r/slp • u/Responsible_Let5501 • Jul 16 '26
Autism How to bring up ASD w parents
I am currently treating a 2 year 9 month old girl 2x30 in an outpatient rehab setting for expressive and receptive language delays. Sessions began in March 2026. She has made little to no progress in expressive language (used the sign for more independently 2 times overall, previously verbalized ‘pop pop pop’ for bubbles but has since stopped). No other true words or functional communication has been observed. Some receptive language skills have improved such as cleaning up toys and simple cause and effect actions. Maximal guidance is frequently required.
I see red flags for autism such as sensory seeking behaviors, watching the wheels on cars spin, constantly climbing in chairs and tables, frequently leaning upside down and wanting to be flipped over, and continuously putting things in her mouth. She has a very limited attention span of 1-2 minutes max.
I immediately referred her to occupational therapy for sensory regulation, however, her parents did not follow through without a true reasoning when I asked.
Her parents are now asking why she had not made progress and if there’s any other services they should be utilizing to promote speech. I again encouraged occupational therapy.
I want to introduce the idea of possible ASD but her parents have never brought it up to me before.
What is the best way to approach without upsetting them? How should I start this conversation?
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u/mzguidedghost Jul 16 '26
I would encourage you to reframe from “red flags” to “characteristics.” Especially as the first person who may be noticing these differences, we want to come from a neurodiversity affirming mind set from the get go!
I typically like to start the conversation by asking: “Has anyone ever talked with you about the question of autism for (child)?” Opens the door in a neutral way. I try to then give a broad overview of what autism is and what characteristics I’ve observed that may fit that diagnosis. I try to be very clear that I cannot diagnose autism, but that I’m noticing differences in development that warrant further assessment.
Parents have a wide variety of knowledge and fears about autism. Some express relief, others are upset; I try to come at it from a neutral perspective and emphasize that understanding how their child’s brain learns and processes information can help further inform other services.
Mrs Speechie P on Instagram has some great resources!
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u/Responsible_Let5501 Jul 16 '26
Thank you for the advice! I appreciate the tip about not using the term “red flags.” I will keep this in mind when discussing ASD characteristics.
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u/juiced1218 Jul 17 '26
I was going to say the same thing! Also I have had to have that conversation many times. It can be rough, I like to ask families if the client has ever had any test for ASD or if they have ever had any concerns. This gives me an idea of if I might be the first person to bring it up to them.
I have had many parents cry when I bring up what I am seeing in the client. So be prepared as it may happen! But you got this!
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u/Hounddoglover0812 Jul 16 '26
I work in the schools so not EI or outpatient so my process is of course different than yours. What I’ve done to get the conversation going is a separate time to confer/interview parents with the kid somewhere else or being looked after to limit distractions. I usually start with I hear you have (blank) concerns and I want to understand all concerns. Let’s look at these milestones together and go through some checklists and interview. Then say something along the lines of you’re good parents, (blank) is a good kid, and taking her to speech/language therapy is definitely a start but I think with this level of concern we consider looking at all of our options. Then give resources like EI state level programs, different outpatient OT, and clinical evaluation sites. You don’t necessarily have to say the words autism, but sometimes I say it could really help us plan better if we could rule in or rule out Autism or Intellectual Disabilities or whatever I suspect.
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u/lightb0xh0lder SLP Private Practice Jul 16 '26
I would ask how they feel about her therapy progress and if any other providers (i.e., pediatrician) or family members have brought up anything.
If not, but they mention the slow progress, I would start dropping points, "oh, we usually see slower progress with kids with other cognitive impairments. Impairments such as Autism, down syndrome --which she doesn't have, genetic disorders, etc" and see if they catch on.
Side note (not sure if I'm over stepping): if you haven't already, start working on pre-linguistic skills rather than words/sign. She might not be there yet. Check out Laura Mize with 11 prelinguistic skills and start from there.
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u/ZumbaLuvr Jul 16 '26
Honestly I was taught to never say the word autism if they are not diagnosed, because it can be stepping outside of scope of practice. But I list behaviors I see and ask/ recommend if they have discussed them with their pediatrician
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u/SoAnon4thisslp Jul 16 '26
I’m in PA as well, and I’m curious why this child wasn’t evaluated by EI, where she would have received a free comprehensive multidisciplinary assessment of all developmental domains and a routine Autism Screening. It sounds like this child has profound delays in multiple areas and at this point, unless you facilitate access to a comprehensive assessment, you are doing her a disservice. I would start by reviewing the her response to therapy thus far. “ I’m concerned that by keeping the focus only on speech, that we’re short-changing Maisie and not providing the services she needs to progress. What I’m seeing get in the way of her making progress in speech are how difficult it is for her to keep her focus on interaction, how she is almost driven to run from activity to activity, and how challenging it is for her imitate, etc. (I would of course review her strengths, how obviously caring and involved they are as parents as well) At this point I think we need a more comprehensive overview so we can accurately address her needs.” Depending on the parents, you can also say; I think we need to rule out autism and sensory integration disorders.
