Today, in my Therapy Cheat Sheet Series, I'm here to talk about autism and speech therapy. Why is speech therapy so often recommended for autistics? Well, it can help develop our communication skills, to become more independent and self-actualized people.
Communication is a basic skill, and one that is necessary in all aspects of life, but it's also something that many autistic people struggle with. Speech therapy is one option for developing further communication skills, and accessing new communication tools, that can really help support autistics to have more fulfilling lives.
As I mentioned in my last post, the goal of any type of therapy for autism should be to help an autistic person function the best they can and be the happiest they can. Therapy should never be about making your child less autistic in some way. Speech therapy is no exception to that. So, let's get into it!
What's the Connection Between Autism and Speech?
Let’s talk about autism and speech therapy. First, what do we know about how autism affects speech and communication?
Well, we know that most people with autism are verbal, but about 1 in 3 or 4 are non-verbal all or most of the time. A lot more of us are non-verbal some of the time. If we're verbal, we may still communicate using non-word sounds, like grunting or shrieking, or we may use sounds that sound like words, but aren’t words. We may also hum or sing-song talk. Echolalia is common in autistic folks, and in fact I did a whole podcast episode on it - that's how common it is. And some folks speak fine, but their tone is off to neurotypical ears.
Also, there is a percentage of autistic folks who have a huge vocabulary and the ability and willingness to speak, but their way of producing sounds means that it’s hard for them to be understood by other people.
What About Other Kinds of Communication?
So, even if autistic people can speak so others can understand us, and even if we want to speak, there are still communication issues that are common for autistic folks. A lot of us have trouble with conversational skills, including eye contact and gestures.
A lot of us don’t understand the meaning of words outside of the context where we learned things. Personally, I learned a ton of words from reading when I was young, and still to this day routinely find out that I have been mispronouncing a word for years and no one told me. I understand what the word means and am using it correctly, but saying it completely wrong.
You want an example, you say? See "boo-quett" instead of bouquet, and "played" instead of plaid. Oh, also "seeg" instead of segue; that one was really embarrassing. I knew what "segue" meant, of course, when somebody else said it, but I didn't realize it was the same word as the one I was pronouncing "seeg" for years. So, yeah, context is hard.
Similarly, a lot of us can memorize what someone else said, but misunderstand the meaning behind it, so that we can’t use what we’ve memorized appropriately. These issues seem to be a problem grasping symbolism in certain contexts, but I don’t know that it’s completely understood.
And some of us lack creative language, or use creative language that makes complete sense to us, but doesn’t translate well to other people, for whatever reason. I’m great at stealing lines from TV shows and repurposing them in ways that I think are hilarious, but are apparently non-sensical to other people.
So an autistic child might have any number of these issues, in any variety of severity. If so, speech therapy is probably where you’re headed to work things out.
Who is a Speech Therapist, and What Can You Expect from Speech Therapy?
Speech-language pathologists are sometimes referred to as SLPs, and they are therapists who specialize in treating language problems and speech disorders of all kinds. A speech therapist works directly with the patient and coordinates with parents, caretakers, the school, other therapists, any doctors involved, etc., to create a treatment plan that works for everyone. A speech therapist’s job is to figure out the best ways to improve communication for someone, and enhance that person's quality of life.
Good speech therapy is tailored to an individual’s age and interests. It should be a fun, positive experience for most folks, and at worse a mildly frustrating experience while you’re both getting used to each other and trying to learn to collaborate.
Most autistic people like and respond well to highly structured programs, so most therapists will start there. Parents, caregivers, and other family members should be involved in the program so that the therapy can be integrated into everyday, family life. Additionally, the speech therapist should be working on goals that the autistic person and the family agree with. She should not be forcing anything, using any negative feedback systems, or trying to make the child less autistic.
Speech therapy interventions and techniques might include:
- Using picture boards with words and symbols
- Using sounds to teach us how to move our mouths the right way
- Having us sing songs to match the flow and rhythm of a practice sentence
- Improving articulation in speech by massaging or exercising the lips or the muscles of the face
- Introducing electronic "talkers"
- Teaching signing, typing, or other alternative communication systems
All speech therapists have different tools in their toolbox. If you’re confused why they’re doing something, ask them! It’s a science-based field, they should have research to back up their methods and ideas.
What are the Benefits of Speech Therapy for Autism?
The goal of speech therapy is to improve communication for the autistic person, so that we can have more control over our own lives and be understood by a wider variety of people around us. It should help us become more independent and better at self-advocating, for example.
Specific goals of speech therapy might include helping us:
- Communicate verbally and nonverbally. Using gestures and looking at the thing you’re talking about is an important part of communication, and speech therapy can help autistic people learn to do those things if they want to.
- Understand verbal and nonverbal communication, like understanding others peoples' intentions in various settings. A lot of us have trouble reading neurotypical faces, so we made need extra help with understanding their communication, too.
- Articulate words well, to be better understood. For example, when my son was learning to speak, I could understand him, but no one else could (not even his dad sometimes). Now everybody understands him and he's a lot less easily-frustrated when we do have trouble.
- Initiate communication without prompting from others. This is more important to some than others, but useful in many settings.
- Know the appropriate time and place to communicate something. For example, it's useful to know when in the conversation is the best time to use greetings, to ask questions, or to leave.
- Develop our conversational skills to develop relationships with friends and family, and communicate our own ideas. Despite many myths to the contrary, autistic people do want friends, romantic partners, and close family relationships. We may need some support developing the communication skills to get there, though.
- Enjoy communicating, playing, and interacting with peers. Playing shouldn't be stressful, but it is for a lot of us! Speech therapy can help us develop scripts, learn the routines of social interactions, and make talking to people way less stressful overall.
Now, as a mom, I like speech therapy because a good therapist is trying to find weaknesses and help you strengthen them where possible, or find good alternatives where not possible. She is in no way trying to make you less autistic, or looking askance at your autistic traits. She’s really just trying to help you bridge that gap between your current abilities, and the abilities you’ll need to function reasonably well in current society, as best she can.
How Do I Know What My Goals For Speech Therapy Should Be?
If you received a formal diagnosis from a professional team, they should have given you a specific list of goals that you can share with your speech therapist. If you have an Individual Education Plan (IEP) or a 504 from a school district, you can also bring that to the therapist, to give her a starting place. Otherwise, your therapist can evaluate you and start from there.
Having specific goals is important because you want to be working to achieve something clear, so you can mark your progress and notice if progress isn’t happening as quickly as it should, as this may indicate some complication or unnoticed issue you need to deal with.
Of course you are under no obligation to work on goals just because the autism evaluation team or your speech therapist thinks you should. Make sure you're working on goals that you want to achieve, that are important to you.
To give you a specific example, here are some goals from a real autism diagnostic report for a 2 ½ year-old, shared with permission:
- Child will follow 2 step directions involving use of a variety of verbs and various spatial directions in ⅘ opportunities
- Child will participate in multiple adult-led tasks between 4-7 minutes over a 30 minute period consistently over 2 months as measured by clinical observation and data collection
- Child will improve his understanding and use of adjectives within the expected range for his age as measured through clinical observation and normed tests
What you’ll notice about these goals is that they tell you not only what the child should accomplish, but in what circumstances, how often, and how to measure success. You'll also notice they cover specific speech goals, but also communication goals that are not based in speech.
Even if you don’t like the goals in your report, you and your therapist can develop different goals along the same lines, with clear ways to measure success or failure. This will help you know if therapy is working over time and progress is being made, or if you are not seeing progress and you need to try a different approach, therapist, or intervention altogether.