Speech-language therapy in asd intervention
By: Mrs. Sheetal Ghadge
Autism spectrum disorder (ASD) is a developmental disorder. It affects a person’s behavior and makes communication and social interactions difficult.
ASD can range from mild to severe. The type of symptoms a person has and how severe they are varies. Some children may not be able to function without a lot of help from parents and other caregivers. Others may develop social and verbal skills and lead independent lives as adults. As the saying goes, if you‟ve met one child with autism, you‟ve met one child with autism. Each child with this diagnosis is completely different and will have different communicative strengths and needs.
Most people with ASD will always have some trouble communicating or interacting with others. But early diagnosis and treatment can help them to survive better.
For that reason, it‟s impossible to set forth a single plan of action in speech therapy that will work for every child with autism. There are some parameters as a framework which can help to decide the area in Speech Therapy to work on.
- Functional & spontaneous communication : The educators must see whether a child with Autism can communicate functionally and spontaneously. This means that the child needs to be able to communicate his basic wants and needs to those around him without needing to be prompted through it (the adult shouldn‟t have to say “what do you want?” or “use your words”).
If the child is already has this skill, awesome! You can move on. If not, we must work on it, do not pass go. Following are the therapies to work it on:
- Use of Augmentative-alternative communication (AAC): If the child‟s speech is not adequate for functional speech (meaning that the child isn‟t talking), you will need to introduce various forms of (AAC) until you find a method that works for the child. Remember, each child is different so different methods will work differently for each child. Here are a few options to try:
- Picture Communication System: Some children benefit from using pictures to communicate. This makes communication much more concrete for them. You can start by using a simple communication board and having the child point to what he wants. Or, you can use a more complex system like the Picture Exchange Communication System (PECS).
- Sign Language: Some children benefit from using their own body to communicate by using sign language. This has been used very successfully with children with autism and has even been shown to get kids talking with their mouths more quickly than they would have without using sign language. But if a child is good at functional speech, never use sign language technique as it may lead a child to become more lazy and reluctant. Let him/her communicate their needs using words not the gestures.
- Using Language Spontaneously (without being prompted): Children with autism often have difficulty with using language spontaneously. They may speak when told to or in response to specific questions but won‟t speak up when they need something or when they are upset.
For these children, it‟s important to work on fading the amount of prompts that you are giving so that the child does more and more
independently each time. For example, at first you may have to tell the child exactly what to say in each situation. Then, you can fade back to a prompt
like “I want to listen music”. Then, you can fade back to a visual cue like a picture that says “I want to listen music” or shows someone listening the music. There are many such ways to fade cues as this is just an example.
Another alternative for helping children who are having trouble using language spontaneously is to use a PECS system like mentioned before. This structured program has been very successful with increasing spontaneous communication in children with autism.
It also may be helpful to start with teaching the child basic requests (as those will be the most motivating for him) and then move on to other types of communication such as commenting, greeting, asking, etc. once requesting has been established.
Getting ‘Parents’ in
One of the most common requests we hear from parents of children with autism is “My child should spend more time with the speech therapist”. I completely understand why they want this! The speech therapist is the person who is helping their child communicates better so more time with that person should be beneficial for better communication, right? Unfortunately, that‟s not exactly the „right approach‟.
According to our „Learning Process‟ must go through certain stages such as Input (taking the information from the surrounding) –processing (organizing the information to Generalize it)-Storage (memorizing)-Output (Retrieval). To summarize Learning of any concept will not happen if the learnt concept is not getting generalized.
Children with autism tend to have trouble generalizing skills. For example, if you teach a child with autism the basic shape „CIRCLE‟ using the same circular objects from your teaching kit for every session and you never make him/her practice identifying „Circle‟ shape anywhere else, the child will identify the „CIRCLE‟ shape perfectly from your teaching aid‟s kit but may not be able to transfer that concept anywhere else, e.g he/she may not be able to understanding that even a „button; put up on our cloths has „CIRCLE‟ shape.
The same goes for communication. If a speech therapist teaches a child with autism to communicate with her in the speech therapy room, it doesn‟t necessarily mean that the child will then start communicating with other people and in other settings.
Instead, the child must practice the same communication skills with a variety of different people and in a variety of different settings. For that reason, it is important that the child does not spend every moment with the speech therapist. We want the child to communicate in any situation, not just when the speech therapist is present.
If the child needs to work on communicating better, then the answer is not necessarily just to add more time with the speech therapist. Instead, the speech therapist must train the other adults that interact with the child on how to do the same types of instruction, prompting, and modeling that she does.
