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Speech Therapy – Alternative and Augmentative Communication (AAC): a powerful tool

Autism Spectrum Disorder (ASD) affects a great number of children and often these children have difficulty communicating.  In addition to having an applied behaviour analysis team, these children benefit from speech therapy.

Updated: August 30, 2021

This by no means, should suggest, that these children understand less. Rather, they just have difficulty expressing what they understand. Speaking is one of the most effective ways of communicating and it allows us to successfully interact and navigate our way through life.  However, many ASD children, do not have this option and sadly have a challenging time having their needs met. 

How can Speech Therapy help?

Being the parent of an ASD child can be very stressful and overwhelming.  It is important to know that there is help. Communication and language development have been helped by numerous tools and programs. These are known as Alternative and Augmentative Communication (AAC) systems.

AAC is an alternative method of communicating, outside of traditional speech, that has been developed to assist those with communication and language issues. These systems can be added to your child’s existing speech therapy programs. In some cases, they also introduce new and alternative ways of dealing with communication issues.

AAC is a way to provide your ASD child with the ability to relay their thoughts and needs through alternative ways that include the use of pictures, gestures, sign language, visual aids or speech-output devices such as an iPad or Tablet. 

AAC systems help your child access their basic human right of communication. AAC also helps ensure that their needs are heard. Every person deserves the right to share in the decisions surrounding their care and well-being.

Sounds liberating, (not only for your child but for you, the parents and caregivers), doesn’t it? Taking the guesswork out of what your child is trying to communicate helps to reduce stress, for everyone, and opens up the opportunity to build stronger relationships between your child and the rest of their world. 

Unaided and Aided & Low and High Tech Systems in Speech Therapy

Unaided systems – These systems don’t require the use of any equipment. Gestures, facial expressions, body language and sign language are some examples of unaided systems used to communicate.

Aided systems – These systems use tools or materials and can be either low-tech or high-tech. Some examples of low-tech are symbol boards, choice cards, communication books, alphabet boards or cards. High-tech examples include speech-generating devices (SGD) or communication devices and AAC apps on mobile devices.  Often the Speech Therapy team will advise which system is best for the child.

Below I will further elaborate on four of the aided systems that I feel may be helpful with your ASD child’s path to achieving successful communication.

LOW-TECH



Picture Exchange Communication Systems (PECS) – This program is a tool to aid in communication with non-verbal ASD children. Pictures of desired objects are exchanged (such as clothes or food) as a way of communicating.  These pictures can be photographs, digitally created images or hand-drawn pictures.

When a child wants something, they would hand a picture of the desired item to their communication partner (the parent, peer or caregiver) in exchange for the desired object. PECS begins with a basic request which will be extended to include sentences and eventually comments as well. 

As with most things that are of value and worthwhile, this program can take a long time (months) to become independent.  It also requires special training and materials and is able to be supervised by anyone who has taken the PECS training (usually speech therapists or BCBAs). Often Speech Therapy is used to introduce PECS.

While some children will be able to pair a vocalization with the exchange, PECS itself does not teach the use of vocal language. Creating a ‘verbal’ child is not the goal but rather creating a ‘communicative’ child is the end goal.

HIGH-TECH

Speech Generating Devices (SGDs) or Voice Output Devices

These are hand-held electronic devices that when a child presses a button or flips a switch, the device will play pre-recorded words or phrases. These SGDs allow non-verbal people to communicate electronically. Therefore, in its most basic form, if a child would like a banana, they would press a picture of a banana and the device would then say “banana”, “banana please”, “I want banana” or I would like a banana, please” (or some other variation) in a pre-recorded human voice. 

Here are three examples of apps that become SGDs when paired with a dedicated device:



TouchChat HD with WordPower – Although this is one of the most costly communication apps on the market, this program offers a range of options that far outweigh the competition. Utilizing Its voice recording capabilities allows you to touch individualized set-up cells and the program will then conveniently speak.   

Linggo Logo, an app used in speech therapy to help non-verbal people communicate.


LINGGO – Created by a team led by a behaviour analyst in Toronto. The app lists words that are most used and relevant to the child’s daily needs, preferences and social activities. Linggo learns the language patterns of its users through machine learning.  It also aims to enhance literacy by transitioning the learner from using picture-based communication to written words and phrases.

Linggo also encourages vocal speech in the learner with the optional time delay feature to allow time for the learner to vocalize before the app. One of the most exciting parts of Linggo is that it gathers data on the learner’s independent vs prompted communications which will help the speech therapy team fine-tune the teaching program to achieve maximum learning and communication.


LAMP Words for Life – This is an AAC app that is available for the iPad.  It is based on the motor planning theory of language acquisition. It utilizes pre-designed vocabulary pages that do not require much individualization or adjustment. This allows the user to transition between pages without having to re-learn the positions of previously acquired words.  There is evidence to suggest that children can become more proficient AAC users using motor planning because there is less searching for icons and specific phrases or sentences become almost rote. 

Now that you know about some of the AAC systems, the implementation may be another challenge. Finding professional help can be useful and will play a very important role in your child’s communication development.  It is important to work closely with a Speech Therapy team to ensure that you are using the correct AAC systems.

