Autism Therapy: speech therapy

Speech and Language Therapy for Children with Autism

Published Nov 6, 2009, last updated Dec 21, 2009

What is it?

The goal of speech therapy is to improve all aspects of communication. This includes: comprehension, expression, sound production, and social use of language ⁽¹⁾. Speech therapy may include sign language and the use of picture symbols ⁽²⁾. At its best, a specific speech therapy program is tailored to the specific weaknesses and the environment of the individual child ^{(1, 3)}. Unfortunately, it can be difficult to create a child-specific, evolving, long-term speech therapy plan ^{(1 , 4)}.

The National Research Council describes four aspects of beneficial speech therapy.

Speech therapy should begin early in a child's life and be frequent.
Therapy should be rooted in practical experience in the child's life.
Therapy should encourage spontaneous communication.
Any communication skills learned during speech therapy should be generalizable to multiple situations ⁽⁵⁾.

Thus, any speech therapy program should include practice in many different places with many different people ⁽²⁾. In order for speech therapy to be most successful, caregivers should practice speech exercises during normal daily routines in the home, school, and community ^{(1 , 6, 7)}. Speech therapists can give specific examples of how best to incorporate speech therapy throughout a child's day ⁽⁸⁾.

What's it like?

Speech therapy sessions will vary greatly depending upon the child. If the child is younger than three years old, then the speech therapist will most likely come into the home for a one-hour session. If the child is older than three, then therapy sessions will occur at school or in the therapist’s office. If the child is school age, expect that speech therapy will include one-on-one time with the child, classroom-based activities, and consultations between the speech therapist and teachers and parents ⁽²⁾.

The sessions should be designed to engage the child in communication. The therapist will engage the child using games and toys chosen specifically for the child. Several different speech therapy techniques and approaches can be used in a single session or throughout many sessions (see Does it work?).

Speech and language therapy may include tools and strategies called augmentative and alternative communication (AAC). These tools can be very helpful for children with little or no verbal communication skills. For example, a picture exchange communication system (or PECS; http://www.pecs.org.uk/) allows the child to communicate using pictures. Go to our PECS Fact Sheet for more information.

What is the theory behind it?

Children with autism not only may have trouble communicating socially, but may also have problems behaving. These behavioral problems are believed to be at least partially caused by the frustration associated with the inability to communicate. Speech therapy is intended to improve social communication skills, and teach the ability to use those communication skills as an alternative to unacceptable behavior ⁽¹⁾.

Does it work?

Many scientific studies demonstrate that speech therapy is able to improve the communication skills of children with autism ⁽¹⁾. Parents reported improvements in social play, confidence, and behavior at home and at school with speech therapy ⁽⁹⁾. The most successful approaches to speech therapy include components of early identification, family involvement, and individualized treatment ⁽⁸⁾.

There are many different approaches to speech therapy and most of them are effective. The table below lists some of the different approaches. In most cases a speech therapist will use a combination of approaches in a program.

Type of Speech Therapy	Definition	Does the Research Support It?
Augmentative and alternative communication (AAC)	broad term for forms of communication that supplement or enhance speech, including electronic devices, picture boards, and sign language	Yes ⁽¹⁰⁾
Discrete trial training	therapy that focuses on behavior and actions	Yes ⁽¹⁾
Facilitated communication	communication technique that involves a facilitator who places his hand over the patient's hand, arm or wrist, which is placed on a board or keyboard with letters, words or pictures	No ^{(1, 4)}
Functional communication training (FCT)	use of positive reinforcement to motivate the child to communicate	Yes ⁽¹¹⁾
Generalized imitation	child is encouraged to mimic the therapists mouth motions before attempting to make the sound	Yes ⁽¹²⁾
Mand training	use of prompts and reinforcements of independent requests for items (referred to as mands)	Yes ⁽¹²⁾
Motivational techniques	therapy techniques that focus on following the child's lead and capitalize on the child's desire to respond	Yes ⁽⁶⁾
Peer mentors/circle of friends	use of children who are trained to interact with the autistic child throughout the day	Yes ⁽⁸⁾
Picture exchange communication system (PECS)	a type of AAC that uses picture symbols to communicate (see PECS Fact Sheet)	Yes ⁽¹⁰⁾
Relationship development intervention (RDI)	trademarked treatment program that centers on the belief that individuals with autism can participate in authentic emotional relationships if they are exposed to them in a gradual, systematic way	Yes ⁽⁸⁾
Sign language/total communication	language of hand shapes, movements, and facial expressions (especially useful for ages 0 to 3)	Yes ⁽¹⁾
Story scripts/social stories	actual stories that can be used or adapted to teach social skills	Yes ^{(1, 8)}

Is it harmful?

There are no reports of speech therapy being harmful.

