Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by

issues in social communication, social interaction and restricted, repetitive

behaviours. Social communication includes impairments in aspects of joint attention
as well as challenges in the use of verbal and nonverbal communicative behaviours
for social interaction. Restricted, repetitive behaviours, interests, are manifested by
stereotyped, repetitive speech, motor movement, or use of objects; inflexible
adherence to routines; restricted interests; and hyper- and/or hyposensitivity to
sensory input. At its core, communication is a social process; therefore, the social
communication issues experienced by individuals with ASD also impact their
communication partners. Family members, friends, teachers, SLPs, and other
service providers who interact with someone with ASD are faced with the challenge
of learning to respond to subtle messages for communication, interpreting the
functions of problem behaviour, and modifying the environment to foster active,
social engagement. Peers often feel ineffective when engaged in social exchanges
with an individual with ASD and may avoid that person and/or react in a negative
way (e.g., teasing or bullying), which can have a negative impact on the
development of appropriate social skills. Given the challenges experienced by
communication partners, treatment considers the whole range of service delivery
models, including traditional pull-out; home-, classroom-, and community-based
models; and collaborative consultation models. Service delivery focuses on natural
learning environments and includes education and training of family members,
teachers, peers, and other professionals.
The goal of family-centred practice is to create a partnership so that the family fully
participates in all aspects of the individual's care. The participation of families in
services aimed at addressing the needs of the individual with autism can serve to
eliminate the stress experienced by family members. Cultural, linguistic, and
socioeconomic factors affect families' access to and selection and usage of services.
The range of services offered include counselling, education and training,
coordination of services, and advocacy for practices that incorporate family
preferences and address family priorities. Support may take different forms at
different times, including coordinating services for the family, obtaining resources
and information, teaching the family or other significant communication partners
specific skills, and advocating for or with the family. It can also result in greater
consistency in activities and routines across different contexts and communication
partners.
Some signs and symptoms of ASD can vary, individuals can have abilities ranging
from significant cognitive and language impairments (e.g., nonverbal) to superior
cognitive and language abilities (e.g., college- and career-bound). However,
regardless of these differences, the common characteristics and challenges
associated with ASD impact the development of critical social communication skills.
The core features of ASD include impairments in social communication, language,
and related cognitive skills and behavioural and emotional regulation and the
presence of restricted, repetitive behaviours. These core features are significantly
influenced by an individual's developmental level of language acquisition (e.g., pre-
symbolic, emerging language, and conversational language) and the level of severity
of the disorder. In addition to these core features, sensory and feeding issues can
also be present. Awareness of individual and cultural differences is necessary to
differentiate differences from disordered behaviours, for example, direct eye contact
with an authority figure may be considered disrespectful due to cultural influences,
and silence may be valued as a sign of respect. When observing signs and
symptoms, an SLP must be sure to account for cultural factors that influence social
communication skills. The following is a list of signs and symptoms common to ASD.
Specific areas of deficit will vary; no one individual will have every sign and
symptom. Some deficits in joint attention include difficulty orienting to people in a
social environment, limited frequency of shared attention, impaired monitoring of
emotional states, restricted range of communicative functions to seek engagement
and comfort from others and limitations in considering another's intention and
perspective. Deficits in social reciprocity include difficulty initiating and responding to
bids for interaction, limitations with maintaining turn-taking in interactions and
problems with providing contingent responses to bids for interaction initiated by
others. Social cognition refers to the mental processes involved in perceiving,
attending to, remembering, thinking about, and making sense of the people in our
social world. Deficits in social and emotional learning include: difficulty managing
emotions, appreciating the perspectives of others, developing prosocial goals, using
interpersonal skills to handle developmentally appropriate tasks, difficulty
differentiating one's own feelings from the feelings of others and difficulty integrating
diverse information to construct meaning in context (i.e., central coherence).

