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Position Statement Diagnosis, Assessment, & Treatment of ASD 2006/1Position Statement

Reference this material as American Speech-Language-Hearing Association. (2006). Roles and responsibilities ofspeech-language pathologists in diagnosis, assessment, andtreatment of autism spectrum disorders across the life span:Position statement. Available from http://www.asha.org/members/deskref-journal/deskref/default

Index terms: autism, autism spectrum disorders, pervasivedevelopmental disorders, family roles, screening, diag-nosis, social communication, assessment, intervention

Associated documents: Technical report, guidelines, andknowledge and skills

Roles and Responsibilities of

Speech-Language Pathologists

in Diagnosis, Assessment, and

Treatment of Autism Spectrum

Disorders Across the Life Span

Ad Hoc Committee on Autism Spectrum Disorders

This position statement is an official policy of theAmerican Speech-Language-Hearing Association

(ASHA). It was developed by ASHAs Ad Hoc Commit-tee on Autism Spectrum Disorders. Members of the com-mittee were Amy Wetherby (chair), Sylvia Diehl, EmilyRubin, Adriana Schuler, Linda Watson, Jane Wegner, and

Ann-Mari Pierotti (ex officio). Celia Hooper, vice presidentfor professional practices in speech-language pathology,20032005, served as the monitoring officer. The ASHA(2001) Scope of Practice in Speech-Language Pathologystates that the practice of speech-language pathology in-cludes providing services for individuals with disorders of

pragmatics and social aspects of communication, whichwould include individuals with autism spectrum disorders.This also includes individuals with severe disabilities and

language disabilities in general. The ASHA (2004) Pre-ferred Practice Patterns for the Profession of Speech-Lan-guage Pathology are statements that define universallyapplicable characteristics of practice. It is required thatindividuals who practice independently in this area holdthe Certificate of Clinical Competence in Speech-LanguagePathology and abide by the ASHA (2003) Code of Ethics,including Principle of Ethics II, Rule B, which states thatindividuals shall engage in only those aspects of the pro-

fessions that are within the scope of their competence, con-

sidering their level of education, training, and experience.This statement (LC_SLP/SLS_1-2006) was approved by

ASHAs Speech-Language Pathology/Speech or LanguageScience Assembly of the Legislative Council on February3, 2006.

Position Statement

It is the position of the American Speech-Lan-guage-Hearing Association (ASHA) that speech-lan-guage pathologists play a critical role in screening,diagnosing, and enhancing the social communicationdevelopment and quality of life of children, adoles-cents, and adults with autism spectrum disorders(ASD). The core features of ASD include impairments

in reciprocal social interaction, impairments in ver-bal and nonverbal communication, and restrictedrange of interests and activities, which are due toneurobiological factors. There is great heterogeneityin this population, evident in a broad range of cogni-tive, social, communication, motor, and adaptiveabilities. Integral to the diagnostic criteria, all indi-viduals with ASD are challenged in the area of socialcommunication. Thus, many individuals with ASDhave difficulty acquiring the form and content of lan-guage and/or augmentative and alternative commu-nication systems, and all have needs in acquiringappropriate social use of communication. Therefore,

problems in use of language and communication areoverarching because ASD is primarily a social com-munication disability. These challenges result in far-reaching problems, including difficulties with jointattention, shared enjoyment, social reciprocity innonverbal as well as verbal interactions, mutuallysatisfying play and peer interaction, comprehensionof others intentions, and emotional regulation. Dueto the nature of ASD, family members, peers, andother communication partners may encounter barri-ers in their efforts to communicate and interact with

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American Speech-Language-Hearing Association2006/2

individuals with ASD. Therefore, the speech-lan-guage pathologists role is critical in supporting theindividual, the environment, and the communicationpartner to maximize opportunities for interaction inorder to overcome barriers that would lead to ever-decreasing opportunities and social isolation if leftunmitigated.

Individuals with ASD should be eligible forspeech-language pathology services due to the per-vasive nature of the social communication impair-ment, regardless of age, cognitive abilities, orperformance on standardized testing of formal lan-guage skills. As mandated by the Individuals withDisabilities Education Improvement Act of 2004 (Pub.L. 108-446), speech-language pathologists shouldavoid applying a priori criteria (e.g., discrepancies

between cognitive abilities and communication func-tioning, chronological age, or diagnosis) and makeindividualized decisions on eligibility for services.

