SPEECH AND LANGUAGE THERAPY FOR AUTISM
Will my child ever speak?
While this is the question uppermost on the minds of parents, it is difficult to answer this with certainty. However, there are certain factors that indicate a favourable outcome…
1. The age at which intervention was initiated; the earlier, the better.
2. The severity of the autism. Children with greater involvement may find speaking more difficult.
3. Degree of oromotor involvement. Oral structures include the jaw, lips, tongue, vocal folds, etc. Any difficulty in using these motor components effectively could make it difficult for the child to speak. Difficulty/inability to blow, suck through a straw,
chew well, phonate (make a sound) on command, difficulty/inability to move the tongue easily, etc, are all signs of oromotor difficulties.
See The Com DEALL Trust’s paper on this topic for scientific backing.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696837/
4. Co-morbidity (difficulties in addition to Autism). Speech could be harder if the child has problems additional to Autism (like mental retardation, uncontrolled seizures, hearing impairment, etc).
5. Degree of parental involvement. It is extremely important for the parents to be involved in the intervention process. Parents can be effective when they are tuned
in to their child’s needs and can help him/her experience success in stress-free
How can I help my child to speak?
The first thing to understand is that your child is not speaking because he finds speech difficult. Forcing the child to speak will not help. In fact, this will make it even harder for the child.
Second, we need to shift from thinking about speech to thinking about communication. Communication involves sharing of information between two or more people. The right question to ask would be: How can I help my child to understand me and be understood by me?
Click on the link below to hear Ms.Deepa Bhat Nair speak on some of the Do's and Dont's of speech therapy.
How do I help my child to understand me better?
Speak to your child in a slow and gentle manner.
Give your child time to respond. Children with autism may take a little longer than their peers to respond to instructions.
Repeating instructions without giving your child time to respond could make it very confusing for the child.
Do not raise your voice or shout at your child when he/she does not follow you. Instead, try to take the child gently by the hand and indicate what is required. Help your child to follow your command by doing it with him/her.
Use visuals. If your child is finding it hard to respond to the spoken word, supplement it with pictures. For example, when you are telling your child it is time to use the toilet, show him a picture of the toilet. Similarly, pictures could be used to help your child understand the structure of the day. Pictures should be arranged in the order of the activity. Pictures for waking up, brushing, bathing, meal time, etc, would help the child understand better.
Follow this link to see the American Speech and Hearing's position statement on best practises for Autism treatment:
For children in schools, pictures could be used to help understand the rules of classroom behaviour. For example, pictures could indicate the simple rule of keeping quiet when the teacher is talking or sitting in one's place.
Use gestures, sometimes exaggerating your facial expressions, pointing to the object
you are talking about. Indeed, using basic gestures for the toilet, to come here, food, drink, etc, could prove helpful.
How can I improve my child’s communication abilities?
The first step is to have fun with your child. Often, parents are so busy being
therapists and teachers that the fun element is missing from their interactions. Find stuff your child likes to do.These are things you could do together. For instance, water play, soap bubbles, jumping off a low stool, tickle-tickle, akkad bakkad bambe bo, a plate full of rava to throw around, fooling around with shaving foam are all good ways to start. Do remind yourself that there is no 'goal' here. The only target is that you meet your child at his/her level and enjoy yourselves.
Ideally, these should be quiet times together with little or no direction given to the child. Gradually, as the child begins to anticipate these; he will wait for these interactions. This may be a good opportunity to teach the child the gesture for “come” play with me. Work with your therapist to build up communication once the child is interested in being with you. Words like “more”,” give me” “yes/no”, “do not want" are easy to stimulate during play.
At Com DEALL, we create an environment that facilitates language development. The speech therapist is trained to elicit, not demand, speech. You will not find our therapist teaching your child a long list of fruits and vegetables even before he can communicate his basic needs. Speech therapy for Autism at Com DEALL believes in functionality of goal setting. It is all about setting goals that have relevance to your child’s life.
My child can make only some sounds; how can I build on this further?
