Use Developmental Stages to Guide Treatment in ASD Considering a child’s developmental stage can help SLPs select the best evidence-based treatment. School Matters
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School Matters  |   June 01, 2017
Use Developmental Stages to Guide Treatment in ASD
Author Notes
  • Emily Rubin, MS, CCC-SLP, is the director of the educational outreach program at the Marcus Autism Center, an affiliate of Emory University. She is an affiliate of ASHA Special Interest Group 1, Language Learning and Education. emily@commxroads.com
    Emily Rubin, MS, CCC-SLP, is the director of the educational outreach program at the Marcus Autism Center, an affiliate of Emory University. She is an affiliate of ASHA Special Interest Group 1, Language Learning and Education. emily@commxroads.com×
Article Information
Development / Special Populations / Autism Spectrum / Research Issues, Methods & Evidence-Based Practice / School Matters
School Matters   |   June 01, 2017
Use Developmental Stages to Guide Treatment in ASD
The ASHA Leader, June 2017, Vol. 22, 40-41. doi:10.1044/leader.SCM.22062017.40
The ASHA Leader, June 2017, Vol. 22, 40-41. doi:10.1044/leader.SCM.22062017.40
Have you heard of a “gold standard” treatment for children with autism? If so, get ready to respond to those proclaiming this myth that autism is not static and cannot be addressed with one treatment. It is developmental by nature.
This means autism manifests quite differently for pre-symbolic children who don’t yet use words, as opposed to those whose command of syntax and grammar often results in talking “too much.” To suggest that a one-size-fits-all treatment exists reflects a bias toward selecting an approach before identifying a child’s needs.
Instead what we need to do is determine a customized treatment plan for each client following evidence-based practice. That means speech-language pathologists use proven, effective and replicable practices that also match our students’ values, preferences and developmental needs, as well as the demands of a specific setting.
Designing a program
We can incorporate more than two dozen evidence-based practices—all considered effective at promoting positive outcomes in children and adolescents with autism—into treatment (explore many of them in this report from The National Professional Development Center on Autism Spectrum Disorder). These strategies target a wide range of behaviors, however, some of which may or may not be relevant or of utmost priority for a certain child. When designing a program for children with autism, begin by identifying the needs and critical priorities in areas of development most predictive of positive long-term outcomes.
Begin with a developmental assessment
Everyone on the autism spectrum faces a core challenge with social communication. Most positive long-term outcomes correlate with social and emotional competence. So selecting the most relevant evidence-based practices begins with identifying the next key steps in social communicative development (read more on using developmental assessments for autism in this “Topics in Language Disorders” article).
The SCERTS (Social Communication, Emotional Regulation, Transactional Support) Assessment Process—a curriculum-based assessment tool—can help identify developmentally sensible skills predictive of developmental growth and social and emotional competence.
Pre-symbolic children
For a pre-symbolic child with autism, there is often a clear preference for nonsocial stimuli and less social engagement. Therefore, the strongest predictors of language acquisition include the ability to initiate shared attention and the child’s frequency of spontaneous nonverbal communication.
When choosing from available evidence-based approaches at this developmental stage, ask yourself two questions: Does the strategy produce “results?” And, do those “results” lead to an increase in your student’s attention toward others and the frequency of self-initiated, nonverbal forms of communication?
An example of an effective strategy at this stage is a “communicative temptation.” For example, give the child a choice of see-through containers containing enticing items. By responding to even subtle signals of interest, you might teach your student that their communicative partners can provide assistance and support.
Emerging language stages
For children who communicate with speech, pictures or other symbols, try using relational word combinations—made up of people’s names and actions—to express a range of social functions, such as requesting, commenting or sharing emotion. When successfully incorporated into a child’s communication method, these name-action combinations often predict creative language acquisition.
However, a child’s preference for nonsocial stimuli often results in a limited vocabulary of just nouns or object labels. Encourage the child to use people’s names with relational words, such as actions, rather than just nouns and rote language forms (explore benefits of this type of early social interaction in this Pediatrics journal article). It’s difficult to build social relationships without using a person’s name. You might instead show photos of people paired with desired actions— “Emily blow bubbles,” for example.
Conversational children
Once creative and generative language emerges—verbally or through augmentative communication—the child’s ability to communicate effectively using social conventions becomes the strongest predictor of positive outcomes. By this developmental stage, students are often more socially motivated, but learning differences make understanding what others are thinking a challenge. Focus treatment on increasing the child’s awareness of conversation social rules—like appropriate proximity, vocal volume and speaking style—plus the ability to consider another’s perspective. Effective strategies include cognitive-based interventions and visual tools to depict the thoughts, opinions and emotions of others.
Using this type of developmental framework allows us to consider all forms of evidence-based practice for our students with autism.
Learn More About Treating Students With Autism at Schools Connect

Emily Rubin will present a session on helping students with autism develop social and communication skills at ASHA’s Schools Connect, July 7–9 in New Orleans. This conference is designed specifically to meet the continuing education needs of school-based clinicians. Dozens of sessions will focus on working with special populations of children, language and literacy, service delivery in schools, and professional issues in schools.

Schools Connect is co-located with Private Practice Connect and Health Care Connect. Attendees may participate in sessions at any of the three conferences.

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FROM THIS ISSUE
June 2017
Volume 22, Issue 6