Because formal assessment tools may not accuratelydetect problems in the social use of language andcommunication, eligibility may need to be based onclinical judgment and more informal, observationalmeasures.

Appropriate roles for speech-language patholo-gists include but are not limited to the following:

1. Screening: Speech-language pathologists playa critical role in screening and early detectionof individuals at risk for ASD and makes re-ferrals to experienced professionals for diag-nosis and intervention services.

2. Diagnosis: Speech-language pathologists whoacquire and maintain the necessary knowl-edge and skills can diagnose ASD, typically aspart of a diagnostic team or in othermultidisciplinary collaborations, and the pro-cess of diagnosis should include appropriatereferrals to rule out other conditions and facili-tate access to comprehensive services.

3. Assessment and Intervention: Speech-lan-guage pathologists should prioritize assess-ment and intervention in those aspects ofdevelopment that are critical to the achieve-ment of social communication competence

and that honor and adapt to differences infamilies, cultures, languages, and resources.Speech-language pathologists should recog-nize the guidelines and active components ofeffective, evidence-based practice for indi-viduals with ASD. They should draw on em-pirically supported approaches to meetspecific needs of children with ASD and theirfamilies, thereby incorporating family prefer-ences, cultural differences, and learning styles.

Speech-language pathologists should assistcommunication partners in recognizing thepotential communicative functions of chal-lenging behavior and designing environmentsto support positive behavior. Embracing a

broad view of communication, speech-lan-guage pathologists should assess and enhance

the following: the initiation of spontaneous communica-

tion in functional activities across socialpartners and settings;

the comprehension of verbal and nonver-bal communication in social, academic,and community settings;

communication for a range of social func-tions that are reciprocal and promote thedevelopment of friendships and socialnetworks;

verbal and nonverbal means of communi-

cation, including natural gestures, speech,signs, pictures, written words, functionalalternatives to challenging behaviors, andother augmentative and alternative com-munication systems;

access to literacy and academic instructionand curricular, extracurricular, and voca-tional activities.

4. Working With Families: Speech-language pa-thologists should form partnerships with fami-lies in assessment and intervention withindividuals with ASD because effective pro-

grams have active family involvement.Speech-language pathologists should providecounseling, education and training, coordina-tion of services, and advocacy for families.

5. Collaboration: Speech-language pathologistsshould collaborate with families, individualswith ASD, other professionals, support per-sonnel, peers, and other invested parties toidentify priorities and build consensus on aservice plan and functional outcomes.

6. Professional Development: Speech-languagepathologists should participate as trainers and

trainees in preservice and continuing educa-tion designed to prepare and enhance theknowledge and skills of professionals whoprovide services for individuals with ASD.

7. Research: Speech-language pathologistsshould be informed of current research and/or participate in and advance the knowledge

base of the nature of the disability, screening,diagnosis, prognostic indicators, assessment,treatment, and service delivery of individualswith ASD.

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Position Statement Diagnosis, Assessment, & Treatment of ASD 2006/3

8. Advocacy: Speech-language pathologists alsoplay an important role as advocates for indi-viduals with ASD in promoting social commu-nication skills that lead to greater indepen-dence in home, school, work, and communityenvironments and greater participation in so-cial networks.

The broad impact of the social communicationchallenges and problems with generalization for in-dividuals with ASD necessitates service deliverymodels and individualized programs that lead to in-creased active engagement and build independencein natural learning environments. Speech-languagepathologists should recognize the importance of fam-ily involvement and collaboration with a variety ofprofessionals and communication partners, the facili-tation of peer-mediated learning, the continuity ofservices across environments, and the importance ofmatching service delivery to meaningful outcomes.

Speech-language pathologists should provide ser-vices that are connected with functional and mean-

ingful outcomes. Therefore, they should provide pull-out services only when repeated opportunities do notoccur in natural learning environments or to work onfunctional skills in more focused environments. Be-cause of the limited impact of pull-out services fo-cused on discrete skills, speech-language pathologistsshould ensure that any pull-out services are tied to

meaningful, functional outcomes and incorporateactivities that relate to natural learning environments.

References

American Speech-Language-Hearing Association. (2001).Scope of practice in speech-language pathology. Rockville,MD: Author.

American Speech-Language-Hearing Association. (2003).Code of ethics (Revised).ASHA Supplement, 23, 1315.

American Speech-Language-Hearing Association. (2004).Preferred practice patterns for the profession of speech-lan-

guage pathology. Available from http://www.asha.org/members/deskref-journals/deskref/default