The trick here is to think communication. Perhaps your child is making some random sounds like a/ba-ba/etc that have no meaning at all. This is a good time to develop the child’s protovocabulary, a technique we use at DEALL quite often. Assign meaning to the sounds your child is making. Gradually, your child will understand the power of the sounds he/she can make and begin to use these sounds more consistently. Your child may eventually even move towards real words.
Also remember to encourage a back and forth, where you imitiate sounds your child is making and encourage him/her to make more sounds. This builds the basic blocks of taking turns during conversation. The more times you facilitate sound production, the greater the strengthening of the neural networks required to produce the sounds. All speech therapy for Autism at DEALL Mumbai is backed by sound, scientific rationale.
Follow the link for Com DEALL's protovocabulary booklet and other therapy aids to build communication:
My child does not speak at all. Does that mean he cannot understand me?
Children understand much more than parents give them credit for. It is a common mistake to assume that a child who does not speak does not understand too. Speak to your child as you would with any other child of that age. It is very important that a child with a language disorder is provided a language-rich environment. Speak to your child about what he/she is seeing, doing, about his/her feelings. It will help share your thoughts. Parallel talk is a powerful technique all therapists use. We train parents to parallel talk as well. This involves speaking on your child’s behalf. Many parents of children with Autism at our Centre have used it with fantastic results.
Follow the link for a manual on parallel talk:
My child has no speech. How can I help him to communicate?
Remember, it is important not to force your child to speak. It is equally important to encourage and develop some means of communication as quickly as possible. Explore AAC (alternate augmentative communication) with your therapist. A child who cannot speak can be taught to point at pictures to indicate his needs; for example, pictures of food, toilet, water, etc. Some children pick up gestures to indicate these needs. It is important to develop these skills. Not being able to indicate even these basic needs can make a child very restless and frustrated. This may even lead to much negative behaviour such as kicking, throwing things, biting, etc.
Many parents are scared to introduce AAC. They fear that their child will get too dependent on these alternate systems and will not try to speak at all. Nothing could be further from the truth. There is a lot of research that suggests that using alternate communication systems promotes speech and language development. This has certainly been our clinical experience at Com DEALL as well.
What are the alternate systems I can use with my child?
Makaton signs and symbols: The decision to use signs/picture symbols for your child will depend upon your child’s profile. Makaton is a language programme offering a structured, multimodal approach to teaching communication and language skills. This was developed in the UK but an Indian version of the same is available. The child
can, therefore, use specific signs to indicate his needs.
Picture exchange communication system (PECS): Here, children use small pictures or symbols of commonly used words to request desired items or communicate basic concepts non-verbally. As mentioned earlier, it is important to introduce communication as early as possible. This helps the child understand the power of communication and that he/she can use words to be understood. Further, using pictures also helps children who face difficulty with initiating communication.
Voice output machines: These are typically small electronic computers that use a video screen controlled by touch (either buttons or, in some cases, a touch screen), which speaks aloud the language inputed by the child. A variety of voice output devices are available in the West. One big drawback of these devices is the initial cost and complexity involved in keeping the device tuned to the child’s communicative needs and language levels. However, they are helpful because they allow the child to hear the language repeatedly. They also help when the gap between the child’s ability to understand language and speak language is very wide.
Voice output communication aids (VOCA) in India:
Kathamala, a low-cost indigenous VOCA
Gupshup, a software of Indian symbols for picture communication
Kavi, picture-to-speech software that can be uploaded to tabs or phones,
developed by Mind Tree
Mobiles and tabs: Advances in mobile and tablet technology have revolutionized AAC usage. Children with Autism respond well to these devices and with the right guidance they can be powerful mediums for communication and learning.
Proloquo2go (an advanced version that can grow with your child) https://itunes.apple.com/us/app/proloquo2go-symbol-based-aac/id308368164?mt=8
Tap To Talk (for more basic communication; a free, simpler version available)
Avaz (has Indian vocabulary)
Bol (again, specific to Indian context, developed by SAP Lab, free to use)
Our therapists at Com DEALL are trained in all these and more. Our program, called “Communication DEALL”, has heavy emphasis on developing communication and speech skills in a child with Autism.