A Strengths-Based Approach to Autism: Neurodiversity and Partnering PDF

Perspectives of the ASHA Special Interest Groups SIG 1, Vol. 2(Part 1), 2017, Copyright © 2017 American Speech-Language-Hearing Association A Strengths-Based Approach to Autism: Neurodiversity and Partnering With the Autism Community Amy L. Donaldson Department of Speech and Hearing Sciences, Portl...

Perspectives of the ASHA Special Interest Groups SIG 1, Vol. 2(Part 1), 2017, Copyright © 2017 American Speech-Language-Hearing Association A Strengths-Based Approach to Autism: Neurodiversity and Partnering With the Autism Community Amy L. Donaldson Department of Speech and Hearing Sciences, Portland State University Portland, OR Karen Krejcha Executive Director and Co-Founder, Autism Empowerment Vancouver, WA Andy McMillin Department of Speech and Hearing Sciences, Portland State University Portland, OR Disclosures Financial: Amy L. Donaldson has no relevant financial interests to disclose. Karen Krejcha has no relevant financial interests to disclose. Andy McMillin has no relevant financial interests to disclose. Nonfinancial: Amy L. Donaldson has no relevant nonfinancial interests to disclose. Karen Krejcha has no relevant nonfinancial interests to disclose. Andy McMillin has no relevant nonfinancial interests to disclose. Abstract The autism community represents a broad spectrum of individuals, including those experiencing autism, their parents and/or caregivers, friends and family members, professionals serving these individuals, and other allies and advocates. Beliefs, experiences, and values across the community can be quite varied. As such, it is important for the professionals serving the autism community to be well-informed about current discussions occurring within the community related to neurodiversity, a strengths-based approach to partnering with autism community, identity-first language, and concepts such as presumed competence. Given the frequency with which speech-language pathologists (SLPs) serve the autism community, the aim of this article is to introduce and briefly discuss these topics. Speech-language pathologists (SLPs) play an important role on interdisciplinary teams that serve the autism community. According to the American Speech-Language Hearing Association (ASHA, 2016), 90% of school-based SLPs reported serving students experiencing autism spectrum disorder (ASD); in addition, SLPs in early intervention, private practice, medical, and other clinical settings all report serving children, adolescents, and adults with ASD (Coffey & Donaldson, 2015; Paynter & Keen, 2015; Plumb & Plexico, 2013). Given the strong presence of such individuals on the caseloads of SLPs, it is important for professionals to understand the dynamic nature of the autism community and how to best partner with its members. Indeed, as evidence-based clinicians, it is incumbent upon SLPs to gather information about family, individual, and consumer values, beliefs and preferences and utilize such information in family-centered assessment and intervention planning (ASHA, n.d.; Crais, Roy, & Free, 2006). Much like autism presents as a spectrum across individuals, one might describe the members of its community in the same way. The community includes individuals with ASD, caregivers, family members, service providers, and other stakeholders. Diversity of opinions and perspectives within the community is reflected in many ways–from self-identification to pursuit of intervention (Davidson & Orsini, 2013). As Kenny and colleagues stated (2016), “Members of the 56 autism community–autistic people, their family and friends and broader support network –often disagree over how to describe autism” (p. 442). Traditionally, many community members (particularly service providers) have espoused a “medical model” of autism. This model views ASD from a deficit-based perspective with an aim toward normalization and elimination of symptoms; in some cases, autism is compared to a disease, with the goal of being “cured” (Kapp, Gillespie-Lynch, Sherman, & Hutman, 2012). Further, the medical model influence has resulted in far greater research funding focused on determining the etiology of autism and for early intervention than for supports for those currently experiencing autism (Holmer Nadesan, 2013; Singh, Illes, Lazzeroni, & Hallmayer, 2009). The other end of the spectrum is the view of ASD, and of disability in general, from a social model of disability (Carol, 2010). This approach is informed by the critical disability research over the last 30 years, and captures the political movement of those with disabilities who argue for changing discriminatory social mechanisms and for the attainment of civil rights for disabled people (Carol, 2010; Soffer & Almog-Bar, 2016). When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives. For those on the autism spectrum, it specifically represents a neurodiversity perspective. Neurodiversity advocates promote a view that autism and other neurological conditions are natural