What is autism? What is a sensory processing disorder? Are they exclusive of one another? How can you know and quantify the difference? Research suggests 70% of all children diagnosed with autism have sensory processing disorders (SPD). Children with SPD may not, and often are not, on the autism spectrum.
Initially the characteristics demonstrated by these children may be identical. Yes! They canÂ look the same! Hand flapping, echoing, limited attention span, little to no eye contact, and poor reciprocal playÂ are a Â few characteristics of both SPD and ASD. As speech language pathologists we are not licensed to label either autism spectrum disordersÂ (ASD) nor sensory integration disorders/ SPD. We can however, provideÂ crucial insights that will guide physicians in their differential diagnosis and treatment decisions.
We areÂ experts in evaluating play skill development, receptive and expressive language development, and pragmatic development. We can determine dysarthria versus apraxia, selective mutism versus an expressive language disorder, and typical bilingual language acquisition variables versus learning disorders. We greatly impact children and their families with our observations, diagnosis, and recommendations.
It is imperative that we understand theÂ characteristics of sensory integration challenges in addition to our classical training. In an ideal “whole childÂ evaluation” a developmental pediatrician willÂ haveÂ requested blood work and other tests as appropriate, an OT and PT will evaluate gross and fine motor skills and sensoryÂ functioning, an audiologist will have assessed hearing,Â and we as SLP’s will have looked at all communicative aspects of the child, including their language exposure. Â If there are severe feeding concerns (or you are not comfortable with feeding enlist a trusted SLP / OT), a nutritionist and modified barium swallow study may be in order. The bottom line is to look at all aspects of the child who is exhibiting “autistic like symptoms”.Â Forget the addage “when I see a bird that walks like a duck and swims like a duck, I call that bird a duck.” (J.W. Riley).
Look, (LOOK!!!) at the theÂ whole child.Â Interview the parent, after allÂ mom or dad is that child’s day to day expert.Â What age level is his/ her receptive language vs. expressive language? What level of symbolic play does he or her exhibit? Is there any evidence of oral motor dysfunction or motor planning disorders? What pragamtic strengths are exhibited, if any?
I have treated several children who were misdiagnosed at an early age. Thankfully their parent(s)Â were proactive in seeking treatment. Within the last year I treatedÂ a four year old diagnosed with autism. He had been to five other SLP’s with no increase in his global language skills. They had done floortime, used PECS, and told his mother his prognosis was poor.
DuringÂ his Â initial evaluationÂ he nearly bit me, did scratch me, and performed what I can only label as hybrid somersaults and cartwheels. He had limited joint attention and required constant movement.Â Because I was able to SEE his strengthsÂ in play and later use sensory strategies provided from an OTÂ I referred him to, Â he went from non verbalÂ to speaking in 3-4 word phrases 12 months later.
Is this common, no. Can it happen if you as an SLP can aid in an appropriate diagnosis and related referrals, yes.
I am not against “labels.” I tell the parents of my clients that labels are great for driving placement in schools and for insurance reimbursement. If we effectively evaluate all areas of communication and have a multidisciplinary team, as needed,Â we can be assured our kids are getting an appropriate diagnosis. Always include communicative strengths as well as weaknesses in your reports.Â Resist the temptation to drive goals orÂ treatment with a label in mind.Â Keep “the bar” high in treatment sessions.
Remember! Research has proven the plasticity of the mind before the age of five. Our impact as therapists in development of new neural pathways and subsequent new communicative skills is proven.Â Never underestimate a child’s potential by fixating on what may be sensory differences and not a true spectrum disorder.
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