ASD Q&A Submitted by: ASD Committee 2019
Submitted by: Dr. Osnat Segal, PhD.
Re: 11 year old with moderate ASD
Question by Parent: My son is having some difficulty producing speech. He can articulate all speech sounds accurately, but his speech still does not sound natural. My question is: Why is his speech sounds different and is it something that a SLP can improve?
Answer: Clinicians and researches report that speech of even highly verbal individuals with ASD can be ‘unusual’(1). In many cases the problem is not in the ability to utter the speech sounds, vowels and consonants, but the use of prosody including rate of speech, rhythm, lexical and phrasal stress. The prosody of individuals with ASD is in many cases exaggerated or monotonous, with exaggerated or narrow pitch range. The pitch is usually high and there is a tendency to utter syllables in words and words in sentences with even stress. The rate of speech can be too slow in some individuals and very fast in others. The reason of prosody misuse is not fully understood (1,2). These characteristics may create the impression of unusual speech. SLPs are trained to assist individuals with ASD to improve their speech including its prosodic aspects. Speech intelligibility and prosody may influence the way other people accept and evaluate the social competence of an individual with ASD (3). Thus, speech prosody is an important aspect to consider in a treatment plan. There is some evidence for the involvement of cortical and subcortical brain regions in producing and processing prosody in individuals with ASD (4).
- Shriberg LD, Paul R, McSweeny JL, Klin A, Cohen DJ, Volkmar FR: Speech and prosody characteristics of adolescents and adults with high-functioning autism and Asperger syndrome. J Autism Dev Disord 2001; 44: 1097– 1115.
- Paul R, Augustyn A, Klin A, Volkmar FR: Perception and production of prosody by speakers with autism spectrum disorders. J Autism Dev Disord 2005, 35;205-220.
- Paul R, Shriberg, LD, McSweeny J, Cicchetti D, Klin A & Volkmar F: Brief report: Relations between prosodic performance and communication and socialization ratings in high functioning speakers with autism spectrum disorders. J Autism Dev Disord 2005; 35:861–869.
- Eigsti IM, Schuh J, Mencl E, Schultz RT, Paul R. The neural underpinnings of prosody in autism. Child Neuropsychol. 2011;18(6):600-17.
Submitted by: Dr. Yvette Hus, PhD
Re: 3.9 year old with mild-moderate ASD
Question By Parent (problem at daycare): My son is presently having some difficulty at daycare since they integrated a child he does not like into his class, and this is worrying me. The educators tried preparing him ahead of time by telling him that this boy would be in his class, they tell him an hour before the boy arrives (then the tears begin), social stories, visual representations, etc.) Preparing him ahead of time doesn’t seem to be working. All it is doing is causing anxiety beforehand. He has been going to daycare for an entire year happily. Now all he does is cry. It is difficult hearing that he is so miserable. My question is (problem at home): how do you prepare a child for an event that you know he will be troubled by (separation, death, person they dislike coming over, etc.) aside from what’s presently being done?
Answer (problem at daycare): According to Dr. Wood (1), social anxiety – or a fear of new people and social situations – is especially common among children with autism. It sounds that this may be your child’s problem. If your child suffers from anxiety, he may experience strong internal sensations of tension. It is disturbing to a parent to see the child distressed and unable to adjust to a new event in his daycare setting. He should not be ‘prepared’ in advance to meeting his ‘object of fear’- it just feeds into his anxiety, and re-enforces his behaviour. Instead have him be preoccupied with something he really likes with an educator, away from the door where he can watch the other child enter- set up the other child with a classmate as soon as he arrives so these two play, and the educator can continue playing with your son. If he cries, Just be empathetic and ‘divert’ his attention. If there is no ‘pay off’ with extra attention- this behaviour should extinguish itself gradually.
