ASHA Advocacy Ensures Speech-Language Services for Students With ASD Federal education officials clarify that school services for autism spectrum disorder should not be limited to applied behavior analysis therapy. ASHA News
ASHA News  |   October 01, 2015
ASHA Advocacy Ensures Speech-Language Services for Students With ASD
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Speech, Voice & Prosodic Disorders / Special Populations / Autism Spectrum / School-Based Settings / Regulatory, Legislative & Advocacy / ASHA News & Member Stories / ASHA News
ASHA News   |   October 01, 2015
ASHA Advocacy Ensures Speech-Language Services for Students With ASD
The ASHA Leader, October 2015, Vol. 20, 62-63. doi:10.1044/leader.AN1.20102015.62
The ASHA Leader, October 2015, Vol. 20, 62-63. doi:10.1044/leader.AN1.20102015.62
When the U.S. Department of Education told public school administrators in a July 2015 letter that applied behavior analysis (ABA) may not be considered the only treatment for autism spectrum disorders, it acted in response to ASHA advocacy.
The “Dear Colleague” guidance letter, issued by the department’s Office of Special Education and Rehabilitation Services, indicated that school and early intervention programs should not rely on a single treatment method for children with autism spectrum disorder (ASD) and should include speech-language pathologists and other professionals in all decisions regarding evaluation, eligibility determinations and treatment programs.
ASHA members and state association leaders had been reporting for several years that ABA-only policies for treating autism were finding their way into legislative and regulatory vehicles, schools and health care settings, potentially denying students access to school-based speech-language services.
In December 2014, ASHA asked members to relate their experiences—both challenges and successes—working with ABA therapists in the evaluation and treatment of children with ASD. Most of the commenters support a collaborative model that includes SLPs and ABA therapists, but some expressed concerns about the evaluation process and eligibility determination, as well as inappropriate services—or no services at all—identified and recommended for children with ASD.
In California, for example, an SLP who works with school systems is consistently told by administrators that SLPs do “speech,” and behavior intervention specialists/BCBAs [board certified behavior analysts] do “autism.”
“‘Speech’ is defined as articulation-only,” the SLP said. “When I need to complete speech and language assessments and identify significant deficits in language, pragmatics, semantics, communicative functions, etc., I was told to ‘ignore’ those scores for eligibility of speech and defer those to the ABA program—which would treat ‘autism’—and I was to only speak to eligibility for speech, based on articulation.”
An SLP in Utah was “surprised that BCBAs are writing goals for expressive and receptive language as well as articulation. BCBAs have become the ‘go-to’ for autism treatment and there is a huge component of training that they do not bring to the table … Understanding how language develops is paramount to understanding how to treat language development in autism. I am shocked at how non-verbal children with autism are being taught language with minimal or no regard to what we know about effective and appropriate language intervention.”
These and other such reported instances are examples of limiting access to speech-language services, ASHA staff concluded, which violates the free, appropriate public education provision of the Individuals With Disabilities Education Act. Staff also believe that exclusive use of ABA for students with ASD violates a child’s right to individualized treatment based on the child’s specific needs.
ASHA took its concerns to officials in the Office of Special Education Programs (a part of the Office of Special Education and Rehabilitation Services), compiling members’ comments and preparing a white paper outlining the issues: violating IDEA by limiting services; ABA therapists providing services beyond their scope of practice; ABA therapists acting as sole decision-makers in determining appropriate services for students without involving the entire educational team; ABA not being appropriate for all students with ASD.
“While ABA therapists may work on a child’s behaviors, an SLP focuses on understanding and use of language, social communication, literacy, speech production, and augmentative and alternative communication (AAC),” the white paper states. “Speech-language pathologists assess, diagnose, and provide a variety of interventions, typically in conjunction with a team that may include ABA therapists, for children with ASD based on individual strengths and needs.”
ASHA also called federal officials’ attention to information from the Centers for Medicare and Medicaid Services that clarifies this same issue for Medicaid beneficiaries. The July 2014 bulletin and follow-up information indicate that Medicaid does not mandate any specific treatment for children with ASD, and that Medicaid-eligible treatments should address the specific service needs of any individual who needs speech-language and other services.
ASHA requested that the U.S. Department of Education issue a statement that indicates:
  • Treatments other than ABA may be offered to students with ASD.

  • School systems that rely solely on ABA for students with autism are in violation of IDEA.

  • Children with ASD must be provided with the full complement of services to meet their individual needs.

The letter, sent to early intervention coordinators and state educational agencies, includes this information and more. “We recognize that ABA therapy is just one methodology used to address the needs of children with ASD,” the letter states, “and remind states and local programs to ensure that decisions regarding services are made based on the unique needs of each child with a disability.”
Together with the CMS bulletin, the letter sends a strong message to the education and health communities that people with ASD should receive the full array of appropriate treatments. This guidance can be used to inform state insurance regulators and legislators that coverage policies for Affordable Care Act plans—which must include habilitation services as one of the 10 essential health benefits—should include comprehensive treatments for individuals with developmental disabilities, including ASD.
1 Comment
June 9, 2016
Nikia Dower
Re: ASHA Advocacy Ensures Speech-Language Services for Students With ASD
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October 2015
Volume 20, Issue 10