Evidence-Based Practices and Teaching NonVerbal Pragmatic Skills to Adolescents With ASD: Lessons Learned From Parent Perspective and Brain Research As a growing population with Autism spectrum disorder (ASD) leaves the K-12 educational system and enters the workforce and college settings, long-term outcomes inform the need for further development of social skills interventions promoting success in these new contexts. Drawing from neuroscience literature describing neuropathology of ASD over the lifespan, ... Article
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Article  |   February 01, 2017
Evidence-Based Practices and Teaching NonVerbal Pragmatic Skills to Adolescents With ASD: Lessons Learned From Parent Perspective and Brain Research
Author Affiliations & Notes
  • Georgina Lynch
    Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine Washington State University, Spokane, WA
  • Disclosures
    Disclosures ×
  • Financial: Georgina Lynch has no relevant financial interests to disclose.
    Financial: Georgina Lynch has no relevant financial interests to disclose.×
  • Nonfinancial: Georgina Lynch has no relevant nonfinancial interests to disclose.
    Nonfinancial: Georgina Lynch has no relevant nonfinancial interests to disclose.×
Article Information
Special Populations / Autism Spectrum / Professional Issues & Training / Language Disorders / Social Communication & Pragmatics Disorders / Attention, Memory & Executive Functions / Part 1
Article   |   February 01, 2017
Evidence-Based Practices and Teaching NonVerbal Pragmatic Skills to Adolescents With ASD: Lessons Learned From Parent Perspective and Brain Research
Perspectives of the ASHA Special Interest Groups, February 2017, Vol. 2, 47-55. doi:10.1044/persp2.SIG1.47
History: Received August 5, 2016 , Revised November 2, 2016 , Accepted November 13, 2016
Perspectives of the ASHA Special Interest Groups, February 2017, Vol. 2, 47-55. doi:10.1044/persp2.SIG1.47
History: Received August 5, 2016; Revised November 2, 2016; Accepted November 13, 2016

As a growing population with Autism spectrum disorder (ASD) leaves the K-12 educational system and enters the workforce and college settings, long-term outcomes inform the need for further development of social skills interventions promoting success in these new contexts. Drawing from neuroscience literature describing neuropathology of ASD over the lifespan, physiologic deficits have been documented which impact nonverbal pragmatics, informing development of new treatments for those on the spectrum representing high-functioning autism. Nonverbal language skills warrants focused intervention to promote greater success in the workplace and college, and are directly influenced by the visual pathway, known to be atypical within ASD. Parent perspective offers insight about deficiencies in nonverbal skills which persist into early adulthood, in line with brain imaging data indicating a decline in adaptive skills and socialization. Evidence-based practices (EBP) for treating adolescents with ASD by targeting visual attention and pragmatics are presented. New insights are offered about how to integrate knowledge of brain function within targeted language therapy approaches emphasizing visual teaching. Empirical evidence is provided guiding future clinical research supporting the need for continued language intervention into late adolescence and early adulthood.

Clinicians and researchers in the disciplines of speech-language pathology, psychology, neurology, and medicine have reached a pinnacle in autism research in which vast empirical data now exist for developing new treatments, educating the public, and for targeting behavior in ways that promote changes in the developing brain. These data have supported the development of interventions fostering improvements in language and adaptive skills critical for long-term outcomes (National Autism Center, 2015; National Research Council, 2001). Now more than ever, an extensive research base exists upon which to guide treatment, informing clinicians not only based on results reported in efficacy studies, but also from findings rooted in basic science, in which new discoveries at the molecular level and behavioral data integrating brain imaging, inform possibilities for novel treatments and positive outcomes. Whereas the past two decades of behavioral and brain research informed practitioners about the positive effects of early intervention for young children with autism spectrum disorder (ASD), we are now faced with an “aging” population. The therapeutic seeds planted early have given these individuals the fundamental language skills necessary to build upon future learning. Thus, success was gained for many children with ASD in the academic realm with varied levels of support, many of which became reduced substantially in later stages of development beginning in early adolescence.
