Developing and Implementing Early

Intervention Plans for Children with Autism

Spectrum Disorders
Vanessa Khouri Smith, M.S., CCC-SLP,1 and Ann Dillenbeck, Ed.S.2

ABSTRACT

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Autism spectrum disorder (ASD) is a complex neurobiological
disability that affects communication, social interaction, and behavior and
can now be reliably diagnosed in children as young as 2 years of age.
Research indicates that intensive early intervention is critical for improving
outcomes for children with ASD and their families. There is, however, scant
research describing effective intervention programs for children under the
age of 3. Because communication is one of the core developmental areas
affected by ASD and is likely to be an area parents consistently identify as a
priority, speech-language pathologists are in a critical position to support
children with ASD and their families at the earliest stage of intervention.
The purpose of this article is to present promising practices for speech-
language pathologists to use while collaboratively developing and imple-
menting early intervention plans for children with ASD and their families.

KEYWORDS: Autism spectrum disorder, early intervention, collaborative

teaming, home visits

Learning Outcomes: As a result of this activity, the reader will be able to (1) define a routines-based interview
and describe its purpose; (2) define three types of support speech-language pathologists provide families during
home visits; (3) define three alternative domains to address when implementing a child’s early intervention
program; and (4) list three strategies teams could use to evaluate the effectiveness of an early intervention plan.

I n the field of early intervention, there is a (ASD) is a complex neurobiological disability

unique opportunity to promote positive out- that affects communication, social interaction,
comes for children with some of the most and behavior.1 The call to support young
significant needs. Autism spectrum disorder children with ASD and their families has

