LSHSS

Training and Knowledge in Autism

Among Speech-Language Pathologists:
A Survey
Heatherann Schwartz
Kathryn D. R. Drager
The Pennsylvania State University, University Park

A utism is believed to be the fastest growing develop-

mental disability in the United States today. It is
estimated that the prevalence of all types of autisim
is approximately 60 persons for every 10,000 (Fombonne, 2005).
With each passing year, the prevalence of autism appears to be
stereotyped interests were all required for a positive diagnosis of
autism, in addition to an “early onset during childhood” (APA,
1987). With the publication of the DSM–IV (APA) in 1994, diag-
nostic criteria were fine tuned, and a more precise onset of before
3 years of age was established.
rising across the United States and throughout the world. Even with
extensive research currently being conducted, there are still many Autism and Speech-Language Pathology
questions about this puzzling disorder that remain unanswered.
Since Kanner’s first report of autism in 1943 (Kanner & In order for a child to receive a diagnosis of autism using the
Eisenberg, 1956), the diagnostic criteria for autism have changed criteria established in the DSM-IV, the child must exhibit at least one
considerably. The publication of the Diagnostic and Statistical diagnostic criterion falling into the category of “qualitative im-
Manual of Mental Disorders, 3rd edition, revised (DSM–III–R; pairments in communication” (APA, 1994, p. 70). Beyond this,
American Psychological Association [APA]) in 1987 significantly social interaction impairments also have a significant effect on com-
altered all previous diagnostic criteria for autism in specific terms. munication, specifically social communication and pragmatics. As
Although a focus on core deficits in social interaction, communi- deficits in communication are a diagnostic criterion for autism,
cation, and behavior has been fairly consistent throughout, it was speech-language pathologists (SLPs) should be knowledgeable
in the DSM–III–R that the notion of the triad of impairments about this disorder.
was first specifically documented. Deficits in the areas of social Recently, the American Speech-Language-Hearing Association
interaction, verbal and nonverbal communication, and repetitive (ASHA) published a series of documents outlining guidelines and

ABSTRACT: Purpose: The current study was designed to answer of diagnostic criteria for autism. Although most participants did
the following questions: (a) What knowledge do school-based address autism at some level of their educational training, little
speech-language pathologists (SLPs) have concerning autism? time was spent discussing the topic. Additionally, some SLPs lack
(b) What educational and clinical training do SLPs receive in confidence in their abilities to provide services to children with
autism? (c) Do SLPs have confidence in their ability to provide autism.
services to children with autism and their families? Conclusion: The return rate for participants was small, and it is dif-
Method: An original 52-item survey was designed to answer the ficult to generalize the results. However, the majority of respond-
research questions. Participants were recruited through e-mail and ents reported that they could have benefited from additional training
were asked to respond to a Web-based survey. in the area of autism. As a result, it may be necessary to consider
Results: Sixty-seven school-based SLPs practicing in 33 states strategies for providing this training.
across the United States responded to the survey. Most partici-
pants had accurate knowledge about the characteristics of KEY WORDS: autism, training, knowledge, diagnosis,
children with autism; however, they had mixed perceptions characteristics, survey

