The New Hampshire Task Force on Autism: Part I Assessment and Interventions
New Hampshire Task Force on Autism. (2011).
Concord (NH): State of New Hampshire, Department of Health and Human Services, 1-84.
This guideline provides recommendations for the screening, assessment, and treatment of children and adults on the autism spectrum.
Department of Health and Human Services, State of New Hampshire
<p>When considering auditory integration therapy (AIT) as an intervention, the following should be considered:</p>
<ul>
<li>the treatment has been recommended for several populations, including [children on the autism spectrum] ... despite insufficient efficacy data;</li>
<li>practitioners must be properly trained;</li>
<li>parents should be wary of claims that AIT may cure a child from an ASD; and</li>
<li>there is some evidence that positive effects of AIT, if any, are not maintained.</li>
</ul>
Families considering the use of the Son Rise/Option Program should not plan to use this as a singular approach to intervention and should be fully aware of the cost of intervention and ongoing consultation fees.
<p>If augmentative and alternative communication (AAC) intervention is decided upon, it is recommended that:</p>
<ul>
<li>the device or system be used in a trial evaluation prior to purchase;</li>
<li>recommendations from other users are considered;</li>
<li>members of the evaluating team have appropriate knowledge and skills; and</li>
<li>the individual receiving AAC is motivated to engage in communication, or that the device is being used to foster interest in communication skills and social interaction.</li>
</ul>
Components for effective interventions include but are not limited to:
<ul>
<li>beginning services as early as possible;</li>
<li>engaging children in active goal-directed activities for at least 25 hours/week year-round;</li>
<li>specialized instruction in settings where interactions with typical peers are possible;</li>
<li>repeated assessment and program adjustments at least every 3 months;</li>
<li>ensuring intervention is developmentally appropriate and purposeful; and</li>
<li>involving the family.</li>
</ul>
<p>Instructional priorities for children on the autism spectrum should include:</p>
<ul>
<li>"functional, spontaneous communication;</li>
<li>social instruction in a variety of natural settings;</li>
<li>teaching of play skills focusing on ... use of toys and play with peers;</li>
<li>instruction leading to generalization and maintenance of cognitive goals in natural contexts;</li>
<li>positive approaches to address problem behaviors; [and]</li>
<li>functional academic skills when appropriate" (p. 25)</li>
</ul>
<p>For children on the autism spectrum, instruction priorities should include:</p>
<ul>
<li>"functional, spontaneous communication;</li>
<li>social instruction in a variety of natural settings;</li>
<li>teaching of play skills focusing on ... use of toys and play with peers;</li>
<li>instruction leading to generalization and maintenance of cognitive goals in natural contexts;</li>
<li>positive approaches to address problem behaviors; [and]</li>
<li>functional academic skills when appropriate" (p. 25).</li>
</ul>
Children identified as potentially being on the autism spectrum from screening and surveillance should receive an audiologic evaluation to determine if the individual has hearing loss.
<p>If implementing an applied behavioral analysis approach clinicians should:</p>
<ul>
<li>"ensure that adequate training, oversight, time, and rigor are devoted to the program;</li>
<li>avoid any use of punishment that induces shame or pain;</li>
<li>include adequate family and child input, choice, and education;</li>
<li>ensure adequate development of generalization skills, natural reinforcement strategies, discrimination training, and maintenance procedures for more complex behaviors such as social skills and play;</li>
<li>use only developmentally appropriate interventions;</li>
<li>be aware that overemphasis on discrete trial instruction may foster dependence on prompts from others; [and]</li>
<li>avoid overemphasis on the methods and techniques; make sure to stress the importance of the person's quality of life" (p. 29).</li>
</ul>
"The speech and language pathologist determines the specific approaches.... For a ... [non-speaking] person, this might include enhancing communication skills through the use of sign language, object communication exchange, picture communication exchange, written language, or varied types of communication boards/systems.... Speech and language therapy for individuals who are verbal might include developing strategies for someone who uses echolalia, expanding vocabulary and/or sentence structures, supporting ways to increase understanding/comprehension skills, or teaching conversational skill development" (pp. 47-48).
"The speech and language pathologist plays a critical role in the initial assessment of and subsequent treatment of individuals who are diagnosed with autism spectrum disorder [ASD]. Given that communication is one of the three major areas used in determining a diagnosis of ASD, an experienced speech and language pathologist is an important member of the evaluation team" (p. 47).
<p>The diagnostic assessment for autism should include an instrument with recognized sensitivity and specificity. Instruments recommended for the diagnostic process include:</p>
<ul>
<li>the Autism Behavior Checklist (ABC);</li>
<li>the Autism Diagnostic Interview-Revised (ADI-R);</li>
<li>the Autism Diagnostic Observation Schedule (ADOS-G);</li>
<li>the Childhood Autism Rating Scale (CARS); and</li>
<li>the Gilliam Autism Rating Scale (GARS).</li>
</ul>
<p>Clinicians implementing developmental or social-pragmatic interventions should:</p>
<ul>
<li>"ensure adequate training and oversight are provided;</li>
<li>ensure sufficient time and rigor are devoted to the program;</li>
<li>try not to implement the program in the midst of competing activities; [and]</li>
<li>not use these as the sole interventions when individuals also need direct, skill-based intervention (especially to learn imitation skills)" (pp. 31-32).</li>
</ul>
<p>When using the Social-Communication, Emotional Regulation and Transactional Support (SCERTS) model, clinicians should consider the following:</p>
<ul>
<li>The positive supports portion of the model should be adequately addressed.</li>
<li>Results of this intervention may take a bit longer as it takes time to build relationships which are the foundation of the SCERTS model.</li>
<li>An individual's strengths and needs should be thoroughly assessed before beginning SCERTS.</li>
<li>All clinicians should be properly trained.</li>
</ul>
When using the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) model, assessment and intervention providers should be adequately trained and supervised and should collect sufficient data to monitor progress.
