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Rehabilitation Reference Center Speech-Language Pathology Clinical Case Scenario #2: Autism Spectrum Disorder

Speech-Language Pathology

Clinical Case Scenario #2

Plan of care for a child with autism spectrum disorder

Clinical Scenario

A 6-year-old male who has a diagnosis of severe autism is on caseload for the new school year. His parents’ first language is Spanish and he is spoken to in both Spanish and English. The child himself is minimally verbal. He is new to this school, but has received early intervention services through the state and from private therapists for physical, occupational, and speech therapy.

The school speech-language pathologist (SLP) uses Rehabilitation Reference Center (RRC) to review the latest evidence based information about assessment and treatment of communication disorders in children with autism.

Searching in RRC

From the Home Page the SLP searches Autism Spectrum Disorder and from the results list selects Clinical Reviews Communication Disorders: Autism in Children (AN: 5000013236) and Augmentative and Alternative Communication: Children with Autism Spectrum Disorder (ASD) (AN: 5000013321). Reading the Clinical Reviews, she determines what formal and informal tests should be included in the child’s initial speech and language evaluation to provide the most comprehensive assessment and treatment plan. Additionally, she is able to construct an appropriate parent interview including questions regarding patient medical, developmental and early intervention (EI) history. Because the child is from a non‐English speaking home and is exposed to two languages, the SLP searches Bilingual in the RRC home page and chooses Clinical Review Language Disorders: Bilingual School-Aged Children (AN: 5000011704) to ensure she selects the most appropriate language assessments for this child.

Prior to meeting with the child for the first time and after thoroughly reviewing the child’s medical and intervention history, the SLP searches for Autism Spectrum Disorder on the RRC home page and selects the Guidelines tab. She reviews the US National Guideline Clearinghouse guidelines titled Autistic spectrum disorders: best practice guidelines for screening, diagnosis and assessment: complete summary to ensure that she and her multidisciplinary team are providing the most up‐to‐date and appropriate assessment for this child based on his age, diagnosis, and current level of functioning (as determined by reviewing recent evaluation and/or discharge reports).

After reviewing the Examination section of the Clinical Review, she is reminded that children with autism can be sensitive to sensory stimulation as well as unexpected transitions in routine and she is able to plan her evaluation accordingly by re-arranging the treatment space and dimming the lights.

Clicking on Assessment/Plan of Care the speech-language pathologist reviews the Treatment Summary and learns that two separate systematic reviews have examined the effectiveness of communication treatment for children with autism. According to these findings, challenging behaviors decrease when children with autism are taught efficient and effective communication skills. The individual’s profile of communication abilities and deficits is important to consider when selecting a particular treatment method. Additionally, the reviews found that a combination of approaches, rather than a single treatment approach, may be most beneficial for children with autism.

After the initial evaluation with the child the SLP meets with the individualized education plan (IEP) team that includes herself, the child’s parents, the child’s classroom teacher, and physical and occupational therapists. Working collaboratively the team formulates a multidisciplinary plan for the coming school year. Due to the severity of communication impairment and the Treatment summary in Clinical Review Augmentative and Alternative Communication: Children with Autism Spectrum Disorder (ASD) (AN: 5000013321), the SLP recommends expanding the Picture Exchange Communication System (PECS) that the child’s EI team initiated for use in the child’s daily routines, classroom activities, and therapy sessions for improved functional communication.

The SLP returns to the Results List and chooses the Patient Education tab to print Autism [Spanish version] (AN: SPA2009543500) for the child’s parents.

At the end of the year, the SLP has planned a re‐evaluation of communication skills based on the Desired Outcomes/Outcome Measures section of the Clinical Reviews to include an environmental assessment/ecological inventory as well as a bilingual assessment of receptive and expressive language that should include a combination of formal and informal measures.

The SLP adds the collection of evidence-based papers to a designated Autism Spectrum Disorders folder in RRC.