Answer (problem at home): Children with ASD find unexpected change very stressful and their anxiety level increases dramatically (2). They may respond to the event with aggression, withdrawal, increase in repetitive behaviours or tantrums. Trying to prepare the child may work but consider that in the face of limited communication and language skills, reading a social story or having ‘a talk’ about the event may not be a viable solution at this time. Instead, try to re-direct by using a calming activity, e.g. you and your child can deep breathe together, hug their favourite stuffed animal and sit on a rocking chair and rock gently. Most importantly, use a soothing, calm voice, and validate the child’s feelings, “yes, I know this is upsetting you.”
- Dr. Jeffrey Wood, psychologist, University of California, Los Angeles (May 29, 2014): Managing anxiety in children with Autism. Autism Speaks. Retrieved from: https://www.autismspeaks.org/expert-opinion/managing-anxiety-children-autism
- Dr. Karen Burner, Seattle Children’s Hospital (Feb. 8, 2013): Autism and Dealing with Change. Retrieved from: https://theautismblog.seattlechildrens.org/autism-and-dealing-with-change/
Submitted by Dr. Yvette Hus PhD
Re: Children with ASD from Culturally and Linguistically Diverse (CLD) families
Question by CLD Parents in the Clinic: We use our native language at home as well as the school language. We were told to use only the school language. Why?
Answer: It is a fact that clinicians and educators often advise CLD families to use only one language when the child has ASD, and preferably the school language (1). This is because it is believed that two languages are too challenging, despite no evidence that this is so (2, 3). Research comparing bilingual children with ASD to monolingual ones found no significant difference between them on severity, first word and phrase onset, or expressive-receptive-social communication scores (4). Other research looked at symptoms and language development and again found that bilingualism in ASD children was not disadvantageous. As for smaller vocabularies in these children, researchers found that the amount of exposure time in the second language determined their vocabulary size rather than interference from their ASD (5). In short, the benefits of preserving both home language and learning a school language are obvious. As a particularly poignant poster advocates: “Monolingualism can be cured, Learn a second language.” Obviously, bilingual children with ASD are cured.
- Hus, Y. Issues in Identification and Assessment of Children with Autism and a Proposed Resource Toolkit for Speech-Language Pathologists. Folia Phoniatrica et Logopaedica. 2017; 69(1-2):27-37.
- Park S: Bilingualism and children with Autism Spectrum Disorders: Issues, research, and implications. NYS TESOL 2014; 1(2):122-129.
- Yu B: Issues in bilingualism and heritage language maintenance: Perspectives of minority-language mothers of children with Autism Spectrum Disorders. Am J Speech Lang Pathol 2013; 10(22):10–24.
- Ohashi JK, Mirenda P, Marinova-Todd S, Hambly C, Fombonne E, Szatmari P, Bryson S, Roberts W, Smith I, Vaillancourt T, Volden J, Waddell C, Zwaigenbaum L, Georgiades S, Duku E, Thompson A, Pathways in ASD Study Team: Comparing early language development in monolingual- and bilingual- exposed young child with Autism Spectrum Disorders. Res Autism Spectr Disord 2012; 6:890-897.
- Hambly C, Fombonne E: Factors influencing bilingual expressive vocabulary size in children with autism spectrum disorders. Res Autism Spectr Disord, 2014; 8:1079–1089.
Submitted by: Dr. Maria Christopoulou, PhD
Re: 13 year old with mild-moderate ASD
Question By Parent (problem at everyday relationships): My son feels so lonely at school and he is constantly isolated. He tries to communicate and practice the techniques he has learned for so many years from the speech therapy and educational programmes he has attended but he fails. Unfortunately, I do not know what to answer when he comes and asks me how to make friends. My questions are (problem at school): Do Autistic children have
and express emotions? How can I help my own child to understand his emotions and control them now as a teenager? How can I help him to express his feelings to find ways to make friends?
Answer (theoretical base): According to Mazefsky and White (1) Children with autism spectrum disorder (ASD) often find it hard to:
- recognize facial expressions and the emotions behind them
- copy or use emotional expressions
- understand and control their own emotions
- understand and interpret emotions – they might lack, or seem to lack, empathy for others.