Some AAC programs can be quite costly, you want to be sure they are worthwhile and effective for your child’s specific needs. A Speech Therapy team will often include a Speech-Language Pathologist, a communication disorder assistant or a speech therapy assistant. The Speech Therapy team will take into consideration which AAC is appropriate and valuable for your child and will be able to address the many questions you will have.  Furthermore, they will create and implement a program that will work with your child at their current stage of communication development and capabilities.

Some advantages of AAC as described by users include:

  • Improved ability to communicate
  • Stronger friendships and relationships 
  • Increased ability for social interactions
  • Improved independence
  • Increased involvement in decision-making and autonomy regarding their lives
  • A feeling respected
  • Access to employment and volunteer opportunities
  • An improvement in physical and mental health.

AAC systems have proven to be tools that can open up doors for your ASD child by empowering them to communicate their needs and wishes.  Through the set-up of a well-designed communication program with the help of a Speech Therapy team, including the use of AAC tools and consistent practice, your child will find that a whole new world of opportunities can become available.  

If you would like help to develop your child’s communication skills using AAC or otherwise, please contact us to set up a no-charge consultation today. 

Should my toddler see a speech therapist?

Read time: 4 minutes

Many new parents aren’t confident in their child’s milestone mastery. They often wonder ‘Should my toddler see a speech therapist?’ In their first two years, children accomplish many things. They learn how to walk, crawl, talk and socialize in just a few months. The expected age range for most skills that your child will learn is usually around 6-10 months. Most babies crawl between 6-10 months old, while the majority of children are able to walk by age 15.

Speech milestones are the same. Your child should be able to say their first words by the age of 1, and should know 20 words by the age of 18 months. Don’t panic if your child falls short of these goals. You may find your child slow to develop their language skills. A speech therapist could help.

Should my toddler see a speech therapist? Side by Side ABA Therapy

Side by Side Therapy can help your child if they are having difficulties with their development. Our therapists are warm and inviting, and we can help your child develop the skills necessary to live a happy and independent life. We have paediatric occupational therapists, speech therapists and behaviour analysts to help your child learn the skills necessary to face whatever challenges lie ahead.

Speech and Language

Speech therapy can be used to help your child improve their language and speech skills. While speech and language are closely related, they are quite different. Children might have difficulties with speaking, with language, with fluency or with any combination of the three.

Speech

Speech includes articulation, voice and fluency. Effective verbal skills require the integration of all three components. Articulation refers to the movement of our lips, tongue, mouth, and mouth in order to produce certain sounds. Children who have difficulty with articulation might have difficulties with the “r” and “th” sounds. Voice refers to the use of breath and vocal folds in order to produce sounds. Your child does not need to speak loudly, but they should be able and able to communicate clearly at a consistent volume. Fluency refers to the ability to speak in a rhythmic manner. 

Language

Language is the use of words and how they are used to communicate ideas and achieve our goals. It can be understood, spoken, read, and written. One or more of the skills that a child may struggle with is language.

Including:

  • What does the word mean? Some words can have multiple meanings. A bright object in the sky, or someone famous can both be considered “star”.
  • How to create new words.We can use the words “friend”, “friendly”, or “unfriendly” to mean different things.
  • How to combine words.In English, we use the phrase “Peg walked to new store” rather than “Peg walk new store”.
  • What to say at different times.We might say, for example, “Would your mind moving your feet?” If the person doesn’t move, we may say “Get off my foot!”

A receptive language disorder is when you have difficulty understanding the meaning of others’ words. Expressive language disorders are when you have trouble sharing your thoughts, ideas and feelings.

Fluency

Fluency refers to continuity, smoothness, rate and effort. In other words, how easily a person is able to retrieve words and use them. Fluency disorders like stuttering and cluttering are common in children with autism.

Should my toddler see a speech therapist?

Each child learns at their own pace and there are many milestones to reach. If your child shows any of these signs, then it might be time to consider speech therapy.

Number of words

Your 18-month-old child will use less than 20 words and 50 words by the age of 2.

Numerous sounds

Only a few sounds are required to make all words sound right. This is due to articulation.

Understanding

Most children can understand 300 words by age 2. Speech therapy may be necessary if your child is having trouble understanding simple sentences such as “Get your coat!”

Social situations

Your child speaks infrequently and struggles to use language socially. Sharing and turn taking are also important social skills that are related to speech and language development

If you’re looking for services for your child, please contact Side by Side Therapy to arrange a no-charge consultation to discuss your child’s development and needs.

What kind of therapy does a child with autism need?

Many parents of children recently diagnosed with autism ask themselves “What kind of therapy does a child with autism need?” This blog will cover therapy options and some guidelines for what to avoid when picking a therapy model and provider.

What kind of therapy does a child with autism need?

There are many evidence based therapies for autistic children. Applied Behaviour Analysis, Speech-Language Pathology and Occupational Therapy are 3 options. Each child is different and will need an individualized therapy program. In any case, therapy should begin with an assessment that is updated regularly. Each kind of therapy will have it’s own way of setting goals but the goals should be specific to the child. The type of therapy that a child needs will likely change as they grow and learn.

