Current Assessment and Treatment Practices for Children with Autism and Suspected Childhood Apraxia of Speech: A Survey of Speech-Language Pathologists

摘要

Purpose: The occurrence of similar speech and non-speech behaviors in some children with autism and Childhood Apraxia of Speech (CAS) calls for the consideration of CAS in some children with autism. The majority of research on CAS has been conducted with children who are otherwise typically developing. The purpose of this study was to determine whether and to what extent children with autism are being diagnosed with or suspected to have CAS as well as what assessment and treatment methods are currently being used with these children. Method: A nationwide survey of speech-language pathologists (SLPs) working with children ages 0-6 years was distributed through snowball sampling, e-mail distribution lists and Facebook discussion pages. The survey requested information on numbers of children served with autism and suspected CAS as well as the criteria used to identify CAS in children with autism and the treatment methods being used in intervention. Results: 132 surveys were received and analyzed. SLPs from across the United States participated in the study. The mean number of children with autism currently served per participant was 6 children and the mean number of children with autism and suspected CAS per participant was 1. Participants reported suspected CAS in 16% of children with autism. SLPs working in the field the longest and those serving more total children with autism were suspecting CAS in children with autism more often than other participants. Of the total participants, 80% indicated that they would begin assessment for CAS in a child with autism as soon as they notice specific signs of CAS. The most common markers used were difficulty combining and sequencing phonemes and inconsistent production of speech sounds. Participants reported using a wide range of assessment tools to assess for CAS in a child with autism. Participants tended to rely upon informal assessment measures for this population; the most common assessment tool was a connected speech sample. The most commonly used intervention technique with this population was AAC; participants also reported high familiarity with PROMPT as a treatment for CAS. The least commonly used intervention technique was integral stimulation; 62% of the participants indicated that they have no knowledge of the technique. Conclusion: Results revealed that on average, SLPs are suspecting CAS in approximately 1 in 5 children with autism but much fewer children with autism have a second diagnosis of CAS. The decision of when to assess a child with autism for CAS as well as the assessment tools used varied greatly across participants. Participants reported using up to 22 different diagnostic markers to identify CAS in a child with autism. It was also discovered that not all of the traditional diagnostic markers for CAS should necessarily be considered diagnostic markers of CAS in a child with autism (e.g. suprasegmental abnormalities). With no scientific research to date regarding treatment efficacy for the treatment of CAS in children with autism, SLPs are forced to rely on anecdotal data when selecting a treatment to target CAS in a child with autism; SLPs may not be using the most effective treatment methods for this population. Results of the study support continued investigation of CAS in children with autism. There is a strong need for the development of clear diagnostic guidelines for CAS in a child with autism as well as reliable assessment tools that should be used. Further studies are needed to identify the most effective treatment approach for children with CAS and autism and how an SLP should incorporate that treatment into an overall comprehensive treatment approach for autism.