By school age, children with less severe ASD tend to show their feelings in a similar way to typically developing children, but can find it hard to describe their feelings. They might say that they don’t feel a particular emotion. At the same age, many children with more severe ASD seem to have less emotional expression than typically developing children. It might look like children with ASD don’t respond emotionally, or their emotional responses might sometimes seem over the top – for example, they might get very angry very quickly. By adolescence, those with ASD still aren’t as good at recognizing fear, anger, surprise and disgust as typically developing teenagers (2).
Answer (problem at school): The best way is to develop the understanding of your child’s feelings with techniques such as social stories and creating situations where they can share these feelings securely. There are virtual reality programs that can help your child practice his feelings and how to express these feelings to communicate with others. Continue to offer him your love and support. Contact his school to develop a safety net so that he does not feel alone and isolated. Sensitize his peers and speak with their parents about the specific features of the autistic spectrum and try to find ways to encourage friendships with those he selects.
- Mazefsky, C. A., & White, S. W. (2014). Emotion regulation: Concepts & practice in autism spectrum disorder. Child and adolescent psychiatric clinics of North America, 23(1). doi: 10.1016/j.chc.2013.07.002
- Samson, A. C., Hardan, A. Y., Podell, R. W., Phillips, J. M., & Gross, J. J. (2015). Emotion regulation in children and adolescents with autism spectrum disorder. Autism Research, 8(1), 9-18.
Submitted by: Skye Adams
Re: 6 yr old with ASD
Question by Caregiver (struggling with problematic and aggressive behaviour at school)
I am a single mother with two children, one diagnosed with ASD. My son has just started at school and I have been having some difficulty with his behaviour in the mornings. He does not want to get ready and he hits and bites me when I try and get him dressed, however, once we are at school he is happy and enjoys the day. When I pick him up he is a lot calmer and the teachers say that he has been well behaved. I have spoken to his teachers who have said that it may just be an adjustment period but I am finding it very difficult to manage and going through this every morning is exhausting for me. I am feeling low and I know it is effecting me negatively. As there is no trouble at school it sometimes feels like I am doing this on my own and I am the only one who is unable to look after my own child. How can I improve his behaviour at home and do other parents also struggle with aggressive behaviour at home?
Answer: It can be difficult with readjusting to a new routine and although it may take some time for your son to get accustomed to this I understand your frustration and it is important that you work through his behaviour as well as your own well-being.
Behaviour at home: Children with ASD may expressive their fears and anxieties in other ways and many children may exhibit aggressive behaviours (1, 2, 3). A number of parents have problems with difficult and aggressive behaviour particularly within the adolescent years. It is important to first find out what the trigger of this behaviour is (behaviour) as well as what happens before the behaviour (antecedent) as well as what happens after and what your response to his behaviour is (consequence) it may be that he is unaware he is getting ready for school. It is important that you yourself stay calm as a number of outbursts are a reaction to your own emotions or your child not being able to communicate their feelings to you (2). One way to keep calm is to remove yourself from the situation for a short period, use short simple phrases and try not to raise your voice, move your child to a safer place so they cannot hurt themselves and use visual cues (picture of them sitting quietly).
Caregiver wellbeing: It is important that not only your son is taken care of but you as well. Researchers (4) reported that many caregivers feel stressed, anxious and depressed when caring for a child with Autism. The results indicated that female caregivers had lower mental and physical health scores than that of the general population. The study also indicated that these scores were indicative of behavioural problems and not ASD severity. Therefore, this is a problem that is being experienced by many other caregivers and you are not alone. One way to deal with this is to make sure you have adequate support, as a single mother this can be difficult. See if any other parents go through something similar or find a support group. Additionally, support can be found through family, friends, your community as well as psychological services- especially if you are feeling very low at the moment. You need to make sure you take care of yourself in order to adequately take care of your child.
- Maskey, M., Warnell, F., Parr, J. R., Le Couteur, A., & McConachie, H. (2013). Emotional and behavioural problems in children with autism spectrum disorder. Journal of autism and developmental disorders, 43(4), 851-859.
