Thursday, May 14, 2020

Finding the Right Speech-Language Pathologist (SLP) For Your Autistic Child

Julie Roberts, M.S., CCC-SLP
www.TherapistNDC.org

Photo courtesy Julie Roberts
[image: Ms. Roberts, a smiling white
woman with long straight blonde hair.]
After your loved one receives a diagnosis of Autism, your physician, school, family members, friends and possibly even total strangers may bombard you with (possibly unsolicited) advice for the next steps to take. One such step your family may actually want to consider is to seek the services of a Speech-Language Pathologist (SLP).

But what is an SLP? They are professionals uniquely qualified to evaluate, diagnose, treat speech, language, social communication, cognitive-communication, and swallowing and feeding disorders in children and adults. An ASHA (American Speech and Hearing Association) certified SLP must complete 400 clock hours of supervised clinical experience in the practice of speech-language pathology during graduate school, and 375 hours of that must be spent in direct client contact.

Once an SLP graduate student has finished the required coursework and supervised clinical experiences, obtained a master’s degree in speech pathology or communication disorders, has passed a national Praxis exam and has completed 36 weeks of full-time professional experience as a Clinical Fellow, only then may they obtain their CCCs (Certificate of Clinical Competence in Speech-Language Pathology).

SLPs also take distinctive graduate coursework unique to their scope of practice, in areas including: Voice Disorders, Stuttering, Motor Speech Disorders, Neurogenic Communication Disorders, Dysphagia, Language Acquisition, Articulation Disorders, Anatomy and Physiology of Speech and Hearing, Childhood Apraxia of Speech, Articulation and Phonological Disorders, Dysphagia in Public Schools, Dysphagia in Infancy, Medical terminology and scope of practice of the medical SLP, Dementia, Pulmonary Issues, and Tracheostomy and Ventilators, Pediatric Feeding, Speech Science: Anatomy, physiology and functional organization of speech. Mechanisms of normal speech production and perception with applications to the clinical setting.

Please know that therapists who are not SLPs in ABA clinics may claim to provide speech and language therapy in conjunction with ABA therapy. Beware: These clinics may have BCBAs and RBTs acting in the role of the SLP, but neither discipline is uniquely trained in communication disorders, language acquisition, AAC and feeding and swallowing. In fact, if an untrained therapist is providing therapy within the scope of practice of the SLP, they may do significant emotional and physical harm to your child because they do not have the educational background and training to determine whether something might be a motor issue, or if your child has accompanying anatomy, and physiology deficits, or if your child has accompanying health issues secondary to feeding difficulties (dysphagia, need for ENT services, a GERD diagnosis, etc.) Additionally, when your child is not physically or cognitively able to do something and a reward/punishment is in place, not only is their physical well-being in jeopardy, but their emotional well-being, too.

Parents should know that an autism diagnosis may or may not include accompanying intellectual disability, and may or may not include accompanying receptive and expressive language impairment. Licensed, certified SLPs are uniquely educated and trained to work with Autistic people in the areas of global language acquisition and expression, total communication (speaking and non-speaking communication and written expression), Augmentative and Alternative Communication (AAC), feeding difficulties and pragmatic language.

As when seeking any type of therapy, the primary goal is first, do no harm. Pro-neurodiversity SLPs practice from mind-set of “Autism Acceptance.” SLPs who practice in this manner do not “treat Autism,” they treat communication delays and disorders, provide evaluations and therapy for AAC use, provide non-behavioral, humane feeding therapy, and provide therapy for articulation, phonological processing, apraxia, voice and dysfluency issues. If your SLP tells you that they will treat your child’s autism, you will want to ask them to expand on this statement to understand how they view Autism, (and subsequently how they view your child/adolescent).

