The Role of SLP in Working With Patients with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder of unknown cause that affects roughly 1 percent of the population worldwide. In the United States, according to statistics from the Centers for Disease Control (CDC), around 1 in every 68 children will be diagnosed with some form of ASD.

One of the key diagnostic criteria used to identify those children, and the disorder itself, revolves around deficits in social communication skills, both verbal and non-verbal. Language acquisition and use can be anywhere from moderately to significantly challenged in ASD patients. Further, ASD is often present in patients with co-morbid disorders and afflictions, including:

• ADHD (Attention Deficit Hyperactivity Disorder)
• Depression or anxiety
• Bipolar disorder
• FragileX syndrome
• Downs syndrome

All by themselves, these related issues often lead to speaking and language deficits. Add in the communication issues often associated with autism, and the challenge is compounded for both patients and practitioners.

Some professionals estimate around 50 percent of all children with ASD are completely non-verbal prior to treatment. Another study found that almost 64 percent of children initially diagnosed with ASD also had apraxia, a speech disorder that is quite rare in the general population. This all adds up to patients with Autism Spectrum Disorder being a population with a strong need for SLP services.

Speech-Language Pathology Emerges as a Preferred Treatment for Autism

Autism therapy has become the 800-pound gorilla in the healthcare field since the explosion of diagnoses among children starting in the 1990s. With the passage of the IDEA (Individuals with Disabilities Education Act) in 2004, which required public schools to begin providing accommodations tailored to the individual needs of all children, the funding available for treating autism also exploded.

Even as early as the late 1970s and early 1980s, treatment for autism was already being reshaped to take on a more hybrid, pragmatic approach that combined multi-disciplinary treatment teams working in a variety of specialty areas. SLPs became more involved in both treatment and research efforts around ASD. Today, according to a survey by autism advocacy group Autism Speaks, speech therapy is the second most successful therapeutic approach in use with ASD patients.

How SLPs Treat Patients with ASD

When working with individuals with ASD, SLPs use many of the same types of diagnostic and therapeutic techniques as they do with other patient populations. Their training in identifying and addressing the motor, neurological, or cognitive issues that affect speech production and language acquisition is just as effective when working with people on the spectrum.

That’s not to say there aren’t some additional challenges stemming from the unique social communication problems and repetitive behaviors that are endemic to the disorder. Therapy has to be built around those difficulties and often may need to conform to other concurrent therapy programs like applied behavior analysis, which are commonly used to treat ASD.

The autism spectrum runs from low-functioning to high-functioning ranges, and the approaches SLPs use vary on that basis…

• Low-functioning autism patients can have severe feeding/swallowing issues and motor speech disorders that need to be addressed by way of physical therapeutic interventions.
• With higher-functioning patients, SLPs might use multimodal alternative and augmented communication (AAC) supports to work with patients, such as speech generators or tablet-based communication screens.

In virtually all cases, SLPs work as part of a larger team of medical professionals and therapists involved in treating the patient. Frequently, they collaborate with teachers, family members or other caregivers since the therapies they design often requires every person the patient interacts with to be familiar with the treatment methods prescribed.

Becoming a Speech-Language Pathologist Specializing in Autism Treatment

No special qualifications are required to become an SLP who specializes in working with patients with ASD.

Due to the prevalence of the condition among younger patients, it can be beneficial to have experience working in schools or with children. It’s often possible to volunteer in special education roles in schools even before obtaining your CCC-SLP, which gains you familiarity with the role before committing to it, while also looking good on a CV when the time comes to apply for a job in the schools or a clinic that specializes in treating autism.

There are also specialty certifications that will improve your credentials and build your knowledge base in ASD treatment.

CCC-SLP Clinical Specialty in Child Language and Language Disorders

Although not specific to autism, the ASHA-approved clinical specialty certification for Child Language and Language Disorders through the American Board of Child Language and Language Disorders is a valuable credential when it comes to finding a position that involves working with children on the spectrum.

The certificate requires that you already hold your CCC-SLP before applying. Additionally, you must acquire:

• Five years of practice experience as a CCC-SLP with an emphasis in child language
• Document at least 100 hours in intermediate or advanced coursework or training related to typical and atypical language learners beyond the basic CCC requirements
• Demonstrate advanced knowledge, skill, and leadership in Child Language

There is a $50 application fee and the credential itself costs $100 per year to maintain, together with evidence of ongoing practical work in the child language field and 35 clock hours of dedicated continuing education.

Becoming a Certified Autism Specialist

Another widely recognized credential is the Certified Autism Specialists (CAS) from the International Board of Credentialing and Continuing Education Standards (IBCCES). The CAS is specific to autism but not to speech-language therapy; other CAS-holders may be teachers, applied behavior analysts, or other therapists and medical professionals. But holding a CAS as well as a CCC-SLP signals a high degree of expertise in autism-specific speech and language issues.

To obtain a CAS you must have:

• A master’s degree in an approved field (the degrees accepted for the CCC-SLP are included, so you can expect to meet this requirement automatically once you’ve been board certified).
• A minimum of two years of experience in a field supporting individuals with autism.
• Fourteen continuing education hours within the past two years, obtained through IBCCES and dealing with autism.
• Pass an autism competency exam.
• Pay a $495 registration fee.

To retain the certification, an additional 14 CEUs in related training have to be taken and a $199 fee paid every two years.

Practice Settings Where SLPs Typically Work With ASD Patients

SLPs who specialize in working with patients with autism have a number of different venues for possible employment:

• Private practice clinics
• Long-term care facilities
• Schools

Most school districts and many private autism-focused therapy centers have at least one SLP on staff. Speech and language issues cut across the entire range of developmental disorders that these agencies address. SLPs in these settings have to have a flexible approach to treatment options and can expect to work with patients one-on-one or in a group setting.

The speech issues that SLPs encounter in these settings vary based on the age group—schools have many students with ASD but also a wide array of other childhood and developmental issues. SLPs in long-term care facilities, on the other hand, would work with geriatric patients who often have neurologically based swallowing and speech issues like aphasia caused by stroke, Parkinson’s and other diseases.

Finding a facility or private clinical practice that specializes in treating autism is probably the best way to ensure you primarily treat patients with ASD. The autism epidemic in the United States is far from over, and expertise in managing the speech issues in this growing patient population will continue to be in strong demand.