Speech and Language
Speech-language therapy is the treatment for most children with speech and/or language disorders. A speech disorder refers to a problem with the actual production of sounds, whereas a language disorder refers to a difficulty understanding or putting words together to communicate ideas.
Speech-language pathologists (SLPs), who are often informally known as speech therapists, are professionals educated in the study of human communication, its development, and its disorders. They hold at least a master's degree and state certification/licensure in the field, as well as a certificate of clinical competency from the American Speech-Hearing-Association.
The purpose of speech-language therapy is to enhance intentional communication via expression of ideas, obtaining desires, sharing information and interpersonal interaction. Language is the means by which communication is achieved.
Components of language include but are not limited to:
- understanding/verbal expression
- facial/manual gestures
- tone of voice
- body orientation
In order to use our language knowledge of content (vocabulary, concepts), form (how words are linked into phrases/sentences) and use (what the child wants to get from using his/her language) is necessary. Therefore, speech therapy focuses around teaching the child what he or she needs rather than the use of language for communication.
For the child who is not currently using words, language is still possible through other means. A child may be taught to use various ways of utilizing their language skills to convey meaning. These may consist of gestures/signaling, eye contact, facial expression, vocalizations or manual tools such as communication pictures/boards/books.
Therapy should begin as soon as possible. Children enrolled in therapy early in their development (younger than 3 years) tend to have better outcomes than children who begin therapy later. This does not mean that older children can't make progress in therapy; they may progress at a slower rate because they often have learned patterns that need to be modified or changed.
Ask your child's therapist for suggestions on how you can help your child, such as performing speech-language exercises with him at home. The process of overcoming a speech or language disorder may take some time and effort, so it's important that all family members be patient and understanding with the child.
Occupational therapy services focus on enhancing participation in and performance of activities of daily living (e.g., feeding, dressing), instrumental activities of daily living (e.g., community mobility, safety procedures), education, work, leisure, play, and social participation. For an individual with ASD, occupational therapy services are defined according to the individual’s needs and desired goals and priorities for participation.
Occupational therapy intervention helps individuals with autism develop or improve appropriate social, play, learning, community mobility, and vocational skills. The occupational therapy practitioner aids the individual in achieving and maintaining normal daily tasks such as getting dressed, engaging in social interactions, completing school activities, and working or playing.
- Evaluate an individual to determine whether he or she has accomplished developmentally appropriate skills needed in such areas as grooming and play or leisure skills.
- Provide interventions to help a child appropriately respond to information coming through the senses. Intervention may include developmental activities, sensory integration or sensory processing, and play activities.
- Facilitate play activities that instruct as well as aid a child in interacting and communicating with others.
- Devise strategies to help the individual transition from one setting to another, from one person to another, and from one life phase to another.
- Collaborate with the individual and family to identify safe methods of community mobility.
- Identify, develop, or adapt work or engagement in meaningful activities that enhance the individual’s quality of life.
The role of the occupational therapy practitioner may be as a provider of direct services; as a job coach; or as a consultant to family members, educators, employers, or team members.
Occupational therapists and occupational therapy assistants provide interventions to clients in the environments where they typically engage in their occupations, such as a child care center or preschool, school, home, worksite, adult day care, residential setting, or any range of community settings.
Occupational therapy assistants and occupational therapists help families and other people learn how to adapt the environment to increase the comfort and performance of individuals with ASD. Occupational therapy assistants and occupational therapists also can provide information about other services that may support the individual or family.
- American Occupational Therapy Association, Inc: www.aota.org
Sensory Integration Dysfunction
Sensory Integration is a theory developed over more than 20 years by A. Jean Ayres, an occupational therapist with advanced training in neuroscience and educational psychology (Bundy & Murray, 2002). Ayres (1972) defines sensory integration as "the neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment" (p. 11). The theory is used to explain the relationship between the brain and behavior and explains why individuals respond in a certain way to sensory input and how it affects behavior. The five main senses are:
- Touch – tactile
- Sound – auditory
- Sight – visual
- Taste – gustatory
- Smell – olfactory
In addition, there are two other powerful senses:
- vestibular (movement and balance sense) – provides information about where the head and body are in space and in relation to the earth's surface
- proprioception (joint/muscle sense) – provides information about where body parts are and what they are doing.
