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 of the individual child (1). Unfortunately, it can be difficult to create a child-specific, evolving, long-term speech therapy plan (1, 3).
The National Research Council describes four aspects of beneficial speech therapy-
(1) Speech therapy should begin early in a child's life and be frequent.
(2) Therapy should be rooted in practical experience in the child's life.
(3) Therapy should encourage spontaneous communication.
(4) Any communication skills learned during speech therapy should be generalizable to multiple situations (4).
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, 5). Speech therapists can give specific examples of how best to incorporate speech therapy throughout a child's day (6).
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 session swill 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 through 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 below).
What is the theory behind it?
Children with autism not only have trouble communicating socially, but often 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 not only improve social communication skills, but also 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). The most successful approaches to speech therapy include: early identification, family involvement, and individualized treatment (3). 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 it Work?
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 (2)
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, 3)
Functional communication training (FCT)
use of positive reinforcement to motivate the child to communicate
Yes (4)
Generalized imitation
child is encouraged to mimic the therapists mouth motions before attempting to make the sound
Yes (5)
Mand training
use of prompts and reinforcements of independent requests for items (referred to as mands)
Yes (6)
Motivational techniques
therapy techniques that focus on following the child's lead and capitalize on the child's desire to respond
Yes (7)
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
method of using picture symbols to communicate
Yes (9)
Relationship development intervention
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 0-3)
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). 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)
Speech therapy requires parental investment of time. In order to be most effective, parents should be fully integrated into the therapy program and should seek out opportunities to practice communication throughout the daily routine. With time, this should become a new way of life.
Resources
Autism is a condition covered under the Individuals with Disabilities Education Act (IDEA). Services covered by IDEA include early identification and assessment and speech language pathology (speech therapy). 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 Web site). Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). School districts will coordinate special services for children 3-21 years old.
Parents of nonverbal children should consider incorporating PECS.
Signing Times is one of many companies selling systems that help to teach children sign language.
American Speech-Language-Hearing Association. (2006). Principles for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span: Technical report.
Charman T, Stone W. Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention. New York, The Guilford Press, 2006, pp. 115-266.
Paul R, Sutherland D. Enhancing early language in children with autism spectrum disorders. In Volkmar FR, Paul R, Klin A, et al. Handbook of Autism and Pervasive Developmental Disorders, Third Edition, Volume Two. Hoboken, John Wiley & Sons, 2005, pp 977-1002.
References
1. 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.
2. 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.
3. 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.
4. Committee on Educational Interventions for Children with Autism, C.L.a.J.P.M.E.2001. "Educating Children with Autism." Committee on Educational Interventions for Children with Autism, C.L.a.J.P.M.E. The National Academies Press.
Ref Type: Book, Whole
5. Koegel, L.K. 2000. "Interventions to facilitate communication in autism." J.Autism Dev.Disord. 30(5):383-391.
6. Safran, S.P., et al. 2003. "Intervention ABCs for Children with Asperger Syndrome." Topics in Language Disorders v23 n2 p154-65 Apr-Jun 2003.
7. 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.
8. Keen, D., et al. 2001. "Replacing prelinguistic behaviors with functional communication." J.Autism Dev.Disord. 31(4):385-398.
9. 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.
© 2007 Healing Thresholds
Healing Thresholds Inc. authorizes you to view or download the material on the Healing Thresholds site if you include the following copyright notice: "Copyright © 2007, Healing Thresholds, Inc. All rights reserved"
Lara Pullen, PhD is the CEO of http://autism.healingthresholds.com. Healing Thresholds Autism Therapy is a free website and email newsletter dedicated to healing the lives of families touched by autism. They provide comprehensive therapy fact sheets, daily updates of autism therapy research and news, and a global directory of autism-related therapists and services. The 100 top autism therapies are listed and discussed at Healing Thresholds with comprehensive fact sheets provided for the top twelve therapies. This article, with links to layperson summaries of all referenced research, is available at: http://autism.healingthresholds.com/therapy/speech-therapy.
Lara is a former research scientist in the field of immunology. She has been a medical writer since 1999 and has written on a wide range of topics from Alzheimer's disease to diabetes. She is the mother of three children, the youngest of whom has Prader-Willi Syndrome.
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