Communication is an essential component of human existence and interaction. Human beings are naturally social beings, which establishes the need for languages, speech, and communication for human existence. The existence and constant improvement in communication technology and media is evidence of the value of speech, language, and communication. However, some barriers often limit an individual’s communication capabilities. Developmental challenges such as autism spectrum disorders (ASD) limit a child’s basic communication, which often adversely affects growth and development and their overall quality of life. In most cases, the developmental challenges affect the pragmatic level of language, which underpins human communication abilities, thus, limited interaction with their environment.
Communication-related developmental challenges often call for interventions to address the enhance the victims’ communication abilities. A common, effective intervention is the use of Speech-Language Therapy (SLT). Understanding the dynamics of the SLT as an intervention for the assessment and management of pre-school children with ASD is crucial to unraveling its full potential in addressing communication ability limitations resulting from developmental challenges. The critical evaluation of the potential of the approach involves an in-depth analysis of the communication challenges of autistic pre-school children and alternative assessment and management approaches. It is also necessary to consider the different aspects and approaches of SLT implementation in pre-school children, and how it fits into the modern learning and child development environment. SLT has great potential in the assessment and management of ASD from a communication-capabilities point of view.
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ASD and SLT in Pre-School Education
Most education systems identify children with autism as special students. As a result, they often have access to special programs that enable them to learn and develop. However, there is no universal law on an ASD-appropriate learning environment. Different institutions take different approaches that often have varying effects on the victim’s learning and growth (Tachibana et al., 2017). Pre-school education is often an important stage of child growth and development. It is the stage where most children learn how to use language effectively as well as social interaction. As a result, it is essential to address the special needs of autistic children at the pre-school stage to enhance the proper development of communication capabilities through early interventions.
Developmental Challenges in Autistic Pre-School Children
Autistic children face similar challenges to most special children at the pre-school level. However, some unique challenges often require unique interventions. One important characteristic of ASD is the complex relationship between the condition and heterogenous development disorders. One common developmental challenge is intellectual function. According to Carlsson et al. (2013), autistic children often have a low IQ, which constitutes an intellectual disability. From a language and communication point of view, the challenge limits the victims’ ability to learn new communication techniques and languages.
A common developmental challenge is Language. A recent study showed that 78% of autistic children have a problem in receptive and expressive language (Carlsson et al., 2013). The results suggest that autistic children have a challenge expressing themselves as well as understanding what other people are telling them. Another developmental challenge is intellectual function. Autistic children often have a low IQ, which constitutes an intellectual disability (Carlsson et al., 2013). From a language and communication point of view, the challenge limits the victims’ ability to learn new communication techniques and languages. Motor function, activity regulation, and vision and hearing problems also contribute a great deal to developmental challenges facing autistic children. It is important to establish interventions to address speech and language challenges for E-210706230642 autistic pre-school children to enhance growth and development.
Factors Affecting Assessment and Management of Pre-School Children with ASD
Most current interventions for ASD students are designed to address the major developmental challenges. Several factors guide the development and implementation of such interventions. However, it is important to note that the interventions are often suitable in particular situations considering the heterogeneous nature of the condition (Randall et al., 2018). Regardless, the factors are essential in the choice of approach and its design and implementation.
One important factor is the severity of the disorder. ASD has a varying effect on different individuals. As a result, it is important to set different learning objectives for different patients (Rosenbaum et al., 2016). For instance, a patient might have good motor skills but poor language and behavioral management skills. The intervention should address the specific challenge to ensure maximum efficiency. The developmental level of the child is also a suitable factor (Rosenbaum et al., 2016). A good approach should be adapted to the victim’s speech and language skills, physical development, social and emotional status regardless of their age. Resource availability is also a significant factor for the choice of assessment and management approaches for pre-school children with ASD. Finally, the individual’s environment is also significant to the choice of approach (Rosenbaum et al., 2016). For instance, an effective school-based program varies in design from a home-schooling-based approach. Overall, considering the different factors enables experts to make informed decisions on the most promising assessment and management approach.