Therapy Models which are ABA derived and therefore not recommended:
  • ABA – all forms; including “new and improved” or “play-based” ABA
  • Verbal Behavior (VB)
  • The Lovaas Approach
  • Pivot Response Treatment (PRT)
  • Natural Language Paradigm (The “old” PRT)
  • Early Start Denver Model (ESDM)
  • Early Intensive Behavioral Intervention (EIBI)
  • ABA Derived Errorless Learning Therapy Models
  • Intensive Behavioral Intervention (IBI)
  • Positive Behavior Support (PBS)
  • Relationship Development Intervention (RDI)
  • Picture Exchange Communication System (PECS®)

Questions to consider when choosing an SLP:
  1. Autism: Does the SLP claim to “treat autism?” A pro-neurodiversity SLP treats the problem your child is having with communication, speech production, feeding, etc. If you SLP claims to “treat autism” you will need to ask them to clarify. Coercing a neurodivergent person to “normalize” through masking autistic traits (eye contact, mandated social scripting, tone, body language, suppress harmless stimming, etc.) is disrespectful and can cause substantial trauma.
  2. Presume Competence: Does the SLP presume competence, or do they predetermine your child’s abilities, especially your non-speaking child or and/or intellectually disabled child or adolescent? The right SLP will never predetermine your child’s potential, nor would they consider standardized assessments as solid evidence for the current level of cognitive or language abilities or future potential outcomes. The right SLP will approach therapy from a strengths-based model, taking into account their client’s special interests.
  3. AAC without Prerequisites: Does the SLP use AAC (Augmentative and Alternative Communication) liberally without gatekeeping, and as a supplement for speaking children? (AAC is very helpful during sensory overload, to communicate when overwhelmed, to ward off or get through a meltdown, to use when spoken communication is too much to handle.) Do they accept total communication? The right SLP will acknowledge and respond to all communicative attempts, including behavior; they won’t insist on one type of communication method, such as speech.
  4. Applied Behavioral Analysis (ABA): Does the SLP use ABA? The right SLP does not force compliance through the earning of snacks, check marks, behavior charts, stickers, access to favorite toys, activities, special interests, or similar. They will completely reject aversion therapy (punishment) for any situation, including the withholding of attention or affection, favored foods, drink, activities, special interests, or objects. Pro-neurodiversity SLPS don’t train human beings like pigeons, chickens, or dogs. The right SLP trusts that intrinsic motivation will guide your loved one’s therapy progress, rather than a system of external rewards (and possibly punishments).
  5. Body Autonomy: Does the SLP respect body autonomy? The right SLP will always ask your child or adolescent permission before they touch them. They will use hand under hand, only when necessary and only with the child’s consent. The right SLP will not enforce “whole body listening,” write eye-contact goals, or insist upon quiet hands. They will not force-feed. They will not suppress harmless stimming and they will look for the reason behind harmful stimming, rather than just attempting to extinguish it. Compliance over the child’s or adolescent’s body, food intake and will is never the goal; if it is, you have the wrong therapist.
  6. Sensory: Does the SLP respect and honor sensory differences? The right SLP will not force children and adolescents to comply with tolerating sensory input that is uncomfortable or distressing. A good SLP will willingly collaborate with an OT to help your child with their sensory issues.  They will heavily advocate for sensory supports and accommodations in all of your child’s environments. The right SLP will understand what a meltdown is, and what it isn’t (a tantrum) and will approach your child’s meltdowns with compassion and empathy.
  7. Neurodivergent Mentors: Does the SLP learn from neurodivergent mentors as to what therapy approaches and methodologies are respectful? Do they keep up with research conducted in partnership with and by Autistic people?
  8. Empowerment: Do they work in partnership with the client and their family to problem-solve? Do they teach self-advocacy and respect self-determination? Do they advocate for inclusion? Do they advocate for supports, accommodations and inclusion in IEPs?
  9. Emotional well-being: Does the SLP put your loved one’s emotional well-being first and foremost? Do they stop what they are doing when your child indicates distress, or do they “encourage” them to continue through the distress? Encouraging a child to continue through their distress can trauma by forcing compliance for the sake of compliance. Does the SLP hear and validate, “no?” Does the SLP try to get to the root of the problem (pain, sensory, trauma, anxiety, etc.) rather than extinguishing behavior? The right SLP will consistently put your child’s emotional well-being above their ability to comply.
  10. Kindness and Empathy: Is the SLP kind and empathetic? Do they truly believe that all children do well when they can? If your SLP uses words like: “child is manipulative,” “exhibiting maladaptive behavior,” “need to break the behavior,” “extinguish the behavior,” “desensitizing the child,” or similar, RUN.
Some SLPs may balk, becoming offended or even defensive as you ask these questions during an initial consultation. These are not the SLPs for your family. An SLP who practices with a pro-neurodiversity model will welcome your questions, and they will partner with you to empower your autistic child or adolescent along with your family. The right SLP will help your loved one meet their therapy goals while always using empathetic and respectful therapy practices.