Some other deficits in language and related cognitive skills include impaired
acquisition of words, word combinations, and syntax, initial words are often nouns
and attributes, while words representing social stimuli, such as people's names (i.e.,
subjects) and actions (i.e., verbs), are delayed, the child loses words previously
acquired, use and understanding of nonverbal and verbal communication, this
includes: facial expressions, body language, and gestures as forms of
communication are delayed in the latter part of the first year of life and remain
unconventional throughout development, unconventional gestures (e.g., pulling a
caregiver's hand toward an item) emerge prior to more conventional gestures (e.g.,
giving, pointing, and head nods/headshakes), understanding of gaze shifting, distal
gestures, facial expressions, and rules of proximity and body language is limited,
receptive language appears more delayed than expressive and use of immediate
echolalia and/or delayed echolalia (scripted language) is observed. Vocal
development deficits, including: atypical response to caregiver's vocalizations,
atypical vocal productions beyond the first year of life and abnormal prosody once
speech emerges (speech may sound robotic), symbolic play deficits, include:
delayed acquisition of functional and conventional use of objects, repetitive, inflexible
play and limited cooperative play in interactive situations, conversation deficits,
include: limitations in understanding and applying social norms of conversation (e.g.,
balancing turns, vocal volume, proximity, and conversational timing), provision of
inappropriate and unnecessary information in conversational contexts, problems
taking turns during conversation, difficulty initiating topics of shared interest,
preference for topics of special interest, difficulties in recognizing the need for
clarification, challenges adequately repairing miscommunications and problems
understanding figurative language, including idioms, multiple meanings, and
sarcasm. Literacy deficits, include: difficulty reading for meaning (functional use of
books), understanding narratives and expository text genres that require multiple
perspectives (e.g., persuasive and comparative/contrastive), getting the main idea
and summarizing and providing sufficient information for the reader when writing and
executive functioning deficits, include: lacking/limited flexibility, poor problem solving,
poor planning and organization and lack of inhibition.
Some deficits in behaviour and emotional regulations include: problems dealing with
changes in routine and/or changing from one activity to the next, problems
generalizing learned skills, using objects in unusual ways and uncommon
attachments to objects, difficulty sleeping, crying, becoming angry, or laughing for no
known reason or at inappropriate times, anxiety and/or social withdrawal, using
early-developing strategies for self-regulation (e.g., chewing on clothing, rocking,
hand flapping, vocal play), using unconventional behavioural strategies and
emotional expressions (e.g., aggression, tantrums, bolting from situations),
restricted, repetitive patterns of behaviour, interests, or activities (e.g., immediate
echolalia and scripted language) and problems with self-management. Sensory and
feeding challenges, include: sensory modality difficulties, including over-
responsiveness, under-responsiveness, or mixed responsiveness patterns to
environmental sounds, light, visual clutter, and social stimuli (e.g., social touch,
proximity of others, voices), preference for non-social stimuli leading to intense
interests with sensory aspects of objects and events, patterns of food acceptance or
rejection based on manner of presentation or food texture and consumption of a
smaller variety of foods than the variety consumed by other family members.
In addition to adults diagnosed with ASD as children, some live with undiagnosed or
newly diagnosed ASD. Some of these individuals may seek out various supports and
services (e.g., vocational/career counselling), particularly when they begin to
experience problems in work and/or social settings. For transitioning adolescents
and adults with ASD, social communication is a particularly important skill area to
consider. Communication rules in adolescent social interactions are often subtle and
unspoken, and successful navigation within social settings requires awareness of
these rules. Similar social communication skills are important for young adults with
ASD in workplace interactions with supervisors, co-workers, and the public. Other
areas of importance include executive functioning and problem-solving skills needed
to achieve greater independence in all settings.
Diagnosing autism spectrum disorder (ASD) can be difficult, since there is no
medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s
behaviour and development to make a diagnosis. ASD can sometimes be detected
at 18 months or younger. By age 2, a diagnosis by an experienced professional can
be considered very reliable. However, many children do not receive a final diagnosis
until much older. This delay means that children with an ASD might not get the help
they need. Diagnosing an ASD takes two steps: Developmental Screening and
Comprehensive Diagnostic Evaluation. Developmental screening is a short test to
tell if children are learning basic skills when they should, or if they might have delays.
