The Role of Speech in Autism Spectrum Disorder

Think about the different ways that you communicate with others in your daily life. Do you focus on their facial expressions, body language, or their tone of voice? People with autism are characterized as complex communicators.

What is speech therapy?

A speech-language pathologist (SLP) works on training children, families, educators, and other key team members. Whether you are seeking speech therapy utilizing an educational or medical model, the goal of speech therapy is to maximize functional living, quality of life, and other impacted areas of need. A child with autism of varying degree and severity may work on goals in several different areas, like: communication, academics, social skills, motor skills, and routines. Speech therapy makes it possible to focus on the things that appeal to the child, while they learn to work independently and feel a sense of pride and accomplishment as new skills and concepts are mastered. There is no greater feeling than seeing a parent, teacher, or other team member impressed as they watch a child with autism in wonder, while improving his/her verbal and non-verbal skills at their own pace.

Signs and Symptoms of Autism

Communication

Communication includes understanding, talking, reading, and writing. A person with autism may have challenges

• understanding and using gestures;

• understanding and using words;

• following directions;

• learning to read or write—some children with autism read early but do not understand what they read (called hyperlexia); and

• having conversations.

A person with autism may

• be hard to understand;

• repeat words or phrases they just heard or that they heard days or weeks earlier (echolalia);

• use a robotic or singsong speaking voice;

• talk very little or not at all; and

• use challenging behaviors instead of words or gestures to communicate what they want.

Social Skills

A person with autism may have challenges relating to others. It might seem like they are not interested in others or in making friends.

It may be hard for a person with autism to

• share attention with someone else and focus on the same object or event;

• join in play with others and share toys;

• respond when others invite them to play or talk;

• understand how others feel;

• take turns in play or in conversation; and

• make and keep friends.

Behaviors

A person with autism may

• repeat certain behaviors including hand or body movements;

• cry, laugh, or become angry for unknown reasons;

• have trouble changing from one activity to the next;

• get upset by certain sounds, smells, or textures;

• like only a few foods;

• choose foods based on look or texture; and

• be interested in only a few objects or topics.

13 things you should know an SLP does with children showing signs of autism:

1. Advocacy: Though a speech therapist cannot diagnose autism, it is often the SLP who initiates the conversation with the developmental pediatrician to further evaluate the child. Speech therapists can be an advocate on an IEP or healthcare team due to their clinical medical expertise and knowledge of ethical, evidence-based practice in treating and evaluating children with autism. SLPs also can facilitate

2. Transition planning: Speech therapists are often case managers or key team members that assist with transition planning. Often times, a person with autism may switch facilities or schools. The SLP can determine which supplementary accommodations/supports, personnel, training, or equipment may be required to ensure no gaps in access to communication.

3. Goal development: Based on formal and informal means of assessment/evaluation, a speech therapist authors and creates goal areas that are meaningful and achievable to a child with autism. These goals are facilitated by individual therapy, group therapy, or co-treatment models depending on the individual needs and coverage options.

4. Data collection and progress monitoring: Speech therapists utilize qualitative (descriptive) and quantitative (numerical) methods of data collection. A key role as an SLP is to monitor developmental milestones and communication red flags. Through reliable data and consistent care, an SLP can be well-informed throughout the therapeutic process by altering, modifying, and adding levels of support. Children with autism attain skills at different rates. A speech therapist can counsel families to ensure their child does not fall through the cracks.

5. Language development: An SLP diagnoses and treats an array of receptive and expressive language deficits. This includes comprehension and use of language in a variety of environments with diverse communication partners. Language can be broken down into many different parts like: phonology (speech sounds), morphology (word structure), syntax (sentence structure), semantics (meaning), and pragmatics (rules within social contexts).

6. Social skills: A key area that is almost universal is pragmatic and social difficulties in people with autism. Speech therapists may use video modeling, social stories, and community group programs to teach social skills. The importance of social skills training can improve client-caregiver relationships, develop and maintain more friendships, and strengthen functional life skills that help with school and job functions.

7. Literacy: Phonological awareness (PA) involves a continuum of skills that develop over time and that are crucial for reading, writing, and spelling success. Speech therapists may use explicit teaching of phonological awareness to eliminate reading problems. Children with autism may have problems with blending, segmenting, or vocally playing with phonemes (speech sounds), as well as demonstrate weaknesses in language and perception skills. The SLP helps a child with autism to recognize and manipulate spoken parts of sentences and worlds, as well as notice, think about, and work with individual sounds in spoken words.

8. Articulation: Like the condition itself, speech intelligibility in autism can range from non-verbal to perfect intelligibility. And while a child may currently need assistive technology supports to communicate… this can change! Most SLPs strongly feel that earlier on in the communication development of a child with ASD, the ability to communicate his or her needs and wants to promote academic and social success is the most important goal. However, at some point in the long-term plan, misarticulated speech should become a strong priority. Speech therapists use developmental norms of mastering certain sounds as a guideline to goal setting and progress monitoring. The rule of thumb is to target the sounds that kids tend to master earlier in childhood because these also tend to be simpler to say from the standpoint of what the mouth needs to do to say the sounds correctly.

9. Voice & Intonation: When people with autism use spoken language, they often use it quite literally. As a result, sarcasm, irony, idioms, metaphors, similes, and subtle differences in meaning may be difficult. People with autism rarely learn social communication skills through imitation alone, so if they're not actively taught the rules of prosody they may never learn them.

10. Feeding therapy: Feeding intervention programs are developed for children who show signs of food selectivity and/or swallowing problems. They are designed to expand a child’s food repertoire, volume, texture, and address other food-related problems. Picky eating can be a cause for concern when children do not receive the nutrients they need to thrive. Research shows that food selectivity often fails to resolve without intervention, and that the sooner an intervention can occur, the more likely good eating habits will be established and last. Speech therapists can utilize sensory techniques. food chaining, and trauma-informed practice to address feeding and swallowing problems.

11. Oral motor: Oral motor dysfunction is common in some children with autism. Speech therapy may involve exercises to help a person with autism strengthen the muscles utilized when eating or speaking, improve range of motion, or increase coordination.

12. AAC: Augmentative and Alternative Communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. AAC can be used to supplement existing speech and alternatively be used in place of speech that is absent or not purposeful. For years now, research has shown that AAC can be used to help those with developmental and acquired disabilities to communicate successfully. Speech therapists provide and accept multiple ways for the child to communicate. This can range from gestures, sign language, voice output from a speech-generating device, or a combination of forms.

13. Play-based therapy: Neuroplasticity refers to the brain’s ability to change (organize and reorganize) its structure as a result of internal (genetic) factors, as well as external (experiential) factors that lead to new learning. Play is one of the biggest forms of increasing neuroplasticity in the brain. Speech therapists frequently used play based materials and models during therapy to work on speech-language skills. Play is also usually incorporated in the child’s most natural environment. Play-based therapy can take place in a living room, clinic, hospital, playground, or virtual telemedicine platform. The possibilities are endless!

Conclusion:

It may take a little more effort to talk to and play with a child with autism. Speech and language delays tend to be among parents’ earliest developmental concerns. As a result, speech-language pathologist are often among the first clinicians to work with a child who has undiagnosed autism and can be a key part of the multi-disciplinary team that guides the diagnosis. SLPs are in an ideal position to spot early warning signs of autism and collaborate in a full evaluation if needed. The result can be earlier diagnosis and intervention that supports brain development and improves outcomes. It is important that you never feel alone in helping your child, and that you remember that there are plenty of resources (your child’s pediatrician being one of the best ones) to reach out to when you suspect that your child is exhibiting symptoms of autism.