHA’s Practice Portal page on Written Language Disorders and ASHA’s Autism Evidence Map for summaries on literacy interventions.

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 is based on the person’s current level of language skills. See also ASHA’s Practice Portal page on Spoken Language Disorders for descriptions of various treatment options and approaches. Interventions may also reflect views on natural language acquisition patterns in children with ASD and the role of echolalia and gestalt language processing (see, e.g., Blanc et al., 2023).

Natural language acquisition (Blanc et al., 2023) is an example of a protocol to describe gestalt language. At first, children produce “chunks” or “gestalt forms” (e.g., echolalic utterances), without distinction between individual words and without appreciation for internal syntactic structure. These gestalt forms are considered units of communication (Peters, 1983).

Children begin to recognize similarities and patterns between these gestalt forms. They begin to combine different segments and words into new forms. Eventually, the child can formulate creative, spontaneous utterances for communication purposes. As such, using a strengths-based approach, gestalts are used to promote language development and progress. Clinicians use modeling and utilize a framework of development to coach a child through language stages in child-led activities. No current efficacy studies are available. See Blanc et al. (2023) and Hutchins et al. (2024) for further discussion of natural language acquisition and gestalt language processing.

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.

Strategies and Accommodations

Activity Schedule and Visual Supports

Activity schedules and visual supports include objects, photographs, drawings, or written words that act as cues or prompts. They 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). See ASHA’s Autism Evidence Map for summaries on visual supports and activity schedules.

Assistive Technology

AAC is considered a form of assistive technology. Additional assistive technology can include hearing technology, FM systems, and text-to-speech readers. This technology can further support the person with autism’s participation in daily activities.

Self-Management

Self-management is 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. See ASHA’s Autism Evidence Map for summaries on self-management.

Treatment Not Endorsed by ASHA

The treatment options and approaches below are not endorsed by ASHA. ASHA stands firmly behind its members in support of effective services leading to independent communication for those they serve. See ASHA’s position on each. Click on the hyperlinks provided to read ASHA’s full position statements.

Auditory Integration Training (AIT)

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

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

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).

Postsecondary Transition Planning

Young adults with autism experience high rates of unemployment and underemployment (Lounds Taylor & Seltzer, 2011; Shattuck et al., 2012). They may have difficulty maintaining employment once they have the job (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. For example, job-related support from an SLP could include improving interview skills (Morgan et al., 2014; Smith et al., 2014). Transition goals focus on facilitating self-determination and self-advocacy (Perryman et al., 2020).

See ASHA’s resource on postsecondary transition planning for more information about postsecondary supports and services. See also ASHA’s Autism Evidence Map for summaries on employment and vocational skills of people with autism.

Services for 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 comprehensive discussion about supporting the needs of people on the autism spectrum, see Question 6 of the 2021–2023 IACC Strategic Plan for Autism Research, Services, and Policy (IACC, 2023). 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 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

Format refers to the structure of the treatment session. In-person formats can include individual sessions or small groups. Telepractice may be a usable and versatile format for people with autism. However, each state’s requirements for telepractice vary. See ASHA’s state-by-state resource for specific state rules and ASHA’s Practice Portal page on Telepractice. Payer coverage for telepractice also varies widely, even when states allow telepractice. See ASHA’s telepractice payment and coverage resource for more information. Trained individuals may need to be available to help the person receiving telepractice services (Edwards-Gaither et al., 2023).

Clinicians might also consider incorporating additional technology into service delivery. 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 (also called “video modeling”) uses video recordings to provide a model of the target behavior or skill. Video modeling procedures can be implemented in following three ways:

1. having another person model the targeted behavior
2. using a video of the targeted behavior without a model, usually called point-of-view modeling
3. having the learner be the model, known as self-modeling

In all cases, the clinician works with the learner to provide practice and feedback. Video-based techniques are more frequently being used in treatment (see, e.g., Wilson, 2013). Video visual screen displays can support social interactions of people with autism who have complex communication needs (Babb et al., 2021).

Provider

The provider is the person offering the treatment, such as the SLP or caregiver. The SLP provides training and coaching to caregivers, peers, or other professionals involved in the interventions. Coaching strategies can include direct teaching, guided practice, reflection, and feedback (Brown, 2016). These trained individuals can help support the communication of people with autism in more natural settings.

Dosage

Dosage refers to the frequency, intensity, and duration of service. Dosage varies based on the person’s needs and desired goals. Some people may make significant gains from intensive programs that are multiple times per week, for many hours. Some people may respond to less intensive programs that are only once per week.