What are the different therapies?

Applied Behaviour Analysis (ABA)

ABA is a scientific discipline that focuses on analysis and evaluation of social and environmental shifts to produce meaningful changes in a person’s life. One of the main ideas behind ABA is the identification of functional relationships. In other words, functional relationships are the correlation between the person’s environment and their behaviour.

ABA can be used to both teach new skills and to reduce challenging behaviours. In fact, it is very important to do both of these things when implementing ABA. When a behaviour is reduced, it needs to be replaced with an alternative that meets the same need or serves the same function. You can read more about the functions of behaviour in this post.

ABA programs can be Comprehensive (more than 20 hours per week) or Focused (between 5 and 15 hours per week). The intensity of your child’s ABA program will depend on a number of factors (age, needs, challenging behaviours, other programs or therapies etc.).

ABA can be a bit like your family doctor. ABA has lots of strategies and techniques to help with most areas of need (behaviour, communication, social skills, motor skills etc), but there are times when a specialist is required – like a speech-language pathologist or an occupational therapist.

Child playing with wooden toys. What kinds of therapy does a child with autism need?

Speech-Language Pathology (SLP)

Speech therapy or SLP focuses on a number of areas: communication, language, pragmatics (or social skills) and feeding/swallowing. Speech therapy is a very popular therapy for autism. Your child’s SLP will do an assessment to determine where your child is in terms of skills and what needs to be targeted and taught. Sometimes the SLP will do a standardized assessment (where the child’s performance is measured against other same aged peers). Other times the assessment is informal. Sessions will usually take place for an hour or two each week.

Occupational Therapy (OT)

OT can be an incredibly effective therapy for autism. The OT will look at a number of domains (or areas) when they’re assessing the child. Some examples are: motor skills, sensory integration skills, self-help/adaptive skills, even academics. OT sessions can happen anywhere: at home, at a clinic, in school even at the park or grocery store. It’s most important that the OT is able to see the child in their natural environments in order to give the best suggestions and be the most effective. Similar to Speech, OT sessions are usually an hour or two per week.

What is an interdisciplinary team in autism therapy?

Interdisciplinary teams happen when clinicians from different disciplines work together to achieve the child’s goals. For example, the OT would give strategies and set goals around a child’s sensory needs while the SLP guides the child’s language program. Both the sensory goals and the communication goals will be carried out by the ABA team, as well! Interdisciplinary teams are the best kind of therapy for a child with autism.

There are lots of decisions to be made when you’re picking a therapy for your autistic child. Let Side by Side Therapy help you understand your options and what services are available.

Autoclitics: 4 Things to Know in 2021

This is the last blog in our series about Skinner’s verbal behaviour. If you haven’t already, you should read the other posts about MandingEchoics, Tacts and Intraverbals. This post will be about Autoclitics.

Skinner created the verbal operants which are: 

  • Echoics
  • Mands
  • Tacts
  • Intraverbals
  • Autoclitics

What Are Autoclitics?

Autoclitics are a complex verbal operant. They function to modify or give further detail about the meaning of the other verbal operants in a sentence. There are 4 types: descriptive, qualifying, quantifying and relational. If you’d like to read more about the different types of autoclitics check out this website. Autoclitics give information about the other parts of the sentence. For example in the sentence “I think that it’s going to snow tomorrow.”, the phrase ‘I think’ is an autoclitic because it refers to the certainty with which it might snow tomorrow.

How Do We Teach Autoclitics?

Once the other verbal operants have been acquired and are consistently being used appropriately, it might be appropriate to teach this new verbal operant. The research is still out on the best way to teach them. What we do know is that it’s important not to teach them too early. Learners need to have very robust mand and tact repertoires before we begin introducing autoclitics. One strategy to teach them is to establish parity. That means to model appropriate use of autoclitics and their meanings. One way to avoid rote responding is to avoid teaching carrier phrases (e.g.: “I want”, “I see”, “I hear” etc). By teaching multiple component mands the child will be better equipped to use autoclitics.

How Long Will It Take To Learn To Use This Verbal Operant?

Each learner has a their own pace. It’s not possible to predict how long it will take a learner to master a skill. However, it is clear that with solid foundational skills and lots of practice it is possible to master most skills.

Two girls laying in the grass, reading and talking using autoclitics in their language.

Why Do We Teach Autoclitics?

Understanding this type of verbal operant and using it correctly will enhance a learner’s ability to communicate. By understanding the speaker’s meaning more clearly they will be better positioned to respond to mands and tacts. An ability to use autoclitics in a learner’s speech allows them to be more clearly understood and helps others to act on their mands and tacts.

If you’d like to discuss your child’s language program, please connect with us at Side by Side Therapy to learn more. We offer ABA Therapy programs and Speech Therapy to help maximize your child’s language skills.

Is There a Cure for Autism? Part 1

“Is there a cure for Autism?” 

“How long will my child have to be in therapy?” 

“How long until they’re like other kids their age?” 

Each week I speak with 10 or so parents, most of who have newly diagnosed autistic children. 

