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

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.

The Effectiveness of Direct Instruction for Teaching Language to Children with Autism Spectrum Disorders: Identifying Materials

Journal of Autism Developmental Disorders, by Ganz, JB, and Flores MM, published in 2009, summarized Oct 21, 2009

The Direct Instruction language program may be helpful for teaching spoken language to school children with autism.

The study involved three children (10-11 years old) with autism or pervasive developmental disorder-not otherwise specified (PDD-NOS). All three children had very poor language development. The children received language therapy with a type of Direct Instruction program called Language for Learning. The children attended sessions for 20 minutes a day, 5 days a week, for about 3 months. All three children improved with Direct Instruction speech therapy. The children were able to correctly say words to identify certain objects.

Catatonia and Autism: A Historical Review, with Implications for Electroconvulsive Therapy

Journal of ECT, by Dhossche, DM, Reti IM, and Wachtel LE, published in 2009, summarized Oct 19, 2009

Some people with autism also have catatonia, and electroconvulsive therapy may be helpful in some of those cases.

Catatonia is a brain condition with symptoms where the person repeats words (his own or the words of others), repeats behaviors, and has a grimace look on his face. Catatonia symptoms are common in some people with autism. Catatonia can be severe for some people, resulting in loss of movement, reduced speech, or stupor. More mild symptoms of catatonia include freezing during actions, slow movement and/or speech. Electroconvulsive therapy (ECT) uses a mild electric shock that is given to specific places in the brain while the patient is under anesthesia (unconscious). The helpful effect of ECT comes from the seizures that are triggered in the brain by the electrical current. The electrical current happens to be the most reliable way to induce seizures in the brain. How seizures improve catatonia is unknown. The authors said that ECT therapy has been helpful for some people who have both autism and catatonia.

Mother in the Philippines Creates Therapeutic Learning Center for Children with Autism

Feb 4, 2010

The RLS Therapeutic Learning Center in the Philippines was founded by the mother of a child with autism. Rhea Lascano-Sunico decided that after the diagnosis of her son, she wanted to help him and other children like him. Currently the center has 30 children who receive occupational therapy, physical therapy, speech therapy, and special education courses. She is hoping to develop the children’s social skills with play therapy.

Read origianl article: At Center, Good Things Happen to Special Kids

Medical Autism Clinic in Alabama Gives Parents a Guide for Dealing with Autism

Jan 26, 2010

The Medical Autism Clinic (MAC) affiliated with the University of Alabama, Birmingham, was created to be a "roadmap" for parents as they deal with the diagnosis of autism. MAC uses the talents and skills of specialists in "genetics, nutrition, occupational therapy, speech therapy, rehabilitation, sleep disorders and audiology in one location to expedite the evaluation of some of the medical problems seen in children with ASDs." While all these areas are supported, Myriam Peralta-Carcelen, M.D., the director of MAC says the focus is on "feeding, sensory, motor, sleep, gastrointestinal and nutritional problems." MAC attempts to address these issues in a thorough and interdependent way. Parents and their children are referred to MAC by their pediatricians; first they complete a questionnaire, and then the children are evaluated by Peralta-Carcelen and her staff. Having all services under one roof allows the parents to leave the appointment at MAC with a course of action and a list of resources.

Read original aritcle: New Medical Autism Clinic Gives Parents Roadmap for Care

Regional Autism Recovery Center Opens in West Virginia

Nov 20, 2009

Dr. Janet Lintala, a DAN! doctor, has seen results in children with autism who utilize her Autism Recovery Resource Center in West Virginia. Dr. Lintala opened the biomedically focused clinic in 2008, and is now receiving children from all over the region. Therapies included at the clinic are: gluten-free and casein-free diets, mild hyperbaric oxygen therapy, antifungal therapy, detoxification therapies, and other therapies to strengthen the immune system. In addition, there are lab facilities to test stool, urine, hair and blood. Dr. Lintala suggests that no one therapy is the answer for a child with autism, and says, "We encourage parents to explore options that will help their child, such as speech, occupational therapy, physical therapy, applied behavioral analysis, behavioral therapy and others." Dr. Lintala's goal is a "multi-specialty, state-of-the art regional center where families can find everything from a diagnosis to educational materials; . . . where a cure is offered."