variants of human neurological outcomes—natural difference, rather than disorder (Sarrett, 2016; Straus, 2016). Indeed, the unique strengths, challenges, and differences associated with autism are central to one’s identity (Kapp et al., 2012). Neurodiversity advocates support interventions in which therapists capitalize upon one’s strengths to support one’s challenges, while respecting the uniqueness of each individual. This approach seeks to challenge current research funding priorities that focus primarily on etiology and remediation; but, rather shift to research for improving the quality of life of people experiencing autism, particularly those who view their “autism as a positive aspect of identity,” as well as research to decrease healthcare disparities (Raymaker & Nicolaidis, 2013, p. 178). Given the wide diversity within the autism community and the key role of SLPs in partnering with this community, we have two main aims for this article. Our first aim is to provide a brief introduction of the neurodiversity movement and its key principles for SLPs who may be new to this viewpoint. As prominent members of interdisciplinary teams who may encounter families new to a diagnosis of ASD, it is important for SLPs to understand the variability of perspectives within the autism community and be prepared to provide a wide range of resources for the families they serve. Our second aim is to discuss how professionals might best partner with the autism community from a strengths-based perspective. In our experience, it is best to approach assessment and treatment from a strengths-based perspective regardless of the beliefs of the family experiencing autism—whether they espouse a medical model, a social disability model, a neurodiversity model, or somewhere along the continuum. Neurodiversity and a Strengths-Based Perspective The term “neurodiversity,” which suggests recognition of neurological variation or brainbased differences as the result of natural human variation (Jaarsma & Welin, 2012), was first coined in the 1990s by an Australian advocate, Judy Singer (1998), and later reported in an article by journalist, Harvey Blume. Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment? Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind. (Blume, 1998) 57 Neurodiversity provides a framework for many key principles that support a strengths-based approach to partnering with the autism community. These principles cross multiple areas integral to an SLP’s clinical practice, including communication, social interaction, and motivation. Word Choice Is Important As communication specialists, SLPs know that words are powerful. As such, it is helpful for our discipline to understand some of the current conversations and cultural dialogue related to self-identity within the autism community. There is ongoing debate with regard to the “D” in ASD. Some argue that “disorder” should be changed to “difference,” while others have started using the term “condition”. Indeed, Lai, Lombardo, Chakrabarti, & Baron-Cohen (2013) stated, …we have opted for the more neutral term “ASC” (Autism Spectrum Conditions) to signal that this is a biomedical diagnosis in which the individual needs support, and which leaves room for areas of strength as well as difficulty, without the somewhat negative overtones of the term “disorder,” which implies something is “broken.” (p. 1) Another equally important topic is identity-first versus person-first language. The standard in our discipline (as in many other rehabilitation professions) is the use of person-first language when serving clients. However, it is important to listen to and respect the wishes of those community members with whom we partner. Much like the Deaf community and disability advocacy community, many individuals in the autism community choose to use the identity-first language of “autistic” or “autistic person” rather than “person with autism” (Dunn & Andrews, 2015; Kapp et al., 2012; Ortega, 2013). Sinclair (1999) was the first autistic self-advocate to write about this topic, offering several reasons for identity-first language: (a) autism cannot be separated from the person, as person-first language seems to encourage; (b) autism is an important part of an individual; and (c) autism is not something “bad” to be separated from a person. Sinclair (1999) states, “I am autistic because I accept and value myself the way I am.” Further, several top-tier research journals (e.g., Autism: The International Journal of Research and Practice and The Journal of General Internal Medicine) have now started using identity-first language in recognition of this cultural and community distinction. Most recently, Kenny and colleagues (2016) completed a survey of the autism community in the United Kingdom to identify their preferred terms for describing autism. The community members who responded to the survey (n=3470) included autistic people (n=502), parents of people with autism (n=2207), professionals involved in the autism community (n=1109), and