Wednesday, July 7, 2010

What a Great Speech-Language Pathologist Can Do for Your Child With Autism

Jordan Sadler, MS, CCC-SLP

When your child is diagnosed with autism, one of the first professionals you will need on your child’s team is a high quality speech-language pathologist (SLP). This is because challenges in communicating and relating are core features of the diagnosis, and improvement in this area will make a tremendous difference in a child’s -- and family's -- life. For many children with autism spectrum disorders (ASD), the speech-language pathologist is the cornerstone of the therapeutic team.

A speech-language pathologist may also be referred to as a “speech therapist” or the more descriptive “communication therapist.” Whatever the title, parents will want to be sure their child’s therapist is licensed by the state and certified by the American Speech-Language-Hearing Association. Furthermore, be sure to work with a practitioner who has extensive training and experience in the field of autism, and don’t be afraid to ask the therapist specifically about the areas that you feel are of greatest concern for your child. All SLPs are trained in helping children communicate better, but finding a therapist who also specializes in helping a child form and maintain positive relationships with others will be highly beneficial. 

An SLP provides a great many services for a child with autism and her family, including the critical element of parent education. It is part of the speech-language pathologist’s job to ensure that parents understand the diagnosis of ASD and how it affects their individual child’s social, receptive, and expressive communication. 

Look for an SLP who has the ability to point out a child’s strengths and explain how she will help the parents build on those strengths to overcome challenges. One of the most valuable things an SLP can do is to observe the child in a variety of environments and focus on the best moments: the ones when the child is attentive and engaged in joyful interaction, at the “top of her game.” If time is spent evaluating the characteristics of those moments -- noting that the child was in a swing with her body supported, and that her father was at eye level using lots of facial expression and affect, for example -- we will have found strategies which will allow us to immediately increase and then expand upon those moments throughout the child’s day. Not all speech therapists know to do this, but if parents find someone who does, the work is going to be so much more meaningful and will have better results.

The SLP is also in a unique position to evaluate and explain how a child is communicating, assessing everything from eye gaze, gestures, intonation, and movement to sounds, words, and complex sentences and interaction with peers. To a speech-language pathologist, non-verbal communication should be at least as important as verbal language -- especially at first -- and is often where the best SLP will start with your child with autism, even if the child uses verbal language at times. 

In other words, when we work with children, we start with early developing communication first in order to solidify the foundation for a child. It can be frustrating at times, even for the SLP, to back up and teach foundational skills to a child who has some verbal language already, but in the long run the communication benefits are enormous if we take our time and fill in any missing skills. Not doing so is akin to building a house without a foundation; a child’s team might be able to help build a beautiful first floor with all kinds of impressive details such as pronouns and multi-word sentences, but if the foundation of eye gaze, multiple circles of reciprocal interaction, and meaningful gestures (to name a few) are missing, the house will crumble at the second or third floor because it will most assuredly not be sturdy. The child won’t be able to use those higher-level skills with others in a meaningful way if basic interactive skills are not yet in place. This is true for children who rely on verbal language as well as those who use an augmentative and alternative communication (AAC) such as the Picture Exchange Communication System (PECS) or a voice output speech device.

Once the fundamentals are firm, an SLP works on a wide variety of language goals, depending on the child’s needs. Typical goals in the area of language comprehension are following directions, understanding concepts, and answering various types of questions. The speech therapist may also work on expressive language skills with your child as she learns to use pronouns, put multiple words together, and tell a story with correct narrative formation.

If needed, a speech-language pathologist will also work with a child on speech sound production, or articulation skills. Some children with autism have apraxia of speech, which is an oral motor planning disorder that causes them to have trouble pronouncing words, especially as they become longer or are in sentences. (Quite often these are children who have general motor planning difficulties in their bodies, which would be diagnosed by an Occupational Therapist (OT).) Sometimes apraxia or challenges with oral sensitivities also cause feeding difficulties.  If a child is having any trouble with feeding, caregivers will want to find an SLP who is also trained in this area [We will cover this topic in an upcoming post -Eds]. A speech therapist can work with the child individually or in a feeding group with peers to make this work more fun and social.

In the field of autism, a well-trained speech-language pathologist will have a solid understanding of pediatric social-emotional development in order to support the child’s emotions around communication with others and to help her learn to identify, express, and grade her emotions appropriately. The SLP will need to fully understand and help parents interpret the child’s sensory profile in order to respond to behaviors accurately. For example, it is critical that caregivers and professionals recognize sensory-seeking behaviors and help the child self-advocate for movement breaks, something to chew on, or a few minutes in a quiet space when needed to soothe herself.  Understanding each child’s unique sensory profile is best accomplished with the help of the child’s OT. 

Work on early social-emotional development is critical for many reasons. First of all, a child must be in a regulated state (and have some strategies to achieve this state at her disposal) in order to learn. Just as an adult wouldn’t be expected to learn a new skill while distracted by horrible airplane turbulence or when exhausted, a child can’t learn new skills when in an over-aroused or under-aroused state. Second, an SLP will teach a child early social-emotional development in order to help her with peer interaction.  Many speech-language pathologists facilitate social groups to work on skills within the natural context of peer play and conversation, depending on the child’s age and skill level. Here a child learns to take the perspective of other people, stay with a group both physically and cognitively, and play cooperatively, among other things.  

In the school setting, a speech-language pathologist might be found working on a child’s goals in the classroom setting.  This may include presenting higher-level linguistic concepts such as synonyms, antonyms, and multiple meaning words, teaching students how to organize and write a paper, or helping a child prepare for an oral presentation. The school SLP should also be monitoring the child’s social-emotional development, ensuring positive social interactions in group work, during lunch, and on the playground.

Finally, the potential role of the speech-language pathologist within the child’s family should not be underestimated. Beyond the early task of education about autism and its impact on a child, the SLP can facilitate improvement of the family dynamics around communication and play by incorporating various family members into therapy. Caregivers should also feel comfortable sharing communication and behavioral challenges going on at home with their speech therapist in order to problem-solve together.

All of this is a big job for one therapist. The speech-language pathologist is able to work productively on so many aspects of a child’s development when she is supported by parents and other therapists who actively participate and communicate about the child’s changing profile of strengths and needs on a regular basis. A good speech-language pathologist will make a significant difference in your child’s life.