Abstract
National trends indicate an increasing number of children identified with autism spectrum disorders (ASD). The diagnostic criteria for autistic disorder include deficits in social interaction and communication. The communication support required by children with ASD is varied and complex, requiring collaboration from many disciplines. The speech-language pathologist must combine specialized knowledge of communication with specific knowledge of ASD to provide effective collaboration. This article explores the application of this specialized knowledge through the assessment and intervention process of two unique case studies.
CURRENTLY there are no consistent biological markers to diagnose autism. The diagnosis is primarily made by observation of behavior. Although speech-language pathologists (SLPs) do not diagnose autism, their expertise as part of a collaborative team can contribute significant observations related to the communication and social impairments seen in this population (Prelock, Beatson, & Bitner, in press). Because communication abilities are central to the diagnosis of these disorders, SLPs' specialized knowledge is a vital part of both the assessment and intervention process.
The diagnosis of autism is typically made by a physician or psychologist using either the national diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR; APA, 2000), or the international system, the International Classification of Diseases, Tenth Revision (ICD-10; WHO, 1993). Both frameworks agree on three focal areas of behavioral characteristics:(1) deficits in the quality of social interaction, (2) communication deficits, and (3) repetitive behaviors or interests. However, the manifestation of deficits in each of these areas differs in degree and presentation across individuals, creating a group who are simultaneously homogenous and heterogeneous. The recognition rules for inclusion and differential diagnosis using these frameworks are quite broadly defined and have created varying and controversial variations of opinions about their application both in research and intervention (Mahoney et al., 1998). Because of this range, the use of autism spectrum disorders (ASD) has become familiar terminology to describe this continuum of developmental disorders that are neurobiologic in origin (Wetherby & Prizant, 2000). This term ASD has also become preferred by clinicians and researchers over more specific terms because the diagnostic distinction between autism and a diagnosis of related disorders such as pervasive developmental disorders -not otherwise specified (DSM-IV-TR; APA, 2000), or atypical autism (ICD-10; WHO, 1993) does not typically translate into significant differences in intervention approaches (Lord & Risi, 2000). In other words, similar services may be appropriate regardless of whether the child's diagnosis reflects a narrow or broad interpretation of the diagnosis of autism. After inclusion in the spectrum is established, the specific configuration of services seems to be best determined by careful integration of family-centered planning that considers context and individual learning variations. It is the purpose of this article to focus on the SLP's role as a member of a collaborative team in (1) identifying patterns of strengths and challenges in communication and (2) providing social, behavioral, and communication supports in school and community settings. For broader assessment and intervention perspectives, the reader is referred to National Research Council (2001) or Prelock, Beatson, and Bitner (in press).