Policies for Assessment and Management of ASD in Pre-School Children
ASD patients and students often have access to special programs in schools and other learning and social institutions. Different government and institution policies often guide the design and implementation of assessment and management programs for ASD victims. In the United States, the Individuals with Disabilities Education Act (IDEA) is crucial. It requires that all ASD patients in the US have access to the least restrictive environment in all public schools. Speech and language services are, therefore, part of the US public education system.
Another crucial policy Affecting pre-school children with ASD is the Medicaid Early and Periodic Screening, Diagnosis, and Treatment Program. The policy requires that all ASD patients under 21 have access to diagnostic, screening, preventive, and specialty services (Rosenbaum et al., 2016). It is, therefore, a legal right of all pre-school students covered by MEDICAID to have access to speech and language services that include identification of the disorder, diagnosis and appraisal, referral for professional services, relevant speech, and language services, and relevant counseling.
Finally, The American Speech-Language-Hearing Association (ASHA) maintains practice guidelines for speech and language therapy that stands as long as necessary to accomplish the objectives of the interventions or until the patient can no longer benefit from the intervention. The practice guidelines state that:
Children receive intervention and/or consultation services when their ability to communicate effectively is impaired because of a communication disorder and when there is a reasonable expectation of benefit in body structure/function and/or activity/participation. Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited (ASHA, 2004).
While the guidelines largely support the delivery of speech and language services for children with ASD, they also result in some program design challenges. For instance, it is difficult to determine the relevant duration of implementation as per the ASHA guidelines. Also, most of the guidelines do not specify the specific services and interventions for different victims, which often results in conflicting opinions in the education and healthcare departments.
Pre-School Interventions for Assessment and Management of ASD
Pre-school is an important period from a child's development point of view. During the period. Children are more exposed to the outside world and interact with new people from varying backgrounds and in different settings. For children with developmental challenges such as ASD, the period marks the beginning of a new phase as the various services move outside the home. Usually, victims have a hard time adjusting to the changes. As per existing guidelines, caregiver and learning institutions strive to establish a suitable learning environment for the victims, often taking varying approaches. The approaches often have varying outcomes for different victims. However, each approach often has its advantages and limitations in addressing language and communication challenges in pre-school children with ASD.
Didactic Approach
A common intervention to address early communication challenges for ASD patients is taking a didactic approach. The approach is based on the behaviorist theory. The approach involves the use of behavioral technologies to achieve the intended objectives. An excellent example is Discrete Trial Instruction (Booth & Keenan, 2018). The didactic approach largely depends on behavioral reinforcement to achieve the intended communication goals in pre-school children with ASD. Numerous studies suggest that the approach is effective in addressing expressive language. However, there are several challenges associated with the approach. For instance, it largely relies on instruction, which suggests that the victim develops a passive form of communication, where they only respond to questions or communication prompts. Such children, however, find it hard to initiate conversations and express themselves. The approach is, therefore, only effective in an educational setting, but does not empower the ASD victim to communicate effectively in a social setting.
Naturalistic Approach
The naturalistic approach attempts to address the generalization challenges of the didactic approach. While the two are similar, the naturalistic approach relies on intrinsic reinforcement. As a result, the approach is more effective in both initiating speech and increasing the complexity of language use and effectiveness of communication. Possible interventions under the approach include prompt-free training, mand modeling, and milieu teaching, the Denver model, and Pivotal response training (Bacon et al., 2019). A challenge of the approach is limited material for training to master the approach. Also, some of the interventions based on the naturalistic approach are difficult to implement universally. Despite its success in addressing the generalization challenge of the didactic approach, it remains ineffective to address the communication and language challenges for autistic pre-school children.
Augmented and Alternative Communication ( AAC )
The approach involves introducing alternative communication methods. It involves the use of non-vocal communication and is based on the idea that all children should communicate, whether or not they are vocal. Some common implementations of the approach are sign language, picture exchange communication, and aided AAC (Ganz, 2015). The approach is not effective in assessing the language capabilities of ASD patients since it negates the use of natural language. However, it is effective in providing a means of communication to the victims. One of the largest challenges of the approach is that it limits the social interaction of the individual in the long run. Not all people understand AAC. As a result, AAC-dependent preschoolers are confined to communicate with only those who understand them, usually their primary caregivers, teachers, and some classmates.