66 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS • Vol. 39 • 66–77 • January 2008 * American Speech-Language-Hearing Association
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 the roles and responsibilities of SLPs in the diagnosis, assess- the area of social and emotional characteristics, it was discovered
ment, and treatment of autism spectrum disorder (ASD) (ASHA, that although the autism specialists viewed autism as a developmen-
2006a, 2006d). These documents clearly specify that SLPs, among tal disorder, many of the other professionals considered autism to
other members of the team, play a critical role in screening, diag- be rooted in emotional factors. Many of the professionals agreed
nosing, and enhancing the social communication of individuals that children with autism are unable to show emotional attachment,
with autism (ASHA, 2006d). Additionally, the Child Neurology a statement with which the autism specialists disagreed. When
Society and the American Academy of Neurology, through a multi- asked about cognitive features, the autism specialists and the clini-
disciplinary consensus panel, have stated that all professionals in- cal specialists disagreed with the statement that all children with
volved in early health care, including SLPs, need to be familiar with autism possess special talents; all the other professionals agreed with
the signs and symptoms of autism and be able to recognize the need this statement. Except for pediatricians, all remaining professionals
for further diagnostic evaluation (Filipek et al., 1999). Specifi- agreed that most children with autism do not speak. In the area of
cally, SLPs have responsibilities at both the screening level and descriptive features, all of the professionals (excluding the autism
the diagnosis and evaluation level of autism (Filipek et al., 1999). specialists) viewed autism as a more temporary disability that exists
With the increased prevalence of children with autism, the only in childhood (Stone, 1987).
majority of SLPs working in the public schools will have children Stone’s 1987 study clearly demonstrated that many profes-
with autism on their caseloads. In a report issued by the Center sionals in many disciplines did not possess accurate knowledge
on Personnel Studies in Special Education, 82.8% of school-based about autism and how it manifested in children. With changes in
ASHA-certified SLPs regularly serve students with autism /pervasive the prevalence of autism, professionals in the medical and educa-
developmental disorder (PDD) (Whitmire & Eger, 2003). The tional fields can no longer consider autism a low-incidence disorder.
field of speech-language pathology encompasses working with a Stone’s research demonstrates the need for SLPs to receive special-
large variety of populations. It is clear, however, that school-based ized training regarding autism in order to adhere to the responsi-
SLPs need to develop specialized competencies to serve children bilities outlined by ASHA, including screening, diagnosis, assessment,
with autism. It will be incumbent on professionals to seek out the and intervention, among others (ASHA, 2006d).
knowledge and develop the skills necessary to serve individuals with More recently, Cascella and Colella (2004) conducted a survey
ASD (ASHA, 2006b). of SLPs in Connecticut to determine their knowledge regarding
A body of literature exists within the field that is designed to PDD. The authors used Likert-type scale questions and self-report
evaluate the clinical and educational preparation of SLPs to work measures to explore practicing SLPs’ preparation to work with
with different populations. The current literature explores training students with PDD and their knowledge regarding behavioral char-
areas such as working with persons who stutter (Brisk, Healey, acteristics of PDD. Results indicated that preprofessional training
& Hux, 1997; Cooper & Cooper, 1985; Kelly et al., 1997), work- regarding autism is an area of great need within the field. As dis-
ing with children who also demonstrate impairments in reading cussed by Cascella and Colella, one of the limitations of this study
(Casby, 1988), working with children with hearing impairments is that regional bias may have existed. All participants in the study
(Moseley, Mashie, Brandt, & Fleming, 1994), working with clients were currently practicing in the state of Connecticut. Respond-
who have experienced a traumatic brain injury (Hux, Walker, & ents had earned their highest degrees in 15 states; however, 78%
Sanger, 1996), working with persons who use augmentative and al- of respondents earned their highest degrees in 3 of those 15 states:
ternative communication (Baladin & Iacono, 1998), working with Connecticut, Massachusetts, and New York.
persons who have undergone a tracheostomy (Manley, Frank, & Although Cascella and Colella (2004) documented the need in
Melvin, 1999), and working with children who are bilingual (Hammer, Connecticut for more training in the area of autism, a more national
Detweiler, Detweiler, Blood, & Qualls, 2004). The results of these view of SLPs’ preprofessional training and knowledge of autism is
studies revealed an overwhelming feeling among SLPs of under- necessary. Additionally, an understanding of SLPs’ confidence and
preparation to work with these more specialized populations. competency in working with this special population is needed. The
In 1987 (before the DSM-IV ), Stone developed a survey to purpose of the current study was to build on existing research regard-
determine what views a variety of professionals held regarding the ing the knowledge and training of SLPs in the area of autism. Speci-
etiology, diagnosis, and characteristics of autism. Information was fically, this study sought to begin to answer three important questions:
collected from clinical psychologists, pediatricians, school psy- & What knowledge do school-based SLPs have concerning
chologists, and SLPs, whose responses were then compared with autism?
responses obtained from 18 “autism specialists,” as deemed in the
& What educational and clinical training do SLPs receive in
study. (It should be noted that the disciplines of those regarded
autism?
as autism specialists were not listed). The survey consisted of two
sections: The first section contained statements related to facts and & Do SLPs have confidence in their ability to provide services
misconceptions about autism that were found in the literature at to children with autism and their families based on the training
that time and asked that the professionals rank how much they they have received?
agreed or disagreed using a Likert-type scale; the second section
addressed diagnostic criteria and asked professionals to differentiate
between which characteristics were required for a diagnosis of
METHOD
autism (according to the DSM–III ) and which characteristics were
helpful for a positive diagnosis of autism (based on current profes- Survey Development
sional opinion).
The results of Stone’s (1987) survey revealed a variety of inter- To determine the amount of knowledge and level of training that
esting beliefs held by the professionals in the various fields. In practicing school-based SLPs have regarding autism, an original

