Speech and language therapy

Communication difficulties
Children on the autism spectrum often have difficulty understanding the communication of others and communicating effectively with them. In fact a child on the autism spectrum may not see any reason to communicate with other people. This may delay their language acquisition and lead to frustration when they cannot make their needs understood. If they find play and social situations difficult and so avoid them, they also have fewer opportunities to learn language.

Children on the autism spectrum often have communication problems more complex than straightforward speech and language difficulties. Characteristically they can find it hard to interpret social behaviour and imagine another individual's state of mind. Reluctance to interact with the world may be evident in the way they fail to make eye contact, use hand gestures, or understand body language.

A delay in spoken language may be the most obvious indication that something is wrong, and the speech and language therapist (SALT) may be one of the first professionals to meet the child. It is vital, however, that the assessment of the child should take into account all aspects of communication and social functioning, not just speech and language. The assessment should be part of a co-ordinated multi-disciplinary assessment which considers how aspects of the assessment relate to and influence one another. Specialists in speech and language are, therefore, key professionals when it comes to assessment and intervention.

Some children on the autism spectrum have limited or even no speech, and their understanding of other's speech may vary enormously. In such cases therapists may focus on getting the child to communicate using visual methods such as signing, symbols and picture systems. They may spend time helping the child develop listening and attention skills; play and social skills; social understanding; understanding of language and expressive language.

At the opposite end of the spectrum, some children have good vocabularies and can talk on particular topics in great depth. Some, but not many, have problems with pronunciation. Many have difficulty using language effectively, and many also have problems with word and sentence meaning, intonation, and rhythm or say things that have no content or information. In its information sheet on speech and language therapy, the National Autistic Society gives a useful description of the most common communication problems experienced by children on the autism spectrum.

For children with some speech, therapists can provide help with:

• Articulation disorders: some children have trouble saying some sounds or words correctly. For example, ‘run’ might sound like ‘won’ or ‘say’ might sound like ‘thay’. Lisps are a common articulation disorder.
• Fluency disorders: some children repeat some sounds or have trouble saying complete words. For example, the word ‘story’ might come out sounding ‘st..st..story’. A stutter (or stammer) is a common fluency disorder.
• Resonance or voice disorders: some children talk in a way which makes it difficult for people to understand them – as if they have a cold or are talking through their nose. Some individuals on the autism spectrum speak in a high-pitched voice or use robotic-like speech.
• Language disorders: some children find it very difficult to understand what people are saying to them as they don’t understand the meaning of words. Some children have trouble making themselves understood as they find it difficult to put words into sentences correctly. Children on the autism spectrum may have a very literal understanding of language or use their own idiosyncratic language. The correct use of pronouns is also often a problem.


Speech and language therapy at school

Children with a statement of special educational needs may have speech and language provision specified in their statement. It is important that this is detailed as an educational need in parts 2 and 3 of the statement for the provision to be enforceable.

Some of the speech and language therapy provided in schools and settings takes the form of one to one sessions with a therapist. But very often the SALT will devise a programme for a child to be delivered by class teachers and teaching assistants. The SALT will provide training for the school staff and suggest communication targets for the child’s individual education plan which should be integrated into the curriculum.