Relationship Between Autism Spectrum Disorder Education and Clinical Decision-Making in Early Intervention

Background:  The American Speech-Language-Hearing Association (ASHA; 2006) emphasizes the critical role of speech-language pathologists (SLPs) in the early identification of and intervention for autism spectrum disorder (ASD). Speech-language intervention for children under the age of three typically focuses on the development of social communication skills. These skills, including prelinguistic communication such as the use of eye contact, gestures, and joint attention, have been shown to predict later language outcomes (Laakso et al., 1999; Rowe, Özçaliskan, & Goldin-Meadow, 2008; Watt, Wetherby, & Shumway, 2006). Thus, early intervention that targets social communication can have a cascading impact on language development. It is important to evaluate the knowledge and use of evidenced-based intervention practices by SLPs providing early intervention for children with social communication deficits including ASD.    

Objectives:   This study used survey responses from SLPs working in early intervention settings with children with social communication delays to determine how clinician educational experiences impact their clinical practices.    

Methods:   The investigators created a web-based, 25-item Qualtrics survey to obtain information about the respondents’ academic preparation, continuing education, and clinical practices in the area of early intervention for children with social communication delays.  SLPs who work in an early intervention setting were contacted through two methods—ASHA Community listservs and direct member emails— and were invited to complete the survey. The survey was available for six weeks; 425 surveys were initiated and 282 respondents answered all questions for a completion rate of 66%. Respondents had worked as SLPs for an average of 16.5 years (SD = 10.9) and worked specifically with children under three for a mean of 12.3 years (SD = 9.0). 56.6% of respondents were working in state-funded birth-to-three settings; the remainder worked in preschools, elementary schools, clinics, hospitals, home health agencies, or other agencies. Participants responded from 38 US states and Canadian provinces. 

Results:   Approximately half of the respondents (49.8%) reported participation in more than 30 hours of continuing education related to autism, while only 11.7% had a graduate level class on ASD. A medium, negative correlation was observed between respondents’ years working as an SLP and coursework covering ASD such that SLPs who had been working fewer years were more likely to have had graduate level coursework in ASD. Additionally, ASD coursework was observed to be negatively correlated with using personal clinical experiences to make decisions and positively correlated with using recommended practice guidelines to structure intervention. Significant, medium positive correlations were observed between continuing education in ASD and use of own clinical experiences and recommended practices. Further analyses will be performed to explore the relationship between ASD education and specific clinical practices.

Conclusions:   While SLPs who have recently graduated may be more likely to complete ASD coursework, SLPs are more likely to learn early social communication intervention strategies through continuing education than coursework. Intervention strategies learned during graduate and continuing education impact use of treatments that adhere to recommended practice guidelines.