Read original article.

Special Needs Center Focuses on Setting Individual Goals for Children with Autism

Nov 19, 2009

The Marian Hope Center in Missouri, like a lot of schools for special needs kids, offers many therapies, but their focus is on individual goals for each child. The center, open since 2007, offers play groups, play classes, and pre-kindergarten classes. Special education teachers work with children with autism on skills that will allow them to mainstream and/or become a part of the community. There is an emphasis on integrative therapy that combines other treatments such as speech therapy and nutrition therapy.

Read original article.

Please comment on this autism topic.

Free Sound Therapy Home Programme

Jan 21, 2010 by Anonymous

Dr. Alfred Tomatis, a French otolaryngologist, is recognised as the modern day originator of sound or music therapy. In the early 1950's he developed an effective therapy method using altered music to treat conditions such as auditory processing disorder, dyslexia, attention deficit disorder and autism. Another French doctor, Dr. Guy Bérard, developed a similar method, Auditory Integration Training (AIT), which has found many followers in the USA. From personal experience I know that many clients report improvements in understanding, speech, balance, behaviour and emotional well-being after just two or three weeks of daily sound therapy.

Sensory Activation Solutions (SAS) is an organisation with Centres in the U.K. and Turkey that provides a unique service for children and adults that face learning or developmental difficulties. When the established educational, psychological or medical services fail to provide adequate support, the SAS methodology often can provide practical solutions that result in noticeable improvements in daily life.

You may be interested to check out their Free Sound Therapy Home Programme. Their Auditory Activation Method builds on the pioneering work of Dr. Tomatis and Dr. Bérard and has been specifically developed with the aim to improve sensory processing, interhemispheric integration and cognitive functioning. It has helped many children and adults with a wide range of difficulties, ranging from dyslexia and attention deficit/hyperactivity disorder to sensory processing disorders and autism. It is not a cure or medical intervention, but a structured training programme that can help alleviate some of the debilitating effects that these conditions can have on speech and physical ability, daily behaviour, emotional well-being and educational or work performance.

There is no catch, it's absolutely free and most importantly often effective. Check it out at: http://www.sascentre.com/uk/uk_free.html.

Applied Behavior Analysis

Jan 18, 2010 by Anonymous

Although I don't know enough about the Sonrise system, I do know that ABA, if done correctly is the most intensive system around and gets the job done in the shortest amount of time. We used ABA on our own son starting at age 2yrs 4mths and got him into a mainstream school at six yrs. ABA taught him speech, reading, writing and age-appropriate behavior.
VInce D'Souza

Nutrition and Essential Fatty Acids May Help Verbal Apraxia and Autism

Dec 2, 2009 by Anonymous

Can nutrition help verbal skills in children with autism? A study reported the August 2009 issue of Alternative Therapies says yes, for some children. Combined vitamin E and omega 3 therapy may help a type of verbal apraxia (a type of speech problem) that may be linked to food allergies and nutritional problems.

Children with verbal apraxia have trouble pronouncing words and may have severe speech problems. Many scientists have thought that verbal apraxia is a brain disorder. This study suggests that verbal apraxia may also be related to metabolism differences and nutritional problems.

Metabolism is the process of making energy from food. Metabolism is a complex system of enzymes, proteins, fats, and carbohydrates that work together to digest food and turn it into energy that the body can use. People likely have a wide range of metabolic differences. Some of those differences can be quite large for some individuals. In this study, they suggest that some children with autism may have metabolism differences that affect how they process foods, and how their brain works.