When the speech therapist trains the parents, the child will make faster progress with his communication skills because he will be getting the same instruction from multiple sources and he‟ll be able to practice those skills in the natural environment (at home and in the classroom as opposed to just in the therapy room).
Different ‘Strokes for different Folks:
Speech therapy services for children with autism can look very different depending on a lot of factors. Each speech therapist will need to determine which services will be best for each child. Here are some different ways that speech therapy services may be assigned to help the child make optimal progress. Based on an Individual Education Plan‟ (IEP), the therapist chalks down Long Term & Short Term Goals for a child. The Long term & Short Term Goals are further divided into daily sessions, which are known as therapy sessions.
- Direct Therapy session (Individualized session) : The therapist provides direct therapy to the child, often in an isolated setting like the therapy room. This is often best for introducing a new skill when fewer distractions are necessary.
- Push-In Therapy Session (Pull-out sessions) : The therapist provides therapy to the child within the regular education environment. This is often best for generalizing new skills to a more natural environment and modeling teaching strategies for the classroom teacher. The child is been pulled out for certain minutes during school hours and after providing the interventions the same child is been left in to the regular flow of education.
- Consultation session: The speech therapist communicates an IEP to classroom teacher as well as parents and shows them the techniques that they can use to help the child learn to communicate in other settings.As you can see, there are many different ways to serve children with autism and you cannot just add more direct therapy minutes and expect it to help the student. Each student needs an individualized plan including a combination of different services such as occupation therapy, remedial education therapy, Physio-therapy etc.
Other communication skills/Areas to be worked on
Finally, we look at other communication skills that may be impacting the child with autism. Once the child begins to make progress on these larger items, we can begin to address some of the smaller issues that may also be impacting the child‟s communication. Here are a few areas that may need to be addressed:
- Body language: Individuals with autism have an especially difficult time reading body language, an important part of communication and social interaction. Students with autism often need specific instruction to learn how to pick up on nonverbal communication.
Visuals are an effective teaching tool for children with autism. Using visuals to support your lesson objective helps students because they do not have to rely solely on spoken language for comprehension. You can show pictures of facial expressions to demonstrate different emotions. Some examples of emotions to focus on include happy, excited, sad, scared, worried, bored, tired and mad. Using photos of actual people making these expressions will help your student generalize this skill in real situations.
- Asking and answering questions: Children with autism may not develop the ability to ask and answer questions without the help of a therapist. The therapist can teach your child how to recognize a question and appropriate answers to provide. She can also help your child formulate, ask, and understand the answers to their own questions.
In this case we can start with simple yes/no questions about his favorite topic. Use “is this ” for favorite characters, objects,
etc. For example, show him a picture of a car and say “Is this a car?” or “Is this a snowman?”. If the child responds verbally, repeat his answer and then praise him for his verbal response (“I like how you said „yes‟”). If the child does not respond verbally, prompt him with “Use your words” or “You can say „yes‟”. If the child doesn‟t respond after that, offer some sort of tangible reinforcement for his verbal response (“If you want the cookie, you need to answer my question. Say „yes‟”). Fade back the use of tangible reinforcements as soon as possible.
Once the child can answer basic yes/no questions verbally, move to basic “what” questions like “What‟s this” and “What is he
doing?” Again, use highly motivating pictures or objects at first to peak his interest. Use the same method of prompting for verbal responses as above.
Keep moving through new question forms in this way. Practice each new question form in therapy during structured activities and then encourage the parents to require a verbal response to those types of questions at home, as well.
- Speech pragmatics: It’s all well and good to know how to say “good morning.” But it’s just as important to know when, how and to whom you should say it. Speech pragmatics training can also help your child understand the meaning of idioms (sometimes hard for people with autism), and to use idioms themselves.
Talk to your child about a wide variety of made-up and real-life situations and what‟s okay or not okay to say in those situations. Be specific. Who is it okay to say these things to? When is it all right to discuss these subjects? Make up rules along the way that your child can understand and apply to real life (you may want to write them down to help you keep track of them). These rules can be adjusted and added to over time as you and your child learn.
The differences in how Autism Spectrum Disorder (ASD) affects each person means that people with ASD have unique strengths and challenges in social communication, behavior, and cognitive ability. Therefore, treatment plans are usually multidisciplinary, may involve parent-mediated interventions, and target the child‟s individual needs. Currently, no treatment has been shown to cure ASD, but several interventions have been developed and studied for use with young children. These interventions may reduce symptoms, improve cognitive ability and daily living skills, and maximize the ability of the child to function and participate in the community
Mrs. Sheetal Ghadge
Director, Pune Inclusive Education Society (PIES)Pune