- Dr. Simon Wallace, psychiatrist, University of Oxford, London (September 12, 2018): My child is sometimes aggressive, what can help? Autism Speaks. Retrieved from: https://www.autismspeaks.org/expert-opinion/my-child-sometimes-aggressive-what-can-help
- Myers, S. M., & Johnson, C. P. (2007). Management of children with autism spectrum disorders. Pediatrics, 120(5), 1162-1182.
- Khanna, R., Madhavan, S. S., Smith, M. J., Patrick, J. H., Tworek, C., & Becker-Cottrill, B. (2011). Assessment of health-related quality of life among primary caregivers of children with autism spectrum disorders. Journal of autism and developmental disorders, 41(9), 1214-1227.
Submitted by: Dr. Kakia Petinou, PhD.
Re: 14 month old child with family history of ASD
Question by Parent: My 14 month-old baby is having some difficulties seeking and keeping eye contact with us and initiating communication acts. Given that my older son has been diagnosed with autism should I worry about my youngest child would “inherit” the disorder? My question is: Are siblings of children with ASD children more “at risk: for developing ASD characteristics too?
Answer: Research (see references below) indicates that ASD has a familial component in the sense that it may sometimes run in the family. A child with a sister or brother who have been diagnosed with autism run a higher risk of developing autism compared to children with no family history. The mechanism underlying this observation remain unclear. However, it is not uncommon for sibling of ASD children to also face pragmatic and social challenges. If a sibling of a child with autism shows restricted communication skills (late onset of speech, lack of eye contact, preoccupation with details of moving objects, failing to prioritize social routines) it is important that the parent recognize this “at risk” behavior and seek assessment and professional opinion the earliest possible. In many cases early signs of autism can be alleviated through early intervention with a primary focus on increasing joint attention, eye contact and encouragement of early vocalizations.
- Elison, JT., Wolff, J.J., Heimer, D.C., Paterson, S.J., Gu, H., Styner, M., Gerig, G., Piven, J. (2013). Frontolimbic neural circuitry at 6 months predicts individual differences in joint attention at 9 months. Developmental Science, 16, 186-197.
- Gillon G, Hyter Y, Dreux F, Ferman S, Hus Y, Petinou K, Segal O, Tumanova T, Vogindroukas I, Westby C, Westerveld M., (2017. International Survey of Speech-language pathologists’ practices in working with children with Autism Spectrum Disorder (ASD). Folia Phoniatrica et Logopaedica. 2017; 69, 8-19
- Klin, A, Jones, W. (2008). Altered face scanning and impaired recognition of biological motion in a 15-month-old infant with autism, Developmental Sciences, 11, 40-60.
- Koegel LK. 1995. Communication and language intervention. In Koegel RL & Koegel LK, (Eds.), Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities: 17–32. Baltimore: Paul H. Brookes.
- Pierce K, Marinero S, Hazin R, McKenna B, Barnes C, Malige A. (2015) Eye Tracking Reveals Abnormal Visual Preference for Geometric Images as an Early Biomarker of an Autism Spectrum Disorder Subtype Associated with Increased Symptom Severity. Biol Psychiatry, 11, doi: 10.1016/j.biopsych.2015.03.032
- Petinou, K., & Minaidou, D. (2017). Neurobiological bases of autism spectrum disorders and implications for early intervention: a brief overview Folia Phoniatrica & Logopaedica DOI: 10.1159/000479181.
- Westby, CE (2014). Social-neuroscience and theory of mind. Folia Phoniatrica & Logopaedica, 66:7-17.
Submitted by: Dr. Sara Ferman, PhD
Re: 6.5 year old with mild-moderate ASD
Question by Parent (child struggling with reading acquisition): My son recently started first grade in a special school for children with ASD. He shows interest in books and points at letters, but still does not read. Is there a chance that he will be able to read? How can I help him?