What did the study show? This study tested 187 children with verbal apraxia, and many of them also had autism. All of the children took 400-3,000 International Units of vitamin E daily. They also took 1-3 grams of polyunsaturated fats (including omega 3 fatty acids) per day.

Almost all of the families (97%) reported improvements in speech, imitation, coordination, eye contact, and other skills with vitamin E and omega-3 therapy. There were few side effects reported during the length of the study.

The authors also described blood test results for nutritional information about 26 of the children. They reported low carnitine levels, high anti-gluten antibodies (suggesting a gluten allergy), low vitamin D levels, and fat absorption problems in most of the children they tested. They described how nutrition and metabolism might be different in some children with autism.

What do these results mean for children with verbal apraxia and autism? The results are exciting because 97% of the children showed improvements, and there were few side effects. Sounds perfect, doesn’t it? But it’s not quite as perfect as it sounds.

There are some major limitations of this study. First of all, the researchers asked parents to give their subjective opinion of improvements. The parents knew they were in a study. Although they were given specific improvements to look for, there is a possibility of bias in favor of reporting a good result.

Secondly, they did not use placebo controls. All of the parents and children knew they were getting the supplements. There is the possibility of the “placebo effect” which is when people taking placebo (“sugar pills”) report feeling better or actually show improvements. Many think it is the power of the mind/body connection that somehow influences how they feel or even how their body physically responds. There is scientific evidence for brain connections to the immune and endocrine systems to support these observations. It is possible that, in this study, the children and/or parents were hopeful that the supplements would work, and that influenced the outcome. There was a placebo effect observed in a recent study of citalopram and autism in children.

Third, the supplements may be helpful for only a subset of children with verbal apraxia. The researchers chose children with verbal apraxia who also had metabolism differences….

What is the bottom line for omega-3 and vitamin E from this study? In spite of the shortcomings of this study, the results are very promising. Children with verbal apraxia may benefit from vitamin E and omega-3 supplements, which may get their metabolism on a better track. And researchers will continue to explore the nutrition/metabolism link with brain function. Good nutrition is likely to be important for many brain functions, not just verbal apraxia.

The Effect of Early Intervention in the Progress of Autistic Child with Mental Retardation

Nov 18, 2009 by Anonymous

INTRODUCTION:

Autism is an incapacitating life long developmental disorder that typically occurs in the first three years of life. Children affected with autism have disturbances in three main areas like social skill, communication and eye contact. There are many causes for autisms some are environmental and some are genetic. Since definite cause is yet to be known it cannot be cured completely. An attempt was made in the present study to know the effectiveness of different types of therapies and treatments. Parental opinion was collected from the children affected with autism. Findings indicated that most of the parents have positive views on standardized therapies, innovative therapies and treatments. Modification in behavior is possible through early intervention by therapies and treatment.

Present Study: the present study finds the effect of early intervention in the progress of autistic child with mental retardation. Investigator considered three major areas, which were generally used in progress of the autistic child, they are as follows:

Treatments
Standardized therapies
Innovative therapies

Comparison between different types of standardized therapies: When different types of standardized therapies were compared with arithmetic mean, it was found that occupational therapy and speech therapy was found to be more effective compared to other type of therapies.

COMPARISON BETWEEN STANDARDIZED THERAPIES

Comparison between different types of Innovative therapies: When different type of innovative therapies are compared with arithmetic mean , it was found that touch therapy and Art therapy was found to be more effective compared to other type of therapies.

Comparison between different types of treatments: When different types treatments are compared with arithmetic mean, it was found that Diet and special diet treatment, was found to be more effective.

Major Findings of the Study

Occupational and speech therapy was found to be more effective among different types of standardized therapies.
Touch therapy and art therapy was found to be more effective among different types of innovative therapies.
Diet and special diet treatments were found to be more effective among different types of treatments.

SUPERVISOR: D.r.A. RAMAKRISHNA PROFESSOR, IASE, OSMANIA UNIVERSITY

INVESTIGATOR: K.SAILAJA

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