Society is at a pivotal juncture in addressing needs of this older group of individuals for whom we were so successful in treating language and building a foundation for learning, that in early adulthood, they are now entering the workplace and college in large numbers. In 2012, the number of individuals diagnosed with ASD turning 18 and leaving secondary education was estimated at approximately 55,000 per year over the next decade; this surge in young people with ASD entering the adult world results from a significant increase in prevalence of ASD during the early 90s who are now “aging out” of the K-12 public education system (Shattuck et al., 2012). Moreover, the socioeconomic cost of treating individuals with ASD who will require moderate levels of support from social services and healthcare fall around $1.4 million over the lifespan and $126 billion annually in the United States (Mandell & Knapp, 2012). Twenty years ago, clinicians were applying evidence-based practices (EBP) to early intervention, it was not uncommon for practitioners to struggle with understanding how best to treat young children with ASD and how to address challenging behaviors interfering with teaching fundamental language skills. Today, few would argue that speech-language pathologists (SLPs) have a good deal of EBP to draw upon for treating young children with ASD which promote successful outcomes of language therapy yielding significant improvement across developmental domains. Moreover, the Autism Collaboration, Accountability, Research, Education, and Support Act of 2014  supported funding for research to continue to identify ways to support families, provide treatments focused on EBP, and to train future professionals serving the ASD population.
Despite a solid empirical base of EBP in early intervention for ASD and federal support for identifying new treatments, a gap continues to exist in the research literature and in common understanding among clinicians about how best to serve adolescents and young adults with ASD. An interdisciplinary approach to unraveling the questions about neurodevelopment in ASD and response to interventions across the lifespan is warranted to develop innovative treatment models. Emerging evidence from the speech-language pathology literature and from neuroscience and psychology are beginning to inform us about the ASD brain later in development and the course of the neuropathology over time, providing insights into brain function and its direct effect on social behavior as children with ASD mature. Despite new evidence indicating a decrease in brain volume correlated with a decline in adaptive skills during late adolescence (Courchesne, Campbell, & Solso 2011), language treatment models and services provided by SLPs tend to cease beyond the adolescent period. Seventy-two percent of school-age children receive speech-language services in the K-12 system, but upon leaving public education, this number drops to 25%. Although early intervention is critical in the treatment of ASD, we are now learning that intervention at critical stages in later development and transitional periods is as important for success in early adulthood. Commonly understood among practicing SLPs, learning o in individuals with ASD occurs in a very context specific manner. It would be erroneous to assume that once fundamental social language skills are taught in early childhood (skills such as joint attention, turn-taking, topic maintenance, and asking questions), that these skills are generalized to new contexts requiring more sophisticated application later in life without the need for further intervention.
Research about needs during the adolescent period reveals intervention in later stages of development to be as important as early intervention for improving long-term social language outcome. Lack of continued intensive intervention later can result in dependency on the parent for basic skills such as gaining a job, making friends, and initiating social interaction. Caregiver burden has been shown to take a physical toll as the parent of the individual with ASD navigates the systems necessary to provide additional support, while also dealing with daily challenges of helping his or her young person with autism. A recent study examining the relationship between caregiver's stress and parenting an adolescent with ASD, in comparison to parenting adolescents with other developmental delays, revealed cortisol levels of mothers of adolescents with ASD on par with returning post-war veterans suffering from post-traumatic brain injury (Mailick et al., 2009). This finding did not hold true for mothers of adolescents with other developmental delays. Although their struggles were not very different in terms of helping their young person with a disability access social supports, it appears that the stress of managing a young adult with ASD and the associated social behavioral needs does not take the same physical toll on the caregiver of adolescents with other developmental delays. The difference in caregiver burden and physical health between groups is attributed to the stress often resulting in parents of ASD out of chronic concern for safety and frequent problem solving to support simple activities of daily living. The physical and emotional burden of caregiving for the young adult with ASD compounds the challenges of engaging their child in gainful employment as many employers underestimate the cognitive abilities of individuals with ASD and prevocational training opportunities remain limited within the K-12 public education system. Post-secondary outcomes for individuals with ASD reveal a lack of employment and limited success in college, despite average to above average intellectual ability. Only 55% of young adults with ASD are employed within two years after high school in comparison to young adults with other developmental disabilities, which are reported at a 74% employment rate within two years of graduation (Shattuck et al., 2012). Although there are public health and health policy challenges tied to these outcomes requiring further work, a shift in thinking is needed by practitioners about intervention models supporting adolescents with ASD in order to better prepare them for complex social language demands in the workplace. Later developing social language skills are dependent on use of inference and problem solving, requiring the client to reflect and understand how they will use the skills learned in the real world. The late adolescent period is conducive to using metacognitive strategies to address these needs, in contrast to earlier stages of development, the period in which most ASD intervention is provided. Based on current practices, with emphasis primarily on early intervention, this model of language therapy may pose missed opportunities for directly teaching skills dependent on the development of metacognition, which comes later within ASD.