Language, Social, and Cognitive Communication in Children with Autism Spectrum Disorders; Editors in Chief, Audrey
L. Holland, Ph.D., and Nan Bernstein Ratner, Ed.D.; Guest Editor, Patricia A. Prelock, Ph.D., CCC-SLP. Seminars in
Speech and Language, volume 27, number 1, 2006. Address for correspondence and reprint requests: Vanessa Khouri Smith,
Visiting Nurse Association of Chittenden and Grand Isle Counties, 1110 Prim Road, Suite 1, Colchester, VT 05446. E-
mail: zekesmith@tds.net. 1Speech-Language Pathologist, Visiting Nurse Association of Chittenden and Grand Isle
Counties, Colchester, Vermont; 2Developmental Educator, Parent to Parent of Vermont, Williston, Vermont. Copyright
# 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.
0734-0478,p;2006,27,01,010,020,ftx,en;ssl00256x.
10
 EARLY INTERVENTION SERVICES FOR ASD/SMITH, DILLENBECK
intensified as the prevalence of the disorder
increases and professionals and families recog-
nize that early intervention supports the long-
term outcomes for these children. Children
suspected of having ASD are now being re-
ferred for evaluation at earlier ages, and ASD
can be reliably diagnosed by 2 years of age.2,3
When a child is diagnosed at this young age,
the delivery of early intervention services can
lead to an increase in social engagement and
language use for the child4 and satisfaction with
family routines for the parents.
The efficacy of early intervention for chil-
dren with differences or delays in development
is well documented5 and early intervention has
led to positive outcomes as measured by gains in
language and IQ scores for preschool-aged
children with ASD.2,6 If early intervention for
preschool-aged children with ASD correlates
with more positive outcomes, how can speech-
language pathologists (SLPs) best make use of
the opportunity presented by the recent trend
toward diagnosis of children with ASD at 24,
18, and even 12 months of age? Because com-
munication is one of the core developmental
areas affected by ASD and is likely to be an area
parents identify as a priority,7 an SLP may be
one of the first professionals contacted when a
child is suspected of having, or is diagnosed
with, ASD. As such, SLPs play a critical role in
supporting children with ASD and their fam-
ilies in the earliest stages of intervention. While
more investigation is needed about what types
of intervention are most successful with this
young age group,2,3 SLPs can draw upon
knowledge of how young children learn and
the intervention research for children over 3
with ASD in order to work successfully with
the youngest children with ASD and their
families. The purpose of this article is to present
promising practices for SLPs to use while
collaboratively developing and implementing
early intervention plans for children with
ASD and their families.
DEVELOPING THE EARLY
INTERVENTION TEAM
Given the complex nature of ASD, it is likely
that several professionals will be involved with a
child who has ASD and his or her family. This
11
underscores the need for effective teaming
among professionals to coordinate the evalua-
tion, develop and implement an early interven-
tion plan, and evaluate the plan’s success. Team
approaches reflect best intervention practices
for children with ASD and their families8,9
and involve collaboration among individuals
who establish a joint purpose and shared goals
and are organized to implement these goals.
The Central Role of the SLP
As the team forms and identifies child and
family outcomes, the SLP often assumes a
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central role. Many of the abilities and behaviors
teams choose to address depend upon the
child’s overall communication ability and spe-
cifically the child’s social communication. SLPs
contribute to collaboration among team mem-
bers by clearly describing next steps to target in
the development of communication skills, shar-
ing data sheets so all team members participate
in tracking progress, and planning covisits to
develop strategies simultaneously with the
child’s caregivers and other therapists. At
team meetings, SLPs join in the conversation
about each outcome and look to the family first,
then to other team members, when addressing
the child’s progress in applying communication
skills during various routines.
Selection of Team Members
Although an SLP, a developmental educator
(DE), or behavior specialist, and an occupa-
tional therapist with a background in sensory
processing are often central players on early
intervention teams for children with ASD and
their families, this constellation may not be
necessary or complete, or it may change over
time as the team or family identifies additional
or different needs. The following scenario il-
lustrates the evolution of an early intervention
team based on family priorities and the training
and experience of each professional.
FLEXIBILITY WHEN DEVELOPING THE EARLY
INTERVENTION TEAM
A medical social worker, an SLP, and a DE had
conducted the assessment for Savannah and her
family. Savannah’s mother requested that her
12 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 27, NUMBER 1
early intervention team remain small as she
was concerned about being pulled in many
directions and did not want to be drawn into
additional relationships with different service
providers. Fortunately, the team’s SLP had
training and experience with feeding issues in
young children. Similarly, the team’s DE was
well versed in community resources and could
connect the family with child-care options and
sign language classes. Savannah had no cur-
rent medical conditions. The team selected
the SLP and DE to support the family in
designing the early intervention program for
Savannah, with the DE to provide both spe-
cialized instruction and service coordination.
In this way, the following outcomes could be
addressed while meeting the family’s goal of a
small team:
*
Savannah will eat independently at the dinner
table with her family, without watching TV.
*
Savannah will take at least two turns in each
of three interactive games with her siblings.
*
Using a sign, picture, or words, Savannah will
ask for help when she cannot do something
on her own.
*
Savannah’s mother will have child care while
she attends a sign language class.
Family-Centered Intervention
While team structures may be different for each
child and family, there is one person whose
presence is critical: the primary caregiver. This
is usually the parent, or parents, of the child
with ASD. Research suggests that intervention
approaches that are grounded in a family-cen-
tered framework are best practice for meeting
the needs of children with ASD and their
families.9,10 Family members are the experts
on their child. The family’s knowledge of their
child and their priorities will guide the team in
understanding their child, the family system,
the child and family’s strengths and challenges;
in creating the team composition; and in devel-
oping the early intervention plan. By including
family members in regular team meetings for
children with ASD and their families, teams
can develop coordinated intervention recom-
mendations that are based on a shared under-
standing of what is most likely to benefit
2006
the child and address the needs and concerns
of the family.
DESIGNING AND IMPLEMENTING
THE EARLY INTERVENTION PLAN
In a review of intervention programs, commu-
nication has been identified as one of the
primary areas of intervention for children with
ASD.6 When working with families and teams
to develop the early intervention plan, SLPs
should take into consideration the guidelines
characteristic of effective interventions for
young children presented by the National
Research Council.2 These guidelines include:
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(1) participation in an intervention program
at the time of diagnosis; (2) a minimum of
25 hours a week of systematically planned
intervention provided 12 months a year; and
(3) sufficient adult attention during one-to-one
or small group instruction.
Given the heterogeneity between children
with ASD and their families, it is likely that
each child’s early intervention plan will be
different. The actual implementation of the
National Research Council’s recommendations
will vary depending upon several factors includ-
ing the child and family; the age of the child;
the significance of the symptoms of ASD; the
child’s rate of progress, health, and tolerance for
intervention; and the family’s intervention
needs.
Designing an early intervention plan for a
child with ASD and his or her family will
require several skills from the professionals
and family engaged in the process. An effective
plan requires not only a comprehensive under-
standing of the child and family’s routines, but
the use of routines-based intervention,11 inter-
vention that focuses on three alternative
domains (i.e., engagement, independence, and
social relationships) within daily routines, as
opposed to a focus on discipline-specific do-
mains11; support-based home visits11; regular
evaluation of the plan and progress toward
outcomes; and a plan for transitioning to pre-
school services. Each of these components is
presented in Table 1. The components are
described below and strategies and/or examples
are shared that teams might use to support
their intervention planning process.
 EARLY INTERVENTION SERVICES FOR ASD/SMITH, DILLENBECK 13

