Author
Roberts, M.Y. (2019). Seeing autism signs? Speak up and guide parents to see them too. The ASHA Leader.
SLPs with the relevant expertise absolutely can diagnose ASD, typically as a member of a team.
During speech-language pathologist Jamie’s first visit with 24-month-old Victor, she notices that he isn’t making eye contact, doesn’t communicate very often, and immerses himself in lining up toy cars on the carpet. Jamie knows these are signs of autism, but she also knows that his initial evaluation report didn’t mention autism spectrum disorder (ASD), only that he had significant language delays. One day, Victor’s mother asks why his language is delayed. Though Jamie suspects ASD, she balks at using the panic-inducing word too early with families. So she says there are many reasons for language delay, but right now it’s important to focus on helping Jamie.
A year later, Victor receives a diagnosis of ASD from a multi-disciplinary diagnostic team. Victor’s mother has trouble accepting the diagnosis. She knows that he has trouble talking, but he enjoys giving hugs and playing with his older sister. He can’t have autism! Talking with his mother, Jamie says she believes the diagnosis is accurate because she has seen signs of ASD in Victor. His mother is surprised that Jamie never discussed these concerns with her.
What is the result of Jamie not discussing signs of ASD with Victor’s mother? His diagnosis is delayed by a year, which also delays his access to a host of ASD-specific treatments, from pivotal response treatment (PRT) to applied behavior analysis (ABA) to Floortime to, of course, intensive speech-language treatment.
Earlier in my career, I was Jamie. I thought I wasn’t “supposed to” talk about ASD because that was the job of the diagnostic team. I also didn’t know how to bring up something that I knew would be hard for caregivers to hear. But when I realized how long caregivers wait to receive an ASD diagnosis (often nine months or more), I saw how critical it is to immediately call attention to ASD signs in home and [pre]school settings.
Now I work with the Developmental Diagnostic Program at Northwestern University’s Center for Speech, Language, and Learning. As part of this medical diagnostic early-intervention program, we ask caregivers if any service provider working with the child has expressed concerns about autism. More than 50 percent of caregivers report that no provider has expressed concerns, even though 100 percent of the children are enrolled in early intervention.
This statistic is so staggering that it propelled me to study ways to reduce diagnostic wait times for children with ASD. One important way is providing strategies for SLPs to bring up concerns as early as possible.
There is every reason for SLPs to initiate these conversations earlier. First, discussing signs of ASD is not the same as giving a diagnosis. But, importantly, it prompts parents to pursue a diagnostic evaluation.
Second, SLPs with the relevant expertise absolutely can diagnose ASD, typically as a member of a team (see the ASHA Practice Portal pages on ASD, and early intervention, and a Leader Live post on ASD diagnosis). In some states, SLPs can independently diagnose ASD (check state licensure laws).
Third, SLPs are in a unique position to help caregivers through the ASD diagnostic journey—using carefully cultivated skills and strategies to ease these delicate yet crucial conversations.