These are questions that many parents ask. It’s so difficult to ask these questions and it’s equally difficult to answer them. I am always honest when I answer.  I tell them that I believe that each child can make change and learn new skills but that there is no cure for autism. It’s not for me to say how ‘normal’ they will become. I try to stress to these parents that their child has so much potential and with the right mix of learning opportunities they will grow into incredible little humans. 

Mom holding son while searching the internet for a cure for autism.

Taking the expectation of being ‘normal’ off the table is a relief for some parents. Others aren’t ready to hear my message. They’re still grieving the loss of the child they thought they’d have. One of the most difficult things for people to handle is uncertainty. Humans are hardwired to have a plan or at least a destination. We dream of the future. When your child is diagnosed with a special need your journey takes a turn. There is a wonderful poem that conveys this message so beautifully. It’s called ‘Welcome to Holland’ and it was written by Emily Perl Kingsley in 1987. 

(I need to say that no one poem or piece of writing will perfectly sum up the experience of the entire special needs parenting population.  This poem should be taken for what it is, one woman’s perspective, at one point in her life. Some people will identify with it and others will not.) 

What Should Parents Do?

There are a number of evidence based treatments for autism. Research the options that are available in your area and decide which aligns with your beliefs and goals. Applied Behaviour Analysis (ABA) has the most research backing it’s effectiveness for autistic children. There is also Speech Therapy that can be essential for autistic kids as well as Occupational Therapy. There is a lot of overlap between the disciplines. Sometimes your child’s needs can be addressed by the ABA team alone, but sometimes the expertise of a specialist is required. Any therapy team you work with should be open to collaboration with other disciplines that provide evidence based therapy. 

Alternative Cures For Autism

As with any issue that affects a group of people, there will always be bad actors who try to dupe vulnerable people. I always caution my clients against spending resources on non evidence based interventions.  Resources can be money, time and energy.  Very few people have unlimited resources. When you devote resources to one treatment, automatically you’re taking resources away from the others. You want to ensure that you’re putting your resources where you’ll get the most benefit. Some examples of non evidence based interventions are: biomedical interventions (chelation therapy, autism diets, supplements) or other treatments like swimming with dolphins or hyperbaric oxygen chambers.  While these treatments may have many glowing reviews look for peer-reviewed, double blind controlled studies to use as your base of information when determining if something is evidence based. 

Here is a list of evidence based interventions for you to consider with your child. 

Come back next week as I discuss if we should even be trying to cure autism. 

Red Flags for Autism: 8 Behaviours to look for

Each child develops at their own pace. However, there are general guidelines, called milestones, that are used in monitoring if your child is progressing. When a child doesn’t meet their milestones, it can be a red flag for autism. Red flags don’t necessarily mean your child will be diagnosed, but they are considered when determining if further assessment is needed.

Red flags for autism are divided into 3 categories. These categories align with the 3 diagnostic domains for autism: language, social skills and repetitive and stereotypic behaviours.

8 Red Flags for Autism

Language

No words by 18 months or no two-word combinations by 24 months

Most children will have 10 words by the time they’re 18 months old. These words might not be complete but will be easy to understand and consistent. By 24 months many children are using two-word combinations. These combinations are often a name + item to make a request (e.g.: “Julia Milk”, “Daddy bed” etc.)

No pointing or use of gestures

Pointing is a very important skill. It allows a child to share their thoughts and interests in a non-verbal way. Most children point with their whole hand at first (reaching) but will eventually begin to extend their index finger to point. Likewise, gestures allow us to understand a child’s meaning without spoken language.

Inconsistent responding to name

By about a year old, your child should be consistently looking when you call their name. Responding to their name demonstrates that the child is able to divide their attention from what they’re doing when they hear a specific auditory cue.

Toddler boy covering his eyes. Lack of eye contact is a red flag for autism.

Loss of previously mastered language skills

One of the biggest red flags for autism is a regression in language skills. Regression is when a child has mastered a skill but is then unable to demonstrate the same skill. Many parents of children with autism describe their child’s language development as typical until around 2 years of age, when the child lost the words, comprehension, pointing and gestures they were using.

Social Skills

Inconsistent eye contact

Many children with autism do not make eye contact naturally. In fact, adults with autism have said that eye contact can be painful or anxiety provoking. This goes beyond shyness.

Lack of joint attention

One of the red flags for autism is the inability to show joint attention. Joint attention happens when a child and their communication partner use gaze and gestures to divide their attention between a person and an interesting object or event.

Stereotypic or Repetitive Behaviours

Unusual or repetitive behaviours with their hands or other body parts

One of the red flags for autism is moving hands and the body in general in unusual ways. Some children will wave their fingers near their eyes, flap their hands, rock their body or walk on their toes.

Preoccupation or unusual interests

Another red flag for autism is intense preoccupation with non-toy items. Some children become very attached to random objects (a spoon, a block, a piece of clothing) and will become upset if it is removed.

What to do if you notice red flags for autism in your child

Bring them up with your paediatrician! Getting early intervention is wise because even if your child does not end up with a diagnosis, the early intervention will teach a skill that was lacking. Speech Therapy, Occupational Therapy and Applied Behaviour Analysis can all be helpful.

