Early Identification of Autism and Tough Conversations

In honor of Autism Awareness Month, I’ll be writing a series of posts on Autism throughout the month of April. The first topic is Early Identification. Logo_WAAD

When I was in graduate school, my professors told me speech-language pathologists are often the first professionals who recognize early indicators of Autism, or Autism Spectrum Disorders (ASD). When a child isn’t starting to talk or their communication skills are delayed, pediatricians will often refer a parent to take their child to an SLP. Delayed communication skills can be caused by many reasons other than Autism, but it is one of the early red flags. My professors certainly knew what they were talking about. In my first two years as an SLP in a pediatric clinic, I evaluated many children who were referred for speech therapy due to communication concerns. Some of these children were late-talkers, some had apraxia of speech, some had speech and language delays, and some I suspected had Autism. In this blog post, I intend to explain the early warning signs of Autism and how an SLP is involved in the tough conversations with parents when a child is suspected to have Autism.

According to Autism Speaks, an autism science and advocacy organization, these are early indicators of Autism:

  • No big smiles or other warm, joyful expressions by six months or thereafter
  • No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
  • No babbling by 12 months
  • No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
  • No words by 16 months
  • No meaningful, two-word phrases (not including imitating or repeating) by 24 months
  • Any loss of speech, babbling or social skills at any age

From https://www.autismspeaks.org/what-autism/learn-signs

The American Speech and Hearing Association (ASHA) also has great information about early identification of Autism and I’d recommend this post from the ASHA Leader Blog for anyone looking to learn more.

As you can see, many of these early warning signs of Autism would warrant an evaluation by an SLP as they all relate to communication, including social communication. If you notice any of these red flags in your child, ask your pediatrician for a referral for an evaluation. But what if the child you’re concerned about isn’t your child? This is the tricky part. For speech-language pathologists, it is our responsibility to educate others about Autism and diagnose ASD, typically as part of a multi-disciplinary team (according to ASHA Roles and Responsibilities).  Early identification of Autism is SO important. We know that early intervention drastically improves outcomes for children with a variety of disorders, ASD included. We also know that intervention is more effective when provided before age 3 than before age 5. Many children are not diagnosed with Autism until they begin preschool, or if they don’t attend preschool, they might not be diagnosed until they begin Kindergarten. We know that diagnosing this late means missing a critical intervention window. It certainly does not mean intervention will no longer be effective, we just know that the earlier intervention starts, the better.

So how do you talk to someone else about their child and Autism? These are tough conversations. In short, I have 5 recommendations:

  • Use active listening skills to build trust with parents
  • Be honest, yet gentle, about what you know and don’t know
  • Stress the importance of early intervention
  • Give parents time to process, but encourage them to seek out other evaluations and services as soon as they can
  • Provide quality resources for information and support

Use Active Listening and Be Honest, yet Gentle About What You Know and Don’t Know
Some professionals worry that mentioning Autism too early is going to overwhelm a parent. This is a valid concern. The suspicion that your child might have Autism is extremely scary for many parents. Some SLP’s may delay the conversation out of fear the parent will become upset and discontinue services. Every situation and parent is different, which is why the ability to build trust and relationships with the family is just as important as your evaluation and treatment skills. Active listening and counseling skills are critical in early intervention. Being honest, yet gentle, with the parent about what you know and don’t know is important, and I believe it’s important to express your concerns as soon as possible. For example, in my experience, I have diagnosed a child with a speech, language, or social communication delay (or some combination) and then made a referral to a psychologist for an Autism evaluation if I believe there are red flags present. What I would tell the parent is “I noticed your child demonstrates x, y, z, communication skills, which can be characteristic of Autism. I’m recommending an evaluation by other professionals to give more information about your child’s needs so that s/he can get all of the services s/he needs to be successful.”

Stress the Importance of Early Intervention
Explain to a parent we know early intervention is the most important thing to do for a child with communication delays. Tell them an evaluation by other professionals might result in more services for their child, which will only help them. Other professionals who should be consulted or referred in an initial diagnosis of Autism include child psychologist, occupational therapist, physical therapist, early education specialist/teacher, and behavioral interventionist. There are a variety of evidence-based interventions available to treat children with ASD, but getting a diagnosis is the first step in accessing those services.

Give Parents Time to Process, but Encourage Them to Seek out Other Evaluations and Services as Soon as They Can
As I mentioned above, being the first person to suggest to a parent that their child might have Autism is a tough conversation. It is important to listen to the parent, to allow them time to process, but to also encourage them to seek out additional services as soon as they can. Having a child evaluated by other professionals is not going to hurt them. However, research shows us that delaying the conversation and wasting critical time IS going to hurt a child who needs early intervention.

Provide quality resources for information and support
Parent support groups, online and in person, can be so helpful when a family is newly diagnosed. If you aren’t aware of any in your area, I’d recommend finding one you can refer to parents to help them adjust. There is a TON of information on the internet, and not all of it is helpful. Get familiar with informational websites you think are helpful for newly diagnosed families. I’d recommend starting with ASHA and Autism Speaks. Then, be prepared for their questions after they’ve done their research.

Parents often want to know what the future is going to look like for their child. This is another time when I think it is so important to be honest about what we know and don’t know. What I usually tell parents is “I can’t predict the future, but what I do know is that children do best when they receive early intervention services. You are doing what we know is best for your child and is going to help them have the best possible outcome.”

Early diagnosis and intervention for Autism is something I am passionate about. I’d love to hear your experiences and other recommendations for handling these tough conversations!

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