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? |
|
broad term for forms of communication that supplement or enhance speech, including electronic devices, picture boards, and sign language |
Yes (10) | |
|
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) |
| use of positive reinforcement to motivate the child to communicate |
Yes (11) |
|
|
|
child is encouraged to mimic the therapists mouth motions before attempting to make the sound |
Yes (12) |
|
|
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) |
| use of children who are trained to interact with the autistic child throughout the day |
Yes (8) |
|
| a type of AAC that uses picture symbols to communicate (see PECS Fact Sheet) | Yes (10) |
|
| 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) |
|
| language of hand shapes, movements, and facial expressions (especially useful for ages 0 to 3) |
Yes (1) |
|
| 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
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
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
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.
References
- Goldstein, H. 2002. "Communication Intervention for Children with Autism: A Review of Treatment Efficacy." Journal of Autism and Developmental Disorders v32 n5 p373-96 Oct 2002.
- Diehl, S.F. 2003. "The SLP's Role in Collaborative Assessment and Intervention for Children with ASD." Topics in Language Disorders v23 n2 p95-115 Apr-Jun 2003.
- Ogletree, B., et al. 2007. "Examining Effective Intervention Practices for Communication Impairment in Autism Spectrum Disorder." Exceptionality 15(4):233-247.
- Lord, C. 2000. "Commentary: Achievements and Future Directions for Intervention Research in Communication and Autism Spectrum Disorders." J.Autism Dev.Disord. 30(5):393-398.
- Committee on Educational Interventions for Children with Autism. 2001. "Educating Children with Autism." Catherine Lord and James P. McGee Ed. The National Academies Press.
- Koegel, L.K. 2000. "Interventions to Facilitate Communication in Autism." J.Autism Dev.Disord. 30(5):383-391.
- Siller, M., and M. Sigman. 2008. "Modeling Longitudinal Change in the Language Abilities of Children with Autism: Parent Behaviors and Child Characteristics as Predictors of Change." Dev Psychol. November;44(6):1691-704.
- Safran, S.P., et al. 2003. "Intervention ABCs for Children with Asperger Syndrome." Topics in Language Disorders 23(2):154-165.
- Thomas-Stonell, N., et al. 2009. "Predicted and Observed Outcomes in Preschool Children Following Speech and Language Treatment: Parent and Clinician Perspectives." J Commun Disord. 42(1):29-42.
- Light, J.C., et al. 1998. "Augmentative and Alternative Communication to Support Receptive and Expressive Communication for People with Autism." J.Commun.Disord. 31(2):153-178.
- Keen, D., et al. 2001. "Replacing Prelinguistic Behaviors with Functional Communication." J.Autism Dev.Disord. 31(4):385-398.
- Ross, D.E., and R.D. Greer. 2003. "Generalized Imitation and the Mand: Inducing First Instances of Speech in Young Children with Autism." Res.Dev.Disabil. 24(1):58-74.
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Social Thinking
Feb 10, 2010 by meganicommunicate 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.
Free Sound Therapy Home Programme
Jan 21, 2010 by AnonymousDr. 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 AnonymousAlthough 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 AnonymousCan 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.