Speech Pathology for Autism

Communication is the key area in which speech pathologists assist adults and children with autism. Speech pathologists will often help a person with autism in the development of their speech sounds, language, sign language, social use of language, social skills and augmentative and alternative communication aids (AAC).

Autism, or its full name, Autism Spectrum Disorder (ASD) is recognised in the Diagnostic Statistical Manual of Mental Disorders v5 (DSM5) as “a neurodevelopmental disorder that is characterised by persistent deficits in social communication and interaction, as well as restricted and repetitive behaviours”^[1]. Children and adults who have ASD may be rated on an assessment severity scale (Levels 1 – 3) based on the amount of support they require to ensure they are able to participate in everyday activities with their friends and family^[2].

The DSM5 describes the symptoms and characteristics on a ‘spectrum’. This refers to the wide range of challenges a person with ASD can experience. ASD affects people in different ways and can range from mild to severe. It is typical for a person with ASD to experience difficulty with social interactions and communication. The symptoms and severity of a person’s ASD can change over time and vary greatly from person to person. It is also important to recognise that ASD can also have a very significant impact on the life of parents or care givers. In cases where ASD symptoms are severe, parents and care givers can also experience very significant challenges and need supports themselves.

The DSM5 is one of the most comprehensive and evidence based manuals in human sciences. The first inclusion of Autism in the DSM was in 1952 and the diagnostic critera not developed until 1980. Our understanding of Autism is still evolving as is the language we use to define or discuss it. Research continues to investigate how to support families in making the earliest possible diagnosis^[3] and there is strong evidence to indicate that early intervention by a speech pathologist is the most effective^[4]. However, there is also an emerging understanding that the definition of Autism as a “disorder” might not be helpful in all circumstances.

People diagnosed with ASD as children in the past 30-50 years are now adults and capable of giving feedback on the myriad of therapy interventions designed to help them in different ways. Some of this feedback describes interventions that sort to coerce them out of behaviours that helped them regulate overwhealming feelings. Rather than helping them the therapy seemed designed to help others who found their behaviours disconcerting.

A growing number of these people recognise both the strengths and the challenges presented by their Autism and are embracing Autism as part of their identity. Understandbly, definitions of autism as a disorder can be alienating to people who feel this way about themselves and the phrase “Autistic person” might be more appropriate than “Person with Autism”

From this perspective Autism may be more helpfully understood as a example of neurodiversity rather than exclusively framed as a disorder.

A formal diagnosis for Autism will follow the diagnostic criteria of the DSM5. People with Autism may be rated on an assessment Level 1 – 3, based on the amount of support they require to ensure they are able to participate in everyday activities with their friends and family. 

Autism is described as a ‘spectrum’ because of the huge range of strengths and challenges children, teenagers and adults with ASD possess. Generally speaking indicators for ASD may be evident in children from the age of 6 to 9 months old.

In the identification of ASD speech pathologist are often one of the first professions consulted. Often the first recognised difficulties are largely communication based often appearing as late talking, limited play skills and reduced social engagement (e.g. not responding to their name, limited smiling)^[5].. 

Other characteristics can be.

• Reduced shared attention
• Lack of facial expression
• Limited use of gesture (e.g. pointing to an object on a high shelf)
• Repeated movements of toys or objects
• Enjoyment of repeating whole body (rocking) or arm, hand, finger movements (e.g. shaking)

Longitudinal research has demonstrated that failure to acquire gestural joint attention (e.g. using eye contact to share interest about an object with another person) may form a core component of ASD^[2]. Learning to share interests and interactions with others is a key skill to developing language skills and difficulty establishing joint attention may be a critical milestone that impairs language development^[2].

There is an increasing level of evidence supporting the effectiveness of early intervention for children with ASD^[2]. Supporting families in early detection of Autism allows them to maximise therapy outcomes for their child^[7]. 

The strengths and weaknesses of a person with ASD develop and change as they grow up. A wide range of verbal language abilities are reported in individuals with ASD however a core characteristic of ASD is a difficulty with social communication and interaction^[8]. This often referred to as social communication or pragmatics. Typically, children and adults with ASD could have difficulty with one or many of the skills below:

• Difficulty staying on topic
• Understanding gesture, facial expression and social cues (e.g. when someone is bored)
• Taking turns in a conversation by either talking too much or not enough
• Establishing appropriate eye contact
• Initiating a conversation
• Asking questions

Long-term impacts of social communication difficulties can lead to poorer social relationships^[8]. Seeking evidence based therapy can reduce the level of isolation and long term impacts of social communication barriers for children, teenagers and adults with ASD^[8].

