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ACQ
Volume 11, Number 3 2009
ACQ
uiring knowledge in speech, language and hearing
Autism spectrum disorder assessment needs
to consider factors other than social-
communication deficits
Brian, J., Bryson, S. E., Garon, N., Roberts, W., Smith, I. M.,
Szatmari, P., et al. (2008). Clinical assessment of autism in
high-risk 18 month olds.
Autism
,
12
(5), 433–456.
Vivien Williams
The prevalence and severity of autism spectrum disorders
(ASD) makes them a health care priority which has recently
been financially acknowledged by both state and federal
governments in Australia, with the introduction of significant
funding for diagnosis and early intervention. This longitudinal
study explored the application of the authors’ own scale –
The Autistic Observation Scale for Infants (AOSI) in
combination with the ADOS (The Autism Diagnostic
Observation Schedule) in diagnosing ASD in infants aged 18
months. The AOSI is a semi-structured observational
measure with standardised activities using a variety of toys.
Participants included a risk group of infants (155 siblings of
children already diagnosed with ASD) and compared these
with a control group (73 infants). These infants were then
assessed again at age 3 using the ADOS.
This study identified a number of behaviours present at 18
months which predicted a diagnosis of ASD at 36 months.
These included those from the social and communication
domains, such as eye contact and shared enjoyment, and
also from the behavioural domain. Items unique to the AOSI
which emerged as good predictors of ASD included over- or
under-reaction to objects and motor difficulties (impacting
upon overall fluidity).
The authors concluded by stressing the value of
considering social-communication deficits as well as
temperament and motor control when assessing toddlers
for early signs of autism. They emphasised the importance
of early screening as well as the need for early initiation of
intervention, even if a diagnosis is not confirmed.
Risk and protective factors for mental health
of refugee children
Crowley, C. (2009). The mental health needs of refugee
children: A review of literature and implications for nurse
practitioners.
Journal of the American Academy of Nurse
Practitioners
,
21
(6), 322–331.
Catherine Quin
This article explores the literature regarding the mental health
needs of refugee children settled in the US and practice
implications for nurse practitioners. The three commonly
cited phases of the refugee experience (premigration,
migration, and postmigration) and the associated stresses of
these phases are outlined. The author highlights that much
of the research about children and young refugees focuses
on mental health problems rather than on “resiliency”.
Questions about the applicability of western psychiatric
classifications to a diverse refugee population and the view
Expanding the ports of entry for speech
pathologists working in mental health
Geller, E., & Foley, G. (2009). Expanding the “Ports of Entry”
for speech-language pathologists: A relational and reflective
model for clinical practice.
American Journal of Speech-
Language Pathology
,
18
, 4–21.
Melanie Hall
This article outlines an expanded framework for clinical
practice in speech-language pathology. Specific mental
health constructs are described and their application in
traditional and contemporary models of clinical practice is
discussed. Two case scenarios are presented to compare
and contrast these approaches. The article focuses on
young children with language impairment but the authors
state that the mental health principles described can be
applied to clinical practice with clients and families with
different types of communication disorders across the life
span.
The authors introduce the notion of “ports of entry”
which refers to the intervention approach that is employed
to gain access into the client’s psychological or linguistic
system in order to target particular goals. They state that
speech pathologists often work on the observable patterns
of behaviour of the child or parent and that this port of
entry can be characterised as working from the outside
in. In contrast, some practitioners in allied disciplines use
a port of entry which involves working from the inside out.
This approach focuses on understanding the parent’s
internal feeling states, and representations of his or her
child, and how these affect the developmental growth of
the child. While this port of entry is more often seen in
psychodynamic and relationally oriented interventions, there
are some contemporary language intervention programs that
emphasise aspects of relationship-based practice.
The specific mental health constructs presented in this
article include: attachment theory, working dyadically,
reflective practice, transference–counter transference,
and the use of self. Discussion of these principles is
comprehensive and includes insights from other authors.
Speech pathologists are encouraged to create a therapeutic
environment that slows down the clinical process and allows
time for observation and careful thought.
This article invites speech pathologists to enhance their
interventions by expanding the ports of entry. As well as
educating parents about development and growth, and
assessing and developing skills (working from the outside
in), therapists can pay attention to the less visible forces
at play (working from the inside out), be mindful about the
experience for the client and the family, be aware of their
own responses and reactions, consider the therapeutic
relationship and highlight the strengths and capacities
of each parent–child relationship. This article is relevant
and thought-provoking and may inspire others to further
investigate mental health models and interventions.
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