The short answer is that the possibilities are endless! A speech & language therapist can help someone who has autism with any aspect of communication as well as play skills and self-organisation. How a speech & language therapist helps a person on the autistic spectrum depends very much on what their specific needs are. For this reason, the first step for any speech & language therapist working with someone on the spectrum is to complete a comprehensive assessment of their communication skills.
Once the therapist has gained a clear understanding of where their client is up to with their communication skills development, the necessary support can be put in place. Support is offered in many ways, not just in the form of face to face therapy sessions (for example, it may be more effective for the therapist to train key people in their client’s life). The nature of support depends very much on the individual and their specific needs.
What follows will give you a flavour of the massive range of things a speech & language therapist might provide support with for someone who is on the autistic spectrum.
Before spoken language develops…
- Understanding the value of communication – For more severely autistic clients, the first thing a speech & language therapist will often do is to help their client to start to see the value of communication. This is important both from the point of view of asking for (and getting) what you need and forming positive, enjoyable social relationships with other people.
- Developing the fundamentals of communication – things like using and understanding facial expression, eye contact and gesture, taking turns with others, enjoying being with another person are all fundamental communication skills. Babies start learning these skills from a very early age in face to face interaction with their parents and other adults. Speech and language therapists will use the principles from this early parent child interaction to help people with complex needs and autism (or other conditions) learn these skills through approaches like Intensive Interaction.
- Developing play skills – Play is were children learn to share experiences and objects with others which is an essential learning skill. Imaginative play is also strongly linked to the development of something called ‘symbolic understanding’. Symbolic understanding is what ultimately allows us to realise that a collection of funny sounds (a word) relates to a real life object or action. Speech & language therapists help clients to develop interactive and imaginative play skills.
- Alternatives to speech – Often, a speech and language therapist will recommend using a picture, symbol or object-based communication system for people who are not developing useful spoken language. For many people the Picture Exchange Communication System (PECS) is very effective but this does not suit everyone. A speech & language therapist will work with their client (and family) to establish a system that works for them.
Once spoken language starts to develop…
Autism brings with it idiosyncratic learning patterns and unusual language processing. As a result, children who are on the spectrum often have problems developing spoken language. Many young people with autism learn spoken language in chunks without breaking what they hear down into individual words and sounds. That means they can often repeat long chunks of favourite stories or TV programmes without really understanding what they’re saying or being able to use any of the words in the chunk independently. A speech and language therapist will help with all aspects of spoken language development including:
- Speech errors – pronouncing words so that others can understand.
- Learning and recalling vocabulary.
- Putting words together to make phrases and sentences.
- Putting sentences together into stories (narrative) to express experiences to others.
- Understanding spoken words and sentences.
- Understanding specific vocabulary groups. Many children with autism have great difficulty with time concepts, abstract language and vocabulary that depends on context for meaning.
- Understanding language associated with reasoning skills.
- Understanding non literal language like idioms, hints and indirect instructions.
Using language socially…
For many young people on the autistic spectrum, social communication presents a massive challenge. Speech and language therapists can provide help and support to help negotiate the social minefield under the following headings:
- Self awareness – what are my hobbies, what am I like, what are my strengths and weaknesses…
- Awareness of others – what do others like/dislike, what are their strengths and weaknesses, what are their interests…
- Friendship skills – developing and maintaining friendships
- Feelings and emotions – understanding the vocabulary of emotion, reading and using facial expression, reading and using body language.
- Conversation skills – starting conversations, taking turns in conversation, staying on topic, how to change topics, active listening, ending conversations…
- Assertiveness in communication – saying ‘no’, asking for help…
- Developing self esteem.
- Understanding and making sense of real social situations – SLTs can ‘coach’ young people through problematic situations using a variety of approaches like Social Stories or Comic Strip Conversations to break the situation down, see what goes wrong and provide corrective strategies.
Other bits and bobs…
Speech & language therapists can provide advice and support to help clients use visual supports like visual timetables or organisers to help them with organisation and planning of daily life.
Speech & language therapists who are autism specialists are often a helpful resource when a client is becoming aware of and learning about their diagnosis and what it means.
So, as you can see, there is a huge range of support that SLTs can offer clients who have a diagnosis of autism. There will be some things I’ve missed out but hopefully this post will give you a flavour of what an SLT can do for you or your child.