Lessons Learned From EBP Used in Earlier Stages of Development Within ASD
Clinicians can draw upon practices used in early intervention when treating older individuals with ASD, as many of the skills targeted in early intervention are foundational to the use of more complex language later in development. These skills targeted in early intervention approaches include joint attention, turn-taking, initiating, commenting, and asking questions. Treatments promoting positive outcomes during early intervention, requires adaptation at later stages of development to align with more abstract use of language. A complex neurologic disorder which changes over time, treatment of ASD requires clinicians to utilize dynamic assessment paired with focused treatment at each stage of development in response to new contexts and the complex social language demands. Foundational skills impacting nonverbal pragmatics can be explicitly taught using techniques which break down language into concrete forms and specifically target skills in the receptive domain, distinct from teaching skills primarily falling in the expressive language domain. For example, video modeling has been shown to be efficacious in teaching imitation, play routines, and improving social engagement in young children with ASD (Cardon & Wilcox, 2011; Charlop-Christy, Le, & Freeman, 2000). Additional research is needed examining the outcomes of this approach to new contexts with older individuals, given preliminary data supporting use of video modeling with adolescents (Bellini & Akullian, 2007). Empirical evidence from studies examining neurodevelopment within ASD has the potential to change our understanding and approach to addressing this challenge within the context of skills preparation for workplace interactions, fostering friendships and collaboration, and for seeking resources independently. In addition, parents have contributed greatly to the understanding of long-term outcomes and skills maintained from early intervention, juxtaposed against new or persisting language needs readily apparent as their adolescent embarks on independence.
Although a thorough review of treatment models and post-vocational training programs are beyond the scope of this paper, it is timely to consider social needs, neurodevelopment and neuropathology across the lifespan within ASD in relation to language intervention. Further refinement of treatment approaches for adolescents and young adults can be gained by drawing from brain research and from the insights of parents' views about changing needs over the course of later development. A gap in language intervention at later stages of development is emerging, revealing relatively diminished direct treatment of social responsiveness skills or receptive pragmatic language, shedding new light on areas to target more efficiently therapy which can be targeted more efficiently as clinicians' understanding of brain function and ASD evolves. Many school-based social language treatment models have emphasized perspective taking, figurative language, and conversational skills (Bellini, Peters, Benner, & Hopf, 2007). Upon careful analysis, interventions targeting these areas reveal a disproportionate aim toward expressive verbal language at the expense of breaking down nonverbal skills and using explicit visual teaching. For example, when targeting the goal of initiating a conversation, prerequisite nonverbal language skills such as watching a communication partner, waiting, and determining if the communication partner is ready to engage in conversational discourse, are all necessary to assess before engaging in the verbal exchange and maintaining topic. Quite often, these are the visual cues to which individuals with autism frequently ignore and misinterpret. Yet within the context of conventional social skills teaching, deficits related to visual attention are often minimally addressed and higher cognitive processes are emphasized. Additionally, people with autism struggle with viewing expressions of their own nonverbal behavior and determining the meaning it conveys. Engaging in discourse to explain these behaviors and the communicative messages may not be the best modality for a clinician to use, given the emphasis of this approach on auditory processing and lack of emphasis on visual cues within the social context. Given that auditory processing disorder co-occurs in ASD (O'Connor, 2012), using this modality alone does not support change in behavior. Explicit teaching and practice with fundamental nonverbal language skills are essential to advancing generalization of pragmatics to the workplace or college settings in which first impressions, nonverbal body language, and “reading between the lines” of communication are emphasized.
