Early Identification of Autism Spectrum Disorder: Speech Language Pathologists' Knowledge, Screening, and Referral Practices

Background: Considerable evidence supports the feasibility of identifying children with Autism Spectrum Disorder (ASD) by 18 to 36 months of age. One of the most compelling reasons for early diagnosis is that it allows for intensive behavioural interventions early in life that could lead to more positive outcomes for children with ASD. Communication is one of the most common first concern of parents with children later diagnosed with ASD and parents often seek help or are referred to speech language pathologists (SLPs) for assessment and intervention for their children. SLPs working with very young children are in an opportune position to identify red flags pertaining to ASD early and to refer parents for formal assessment for early identification.

Objectives: To explore the knowledge, screening, and referral practices concerning ASD of Ontario speech language pathologists working with children under 6 years of age.

Methods: A sample of 199 speech language pathologists (years of experience: <5 years, n = 49; 5-9 years, n = 46; 10-15 years, n = 32; >15 years, n = 72) completed an on-line survey on their training, screening, and referral practices, the Autism Knowledge Survey-Revised (AKS-R), and demographic information. Comparison groups of 149 SLP graduate students, 167 undergraduate students and 16 specialists in the field of ASD also completed on-line surveys that included the Autism Knowledge Survey-Revised (AKS-R) and demographic information.  

Results: Speech language pathologists’ knowledge of ASD (as measured by the AKS-R) was significantly greater than that of SLP graduate students and undergraduate students. Eighty percent of SLPs agreed it was important to use formal screening tools when ASD was suspected compared to 97.3 % of SLP graduate students. Forty five percent of SLPs reported having the clinical expertise to identify most children with ASD without the use of a formal screening tool. When ASD was suspected, most SLPs reported rarely or never screening (67%), and almost always or always referring for formal assessment of ASD (64%).  

Conclusions: Speech language pathologists are more likely to refer for formal assessment of ASD when suspecting that young children have ASD rather than formally screening for ASD. More SLPS believed in the importance of screening tools than used them. Most SLPs believed they can identify ASD in young children without screening tools. This emphasizes the importance of accessible and affordable training programs focusing on early signs and characteristics of ASD for speech language pathologists. Investigation of barriers to referral for formal assessment of ASD is also indicated. Data analysis is ongoing.