April is Autism Awareness Month! We define autism spectrum disorder (ASD) as a neurodevelopmental disorder which is characterized by restricted and repetitive behaviors as well as differences in pragmatic skills (or social skills). Frequently, sensory processing differences are present as well. Additionally, according to the Center for Disease Control (CDC) 2016 data, about 1 in 54 children in the U.S. is diagnosed with ASD. And with prevalence increasing, I have an essential role to play as a speech therapist for children with autism.
By learning more about ASD, therapists, doctors, and educators can all better help answer families’ questions and help achieve the best outcomes for our friends with ASD. Typically, speech-language pathologists (SLPs) are one of the first stops for families in their journey with ASD. This is because many children with ASD have difficulties with speech and language and social/play skills.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was released in 2013. The DSM-5 is the standard reference for healthcare providers to use to diagnose mental and behavioral conditions, including ASD. The new edition of the DSM reorganized Autism into a spectrum. This better represent the wide variety and severity of symptoms people can experience with ASD. Researchers and scientists are continually conducting studies to learn and understand more about ASD.
Autism Spectrum Disorder is commonly diagnosed around 3 years of age, but can be diagnosed as early as 18 months of age. The recommended age of diagnosis changes as more research becomes available, so the typical age of diagnosis could fluctuate in the years to come. As such, some children get “missed” at younger ages. One common reason is that social demands and expected milestones change with age. Many parents of younger children won’t recognize anything amiss until their child is among peers. Some children may not be diagnosed with ASD until elementary school or even later! Being expected to read nonverbal cues, sarcasm, and subtle “hints” are all examples of social skill demands. It is important to understand the “red flags” of ASD in order to discuss with your pediatrician.
Common Signs or “Red Flags”:
Restricted interests and play routines (ex: My daughter only wants to play with her dinosaurs. She knows a lot about dinosaurs and only wants to talk about them and nothing else. The only way she plays with the dinosaurs is to pretend to feed them. And, she gets really upset when we try to pretend to put them to bed.)
Unusual over-sensitivity or under-sensitivity to noises and/or textures
Difficulty dealing with changes, especially with routines
Poor safety awareness
Inappropriate play routines (ex: will line up blocks, but will not stack them)
Inappropriate eye contact
Does not turn when their name is called
Arm flapping or other inappropriate repetitive movements
Delayed speech development
Prefer to play alone
Difficulty calming themselves
Extremely picky eater
Regression of speech and language skills
Many children may show one or two of these signs and behaviors. While concerning, they must be taken into consideration along with many other factors before they are diagnosed with ASD. Therefore, a formal evaluation with a team of expert is the recommended approach. Dr. Elisabeth Thurlow is one such expert on diagnosing autism here in San Diego.
A Speech Therapist’s Role
Speech-language pathologists (SLPs) are typically a core part of a team of therapists and educators who can help a child with ASD. As part of this team, an SLP provides therapy to help improve a wide range of skills, such as identifying objects, sequencing stories, using appropriate eye contact, producing longer phrases, and using age-appropriate grammar. Remember, every child is different, and that goes for children with ASD as well! Rarely do children have the exact same difficulties in language and social skills. Therefore, their goals, activities, and treatment plans in speech and language therapy are really different, too!
The Role of Alternative Communication
Some children and adults with ASD are nonverbal and require Augmentative and Alternative Communication (AAC) devices. This can include high-tech devices that resemble tablets or simple picture cards that can be made into choice boards and schedules. While many children with ASD have difficulty interacting and maintaining conversations with their classmates, the family plays a role by learning and practicing conversational turn-taking at home. In addition, these tools can also help children keep “on topic” during speech and language therapy. Likewise, children with ASD can also sometimes have trouble understanding directions, answering questions, retelling stories, and identifying objects or other concepts. So, no matter the speech and language concerns, the child’s therapy and educational team is here to help!
A Family-Focused Role
It is important that families are ready and willing to bring therapy strategies into their everyday lives. This increases the child’s skills and “carries over” the skills learned in therapy to other environments. Understandably, a lack of quick progress can become frustrating. Therefore, it is important to remember that children with language delays require many more exposures and practice to vocabulary words and grammatical elements (ex: prepositions, past tense verbs) in order to retain them when compared to children without language delays. In other words, repetition is very important for learning new skills.
While Autism Awareness Month is concluding, it’s important to understand how ASD affects so many lives in unique ways. One of my favorite professors, an expert in autism, once said, “Autism is not just a disability. It is a different ability!” I believe and implement that statement into all my therapy techniques. That’s because I believe that everyone deserves to find their voice. SLPs are here to help people do just that!
Disclaimer: My Kids Place works to provide reliable and relevant information for parents, educators, healthcare professionals, etc. to further support and understanding for children with special needs. The presented information is provided by skilled and state-licensed therapists. All expressed opinions and ideas are for your consideration and should not be considered formal medical advice.