Schwartz & Drager: Training and Knowledge in Autism 67

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 52-item survey was created (see Appendix). The survey consisted was chosen. If the original name chosen was the last person from a
of four parts. Part I, Background Information, asked participants particular state, the previous name was chosen (to ensure that the
about their experience working in a school setting and, more spe- participant was from the same state as the originally intended partic-
cifically, their experience in providing speech and language services ipant). The same introductory e-mail used in the first wave was sent
to students with autism. Questions in this section were modeled to each potential participant individually by e-mail. A total of 400
after the introductory section of Brisk et al.’s (1997) study concern- e-mails were sent to potential participants in all 50 states. The final
ing students who stutter. Part II, Clinical and Educational Training, participant pool included 67 respondents—28 from the ASHA
sought to determine how much autism had been taught in the Division 1 listserv and 39 from the mailing list obtained from ASHA.
participants’ coursework during their undergraduate and graduate
studies. Questions involved the number of courses taken that ad- Data Reduction
dressed autism, how long autism was discussed in each course, and
the larger discipline of each course taken (e.g., speech-language In conjunction with the creation of the Web-based survey, an
pathology, special education, etc.). e-mail database was created for the sole purpose of receiving re-
Part III, Characteristics of Autism, consisted of true/false and search data. For each participant, four e-mails (one for each section
Likert-type scale questions designed to gain insight into what of the survey) containing participants’ responses were sent auto-
knowledge current SLPs had concerning autism. This section tar- matically from the Web survey to the e-mail database upon comple-
geted information concerning diagnostic criteria, characteristics tion of the survey. Any question(s) not answered by a participant
of children with autism, current myths, and the etiology of autism. received a response of “N.” Once received, responses from each
Questions from this section were shaped using a variety of sources, e-mail were transferred into a spreadsheet corresponding to the
including the DSM–IV (APA, 1994) and Stone’s study on pro- section of the survey. To obtain a mean response for each item on
fessional knowledge of autism (1987), and touched on myths cur- the survey, the responses from all participants who answered that
rently circulating regarding autism. Part IV, Competency in Autism, question were averaged. If not all participants chose to answer an
was included in order to determine if currently practicing SLPs item on the survey, the average was calculated using the number
felt confident in their ability to provide effective services to students of participants who answered that item, not the total number of
with autism. It also posed the question of whether the existence persons who completed the survey.
of autism specialists would be seen as a helpful asset to the field
of speech-language pathology. Questions were adapted from the
Clinical Management of Stuttering section of Brisk et al’s (1997)
study to reflect providing services to children with autism.
RESULTS
Throughout the survey, the term “autism” was consistently used,
rather than the broader ASD or PDD. This term is consistent with Background Information
terminology used in the Individuals With Disabilities Education
Act (IDEA, 1997, 2004), the federal legislation under which chil- The 67 participants were practicing in 33 different states across
dren and youth with disabilities receive special education and the United States at the time of their response. The majority of
related services. School-based SLPs should be familiar with this respondents held their master’s degree (94%; n = 63), with the
labeling system. The terminology was not defined or explained remaining 4 participants holding a doctorate. Participants had
for the participants. earned their highest completed degree as far back as 1970 and were
grouped into five date-of-degree categories: 1970–1979 (10.4%;
Procedure n = 7), 1980–1989 (26.9%; n = 18), 1990–1999 (35.8%; n = 24),
and 2000–2004 (26.9%; n = 18). The majority of participants
Participants for the current study were obtained via two meth- earned their highest degree within the past 15 years (62.7%; n = 42).
ods. In the first wave of the study, the coordinator of the Language, The number of years that the respondents had worked in a school
Learning and Education Special Interests Division (Division 1) setting paralleled the years in which they had earned their high-
of ASHA was contacted regarding the project. This division was est degree: 16 or more years (20.9%; n = 14), 11–15 years (13.4%;
chosen due to the probability that a large percentage of its members n = 9), 6–10 years (29.9%; n = 20), and 1–5 years (35.8%;
were currently employed in a school-based setting. An introduc- n = 24). Respondents worked in a variety of settings, ranging from
tory e-mail was forwarded to the coordinator of the division, who working with children in preschool through working with students
then distributed the survey to the Division 1 listserv. The e-mail in high school. Approximately 43% (n = 29) worked in more
introduced the survey to potential participants and provided a Web than one setting (e.g., worked in a preschool and elementary school);
link to the online survey. A total of 28 participants completed the 26.8% (n = 18) worked in a specialized school setting.
survey in the first wave of the study. All 67 participants reported that they had worked with at least
For the second wave of the study, in an effort to increase the one student with autism in their career. The number of SLPs
number of respondents, a mailing list was obtained from ASHA who currently had students with autism on their caseload varied
with the names and mailing addresses of 1,000 potential participants. greatly and was broken down into seven ranges: 0 students (14.9%;
All of the names received were persons who were (a) currently n = 10), 1–3 students (28.4%; n = 19), 4–6 students (28.4%; n = 19),
working in a school setting and (b) working with students aged birth 7–9 students (13.4%; n = 9), 10–12 students (4.5%; n = 3),
to 17 years. Beginning with the first name on the list, every other 13–15 students (0%; n = 0), and 16 or more students (10.4%; n = 7).
name was entered into ASHA’s membership directory to obtain their Similarly, the number of students with autism that each respondent
e-mail address. In the event that an e-mail address was not listed for had worked with throughout his or her career varied and was
a chosen participant, the next name on the list from the same state again broken down into seven ranges: 1–5 students (10.4%; n = 7),