family members and friends (n=380). Survey results indicated that the term “autistic” was favored by autistic individuals, family members/friends, and parents (61%, 52% and 51% respectively), but considerably less so by professionals (38%). An opposite trend was noted for “person with autism;” 49% of professionals favored the phrase, whereas only 28% of autistic individuals and 22% of parents preferred the phrase. Across all groups use of the term “low-functioning autism” was limited, as it makes assumptions regarding one’s competence; the same was concluded regarding the term “highfunctioning autism”. For example, one respondent reported, In my experience if you’re viewed as high functioning, then your needs are often dismissed. If you’re viewed as low functioning, then your strengths are often dismissed. Also, ‘functioning’ is something that can vary between tasks and on different days according to stress levels, for example. (Kenny et al., 2016, p. 452) Many in the autism community advocate discontinuing use of functioning terms for exactly these reasons (see Edow, 2015 and Ollibean, 2016 for additional discussion on this topic). As aforementioned, a spectrum within the autism community exists. Many individuals (and their families) use identity-first language, others use person-first language, and some use these interchangeably (Davidson & Orsini, 2013; Kenny et al., 2016). Given these factors, the authors have used both terms within this paper, and when working with the autism community 58 we defer to the self-identification (with regard to language use) of the families we serve who experience autism. In other words, within a clinical or educational context, we advocate for professionals to follow the preferences of the individuals and families they serve – if an individual indicates that they identify as a “person with autism,” it’s respectful and appropriate for us to follow that lead. If the family indicates they prefer the term “autistic,” the same principle applies. As professionals, we feel it is not our place to determine how an individual self-identifies, but rather to listen and respect that individual’s right to do so. Additionally, we feel it is important to educate speech-language pathology students, other team members, and those who interact with the autism community about neurodiversity and identity-first language, so that they become accustomed to hearing both person-first and identity-first language within professional contexts. Finally, although Asperger syndrome is no longer included as a distinct condition in the most recent Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; American Psychiatric Association, 2013), many youth and adults previously diagnosed as such continue to self-identify as Asperger or “Aspie” (Kenny et al., 2016). This segment of the autism community has established a strong presence in autism self-advocacy (Calzada, Pistrang, & Mandy, 2012; Global and Regional Asperger Syndrome Partnership, 2017) and shares their experiences through books (Kim, 2014), online blogs (e.g., Dude, I’m an Aspie n.d.; Musings of an Aspie, n.d.), and community activism (e.g., Oregon Commission on Autism Spectrum Disorder, n.d.). Professionals partnering with the autism community can benefit not only from a recognition of the range of ways that individuals selfidentify, but also by gathering resources (locally, regionally, and online) to share with the clients they serve, enabling families to connect with other members of the community who may share their experiences and/or bring a new perspective to their understanding of autism. To this end, the authors have provided a brief list of resources for professionals who are new to neurodiversity and autism self-advocacy. The list is not intended to be exhaustive, but rather a starting place for those seeking additional information (see Appendix A). We also strongly encourage professionals to read the personal blogs of autistic individuals to learn their first-hand, insider perspectives (as often professionals only have interactions with parents of children with ASD); these can be found through a simple Internet search. Partnering With the Autism Community The family-centered approach to service provision has long advocated partnering with the communities SLPs serve. Although one might associate family-centered services with young children, this approach is not limited by chronological boundaries (Bruce, DiVenere, & Bergeron, 1998); rather, it can apply to all populations SLPs serve. It is a model of collaboration and an approach to relationship building that moves away from the traditional service provider as “expert” model of intervention. Indeed, a true partnership requires development of a working relationship between an individual and/or family member and the clinician where each is contributing to the learning of the other and shared decision-making is the goal (Bruce et al., 1998; Dunst, Trivette, & Deal, 1988). This type of partnership can promote a strengths-based approach to