During developmental screening the doctor might ask the parent some questions or
talk and play with the child during an exam to see how they learn, speak, behave,
and move. A delay in any of these areas could be a sign of a problem. All children
should be screened for developmental delays and disabilities during regular well-
child doctor visits at: 9 months, 18 months and 24 or 30 months. Additional
screening might be needed if a child is at high risk for developmental problems due
to preterm birth, low birth weight or other reasons. In addition, all children should be
screened specifically for ASD during regular well-child doctor visits at: 18 months
and 24 months. Additional screening might be needed if a child is at high risk for
ASD (e.g., having a sister, brother or other family member with an ASD) or if
behaviours sometimes associated with ASD are present.
It is important for doctors to screen all children for developmental delays, but
especially to monitor those who are at a higher risk for developmental problems due
to preterm birth, low birth weight, or having a brother or sister with an ASD. If the
doctor sees any signs of a problem, a comprehensive diagnostic evaluation is
needed. As a parent if your child’s doctor does not routinely check your child with
this type of developmental screening test, then ask that it be done. The second step
of diagnosis is a comprehensive evaluation. This thorough review may include
looking at the child’s behaviour and development and interviewing the parents. It
may also include a hearing and vision screening, genetic testing, neurological
testing, and other medical testing. In some cases, the primary care doctor might
choose to refer the child and family to a specialist for further assessment and
diagnosis. Specialists who can do this type of evaluation include: Developmental
Paediatricians (doctors who have special training in child development and children
with special needs), Child Neurologists (doctors who work on the brain, spine, and
nerves) and Child Psychologists or Psychiatrists (doctors who know about the
human mind).
If a child hasn’t officially been diagnosed with autism spectrum disorder, they may
still benefit from certain treatments. The Individuals with Disabilities Education Act
(IDEA) makes those treatments possible for children under age 3 who may be at risk
for developmental problems. The type of treatment a child receives for autism
spectrum disorder depends on their individual needs. ASD is a spectrum disorder
(meaning some children have mild symptoms and others have severe symptoms)
and each child who has it is unique and there are a variety of treatments. Some of
the treatment can include different kinds of therapies to improve speech and
behaviour, and sometimes medications to help manage any medical conditions
related to autism. The treatments a child can benefit from most depends on their
situation and needs, but the goal is the same: to reduce their symptoms and improve
their learning and development. Applied Behaviour Analysis (ABA) is often used in
schools and clinics to help a child learn positive behaviours and reduce negative
ones. This approach can be used to improve a wide range of skills, and there are
different types for different situations, including: Discrete trial training (DTT), this uses
simple lessons and positive reinforcement, pivotal response training (PRT) helps
develop motivation to learn and communicate, early intensive behavioural intervention
(EIBI) is best for children under age 5 and verbal behaviour intervention (VBI) focuses
on language skills. The developmental, individual differences, relationship- based
approach (DIR) involves getting on the floor with the child to play and do the activities
they like, this kind of treatment is better known as Floor time. This approach supports
emotional and intellectual growth in children by helping them learn skills around
communication and emotions. Other approaches that help with ASD are: Treatment
and Education of Autistic and Related Communication-handicapped Children
(TEACCH). This treatment uses visual cues such as picture cards to help a child learn
everyday skills like getting dressed. Information is broken down into small steps so they
can learn it more easily. The Picture Exchange Communication System (PECS). This
is another visual-based treatment, but it uses symbols instead of picture cards. The
child learns to ask questions and communicate through special symbols. Occupational
Therapy helps a child learn life skills like feeding and dressing themselves, bathing,
and understanding how to relate to other people. The skills they learn are meant to
help them live as independently as they can and Sensory Integration Therapy is
great If a child is easily upset by things like bright lights, certain sounds, or the
feeling of being touched, this therapy can help them learn to deal with that kind of
sensory information. There is no cure for autism spectrum disorder, and there’s
currently no medication to treat it. Some medicines can help with related symptoms
like depressions, seizures, insomnia, and trouble focusing. Risperidone is the only
drug approved by the FDA for children with autism spectrum disorder. It can be
prescribed for children between 5 and 16 years old to help with irritability.