Children with autism frequently have sensory difficulties. They may be hypo – or hyper – reactive or lack the ability to integrate the senses. Sensory integration therapy, usually done by occupational, physical or speech therapists, focuses on desensitizing the child and helping him or her reorganize sensory information. For example, if a child has difficulties with the sense of touch, therapy might include handling a variety of materials with different textures.
Before proceeding with any sensory integration therapy, it is important that the therapist observe the child and have a clear understanding of his/her sensitivities.
Fostering the child's participation in normal everyday childhood activities or "occupations" is the main goal of occupational therapy. Intervention starts when teachers and parents are taught about DSI and intervention so they can develop strategies that help with adaptation or compensation for dysfunction (Bundy & Koomar, 2002). Based on information gathered, the therapist collaborates with teachers and parents to design an intervention plan to address the child's sensory integration problems.
- SPD Foundation: www.sinetwork.org
Interventions Based on Sensory Integration Theory
Therapist consultation aims to educate teachers, parents, and older children about sensory integration and to develop strategies to adapt to and compensate for dysfunction such as:
- Environmental modifications
- Adaptations to daily routines
- Changes in how people interact with the child (Wilbarger & Wilbarger, 2002)
Examples are reducing distracting visual materials in the classroom, giving the child an alternative to a messy art activity, or refraining from wearing perfume or bright, floral clothing.
A sensory diet is a strategy that consists of a carefully planned practical program of specific sensory activities that is scheduled according to each child's individual needs. Like a diet designed to meet an individual's nutritional needs, a sensory diet consists of specific elements designed to meet the child's sensory integration needs. The sensory diet is based on the notion that controlled sensory input can affect one's functional abilities (Wilbarger & Wilbarger, 2002b). A sensory diet can help maintain an age appropriate level of attention for optimal function to reduce sensory defensiveness.
The "How Does Your Engine Run?" Program (Williams & Shellenberger, 1994) is a step-by-step method that teaches children simple changes to their daily routine (such as a brisk walk, jumping on a trampoline prior to doing their homework, listening to calming music) that will help them self-regulate or keep their engine running "just right." Through the use of charts, worksheets, and activities, the child is guided in improving awareness and using self-regulation strategies.
Traditional sensory integrative therapy takes place on a 1:1 basis in a room with suspended equipment for varying movement and sensory experiences. The goal of therapy is not to teach skills, but to follow the child's lead and artfully select and modify activities according to the child's responses. The activities afford a variety of opportunities to experience tactile, vestibular, and proprioceptive input in a way that provides the "just right" challenge for the child to promote increasingly more complex adaptive responses to environmental challenges. The result is improved performance of skills that relate to life roles, e.g., player, student, (Schaaf & Anzalone, 2001). This type of intervention may be used along with other treatment approaches.
DSI can have a profound effect on a child's participation in everyday childhood "occupations," including play, study and family activities. Collaboration between the therapist, teacher, and parent is the most efficient way to understand the child's behavior and unique sensory needs. Together, they can implement strategies to support the child's performance in roles and occupations across multiple environments.
- ERIC Digest ERIC Clearinghouse on Disabilities and Gifted Education: www.eiclearinghouse.org
- Autism Society of America: www.autism-society.org
Art – Music – Animal Therapy
While early educational intervention is key to improving the lives of individuals with autism, some parents and professionals believe that other treatment approaches may play an important role in improving communications skills and reducing behavioral symptoms associated with autism. These complementary therapies may include music, art or animal therapy and may be done on an individual basis or integrated into an educational program. All of them can help by increasing communication skills, developing social interaction, and providing a sense of accomplishment. They can provide a non-threatening way for a child with autism to develop a positive relationship with a therapist in a safe environment.
Art and music are particularly useful in sensory integration, providing tactile, visual and auditory stimulation. Music therapy is good for speech development and language comprehension. Songs can be used to teach language and increase the ability to put words together. Art therapy can provide a nonverbal, symbolic way for the child with autism to express him or herself.
Animal therapy may include horseback riding Hippotherapy) or swimming with dolphins. Therapeutic riding programs provide both physical and emotional benefits, improving coordination and motor development, while creating a sense of well-being and increasing self-confidence. Dolphin therapy was first used in the 1970s by psychologist David Nathanson. He believed that interactions with dolphins would increase a child's attention, enhancing cognitive processes. In a number of studies, he found that children with disabilities learned faster and retained information longer when they were with dolphins, compared to children who learned in a classroom setting.