68 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS • Vol. 39 • 66–77 • January 2008

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 6–10 students (10.5%; n = 7), 11–15 students (17.9%; n = 12), autism, as compared to coursework in undergraduate studies, de-
16–20 students (19.4%; n = 13), 21–25 students (10.4%; n = 7), creased from 25 participants (37.3%, n = 25) to 15 participants
26–30 students (1.5%; n = 1), and 30 or more students (29.9%; (22.4%; n = 15). The percentage of courses that fell under the
n = 20). When looking at the caseload from each participant’s categories of language disorders and speech pathology increased
career, 58.2% (n = 39) have worked with 20 or fewer students with to 78.3% (n = 65/83). As seen in courses during respondents’ under-
autism. graduate studies, the majority of courses (59.2%; n = 29/49) ad-
dressed autism for a period of 1 week. Results indicated that 11
Clinical and Educational Training of the 67 participants (16.4%) received no coursework in their
undergraduate or graduate programs that addressed autism.
Participants received their highest degree from 54 different pro- Respondents were also asked about their clinical training in
grams in 27 states. Fifty-five percent of participants received both preparation to provide services to students with autism. Just more
their undergraduate and graduate degrees from the same univer- than half of the respondents (55.2%; n = 37) reported that they did
sity. The percentage of courses that addressed autism in respon- not provide speech and language services to persons with autism
dents’ undergraduate programs is shown in Figure 1. During their as part of their clinical training. For those 30 participants who
undergraduate studies, all 67 respondents reported that they had did see persons with autism during their clinical training, 50%
zero courses that solely addressed autism. The majority of respon- (n = 15/30) reported having between 2 and 5 clients.
dents (56.7%; n = 38) reported having one or two courses that
addressed autism, with 37.3% (n = 25) reporting that they had Characteristics of Autism
no coursework as an undergraduate student that addressed autism.
Figure 2 shows the breakdown of the types of courses that ad- Results indicated that practicing SLPs may have mixed percep-
dressed autism in respondents’ undergraduate programs. Of those tions of what criteria are necessary for a child to receive a diagnosis
courses that did address autism, 68% (n = 43) were either a language of autism (Table 1). Although impairments in social interaction
disorders or general speech pathology course; these courses were abilities is a diagnostic criterion for autism, 21% of the participants
likely to be mandatory for students pursuing a bachelor’s degree did not agree that this deficit was required for a child to receive a
in speech-language pathology or communication sciences and diagnosis of autism. Similarly, although stereotyped and repeti-
disorders. The amount of time that respondents spent in their tive behaviors are a required diagnostic criteria of autism, almost
undergraduate coursework on autism is shown in Figure 3. Eighty- half of the respondents believed that these behaviors were not nec-
one percent (n = 34/42) of reported undergraduate courses addressed essary for a positive diagnosis of autism. All but 1 participant
autism for approximately 1 week. agreed that the existence of self-injurious behaviors is not manda-
Figures 1, 2, and 3 also show the percentage, type, and dura- tory for a positive diagnosis, indicating that practicing SLPs are
tion of attention within courses that addressed autism during the aware that this is not a true diagnostic criterion of autism. Commu-
respondents’ graduate programs. During their graduate studies, nication impairments are an essential diagnostic criterion for au-
2 respondents reported having a course that solely addressed tism, and 85% of the respondents agreed with this.
autism. Just as in their undergraduate programs, 56.7% (n = 38) Practicing SLPs appeared to have more accurate knowledge
reported having one or two courses that addressed autism. The regarding the characteristics of children with autism than they did
number of participants who had no coursework that addressed regarding the diagnostic criteria (Table 1). All respondents agreed

Figure 1. Percentage of courses that addressed autism in respondents’ undergraduate and graduate programs.

Schwartz & Drager: Training and Knowledge in Autism 69

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 Figure 2. Discipline categorizations of coursework that addressed autism in respondents’ undergraduate and graduate programs.

that currently more boys are diagnosed with autism than are girls. autism manifests within the first 2 years of life (as determined by
Eighty-eight percent of participants agreed that some children combining responses from the first four response choices on the
with autism exhibit over- or undersensitivity to pain stimuli. Almost survey), 18% (n = 12) believed that autism manifests between the
all respondents also agreed that some children with autism dem- ages of 2 and 3 years, and 9% (n = 6) believed that autism revealed
onstrate uneven gross motor and fine motor skills and disagreed itself after the child reached the age of 3 years.
with the perception that children with autism never make eye Part III also contained Likert-type scale questions targeting
contact. SLPs’ beliefs regarding the etiology of autism as well as additional
In response to the age at which autism manifests in children, characteristics of children with autism (see Table 2). Participants
43% (n = 29) responded that the characteristics of autism first re- appeared to strongly disagree that emotional factors play a signifi-
veal themselves between the ages of 18 and 24 months. No par- cant role in the etiology of autism (mean response = 1.59; scale 1.0
ticipant believed that autism manifested before the age of 6 months. to 4.0); responses were almost evenly split on the statement ask-
Seventy-three percent (n = 49) of respondents believed that ing if autism was a developmental disorder (mean response = 2.37).