serving individuals with ASD in that it enables a clinician to “meet a family where they are at” in their personal journey/experience with autism. The clinician can learn about the family’s experience with autism and what perspectives they hold related to culture and identity. The clinician can assist the family in learning about the autistic’s strengths and challenges and use this information to jointly establish priorities for functional intervention outcomes, tapping into strengths to support challenges. Finally, by partnering with the individual and family, the clinician is upholding a key tenet of the disability community—“Nothing about us without us” (Charlton, 2000), that is also the motto of the Autistic Self Advocacy Network (ASAN, 2017). Community-based participatory research is another area rife with opportunity to partner with the autism community. As Raymaker and Nicolaidis (2013) discuss, like many minority communities, the autism community has been the subject of much research, but rarely have they been involved in the development of said research, which can lead to feelings of distrust, issues with study validity, and challenges with study effectiveness. They suggest use of participatory research approaches that include community members as full members of the research team, 59 not “simply a source of raw data” (p. 169). This approach ensures that research projects, from ideation to dissemination are rooted in community contexts and priorities, and shaped by immediate community feedback. Research outcomes that are generated from such partnerships will contribute to our corpus of evidence-based practices in socially and ecologically valid ways that may not have been considered in the past. A Familiar Model Finally, the neurodiversity movement is not unique in cultivating views that are consistent with a social model of disability. SLPs will most likely be familiar with the social model from their interactions with the stuttering community, where several voices of advocacy have emerged. Indeed, ASHA’s Special Interest Division 4: Fluency and Fluency Disorders issued a report noting that “no systematic research was carried out” to support establishing the policy of person-first language (ASHA, 1999, p. 33). St. Louis (1999) and Dietrich, Jensen, and Williams (2001) each compared public attitudes and reactions to the identity-first label “stutterer” compared with the person-first label “person who stutters” and found no differences in reactions to these two terms. Since then, the question of identity as a “person who stutters” or as a “stutterer” has been a frequent topic of conversation among people who stutter, particularly in support group situations and on conversation-based podcasts such as StutterTalk. Many people embrace person-first language related to stuttering, though just as with the neurodiversity movement, there are others who specifically reject person-first labeling and embrace identity-first language. For example, Schick (2015) notes ways in which person-first language can backfire, dividing disabled communities and thus diluting their potential power. Voices advocating for partnerships between clinicians and clients have also been noted in the stuttering community. Advocates of comprehensive treatment approaches to stuttering have long suggested that one size does not fit all when it comes to treating stuttering, and that the inclusion of the client’s goals is essential in any treatment plan (Yaruss, Coleman, & Quesal, 2012). Similarly, Watermeyer and Kathard (2016) argue that treatment plans that focus on fluency may inadvertently reinforce prevailing cultural attitudes toward stuttering, which are primarily negative. And the journalist Barry Yeoman, in a recent keynote address to the National Stuttering Association’s New York City Chapters Conference, called for a culture that recognizes, “that speech therapy is an option …but it’s not the only option. And that if we choose it, we get to decide which type of therapy we need”. He further advocates for a cultivation of pride in stuttering itself, saying that “speaking with a stutter, even a severe one, is an option, that there is no shame in it, and that there is in fact music in it” (2016). Stuttering pride is also reflected in the Did I Stutter Project (n.d.). They view stuttered speech as a naturally occurring variant in human communication, and make the case that a part of valuing diversity must include valuing stuttered speech. In alignment with the neurodiversity movement, the Did I Stutter Project calls upon us to recognize the underlying neurological makeup that likely contributes to stuttering, and to value this neurological diversity in the same way that we value other aspects of human diversity. Presumed Competence A key component of a strengths-based approach to assessment and intervention for serving any population is the notion of presumed competence – the assumption that the individual brings capability, strengths, and competency to a task or endeavor. This viewpoint is