The Office of Special Education Programs of the United States Department of Education (“OSEP”) issued a “Dear Colleague Letter” letter on July 6, 2015 regarding speech-language services and evaluations for children with Autism Spectrum Disorder (ASD).
OSEP identified concerns with speech-language evaluations and services for infants and toddlers (Early Intervention) as well as for school-age children. Under IDEA Part B, which applies to children ages 3-21, the LEA must ensure that a free appropriate public education is made available to all eligible children with disabilities, delivered pursuant to an IEP. Under IDEA Part C, which applies to infants and toddlers under age 3, states must ensure that each eligible child has early intervention services available that are designed to meet their developmental needs, delivered pursuant to an individualized family service plan (IFSP). Part B requires an LEA to conduct an initial evaluation “in all areas related to the suspected disability, including, if appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities.” See 34 CFR § 300.304(c)(4). Part C requires an evaluation that identifies a child’s level of functioning across cognitive, physical (including vision and hearing), communication, social/emotional, and adaptive development. See 34 CFR § 303.21. As OSEP’s letter highlights, “The IDEA’s IEP and IFSP processes are designed to ensure that an appropriate program is developed to meet the unique individual needs of a child with a disability, and that services are identified based on the unique needs of the child by a team that includes the child’s parents.”
Professionals in the field raised concerns that a growing number of children with ASD were not receiving appropriate services to address their communication needs. OSEP’s letter states, “Some IDEA programs may be including applied behavior analysis (ABA) therapists exclusively without including, or considering input from, speech language pathologists and other professionals who provide different types of specific therapies that may be appropriate for children with ASD when identifying IDEA services for children with ASD.”
A diagnosis of Autism Spectrum Disorder (DSM-V 299.00) requires the presence of “[p]ersistent deficits in social communication and social interaction across multiple contexts.” Such deficits can include abnormal social approach, failure of normal back-and-forth conversation, failure to initiate or respond to social interactions, poorly integrated verbal and nonverbal communication, and echolalia (meaningless repetition of another person’s spoken words). Speech-language pathologists can and do evaluate and deliver services addressing such deficits. Given the universal deficits in social communication that are part of the diagnostic criteria for ASD, we would submit that every evaluation and likely every IEP/IFSP for a student with ASD would require the participation a speech-language pathologist or similar professional. While the involvement of qualified ABA personnel is obviously crucial for many children, and often more difficult to come by, OSEP’s letter provides an excellent reminder that input from a speech-language expert can be just as important.
Although OSEP’s letter addresses only those carrying the official diagnosis of ASD, there are other diagnoses and disability categories that would call for the involvement of speech-language experts for the same reasons outlined in the letter. The DSM-V diagnosis of ASD includes those who once might have been (and often still are) diagnosed as having PDD-NOS, Asperger’s, or Child Disintegrative Disorder. Outside of the ASD umbrella, those with a diagnosis of Non-Verbal Learning Disorder (which is not a DSM-V diagnosis but is still used in the field) and those who are diagnosed with Social Communication Disorder (a new diagnosis in the DSM-V) can also experience challenges with developing social communication skills and may require involvement by speech-language personnel.
Moving beyond school-based assessments and services, parents who are assembling an independent team to help assess a student’s needs and the services required to address those needs should make sure to seek out a competent speech-language evaluator. A neuropsychologist will often be the anchor around which a good outside team is built but, for students with oral, written, or social language difficulties (e.g., specific learning disabilities, ASD, brain injuries, developmental delay), a speech-language evaluation is a key ingredient in fully assessing a child.
All parents should ensure that every initial evaluation or three-year re-evaluation of their child includes all of the areas of potential disability which, in the case of children with ASD, should include a speech-language/communication evaluation. Parents should also remember that the Team’s conversation about the services that a student requires to access the curriculum and to make effective progress should include the student’s ability to communicate.
Melanie R. Jarboe is an associate in the Special Education & Disability Rights practice group at Kotin, Crabtree & Strong, LLP in Boston, Massachusetts.
What about the practice of “cognitive referencing”, where speech pathologist refers to the finding of lower cognitive ability in the psychological evaluation that indicates further gains in speech skills will be impacted so recommendation is made to discontinue direct or even consult speech services despite speech evaluation findings indicating both expressive and receptive challenges?
Thanks for your comment. Questions about whether a student can access the curriculum with or without a certain service and whether the student has the capacity to make progress in a particular area are highly fact-specific and individualized issues. However, just because a student has low cognitive ability does not automatically mean that the student lacks the potential to make further gains or that termination of a service is necessary or appropriate. Feel free to call our office for a more in-depth discussion.