Figure 3. Duration of attention to autism in respondents’ undergraduate and graduate coursework.

70 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS • Vol. 39 • 66–77 • January 2008

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 Table 1. Results of true/false questions regarding the characteristics of autism.

Number of
Survey statement respondents True False

Children must exhibit impaired social interaction to receive a diagnosis of autism. 66 52 (79%) 14 (21%)
Children must exhibit self-injurious behaviors to receive a diagnosis of autism. 67 1 (1%) 66 (99%)
Children must exhibit behaviors and interests that are repetitive and stereotyped to 67 35 (52%) 32 (48%)
receive a diagnosis of autism.
Children must exhibit impaired communication skills to receive a diagnosis of autism. 66 56 (85%) 10 (15%)
Some children with autism exhibit over-sensitivity or under-sensitivity to pain. 67 59 (88%) 8 (12%)
More boys are diagnosed with autism than girls. 67 67 (100%) 0 (0%)
Some children with autism demonstrate uneven gross motor and fine motor skills. 67 64 (96%) 3 (4%)
Children with autism never make eye contact. 67 2 (3%) 65 (97%)

Table 2. Results of Likert-type scale questions regarding the characteristics of autism.

Survey statement Participants’ response

I feel that emotional factors play a major role in the Strongly Disagree 1 2 3 4 Strongly Agree
etiology of autism.
1.59
I feel that children with autism are deliberately Strongly Disagree 1 2 3 4 Strongly Agree
negativistic and non-compliant.
1.20
I feel that children with autism do not show emotional Strongly Disagree 1 2 3 4 Strongly Agree
attachment, even to parents.
1.48
I feel that most children with autism do not talk. Strongly Disagree 1 2 3 4 Strongly Agree

1.70
I feel that most children with autism are also mentally Strongly Disagree 1 2 3 4 Strongly Agree
retarded.
1.81
I feel that most children with autism have special Strongly Disagree 1 2 3 4 Strongly Agree
talents and abilities.
2.58
I feel that most children with autism are more intelligent Strongly Disagree 1 2 3 4 Strongly Agree
than scores from tests indicate.
2.87
I feel that autism exists only in childhood. Strongly Disagree 1 2 3 4 Strongly Agree

1.41
I feel that with proper treatment, children can outgrow Strongly Disagree 1 2 3 4 Strongly Agree
autism.
1.68
I feel that autism is a developmental disorder. Strongly Disagree 1 2 3 4 Strongly Agree

2.37
I feel that with even with early intervention, the prognosis Strongly Disagree 1 2 3 4 Strongly Agree
for independent community functioning of children
with autism is poor. 1.62
I feel that when children with autism do not respond to Strongly Disagree 1 2 3 4 Strongly Agree
a question/direction to which he or she has shown
previous response to, that he or she is being stubborn 1.40
and non-compliant.

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 The overall average scores for all statements indicated that SLPs for children with autism, and 32.8% (n = 22) were not com-
disagreed with the statements presented. Such responses indicated fortable counseling parents of children with autism. In considera-
that SLPs disagreed with many of the myths that currently exist tion of their academic and clinical training to work with students
regarding children with autism, including their abilities and their with autism, 73.1% (n = 49) felt that the training they received
potential. Only two statements received an average response score was adequate to prepare them to work with students with autism;
greater than 2.50, indicating that although the mean response fell however, 91.0% (n = 61) stated that they could have benefited from
below a true agree response, more participants agreed than dis- additional coursework and training concerning autism. Similarly,
agreed with the information presented in these questions. The state- 79.1% (n = 53) believed that the existence of more postgraduate
ments that received an average response greater than 2.50 included: learning opportunities in the area of autism would be beneficial to
“I feel that children with autism have special talents and abili- the field. Concerning the existence of autism specialists, 82.1%
ties,” (average score of 2.58) and “I feel that most children with (n = 55) felt that schools, in general, could benefit from autism
autism are more intelligent than scores from tests indicate” (average specialists, and 85.0% (n = 57) would use an autism specialist
score of 2.87). The increase in the number of participants who as a resource in determining intervention goals for students with
agreed with these two statements indicated that practicing SLPs are autism should that type of professional be made available to
aware that children with autism have greater intellectual potential them.
than they may exhibit. For the statement regarding whether or
not children can outgrow autism, the average score was 1.68, indi-
cating that SLPs agree that autism is a lifelong disability and is not
something that can be outgrown or cured. DISCUSSION
Although the results of the current survey were more encourag-
Competency in Autism ing than those of Stone (1987), some professionals in the field
of speech-language pathology do not demonstrate a clear under-
The results of Part IV are found in Table 3. Responses to the standing of what autism is and how it is diagnosed. This information
statements posed in this section revealed that 25.3% (n = 17) of is clearly part of the SLP’s role in working with students with
participants did not feel competent in their ability to determine goals autism (ASHA, 2006d) and should be contributing to theory and

Table 3. Results of Likert-type scale questions regarding competency in autism.

