How can speech therapy help a child with autism

What is Speech Therapy?

Speech-language therapy addresses challenges with language and communication. It can help people with autism improve their verbal, nonverbal, and social communication. The overall goal is to help the person communicate in more useful and functional ways.

Communication and speech-related challenges vary from person to person. Some individuals on the autism spectrum are not able to speak. Others love to talk, but have difficulty holding a conversation or understanding body language and facial expressions when talking with others.

A speech therapy program begins with an evaluation by a speech-language pathologist (SLP) to assess the person’s communication strengths and challenges. From this evaluation, the SLP creates individual goals for therapy.

Common goals may include improving spoken language, learning nonverbal skills such as signs or gestures, or learning to communicate using an alternative method (such as pictures or technology).

Examples of the skills that speech therapy may work on include:

• Strengthening the muscles in the mouth, jaw and neck
• Making clearer speech sounds
• Matching emotions with the correct facial expression
• Understanding body language
• Responding to questions
• Matching a picture with its meaning
• Using a speech app on an iPad to produce the correct word
• Modulating tone of voice

Alternative Augmentative Communication (AAC)

Some people with autism find that using pictures or technology to communicate is more effective than speaking. This is known as Alternative Augmentative Communication (AAC). Examples of AAC methods include:

• Sign language
• Picture exchange communication system (PECS)
• iPads
• Speech output devices (such as Dynavox)

The speech-language pathologist can help to identify which AAC method (if any) is right for someone with autism and teach him/her how to use the method to communicate.

Learn more about AAC and autism.

You can also visit the American Speech-Language Hearing Association’s AAC webpage for more information. 

Social Skills

Speech therapy can also help people work on goals related to social communication. Speech therapists sometimes offer social skills groups in addition to one-on-one therapy.

They may also work on coaching children and adults on communication in different settings. This can include how to communicate with friends, communicating in a relationship, appropriate behavior at work, and more.

Click here for more information on social skills.

Feeding Challenges

Some SLPs are specifically trained to address feeding and swallowing challenges in people with autism. They can evaluate the particular issue a person is dealing with and provide treatment plans for improving feeding-related challenges.

Click here for more information on feeding issues. 

Where are services provided?

Speech therapy can take place in a variety of settings:

• Private clinic setting
• At school, through an Individualized Education Program (IEP)
• At home, as part of an Early Intervention program for children under 3
• In the community, to practice new skills in a natural environment

Services can be provided one-on-one, or in a group setting depending on what skill is being practiced.

Who provides the services?

Speech-Language Pathologists (SLP) provide speech therapy services. They have a master’s degree and are specially licensed to practice through the state.

You may notice that a speech therapist has the credentials “CCC-SLP” after their name. This stands for Certificate of Clinical Competence (CCC) and is a credential through the American Speech-Language Hearing Association (ASHA). It indicates that the speech therapist has achieved excellence in academic and professional standards. You can learn more on the ASHA website.

In some cases, a Speech Therapy Assistant provides direct speech therapy services. This is a person with an associate’s or bachelor’s degree, who is trained and supervised by a certified speech-language pathologist. The assistant works directly with the person with autism to practice skills and work towards goals that are written by the SLP in the clinical treatment plan.

Is it covered by insurance?

Yes, speech therapy is often covered by health insurance. In some cases, a doctor must state that the therapy is medically necessary for health insurance to provide coverage. [Please see our insurance resources for more information about insurance and coverage for autism services.]

Students can get speech therapy as part of their Individualized Education Program (IEP) at school. Speech therapy is often written into IEPs as a related service. Speech services as part of an IEP are provided at no cost to families.

Some young children receive speech therapy through their Early Intervention program. Early intervention is offered in each state to children under age 3 who are not growing and developing at the same rate as others. These services are free or low-cost based on your family income. 

Where do I find a speech therapist? 

Autism Speaks Directory

American Speech-Language Hearing Association (ASHA)

What questions should I ask?

The following questions can help you learn more about speech therapy before you begin. It can also help you learn whether a particular speech therapist or clinic is a good fit for your family:

1. Who will be working directly with my child?
2. How many years have you been working with people with autism?
3. Where will services be provided?
4. What does the initial assessment involve?
5. What type of insurance do you accept? Will my insurance cover your services?
6. Do you have a waiting list? 
7. How many hours of therapy per week?
8. How long are therapy sessions?
9. Can I observe my child’s sessions?
10. What is a typical caseload for each therapist?
11. How are goals determined? Can clients and parents provide input?
12. What does a typical program look like?
13. How do you measure progress?
14. What are some of the typical milestones for speech and language?
15. What can we do to practice at home? 
16. What progress should we expect? 

