The Autism Society Event and Education Recordings Archive

This presentation will address the remediation of speech production difficulties from the inside out—that is, from underlying cause to individualized intervention. The overall goal is to provide a framework for determining when direct work in the area of speech production should be initiated, and when work in other areas of communication, that are prerequisite to the development of verbal language, should be emphasized. In addition, specific strategies for effectively facilitating speech production, when appropriate, will be provided. When parents are asked what they want most for their children on the autism spectrum, many say, “I just want him to talk.” Indeed, the development of verbal language can seem to be completely elusive for many children with ASD. For others, speech production seems almost to be on the “tip of their tongues,” in that these individuals may produce brief snippets of perfectly articulated words or phrases, only to plunge back into the nonverbal abyss when caregivers try to get them to “say it again.” In either case, these parents' simple wish can be the bugaboo of speech-language pathologists, teachers, and other professionals charged with remediating the student's educational needs. Given the sensitive nature of the desire for speech, when parents try to have speech production goals inserted into their child's IEP, many professionals have difficulty addressing the issue.

The reasons why many individuals with ASD present with significant delays in the development of spoken language, if it develops at all, has only partially been addressed in the research literature. While there have been numerous studies on pragmatic and cognitive impairments (e.g. Sigman & Ungerer, 1984; Wetherby & Prutting, 1984), very few have addressed the physical aspects of speech production (Adams, 1998). Despite the virtual invitation to research given in Minshew's (1996) review article, which stated that individuals with ASD experienced difficulties in the area of “complex motor abilities or praxis” (p. 207), research has been limited. Some studies have investigated and discovered difficulties with, whole-body motor imitation (e.g. Dawson & Adams, 1984; Stone, Ousley, & Littleford, 1997), but few have expanded this to include oral motor or vocal imitation (Rogers, et al. 2003). Even though little research has investigated possible physical bases of speech production difficulty, research regarding ways to improve speech production and vocal imitation is quite prevalent (e.g. Baer, Peterson, & Sherman, 1967; Ross & Greer, 2003; Williams & Greer, 1993). While some have shown promising results (e.g. Ross & Greer, 2003), the application of these studies to children across the autism spectrum is limited because the likely underlying neurologically based causes of the speech production difficulty are not used as a basis for intervention design. Since a child's oral-motor / motor speech strengths and needs can be evaluated by a speech-language pathologist, this does not need to be the case.

This presentation will address the remediation of speech production difficulties from the inside out—that is, from underlying cause to individualized intervention. The overall goal is to provide a framework for determining when direct work in the area of speech production should be initiated, and when work in other areas of communication, that are prerequisite to the development of verbal language, should be emphasized. In addition, specific strategies for effectively facilitating speech production, when appropriate, will be provided. The format of the presentation is as follows:

1. Prerequisites to the effective use of speech as a means of communication will be detailed in three areas: ¨ Cognitive (i.e. symbolic representation skills—specifically, the understanding that a spoken word refers to a specific object or idea) ¨ Pragmatic o The understanding that a message needs to be transmitted to another person in order for that person to respond o The understanding that one's voice can be used to communicate a message ¨ Physical o Brief description of the physical processes involved in speaking o Potential oral-motor / motor speech disorders µ General description with specific application to ASD o Oral sensitivity issues that impact speech development

2. If the child has not met cognitive or pragmatic prerequisites, strategies for helping the child to get to the level of speech will be provided: ¨ Cognitive ¨ Pragmatic

3. Strategies will also be provided for children who are not ready for direct work in speech production, or those who are, but present with more severe oral-motor difficulty. These will be termed, “oral-motor support skills:” ¨ Activities for normalizing oral sensitivity ¨ Activities for improving oral-motor control and movement patterns ¨ Activities for increasing babbling and the child's sound repertoire

4. For students who are ready to work on speech production skills, strategies will be provided for eliciting speech: ¨ Strategy is determined by the disorder o Dysarthria strategies o Apraxia strategies µ The case against imitation-based methods for eliciting speech production µ “Back door” approaches to eliciting speech

In conclusion, specific therapy designed to facilitate the development of speech production and/or oral motor skills is an all too infrequent part of a child's treatment plan. While a lack of direct research in the area, and the rarity of oral motor / motor speech skills as a presentation topic at conferences have likely contributed to this problem, all is not lost for the child with ASD. Individual evaluation and the design of specific treatment programs that are based on a child's specific speech production strengths and needs can ensure that this important part of the child's treatment puzzle is not overlooked. Given the above factors, this presentation can only add to the development of best practices in the treatment of autism spectrum disorders, as it opens a new door of intervention for many of these children.

Learning Objectives:

· Participants will be able to describe 3 prerequisites to the effective use of speech as a means of communication.

· Participants will be able to describe 2 cognitive or pragmatic strategies designed to help the child reach the level of specific speech therapy

· Participants will be able to describe 3 activities designed to normalize oral sensitivity.

· Participants will be able to describe / list at least 3 strategies designed to elicit speech in children with ASD.

Content Area: Communication