Parent Perspective on Treatment Outcomes Related to Pragmatics
A recent survey of parents of youth with ASD between 11–20 years of age revealed a gap in the outcomes of treatment models serving older children with ASD, specifically in treating what are known as “social responsiveness” skills, or nonverbal skills necessary for successful social interactions at the post-secondary level (Coucouvanis, 2005; Davenny, Lynch, & Fuller, 2014). Following a minimum of two years or more of speech-language therapy in secondary education and service delivery by a SLP, parents of young people with ASD reported limited concern about such skills as asking for help, initiating a conversation with familiar people, and asking appropriate questions. Whereas results indicated greater concern in the area of nonverbal pragmatic skills, verbal social initiation skills were reported as a lesser concern. Although based on a relatively small sample of responders, these initial results suggest maintenance of expressive language skills targeted earlier in treatment emphasizing verbal language and social initiations. Based on this analysis, it appeared adolescents with ASD had consistently received intervention targeting conventional expressive pragmatic skills such as greetings, topic maintenance, and conversational turn-taking. Reading body language (84% of parent concern) and reading the feelings of others (75% of parent concern) rated higher in terms of parental concerns following treatment at the secondary level in comparison to expressive pragmatic language skills. Findings revealed two primary areas of persistent deficiency: transference of skills to unfamiliar people and reading nonverbal cues to support the use of verbal language skills in conversational discourse. Areas of concern cited within social initiations included entering a conversation, greeting an unfamiliar person, and exchanging conversation with an unfamiliar person. These specific challenges indicate difficulty with timing of interactions which are dependent upon “reading” the new context and paying close visual attention to the nonverbal cues of the conversational partner.
These preliminary data lend insights about intervention approaches for ASD at later stages of development and the need for explicitly teaching steps of social interactions with emphasis on identifying the basic components of nonverbal cues such as attending to the communication partner's face, determining if the communication partner is looking or oriented toward the client, and following a line of regard and joint attention with a conversational partner. Using visual attention within the context of pragmatics is dependent on metacognitive ability and also on one's ability to visually track dynamically changing faces and objects in the environment while integrating the auditory system to process abstract language. The use of video modeling, an established EBP (National Autism Center, 2015), holds the strongest promise for helping the clinician break down these steps and for debriefing the context/social scenario using real world situations one might encounter in the workplace. It is well established that integration of brain regions is impacted within ASD, making integration of modalities challenging. When targeting the use of visual attention from the perspective of a motor-based deficit affecting the visual pathway, consideration of the visual field, visual discrimination, and sustained physical eye gaze should be given, shifting goals from complex inferential cognitive tasks to more concrete social language concepts. This approach supports integration of neural systems shown to be atypical within the ASD brain across modalities (Abrams et al., 2013; Harris et al., 2006).
Empirical Evidence: Differences in Brain Function Contributing to Deficits in Following NonVerbal Communication and Integration of Communication Modalities
Avoidance of eye contact and disengagement from social interaction are hallmark characteristics of ASD often attributed to social anxiety, difficulty with “theory of mind”, and challenges with emotional regulation (Baron-Cohen, 2000; Baron-Cohen, Leslie, & Frith, 1985; Mazefsky, Schreiber, Olino, & Minshew, 2014; Prizant, Wetherby, Rubin, & Laurent, 2003). However, evidence for under-connectivity of cerebral regions based on brain imaging, inefficient reciprocal neural transmission from brainstem to cortex, and maldeveloped pyramidal neurons within prefrontal cortex (Casanova, Buxhoeveden, & Gomez, 2003; Courchesne et al., 2007) may also help explain these behaviors from a physiologic standpoint. Deficient neuromodulation of circuits involving language and emotion across brain regions result in a latency or lack of response and “under-connectivity,” compounding the verbal and receptive language deficits found with ASD, as synaptogenesis and efficiency of neural activity is reduced. Additional evidence for a deviant trajectory of brain development in comparison to typically developing children further supports a neurogenic component to the behavioral features of ASD and the basic physical responses impacting language, such as the ability to control eye gaze (oculomotor skills), deficient auditory processing, and latency in motor planning skills. Whereas often these behaviors are characterized as preferential or “willful,” integration of behavior and physiology are at work, expressing deficits in basic visual and auditory systems which underlie higher cognitive abilities such as attention, problem solving, and language comprehension. Not solely a function of reinforcement and motivation, the neuroscience literature reveals the influence of neuropathology on behavior, not typically emphasized within conventional language therapy and behavioral approaches which attribute atypical communicative behaviors to social contingencies or environment. Magnetic resonance imaging (MRI) data document overgrowth of head circumference and cerebral volume in ASD early in childhood which correlates with level of ASD severity, then a plateau in these measures when compared to typically developing children (Courchesne & Pierce, 2005; Courchesne et al., 2007; Shen et al., 2013). For children with ASD who do not demonstrate regression of skill, this plateau is observed in later childhood up to early adolescence. Longitudinal investigations have indicated there begins a decline in brain volume that correlates with a decline in adaptive skills and social behavior in late adolescence and early adulthood (Courchesne et