Cost

The cost of speech therapy is covered by the government through the Individuals with Disabilities Education Act (IDEA) of 2004. The amount of speech therapy provided in this setting may be suboptimal and thus should be supplemented with private therapy. Private speech therapy can be expensive (approximately $100/hour or more)

Speech therapy requires parental investment of time. In order to be most effective, parents may need to be fully integrated into the therapy program and should seek out opportunities to practice communication throughout the daily routine ⁽⁷⁾. With time, this should become a new way of life.

Resources

Healing Thresholds has partnered with Natural Learning Concepts. They have many tools to help children build their vocabulary.

Healing Thresholds has also partnered with Discount School Supply. Discount School Supply sells toys such as the “How Do You Feel?” Play and Learn Chart that can be used with older children to help them learn to describe feelings.

Signing Time is one of many companies selling systems that help to teach children sign language.

Autism is a condition covered under the IDEA of 2004. Services covered by IDEA include early identification and assessment by an occupational therapist. This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21 (U.S. Department of Education).

Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). There is a listing on this Web site for state early intervention centers. School districts can coordinate special services for children 3 to 21 years old.

Several articles and books that might be useful:

Principles for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span: Technical report by American Speech-Language-Hearing Association (2006). Available from http://www.asha.org/docs/html/TR2006-00143.html. 2006.

Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention by T. Charman and W. Stone. 2006. The Guilford Press, pp. 115-266.

Enhancing Early Language in Children with Autism Spectrum Disorders by R. Paul and D. Sutherland. In Handbook of Autism and Pervasive Developmental Disorders, Two Volume Set. 2005. John Wiley & Sons, pp. 977-1002.

Improving Speech and Eating Skills in Children with Autism Spectrum Disorders – An Oral Motor Program for Home and School by M.A. Flanagan. 2008. Autism Asperger Publishing Company.

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References

Improving Social Initiations in Young Children with Autism Using Reinforcers with Embedded Social Interactions

J Autism Dev Disord, by Koegel, RL, Vernon TW, and Koegel LK, published in 2009, summarized May 6, 2010

Children with autism who are rewarded with social interactions during therapy may learn to seek out and initiate social interactions.

The purpose of this study was to see if social exchange could be used to as a reinforcer during speech therapy. This means that rather than giving a reward, the therapist provides social exchange as the reward. The data show that speech therapy sessions with social exchanges helped the child to be more engaged and have higher affect ratings. The authors hope that teaching social exchange will also improve speech and behavior. They also hope that helping children to learn to connect with the therapist will help the child learn to connect with other children.

Speech and Language Pathology and Autistic Spectrum

The Spanish Journal of Psychology, by Carduso, C., and Montenegro MS, published in 2009, summarized Apr 20, 2010

Allowing a student with autism consistent access to the same speech therapist may help progress in speech therapy.

The purpose of this study was to see if one form of speech therapy yielded better results than another form of speech therapy. The study had only eight children with autism spectrum disorders (ages 3 to 17 years old). The authors could not find a large difference between the speech therapy groups. The only difference that they found was that the group that had the same therapist for 12 months did slightly better than the group that changed therapists. The children in the group that changed therapists did worse at the end of therapy than they did at the start of therapy.

Corticosteroid Treatment of Behaviour, Language and Motor Regression in Childhood Disintegrative Disorder

Official Journal of the European Paediatric Neurology Society, by Mordekar, SR, Prendergast M., Chattopadhyay AK, and Baxter PS, published in 2009, summarized Dec 14, 2009

An immune system suppressant (corticosteroid) may help some children on the autism spectrum.

Two 4-year-old children had a rapid onset of childhood disintegrative disorder (CDD). They had a change in personality, loss of speech, and withdrew from people. They also had seizures. The authors treated them with the corticosteroid prednisolone, and their symptoms gradually disappeared over the next 4 years. Prednisolone acts to reduce inflammation and calm down the immune system, and may have other effects. The doctors found no sign of inflammation in their nervous system. The doctors do not know why the medication worked for these children.

One-Year Change in Repetitive Behaviours in Young Children with Communication Disorders Including Autism

Journal of Autism and Developmental Disorders, by Honey, E., McConachie H., Randle V., Shearer H., and LeCouteur AS, published in 2008, summarized Oct 26, 2009

Repetitive behaviors in children with autism may decrease over time without therapy interventions.

This study evaluated children (58 children, 24 to 48 months of age) with autism or language problems over the course of one year. Children with poor language or adaptive skills generally had higher levels of repetitive behaviors. Repetitive behaviors for all of the children lessened somewhat during the year. The biggest decrease in repetitive behaviors was seen in children with autism who had lower abilities. The authors think that parents may have hope that the behaviors will get less frequent in their own children as they get older. Children were recruited for the study through pediatricians and speech and language pathologists. Therefore, it appears that children were getting some form of therapy, but the authors did not evaluate what role their therapy played in reducing the behaviors.