Conclusion

While none of these red flags for autism are enough to get a diagnosis on their own, it is important to notice them. When a child’s displaying a combination or stops making gains make an appointment with your paediatrician for advice and potential referrals.

Things You Need To Know About Language Delays

Often autistic children have language delays. Receptive language is the ability to understand information provided by other people, either verbally or in writing. Expressive language is the ability to put our own thoughts into words, both spoken and written. Speech therapy can help your child learn these valuable skills.

Autistic children might have a language delay, meaning their communication skills are not developing as expected. This delay can affect the receptive or expressive language and, in some situations, both. When the child does not follow a typical developmental pattern, all areas of their learning and development are impacted.

Language delays add to the complexity of ASD

Language delays add to the complexity of an autism diagnosis, having a negative impact on socialization and academic performance.

When a child has poor language abilities, she might find it hard to interact with peers. Children rely on verbal cues to play and take part in games, not to mention they need to understand language to follow instructions. The struggle is complex. The child cannot use expressive language to convey her thoughts. In addition, she might have a hard time understanding explanations or directions.

Toddler sitting on mother's lap with a speech therapist discussing her language delay

Receptive language disorder

When receptive language is delayed, the ability to understand words and associated concepts suffers. During the initial assessment, the therapist will determine the level of comprehension and establish an intervention plan.

Receptive language disorder is common in autistic children, affecting their ability to understand spoken language. The child might not follow directions, answer questions, or identify various objects. she might not understand gestures and their reading comprehension might suffer.

How does therapy help?

The speech-language pathologist can help the autistic child improve her receptive language. After identifying areas of need, the S-LP will use strategies to increase the level of comprehension. During therapy the S-LP will work on expanding comprehension, identifying pictures, following instructions and more. Progress will result in a higher level of independence and participation in activities of daily living.

Expressive language disorder

Many autistic children have difficulties in expressing their thoughts using words. Very often the expressive language is more affected than the receptive. Thus, the speech-language pathologist will concentrate on helping the child with the production of sounds and words. Visual support might facilitate the learning process.

Initially, the therapist will assess the child’s ability to use spoken language. She will also assess the child’s non-verbal communication. Based on the identified weaknesses, she will develop an intervention plan.

Autistic children who suffer from an expressive language disorder might have difficulties communicating their wants and needs. For instance, they might not say when they are hungry or if they need to use the toilet. Common struggles include using appropriate gestures and facial expression, correct choice of words and asking questions.

How does therapy help?

The S-LP will work to improve expressive language. During therapy, she will use strategies to teach the child to communicate her wants and needs. As therapy progresses the child will learn to express more complex thoughts and ideas.

The therapist might also use an augmentative and alternative communication system (AAC) to increase the expression of thoughts and feelings. Some examples are PECS, high-tech systems (LAMP etc) or even sign language. For more information about AAC read this blog post.

Mixed receptive and expressive language disorder

It can happen that both the expressive and receptive language abilities are impacted. In this situation, the speech-language pathologist will have to work on both areas, helping the child progress towards greater ease of communication. The earlier one starts intervention, the better the outcome is likely to be.

The most important thing to remember is that language impairments become visible as early as the first two years of life, when one can still take advantage of the brain’s neuroplasticity. Parents should be active in the intervention process, as they need how to communicate with their child and meet her on her level.

Patience is key in working to develop language abilities in autistic children. In the beginning, prompting and offering instructions in multiple steps might be highly beneficial. Also, one should provide the child with adequate time to respond. Visual supports can be useful in helping the child overcome any existing challenges and even to establish long-term communication.

You can read about language development milestones here.

How To Choose A Speech-Language Pathologist

For parents knowing how to choose a Speech-Language Pathologist can be tricky. The diagnosis of autism often involves language delays, causing parents to wonder what steps they should take in terms of intervention. Naturally, every parent wants the best for his/her child, including in therapy.

A Speech-Language Pathologist can help your child learn to communicate more effectively. But how can you be certain you have chosen the right S-LP? What are the things you should look for and what are the right questions to ask?

Two women sitting at a table talking about how to choose a speech-language pathologist.

Things to consider in choosing a Speech-Language Pathologist

This might sound like a given but you need to choose a therapist that has experience in working with children. This kind of specialist will know how to approach the child so he/she feels comfortable. Therapy should look like play, especially for young children.

Experience is essential. A knowledgeable Speech-Language Pathologist should interact with the child through play, opting for subtle strategies to improve communication. He/she should involve the parents in the intervention. A transdisciplinary approach always guarantees the best results, and he/she should include parents at all times.

A good therapist knows that parents play a major role in the therapeutic progress the child will make. The S-LP should teach parents strategies to use at home, taking parental input and comfort level into account.

From a pragmatic perspective, you can get referrals or research for Speech-Language Pathologists online, looking at your province’s College of Speech-Language Pathologists. You can also ask your child’s paediatrician or the school counsellor for a recommendation. Other parents are also a good resource. Once you have found a therapist, be sure to inquire about certification and additional education on autism intervention.