Answer: Reading is a complex cognitive function in which the reader builds a message from written (visual) symbols. The reading consists of two main phases: decoding the written words and reading comprehension. There is no value to reading if you do not reach meaning. Reading comprehension depends to a large extent on language knowledge. There is large individual variations in the reading performance of children with ASD (1, 2, 3). Some children with ASD have reading levels within normal range (4). Children with high functioning ASD are often characterized by good decoding skills but may show impaired comprehension (5) while children with oral language impairment are more likely to present difficulties in learning to read text (despite their abilities to read single words) (6). There are however, children with ASD who are unable to read words at all (1).
There are various intervention approaches for improving reading in children with ASD. Some of them aiming to improve single-word reading while others directed to improve reading comprehension. Behavioral techniques are the basis for the strategies that are focused on improving single-word reading. Programs for enhancing reading comprehension include approaches such as computer-assisted instruction, direct instruction, talking about a book, graphic organizers, story maps, prompting, scaffolding and the use of designed software. Some of the approaches are considered flexible, allowing one-to-one adaptations (2). Parents can support their child’s reading acquisition, by collaborating with the child’s reading instructor: incorporate practice recommendations with the appropriate strategies for the child’s targeted reading goals into the child’s daily routine. Remember, reading practice improves reading. Therefore, encouraging (but not forcing) the child to read is essential. Talking about the book or story the child has read can also contribute to reading comprehension.
- Nation, K., Clarke, P., Wright, B. & Williams, C. (2006). Patterns of reading ability in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36(7), 911–919.
- Fernandes, F. D. M., Amato, C. A. D. L. H., Cardoso, C., Navas, A. L. G. P., & Molini-Avejonas, D. R. (2015). Reading in autism spectrum disorders: a literature review. Folia Phoniatrica et Logopaedica, 67(4), 169-177.
- Ferman, S. & Bar-On, A. (2017). Children with ASD show difficulties when required to use phonological and morphological information in reading pseudowords. Folia Phoniatrica et Logopaedica, 69 (1-2), 54-66.
- Davidson, M. & Weismer, S. (2014). Characterization and prediction of early reading abilities in children on the autism spectrum. Journal of Autism and Developmental Disorders, 44, 828–845.
- Inoue, K., Wada, M., Natsuyama, T., et al. (2014). The feature of high reading ability in high-functioning pervasive develop mental disorders of childhood: analysis of the K-ABC and WISC-3rd assessment. Research in Autism Spectrum Disorders, 8, 25–30
- Lucas, R, & Norbury, C. (2014). Levels of text comprehension in children with autism spectrum disorders (ASD): the influence of language phenotype. Journal of Autism and Developmental Disorders, 44, 2756–2768.
Submitted by Dr. Carol Westby PhD
Re: 9 year old with high-functioning autism
Question by Parent: My child likes to talk a lot, yet when I ask him what he has done when he comes home from school or an outing with friends or family members, he just says, “nothin’” or “I don’t know.” Why won’t he tell me what he has done?
Answer: Children with autism struggle to remember details of events from their own lives (1). Remembering your experiences is called autobiographical memory. Autobiographical memory involves retrieving past experiences with people, objects, and events associated with emotion. Children with autism have difficulty with emotional processing, which likely influences their development of autobiographic memories (2).
Children with high-functioning autism often have good memory for facts, but they have poor autobiographical memory. Like typical children, children with autism form their first memories autobiographical memories around 3-4 years of age. However, when asked to talk about past experiences, child with autism retrieve fewer memories than typical children. They also tend to describe past events in general terms, such as, “my holiday with Grandma” or recall nothing at all, rather than supplying specific details.
Social interaction is fundamental to autobiographical memory development because it is through interaction with caregivers, that the child learns what is socially significant, and therefore, memorable (3).You can help your child develop autobiographical memory by reminiscing with your child. Because autobiographical memories are dependent on the link between the events and the emotions associated with the events, it is important that you discuss your emotional response to the situation and suggest likely ways your child felt in the situation. Engage in conversations in which you elaborate on the experience (4, 5, 6). Model how you would talk about the experience. Avoid closed yes-no questions that allow children to give minimal responses. Ask open-ended questions that encourage children to give details; but don’t make it a question-answer session. When you child makes a statement, elaborate on it, rather than asking another question. Notice how this mother elaborates on statements her child makes:
Adult: What did you do at the balloon fiesta?