al., 2011). Whether decline in social behavior following periods of success post-treatment is due to a neurodegenerative process or due to a lack of continued intensive intervention as previously described, remains unclear based on existing studies. However, the empirical data are revealing that efficiencies in brain function decline at this pivotal developmental period (Courchesne et al., 2011; Muller et al., 2011). Where typically developing adolescents' cognitive performance strengthens, and the efficiency of the auditory and visual pathways and behavioral inhibition increases, adolescents with ASD demonstrate less efficiency in neural processing across brain regions and modalities (Klin, Jones, Schultz, Volkmar, & Cohen, 2002). The visual system plays a key role in the attainment of pragmatic skills and is implicated in ASD. Latency in the visual pathway within this population has been replicated in a number of eye-tracking studies across developmental levels, documenting difficulty with visually tracking dynamic social exchanges between communication partners and an affinity for observing static objects versus core features of faces (Hernandez, et al., 2009; Klin et al., 2002). This latency has also been observed in physiologic responses of the visual pathway in response to changes in environment, such as in the pupillary reflex (Daluwatte et al., 2013; Fan, Miles, Takahashi, & Yao, 2013; Lynch, James, VanDam, & Potter, 2015). Not only is the pace of complex social interaction difficult for the adolescent with ASD to follow based on cognitive demands, but also from demands on the auditory and visual pathways subserving integration of information shown to be atypical on functional magnetic resonance imaging (fMRI; Muller et al., 2011).
Evidence-Based Practices to Target Neural Circuits Influencing Social Behavior
When given social scripts and video modeling, followed by debriefing with the client, visual teaching strategies help slow social interactions down, making them more concrete. Using visual teaching methods, improvements in social interaction and adaptive skills have been documented within ASD up through 22 years of age (National Autism Center, 2015). Visual teaching methods and video modeling are evidence based practices which address the social and physical behaviors associated with deficient neuromodulation of pathways impacting receptive language and divergent visual/auditory processing. Latency in neural activity affects one's pragmatic abilities in the form of difficulty interpreting nonverbal communicative messages in the moment. The use of explicit visual teaching strategies assists the individual with ASD in reflecting on the given interaction, identifying key elements of the interaction, and offering a possible solution to the social problem posed, lending additional support for practicing pragmatic skills. More clinical trials are needed incorporating brain/behavior measures using eye tracking, electroencephalography (EEG), and fMRI in tandem with these intervention approaches to better understand how they may help strengthen neural activity and integration of neural systems and modalities. Using static photos and visual cues/symbols, pausing steps within video modeling demonstrations, and identifying key features of the face explicitly, all help the individual with ASD beyond the use of simple peer mediation and peer-modeling within social language groups. The extant neuroscience literature on ASD has taught clinicians and other researchers that in order to sustain changes in social language skills, a combination of these therapeutic approaches (visual teaching and social group interaction with peer models) is necessary for optimal response to pragmatic skills intervention.
General Intervention Strategies
Following the “under-connectivity” hypothesis and applying it to treatment of nonverbal pragmatic skills requires close observation of the individual's use of visual attention, as communication is not solely based on verbal language. Bearing in mind latency in eye-gaze and reduced speed of tracking social exchanges, clinicians must break down pragmatic exchanges beyond simple role-play, incorporating nonverbal pragmatics and attention to visual cues as part of the treatment method. For example, the use of “shared referents” (joint visual attention to objects) facilitates teaching “small talk,” a conversational skill used in daily interactions. This model is akin to methods for teaching joint attention in young children to facilitate emerging language skills such as bringing objects within a line of sight and enticing requests for toys and play routines. These foundational nonverbal skills form the basis for using advanced discourse later. In this example, joint attention is the foundational skill, but the technique is adapted to initiating small talk about an object both communication partners can observe, thus making the exchange concrete. Additional nonverbal skills to target include attending to and demonstrating body orientation, watching, timing interactions appropriately, initiating, waiting, following a line of regard, and identifying emotions based on body language within specific contexts, not in isolation. Competency in pragmatic skills which are dependent on the visual system allow the individual with ASD to better engage in higher cognitive processes such as forming inference and answering “Why” questions about social interactions/scenarios. This ability then supports problem-solving based on the given social context and identification of possible solutions. Quite often, initial goal areas targeted are much higher in cognitive demand and expressive language use, bypassing the nonverbal fundamentals of communication, lacking a foundation needed for applying language use to novel situations. Thus despite social skills intervention, pragmatic challenges persist, and the adolescent with ASD learns skills which might be considered conversational “etiquette” or simple verbal exchanges. Practicing nonverbal components of pragmatics using video modeling and debriefing with the SLP and peer mentor models promotes self-monitoring and visually attending to communication partners. Skills generalize more easily when practiced in multiple environments with multiple communication partners. Social scripts, paired with visual cues and metacognitive strategies for debriefing social scenarios capitalize on the integration of neural systems and associative learning, strengthening the response to intervention.