Questions to ask when choosing a Speech-Language Pathologist :

When choosing a Speech-Language Pathologist it is normal to ask questions. It might be a good idea to start by asking about the experience that they have.

Don’t be afraid to ask about the methods used and the reasoning for choosing these. The S-LP should also be able to provide evidence supporting her/his recommendations and point you toward resources where you can learn more.

These are some questions you might ask:

  • Who will work with my child?
    • Often, the Speech-Language Pathologist is part of a transdisciplinary team, which includes a speech therapy assistant, a behavioural therapist, occupational therapist, educator and so on.
  • What are the primary objectives of intervention?
    • You will work on these together but as a general rule the principal aim is to improve communication and social interaction. In some children, feeding and swallowing issues might also be addressed.
  • How many years of experience do you have with autistic children?
    • This is not necessarily relevant, but it can help you get an idea about how knowledgeable the SLP is in this field. Follow up with some discussion about previous cases and outcomes.
  • What is your treatment philosophy?
    • You are putting your trust in a new person, so it is important to know this. A good therapist will work with the family. He/she will always take the child’s needs into account.
  • Do you use AAC (Augmentative and Alternative Communication)?
    • This is important, as it is beneficial for many autistic children at the beginning of therapy and even later on.
  • How do you gain the trust of a child?
    • Some children require time to trust a new person. A good therapist will respect the child and his/her uncertainty, putting his/her emotional well-being in first place. Therapy should be offered through a lens of caring and empathy.

Practical questions are important as well:

  • What does the initial assessment entail?
  • Can I use my insurance to pay for therapy?
  • Are your services available right now? Or do I have to join a waiting list?
  • How many hours of therapy are recommended per week? And how long is a therapy session?
  • Are parents allowed to observe therapy sessions?
  • How is the intervention plan established? Are we allowed to offer suggestions?
  • How is the progress the child has made assessed?

Do not hesitate to ask as many questions as possible, as this process will help you choose a Speech-Language Pathologist for your child. It never hurts to follow your instinct, as parents often have a gut feeling telling them they found the right person for the job.

Speech Therapy in Autism Treatment

Read time: 2 minutes

Communication represents one of the core challenges for autistic children. Speech Therapy in autism treatment is essential. They may have difficulties engaging in a conversation. Not picking up on social cues, they might find it hard to interact with their peers.

A speech-language pathologist can help autistic children improve their communication and social skills. Addressing key areas, the therapy team will help the child overcome daily challenges and learn how to function within a social context.

What are some of the challenges caused by autism?

It depends on the severity of the condition – autism is a spectrum. Some children may not understand non-verbal communication easily, while others will have trouble with spoken language. They may need help learning to read or write or engage in conversations with others.

Speech Therapy in autism treatment with a young boy and a Speech-Language Pathologist

In severe forms of autism, the speech/language impairment will be more obvious. These children might not speak at all, or they might resort to challenging behaviours to express themselves. They may not seek interaction with others or prove unable to maintain eye contact.

Red flags 

Speech/language delays are among the first noticed by parents. Many go to their paediatrician or family doctor stating their concern that the child has lost some or all of the previously gained words.

Others are worried that their child constantly repeats certain words or phrases, either heard on the spot or weeks before. This is called echolalia. It can also serve the purpose of communication. The therapist will help the child resort less to repetition and rely more on novel speech.

How can Speech-Language Pathology help?

The first thing a Speech-Language Pathologist (S-LP) does is assess communication, articulation and social skills. The S-LP will notice any red flags, and work out an intervention plan to improve the areas. The primary goal is to help the child become more communicative within the home, school and social environments.

When we say communicative, it is important to remember that might not always refer to verbal language. There are children who will use other communication methods to interact with other people, and they will need help to master these. Some examples of other methods of communcation are: sign language, picture exchange, typing/writing or high-tech speech output devices.

During S-LP sessions, autistic children might work alone or in groups. The therapist will facilitate interaction, teaching the child to use appropriate communication behaviours. The child will learn to maintain eye contact, take turns and communicate according to the context and other’s cues. They will also work to develop reading and writing skills where possible.

A non-verbal child can communicate 

You might not know this, but 90% of communication is non-verbal. If an autistic child presents severe language impairment, he/she might still communicate. Through speech-language pathology, he/she can learn alternative means of communication.

The S-LP can teach him/her to understand and use gestures correctly. Communication systems can be helpful, including those based on pictures or visual supports. Some children find it easy to communicate with the help of electronic devices. The goal is to find the best method for each child, taking his/her abilities and challenges into consideration.

What about verbal children?

Once again, the intervention depends on the language and communication difficulties the child is experiencing. All children must learn the appropriate use of language and how to have a conversations with their peers and those around them.

At more advanced levels, Speech-Language Pathology might help the child understand the complexity of language. For instance, that a word can have more than one meaning or how certain expressions are used figuratively.

Social communication, one of the primary goals of S-LP

Human beings are social creatures by nature, and autistic children do not represent an exception. With the help of S-LP, they can learn how to interact with their peers and overcome the communication their challenges.

