During November, our monthly online noala club session was focused on evidence based practices based on three peer reviewed research articles. Noala club is a free monthly online session during with our speech and language community gathers to discuss a specific topic between practitioners, evidence based. This session counts as a CPD activity and led by US clinical director, Sharon Baum.
Discussing these research papers, evidence based, we hosted speech and language professionals from across the UK and the US specialising in both paediatrics and adults. The discussion between practitioners was centred around assessing and intervening with social communication disorders and ASD.
(As per the article we discussed: the American Psychiatric Association (APA) labels SPCD to include: persistent difficulties with using communication for social purposes, changing communication to match the expectations of the listener, following rules for conversation, and understanding non-literal language).
We had a chance to review social pragmatic communication disorder and how it manifests in different children, despite limited assessment tools. The group’s discussion brought in many opinions that overlapped regarding spotting this type of communication disorder, as a separate disorder from someone with ASD. As with ASD, many of our professionals indicated that they have seen a profile of children and adolescents who struggle with problem solving, interpreting verbal and non verbal communication, and making inferences as they relate to real life social situations. Restricted behaviours and repetitive interests were discussed - as aligned with the designated research paper - to stand separately as the one significant area that can help a practitioner delineate the difference between social communication disorder and ASD. We discussed that sometimes even if there is no ASD diagnosis, there can be fixed interests when someone has a social communication disorder, despite the research. It is important to be aware of cultural differences that may not be social in nature (i.e. not maintaining eye contact with adults due to cultural norms, not speaking until someone else finishes their thoughts, etc.)
The consensus of our rich discussion revealed that at times other external factors have affected those with social communication disorders and ASD. When there is a diagnosis of trauma, it is important to be trauma informed while operating from a strengths and needs perspective. Sometimes, the extent of the struggle is missed until neurotypicals are part of the communication. Additionally, using current events as a part of your observation is critical, as many of us have observed the effects on social communication post COVID. The loss of two years of social interaction needs to be examined through conversations with teachers, parents, and reviews of records to help develop a holistic picture of what is going on now. A great suggestion was asking parents to take a video of the child in another context i.e. at home in order to better understand how social communication changes for the individual based on context. This can inform a treatment plan that looks at emotional impacts when collaborating with parents or school based support teams. The discussion also targeted assessment based on real life experiences supported by different assessment approaches; bridging the gap between research and learned best practices.
While there are many formal tests that assess social communication deficits including the Pragma test mentioned in the article – adapted from an Italian Test in Finland to be used to assess social language - the members of the club discussed the importance of informal assessment. Not all tests are culturally and linguistically sensitive. Especially in regards to social communication, environment and culture play a big role in how a student performs on a standardised test. The LEADERSproject | Connecting clinical practice with law and research in order to provide culturally and linguistically appropriate services is a great place in cyberspace to find informal tools that can be tailored to the individual with cultural sensitivity.
This study confirmed to the those who attended the club that those with ASD had a high level of intelligence, while differing in theory of mind (ability to observe and be aware of one's own mental states and the mental states of others) when compared to neurotypical individuals who have this theory of mind with automaticity. While the discussion revealed that in the US the DSM-5 which is the psychological bible indicates an Autism diagnosis, that is assessed and determined by a neuropsychologist; in the UK the ADOS assessment used with a paediatrician and psychologist can achieve this diagnosis. Based on our discussion, it seems that there is less autonomy with limited training and access to the ADOS. While some incorporate it into their findings, it needs to be then reviewed by a psychologist or doctor that are part of the case.
Assessment always leads to formulating a treatment plan, and we looked at the research to compare our treatment approaches with evidence based practices. The conversation focused on the importance of asking the individual with ASD what they need or want rather than telling them what they need. Adults with autism have become big advocates as they reflected on what they needed at the time of treatment when they were younger. Some use questionnaires to support this type of advocacy.
The research article focused on letting the individual guide the session along with caregivers in natural contexts based on consistent observations using a DSP (Development Social Pragmatic) model. The discussion pointed to this as the practitioners in the discussion work with the individual but also coach the parents as to what social piece they are working on and how to implement this in settings that are more natural (at home, at social activity etc.) that are part of their daily routines. The conversation stressed not just teaching children flexibility, but modelling flexibility based on your own actions. One member discussed using talking mats to allow different options for students to choose from for activities in order to enhance flexibility. The discussion continued to come back to working on what the children want to work on by asking them, giving them questionnaires, and when needed - teaching them to advocate for their needs!
The discussion by professionals emphasised using natural contexts to launch social interventions, even when caregivers report that their child is struggling to apply the social interventions in the natural setting. There was agreement between professionals that application takes time, and the way generalisation occurs will differ based on the individual and their specific needs. Constant tailoring of treatment according to external impacts on the individual, will ultimately create a treatment plan that optimises success with the individual across different settings. Professionals highlighted the importance of speaking with caregivers after they attempt to incorporate treatment models so they can reflect on how the child is responding. This will allow for tweaking plans for individuals with ASD and/or social communication disorder based on individual complexities.