Survey statement Participants’ response

I feel competent in my ability to determine appropriate Strongly Disagree 1 2 3 4 Strongly Agree

intervention goals for children with autism at all
stages of therapy. 2.94
I am comfortable counseling parents and guardians of Strongly Disagree 1 2 3 4 Strongly Agree
children with autism.
2.85
I usually like having assistance and direction from another Strongly Disagree 1 2 3 4 Strongly Agree
professional or “autism specialist” when developing
appropriate programs for children with autism. 2.98
I feel competent I have enough clinical and educational Strongly Disagree 1 2 3 4 Strongly Agree
training to deliver effective services to children with
autism. 2.96
I feel that I could have benefited from receiving additional Strongly Disagree 1 2 3 4 Strongly Agree
coursework and training in the area of autism.
3.38
I feel the existence of more post-graduate learning Strongly Disagree 1 2 3 4 Strongly Agree
opportunities in the area of autism would be
beneficial to the field. 3.33
I feel that schools, in general, could benefit from “autism Strongly Disagree 1 2 3 4 Strongly Agree
specialists.”
3.24
If I knew that an “autism specialist” was available in my Strongly Disagree 1 2 3 4 Strongly Agree
school district, I would use that person as a resource.
3.42
I would be interested in becoming an “autism specialist” Strongly Disagree 1 2 3 4 Strongly Agree
even if it meant participating in additional training.
2.53

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 clinical practice. It appears, however, that despite a deficit in knowl- significant challenge facing the field (Simpson, 2004). In an effort
edge of autism, some SLPs are more confident in providing services to increase the readiness of graduating clinicians, coursework in
to children with autism than would have been anticipated. Ques- providing services to special populations should be available in all
tions could be raised regarding how SLPs can feel that they are pro- graduate programs in speech-language pathology. Although per-
viding adequate services when they appear to not have a firm grasp haps ideal, it is unrealistic to expect graduate programs to devote
of the core deficits demonstrated by students with autism. Re- an entire course to autism and PDD, particularly because not all
sults indicated that although most participants did address autism at educational institutions have faculty who possess the knowledge
some level of their educational training, little time was spent dis- base to teach such a course. It is reasonable, however, to expect that
cussing the topic. This is evidenced by the unbalanced knowledge all graduate programs address autism in some focused manner.
that respondents had regarding the diagnostic criteria and char- ASHA has provided direction on the areas that SLPs are expected to
acteristics of autism. understand, and has compiled current evidence-based knowledge
At least 10% of the respondents received their graduate degree of the core characteristics and challenges of this population (ASHA,
before publication of the DSM–III–R, and at least 37% received their 2006c). This information should serve as the basis for the content
degree before the most recent revision to the DSM criteria. This may in preprofessional programs.
have impacted the knowledge base of some of the participants. Beyond including information about autism in speech-language
Regardless, a significant percentage of participants demonstrated pathology undergraduate and graduate programs, there are other
that they did not possess accurate knowledge of autism, nor were ways to address increasing competencies in autism, such as through
some confident in their abilities to provide services to students with clinical education or courses in other disciplines, such as special
autism, with a significant number of participants reporting that they education. Additionally, a variety of postprofessional training op-
felt they could have benefited from additional training. portunities, such as in-service learning, have been and should
continue to be widely available.
Current Professional Training Programs
Most of the current literature on training programs in autism
addresses the preparation of special education teachers but can be LIMITATIONS OF THE CURRENT STUDY
applied to SLPs as well. “If a teacher meets state standards for
special education certification but has no coursework in or experi- Several limitations exist with the design of the current study and
ence with autism, is that teacher ‘highly qualified’ to teach stu- must be considered when interpreting and placing value on the
dents with autism?” (Scheuermann, Webber, Boutout, & Goodwin, results obtained. The largest limitation was the sample size. Al-
2003, p. 197). The same question may be asked of SLPs. Personnel though several efforts were made to increase the sample size,
working with students with autism must possess specialized in- including approaching multiple listservs (only one responded affir-
structional and management skills as well as redesigned curricu- matively) and different avenues of obtaining names of potential
lum if a student with autism is to benefit from their education respondents, the resulting number of participants was low. It is pos-
(Scheuermann et al., 2003; Simpson, 2004). In both bachelor’s and sible that the results do not reflect the perspectives of the profession
master’s programs, students pursuing degrees in speech-language as a whole.
pathology are, in some cases, not being exposed to autism; without Because the return rate for participants was small (approxi-
exposure, students cannot be taught specific strategies to provide mately 10% from the ASHA mailing list), it cannot be ignored that
effective services to this specialized population. only SLPs with an interest in autism may have responded to the
ASHA has specifically addressed the knowledge and skills survey. Because participation was voluntary, SLPs without a true
across 11 broad areas necessary for SLPs to adequately serve chil- interest in autism may have opted not to respond. This may be re-
dren with autism (ASHA, 2006b). It will be critical that preprofes- flected in the results. It is possible that the figures would be higher
sional programs begin to address these competencies. SLPs need or lower depending on the particular respondents. For example,
to have the training required to address this complex disorder of SLPs who chose not to respond may be even less confident in their
social communication. Additional areas of knowledge that are re- knowledge and skills. However, given that this sample of respon-
quired to work with this population include augmentative and dents may have a higher interest in autism, and in fact, 30% of the
alternative communication to augment both expression and compre- participants had experience with greater than 16 students with
hension (Mirenda, 2003); collaboration, including working with autism, the lack of knowledge of diagnostic criteria is especially
families (Beatson, 2006) and working with other professionals (Peck troubling.
& Schuler, 1987); and addressing challenging behaviors (Horner, In addition, although 33 of 50 states were represented in the
Carr, Strain, Todd, & Reed, 2002), among others. SLPs are in an ideal participants, 14 states were only represented by 1 participant, and
position to help develop interventions that address the complex needs only one state (New York) was represented by more than 5 par-
of children with autism within a social framework, such as that ticipants. Similarly, although participants received their highest
developed by the World Health Organization (WHO, 2001). degrees from 54 programs in 27 states, curriculum varies among
different universities at different times. Different professors may
have chosen to focus on different areas in their courses, and would
therefore influence whether or not autism was addressed in that
FUTURE DIRECTIONS class. Also, the survey did not address postgraduate training, which
is an avenue for training that many professionals can pursue.
As in the education field, there is a shortage of “qualified Although the survey developed for the present study was based
professionals” to educate children with autism, and this gap is a on several examples from the literature, the survey itself was not