The Speech-Language Pathologist will work with the child to adapt his/her language to the correct context. They will explore non-verbal cues in a social setting and practice with other children.

It takes time, but some children can learn to recognize verbal and non-verbal cues, improving their communication abilities. This will help them feel less frustrated. When these skills improve, the challenging behaviours often become less frequent. This will have a positive effect on the academic outcome.

S-LP, helping with early diagnosis of autism

When parents have concerns about their child’s development, speech and language delays are present at the top of the list. The Speech-Language Pathologist can help with the early diagnosis of autism, recognizing the red flags associated with communication and social skills problems. The earlier the diagnosis of autism is made, the more successful the specialized intervention can be.

S-LP and the Ontario Autism Program

Your child can access S-LP services using their OAP funding (legacy funding, childhood budgets and one-time interim funding). Here is a list of eligible services and supports that can be purchased with the funding.

Read about how Side by Side Therapy can develop a transdisciplinary team to address your child’s needs and use their Ontario Autism Program funding.

Top 7 Effective Speech Therapy in Toronto Strategies to Try With Your Children

Read time: 5 minutes

Parents are often the first ones to notice that their child isn’t developing, especially in terms of communication. The lack of infant babble, the absence of eye contact and reduced interest in interaction are just a few of the features that cause one to question a potential diagnosis of autism. It is possible and often practical to begin speech therapy in Toronto before a formal diagnosis is given.

Mother and child sharing a tender moment before speech therapy in Toronto.

Autistic children might also present a limited range of facial expressions, being unable to comprehend language or show a regression (loss of words). The sooner Speech Therapy in Toronto is started, the better the outcomes are going to be. In this article, you will find a number of therapeutic strategies which might be of help. 

Speech Therapy in Toronto Strategies:

#1 Using non-verbal communication 

Interestingly, non-verbal communication accounts for 90% of all communication. Our body language, the gestures we make, along with eye contact, help us interact with other people and communicate our needs. 

A good strategy is teaching the child, through imitation, gestures that can be used daily. You can begin with gestures that are easy to imitate such as: clapping the hands, waving, stomping feet or raising arms in the air. 

#2 Oral Motor Exercises

For children who exhibit few or no facial expressions, this strategy might be quite useful. Performed regularly, it can strengthen the oral muscles, especially the ones around the mouth and jaw. 

The exercises can be practiced with a  mirror, so your child is able to see what their face looks like when they make the specific movements.  You can get some ideas of exercises from this Youtube Channel: Speech Therapy Practice. They have a series of different videos depicting different exercises you can try with your child. 

#3 Animal noises 

A fun beginning step to teach vocal speech might be to try and have the child make animal noises, especially if the child is motivated by animals. Capitalizing on this motivation might be helpful in engaging your child in doing the difficult work of learning to make the sounds. 

Various toys or books can be used to introduce the child to animal sounds. As his/her interest becomes visible, you can move to more complex games – perhaps you can create a toy barn or an animal train, having fun in the process. Be patient and have fun. 

#4 Singing songs

Very few children dislike music. Singing can help the child to learn new vocabulary, rhythm and even new topics or ideas.  

In choosing songs, it is important to take into account not only the current communication abilities of your child, but also their cognitive level. Nursery rhymes are a great place to start for younger children but older children can be introduced to all kinds of music. 

#5 Technology as basis for communication

We are lucky to live in an age where technology is advanced, creating opportunities for us to help autistic children communicate. Augmentative and alternative communication represents an option for children with limited or no functional speech, allowing them to communicate desires, needs, preferences, dislikes and comment. 

There are devices that contain recorded messages, which the child can use with the push of a button. As progress is made, these messages can become more complex. A low tech alternative is a picture exchange communication system.  You can read more about Alternative and Augmentative Communication in this blog I wrote at the end of April. 

#6 Learning how to sequence and tell a story

This is a strategy which is generally used in children with more advanced receptive language, allowing them to continue to develop their language. You would present them with images of the parts of a story, and ask them to put them in order.

For example, you might provide a picture of an empty glass with a carton of milk beside it, another picture with a full glass of milk and a third picture with half the glass of milk drank by a child in the picture. 

In opting for this activity, you would choose to begin by presenting the stories or situations that your child has experienced. This makes it more concrete and is easier for the child. In time, he/she can do this activity alone, or even draw his/her own pictures to tell a story. Many children enjoy ‘authoring’ their own stories. 

#7 Pretend play

Pretend play is a difficult skill for an autistic child to achieve but, with perseverance, it will help improve many aspects of the child’s development. On the plus side, it helps with social interaction, reinforcing communication again and again. 

The strategy would be to choose some of the child’s favorite activities, expanding on their existing sounds, words or sentences. Once you’ve identified what your child is doing naturally, you want to encourage the next step.

For example, if your child is building towers with blocks, you might begin labeling the colours of the blocks or dividing the blocks into colour groups to make red buildings and blue buildings.  You could also create a road (by laying the blocks side by side instead of on top of each other) to expand their play. 