Child: I talked to the pilot.
Adult: You talked to the pilot? What did he tell you?
Child: How to make the balloon go up.
Adult: Yes, he showed you how to pull the cord to ignite the burner. That made the air inside the balloon hot. The hot air made the balloon rise.
Child: The burner was real hot.
Adult: Yes, it was very hot so you needed to be careful not to touch it.
Child: Then the balloon went up
Adult: I think you were a little bit scared when it left the ground.
It can be helpful to share photos or videos when you reminisce with your child. You can use the acronym RECALL to help you remember what you should do when you reminisce.
- Retell events that have happened – talk about experiences you have had and books you have read.
- Elaborate: Give new information (e.g., The lion had a big furry mane – a mane is the lion’s fur around his head.)
- Confirm: Acknowledge your child’s responses (e.g., That’s right, we did see a lion!)
- Ask open ended questions: Who? What? Where? When? How? Why?
- Let your child take the lead: Talk about what is interesting to your child
- Link the events to emotion words: How did the experience make you feel? How did the characters in the book feel? (e.g., “That was a loud and scary lion! You were afraid!”)
- Goddard, L, Dritschel, B., Robinson, S. (2014). Development of autobiographical memory in children with autism spectrum disorders: Deficits, gains, and predictors of performance. Development and Psychopathology 26, 215–228.
- Uljaravek, M., & Hamilton, A. (2013). Recognition of emotions in autism: A formal meta-analysis. Journal of Autism & Developmental Disorder, 43, 1517–1526.
- Nelson, K., & Fivush, R. (2004). The emergence of autobiographical memory: a social cultural developmental theory. Psychological Review, 111, 486–511.
- Cleveland, E., & Morris, A. (2014). Autonomy support and structure enhance children’s memory and motivation to reminisce: A parental training study. Journal of Cognition & Development, 15, 414-436.
- Goldman, S., & DeNigris, D. (2015). Parents’ strategies to elicit autobiographical memories in autism spectrum disorders, developmental language disorders and typically developing children. Journal of Autism & Developmental Disorders, 45, 1464–1473.
- McCabe, A., Hillier, A., DaSilva, C. Queenan, A., Tauras, M. (2017). Parental mediation in the improvement of narrative skills of high-functioning individuals with autism spectrum disorder. Communication Disorders Quarterly, 38(2), 112-118.
Submitted by Dr. Carol Westby PhD
RE: Reading comprehension in high-functioning students with ASD
Question from teacher: I have a student in my class with a diagnosis of ASD. He’s great in math and the most fluent reader in my class, but he doesn’t seem to understand much of what he reads and he tests low on reading tests. Why is his comprehension so poor, when he is such a fluent reader?
Answer: Many high-functioning students with autism are exceptionally fluent readers, but they have specific comprehension deficits. They can often answer literal questions, but have particular difficulty answering questions that require them to make inferences (1). Although they typically have difficulty with all types of inferences, some inferences are more challenging for them than others. Students with ASD usually do their best with inferences that require understanding of physical causality. They have much greater difficulty making inferences that require that they have a theory of mind, that is, when they must make inferences about the intentionality and emotions of persons or characters (2).
An example of a passage which invites an inference based on physical causality would be: Jane knew Pete loved pot roast so she invited him over for dinner. While the pot roast was in the oven, the telephone rang. Jane had to open up all her windows to let the smoke out (3). Here the relation between roasting and smoke is based on physical causality. Errors that students with ASD make on this type of inference may be related to difficult integrating world knowledge with context/situation.
