Critical Components of
for Children with ASD
Rachel Hopf, M.A., CCC-SLP, Graduate Assistant
Typically, parents of children with ASD first become concerned about their child’s development when (a) speech onset is delayed or (b) when their child stops articulating words they previously learned to produce (Johnson, 2007; Lord, Shulman, & DiLavore, 2004); however, the core signs of ASD occur in the prelinguistic stage, before the onset of speech or language would be expected (Alpern, 2012). By six months of age, some children with autism are noticeably vocalizing with less intent and looking at people’s faces less often than their typically developing peers. By 12 months, children with ASD are distinguished from peers by reductions in a variety of nonverbal communication skills, such as eye gaze, social affect (e.g., facial expressions/feelings), and gestures (Maestro et al., 2001/2005; Zwaigenbaum, Bryson, & Garon, 2013). These developmental differences ultimately influence components of early intervention for young children with ASD.
The social differences reflect a decreased ability to orient to people in the environment and a lack of social attention among young children with ASD. These children also demonstrate difficulty using symbols to represent ideas at the nonverbal level initially (e.g., reduced use of gesture, such as pointing) and later at both nonverbal and verbal levels (e.g., pretend play). Additionally, joint attention, or the ability to shift social attention between people and objects, is another critical prelinguistic deficit in ASD (Alpern, 2012).
Joint attention is a preverbal skill, emerging in typically developing children between 9-12 months (Carpenter, Nagell,& Tomasello, 1998). While it precedes language and speech in development, it also appears to aid and predict the later acquisition of skills in children with ASD (Paul et al., 2007; Paul et al., 2013). There are two types of joint attention, (1) responding to joint attention (the communication partner initiates shared intent and the child responds with positive affect) and (2) initiating joint attention (the child initiates shared intent using positive affect and the communication partner responds). Examples of joint attention can be found at: https://www.youtube.com/watch?v=1Ab4vLMMAbY&t=37s.
Joint attention is regarded as a building block for language development. Children need to be able to shift social attention between people and objects to learn names for people, places, things, actions, and events. Impairments in joint attention have been linked to later issues with not only language, but also cognition, self-regulation, and social skills (Mundy et al., 2007; Striano et al., 2006). These associations are critical to the development and determination of early intervention practices for young children with ASD.
When reviewing early intervention practice recommendations, Schertz, Baker, Hurwitz, and Brinner (2011) identified four main principles of early intervention:
|1. Family-centered||Considers family culture and needs throughout the intervention process and includes parents as part of the intervention process|
|2. Naturalistic||Occurs in natural, everyday settings|
|3. Child-directed||Follows the child's lead and his/her intrinsic motivation|
|4. Systematic and functional||Follows a developmental or behavioral trajectory|
From Shertz et al. (2011)
These findings suggest that (a) parents should be involved in intervention, (b) intervention should occur in the child’s natural environments when possible, such as the home or community settings, (c) intervention should be tailored to the child’s motivation and interests and (d) intervention should have an incremental approach by targeting objectives immediately beyond the child’s current abilities.
Keeping these recommendations in mind, concerns about speech development should not completely overshadow lagging or absent prelinguistic skills, such as joint attention. Implementing a systematic, developmental, and functional intervention suggests that prelinguistic skills, which naturally precede speech onset in typically developing children, should take high priority in early intervention for children with ASD. In fact, even in a comparison of spoken language interventions for minimally verbal toddlers with autism, Paul, Campbell, Gilbert, & Tsiouri (2013) found that children demonstrating greater frequency of joint attention benefitted the most from treatment. This reinforces the idea that joint attention skills are foundational for later linguistic and verbal success.
Practitioners and caregivers should keep in mind that just as communication may be defined differently than speech, speech may also be defined differently than language. In some cases, a child may have a pure motoric or apraxic speech impairment disrupting his or her ability to effectively produce speech. However, in these cases, alternate methods of communication can be used to aid spoken language development, such as writing, typing, picture symbols, or sign-language, etc. Even in these cases, the core social communication deficit in ASD should not be forgotten. In ASD, delayed joint attention and difficulty with symbolic communication is expected. Therefore, these skills should be targeted early and intensely due to their domino effect on receptive and expressive language and social skills and their potential to moderate spoken language outcomes.
Speech, language, and social communication can be defined separately but inevitably interact with one another. Knowledge of these processes and their specific course in ASD will guide therapists in designing better goals and objectives, and ultimately advance outcomes for young children on the spectrum.
| Social Communication
| Difficulty using presymbolic and symbolic language to express thoughts, ideas, or feelings with another person in socially acceptable or developmentally appropriate formats
Impaired social cognition, social interaction, and social pragmatics
| - Difficulty turn-taking during a conversation or a game|
- Inability to properly interpret body language, emotion, or tone of voice
|Speech Impairment||Inability to plan or produce fluent, intelligible, or precise speech|| - Articulation errors
- Motor speech disorder
- Apraxia of speech
|Language Impairment|| Difficulty comprehending or producing spoken or written language
May have errors in morphology, syntax, grammar, semantics, pragmatics*, or a combination
| - Using incorrect tense markers (He tooked him) or plurals (Two cat)|
- Misinterpreting idioms, sarcasm, or humor
- Misunderstanding directions
*Some overlap exists between social-communication/language impairments, specifically in regards to pragmatic language.
For examples of early intervention programs/approaches aligning with the four principles of early intervention described by Schertz et al. (2011), seek information on: The Early Start Denver Model (ESDM), the Early Social Interaction Project (ESI), and Joint Attention Mediated Learning (JAML) or see the review by Shertz et al. (2011).
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Mundy, P., Block, J., Vaughan Van Hecke, A., Delgado, C., Parlade, M., & Pomeras, Y. (2007). Individual differences in the development of joint attention in infancy. Child Development, 78, 938–954.
Paul, R., Campbell, D., Gilbert, K., & Tsiouri, I. (2013). Comparing spoken language treatments for minimally verbal preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(2), 418-431. doi:10.1007/s10803-012-1583-z
Paul, R., Chawarska, K., Fowler, C., Cicchetti, D., & Volkmar, F. (2007). “Listen my children and you shall hear”: Auditory preferences in toddlers with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 50(5), 1350-1364.
Schertz, H., Baker, C., Hurwitz, S., & Benner, L. (2011). Principles of early intervention reflected in toddler research in autism spectrum disorders. Topics in Early Childhood Special Education 31(1): 4-21.
Striano, T., Chen, X., Cleveland, A., & Bradshaw, S. (2006). Joint attention social cues influence infant learning. European Journal of Developmental Psychology, 3, pp. 289–299.
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Hopf, R. (2017). Critical components of early intervention for children with ASD. The Reporter, 22(03). Retrieved from https://www.iidc.indiana.edu/pages/critical-components-of-early-intervention-for-children-with-asd.