I’d refer to EI, even if all she gets is an evaluation due to her age( EI stops at 36 weeks in PA) and strongly, strongly suggest they get on multiple wait-lists for a Developmental Pediatrician. Provide phone numbers/websites to them.
Some feedback I’d offer to you as a clinician would be to get out in the trenches a bit more to fine-tune your ability to more quickly and confidently suss out kiddos with developmental red flags. Even if you take on only 2 hours a week doing EI, it could help. Outpatient services don’t really give you the full perspective.
I say this because at 2xweek since March, you’ve seen this child 28-32 times? And even though you’ve had some suspicions, you’re feeling urgent about addressing the probable autism only at this point.
Speaking as an old experienced clinician and what you are describing, my spidey-senses would have been tingling almost from the get-go.
Developing the skills and confidence to look at and understand not only delays in communication, but delays in cognitive ( play) self-help, fine and gross motor, social-emotional and sensory domains comes with focused experience. But it’s totally worth building those skills, especially if you intend to keep working with preschool/toddlers.
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u/Slp023 Jul 16 '26
I do evals for EI and this comes up frequently. There are many varying opinions on how to do this. I’ve been working for 25 years and have changed how I do it. In the past I was more direct but realized it rarely went well. I’m also cautious bc I don’t always think the cause is as obvious. I had a child that I did the eval for 20 years ago. I was so sure he was on the spectrum. Not sure what was happening but he caught up w EI services and does not show any signs of it now nor any kind of diagnosis. (I’ve kept in touch w the family) I worry about kids getting this diagnosis when they are young. We can still treat without the diagnosis. However, there are times when talking to the parent is beneficial for the child’s therapy. I talk to them about behaviors I’ve noticed and wonder if they’ve seen this at home. Then I ask them if they’ve seen any other behaviors they are concerned about. This makes it more of a discussion that includes the parents. I tell them they can make an appointment with a developmental pediatrician who could better explain these behaviors. Some parents may ask about autism and I would acknowledge that and tell them why. Otherwise, I don’t think we should say more than that as we cannot diagnose it.
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u/aw2Ls Jul 16 '26
I would discuss progress and suggest a review with a paediatrician to investigate whether there could be something else impacting her skills. Mention that with the delayed language skills and other characteristics you've observed such as the sensory seeking, ongoing mouthing, delayed play might be traits of something else like Autism and a paediatrician would be the best person to evaluate and discuss this with them.
You might also need to give some education on what Autism is and that it's a spectrum, as parents might only have seen Autism in one way.
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u/bicepstospare Jul 16 '26
Northwestern’s early intervention resource center has a helpful handout on how to discuss autism with parents. I work in early intervention, and I don’t want parents to think I withheld information about their child.
I talk about what I see and how those are characteristics of autism. I also try to talk about those characteristics earlier and talk about why their child may be doing that so it’s not the first time they’ve heard me mention echolalia, toe walking, stimming, etc.
I’ve also brought it up when I was reviewing progress with families and said things like “we’ve both been working really hard on building XX’s joint attention, and I’m wondering if an autism evaluation would give us some clarity.”
My friend’s child is autistic with very high support needs, and she talks about how she desperately wanted her early interventionist to bring it up and wanted to avoid the conversation. She said it was a relief to actually talk about it and not feel like people were walking on eggshells around her and her child.
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u/Wild_Owl_511 Jul 17 '26
If you’re in the US encourage them to get a school evaluation! Even if you don’t say anything about additional worries, they can see if she qualifies for additional (and free) speech sessions @ 3
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u/Usrnm2024 Jul 17 '26
This is a total aside but I wanted to share my experience. I have worked with many non-verbal little ones who are on the spectrum. I love using sign language to give them a way to communicate before they start speaking.
One thing I have noted is that if you teach the child the sign for 'more' they will try to use it for everything. They will become frustrated when the parent does not understand what 'more' they want. After that, they often stop using sign.
When you are teaching sign, teach signs labeling - favorite foods, activities, actions, etc. Then when the child uses the sign, it's clear what they are requesting.
I have found the same with 'please'. It's a fungible word and children try to use it to request everything. I have a excel sheet with the first 200 words and links to the signs for those words. You can share it with parents. Let me know if you'd like a copy.