Schwartz & Drager: Training and Knowledge in Autism 73

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 validated. It is possible that some questions may have been con- This research was completed in partial fulfillment of the requirements
fusing to participants. For example, the question that involved the for the degree of Master of Science for the first author under the direction of
length of time that autism was addressed in coursework had five the second author.
possible answers (1 week, 2 weeks, 1 month, 1-1/2 months, and
2 months). This was done to limit the answers, to provide an objec-
tive measure, and because different institutions have different
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Contact author: Kathryn Drager, Department of Communication
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 APPENDIX (p. 1 of 2). THE AUTISM SURVEY: EDUCATION AND COMPETENCE WITH AUTISM

Background Information

1. Highest degree received:

( ) Bachelors ( ) Masters ( ) Doctorate
2. Date received highest degree:
( ) Prior to 1979 ( ) 1980–1989 ( ) 1990–1999 ( ) 2000–Present
3. Years of professional experience in the schools:
( ) 1–5 years ( ) 6–10 years ( ) 11–15 years ( ) 16+ years
4. Number of students currently on my caseload with autism / PDD:
( ) 0 students ( ) 1–3 students ( ) 4–6 students ( ) 7–9 students
( ) 10–12 students ( ) 13–15 students ( ) 16+ students
5. Approximate number of students with autism I have worked with in my professional career:
( ) 0 students ( ) 1–5 students ( ) 6–10 students ( ) 11–15 students
( ) 16–20 students ( ) 21–25 students ( ) 26–30 students ( ) 30+ students
If you answered 0 students, would you consider working with students with autism / PDD?
( ) Yes ( ) No
6. My typical session with a student with autism lasts:
( ) Less than 30 minutes ( ) 30 minutes ( ) More than 30 minutes
7. I see my students with autism for therapy ___ sessions a week:
( ) 1 session ( ) 2 sessions ( ) 3+ sessions
8. I see students in the following grade levels (Check all that apply):
( ) Specialized School ( ) Preschool ( ) Elementary ( ) Secondary (middle and high)
9. I have obtained continuing education credits related to autism since receiving my highest degree:
( ) Yes ( ) No
If yes, how many courses or lectures have you attended?
( ) 1–5 ( ) 6–10 ( ) 11–15 ( ) 16+
10. I currently practice and am licensed in the state of:

