In summary, the available literature on young, mostly preverbal children with ASD suggests there are several variables related to facets of the child’s development as well as caregiver-child interaction variables that relate to the child’s developing language and communicative abilities. These include the child’s development of play and imitation skills, following of attention cues provided by others, and the child’s own preverbal intentional communication, as well as the tendency of caregivers to use perceptually salient cues, and to comment in a nondemanding way on the objects and events that engage the child’s interest. In the remainder of this article, we will use this background information as a framework for describing assessment and intervention strategies appropriate for toddlers with ASD. In addition, due to the important role of parents and other caregivers in the development of young children with ASD, we will address the sources of stress and needs for support for families of these children.
The ultimate purpose of a comprehensive communication assessment is to develop a communicative intervention plan (Marcus & Stone, 1993). Gillingham (2000), a well-respected teacher of individuals with ASD, suggests that the professionals’ role is not to “teach” communication but to “find it”. Regarding children with autism, Gillingham says, “They may not be using words. Their gestures may not exactly match ours. Their behavior may appear ‘inappropriate.’ All of this is communication. If and when we take the time and make the effort to observe and to listen, we can and will understand (p. 111).” The communicative assessment should, thus, provide careful and systematic attention to the characteristics of the environment and interactive partners that help produce or facilitate communicative acts; the goal being to “find” what motivates the child to communicate and how s/he communicates, in order to support the child and family in expanding on current interests and abilities (Peck, 1989).
The communication assessment should include analysis of not only the affected child, but also the social contexts between the child and primary caretakers (Warren, Yoder, & Leew, 2002). This will require the examiner to understand the crucial role of families in the assessment and intervention process for toddlers, consider his or her own beliefs about families and disability, and encompass the competencies to assess the child’s social-communicative understanding, communication means, communication functions, and play behaviors (Wetherby, Prizant, & Schuler, 2000). The professional evaluating and/or treating the child with an ASD and their family may find it helpful to reflect and self-evaluate their own attitudes and beliefs concerning child development and the role of families, as the children’s ultimate success is contingent on not only their own abilities, but also the ability of the adults in their lives to facilitate their growth (Kluth, 2004). This introspection may later be used to help families of children with autism adapt their style to best meet the needs of their child, an important professional purpose as parents are often less aware of the centrality of language comprehension compared to expressive language abilities, or assume that their child understands what they say (Marcus & Stone, 1993).