Table 1 Process for Designing and Implementing the Early Intervention Plan
 Develop the early intervention team.
 Develop a comprehensive understanding of the child and family’s strengths and challenges by interviewing
the family about their day-to-day life.
 Design early intervention goals based on family priorities and specific daily routines at home and/or day care.
Focus on three alternative domains: engagement, independence, and social relationships within specific
daily routines.
 Provide support-based home visits.
 Evaluate plan and strategies and revise as needed.
 Develop transition plan.

Understand the Routines and practical terms. In addition, it encourages

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The 1997 Amendments to the Individuals with
Disabilities Education Act highlights the need
for early intervention services to occur within a
child’s natural environment.12 For children in
the birth to 3-year-old population, the natural
environment typically consists of home, child
care, or community groups (e.g., play groups).
Within the natural environment, a child and
family’s routines and child-care routines are
recognized as optimal opportunities for teach-
ing new skills.3,12,13 Routines are defined as the
everyday activities that occur in a child and his
or her family’s life14 and include activities such
as waking up, eating a meal, going on an outing,
getting dressed, or playing a game. The possi-
bility of daily routines providing opportunities
for learning may seem contrary to what fami-
lies, and maybe some professionals, typically
view as effective intervention contexts. How-
ever, daily routines naturally offer structure and
predictability, both of which are important for
teaching children with ASD. Greater amounts
of time spent in engaged learning activities is
known to support long-term outcomes for
young children with ASD,2 and intervention
provided within daily routines can maximize
the amount of time a child participates in
learning activities.11,13
families to think about family-based outcomes
(e.g., finding affordable housing, being able to
travel safely in the car, teaching siblings about
ASD, or identifying respite options) as well as
more child-centered outcomes, such as increas-
ing engagement by responding to invitations of
peers.
To help families identify functional out-
comes for their child and themselves, SLPs can
collaborate with other professionals to conduct
a Routines-Based Interview developed by
Robin McWilliam.14 During this interview, a
family member and one to two providers meet
to discuss the family’s main concerns about the
child, review the daily routines and how the
child participates in them, and set priorities for
developing the early intervention plan.
The Routines-Based Interview can also be
used with other regular caregivers such as child-
care providers. Many young children spend
their days, or part of their days, in some type
of child-care situation. While quality child-care
programs offer consistent and predictable
routines and regular opportunities for learning
social skills,15 it is not enough to simply have
children with ASD participate in these types of
programs. Incorporating supports for children
with ASD in child-care settings involves
understanding the child-care routines.

Routines-Based Interview ROUTINES-BASED ADAPTATION

When SLPs first ask families about their goals
and priorities, families often provide very gen-
eral statements specific to their child. Thinking
about the sequence of their day, and each family
member’s actions as the day unfolds, helps
families articulate outcomes in more specific
In Liam’s child-care setting, for a brief time
every morning, the children were invited to join
in singing, dancing, and moving ribbons tied to
bright rings. Although Liam, a 33-month-old
boy with ASD, remained on the periphery
of the group, he always copied some of the
14 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 27, NUMBER 1
teacher’s and children’s movements and di-
rected his attention to the group during this
cheerful and active time. Together, Liam’s
teacher and SLP developed a set of song cards,
with pictures and words, from which the chil-
dren could select the next song to be played.
When the teacher asked Liam to bring the
cards to the group and select the first one, he
did and often remained in close proximity for
the rest of the activity. In this setting, the SLP
was able to design individual adaptations and
supports for Liam, augmenting the develop-
mentally appropriate and motivating commu-
nication that was already in place.
PROVIDE INTERVENTION THAT
FOCUSES ON ALTERNATIVE
DOMAINS
McWilliams11 suggests early intervention
teams consider three alternative domains (i.e.,
engagement, independence, and social relation-
ships) as opposed to discipline-specific ones
when developing early intervention plans.
These domains are consistent with recommen-
dations from the National Research Council2
that identify personal independence and social
responsibility as appropriate goals for children
with ASD. Each of these areas is described with
examples of application to young children with
ASD and their families.
Engagement
Engagement is defined as ‘‘the amount of time a
child spends interacting with the environment
in a developmentally and contextually appro-
priate manner at different levels of compe-
tence.’’16 For children with ASD, joint
attention, or the capacity to communicate for
social purposes, is particularly challenging17
and is considered an important target for early
intervention. The strategies to develop a child’s
social connection may take various forms, but
the application of key principles from early
intervention increase the likelihood for success
at encouraging this critical area of development.
One of these key principles is the use of child-
directed activities. Child-directed activities fol-
low a child’s interests13 and have been found to
increase engagement.18 By capitalizing on a
2006
child’s interests and strengths within natural
routines, SLPs and family members can work
together to create numerous learning opportu-
nities throughout the day.
FACILITATING ENGAGEMENT WITHIN A
CHILD-DIRECTED ACTIVITY
Ning seemed most responsive to adults during
active games that involved jumping, rocking, or
swinging. Given this, the adults engaged Ning
by singing Row, Row, Row Your Boat while
seated face-to-face on the floor with him,
holding hands, and rocking in rhythm with
the tune. At the end of the song, much to
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Ning’s delight, the adult provided strong tickles
and said in an animated voice, ‘‘tickle, tickle,
tickle.’’ After repeating this game over several
weeks, Ning would come and sit with the adult
when she began singing the song. He made
frequent eye contact while rocking face to face,
and, during a pause before the tickle, tickled
himself and imitated the intonation of the
adult’s ‘‘tickle, tickle, tickle.’’ By using child-
directed activities, Ning’s mother was able to
address Ning’s social communication needs to
support his development of reciprocal interac-
tion and verbal imitation.
Independence
Independence is evident when children are able
to participate in daily routines without adult
support. Many families with children who have
ASD find themselves doing more for their child
than they might for another child, as children
with ASD typically have difficulty orienting to
and learning the various tasks for independence
within daily routines. For example, during
snack time, a family member may simply select
a snack item for their child, bring their child to
the eating area, and help the child eat the snack.
This type of routine, however, offers numerous
opportunities to develop a child’s independence.
A variety of social interaction and communica-
tion goals can easily be incorporated in the daily
routines and support a child’s independence.
DEVELOPING INDEPENDENCE WITHIN ROUTINES
Working toward independence within daily
routines for Matthew entailed reviewing his
and his family’s daily activities (e.g., meal
 EARLY INTERVENTION SERVICES FOR ASD/SMITH, DILLENBECK 15

time, getting dressed, taking a bath) and iden-
tifying a particular component of the activities
that he could be supported in performing in-
dependently. For example, Matthew’s family
selected the simple direction of ‘‘get
your____’’ for three routines. By providing
Matthew with visual cues, verbal direction,
and direct hand-over-hand support, he was
eventually able to get his own spoon for meals,
get his towel for baths, and get his shoes from
the closet for dressing. This met the family’s
goals of helping Matthew follow more direc-
tions and it led toward increased independence.
recognized this game as an excellent opportunity
for supporting Thomas’s social relationship with
his brother and turn-taking skills. Thomas had
excellent verbal imitation skills and quickly
learned how to spontaneously say ‘‘my turn,’’
and this game became a pleasant experience for
all family members. The SLP and the family
then decided upon additional social phrases that
Thomas could use during this game (e.g., ‘‘This
is fun!’’ or ‘‘Watch me.’’)
PROVIDE SUPPORT-BASED
HOME VISITS

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Social Relationships
As mentioned previously, children with ASD
typically communicate for purposes of behavior
regulation and demonstrate challenges in using
communication for social purposes.17 Specific
strategies for supporting children’s social com-
munication development within integrated set-
tings are now part of many children’s programs.
In addition to systematically supporting child-
ren’s development of social relationships in
integrated settings, SLPs can support families
in developing social relationships between
siblings.
FACILITATING SOCIAL RELATIONSHIPS
Thomas was a 2½-year-old boy with ASD who
lived with his older brother who was 4½ years,
Scott, and his mother and father. Thomas and
Scott loved to rough-house with their father and
particularly enjoyed a game where their father
would pick them up and help them flip over. If
Thomas saw Scott engaging in this game with
his dad he would want to participate, but he did
not know how to let people know this other than
to fuss or stand in proximity to his father and
wait for his father to read his cues and ask him if
he wanted a ‘‘flip.’’ Thomas’s SLP and family
Any family receiving early intervention services
may look for a broad range of support, from
processing emotional issues to deciphering
technical information related to their child’s
disability, delay, or medical condition. For
families whose child has been diagnosed with
ASD, this support is essential in helping fam-
ilies determine what the diagnosis means, what
treatments they will seek, and what resources
will best support them as they confront new
challenges over time. The types of supports that
are typically provided to families during home
visits have been categorized as emotional,
material, and informational supports.11 Parents
have shared with the authors that their need for
all three support categories is especially signifi-
cant during the time their child is first diag-
nosed with ASD. The three types of support
and examples of each are shown in Table 2.
A discussion of these supports and examples
for children with ASD and their families is
provided in the following paragraphs.
Emotional Support
As expected, each family has a unique defini-
tion of support. For most parents, though, some
connection to other parents of children with