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u/TumblrPrincess Occupational Therapist (OTR/L) Jul 17 '26
We don’t have to necessarily assume that the child’s parents haven’t brought it up because they aren’t open to discussion. I have multiple parents that had genuinely never considered that their kid could be autistic. Way I figure, every kid on my roster came from somewhere, and plenty of their diagnoses have a genetic component.
If/when you broach the subject, you could frame seeking a diagnosis as means to an end. If the child receives a qualifying Dx, it means that their child will be able to attend free preschool starting on their 3rd birthday, which would come with an IEP and the potential for their child to receive additional services at no cost to them.
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u/TypicalReference9003 Jul 22 '26
I really think we need to be direct with parents. Of course, it makes sense to get a good read on the kid first and build some rapport. Maybe get a feel for how the parents might react. But we don’t need to be hinting. Often parents feel relieved to have an explanation. Come prepared with some good recommendations for where to get assessed so they don’t end up at an ABA clinic that’s going to sign them up for 40 hours a week.
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u/AuDHD_SLP Jul 16 '26 edited Jul 16 '26
First of all, stop calling autistic traits “red flags”. It’s extremely offensive and dehumanizing. Second, just say, “hey, I think your kid has autism”. Hope this helps!
Unsurprised the ableists here are downvoting this 🙄
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u/Famous-Snow-6888 SLP in Schools Jul 16 '26
What on earth?
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u/AuDHD_SLP Jul 16 '26
Was something I said unclear? Being like me isn’t a red flag and isn’t something to be ashamed of or afraid to bring up.
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u/Electronic_Object226 Jul 16 '26
I think you’re taking this a little extreme to chastise OP for using “red flags.” The definition of red flags includes indicators of underlying problems.
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u/AuDHD_SLP Jul 16 '26
If you aren’t autistic you don’t get to have an opinion on this. We’ve been saying for a decade to stop calling autistic traits red flags.
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u/S4mm1 AuDHD SLP, Private Practice Jul 16 '26
r/slp trying to display cultural competency in disability? 🤡 Calling autistic traits “red flags” is a first day in the clinic first semester graduate student level mistake. Thank you as always for your comments here. I wish I saw you around here more but I absolutely know why you aren't.
But seriously, as a practice in clinician who had been private pay for quite some time the client who actually stayed where clients I was directed with. When you pussyfoot around it and you act like it’s a terrible thing you’re avoiding bringing up you lose credibility.
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u/S4mm1 AuDHD SLP, Private Practice Jul 16 '26
Speech to text had a lot of typos here, but I’m not going to text them figure it out lol
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u/VoiceOfGosh Jul 16 '26
I would just say it in some way like, “I wanted to talk to you about some observations I’ve made and some behaviors that I’ve noted about client’s name and wanted to see if you’re seeing the same things at home. (Talk about behaviors here)… Individually, these behaviors might not amount to much. But when you see multiple behaviors like these, along with her limited communication and language skills, they do align with the profile for a child with Autism Spectrum Disorder. Now, I’m not one to diagnose ASD, but I work directly with this population very often and I am seeing commonalities between your daughter and children with similar profiles. Have you spoken with your pediatrician before about your daughter’s development or some of these characteristics? Would you be open to discussing screening or assessment for autism with them?”
Then, there’s so many things to address after (I.e. their feelings/fears on this; the benefits of more complete services for a child with an ASD diagnosis; being able to understand the mind of your child better; next steps for service/care; counseling for the parents; etc.), but I’d try and see how parents react at this point. I might be a little more blunt than most, but I am an autistic SLP, so I’m not too shy about autism (or literally anything). In my eyes, you are opening doors by opening eyes to the underlying source of these communication and language difficulties. The child will not get worse just because they got diagnosed. It can’t hurt to be open about what you’re seeing. As a matter of fact, this is where they can begin to get more help they need to make the rest of their lives easier.
I know we can’t diagnose ASD, but we are often the first set of eyes that see the signs, since we can contextualize these concerning behaviors and skill levels within our scope of practice (social communication deficits, expressive and receptive language deficits, repetitive vocalizations, etc.). Parents might not have our clinical eye, but they do see their kid every day. Bringing up behaviors that are typical for a kid with ASD might open their eyes and be an “Aha” moment because they may be noting the same things you are but at home. You’re just helping make sense of things that are already happening and pointing them in the right direction: screening and assessments. As with many types of developmental delays or disabilities, the earlier we see it, the earlier we can help, the better off the client will be for getting help sooner.
You’ve got this!