I recently read an article about the shift in thinking surrounding regression in autism (Dobbs, 2017; https://spectrumnews.org/features/deep-dive/rethinking-regression-autism/). I have been following the research for a while that looked at video tapes of children before their first birthday, younger siblings displaying signs of autism from an early age, and many other markers that appear to indicate autism and regression may happen earlier than we realize. It used to be theorized that regression in autism was rare; however, the article suggests that most children with autism regress to a degree.
As a speech language pathologist, regression of language has always been a key indicator for me to think about a possible autism spectrum disorder with a client. Parents can recognize this regression as their children become quieter and quieter until speech and often even babbling disappears. This regression is overt and frightening for many families and it is often at this point that they contact their Pediatrician or a Speech Pathologist.
But what about the other types of regression that may be less obvious to parents? Regression in gross motor or fine motor skills? Regression in eye gaze or eye tracking? Regression in emotional readiness? Regression in social reciprocity? In the article, David Dobbs states that, “Regression should be seen not as an event but as a process.” This is an important concept that we need to rethink as researchers and clinicians.
We need to be working closely with colleagues in other disciplines (e.g., OT, PT, Developmental Specialists, Pediatricians) to understand the ‘process’ they may be seeing in a young child. The whole concept of early intervention is to support a child as a team, and yet, have we been addressing the possible process of regression as a team? It is imperative that clinicians working with young children understand development across domains (i.e., cognitive, motor, social-emotional, language, self-help) so that we can all recognize and address when development is not only delayed, but starts to backslide.
To aid in this effort, interprofessional education is vitally important across target disciplines in higher education. Occupational therapists should be cross training with speech pathologists and pediatricians. Psychologists and physical therapists need to understand development from each other’s perspectives. Behavior analysts can engage in training with speech pathologists, and so on. Beyond higher education, clients with autism should be supported via integrated care and behavioral health models.
I have worked with children on the autism spectrum for over two decades and time and again I have realized the importance of interprofessional education and integrated care. Autism is not one thing and cannot be addressed by only one discipline. We are constantly reminded through research that we have much to learn. An integrated model of care should start early in our training and continue throughout our careers.