Table 2 Types of Support for Families during Home Visits

Three Types of Support Examples

Emotional Support groups, parent match, counseling

Material Funding, voice-output communication aides, pictures for visual support systems
Informational Types of intervention available, community resources, information about how
a child learns, diagnostic characteristics
16 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 27, NUMBER 1
ASD is invaluable. For one parent of an 8-year-
old with autism, along with 54 others in the
year 2004, that connection came through Pa-
rent to Parent of Vermont: a nonprofit organ-
ization that offers a variety of programs and
services that support families with children with
special needs. Through Parent to Parent, pa-
rents may participate in a one-to-one match to
talk with a parent who has had a similar
experience.
EMOTIONAL SUPPORT: VIGNETTE FROM
MOTHER OF 8-YEAR-OLD WITH AUTISM
‘‘When I think back to those awful days after
receiving my daughter’s diagnosis, I remember
how alone we felt. There were only three people
I could express my grief to: one was a friend
who grew up with a sister with a developmental
disability; one was a wonderful person at Parent
to Parent of Vermont who shared my family’s
struggles with me the first day I went looking
for help; and the last was my parent match from
Parent to Parent of Vermont, who shared her
daughter’s progress without glossing over how
hard it had been. These three people were the
only ones I cried with. With our other friends
and family, I kept the utter terror and heart-
break to myself and remained upbeat. This is
why I love Parent to Parent: there is no sub-
stitute for connecting with another parent
who’s walked in your shoes.’’
Some parents seek membership in a family
support group instead of, or in addition to, a
parent match. Again in Vermont, Autism Sup-
port Daily provides both in person and online
meetings. Their web site notes that, ‘‘Topics
discussed include but are not limited to the
gluten free/casein free diet, medical interven-
tions for removal of heavy metals, ABA, DTI,
RDI and other forms of interventions, parent-
to-parent support, education, services and other
topics our members would like to discuss.’’
Between January and July of 2005, members
posted an average of 541 messages a month,
providing and soliciting emotional, material,
and informational support.
Material Support
For many families, material support must pre-
cede systematic implementation of the early
2006
intervention plan. This type of support may
include equipment, informational materials,
and/or financial resources and, again, requires
SLPs to expand their traditional role. Providing
material support may require guiding a family
through the application for a Medicaid waiver,
ordering a Rifton chair (used for trunk sta-
bility), or organizing a book to store picture
symbols used for communication. While an
SLP may not be directly responsible for
completing all these tasks, she or he might
help the family recognize the need for material
support and connect them with the appropriate
resources.
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MATERIAL SUPPORT: DYLAN’S STORY
Dylan, a 30-month-old boy with ASD, lived
with his grandparents. While they worked,
Dylan attended a home-based child-care center
with a caregiver and four other children. At the
caregiver’s home, Dylan watched TV, played
with the caregiver’s dogs, napped, and ate lunch
and snacks. The caregiver did not welcome the
service providers on Dylan’s early intervention
team. As a result, a change in child-care place-
ment was identified as a primary need because
his grandparents were seeking to maximize
intervention during his day. Although they
had begun the search for a quality child-care
program, they could not afford increased tui-
tion and knew Dylan would not be successful,
or possibly even welcomed, without the support
of an individual assistant.
Dylan’s early intervention team sought and
secured funding for his family to meet their
goals. These are the solutions they identified:
*
Funding through the local resource and re-
ferral agency for attendance at a registered,
developmentally appropriate program. Dy-
lan’s grandparents completed the application
for and were granted both a child-care sub-
sidy for working parents and family support
funds for families in crisis.
*
One-to-one support for Dylan while he was
at child care through a grant for individual
assistance (through the Family, Infant, and
Toddler Program and the Childcare Services
Division of the Agency of Human Services)
and Personal Care hours through statewide
Medicaid. Dylan’s full day at child care
 EARLY INTERVENTION SERVICES FOR ASD/SMITH, DILLENBECK
encompassed both his instructional program
and hours of custodial care. Together, the
child-care center and the family employed
one person to fulfill both roles.
By addressing both the family’s needs (i.e.,
for child care while they worked and for
planned intervention while Dylan was in a
social setting) as well as the child-care center’s
needs (i.e., for safety and an individualized
program for Dylan), this early intervention
team set the stage for constructive intervention
between visits by service providers. Before suc-
cessfully implementing Dylan’s program, the
team needed to provide material support so
that his child-care placement would be condu-
cive to both services and intervention.
Informational Support
Those who care for children with ASD have a
range of information about the diagnosis and
available treatments. The validity of the infor-
mational support they receive from professio-
nals, the Internet, the popular press, and from
friends will vary. It is important for SLPs to