As with any therapy or treatment approach, it is important to gather information about the treatment and make an informed decision. Keep in mind however, as with most complementary approaches, there will be little scientific research that has been conducted to support the particular therapy.
- Autism Society of America: www.autism-society.org
The greatest area of difficulty for children with ASD is the social realm. Even individuals who are able to use and understand language may struggle with social communication. Problems with social communication may include the inability to use eye gaze in a meaningful way, difficulty using or responding to gestures, difficulty using or reading facial expressions and body language, preoccupation with the topic rather than the process of conversation, and difficulty understanding the communication partner’s perceptions, feelings and needs.
Circle of Friends is a peer-building process used to develop a network of supporting individuals (i.e., parents, friends, family members, caregivers) who promote peer understanding and acceptance while building friendships. The Circle of Friends is a process for children who have challenges making friends. It offers opportunities for learning strategies to develop friendships with peers. The circle can help the child with autism spectrum disorders (ASD) learn social skills including cooperation, negotiation, problem solving, trust, and empathy. The circle becomes the medium through which relationships are formed. It is hoped that once all the children in the circle can relate to each other and have fun together during the circle, they will seek each other out for subsequent positive interactions on the playground and at home. This lesson is intended to share activities that will start you on your way to developing and individualizing your circles. Through building a Circle of Friends for an identified child, whether at home or at school, an understanding of individual similarities and differences can develop among all the participants
Peer-mediated instruction and intervention, also known as peer tutoring, is basically a system in which students teach other students or classmates, particularly social skills and academics. Peer-mediated intervention programs may begin at the preschool level and continue on through adulthood. Interventions vary according to instructional situations and individual strengths and needs. Students may work in dyads (pairs) or groups. Peer tutors are trained by their adult teachers regarding their roles, and given thorough information and support regarding their peers’ special needs and strengths. The tutors must learn how to get responses from their peers, as well as give effective feedback in a systematic way. Adult teachers facilitate and monitor the progress and success of the peer mediated intervention and adapt the program as necessary.
Many Social skills groups can be found through community organizations. Some schools may also offer social skills groups that take place during the school day within the context of school. Autism Spectrum Disorder groups are usually planned around age level and/or functioning level. The purpose of a social skills group is to teach and guide social interaction of the children participating in the group so as to teach them how to establish and maintain friendships.
- The Autism Network: www.autismnetwork.org
Assistive Technology (ACC)
Many children with autism spectrum disorders require the use of assistive technology to help them learn at home, in the community, and in school. The term “technology” does not simply relate to things like computers, TV, video, or cameras. In fact, these materials are considered to be “high technology” compared to items which are “mid technology” such as overhead projectors, calculators, and CD players. There are also “low technology” items which are probably used the most for this population. This would include things like picture schedules, picture communication, highlighters, dry erase boards, and many of the other visual supports that are needed to help the child learn.
Outline of various skill areas commonly associated with children with autism, with supporting technology strategies follows:
Low Technology: Visual support strategies which do not involve any type of electronic or battery operated device – typically low cost, and easy to use equipment. Example: dry erase boards, clipboards, 3-ring binders, manila file folders, photo albums, laminated PCS/photographs, highlight tape.
- Comprehension: Picture or written schedules
- Expressive Communication: Laminated Pictures
- Social Skills: Social stories or Social Scripts, Wait Cards
- Attending Skills: Wait cards, Almost done, First This/Then That
- Academic Skills: Color coded file folder, highlighted tape for reading
Mid Technology: Battery operated devices or "simple" electronic devices requiring limited advancements in technology. Example: tape recorder, Language Master, overhead projector, timers, calculators, and simple voice output devices.
- Comprehension: Talk Pad; programmed to 1-4 step directions, audiotaping
- Expressive: Voice Output Communication Aid (VOCA)
- Social Skills: audio recordings of appropriate and inappropriate intereactions
- Attending Skills: Overhead projector, Visual Timer
HighTechnology: Complex technological support strategies – typically "high" cost equipment. Example: video cameras, computers and adaptive hardware, complex voice output devices.
- Computers: Academics, Increased focus and Attention
- Adaptive Computer Hardware: Touch Screens, Track Balls, Intellikeys
- Video Taping: Self Help Skills, Social Skills, Emotions
- Illinois assistive Technology Program: www.iltech.org
- Dr. Chris’ Autism Journal: drchris.teachtown.com
- Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction