Autism PT 2

Neurodivergence

Differences in brain structure and function; includes variations in memory and visual recognition, differences in cerebellum and medial temporal lobe, reduced frontal and temporal lobe blood flow, smaller corpus callosum with less interhemispheric connectivity, and altered default mode network connectivity.

Services for ASD

Shift from medical model to social model of support; focus on engagement, improving mood, social behaviour, and adaptation; may include antipsychotic medication.

Initial Stages of ASD Intervention

Teach learning readiness (listening, following directions); use discrete trial training (step-by-step teaching) and incidental training (natural opportunities to reinforce behaviour); identify aggressive behaviour functions and teach positive alternatives (AIM HI).

Operant Speech Training

Step-by-step process increasing vocalizations and imitation of sounds, words, and meanings; teaches labeling, requests, and expressing desires.

Features of Effective Early Intervention

Early, intensive (25+ hrs/week, 12 months/year), low student-teacher ratio, high structure, family inclusion, peer interaction, generalization to new settings, and ongoing assessment.

• 3-4 year olds or younger

Medications for ASD

Antipsychotics, antidepressants, and stimulants may reduce irritability, aggression, and self-injury.

Board Certified Behaviour Analyst (BCBA)

Professionals with master’s degrees who assess and modify behaviour; create intervention plans, train caregivers, and work with individuals with disabilities including ASD, addictions, and academic issues.

Behaviour Analyst Assessment Focus

Identify skill deficits and behavioural excesses (problem behaviours).

Function Over Form

Focus on why someone communicates (function) rather than grammatical correctness (form).

Teaching Language

Language is analyzed and taught through reinforcement, prompting, and shaping techniques.

Speech-Language Pathologist (SLP)

Licensed professional who assesses and treats communication and swallowing disorders; works across lifespan; provides therapy for speech delays, aphasia, apraxia, dysphagia; collaborates with families and professionals.

SLP Areas of Focus

Speech clarity, stuttering, social language, cognition, reading/writing, and swallowing.

Autism in Ontario 2025

Ontario Autism Program funded at $600M (down from $723M in 2024); over 50,000 children on waitlists with only 28% receiving services; average wait 5–7 years; private pay $35K–$60K annually; 25–50% minimally vocal.

Case Study – Mr. G

3-year-old autistic boy with inconsistent communication using a speech device; device use reduced self-harm and aggression.

Autism Team Members

SLP, BCBA, pediatrician, family, occupational therapist, psychologist, and teacher.

SLP Role in Autism

Supports speech and social communication using developmental lens; targets vocabulary, grammar, and language; consults and coaches parents and teachers.

BCBA Role in Autism

Uses data-driven decisions and learning theory; conducts mand training; reduces behaviours interfering with communication.

SLP and BCBA Collaboration

Develop individualized therapy plans, promote functional communication, and use reinforcement strategies.

Collaboration with Psychologist

Psychologist assesses learning, communication, play, and attention; works with SLP and BCBA; provides detailed written report.

Assessment Process – Behaviour Analyst

Uses criterion/curriculum-referenced measures, observational data, and parent interviews.

Assessment Process – Speech Pathologist

Uses standardized language tests, observational data, and parent interviews.

For Mr. G

BCBA designs learning and language programs and analyzes errors; SLP assesses communication and sets language goals.

Social-Communication and Autism

Intervention targets communication and social interaction; must teach that people and learning are rewarding since social stimuli may not be naturally motivating.

Multimodal Communication Approach

Incorporates gestures, sign language, pictures, and speech-generating devices (SGD).

AAC Research

Best-supported system is the Picture Exchange Communication System (PECS), which teaches requesting objects and activities; overall AAC research remains limited.

Evidence-Based ABA Approaches

Includes Early Intensive Behavioural Intervention (25–40 hrs/week before age 6), Naturalistic Developmental Behavioural Interventions (ESDM, PRT, JASPER; 15–25 hrs/week; parent-delivered sessions), and Parent-Mediated Interventions (1–2 hrs/week coaching with measurable gains in social communication and language).

Evidence-Based Autism Speech Therapy

SLT and OT integrated with ABA; multidisciplinary, individualized, and data-driven care; focus on functional outcomes rather than therapy hours; medication for co-occurring symptoms (irritability, ADHD, anxiety); emphasizes autonomy and participation.

Neuro-Affirming Care

Clinical view: developmental consequences may limit life opportunities; neurodiversity view: autism is a natural variation in human experience; consensus: unique autistic traits shouldn’t be treated only as deficits.

Optimizing Communication

Reduce response effort; accept gestures or alternative communication; attend to communicative cues like eye contact or vocalizations.

Communication Temptations

Use motivating operations (pauses, playful obstruction) to encourage communication; process: temptation → model → prompt → reinforce.

Identifying Behaviour Patterns

Analyze environmental and psychosocial factors; four main behaviour functions: sensory, escape, attention, tangible.

Functional Communication Training (FCT)

Teaches functional communication to replace interfering behaviours (e.g., self-injury, aggression); examines antecedents, behaviours, and consequences.

Beyond Early Years – Autism Intervention

Collaborate with psychologist; focus on symbolic play, games, reading comprehension, full sentences, self-help, and leisure skills.

Teens and Young Adults with ASD

Address emotional intelligence, social communication, sexuality, health, work-life balance, speech/language, and executive functioning.

Theory of Mind in Autistic, Deaf, and Hearing Children

Autistic and deaf children show delays in understanding others’ mental states despite normal non-mental reasoning; deaf children’s delay linked to limited language about thoughts; autistic children’s due to core ToM deficits; language and social experiences crucial to ToM development.

Two best instruments for assessing autism spectrum disorder

1. Autism Diagnostic Observational Scale (ADOS)

2. Autism Diagnostic Interview-Revised Edition (ADI-R)