Speech Therapy & Augmentative Communication for Children on The Autism Spectrum
Nancy Steeves, MS, CCC-A, Executive Director of Northeast Hearing & Speech
A speech-language pathologist (SLP) is part of the team that diagnoses and treats individuals with Autism Spectrum Disorder (ASD). Because problems with communication and social skills are often the first symptoms of autism, an SLP is frequently the first practitioner seen by the family during the diagnosis process. Parents may have noticed that their child is not speaking or has lost words he was previously able to say. Their child may have difficulty expressing basic wants and needs, or have problems following directions. Echolalia (repeating what is said), scripting (repeating dialogue from TV shows or movies), and speech that sounds different (e.g., robotic) may also be concerns. Parents may have observed that their child has poor eye contact, difficulty with pretend and social play, is overly focused on a topic or object, or frequently expresses emotions that don’t match the situation (e.g., crying or laughing for no known reason). Their child may also have an aversion to being touched or held, demonstrate sensitivity to light or sounds, or refuse certain food textures. These signs or symptoms of ASD vary in presentation and severity in each child and the SLP plays an important role in developing a plan of treatment appropriate to the individual’s strengths and needs.
Following a thorough evaluation of the child’s communication and social skills, a treatment plan is established to meet the needs of the child and family. Children who participate in intensive intervention beginning by age 3 have a significantly better outcome than those beginning after age 5. Intervention beginning before age 3 appears to have an even greater impact. Because early intervention is so important, many SLPs work in toddler and preschool programs in collaboration with teachers, occupational therapists, and physical therapists to facilitate the child’s ability to actively engage in and benefit from learning activities and social interactions with peers. Treatment may include a combination of traditional speech and language approaches, augmentative and alternative communication, and behavioral interventions.
SLPs work to enhance (a) the initiation of spontaneous communication in functional activities with adults and peers across settings (i.e., home, school, and community); (b) the comprehension of verbal and nonverbal language across settings; (c) verbal and nonverbal means of communication, including natural gestures, speech, signs, pictures, written words, as well as other augmentative and alternative communication (AAC) systems; (d) social interaction across settings to promote the development of friendships; (e) play skills with a focus on play with peers; and (f) access to literacy and academic instruction, as well as extracurricular and vocational activities.
Some individuals with ASD are unable to rely on natural speech to meet their communication needs and must use augmentative and alternative communication (AAC) systems. SLPs work with the family and a team of professionals (including physical, occupational and cognitive therapists, assistive technology specialists, educators, medical professionals, and social workers) to assess the individual’s communication needs, language, cognition, motor ability, and vision to determine the most appropriate AAC system and set-up. There are many AAC systems available; each can be categorized as aided or unaided communication. Unaided communication involves using no equipment (e.g., vocalizations, gestures, and sign language). Aided communication involves the use of external communication tools (e.g., communication boards, voice output communication aids, and computers) and can range from low-tech (e.g., picture boards) to high-tech (e.g., speech generating devices). Examples of low-tech communication systems include communication boards, the Picture Exchange Communication System (PECS), and eye gaze boards. Examples of high-tech communication systems include Dynavox, Springboard, and iPad apps (e.g., Proloquo2go, Tap to Talk, and Verbally). Once the most appropriate system is determined for the individual, SLPs are then responsible for setting-up, teaching use, and helping to maintain the system.
SLPs also work to reduce challenging behaviors that the individual with ASD may demonstrate. Once the SLP identifies the reason for or the communicative function of the behavior, environmental modifications can be made and a more effective and acceptable means of communication can be taught, thereby reducing the aberrant behavior through positive behavior support.
Because social language difficulties can have such a significant impact on peer interaction and a child’s sense of belonging both in and out of school, group therapy can also be beneficial.
Finally, given the diversity of individuals with ASD and their families, the SLP works collaboratively with the family throughout assessment and intervention to consider their needs, priorities, and cultural and linguistic differences. This partnership is critical to ensure positive outcomes.
Northeast Hearing and Speech (NHS) is a community based speech-language-hearing center in Maine, with a staff of 13 SLPs who evaluate and treat individuals with ASD.