Communication About Autism: Considerations for ASHA Members

Some people view autism as a neurological difference and a fundamental part of a person’s identity. Others consider characteristics of autism, such as social communication differences, as a disorder and seek specific treatment. Both perspectives are valid and important. Both perspectives have implications for speech-language pathology services and reimbursement.

These perspectives have changed the terminology we use about autism, autism spectrum disorder (ASD) and autistic individuals, the role of the speech-language pathologist (SLP) and other professionals, and treatment approaches. ASHA shares different perspectives on disability identity and culture, neurodiversity, and ableism to inform members and other stakeholders. Some ASHA resources emphasize a person-centered approach to services, including co-created treatment goals and family/community involvement. An example of a person-centered approach would be using the term “person with autism.” Other ASHA resources emphasize an identity-centered approach, including the acceptability of and use of language such as “autistic person.”

On occasion, ASHA may take an official position about treatment approaches that are used for people with ASD when reliable research demonstrates a lack of effectiveness or the potential to create harm. Examples are ASHA position statements about the Rapid Prompting Method, Facilitated Communication, and Auditory Integration Training.

Identity-First or Person-First Language

Some people choose identity-first language, such as autistic person, because they consider autism an intrinsic part of a person’s identity.
Others choose to use person-first language emphasizing the person rather than the condition.
Families and caregivers may prefer person-first language—particularly when their child has high support needs. This may be related to advocacy for resources and services and the desire that their child be recognized for more than their disabilities.

The Publication Manual of the American Psychological Association (APA, 7th ed.) details using either person-first or identity-first language, depending on the preference of the individual. For more information, see APA’s style guidelines on bias-free language. Note: APA style guidance is not unique to autism.

Resources About Identity-First and Person-First Language

Neurodiversity and Ableism

A Strengths-Based Approach and Neurodiversity: A strengths-based perspective is more consistent with a neurodiversity paradigm that “views autism as a form of neurobiological diversity that cannot be separated from the person and does not inherently need to be fixed” (DeThorne & Searsmith, 2020). From this perspective, autism is considered another way of “being”—not a disorder. Treatment focuses on building strengths by providing supports, strategies, and/or accommodations rather than by correcting a disorder. SLPs may work on social skills that may be (or are) impacting education and quality of life—not as a way to change autism.

A Disorder-Based Approach and Ableism: Ableism refers to “Beliefs and practices that discriminate against people with disabilities . . . . Ableist language assumes disabled people are inferior to nondisabled people” (Bottema-Beutel et al., 2021). A disorder-based perspective, which some people may consider ableist, establishes the ideal standard to be someone without a disability, and treatment may focus on helping a person appear to look or act in a more “typical” way.

Resources About Neurodiversity and Ableism

A Strengths-Based Approach to Autism: Neurodiversity and Partnering With the Autism Community
Autism and Neurodiversity: Addressing Concerns and Offering Implications for the School-Based Speech-Language Pathologist
Avoiding Ableist Language: Suggestions for Autism Researchers
“I Don’t Have Autism, I’m Autistic”
From the Therapist Neurodiversity Collective:
- Learn Neurodiversity Terminology [PDF]
- We Don’t Treat Autism: Here’s Why [PDF]

Terminology Considerations

Sometimes, a diagnosis is needed so that a person can obtain services or so that SLPs can be reimbursed.
The Diagnostic and Statistical Manual of Mental Disorders (Vol. 5; DSM-5) defines criteria for an autism diagnosis and describes the levels of severity within that formal diagnosis.
In order to qualify for reimbursement, the service provider needs to be working with an individual who is lacking a needed skill, and the service must be medically necessary.
Some impairment-based terms (e.g., impairment, deficit, disability, disorder) are required in certain contexts to establish eligibility for services or accommodations.
The World Health Organization (WHO) framework is cited in ASHA’s Scope of Practice in Speech-Language Pathology. That framework uses the terms impairment, disability, and activity/participation.

The terms services/supports are alternatives to intervention/treatment. The term intervention is typically used in the school setting; the term treatment is typically used in the medical setting. Some prefer the terms services/supports and address severity by using the terms low support needs or high support needs. Payers, however, expect to see widely accepted terms for diagnosis and evidence of intervention/treatment.

Terminology Recommendations

Discuss terminology preferences directly with students/clients/patients and family members/caregivers. Preferences change over time, and individuals may have different views about what constitutes ableist language. Different preferences may also be influenced by severity along the spectrum of autism. Use inclusive alternatives to ableist language whenever possible. Follow administrative guidelines and mandates for eligibility, reimbursement, or other procedural means of providing services.

Consider the following terminology examples, recognizing that these may change over time based on trends and preferences (see table below).

Examples of Ableist Terminology to Avoid	Examples of Alternative Terminology That MAY Be Preferred
“at risk for having autism”	“may be autistic”
“high or low functioning”	“high or low support needs”
“deficit” or “impairment”	Use “challenges,” “limitation,” or “disorder.” Some people may acknowledge a “disorder” but not consider it as a limitation. Consider describing the communication status rather than using a label.
“nonverbal person,” “nonspeaking person,” or “minimally verbal person”	Describe the communication status and modalities of an individual (e.g., “person who uses gesture and picture symbols”).
“person with neurodiversity”	“neurodivergent person” or “person who is neurodivergent”

Not all individuals and families will have the same preferences regarding terminology or treatment approaches. Some families may want their child to appear “normal” and will want a focus on increasing eye contact, modifying facial expressions, or reducing stim behaviors. Others may want to use identity-first language and will want to learn about communication effectiveness strategies and training programs to help their communication partners better understand the range of individual differences.

Applied Behavioral Analysis (ABA)

Applied behavioral analysis (ABA) is the practice of applying principles of learning theory in a systematic way to modify behavior. ABA is primarily used with individuals who have been diagnosed with ASD.
Proponents of ABA may believe that this technique should be used as the primary service for individuals with autism. Opponents of ABA may believe that behavior correction removes autonomy and is abusive.
ASHA’s guidance is that SLPs should be involved in the assessment and intervention of all individuals with communication disorders. Individuals with autism should have a plan that is tailored to their unique needs. Collaboration with ABA professionals, when they are involved in the services for an individual with autism, allows SLPs to maximize resources and ensure optimal outcomes.

Resources About ABA

References

American Psychological Association (APA). (2020). Publication manual of the American Psychological Association (7th ed.). https://apastyle.apa.org/products/publication-manual-7th-edition

Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3(1), 18–29. https://doi.org/10.1089/aut.2020.0014

DeThorne, L. S., & Searsmith, K. (2020). Autism and neurodiversity: Addressing concerns and offering implications for the school-based speech-language pathologist. Perspectives of the ASHA Special Interest Groups, 6(1), 184–190. https://doi.org/10.1044/2020_PERSP-20-00188