Students with ASD typically have more difficulty when they must make inferences about human intentionality, that is, when they must think about characters’ goals or intentions or what persons are thinking, as in the following example: Brad had no money but he just had to have the beautiful ruby ring for his wife. Seeing no salespeople around, he quietly made his way closer to the ring on the counter. He was seen running out the door. The last sentence invites the inference that Brad stole the ring. Readers make this inference based on the information about the manner in which the Bard approached a valuable object in a store; but to make this inference, students need to recognize Brad’s intention.
Students with ASD typically have the most difficulty when they must make inferences based on understanding of emotions of persons or characters in texts such as: Stacy was very sad because her grandmother died yesterday. After Stacy told Jen how sad she was, Jen kept thinking about Stacy. Jen baked Stacy cookies and went to visit her. In this example, the reader has to infer Jen’s emotional state of sympathy as being the source of the action.
Improving the reading comprehension of students with ASD requires developing their theory of mind by teaching them how to infer what persons and characters in texts are thinking and feeling.
- Lucas, R., & Norbury, C.F. (2015). Making inferences from text: It’s vocabulary that matters. Journal of Speech, Language, & Hearing Research, 58, 1224-1232.
- Bodner, K.E., Engelhardt, C.R., Minshew, N.J., & Williams, D.L. (2015). Making inferences: Comprehension of physical causality, intentionality, and emotions in discourse by high-functioning older children, adolescents, and adults with autism. Journal of Autism and Developmental Disorders, 45(9), 2721-2733.
- 3. Mason, R.A., Williams, D.L., Kana, R.K., Minshew, N., & M.A. Just (2008). Theory of Mind disruption and recruitment of the right hemisphere during narrative comprehension in autism. Neuropsychologia, 46(1), 269-280.
Submitted by Dr. Katandria Love Johnson, PhD
Re: 2.11 yr old toddler with Autism.
Question from parent: my child was recently diagnosed with autism. My question is: will the school-based intervention cure my child? Is it OK if I just “wait and see” until things get better before enrolling him in school?
Answer: Autism is a brain-difference and cannot be cured. However with appropriate intervention, symptoms can be minimized significantly. Early intervention is the best way to address any behavioral or speech and language intervention. Waiting will only increase the likelihood that the delay will perseverate. In some programs, social language and communication begin with discrete trial training (behaviourist adult directed training with rewards) within a group setting with peers of like developmental ages and stages. However, research shows that parent mediated play based intervention using strategies such as child-directed rather than adult structured play, is effective in stimulating communication and play behaviour. Programs such as Hanen’s More than Words coach the parent to use strategies such as people play (no toy is used so to help the child learn to enjoy interacting with the adult), observing, waiting, and listening to the child so to follow their lead; the parent Includes their child’s interests, interprets their child’s messages, imitates their child, and intrudes to help build joint attention and increase play behaviour and level. These form the bedrock for social, communication, and language development within a ‘natural’ milieu using ‘natural’ strategies- similarly to what typical children experience. As Drs. Myers and Johnson stated poignantly, “The primary goals of treatment are to maximize the child’s ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization, reducing maladaptive behaviors, and educating and supporting families.”
Submitted by: Kakia Petinou
Re: 3- year-old toddler at risk for ASD and accompanied expressive speech output
My son has recently has been assessed by a team of professional for Autism and speech language delay. The results suggested that our boy exhibits characteristics associated with Autism Spectrum Disorder (ASD) accompanied by speech and language delay. He will be reassessed at a later point to make sure his clinical characteristics continue to be on par with ASD. He says only a handful of words, imitates some basic speech sounds and loves to blow bubbles. Many times, he uses hand gestures to express his needs (points towards items, pulls our hand and guides us to where he wants to be). He rarely looks at us when trying to communicate and that is a worrisome behavior. Three months ago, we started intensive speech and language intervention sessions three times a week in combination with occupational therapy and applied behavior modification approach. His expressive vocabulary increased from 5 to 30 words he uses consistently, and his behavior at home and incidences of temper tantrums have decreased.