Timing

Timing refers to the start of intervention relative to the diagnosis. The earlier the diagnosis or identification, the sooner services can begin. Early intervention can maximize the positive outcomes for children with autism (IACC, 2023).

Setting

The setting is the location of treatment. Interventions can take place in the home, community, and school. School-based services can take place in the SLP’s resource room or in the student’s classroom. Supporting communication in natural settings can promote generalization of skills.

ASHA Resources

ASHA Advocacy and Reimbursement

• Applied Behavior Analysis
• ASHA State Issue Brief: Applied Behavioral Analysis Issues in the States [PDF]
• State Insurance Mandates for ASD
• State-By-State Resources
• Telepractice Payment and Coverage

The ASHA Leader articles

• A Quick Guide to DSM-5
• Building Working Relationships With Applied Behavior Analysts
• DSM-5 Changes May Cause Billing Headaches
• The Right Codes for ASD-Related Services
• When SLP Meets ABA

ASHA Resource Pages

• ABA and Communication Services
• Assessment Tools, Techniques, and Data Sources
• Challenging Behaviors as Communication
• Collaboration and Teaming
• Cognitive Referencing
• Communication About Autism: Considerations for ASHA Members
• Consumer Information: Autism
• Dynamic Assessment
• Focusing Care on Individuals and Their Care Partners
• International Classification of Functioning, Disability, and Health (ICF)
• Interprofessional Education/Interprofessional Practice
• Neurodiversity-Affirming Flowchart [PDF]
• Postsecondary Transition Planning
• Social Determinants of Health

Organizations and Related Content

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

Across the Lifespan

• 2021–2023 IACC Strategic Plan for Autism Research, Services, and Policy
• Easter Seals: Autism Services
• Evidence-Based Practices for Children, Youth, and Young Adults With Autism Spectrum Disorder [PDF]

Adults

• Job Accommodation Network (JAN)
• National Autism Indicators Report 2017: Developmental Disability Services and Outcomes in Adulthood [PDF]

Children

• Birth to 5: Watch Me Thrive
• Autism Navigator
• Center on Secondary Education for Students With Autism Spectrum Disorder
• Centers for Disease Control and Prevention: Learn the Signs. Act Early.
• Center for Disease Control and Prevention: Spotlight On A New Pattern in Racial and Ethnic Differences Emerges in Autism Spectrum Disorder (ASD) Identification among 8-year-old Children
• First Words Project-The Florida State University College of Medicine: Autism Institute
• Family Guided Routines Based Intervention: Key Indicators Manual (Copyright ©2017 by Juliann Woods) [PDF]

General Resources

• Autism Parenting Magazine
• Autism Now
• Autism Self Advocacy Network
• Autism Speaks
• Bilingual Autism Guide
• Interactive Autism Network
• Models of Disability
• National Autism Association
• National Joint Committee for the Communication Needs of Persons With Severe Disabilities
• Report to Congress 2017: Young Adults and Transitioning Youth With Autism Spectrum Disorder [PDF]
• Neurodevelopment of social competence (Rubin, 2012). National Autistic Society free webinar
• Screening and Diagnosis of Autism: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society [PDF]
• The National Professional Development Center on Autism Spectrum Disorder

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Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Autism and Autism Spectrum Disorder page.

• Elizabeth Crais, PhD, CCC-SLP
• Pamela Crooke, PhD, CCC-SLP
• Hillary Crow, MA, CCC-SLP
• Belinda Daughrity, PhD, CCC-SLP
• Sylvia Diehl, PhD, CCC-SLP
• Lynn Kern Koegel, PhD, CCC-SLP
• Rhea Paul, PhD, CCC-SLP
• Patricia Prelock, PhD, CCC-SLP
• Emily Rubin, MS, CCC-SLP
• Carrie Slaymaker, MA, CCC-SLP
• Lillian Stiegler, PhD, CCC-SLP
• Linda Watson, EdD, CCC-SLP
• Jane Wegner, PhD, CCC-SLP
• Michelle Garcia Winner, MA, CCC-SLP

In addition, ASHA thanks the members of the Ad Hoc Committee on Autism Spectrum Disorders whose work was foundational to the development of this content. Members of the committee were Amy Wetherby (chair), Sylvia Diehl, Emily Rubin, Adriana Schuler, Linda Watson, Jane Wegner, and Ann-Mari Pierotti (ex officio). Celia Hooper, vice president for professional practices in speech-language pathology, 2003–2005, served as monitoring officer.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Autism and autism spectrum disorder [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Autism/