When caring for or working with a child with autism, a parent, teacher, or other adult
may become frustrated with the child’s behaviour. Behaviours can come on
suddenly, last for hours, be hard to control, or make the adult scared or
embarrassed. Characteristics of autism can include trouble using and understanding
language or certain aspects of language such as sarcasm, expressions, and body
language, difficulty taking in sensory input in an ordinary way. For example, a
vacuum cleaner may sound overly loud, a smell may be extra strong, or the feel of
something may be extra itchy, a need for a particular routine so they know what to
expect as they can become frustrated when things don’t go the way they had
expected, trouble recognizing another person’s opinion or understanding another
person’s feelings, difficulty working on or participating in activities with no clear
ending (e.g., an open ended writing activity, a class lecture), difficulty switching from
one activity to another, especially if they have to switch from something enjoyable to
something not enjoyable (I think everyone can relate to that) and difficulty organizing
themselves in productive play when not directed or given specific instructions.
Sometimes these characteristics lead to problem behaviours at home, in the
classroom, or in the community which can be frustrating for the child and the adults
caring for them.

Some behaviour strategies that can help children with autism include: letting children
know what will happen next, for example, “After you finish the puzzle, it is time to
brush your teeth”, or “In five minutes it is time to turn off the computer and start your
writing assignment.” For some children it is helpful to set a timer so the child can
keep track of how much time is left. For children who have trouble understanding
the concept of time or numbers, a visual timer can be helpful because the child can
see how much time is left, set expectations, be consistent and follow through, for
example: if you tell a child that you will play a game with them if they play
quietly while you talk on the phone for five minutes, make sure that you keep your
end of the bargain. You may need to give them a choice of what activity to do during
that time that you are on the phone. If the child can’t tell time, set a timer that the
child can see, get off the phone in exactly 5 minutes and play the game. If you do
this consistently, the child will come to know what is expected and will believe in
what you say. As they improve, the time can be increased. If you don’t implement
expectations with consistency and follow through on your words, the child will not
know what to expect. This can lead to anxiety and challenging behaviour. Children
with autism or other challenging behaviours thrive on predictability. Acknowledge the
child for complying with requests, for instance, if a child is using a loud voice in the
cinema and you say, “whisper in the movies,” praise the child with a comment such
as “nice job whispering”, or “thank you for being respectful in the movie.” It is
important to tell a child specifically what is expected and allow them to earn
privileges for complying with the expectation, for instance, if a child often has a
tantrum in a store when they can’t go to the toy aisle, tell them exactly what you
expect of them before you go to the store and reward them with a privilege for
following that expectation. Let the child know that they can earn a privilege for
following the rules. Privilege ideas include getting a sticker of a favourite character,
playing a favourite game once at home, watching a favourite show, going on the
computer, staying up ten minutes past bedtime. When the child earns the privilege,
praise him with specific language. Make sure the privilege is something the child
wants. You can let the child choose what he would like to work for ahead of time.
Children also benefit from nonverbal praise such as high fives, smiles, thumbs up.