Given the current quarantine situation as a result of COVID-19, I am extremely worried that the disruption of therapy sessions will cause him to regress. We, as a team, have invested so much effort and time to achieve progress and now we are not sure as to how we can ensure continuation of his progress. What type of support can I have at home and how can I help him to keep up with therapy goals?
IALP EXPERT ASD COMMIITTEE EXPERT:
Many children with ASD present with serious speech and language challenges which impact effective communication. Specifically, 2/3 of children with ASD are non-verbal. They have restricted vocabulary and marked difficulties in imitating speech sounds, syllables, words etc. It is important that the parent keeps in touch with the therapist, because the therapist can train and guide the parents in assisting their child on specific abilities including the promotion of eye gaze, joint attention, focused sitting-down time, focused stimulation to improve word production and provide expressive vocabulary enrichment. Recent research shows that children with ASD can improve communication skills through focused stimulation on specific words “tailored” around the child phonetic skills. Parents and caregivers can be trained to promote word production in children through online meetings with the therapist. Meanwhile, the promotion of eye contact and joint attention activities (e.g., bring objects closer to your eyes and have child watch you) during every day parent-child interaction can improve social communication skills.
- Lowry, L. (2016). Play & Autism: More evidence for following the child’s lead. https://www.hanen.org/MyHanen/Resource-Centre/Articles/Research/Play—Autism–More-evidence-for-following-the-chi.aspx
- Sussman, F. (2012). More Than Words: A Parent’s Guide to Building Interaction and Language Skills for Children with Autism Spectrum Disorder or Social Communication Difficulties. Toronto, ON: The Hanen Centre.
- Manning-Courtney P, Murray D, Currans K, et al. Autism spectrum disorders. Curr Probl Pediatr Adolesc Health Care. 2013 Jan;43(1):2–11. [PubMed]
- Ozonoff S, Goodlin-Jones BL, Solomon M. Evidence-based assessment of autism spectrum disorders in children and adolescents. J Clin Child Adolesc Psychol. 2005 Sep;34(3):523–40. [PubMed]
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth ed. (DSM5) Washington DC: American Psychiatric Association; 2013
- Myers SM, Johnson CP: Management of children with Autism Spectrum Disorders. Pediatr 2007; 120(5):1162-1182.
- Baron-Cohen S: The development of a theory of mind in autism: deviance and delay? Psychiatr North Am 1991; 14:33-51.
Cacioppo JT, Bertson GG: Social psychological contributions to the decade of the brain: doctrine of multi-level analysis. Am Psychol 1992;47:1019-1028.
Katz, E., & Girolametto, L. Peer-mediated intervention for pre-schoolers with ASD: Effects on response and initiations. International Journal of Speech and Language Pathology 2015: 17: 565-579.
Gillon G, Hyter Y, Dreux F, Ferman S, Hus Y, Petinou K, Segal O, Tumarova T, Vogindroukas I, Westby C, Westerveld M: International Survey of Speech-language pathologists’ practices in working with children with Autism Spectrum Disorder (ASD). Folia Phoniatr Logp, this issue, 2017.
Koegel LK. Communication and language intervention. In Koegel RL & Koegel LK, (Eds.), Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities. 1995:17–32. Baltimore: Paul H. Brookes.
Pierce K, Marinero S, Hazin R, McKenna B, Barnes C, Malige A. Eye Tracking Reveals Abnormal Visual Preference for Geometric Images as an Early Biomarker of an Autism Spectrum Disorder Subtype Associated with Increased Symptom Severity. BIol Psychiatry. 2015, 11, doi: 10.1016/j.biopsych.2015.03.032.
Petinou, K., & Minaidou, D. (2017). neurobiological bases of autism spectrum disorders and implications for early intervention: a brief overview Folia Phoniatrica & Logopaedica DOI: 10.1159/000479181
Tager-Flushberg, H: Risk factors associated with language in autism spectrum disorder: clues to understanding mechanisms. Journal of Speech, Language, and Hearing Research 2016;59:143-154.
Westby CE: Social-neuroscience and theory of mind. Folia Phoni Logop 2014;66:7-17.