Educating Children with Autism
National Research Council. (2001).
Washington, D.C.: National Academy Press, 323.
This guideline provides recommendations for the assessment and treatment of children on the autism spectrum. This report also addresses the needs of families of these children. The target audience of this guideline is professionals involved in the diagnosis and management of children on the autism spectrum, including speech-language pathologists. A detailed review precedes the recommendations, which describes the current evidence base for specific treatment approaches.
National Research Council
"A child must receive sufficient individualized attention on a daily basis so that individual objectives can be effectively implemented; individualized attention should include individual therapies, developmentally appropriate small group instruction, and direct one-to-one contact with teaching staff" (p. 220).
Educational services or supports should begin as soon as a child demonstrates characteristics of being on the autism spectrum and should include "a minimum of 25 hours per week, 12 months a year" (p. 220). This treatment should include individualized attention and specialized instruction in settings with typically developing children (pp. 220-221). Lack of progress over a 3-month period should result in increased intensity of service (pp. 220- 221).
"Functional, spontaneous communication should be the primary focus of early education. For very young children, programming should be based on the assumption that most children can learn to speak. Effective teaching techniques for both verbal language and alternative modes of functional communication, drawn from the empirical and theoretical literature, should be vigorously applied across settings" (p. 221).
"There is now a large body of research indicating that [facilitated communication] FC does not have scientific validity. Therefore, any significant message communicated by a child through FC should be validated through qualitative and experimental analysis.... Past research that invalidates FC should not preempt research and practice in keyboarding, literacy learning, and [augmentative and alternative communication] AAC as a communication modality" (p. 62).
"Hearing should be tested, but behavioral problems may sometimes complicate assessment. Definitive documentation of adequate hearing levels should then be obtained through other methods, such as auditory brainstem evoked responses" (pp. 30-31).
"Social instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age-appropriate, individualized social goals (e.g., with very young children, response to maternal imitation; with preschool children, cooperative activities with peers)" (p. 221).
"The efficacy of communication intervention should be determined by meaningful outcome measures in social communicative parameters, not just the acquisition of verbal behaviors" (pp. 63-64).
Cognitive intervention should focus on skills that are expected to be used in the natural context, and there should be an emphasis placed on generalization and maintenance (p. 221).
A primary focus of early intervention should be functional, spontaneous communication. "For very young children, programming should be based on the assumption that most children can learn to speak" (p. 221).
"The knowledge held by speech and language therapists ... is crucial for evaluating the needs of young children [on the autism spectrum] ... and developing goals and objectives, as well as assessing progress" (pp. 138-139).
Educational objectives should be observable and measurable and should affect the child's participation in everyday activities. Objectives should include development of social skills, expressive verbal language, symbolic communication, engagement and flexibility in play, fine and gross motor skills, cognitive skills, appropriate behaviors, and organizational skills (p. 218).
Research evidence suggests that total communication is more effective for teaching receptive and expressive vocabulary for children on the autism spectrum than speech training alone.
"There is no evidence that use of [augmentative and alternative communication] AAC systems as collaterals to language instruction results in delays in the acquisition of speech, though specifying the advantages and disadvantages of using AAC in support of the development of speech in different populations remains a research question" (p. 58).
Visual symbols have been found to enhance communicative initiations and responses and decrease verbal prompt dependence for children on the autism spectrum, and research has demonstrated that communication partners can easily be trained to provide support.
Evidence suggests that sign language enhances the use of speech for some children and no evidence suggests that it interferes with speech development. "Children with poor verbal imitation skills are the best candidates for an [augmentative and alternative communication] AAC system, such as sign language, because they are likely to make poor progress in speech acquisition without AAC" (p. 58).
Autism spectrum disorder (ASD) assessment should include a "formal evaluation of social behavior, language and nonverbal communication, adaptive behavior, motor skills, ... behaviors, and cognitive status by an experienced multidisciplinary team. Additionally, observations and concerns of parents should be systematically gathered. Diagnosis should be made as early as possible and follow-up diagnostic and educational assessments should be performed within the next one to two years" (p. 214).
Preliminary findings suggest potential for voice output communication aids to support communication for children on the autism spectrum.