of particular importance when partnering with autistic individuals who have limited or no verbal language for communication, as society often makes assumptions about the receptive language and/or cognitive skills of these individuals (Dawson, Soulieres, Gernsbacher, & Mottron, 2007). In 2013, Emerson and Dearden used a presumed competence model to examine a language intervention for a nonverbal 10-year old child with autism. They examined the assumption that because he was nonverbal, he also presented with limited receptive language skills. Based on this assumption, the child’s school had adopted a “minimal speech [intervention] approach”—use of 60 single-word or two-word phrases and use of gestures (Potter & Whittaker, 2001). Emerson and Dearden adopted what they deemed a “less dangerous assumption” approach by “assuming understanding and adjusting language when comprehension difficulties became apparent… The intention was to gradually simplify language if children were demonstrating difficulty comprehending full sentences” (p. 234). Following this presumed competence approach to intervention, the child demonstrated response to increasingly complex questions, as well as literacy skills that had been previously undocumented. The authors noted that one of the main findings of the study was …that the greatest barrier to Jack’s progress may have been the assumption of limited ability by the teaching staff…Staff were initially very skeptical about the approach adopted by the researchers. They repeatedly questioned the researchers’ use of language and warned that the students would not understand. Staff initially interpreted Jack’s responses as random answers. When he correctly selected written words from a choice of two or three they presumed that this was due to chance, no matter how many repetitions he completed correctly. However, once he was consistently identifying the correct word from a choice of six, staff began to recognize that Jack could read. (Emerson & Dearden, p. 243) Kasa-Hendrickson & Buswell (2007) and Hussman (2015) offer some strategies for promotion of presumed competency. These include: • use age-appropriate communication with clients; • support clients in demonstrating their strengths; • assume that every individual will benefit from learning age-appropriate skills/ curriculum; • directly ask client for permission before sharing any information; • support access to age-appropriate information/curriculum through accommodations and adaptations; • look for solutions to success— “how can this work?”; • support communication using multiple modalities; pay particular attention to supporting communication between peers; • do not speak about the client in front of the client; include the person as you would a neurotypical person (a person with “typical development”). • do not speak for the client—allow them to speak for themselves; • recall that “challenging” behavior often serves a communicative or sensory function— with your team, try to determine the function of the behavior, rather than automatically attempting the eliminate it. The function is important— support the client in meeting that need (see Bopp, Brown, & Mirenda, 2004 for information about an SLP’s role in a team-based Functional Behavior Assessment); and • do not assume lack of comprehension—before interpreting information, look for signs for understanding. Self-Determination Another key concept of a strengths-based approach to assessment and intervention is self-determination. Self-determination refers to an individual’s ability to be the agent of their own actions, to pursue their own goals, to face challenges, to achieve success and to learn from mistakes (Wehmeyer & Abery, 2013). Further, one’s pursuit of such goals and how this impacts one’s quality of life is also considered to be a factor of self-determination (Turnbull & Turnbull, 2001). Core assumptions of self-determination include: all people can engage in self-determination, and 61 severity or type of disability does not preclude one’s self-determination participation (Loman, Vatland, Strickland-Cohen, Horner, & Walker, 2010). Promotion of self-determination, regardless of cognitive skills and use of verbal language is consistent with the goals of autistic self-advocacy and the ideals of partnering with the autism community. Indeed, the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Public Law 106-402) defines self-determination activities as “activities that result in individuals with developmental disabilities, with appropriate assistance, having— A. the ability and opportunity to communicate and make personal decisions; B. the ability and opportunity to communicate choices and exercise control over the type and intensity of services, supports, and other assistance the individuals receive; C. the authority to control resources to obtain needed services, supports, and other assistance; D. opportunities to participate in, and contribute to, their communities; and E. support, including financial support, to advocate for