Two Moms in the Philippines Share about Their Children with Autism

Jan 26, 2012

Gina Luna-Bermudo and a college classmate, Mary Rose Ramoso-Pena, both have children with autism. In this article, they share how they have coped, found resources, and used various autism therapies with their kids. What the moms have done is inventive and supported by the Autism Society Philippines. Both have found that their children have strengths, such as athletics and academics, which can be fostered. Both agreed that the earlier years were the most difficult as they tried to find time for occupational therapy, speech therapy, and behavioral therapy while coping with daily activities. Interestingly, both moms take the media to task as they present autism in various ways that might not always be accurate.

Read original article: How Two Moms Deal with Autistic Children

Nigerian Woman Determined to Bring Early Intervention to Her Country’s Kids

Jan 25, 2012

Dotun Akande, the founder of Patrick Speech and Languages Center in Lagos, believes that early intervention is the best chance for children with autism in her country. Akande, mom of a child with autism, works to reach out and educate as many families as possible. She explains, “Parents too should know that having a child that has this challenge is not the end of the world. Early intervention is the key; so, all you need do is to help that child come out of that problem.” Patrick Speech offers interventions that include speech and language therapy, behavioral modification therapy, OT, social skills training, vocational training, academics, music therapy, hydrotherapy, and sensory integration.

Read original article: Early Intervention is the Key to Managing Autism Well

Does Your Child with Autism Suffer from Anxiety?

Jan 19, 2012

Kathie Harrington, a speech and language pathologist and mom of a son with autism, has written an article on dealing with anxiety. She points out that anxiety in a person with autism may affect sensory, physical, imagined, and communication areas in the person’s life. She explains, “They are anxious when they know and they are anxious when they don't know. They are anxious when they see something is close and they are anxious when something is not close enough…. They are anxious when, and when, and when... .” Some techniques she recommends include routine, relaxation, weighted clothing, music, flashlight, View Master, bean bag chair, and reading.

Read original article: How to Ease Anxiety in a Person with Autism/ASD

Texas School Uses Communication Device to Give a Voice to Children with Autism

Jan 12, 2012

The Vantage Lite is a communication tool that gives a voice to non-verbal children with autism. For example, a young student was able to use the augmentative communication device to ask for cardboard tubes. The Vine School uses Vantage Lite to help students use more than just colors and shapes – it offers unlimited communication. One example has a child clicking a photo of a bed, not only does the child see and hear “bed”, but also sees words such as sleep, tired, bedspread, and pillow. Meredith Potts, a Vine School speech pathologist says the main goal remains to enable children to learn to speak, although they understand that some will always be dependent on the computer. Another gain offered by Vantage Lite and communication devices is that children may become less frustrated as they are able to make their thoughts and needs known.

Read original article: Computer Technology Gives Voice to Children with Autism

Please comment on this autism topic.

Responding to insurance

Sep 13, 2011 by Anonymous

We have private insurance for which we pay a premium and deductible. It covers occupational therapy, language therapy, physical therapy and psychological therapy but at a combined 75 visits for calendar year. This is not for each therapy but rather 75 total for all together. Thus, even with illness or vacation times taken, we do not have enough alotted time slots covered to continue therapy for a full year. Once we run out of the 75 covered slots, we must pay out of pocket. We pay a copay of $20 per visit. So, for example, if my child sees a language/speech therapist and the ot once per week it is $40 out of pocket until we hit the magic 75 allowed under the insurance. Then we woud have to pay $150 for one therapy and $160 for the other per week. The psychology/psychiatrist appointments are monthly. All of these therapies would be available more frequently and I am told by the therapists very helpful if we could do more than once a week for 1/2 a session but we cannot afford to do this. The children on the autism spectrum benefit greatly from these therapies and it is something that should be covered under the insurance policies, just as any health or mental health issue should be.

I.E.P. Meetings

Dec 7, 2010 by Anonymous

I am finding that you can request any services at the I.E.P meetings and the school is required to have it for your child. Sometimes, the parent has to be more resourceful than the teacher. Just recently, I helped the teacher obtain a speech therapist for my son's school/class.

Hippotherapy and Speech Pathology

Nov 4, 2010 by Anonymous

Please note that the American Hippotherapy Association recognizes Speech-Language Pathologists, as well as, OTs and PTs as trained hippotherapy providers.

This is particularly important in that Speech-Language therapy is the most common therapy in use for individuals with autism.

Social Thinking

Feb 10, 2010 by megan

icommunicate therapy

icommunicate is dedicated to enhancing Speech, Language and Communication for all individuals by providing information and resources for speech therapy / pathology, and all communication difficulties and disorders. icommunicate has a large section relating to autism and provides many free downloads with information, ideas and strategies to facilitate communication and learning.

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