Speech, Language, and Communication

A speech-language pathologist (often called a speech therapist, or shortened to SLP) is a person who evaluates and treats speech, language, and swallowing disorders. SLPs work with both children and adults with many different disorders. SLPs are often part of the team that works with a child on the autism spectrum. While speech and language are discussed together, they refer to somewhat different, although related things.

These are some key terms within each area:

Speech:

• Articulation: How we pronounce speech sounds; for example saying fwog instead of frog
• Voice: How our voice sounds when we talk; for example speaking too loudly in a small closed space, or using an unusually high pitched voice instead of a normal voice
• Fluency: The rhythm or flow of speech; for example speaking with ease, or having difficulty speaking smoothly or getting the words out

Language:

• Receptive language: Understanding what others say to us; for example, if someone tells us their favorite color is red, we know what that means
• Expressive language: How we communicate our wants, thoughts, ideas, and feelings; for example, we tell the waiter in the restaurant we want macaroni and cheese for lunch and that is what we get
• Pragmatic language: How we use language socially; for example, two or more people have a conversation, back and forth taking turns listening and speaking, understanding, and responding in relation to what was said

Swallowing: Safe eating and drinking and the development of eating and drinking skills

What is the goal of speech-language therapy for a child on the autism spectrum?

Every child on the autism spectrum is different and may have difficulty with any area of speech, language, or swallowing. However, all children on the spectrum have difficulty with pragmatic language, or how we use language socially to interact with others. What an SLP works on in therapy depends on the needs and developmental level of the child. Some common goals of therapy may include:

• Functional communication: Many children on the autism spectrum receive speech-language therapy because they are not speaking, are only talking a little, or because others cannot understand what they are saying. Often the first goal of therapy is to help children find a way to communicate their wants and needs on their own. This could take the form of words, sounds, sign language, pictures, or a communication device.
• Using language for many different purposes: We expect children to use words for many reasons — asking for things, showing things, asking questions, answering questions, and trying to get attention. Some children on the autism spectrum may not use language at all and might throw tantrums rather than using a word to ask for what they want. Or, some children may say some words but only use them in certain situations (for example, children might say "ball" when they see a ball but do not use that word to ask for a ball, or to show their parents/caretakers the ball). SLPs can help children learn to use words in many different ways, and parents and caretakers can help them practice their words and skills.
• Following social "rules": There are rules that we use when talking to others that most children learn without being taught, for example, making eye contact, taking turns while talking, and using body language to show we are interested in what someone is saying. Autistic individuals often have a hard time using these cues and also understanding when someone else uses them. An SLP may help children work on these skills.
• Expressive language development: Children on the autism spectrum often have delays or gaps in how they use words. A speech-language pathologist can help children learn new vocabulary words, rules of grammar (how to put words together into sentences), to ask and answer questions, and many other things to help them communicate more like other children their age.
• Receptive language development: Children on the autism spectrum might also have difficulty understanding words and sentences. An SLP might also help children develop their receptive language skills, including finding objects or pictures by name or description, following directions, and understanding questions.

Please note: Children do not have to be speaking to be eligible for speech therapy.

Why does a child need a speech and language evaluation?

In order to determine where a child is developmentally in the area of speech and language development, a speech and language pathologist will complete an evaluation to understand what the child's strengths are and where there are gaps in development.

What is a speech and language evaluation?

An evaluation by a speech-language pathologist usually has 3 parts:

1. A standardized assessment: This is a test that is given to compare one child's abilities to other children his or her age. A child receives a score which helps the SLP identify strengths and weaknesses in various areas of speech and/or language development.
2. Play and observation: An SLP will also play with the child during the assessment. This helps the SLP see how the child interacts with different toys, how the child shares play routines with others, and how the child communicates during play. During this time, the therapist can anticipate how the child might respond during a therapy session.
3. Caregiver Interview: Children do not always act the same way in a testing setting as they do in a familiar environment. The SLP will talk to the caregivers to learn more about the child's strengths and weaknesses at home and during the family's daily routines, whether at home, in school, or in the community.

Who provides treatment?

Speech-language therapy should be given by a speech-language pathologist who has a license in his or her state and a certification from the American Speech-Language-Hearing Association (ASHA). A clinical fellow (CF-SLP) may also provide therapy. This is an SLP who has received a master's degree but is not yet certified and is supervised by a certified therapist.

Where does treatment occur?

Speech-language therapy for children on the autism spectrum can occur in many different places, including the home, school, or an outpatient setting.

• If a child is under 3 years old, he/she may receive speech-language services through Early Intervention. This usually takes place in the home.
• After the age of 3, services are provided through the school system or county agency, which provides Special Education. Therapy can take place in school, at day care, at home, or wherever the child is.
• Children of any age may qualify for therapy in an outpatient, or clinical setting.
• SLPs working with children also communicate with the parents/caretakers of their patients and their patients' teachers so that treatment can be practiced and skills can be used at home, in school, and in the community, as well as in therapy.

What does a treatment session look like?

The types of activities that a child does in a speech-language therapy session depend on the child. Typically, therapy involves play-based activities, using things that the child enjoys, to work on different goals. The SLP will work closely with the caretakers to find activities that will motivate the child and to talk about ways to work on the goals for the child at home. Speech-language therapy may be one-on-one, with a small group of children, or in a classroom setting.

How often can treatment occur?

School-based treatment is determined by the education team. In a clinic setting, treatment is determined by the parent/caretaker and therapist.

How can we make speech-language therapy as successful as possible?

There are a few things that can be done to help your child be successful. First of all, it is important for the caregivers to be as involved with the therapy process as possible. This could include sitting in on the sessions, watching the sessions, and/or communicating frequently with the SLP. This is the best way for the parent/caretaker to understand what the child is working on in therapy. The SLP can also help parents/caretakers think of ways to work on the same things at home. Often speech and language goals can be incorporated in everyday activities, especially during mealtimes, at playtime, and at bath time. It is also important that everyone who is working with the child is on the "same page" and communicates with each other often. (This includes family members, teachers, therapists, and anyone else who sees your child on a regular basis). This will help make sure everyone is working on the same things the same way.

Additional Resources:

• American Speech-Language-Hearing Association