If your child or person you care for is having difficulties in one or more of these areas discussed we recommend talking to your GP and your nearest speech pathologist. If you don’t have a speech pathologist near you dont hesitate to book an initial consultation with us. It’s a free service we provide and we can help you find the help you need even if you dont need to use our service for speech therapy.

Speech pathologists are communication specialists. This means as a profession we have the expertise required to screen, assess, and support individuals with Autism and their families^[9].

Assessment

At Talkshop, assessment sessions are used to learn and understand the unique strengths and areas for development for each client. They allow us to develop a personalised therapy plan. 

Typically assessment will include: 

• Standardised assessment tools
  During an assessment we will complete a range of norm-referenced standardised assessments, communication or behavioural checklists and informal assessment. These are important for funding, qualifying for additional education support.
• Questionnaires and everyday tasks
  These tools help us understand ‘the bigger picture’ and what is important to the autistic person and their family. It allows us to review not only the individual but also the impact of the environment around them. 

Communication difficutlies present differently across the lifespan for autistic people. Our assessments aim to capture not only the communication disorder ‘on paper’ but also the everyday impact of differences of communication skills. We work together with families, schools and other health providers to set important and meaningful goals 

According to our peak body Speech Pathology Australia assessment of an individual with Autism must account for their strengths and difficulties. Speech pathology assessment must consider the impact of Autism on a child or adults ability to participate in their everyday activities and life. Assessment should also consider personal and environmental factors that would impact on an individual’s functioning^[10]. Applying these principles to our practice we aim to develop an understanding of your child’s overall abilities, not only the test scores on a page. By working with your family and other health professionals we aim to support you in setting and achieving your child’s goals.

Therapy

Speech therapy builds communication skills. For autistic people, this is critical to their ability to happily build relationships and participate in their environments. The Autistic community is advocating for the importance of providing Neurodiverse affirming therapy. This approach encourgaes the celebrate each autistic person’s unique strengths and areas of interest while working towards developing the communication skills critical for their participation at school, work and with friends. It also supports self-advocacy and accomadation of atypical behaviours by schools or communities where practical and helpful.

Speech therapy can help an autistic person through

• Developing the ability to express their ideas, thoughts and needs
• Modelling
• Natural teaching strategies
• Parent training – we are registered Hanen “More than words” providers
• Augmentative and Alternative Communication Devices (AAC)
• Picture Exchange Communication System (PECS)
• Self managing
• Scripting
• Social Communication Intervention Program to develop friendships and interact with peers.
• Story based intervention
• Understand what is being said to them
• Learn to communicate in a way that other people understand
• Clearly articulate words and sentences well

Talkshop is a registered NDIS provider. We work closely with our local schools, teachers and support workers. We support the use of “Total Communication” and provide therapy for speaking and non-speaking clients using Augmentative and Alternative Communication Devices (AAC). We are registered Hanen “More than words” providers.

Social Skills for Teens and Young Adults

Autistic teenagers often struggle to navigate the complicated friendship circles of high school. Research shows they’re more likely to become isolated and lose friendships in the transition from high school to adulthood. 

We support our Autistic teenagers and young adults to improve their confidence and build new connections with our Social Hub groups. These groups are a place for autistic teenagers and young audlts to connect with new people. During the groups they have the opportunity to share their interests, practice hearing different perspectives and negotiating group environments. 

We offer Social Hub – Teens for neurodiverse teenagers (age 13 – 16). This group is typically run in our Frenchs Forest Centre and covers skills such as participating in online chats (e.g. WhatsApp), negotiating and problem solving in a group, getting to know new people. 

Social Hub – Young Adults for neurodiverse young adults (age 18 +). Our autistic young adults enjoy a variety of locations for this group. Sometimes hosted in our Forestville or Frenchs Forest clinc or in local eateries. Typically skills targeted in this group include sharing conversations in a group setting, negotiating and hearing other perspectives, giving clear instructions and organising information so others can understand their message (e.g. giving the right amount of information, not too much – not too little)