SLT implementation for Assessment and Management of Autistic Pre-school Children
Speech and Language Therapy is a valid and effective approach in the assessment and management of autistic pre-school children. Autistic children are challenged in terms of developing communication skills and cognitive ability, thus the need for speech and language therapy. According to Vitásková and Kytnarová (2017), SLT is often a part of special education and inclusion interventions to support children with special education needs. The approach is suitable for the case since it addresses both communication and interaction challenges that are common in autistic children (Monz et al., 2019). Also, the pre-school period is a period of transition and SLT enables students to accommodate the changes in their interactions outside the home in school and other social settings. However, the heterogeneous nature of the conditions is an extra challenge for SLT implementation. Regardless, it is an effective approach in identifying and addressing communication challenges in autistic children.
SLT for ASD Identification
Autistic individuals often have a deficit in pragmatic language. The victims often express non-verbal communication abnormalities and other symptoms of communication disability. In most cases, experts can identify ASD through simulation of the pragmatic levels of language. However, it is necessary to assess various components of the pragmatic level to establish an accurate and conclusive diagnosis of ASD in children. The identification process requires targeted diagnostics in the areas that have a direct effect on the pragmatic level (Vitásková & Kytnarová, 2017). It is also important to identify the material that influences the specific areas to improve communication for ASD patients in different environments.
SLT is suitable for ASD identification in pre-school children since it considers the mutual interaction between an individual’s cognitive abilities and their sensorimotor integration. Speech-Language therapists identify an autistic child by considering variations in their pragmatic-oriented communication behavior identified through learning through imitation exercises. However, it is important to understand that impaired communication pragmatics are not specific to individuals with ASD (Vitásková & Kytnarová, 2017). As a result, it is important to consider other factors before making a conclusive diagnosis.
Identification through SLT occurs through observation and testing. Observation refers to a situation where an expert watches the individuals as they engage in different activities. For instance, the expert might observe children playing a game and identify any unusual verbal and non-verbal communication behavior. Observation needs to occur in a natural setting without any instructions to enhance accurate results (Vitásková & Kytnarová, 2017). While observation is not sufficient to identify communication pragmatic challenges, it forms the basis for testing, which leads to more accurate results.
Testing involves conducting a deeper assessment of potentially problematic areas. One of the test areas is problem behavior, which considers how an individual responds to different social situations. Another important test is eye contact. Challenges in the initiation of eye contact and dyscoordination between gestures and eye contact possibly suggest an individual is autistic. Testing sensory integration is also suitable in identifying ASD through speech therapy. Other critical tests include facial expressions, and motor imitation (Vitásková & Kytnarová, 2017). Proper implementation of observation and testing in SLT can help identify ASD in pre-school children.
SLT for ASD Management
ASD limits an individual’s social and learning capabilities. The majority of the limitation is as a result of challenges in communication and cognitive disability. Upon identification, SLT enables educators, parents, and experts to design interventions to help the victims develop better communication capabilities by addressing the limitations at the pragmatic level of language (Vitásková & Kytnarová, 2017). The implementation of SLT allows access to quantitative indicators as well as detailed qualitative descriptions which enables caregivers to establish a better learning and development environment to address the needs of the child. Research suggests that SLT is most effective at an early age. The approach is, therefore suitable for pre-school children with ASD
A common implementation of SLT treatment techniques in children with ASD is articulation therapy. The exercises address the speech challenges in children who cannot say words correctly and enhances an individual’s communication abilities. Fluency therapy is also a suitable intervention and involves addressing challenges associated with the flow of speech. The approach also helps in managing language disorders. For instance, receptive treatment helps an individual learn how to process language. The approach also uses AAC and other interventions to address expressive communication disorders and cognitive-communication disorders. Overall SLT helps address both language and speech disorders in autistic pre-school children.
Conclusion
SLT is an effective approach in the identification and management of a 3 1/2 -year-old child in pre-school. The approach focuses on the pragmatic level of language which enables experts to assess a child’s performance in social interaction as well as their motor skills. Also, the approach guides the design of targeted interventions to help the victim develop better speech and language, a common challenge for many autistic pre-school children. The approach also establishes an opportunity for improvement in other areas such as cognitive development and motor skills. Existing literature, however, points towards the need for further research on communication pragmatics and the roles of SLT for better identification and management of pre-school children with ASD.
References
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