All children, including those with autism, like to feel a sense of control over their
world. Many children benefit from having the choices limited to two to four options,
as they get overwhelmed with too many choices and cannot decide. Examples of
choices are: “Do you want to play a board game or watch TV.’’ For some children
with language difficulties, showing the child the activity that they will be utilizing next
is helpful to encourage them to move from one activity to another, for example, if the
child is on the computer and you want them to come work on a puzzle, show them
the puzzle so they knows what it is you want them to come do. Using a schedule to
let the child know how their day will go. For children who have trouble reading or
understanding language, a visual schedule would be best. A schedule for after
school could include “eating a snack”, “doing homework”, “watching TV”, “playing a
game with the family”, “reading a book”, “taking a bath” and “going to bed.” A visual
schedule at school could include “math”, “reading”, “gym”, “lunch”, “recess”, “art”,
“science”, “packing up”, and “getting on the bus.” It is important to allow the child to
bring a transitional object from one activity to the next, for instance, if the child has to
leave the classroom to go with a new staff member such as a speech therapist, let
them bring a favourite object from the classroom such as a stress ball, this can assist
with helping them feel more comfortable in the unfamiliar surroundings. When
misbehave occurs, a good technique would be to distract and redirect problematic
behaviour instead of saying ‘’stop’’ or ‘’no’’, for example, if the child is running in the
store, remind them or show them how to walk nicely. If necessary, find something
interesting to show them and call their attention to it, rather than focusing on the
problematic behaviour. If they are running in the hall at school, redirect them back to
the line, with a short directive such as, “Come back to your spot in line” or remind
them to “walk in the hallway.” If a child ever seems over stimulated from a sensory
input, such as in a large crowd bring them to a quieter place to de-stress, be mindful
of situations that children with autism may find themselves in. When educating
students, it is important to make directions clear, short and concrete, for example: if
a child is throwing food at the table say, “eat your food” rather than “Be good at the
table,” “Don’t throw your food” or “Would you stop with that! You are always
throwing your food.” For children with difficulty understanding language, showing
them a picture or a visual demonstration of the behaviour, you want to see, can be
helpful. Always Take advantage of teachable moments, for example, If the child
snatches a toy from another child, teach them how to use their words to ask for they
toy (if he has the language capabilities to do so) rather than reprimanding them for
snatching the toy.
When giving tasks, assignments, chores, many children do better if they know when
the task will end. Some examples of activities with a clear ending include puzzles, a
specific number of math problems, a specific number of pages to read, a timed
event, a specified way to complete a chore such as “Put ten toys in the bin.” or
“Spray the window three times and use the paper towel to wipe the spots off,” a
specific number of lines to write on the page for a writing assignment. Additionally,
when the task has a clear visual ending, it eliminates the need for a timer. Some
children thrive when given structured hands-on or visual activities. As an example,
some teachers of children with autism teach academic skills through sorting tasks,
for instance, an activity about learning colours would require the child to put all the
yellow chips in a yellow cup, all the blue chips in a blue cup, etc. Keeping a child
focused with an activity they do well at is a great way to encourage calm behaviour.
However, if the child is feeling overwhelmed or frustrated from the activity, allow a
break or a change in the task. When interacting with a child, it is important to stay
calm. It is important to not take anything out on children, yelling and threatening will
not make the behaviour better. It may stop the behaviour in the short-term, but the
behaviours will occur again. Children with autism are not choosing to act in a way
that is frustrating to you or anyone else, they legitimately need positive support to
help them meet their emotional/behavioural needs.
When individuals have severe speech and language disabilities, augmentative and
alternative communication strategies (AAC) can provide them with an opportunity to
express themselves and have a voice. The inability to communicate has a significant
impact on quality of life, educational access, and development of social skills and
relationships. The frustration of not being able to communicate can lead to
negative behaviour challenges as well. AAC services developed from the most basic
desire to help individuals who were unable to speak or express themselves. In the
earliest form, eye gaze, letter, and picture displays were included as AAC. In order to
utilize these early forms, face-to-face interaction was required, and the interaction
was usually slow. Personal computers (PC) and standard operating systems became
another option for AAC and opened up a new world for developers. Not only could
consumers use the technology for face-to-face interactions, but they could also use
the technology to write, create and give presentations, and more readily participate
in their home, school, work, and community environments. The PC devices were
more portable and a little less expensive than the previous dedicated AAC devices.
Then along came mobile, multiple use technologies that offered opportunities to the
AAC consumer and/or learner that extended far beyond the capacity of current AAC
devices and at significantly lower costs. Digital computer technology has become a
feature of everyday life and is an increasingly popular means of communication in
today’s society. Mobile technology has dramatically changed how service providers
deliver educational and behavioural services to individuals with ASD. From touch
screen phones to tablet devices, mobile computing devices have never been more
user friendly, cheaper, or universally available. Research findings indicate that as the
development of new communication technology progresses at an increasing rate
each year, children’s competency and awareness of such technology also inevitably
increases, often times overtaking that of their parents’ competence. Children’s
increasing use of technology has implication for both educational and
communicational practices, because it is now part of an environment factor in their
lives. Many individuals on the spectrum are more comfortable interacting with
inanimate objects such as a computer or iPad. In addition, many individuals are
visual learners and have strong technological skills.