themselves and others, to develop leadership skills, through training in self-advocacy, to participate in coalitions, to educate policymakers, and to play a role in the development of public policies that affect individuals with developmental disabilities.” (Administration for Community Living, 2013) Self-determination has long been supported in the rehabilitation, education and psychology literature as an important tenet of our professional work (see Turnbull & Turnbull, 2001 and Ruppar, 2014 for further discussion and examples). Clinicians can promote self-determination in a variety of ways. One significant way to promote self-determination and also capitalize on evidence-based practices for serving individuals with ASD is to encourage and teach choice making. Wehmeyer & Abery (2013) discuss how choice making is a fundamental component of self-determination. By encouraging an individual with autism to make choices, the clinician is promoting independence and improved quality of life. Choice making includes identifying possible options, evaluating the pros and cons of the options, making a choice, developing an action plan, and experiencing the choice (Loman et al., 2010). The choice making process can be targeted across all types of decisions, from everyday choices (e.g., activities, toys, foods) to more significant life decisions (e.g., class choices, jobs, places to live). Further, providing choices within intervention is a key feature of evidence-based practices, such as Pivotal Response Training (Koegel et al., 1989) and the Early Start Denver Model (Dawson et al., 2010; Rogers & Dawson, 2009). By offering choices to young children with ASD within intervention, one maintains the child’s motivation to engage; such motivation has been found to be pivotal for learning for young children with ASD (Schreibman et al., 2015). Another way to promote self-determination is the use of self-directed learning in which clinicians and teachers provide supports for individuals to set goals and self-monitor their progress (Loman et al., 2010). This approach involves teaching of problem-solving strategies to support self-monitoring of skills and places the individual with ASD in control of determining progress and providing self-reinforcement for accomplishment of goals. Following teaching of strategies, clinicians and teachers must provide multiple opportunities for individuals with autism to practice these skills. Environmental Supports Autistic learners have been identified as having particular strengths and preference for processing visual information (Mesibov et al., 2005). As such, visual supports have been examined to determine their effectiveness in supporting learning. Both the National Autism Center’s National Standards Project (2015) and the National Professional Development Center on Autism Spectrum Disorders (n.d.; AFIRM Team 2015) have identified visual supports as an established evidence-based practice. Visual supports can include pictures, objects, written words, schedules, labels, maps, scripts, visual boundaries, arrangement of the environment, timelines, and organization systems. These concrete visual cues can be used alone or in conjunction with verbal 62 cues to provide the learner with information about an expected routine, activity, behavior, and/or how to complete a task. Visual supports have been used successfully to support children and adolescents with autism with play, social communication, cognitive, academic, motor and adaptive skills (AFIRM Team, 2015). In addition to tapping into potential visual strengths, use of visual supports provides predictability around future events and transitions, as well as concrete expectations and boundaries, which may support some individual’s preference for predictability and order (Ryan & Raisanen, 2008; ASAN, 2017). For further information on visual supports, including implementation tips and data collection sheets, please see AFIRM Team, 2015. Additional environmental supports that will enable one to approach assessment and intervention from a strengths-based perspective include attention to the individual’s sensory needs. The ASAN (2017) states, “While all Autistics are as unique as any other human beings, they share some characteristics typical of autism in common.” One such characteristic is experiencing the world differently with regard to one’s senses. Autistic individuals might experience sensitivity to light, sound, smell, taste, temperature, texture, or touch. They might demonstrate difficulty interpreting physical sensations or might experience such sensations differently than neurotypical individuals (e.g., synesthesia; ASAN, 2017). Through discussion of these sensory differences with our autistic clients and/or in collaboration with our occupational therapy (OT) colleagues, we can arrange the environment to strengthen the performance of our clients (e.g., dimming the lights, providing noise-cancelling headphones, creating a quiet place for calm self-regulation, etc.). Passion Is a Strength According