MSHA Position Statement on Autism

Presented to Caring for Mississippi Individuals with Autism Task Force August 23, 2007
Speech-Language Pathologists serve as an integral part of a team that is responsible for formulating and implementing service delivery plans that meet the unique communication needs of individuals with autism.  As part of the process of information gathering, Dr. Maureen Martin, Dr. Carolyn Higdon and Julie Chadwick, representatives of Mississippi Speech Language Hearing Association (MSHA) on the Caring for Mississippi Individuals with Autism Task Force, conducted a survey of MSHA members providing services to children with autism.   There was little variance in issues of concern with most of the respondents focusing on the following areas:
1) Accurate diagnoses and resulting eligibility rulings for services in school settings
Given the importance of communication, including the important aspects of social communication, in the diagnosis of Autism Spectrum Disorder (ASD), the speech-language pathologist plays an important role in both screening and diagnosis.  Because children with ASD are often initially suspected of having a hearing problem, audiologists are in a critical role to spot possible signs of ASD in children whose hearing they are testing and to make appropriate referrals for screening and diagnosis.  Ideally, speech-language pathologists and audiologists will function as a member of an interdisciplinary team, however, because of personnel shortages or lack of service in rural settings, appropriate procedures often are not readily available.
Additionally, although the core deficits of ASD are generally agreed upon, the variability seen in this spectrum of disorders presents challenges to reliable diagnoses of ASD and other disorders that may overlap or be confused with ASD.  High functioning individuals with ASD post particular challenges both for identification and for determining eligibility for services.  Due to the pervasive nature of the social communication impairment, regardless of age, cognitive abilities, or performance on standardized testing of formal language skills individuals with ASD may demonstrate a need for speech language pathology services.  Because formal assessment tools may not accurately detect problems in the social use of language and communication, eligibility for services may need to be based on clinical judgment and more informal, observational measures.  The need for more training in differential diagnosis for all professionals is paramount.  An early accurate diagnosis can assist in earlier access to needed services ad appropriate treatment.
2) Access to appropriate and high quality services
Within the field of ASD, there is a wide variety of approaches to intervention that vary with regard to documentation of success, popular theory, and marketing efforts.  Recent research conducted by the American Speech Language Hearing Association (www.ASHA.org) evaluated treatment approaches with three major conclusions emerging which should form the basis for clinical decision making.  First, to date there is no evidence that any one approach is more effective than another.  Second, there is no research available that will allow prediction of the best strategy or intervention with an individual.  Last, the broad impact of social communication highlights the critical importance of meaningful outcome measures.  To date there is limited research regarding effectiveness of treatments.  The challenge for all professionals is matching intervention approaches and strategies with the core deficits of individuals with ASD as well as philosophical beliefs underlying best practices. 
Changes in demographic and economic trends, as well as reforms in health care and education, are necessitating expansion of the service delivery model options offered by speech- language pathologists.  Models now focus on incorporating decision making and service delivery based on a commitment to serving all children in the environment that best fits an individual’s needs.  We must consider the unique combination of providers, activities, and contexts necessary to meet the specific needs of each individual with ASD.  Application of this collaborative team approach in service delivery necessitates additional and on-going training for not only speech-language pathologists, but must include special education and regular education teachers and administrators, psychologists, psychiatrists, physicians, physical therapists, and occupational therapists.
In a 2002 study of Medicaid-eligible children with autism it was concluded that geographic location and lack of financial resources can be constraints on access.  This study found that Medicaid-eligible children were diagnosed at a much later age suggesting that few children in low-income families received services during pre-school years.  This was regardless of race.  There should be no disparity in the funding of services for children as current research denotes intensive levels of service especially at the pre-school level improves communication abilities and translates to success in school.
3) Services to families
Support for families is an ongoing process that takes different forms with different families based on their individual concerns, priorities and interests.  Families of individuals with autism experience many special demands.  They fulfill multiple roles, investigator, advocate, collaborator, co-therapist, service coordinator, financier of services, and lobbyist for changes in laws and policies.  The multiple roles create challenges for families who are attempting to access information and services through a variety of systems.  A mandate for family-centered services to foster family-professional collaboration is clearly needed.  As the nature of the demands and impacts on families of persons with ASD changes over time so should the service.  Service providers need to be well versed in the agencies and available services as individuals with ASD transition within the system.  There is a need for more specific procedures and protocols for serving individuals with ASD across the lifespan.
Recommendations:
1) Intensive training for all involved professions in the differential diagnosis of ASD, varied interventions strategies, and on a  collaborative or team approach to diagnosis and intervention.
2) Participation in or development of research on effective intervention methodology.
3) Equitable funding of services for all individuals with ASD.
4) Develop specific procedures and protocol for serving individuals with ASD across the life span.
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