On February, as part of its Posted series, the ASHA Leader asked on Facebook, “Do you, as an SLP, diagnose autism spectrum disorder independently or as a team?” The response we received was varied and indicated there is some confusion in the profession about what is proper, expected, or even legal. The biggest question that appeared over and over was, “How can an SLP diagnose independently?” The answer bears some explanation.
When it comes to assessing and diagnosing ASD, interdisciplinary collaboration is important due to the complexity of the disorder, the varied aspects of functioning affected, and the need to distinguish ASD from other disorders or medical conditions. Ideally, the SLP plays a key role on an interdisciplinary team, whose members possess expertise in diagnosing ASD. In cases when there is no appropriate team available, however, an SLP who has been trained in the clinical criteria for ASD and who is experienced in the diagnosis of developmental disorders, may be qualified to diagnose these disorders as an independent professional. For more information check out ASHA’s new Practice Portal and/or position statement on autism.
In most cases, a stable diagnosis of ASD is possible before or around a child’s second birthday (Chawarska, Klin, Paul, Macari & Volkmar, 2009). An early, accurate diagnosis can help families access appropriate services, provide a common language across interdisciplinary teams, and establish a framework for families and caregivers within which to understand their child’s difficulties. Any diagnosis of ASD, particularly of young children, should be periodically reviewed, as diagnostic categories and conclusions may change as the child develops. Interdisciplinary collaboration and family involvement is essential in assessing and diagnosing ASD.
Assessment, intervention, and support for individuals receiving speech and language services should be consistent with the World Health Organization’s International Classification of Functioning, Disability, and Health (2001) framework. This framework considers impairments in body structures/functions; the individual’s communication activities and participation; and contextual factors, including environmental barriers/facilitators and personal identity. There are recommended knowledge and skills for SLPs who are planning on working with individuals with autism spectrum disorder:
- Federal and state laws and regulations regarding scope of practice, referral, and placement procedures.
- Diagnostic criteria for ASD and related conditions (e.g., DSM-5).
- How to obtain information regarding etiology and related medical conditions.
- Importance of early diagnosis and the role of the speech-language pathologis.t
- How to evaluate the validity of diagnostic tools.
- The necessary information to gather in a diagnostic evaluation about the child’s health, developmental and behavioral history, past intervention and academic history, and medical history of the family.
- Other related diagnostic categories and when to make appropriate referrals to identify or rule out related conditions
- How to rule out or confirm hearing loss while working with an audiologist.
- The types of speech and language impairments that can co-occur with ASD, including features of language disorders, apraxia, and dysarthria.
- How to share information about diagnosis with parents.
- The challenges of determining eligibility for services for individuals with ASD, especially high-functioning individuals.
- The needs of culturally and linguistically diverse populations, including the selection and/or adaptations of diagnostic instruments (ASHA, 2004b).
- Observation, recognition, and interpretation of diagnostic characteristics of ASD.
- Selection and correct use of valid diagnostic tools for ASD.
- Appropriate referrals to other professionals to identify or rule out related conditions.
- Diagnosis of the types of speech and language impairments that can co-occur with ASD, including features of language disorders, apraxia, and dysarthria.
- Integration of findings from diagnostic tools for ASD, diagnostic evaluation, and information from other professionals or members of an interdisciplinary team, to determine diagnosis.
- Documentation and communication of findings about diagnosis to family members, individually or in conjunction with a collaborative team.
- Effective, delicate, and empathic communication when informing family members that the child has ASD.
- Decision making about eligibility for services.
- Appropriate recommendations and referrals for services and assistance to families in navigating the educational and health care systems, as well as promotion of self-advocacy.
Some state laws or regulations may restrict the scope of practice of licensees, however, and prohibit the SLP from providing such diagnoses. SLPs should check with their state licensure board and/or departments of education for specific requirements.