have knowledge about evidence-based inter-
vention approaches and other possible ap-
proaches, to help families seek relevant
information and understand their intervention
options. By providing unbiased information,
family’s choices or interests are honored. SLPs
also need to help families balance the informa-
tion they obtain with what is known about their
child’s needs, strengths, and learning style.
INFORMATIONAL SUPPORT: ZOE’S STORY
Zoe is a 3½-year-old girl with ASD who
communicates via unconventional vocalizations
and gestures primarily to regulate others’
behavior. Her early intervention team began
services when she was 2½ and recommended
using Picture Exchange Communication19 as a
primary communication modality, as this was
the system Zoe had started with another pro-
vider. Zoe initially used this system successfully
during highly structured activities to request a
few preferred items. Zoe had difficulty moving
toward spontaneous exchanges and differenti-
ating pictures, and eventually used only one of
her pictures for requesting a social activity with
17
her parents. After several months of frustration,
Zoe’s SLP talked with the family about the
challenges Zoe was having and their frustration
with a system that did not work for them. The
SLP suggested use of a voice-output commu-
nication aid (VOCA). Zoe’s family was willing
to try a VOCA, but expressed concern about
Zoe becoming less willing to attempt using
verbal communication if she used a VOCA.
The SLP provided information to the family
about speech development in children using
augmentative alternative communication. After
receiving this information, the family decided
to integrate a VOCA into three daily routines.
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Zoe demonstrated immediate success with a
single-level VOCA and was able to discrim-
inate messages to request a variety of snack
items, participate in turn-taking with her sib-
ling, and answer yes/no questions.
In the example of Zoe, the SLP was able to
provide information to the family about addi-
tional strategies to support Zoe’s communica-
tion, listen to the family’s concerns about the
challenges of using Picture Exchange Commu-
nication19 and about using a VOCA, and offer
suggestions that met Zoe’s and the family’s
needs.
During the time families with children
with ASD receive early intervention services,
they are learning about their child, themselves
in a new context, and the supports and resour-
ces available to them. The emotional, material,
and informational support SLPs can offer helps
prepare families to be knowledgeable advocates
for their children as they approach their third
birthday and the transition to preschool.
The Central Role of the SLP
SLPs must broaden their service agenda beyond
discipline-specific consultations when partici-
pating in home visits and adopt a broader role
that includes family support. As therapists who
may have known the child and family from the
start of services, they are often approached with
questions about terminology, treatment ap-
proaches, placement decisions, and funding.
SLPs familiar with a variety of resources can
help families address their most pressing needs,
thereby enabling parents and other caregivers to
provide skilled intervention between provider
18 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 27, NUMBER 1
visits. SLPs can also be family advocates, ensur-
ing that family goals are reflected in the early
intervention plan. Further, they can provide
families with the emotional, material, and in-
formational support they need and/or help
families access the resources that can provide
the needed support.
EVALUATE THE EARLY
INTERVENTION PLAN
Once the early intervention team has conducted
the Routines-Based Interview and develop-
mental evaluations, families and professionals
should have a shared understanding of a child’s
strengths, needs, and learning style. With
this information, family members and profes-
sionals work collaboratively to create specific
strategies to use within routines to support
meaningful outcomes. As the early interven-
tion team implements these strategies, team
members must evaluate their effectiveness,
feasibility, and relevance.
Intervention strategies are effective if they
promote both the child’s developmental prog-
ress and the family’s satisfaction with the daily
routines. Effectiveness for the child may in-
clude development of intentional and symbolic
requesting skills around particular routines,
such as snack time. Similarly, parents may
report increased satisfaction with snack time
as their child learns to intentionally communi-
cate when he desires something to eat and then
requests a food choice by using symbolic com-
munication (e.g., pictures, words, or signs).
In addition to evaluating the effectiveness
of particular strategies, teams will also want to
know if strategies are feasible for family mem-
bers, other caregivers, or individual assistants to
implement. Given the strength of children with
ASD in processing visual information, an SLP
might suggest using Picture Exchange Com-
munication19 to teach requesting and symbolic
communication. This strategy, though, may be
difficult for individuals in the initial stages if
the child requires hand-over-hand assistance to
give a picture to an adult who has a desired
item.
Finally, teams will need to evaluate the
relevance of their outcomes and strategies: do
they continue to reflect the family’s priorities
2006
and wishes? Strategies to promote symbolic
communication using visual supports are prob-
ably going to be less relevant as a child develops
verbal imitation.
Several methods for evaluating the effec-
tiveness of an early intervention plan are avail-
