Informed consent is based on the legal and moral premise of patient autonomy. It typically involves an expert or team of experts educating the patient about their diagnosis, treatment recommendations, and all associated risk factors related to the recommended treatment. The intent of informed consent is for the patient to make the final decision of the treatment.

The challenge with informed consent as it relates to the diagnosis and treatment recommendations for asd is the misrepresented idea that ABA is the gold standard of treatment and that other approaches are to be integrated into the aba program. The true gold standard is that children diagnosed with asd have better outcomes when they receive intensive, family centered treatment supported by a team of developmental specialists. The term ABA is now so widely and generically used that it has lost specific meaning. When over generalized terms are used, the process of individualizing to the clients needs is greatly minimized and the process of informed consent is compromised.

Given that ASD is a social communication disorder, often accompanied by speech and language delays, it is imperative that a slp be a team leader involved with the process of providing informed consent to families and clients affected by ASD. An intensive treatment program guided only by professionals and therapist trained in behavioral methodologies puts families and clients at risk for aquired social communication challenges and delayed or atypical acquisition of later developing capacities related to social cognition and executive function.

ASD affects relationships. Developing and implementing evidence based treatment programs build from relationship, starting with informed consent across therapeutic disciplines to comprehensively support families. The model of one expert leading the team has failed our families. Given that we know ASD is best supported by a team of specialists, informed consent begins with helping a family understand what ASD is, how we learn and develop, how we can help build upon their child’s strengths through relationship and a developmental framework, and how we can best empower families to participate.

How often do we observe the handling of challenging behaviors by identifying one child as the cause of the problem and then a rigid rule imposed to end the dispute. This pattern appears to be widespread and an ongoing problem with developing social cognition skills necessary for success across the lifespan.

Challenging behavior is best changed and supported through the relationship lens. Looking at each and every conflict as an exchange of of behaviors, words, and thoughts. We must emphasize perspective. What could I have done differently? How did I make the other person feel? These questions are important for the aggressor, the recipient and the by stander to process and explore and for all those participating to express with each other through conflict resolution. Each participant must be given the opportunity to reflect in the process at all developmental levels to learn, grow and achieve better social outcomes.

I often see rules generated far too quickly eliminating great learning opportunities in the process. For example, the soccer game at recess has become "too competitive" and challenging behaviors emerge. The reaction...no more soccer at recess...you misbehaved so therefore the game is eliminated.. What are we teaching in this scenario...that when there is a conflict simply walk away and stop the potential of fun! No! Look at all the relationships involved. Teach new ways and different options to solve the problem. Speech Language Pathologist, Occupational Therapists, Physical Therapists, classroom teachers, classroom aides, and Principals...go to recess. Join the process and foster the learning as opposed to rigid rule following. We need to teach flexible thinking and problem solving...not just rule following.