Focusing Intervention for Autism If our autism treatment lens is too narrow, our interventions have less chance of generalizing effectively into our clients’ lives. From the President
Free
From the President  |   April 01, 2017
Focusing Intervention for Autism
Author Notes
  • Gail J. Richard, PhD, CCC-SLP, is former department chair, professor emeritus and director of The Autism Center at Eastern Illinois University. gjrichard@eiu.edu
    Gail J. Richard, PhD, CCC-SLP, is former department chair, professor emeritus and director of The Autism Center at Eastern Illinois University. gjrichard@eiu.edu×
Article Information
Special Populations / Autism Spectrum / From the President
From the President   |   April 01, 2017
Focusing Intervention for Autism
The ASHA Leader, April 2017, Vol. 22, 4-5. doi:10.1044/leader.FTP.22042017.4
The ASHA Leader, April 2017, Vol. 22, 4-5. doi:10.1044/leader.FTP.22042017.4
This year the ASHA Convention theme is focusing on the “big picture” as we approach our disciplines of audiology and speech-language pathology. Certainly our professions’ emphasis on interprofessional education and practice are important examples of this.
Another aspect of the big picture relates to work with our clients. Effective intervention requires that we consider the impact of a communication disorder in the context of a person’s life. Social and vocational/occupational options can be significantly compromised by a speech, language, hearing or swallowing problem.
This month’s Leader addresses the topic of the autism spectrum—a disorder area necessitating an expansive and inclusive approach to diagnosis and intervention. Treatment that is isolated and restricted to a single aspect of the symptomatic profile of autism spectrum disorder (ASD) will be minimally effective, with little chance of generalizing productively into the person’s everyday life.
Pediatric neurologist Mary Coleman, who studies the genetics of autism, presented a keynote address at the Gillberg Neuropsychiatry Centre in Sweden in 2015. She argued that the terminology of “spectrum” is inaccurate for autistic disorder; it should be identified as a syndrome disorder. A spectrum implies degrees of involvement or severity within a single clinical entity. She argues that from a genetic perspective, autism is not a single clinical entity. Instead, she sees autism as being many clinical entities, based on the number of different genetic combinations that appear to have causative effects.
Although genetic research has narrowed down some of the leading chromosome combinations, there is still no definitive medical test to determine autism. Diagnosis is based in careful observation of key symptomatic behaviors that clinicians compare with evidence-based diagnostic criteria. In diagnosing ASD, we must therefore consider all aspects of development, including fine and gross motor skills, sensory system, social interaction, and communication. If the lens is too narrow, we can misdiagnose or miss diagnostic features.
For example, childhood apraxia of speech is often a symptomatic component of ASD. If a speech-language pathologist considers only the speech profile of apraxia and ignores the social, sensory and motor aspects of development, the child may not receive a diagnosis of ASD. Although addressing the speech deficit is important, efficacious intervention should consider the apraxia within the broader neurological impairment of the global developmental disorder of ASD.

In diagnosing autism, we must consider all aspects of development, including fine and gross motor, sensory system, social interaction and communication. If the lens is too narrow, we can misdiagnose or miss diagnostic features.

One of the initiatives I’ve been involved with is a transition program for college students with ASD. Most are high-functioning or in the Asperger syndrome profile, with well-substantiated data (from college entrance exams) to support their academic potential. However, many in the program have experienced academic failure at previous universities due to challenges with executive function. Their strong intellectual potential cannot be realized without an infrastructure to facilitate their success. This is another example of the importance of seeing the big picture. An SLP’s assessment of communication skills can show very high scores on isolated tasks. However, in functional reality, a student may struggle academically due to inability to initiate, plan, organize materials, and manage time and academic expectations.
Audiology must also consider the bigger picture when working with ASD. For example, the isolated aspect of hearing acuity can be assessed and determined to be within normal limits. However, many children with ASD present with hyperacusis, or oversensitive hearing to some types of auditory stimuli. Hyperacusis can significantly impair their ability to function in a public environment. The over-responsiveness can lead to disruptive outbursts that are misinterpreted as behavior problems.
Desensitizing oversensitive hearing, suggesting dampening headphones, or providing an alternative replacement auditory stimulus can directly address the auditory issue rather than focusing on the secondary behavioral symptom. Central auditory processing disorder (CAPD) is also sometimes mistakenly diagnosed due to the child’s lack of response to auditory stimuli. However, the lack of response could be due to a hyporesponsiveness to auditory stimuli that often occurs within the speech frequencies in children with ASD, rather than a true CAPD. The isolated aspect of hearing acuity must be interpreted and addressed within the functional application and context of everyday life.
Temple Grandin, a woman with autism who has a PhD in animal behavior and who is a well-known spokesperson on autism, has always advocated for an integrated treatment approach. The functional outcome of intervention is enhanced significantly when goals encompass general application of skills rather than drilling isolated tasks. As clinical service providers, we need to view all aspects of a person’s profile and make sure that we recognize the domino effect of a communication disorder on multiple aspects of life. While careful focus on specific skills is sometimes necessary, be careful of a “silo” approach to intervention that ignores the bigger picture!
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
April 2017
Volume 22, Issue 4