Future Research to Support Development of Language Intervention for Adolescents With ASD
The next decade holds promise in the area of brain-based language interventions for ASD and potential for examining these interventions using technology such as eye-tracking, EEG, and fMRI. Clinical research examining effective treatment models for the developing adolescent with ASD requires examining treatment approaches beyond general social skills groups. There is a need to study specific neural systems and a hierarchy of cognitive and language skills dependent upon primary process systems impacting social behavior. Practicing SLPs would benefit from clinical studies elucidating underlying neural systems in ASD which fundamentally influence speech-language and behavioral treatments. Multi-modality teaching and the use of EBP such as visual teaching methods, use of concrete objects to teach more advanced language skills, and integrating the auditory system are necessary for treating the complex needs of ASD. This approach, when implemented by a speech-language pathologist, takes on an important focus within the context of a broader intervention program for ASD, promoting life skills and further development of abstract language. SLPs can scaffold back to fundamentals of early developmental treatment approaches and balance the receptive/expressive domains in this process using more complex contexts. This approach helps reduce disproportionate emphasis on expressive social language skills at the expense of teaching the use and interpretation of nonverbal language skills essential to all interactions.
The SLP plays a critical role in the treatment and advocacy for adolescents with ASD. Just as with other specialty areas within the discipline of speech-language pathology, such as with clinical management of neurogenic communication disorders, this conceptualization of pragmatics intervention is driven by a firm understanding in neuropathology associated with the disorder. Similarly, brain function and application to intervention approach is emerging within EBP for ASD, where close attention to behaviors indicative of underlying neural processes, drive adaptation of intervention techniques to dynamically address multiple components of social language. The next decade of research will support changing the view of language deficits in ASD as one of difficulty with “perspective taking” and “behavior” to one of neurologic dysfunction mediated by compensatory strategies and integration of modalities, similar to intervention models for treating hearing disorders, cerebrovascular attack/stroke, traumatic brain injury, and neurodegenerative disease. Pairing modalities and integrating the auditory and visual pathways using intensive interventions capitalizing on repetition, reinforcement, and dynamic language opportunities in naturalistic contexts provide a foundation for ensuring greater automaticity for language and communication. SLPs are well trained in neuropathology and neurodegenerative language disorders, which subserve the behavioral characteristics observed in ASD. Although challenging behaviors and disinhibition are common, an understanding of the associated deficits in brain function help the SLP better understand how to integrate neural systems to yield positive treatment outcome across verbal and nonverbal language targets. Moreover, this conceptualization of language treatment requires adaptation of techniques used across developmental levels and close observation of the demands of new contexts found in the workplace, college setting, and community. Observation of environment and the language demands in the context of evaluating visual attention guide intervention goals for nonverbal pragmatics and will help the clinician break down more abstract, subtle nonverbal skills necessary for success in those environments.
Lessons can be learned from the growing body of neuroscience literature examining the neuropathology of ASD. As clinicians gain better understanding of the trajectory of neurodevelopment and brain function in ASD later in development, interventions treating core symptoms of ASD will capitalize on integrating neurophysiology and behavior in the learning process. ASD should not be viewed as a disorder primarily associated with behavior management, rather it should be considered a neurologic disorder in which compensation for deficits in brain function form the basis of therapy. A multimodality approach should be emphasized addressing neural “under connectivity” with ongoing treatment provided into early adulthood. Future clinical research should address adaptation of EBP approaches found with early intervention and their application to treatment of nonverbal pragmatics later in life in relation to complex language use in new contexts. Assessment of the needs of older individuals with ASD through the lens of caregivers and self-advocates will help shape intervention approaches, setting higher standards for quality of life outcomes in early adulthood.
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We've Changed Our Publication Model...
The 19 individual SIG Perspectives publications have been relaunched as the new, all-in-one Perspectives of the ASHA Special Interest Groups.