By Courtney Harrison, Cat Carpinelli, & Caroline Eckels
The treatment of any communication disorder is a dynamic process that requires levels of assessment paired with clinical expertise, evidence based research, and patient preferences.
Human beings are, by nature, unique which means that each individual with a communication disorder will require specific, individualized treatment. Speech-language pathologists (SLPs) work under a broad scope of practice, and are licensed to treat a variety of communication disorders. An Evidence-Based Practice (EBP) approach is necessary in order to uphold both ethical and effective treatment techniques for those whose needs SLPs and other health professionals serve. Autism Spectrum Disorder (ASD) is perhaps the most dynamic disorder with which those in the health professions field may be presented, as it is a spectrum disorder that may present with any number of classifying characteristics, including: impaired social skills, difficulty with speech or other forms of communication, and repetitive behaviors (Autism Speaks, 2017). Dr. Stephen Shore, an Adelphi University professor who has autism himself, once said, “if you’ve met one person with autism, you’ve met one person with autism” (What is Autism, 2017). This is a popular quote in the ASD community because in one sentence it highlights the importance of understanding that ASD is not a fixed disorder, and to classify or predict the needs of someone based solely on their diagnosis would be unfair, unethical, and ineffective. Individuals with ASD often struggle with social communication, can exhibit language problems, and may have restricted and repetitive patterns of behavior or interests (ASHA, 2017).
Understanding the varying differences among each individual with ASD is why it is important to understand the need for variability in treatment approaches. The treatment of ASD is an inter-professional task that cannot be limited to one field. Those with ASD require, and are entitled to, a dynamic set of services that meet the needs of their dynamic diagnosis. Applied Behavioral Analysis (ABA) is a popular treatment technique that is used in the treatment of ASD. Legislation has been proposed in some states that would limit individuals with ASD to receive only ABA, as it would not fund any other type of therapy (Key Issues, 2017). While ABA can be an appropriate approach, it is not the only appropriate approach. It is the responsibility of those in the interprofessional fields that treat ASD to ensure future legislation will not limit the services provided to these individuals, and that interprofessional encroachment does not occur. Ethically, it is imperative that those with ASD receive services from individuals who are trained to administer these therapy techniques. An ABA therapist does not have the same scope of practice as a speech-language pathologist, and visa versa. These individuals require many other types of therapy to help them successfully communicate and be an active member of society. Funding should cover all treatments that the individual shows a specific need for. ABA is not a coverall treatment for this highly variable disorder.
For a deeper understanding of this specific treatment, the American Speech-Language-Hearing Association (ASHA) defines ABA as the intervention and evaluation drawn from the discipline of behavior analysis that allows one to understand the reasons that certain behaviors may occur (ASHA, 2017). ABA uses many techniques that target the increase of useful, positive, and meaningful behavior and the decrease of negative behavior that may cause harm or impede learning (Applied Behavior Analysis, 2012). ABA techniques encourage basic skills such as conversing and understanding another’s perspective, listening and imitating, looking to gain attention, and reading and writing skills (Applied Behavior Analysis, 2012). Individuals with ASD may lack such skills, which is why ABA treatment is recognized as a beneficial treatment for those on the spectrum. Much of the instructions in ABA are highly geared toward speech and language acquisition which is where a speech language pathologist is most beneficial to have as a part of an interdisciplinary team.
It is both impossible and unnecessary to deny that ABA is a beneficial therapy approach for children with ASD. That being said, just as no two children with ASD are alike, no two therapy approaches should be identical, but rather should be individualized to fit the specific needs of each child. Therefore, ABA alone is typically not sufficient for treating children with ASD. A multidisciplinary approach is usually pertinent, and may include components of ABA coupled with other therapy options (ASHA, 2017). While there are a variety of different treatments for ASD available, perhaps the most significant is therapy provided by a speech-language pathologist (SLP). SLPs are trained and certified to address a variety of communicative needs for children with ASD including, but not limited to, social and pragmatic use of language, writing, literacy, executive functioning, and play. Additionally, SLPs can use Augmentative and Alternative Communication (AAC) with children with ASD who are nonverbal or have limited language and can modify them to meet the needs of the individual. SLPs are also trained to help children with ASD who have food aversion or textural issues (ASHA, 2017). They can be trained to administer a variety of accepted ASD treatments as well. This includes the following: PRT, Verbal Behavior, ESDM, Floortime (DIR), RDI, TEACCH, and SCERTS. SLPs are not the only professionals that should be considered when treating children with autism (Autism Speaks, 2017). Physical Therapists, Occupational Therapists, psychologists, and special education teachers may all play a role in treating a child with ASD (ASHA, 2017). Each child must be evaluated for their specific needs and deficits, and an intervention plan that may include any of the aforementioned elements should be put into place.
As of right now, there is no specific legislation in place that limits ABA as the only treatment technique for those with ASD, but that may change in the near future as individual states are leaning toward only funding ABA(Applied Behavioral Analysis, 2012). Again, it is the responsibility of those in the health professions field to ensure that ASD is treated in the same regard as other communication, neurological, and general disorders. The treatment should be chosen based on the individual’s needs and in most cases, children with ASD are dependant on more than one type of therapy. Individuals should not be denied access to effective or appropriate therapy techniques because they are not funded in the same way that ABA is funded.
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American Speech-Language Hearing Association [ASHA]. (2017). “Index of Key Issues.” Key Issues
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