Talk to an educator or the parent of a neurodiverse child about their thoughts on “labels” and “identifications,” and you are likely to receive some passionate and potentially lengthy responses. The use of myriad labels in special education is a necessary evil (as some—and I—might say), because in order to qualify for special education services under the Individuals with Disabilities Education Act (IDEA), children must meet the criteria under one or more of the 13 identified areas of disability. However, those of us supporting children with disabilities are, in parallel, working fervently to fight the limits and preconceived notions commonly related to each of these disability labels. The very labels we rely upon to initiate and sustain the necessary support for children are also what we are continually challenging.
Word Choice Goals—For Clinicians
This discussion is no more relevant than now, the month of April, as we highlight Autism Acceptance Month. More important than the opinions of educators who support Autistic children are the opinions of those who are a part of the Autistic community. As should go without saying, this is a heterogeneous group, and there is debate within this community over the language used for self-reference. For many years, special educators have advocated for “person-first” language, the intent being that we are not defining individuals by their disability, but rather using any given disability label as a descriptor, among other individual descriptors. However, not everyone identified with autism agrees with a “person with autism” reference, as some feel this diminishes the centrality of autism in their lives. In short, it is important to ask each individual and family their referential language preference. It’s essential to respect the perspectives of each individual who is a part of this community.
Another highly accepted (and frequently taught) manner of describing individuals diagnosed with autism is the use of “high-functioning” or “low-functioning” descriptors. But what do these labels actually tell you about an individual? In reality, very little, and yet they are pervasive and can have a wide-ranging and potentially damaging impact. There is thankfully a movement to eliminate the use of functional labels and to, instead, describe individuals based on their strengths and abilities (which should always be at the heart of education across the board). The problem with “high” and “low” functioning descriptors is the limits and expectations automatically placed on each individual who is the subject of either of these labels. Rather than meeting children where they are, celebrating and building upon their strengths and abilities, and working to delineate and provide support and accommodations, the tendency with functional labels is to assume—assume both limits and expectations based on such ill-defined and abstract descriptions of “high-functioning” and “low-functioning.” We can do so much better.
Teletherapy and Speech-Language Services: What, How, and Why?
What does all this have to do with speech-language pathology broadly, and teletherapy services more specifically? A lot. Autism, as indicated in its alternate moniker, Autism Spectrum Disorder (ASD), is defined in DSM-5 as a person who exhibits “persistent deficits in each of three areas of social communication and interaction…plus at least two of four types of restricted, repetitive behaviors.” And under IDEA, autism is described, in part, as “a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance.” Under both definitions, analysis of a child’s communication, across not one but three areas, must be completed before a diagnosis and any related communication supports can be determined.
Speech-language pathologists (SLPs) are uniquely trained and qualified to complete these analyses as a part of interdisciplinary teams. In fact, some states have moved to require that SLPs be part of evaluation teams in order for a child to qualify for an IEP under the autism category. And, what else? An increasing number of these uniquely trained and qualified SLPs are now successfully completing their portion of such evaluations and providing related IEP direct services via teletherapy.
Although many clinicians and parents were only recently introduced to teletherapy during the pandemic, teletherapy is not a new form of therapy. Teletherapy is a service modality wherein licensed and experienced therapists are transitioning their evaluation and therapy skills to the online environment. School-facing special education teletherapy services have existed for over a decade. The evaluative criteria are not different. The goal areas and best practices for intervention for Autistic children are not different. What differs is the modality through which these evaluation and direct therapy services are delivered, and it is essential that SLPs completing evaluations and therapy services for children referred for or with an autism diagnosis have the appropriate technology, platform, and clinical supports in place. Unfortunately, these components were frequently absent for SLPs asked to provide online evaluations and direct service during the pandemic.
Teletherapy was originally born decades ago (in its most rudimentary form), out of the lack of access and equity for individuals with medical and educational needs. In the U.S. school systems, the shortage of licensed SLPs, OTs, and mental health professionals has been a chronic reality for decades. In parallel, according to the Center for Disease Control (CDC), the prevalence of children with autism increased from 1 in 150 in 2000, and to 1 in 44 in 2018. I have known parents who have relocated to new school districts or even new states so their Autistic children could be considered for highly regarded autism programs. However, for most parents, such moves are not possible for any number of reasons. In contrast, teletherapy allows experienced SLPs to provide high-quality evaluation and intervention services to autistic children regardless of their location. In other words, teletherapy has the potential to give all children and their families access to much-needed quality services.
SLPs are rarely the only service providers supporting Autistic children. Rather, they are most commonly part of an interdisciplinary team that might also include general education teachers, special education teachers, occupational therapists, physical therapists, school psychologists, and board-certified behavior analysts (BCBAs). Teletherapy services provided in any discipline require some level of in-person support for the child. The level of support required varies depending on each child and their degree of independence (I often liken the level of support to that required for a child to access general education throughout their school day).
Teletherapy can be a particularly strong model for Autistic children if the person providing the support during teletherapy sessions is an assistant or paraprofessional (if a child is joining therapy sessions from school) or a parent (if a child is joining therapy sessions from home)—a person who also supports the child outside of therapy sessions and throughout their day. The necessary level of involvement from the support person during every therapy session means that not only is the child receiving direct therapy from the SLP and working on communication goals, but the support person is also learning how to reinforce communication goals outside of the therapy session.
As SLPs in school-based settings providing IEP-based services, we may commonly have only 30–90 minutes a week (or even a month) to work directly with a child, so opportunities for real progress on IEP goals and meaningful carryover of skills are vastly improved when the individuals who are with students all day, whether in the school or home setting, have the training and resources they need to provide communication supports, scaffolding, and reinforcement outside of therapy sessions. When implemented by an SLP with the appropriate training, therapy resources, and tech/clinical support, the provision of services via teletherapy reinforces a model of greater student independence and carryover of skills.
While there is much discussion and disagreement about labels and referential language in the Autistic community, one commonality is the desire to identify the need for intervention and related supports early in a child’s development, and to then provide access to high-quality services delivered consistently in the appropriate amount and frequency. Teletherapy is the great equalizer of education services—when implemented with fidelity, children will have access to crucial therapy services to support their social, communication, and academic development at the highest possible level.
About the Author
Kristin Martinez, M.A., CCC-SLP, is Clinical Director of Innovation and Outreach, Speech-Language Pathology at Presence. She received her M.A. in Speech, Language, and Hearing Sciences from the University of Colorado at Boulder, and has been a speech-language pathologist for 19 years. Kristin provided speech-language therapy to children in her local school district and in private practice before starting as a teletherapist with Presence in 2013. Kristin has served as a clinical manager and teletherapy subject matter expert with school districts across the country, and she presents on the topics of speech-language pathology and teletherapy nationwide.
Centers for Disease Control and Prevention Autism Information Center