With expanded play comes the opportunity for you to model expanded language use. The more you speak to the child, the more likely it will be for new words to appear in his/her vocabulary. 

These are some of the strategies that might be used in promoting speech and language development in autistic children. We offer speech therapy in Toronto, as well as a number of other useful therapies: Applied Behaviour Analysis, Occupational Therapy and Recreation Therapy – do not hesitate to contact us for a no charge consultation.

Autism: what’s more important equality or equity?

Read time: 6 minutes

Equality and equity are words that are often understood as being synonymous as they both have the implication of fairness, however, the two meanings are actually very different. Equality means to have the same opportunities as everyone else. Equity speaks to ensuring that everyone has the opportunities they need to be successful.

There have been many political movements that have espoused equal rights: women’s groups, minority groups, autism advocacy groups and other disability rights groups.

With equality, it is assumed that everyone has the same starting point and should be treated in exactly the same way. While with equity, the belief is that not all people start at the same point and for that reason, each person should receive (based on their distinct abilities) what they need to be successful. In understanding the difference between the two, we can conclude  that fairness does not mean equality

Modifications and Accommodations for Autism

While the idea behind equality is to treat everyone “fairly” and “equally”, it has sadly missed the mark when looking at fairness around Autism Spectrum Disorder (ASD). Assuming that everyone is equal and is starting from the same place (which we know is not true, especially in autism) can actually create unintentional barriers. For instance, modifications are necessary for those with autism to be successful in their daily routines.

Making practical changes allows the starting point to truly become one of fairness. Simply put, modifications and adjustments are how we can promote fairness and ensure that all people are provided with the tools they need to achieve success. 

An example of these modifications put into action is an autism framework is that of a child who has sensory concerns or challenging behaviour and has trouble sitting in a circle on the floor with the rest of the class.  Pressuring the child to join on the floor may create resistance or even a meltdown which affects not only the autistic child but the class as a whole. A small concession that a teacher may make is to allow the child to sit on a chair in the circle to help with engagement and integration.

Yes, this may seem to some degree “unfair” to the other children or “special treatment”, however with this minor adjustment being made to accommodate a child that has additional needs, the teacher has effectively created a more positive and successful learning environment not only for the autistic child but for the entire class as well.

We cannot and must not expect every child to fit into one box and hope that success will be the same across the board. We have to realize that accommodations and flexibility provided by parents, professionals and autism caregivers are not only kind but are actually essential to achieving true equity. 

Autism ABA Therapy Lindsey Malc Side by Side Therapy Equality vs Equity Cartoon of boys trying to see over a fence.
Equality vs equity cartoon showing the practical difference between the two terms.

As these adjustments are necessary, we need to position them as being so. Instead of the modification being looked at as unfair, it rather should be seen as levelling the playing field to ensure fairness. If we don’t make a big deal about these accommodations than others (classmates, siblings etc.) won’t either. We need to keep in mind that it’s not only those with autism that are different, but we are also all different in our own way and therefore have different capabilities and needs.

In focussing too much on equality and  fairness, we end up overlooking the wonderfulness of difference. Instead, we need to look at each person individually to ensure equity and flexibility are at the forefront. Then and only then we can indeed provide fairness in its truest form.  

To further exemplify, here in Ontario, Canada all of the changes that are being proposed and made regarding the Ontario Autism Program’s funding is a prime example of the misunderstanding surrounding equality and equity.  The province seems to be under the impression that allocating the same amount of funds for children who fall within provincially designated categories (age, etc). will provide equality across the board.  However, where the mistake lies is that autism does not affect each person in the same ways.

Therefore, funding and resources should not be allocated based on provincially set rigid categories such as age, and should instead be provided and distributed based on individual need. As autism falls on a spectrum from mild to severe, one child who is nonverbal may require, for example, far more Applied Behaviour Analysis (ABA) Therapy or Speech Therapy, than a verbal autistic child. This example is just one of many reasons why “equality” in this case will just not work.    

Below is a helpful example of a lesson that can be played with your children to help explain this confusing topic:  

The One Size Fits All Band-Aid Lesson – Ask the children to share their most serious injury: some may say a broken arm, a dislocated shoulder or a cut on the forehead. Once the injuries have been acknowledged, explain to them that your solution to heal them is to provide them each with a band-aid. 

This solution will most likely raise some confusion to the children, as how is a band-aid supposed to fix a broken arm or a dislocated shoulder? This unhelpful solution shows that there is not one solution to all situations and that each situation needs to be addressed in it’s own way. Even though using the same solution (the band-aid) may in theory seem fair, how can this “equal” method of treating three different injuries be acceptable? All that is accomplished is that only a small number of people actually get the help they need while the rest of the group suffers. 

Once again, it is important to remember that there is a difference between equality and equity. Fairness can only truly be gained with compromises and modifications which ensure that all people are indeed given the tools they need to be successful.  Would you not agree to a person with bad eyesight getting glasses or a non-english speaker having a translator at the hospital? It is a similar situation when making adjustments for autistic children and others with exceptionalities.

We know that not all people are born the same, and in keeping this in mind, we need to continue to work towards levelling the playing field to ensure actual fairness is received. 

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