able for SLPs or other service providers to use.
Regularly scheduled team meetings offer op-
portunities for early intervention teams to cel-
ebrate a child and family’s progress, identify
new outcomes, and refine current strategies.
Videotaping a child in the home or at child
care provides excellent documentation of com-
munication and social interaction skills not
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typically assessed through standard language
testing protocols. Single-subject research de-
signs, as well as ecologically valid measures,
are additional methods teams can use to
measure a child’s progress.3
PLAN FOR TRANSITION
In Vermont, as in many states, children with
ASD make the transition from early interven-
tion to special education services at 3 years of
age. For some families, this means building
relationships with a new group of professionals.
It also means learning about new rights and
responsibilities under an educationally based
system. The skill with which SLPs, along
with other professionals from the early inter-
vention team, partner with families to share
information across teams, compare and contrast
the two systems, and identify additional com-
munity resources, helps shape the quality of this
transition for families.
Fortunately, communication skills are
understood to be integral to children’s educa-
tional outcomes. Preschool teams request
detailed reports from SLPs about children’s
current communication profiles, including spe-
cific strengths and challenges and successful
learning opportunities. By presenting these
skills within the context of family and com-
munity routines, SLPs lay the groundwork for
establishing functional Individualized Educa-
tion Plan (IEP) goals that address a family’s
priorities. With the family’s permission, the
early intervention team should notify school
districts as soon as possible that the child has
received the diagnosis of ASD and is receiving
 EARLY INTERVENTION SERVICES FOR ASD/SMITH, DILLENBECK
intense early intervention services. Ongoing
communication between the sending and re-
ceiving SLPs, through covisits and the attend-
ance of preschool service providers at early
intervention team meetings, reduces disconti-
nuity and conveys to families a reassuring sense
of partnership between the two systems.
Families are the most accurate source of
information about how to design a smooth
transition between early intervention and spe-
cial education services. One parent described
her wish for a parent mentor to accompany
families during their first few meetings with
school district professionals this way: ‘‘This
mentor would be someone with a child that
has been through the system . . . . A mentor
who could tell a parent what programs are
available, give guidance as to what is within
their rights, and generally model what a parent
advocate role should be.’’ This same parent cites
time to build new relationships as another key
factor, ‘‘An area that I thought did go well
during our transition was that our child visited
her new classroom before she became a student,
and we hired her school aide privately to allow
them time to bond before school began.’’
THE REWARDS: RESULTS OF EARLY
INTERVENTION
SLPs providing early intervention for children
with ASD and their families have a unique
opportunity to support their long-term out-
comes, despite the current lack of intervention
research for children younger than 3. Until this
research becomes available, various frameworks
from early intervention research and interven-
tion practices for preschool-aged children with
ASD can positively influence the practices of
SLPs working with the youngest children being
diagnosed with ASD.
Most children with ASD and their families
will require support from a team of professio-
nals. To the extent that they wish, it is critical
that family members be active participants on
the team. Use of a team construct and a family-
centered care approach will enable SLPs to
collaboratively develop and implement early
intervention plans.
SLPs using routines-based interviews,
routines-based intervention, and alternative
19
domains can provide an appropriate individu-
alized early intervention plan that views the
child and his or her family in the context of
their daily life. Child and family goals are
identified and addressed using these processes.
The child’s growth is measured not by disci-
pline-specific changes, but by global changes in
the child’s ability to be engaged, independent,
and socially interactive. Families also have
their goals addressed and experience greater
satisfaction with their family routines.
As families first learn of their child’s diag-
nosis, formal and informal supports are as
important for the child and family as is specific
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intervention. By providing home visits that are
support based, SLPs can help families become
better informed, emotionally supported, and
equipped with needed materials and resources.
This is an important component of early inter-
vention particularly as a child approaches the
transition to a school-based program that typ-
ically focuses on educational goals.
Finally, SLPs who have provided early
intervention services for children with ASD
and their families are able to inform school-
based providers of a child’s strengths, chal-
lenges, and response to intervention and help
shape an IEP that reflects the child’s strengths
and challenges. In this way, when children and
families exit the birth-to-3 system, they are
poised to access community supports, work
collaboratively with a new team, and further
enrich their daily routines with new skills and
strategies.
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