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Speech and Language Therapy for Children with Autism

Published Nov 6, 2009, last updated Dec 21, 2009

What is it?
The goal of speech therapy is to improve all aspects of communication. This includes: comprehension, expression, sound production, and social use of language (1). Speech therapy may include sign language and the use of picture symbols (2). At its best, a specific speech therapy program is tailored to the specific weaknesses and the environment of the individual child (1, 3). Unfortunately, it can be difficult to create a childspecific, evolving, long-term speech therapy plan (1 , 4). The National Research Council describes four aspects of beneficial speech therapy. 1. 2. 3. 4.

Speech therapy should begin early in a child's life and be frequent. Therapy should be rooted in practical experience in the child's life. Therapy should encourage spontaneous communication. Any communication skills learned during speech therapy should be generalizable to multiple situations .

Thus, any speech therapy program should include practice in many different places with many different people

. In order for speech therapy to be most successful, caregivers should practice speech exercises during

normal daily routines in the home, school, and community (1 , 6, 7). Speech therapists can give specific examples of how best to incorporate speech therapy throughout a child's day (8).

What's it like?
Speech therapy sessions will vary greatly depending upon the child. If the child is younger than three years old, then the speech therapist will most likely come into the home for a one-hour session. If the child is older than three, then therapy sessions will occur at school or in the therapists office. If the child is school age, expect that speech therapy will include one-on-one time with the child, classroom-based activities, and consultations between the speech therapist and teachers and parents (2). The sessions should be designed to engage the child in communication. The therapist will engage the child using games and toys chosen specifically for the child. Several different speech therapy techniques and approaches can be used in a single session or throughout many sessions (see Does it work?). Speech and language therapy may include tools and strategies called augmentative and alternative communication (AAC). These tools can be very helpful for children with little or no verbal communication skills. For example, a picture exchange communication system (or PECS; http://www.pecs.org.uk/) allows the child to communicate using pictures. Go to our PECS Fact Sheet for more information.

What is the theory behind it?

Children with autism not only may have trouble communicating socially, but may also have problems behaving. These behavioral problems are believed to be at least partially caused by the frustration associated with the inability to communicate. Speech therapy is intended to improve social communication skills, and teach the ability to use those communication skills as an alternative to unacceptable behavior (1).

Does it work?
Many scientific studies demonstrate that speech therapy is able to improve the communication skills of children with autism (1). Parents reported improvements in social play, confidence, and behavior at home and at school with speech therapy (9). The most successful approaches to speech therapy include components of early identification, family involvement, and individualized treatment (8). There are many different approaches to speech therapy and most of them are effective. The table below lists some of the different approaches. In most cases a speech therapist will use a combination of approaches in a program.

Does the Type of Speech Therapy Definition Research Support It?

Augmentative and alternative communication (AAC)

broad term for forms of communication that supplement or enhance speech, including electronic devices, picture boards, and sign language Yes (10)

Discrete trial training

therapy that focuses on behavior and actions

Yes (1)

Facilitated communication

communication technique that involves a facilitator who places his hand over the patient's hand, arm or wrist, which is placed on a board or keyboard with letters, words or pictures

No (1, 4)

Functional communication training (FCT)

use of positive reinforcement to motivate the child to communicate

Yes (11)

Generalized imitation

child is encouraged to mimic the therapists mouth motions

Yes (12)

before attempting to make the sound

Mand training

use of prompts and reinforcements of independent requests for items (referred to as mands)

Yes (12)

Motivational techniques

therapy techniques that focus on following the child's lead and capitalize on the child's desire to respond use of children who are trained to interact with the autistic child throughout the day

Yes (6)

Peer mentors/circle of friends

Yes (8)

Picture exchange communication system (PECS)

a type of AAC that uses picture symbols to communicate (see PECS Fact Sheet)

Yes (10)

Relationship development intervention (RDI)

trademarked treatment program that centers on the belief that individuals with autism can participate in authentic emotional relationships if they are exposed to them in a gradual, systematic way language of hand shapes, movements, and facial expressions (especially useful for ages 0 to 3)

Yes (8)

Sign language/total communication

Yes (1)

Story scripts/social stories

actual stories that can be used or adapted to teach social skills

Yes (1, 8)

Is it harmful?
There are no reports of speech therapy being harmful.

The cost of speech therapy is covered by the government through the Individuals with Disabilities Education Act (IDEA) of 2004. The amount of speech therapy provided in this setting may be suboptimal and thus should be supplemented with private therapy. Private speech therapy can be expensive (approximately $100/hour or more)

Speech therapy requires parental investment of time. In order to be most effective, parents may need to be fully integrated into the therapy program and should seek out opportunities to practice communication throughout the daily routine (7). With time, this should become a new way of life.

Healing Thresholds has partnered with Natural Learning Concepts. They have many tools to help children build their vocabulary. Healing Thresholds has also partnered with Discount School Supply. Discount School Supply sells toys such as the How Do You Feel? Play and Learn Chart that can be used with older children to help them learn to describe feelings. Signing Time is one of many companies selling systems that help to teach children sign language. Autism is a condition covered under the IDEA of 2004. Services covered by IDEA include early identification and assessment by an occupational therapist. This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21 (U.S. Department of Education). Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). There is a listing on this Web site for state early intervention centers. School districts can coordinate special services for children 3 to 21 years old. Several articles and books that might be useful: Principles for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span: Technical report by American Speech-Language-Hearing Association (2006). Available from http://www.asha.org/docs/html/TR2006-00143.html. 2006. Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention by T. Charman and W. Stone. 2006. The Guilford Press, pp. 115-266. Enhancing Early Language in Children with Autism Spectrum Disorders by R. Paul and D. Sutherland. In Handbook of Autism and Pervasive Developmental Disorders, Two Volume Set. 2005. John Wiley & Sons, pp. 977-1002. Improving Speech and Eating Skills in Children with Autism Spectrum Disorders An Oral Motor Program for Home and School by M.A. Flanagan. 2008. Autism Asperger Publishing Company. back to top


1. 2. 3. 4. 5. 6. 7.

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8. 9. 10. 11. 12.

Safran, S.P., et al. 2003. "Intervention ABCs for Children with Asperger Syndrome." Topics in Language Disorders 23(2):154-165. Thomas-Stonell, N., et al. 2009. "Predicted and Observed Outcomes in Preschool Children Following Speech and Language Treatment: Parent and Clinician Perspectives." J Commun Disord. 42(1):29-42. Light, J.C., et al. 1998. "Augmentative and Alternative Communication to Support Receptive and Expressive Communication for People with Autism." J.Commun.Disord. 31(2):153-178. Keen, D., et al. 2001. "Replacing Prelinguistic Behaviors with Functional Communication." J.Autism Dev.Disord. 31(4):385-398. Ross, D.E., and R.D. Greer. 2003. "Generalized Imitation and the Mand: Inducing First Instances of Speech in Young Children with Autism." Res.Dev.Disabil. 24(1):58-74.