to the DSM-5, restricted interests are one of the defining features of ASD (APA, 2013). This is also noted by ASAN, but can be viewed from a strengths-based perspective. ASAN (2017) notes that autistic individuals present with “deeply focused thinking and passionate interest in specific subjects”. As aforementioned, motivation is a pivotal behavior for children with ASD. For example, Baker, Koegel, and Koegel (1998) examined use of a passionate interest (maps) as the focal point of a game involving a child with autism and neurotypical peers during recess. Following an intervention that incorporated use of maps in a tag game, the child with ASD not only increased his social interactions with peers, but also generalized his interactions to other non-map activities initiated by his peers. Clinicians can tap into the strengths of the autistic children they serve by capitalizing on their intense interests and assisting them in sharing these interests with peers. Further, clinicians can coach parents and teachers in this practice as well. For example, a child who struggles in reading but has a passion for weather might excel at a book report that incorporates his love of weather. Such special interests can be tied to numerous academic domains, including math, writing, music, history, and life skills. As the research indicates, this will increase social interaction and engagement; in addition, it will build equity in peer relationships by giving the child with autism an opportunity to share their knowledge and identify friends who may share similar interests. After all, that’s a key component of friendship – someone who shares one’s interests. Quality of Life Success in sharing one’s interests leads to increased social interactions (Baker et al., 1998; Donaldson, 2015) and, presumably, feelings of self-efficacy and quality of life (QoL). Biggs and Carter (2016) examined QoL factors for adolescents with autism as they transitioned from school age to young adulthood. Parent report indicated ratings of QoL for children with ASD or intellectual disability to be significantly lower than a control group of neurotypical same-age peers. However, the authors indicated that increased involvement in extra-curricular and community activities was associated with higher social support and peer relationship ratings. Further, they stated that the strengths of the adolescents (i.e., courage, empathy, forgiveness, gratitude, humor, kindness, optimism, resilience, self-control, and self-efficacy—as measured by the Assessment Scale for Positive Character Traits- Developmental Disabilities), was one of the strongest predictors of QoL. Conversely, neither ratings of required support nor level of functioning were a significant indicator of QoL. Given these findings, the authors suggested ensuring opportunities for community 63 involvement, increased focus on strengths, preferences and interests of autistic individuals, and support for inclusive learning environments (Biggs & Carter, 2016). Conclusions The autism community represents a spectrum of individuals who present with different perspectives, cultural and community beliefs, strengths, and needs for support. From a neurodiversity model encompassed within a broader social model of disability to a medical model of ASD, the community of autism is large and ever growing. As SLPs, we have the opportunity to partner with the families who experience autism from a strengths-based framework. We should be prepared to build a relationship of joint learning and decision-making, presuming competence in all tasks, maximizing the individual’s strengths and passions, setting up the environment attuned to their sensory uniqueness, empowering their self-determination, and focusing on the broader picture of quality of life through functional community, peer-based, goals that tap into personal strengths and social interaction. References Administration for Community Living. (2013). 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Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering in school-age children: A comprehensive approach to treatment. Language, Speech, and Hearing Services in Schools, 43, 536–548. Yeoman, B. (2016). Keynote address. National Stuttering Association New York City Chapters Conference on the Past, Present, and Future of Stuttering. New York. Retrieved from http://barryyeoman.com/wpcontent/uploads/2016/05/Keynote-speech-Barry-Yeoman-NYC-Stutters-5-15-16.pdf History: Received August 15, 2016 Revised October 14, 2016 Accepted November 13, 2016 https://doi.org/10.1044/persp2.SIG1.56 67 Appendix A. General Resources Autism Self-Advocacy Network: http://autisticadvocacy.org/ Autism Society of America: http://www.autism-society.org/ Autism Empowerment: http://www.autismempowerment.org/ Autism Women’s Network: http://autismwomensnetwork.org/ Global and Regional Asperger Syndrome Partnership: http://grasp.org/ 68 Copyright of Perspectives of the ASHA Special Interest Groups is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.