Clinical and Educational Training

1. I received my highest degree at the following university/college:

________________________________________________________
2. I attended the same university for my undergraduate and graduate studies:
( ) Yes ( ) No
3. I completed ___ courses in my undergraduate studies that solely addressed autism:
( ) 0 courses ( ) 1 course ( ) 2 courses ( ) 3+ courses
I completed ___ courses in my undergraduate studies that addressed autism in some manner:
( ) 0 courses ( ) 1 course ( ) 2 courses ( ) 3 courses
( ) 4 courses ( ) 5+ courses
These courses fell into the following categories (Check all that apply):
( ) Special Education ( ) Language Disorders
( ) General Education ( ) Speech-Pathology with Special Populations
( ) Other
Approximately how much time was spent discussing autism and intervention with students with autism in each of these classes (Check all that apply):
( ) 1 week ( ) 2 weeks ( ) 1 month ( ) 1 2 month
( ) 2 months
4. I completed ___ courses in my graduate studies that solely addressed autism:
( ) 0 courses ( ) 1 course ( ) 2 courses ( ) 3+ courses
I completed ___ courses in my graduate studies that addressed autism in some manner:
( ) 0 courses ( ) 1 course ( ) 2 courses ( ) 3 courses
( ) 4 courses ( ) 5+ courses
These courses fell into the following categories (Check all that apply):
( ) Special Education ( ) Language Disorders
( ) General Education ( ) Speech-Pathology with Special Populations
( ) Other
Approximately how much time was spent discussing autism and intervention with students with autism in each of these classes (Check all that apply):
( ) 1 week ( ) 2 weeks ( ) 1 month ( ) 1 2 month
( ) 2 months

76 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS • Vol. 39 • 66–77 • January 2008

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 APPENDIX (p. 2 of 2). THE AUTISM SURVEY: EDUCATION AND COMPETENCE WITH AUTISM

5. As part of my clinical training (both undergraduate and graduate) I had a client or clients diagnosed with autism:
( ) Yes ( ) No
If yes, how many?
( ) 1 client ( ) 2–5 clients ( ) 6–10 clients ( ) 11+ clients

Characteristics of Autism

The following questions follow a true/false format. Please circle the corresponding letter to your response.
1. Children must exhibit impaired social interaction to receive a diagnosis of autism. T F
2. Children must exhibit self-injurious behaviors to receive a diagnosis of autism. T F
3. Children must exhibit behaviors and interests that are repetitive and stereotyped to T F
receive a diagnosis of autism.
4. Children must exhibit impaired communication skills to receive a diagnosis of autism. T F
5. Some children with autism exhibit over-sensitivity or under-sensitivity to pain. T F
6. More boys are diagnosed with autism than girls. T F
7. Some children with autism demonstrate uneven gross motor and fine motor skills. T F
8. Children with autism never make eye contact. T F
9. Symptoms of autism usually manifest around:
( ) 0–6 months ( ) 6–12 months ( ) 12–18 months
( ) 18–24 months ( ) 24–36 months ( ) 36+ months

Please use the following scale to complete the following questions. If you are unsure about the answer, you may answer “N” for Not Sure.

4 – Strongly agree
3 – Agree
2 – Disagree
1 – Strongly disagree
1. I feel that emotional factors play a major role in the etiology of autism. ________
2. I feel that children with autism are deliberately negativistic and noncompliant. ________
3. I feel that children with autism do not show emotional attachment, even to parents. ________
4. I feel that most children with autism do not talk. ________
5. I feel that most children with autism are also mentally retarded. ________
6. I feel that most children with autism have special talents and abilities. ________
7. I feel that most children with autism are more intelligent than scores from tests indicate. ________
8. I feel that autism exists only in childhood. ________
9. I feel that with proper treatment, most children can outgrow autism. ________
10. I feel that autism is a developmental disorder. ________
11. I feel that even with early intervention, the prognosis for independent community functioning of children with autism is poor. ________
12. I feel that when children with autism do not respond to a question/direction to which he or she has shown previous response to, ________
that he or she is being stubborn and noncompliant.

Competency in Autism

Please use the following scale to complete the following questions:

4 – Strongly agree
3 – Agree
2 – Disagree
1 – Strongly disagree
1. I feel competent in my ability to determine appropriate intervention goals for children with autism at all stages of therapy. ________
2. I am comfortable counseling parents and guardians of children with autism. ________
3. I usually like having assistance and direction from another professional or “autism specialist” when developing appropriate ________
programs for children with autism.
4. I feel competent that I have enough clinical and educational training to deliver effective intervention to children with autism. ________
5. I feel that I could have benefited from receiving additional coursework and training in the area of autism. ________
6. I feel that the existence of more post-graduate learning opportunities in the area of autism would be beneficial to the field. ________
7. I feel that schools, in general, could benefit from “autism specialists.” ________
8. If I knew that an “autism specialist” was available in my school district, I would use that person as a resource. ________
9. I would be interested in becoming an “autism specialist” even if that meant participating in additional academic training. ________
Any additional information or comments:

Note. Adapted from Brisk, Healey, and Hux (1997) and Stone (1987).

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