Almost anyone diagnosed with an autism spectrum disorder will be recommended for speech therapy. In some cases, this makes perfect sense because many autistic children have limited or compromised speech, and clearly need help in forming words and sentences. But even very verbal people with high functioning autism are likely to receive speech therapy. That’s because, while they can form words and sentences, they are likely to misuse and misunderstand language on a regular basis.

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What Is Speech Therapy?

Speech therapy involves the treatment of speech and communication disorders, which means it’s a very wide-ranging field. Speech therapy can help children with stutters or lisps to pronounce words correctly, but it can also help children with developmental disorders to understand and use spoken language in a social context.

A certified speech-language pathologist (sometimes called a therapist) is a communication expert that must hold a master’s degree. That person may work in a private setting, a clinic, a school, or an institution, and may work as part of an educational team. They use a wide range of tools and interventions, ranging from toys and play-like therapy to formal tests and speech curricula.

What a Speech Therapist Does for People With Autism

Speech therapists can play a major role in helping an autistic child learn to communicate and engage with other people. Depending on the setting (school, home, office), your child’s therapist may work 1:1 or in groups. And depending on your child’s functional level, the therapist may focus on one or all these skills:

• Non-verbal communication. This may include teaching gestural communication or training with PECS (picture exchange communication system), electronic talking devices, and other non-verbal communication tools.
• Body language. How can you tell if another person is joking or serious? When is it okay to join a conversation and when is the conversation private? Speech therapists can teach children how to recognize subtly physical signals.
• Asking and answering questions. Children with autism may not develop the ability to ask and answer questions without the help of a therapist. The therapist can teach your child how to recognize a question and appropriate answers to provide. They can also help your child formulate, ask, and understand the answers to their own questions.
• Speech pragmatics. It’s all well and good to know how to say, “good morning.” But it’s just as important to know when, how, and to whom you should say it to. Speech pragmatics training can also help your child understand the meaning of idioms (sometimes hard for people with autism), and to use idioms themselves.
• Prosody. The term “prosody” relates to the melodic sound of a voice as it goes up and down in conversation. Many people with autism have flat prosody, which causes other people to believe they have no emotions. Speech therapists can help children with autism to build their vocal skills.
• Grammar. Some children with autism have a tough time using correct grammar even when it’s modeled at home or at school. They may refer to themselves in the third person (“Johnny wants juice”) or use incorrect tenses, etc. Speech therapists often work with autistic children to help them correct grammar mistakes.
• Conversation skills. Knowing how to make statements is not the same thing as carrying on conversations. Speech therapists may work on back-and-forth exchange, sometimes known as “joint attention.”
• Concept skills. A person’s ability to state abstract concepts doesn’t always reflect their ability to understand them. Autistic people often have a tough time with ideas like “few,” “justice,” and “liberty.” Speech therapists may work on building concept skills.
• Social skills. Along with play therapists, occupational therapists, and people in specific areas of expertise such as recreational therapy, drama therapy, and art therapy, speech therapists often help people with autism to build social communication skills. Such skills include the ability to ask and answer questions, stand at an appropriate distance from a conversational partner, assess the “mood” of a room (or a person), and more.

It’s important to note that while speech therapy is a “must” for autistic children, it can also be extremely beneficial for adults on the autism spectrum. While children often focus on the basics of communication, adults may focus on more subtle forms of communication for different types of social interactions.

How to Find a Qualified Speech Therapist

Because speech-language therapy is so well-established, it is highly likely that your medical insurance will cover all or part of the cost. It’s also quite likely that your child’s school or early intervention provider will provide the service for free. If you choose to go the private route, you may need to pay the therapist in advance and then request reimbursement from your insurance company.

It’s always important to remember, however, that any therapist must be a good personal match for your child’s needs. For that reason, you will want to meet, interview, and observe the therapist as they work with your child. You may also wish to ask the therapist for references from parents with children whose needs are similar to your child’s. Some therapists are terrific with verbal children but less effective with non-verbal children, and vice versa.

For more information about finding a qualified speech-language therapist, contact the American Speech-Language-Hearing Association (ASHA).