Like all technologies and techniques, certain things work for certain people. Not all
individuals with ASD need the iPad for a communication system, but they could have
used the technology to increase another skill. We now know that mobile technology
can be used effectively for not only entertainment and as an AAC device, but to also
assist in teaching academic areas, social skills, video modelling, reinforcement, ABA,
speech/language therapy, fine motor skills, visual supports , functional life skills,
organizational skills, and increasing independence. People with ASD have a need
for, and a right to, the same range of communication options available to everyone
else. Today, most people use multiple devices to address their communication
needs. Some needs may be met by the mainstream device, while others may require
accessories and techniques specifically designed for them (e.g., eye gaze, scanning,
adapted keyboards. A growing concern for all individuals with ASD is employment
and having skills to live independently. Employment is a critical component for
having a productive adult life. Individuals living with autism deserve the opportunity
to contribute as productive workers in appropriate employment settings; paying taxes
and improving their quality of life. Barriers to successful employment for individuals
with autism can be poor communication skills; lack of social “soft skills” such as
small-talk, office politics, and unspoken requirements; the ability to complete the job
independently without a job coach; or sensory issues within the work environment.
The use of mobile technology can address some of these barriers. Using devices like
tablets and other hand-held devices are useful tools, because they are flexible and
portable unlike other dedicated AAC devices that often can be heavy and
cumbersome. A hand-held device is easily carried and can promote peer
acceptance. The touch screen and layout are more accessible for individuals with
coordination or learning difficulties—sliding and tapping are easier than typing.
Technology can improve communication with others by the timely use of email or
texting, which has a cost and time savings. Technology allows for adaptability and
motivation. Many people with ASD are visual thinkers. Technology just makes visual
images more accessible to the individual with ASD. Computer graphics capture and
maintain their attention. Some individuals may have auditory sensitivity and are
better able to respond to lower sounds. Using computers, we can easily download
appropriate voice levels and adjust sound according to the individual’s needs. An
individual with ASD may use an app like Noise Down, which will automatically sound
an alarm when the decibel level gets too high. Some individuals with autism are
unable to sequence. Technology can reduce the number of steps required for the
completion of a task. An example of an app for sequencing tasks is called:
Sequencing Tasks: Life Skills. Sequencing options are lists of printed words, words
and pictures, just pictures and voice/no voice. Often individuals with ASD have
difficulty with fine motor skills making handwriting difficult. Technology helps reduce
the frustration with handwriting or drawing. Using a keyboard, touch screen, or
speech-to-text app can reduce the difficulty and frustration, increasing the
individual’s enjoyment for learning.

Some individuals do not use speech for communication. In times of high stress, they
may need additional augmentation to produce verbal thoughts and words. They can
use technology as a voice output device to speak for them and help them express
themselves more fluently. Nonverbal children with autism find it easier to associate
words with pictures if they see the printed words and a picture together. There are
numerous AAC apps, from low- to high-tech, that can be used by individuals living
with autism. It is thought that some individuals with autism cannot look and listen at
the same time. Their immature sensory system cannot process simultaneous visual
and auditory input. Using technology, they can gradually increase their ability to use
both, or alternate between visual and auditory input. Some children with autism will
learn to read phonetically, and others will learn visually with whole words. Voice
output helps with the auditory reinforcement, and computer graphics can help the
students visualize the words and, therefore, increase their reading skills. Many
individuals with autism have difficulty with executive functioning and struggle with
organizational and self-management skills. Today, there are over one million apps
available, and the number continues to grow daily. Like all strategies used for the
treatment of ASD, the selection of the technology and/or the apps must be
personalized to meet the individual needs of the learner. Assessment and data are
necessary before deciding about any technology used.