Articles 6 & 7: The Importance of Early Identification/Intervention and AAC for ASD

Kern Koegel, L., Koegel, R.L., Ashbaugh, K., & Bradshaw, J. (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. International Journal of Speech-Language Pathology, 16(1): 50-56.

I am putting two articles in this post because I believe they are both clinically useful for talking to parents, teachers, and school districts with children with or at-risk for ASD. The first article, Kern Koegel et al. (2014), delineates several reasons why early identification and intervention by a speech-language pathologist or team of therapists for children at-risk for ASD is so important. This article can also be used as an update on information that still lingers--especially the idea that ASD can't be diagnosed till age 3. Researchers have found this is simply not true. Earlier diagnosis can lead to better outcomes for families and children. Furthermore, if you need another reason to support earlier diagnosis, the article also outlines fiscal savings as the child gets older for school districts and regional centers.

Among the many reasons, here are some that the article points out that I found especially compelling and that could be used in when discussing family-based early intervention services for those ASD rather than choosing a "wait-and-see" approach:

Studies have documented high reliability of diagnosis at 18 months if the examiner is highly trained (Chawarska, Klin, Paul, & Volkmar, 2007) Only ~10% of children diagnosed with autism will remain non-verbal throughout their lives with intervention—compared to ~50% in the 1980s (Koegel, 2000) ASD is not necessarily a lifelong disabling condition if identification and intervention come early (Koegel & Koegel, 2012; Koegel, Koegel, Shoshan, & McNerney, 1999) Non-verbal kids who begin intervention in the early preschool years are far more likely to become verbal than children who begin intervention over the age of 5 years (Koegel, 2000) The “wait-and-see” method is likely to have significant negative consequences on children with ASD (National Research Council, 2001) such as anxiety and depression in adolescence and beyond Early intervention leads to long-term fiscal savings that can be costly at school age due to more intense behaviors and issues, if left untreated (Chasson, Harris, & Neely, 2007; Jacobson & Mulick, 2000; Jacobson, Mulick, & Green, 1998). Include parents to reduce stress, depression, and anxiety in caregivers and provide them with self-confidence and empowerment (Durand, Hienesman, Clarke, & Zona, 2009; Koegel, Bimbela, & Schreibman, 1996) to ultimately benefit children  Promising interventions have been found beginning in the first year of life (Koegel, et al., 2013)    A noted drawback of this study is that some of the studies referenced were written by the authors of this article as well. Schlosser, R.W., & Wendt, O. (2008). Effects of Augmentative and Alternative communication intervention in speech production in children with Autism: A systematic review. American Journal of Speech-Language Pathology, 17, 212-230.     I paired the above article with this article because it also supports early intervention for children with ASD, but specifically for children that may require AAC devices. This article is incredibly useful when speaking to parents when you're suggesting an AAC device. There are many myths out there that have been debunked over the past few years, but that still make parents wary of alternative devices (ASHA has produced a nice page on this as well that can be found here: Key Issues: Myths and Realities of AAC) Some specific takeaways from this article: None of the studies reported a decline in speech production due to AAC (only gains or no change) All children studied showed some gain in speech production; Most gains were modest 1 study reported fairly effective gains for SGD (speech-generating devices) (Parsons & LaSorte, 1993) 3 studies reported highly effective gains for PECS and/or manual signing (Tincani, 2004; Tincani, Crozier, & Alazetta, 2006) 2 studies reported that children with 0% vocal imitation skills at onset of intervention showed no increase in speech or remained the same (Olive et al, 2007, Schlosser, Sigafoos, et al. (2007)). Schwartz & Nye (2006) reported that speech alone, simultaneous communication, and alternating between speech and sign were more effective than speech alone.  Yoder & Stone (2006) reported that PECS was more effective for children with high object exploration interests and Milieu Teaching was better for children with relatively low object exploration interest