Autism, Speech and Communication

One of the key features of autism is communication challenges. These include not understanding the importance of communication, not being able or willing to communicate, not being able to communicate appropriately in social situations, etc.

In addition, an estimated 25 to 35 percent of people on the autism spectrum have little or no functional speech. Speech in autism is also along a wide spectrum, including those that speak fluently to those that do not speak at all. The usual words used in this regard are – minimally verbal for someone who uses little speech, nonverbal for someone with no speech and preverbal for young children.

Like in many areas related to autism, the current research on non-speaking autism is limited, and we do not really know what causes functional speech difficulties. A variety of causes for limited speech in autism are possible: auditory processing, the system in brain that interprets words, might be poor; there could be motor planning issues like speech apraxia that impacts peoples’ ability to plan and coordinate mouth and tongue movements; differences in brain anatomy in the speech production network can also be involved.

Communication is not just speech

However, there is a difference between speech and communication – speech is the ability to produce words, whereas communication is the ability to convey and receive meaning. It is a misconception that children who do not speak cannot understand or communicate. It is also not true that those that can speak can automatically communicate and understand others. Also, people who do not or cannot speak do not have less intelligence scores than those who speak. They need communication as much as anyone else.

Living in a world that revolves around language, speech and communication can be particularly challenging for people on the spectrum and more so for those that do not use much speech. The current assumption is that people who cannot communicate become frustrated and that becomes a trigger for various other unhelpful behaviors. Whether it is completely true or not, there is broad agreement among experts that having a two-way communication channel is important for everyone.

Looking beyond speech - AAC

Speech is particularly difficult for some people on the spectrum. We do not understand the reasons for these difficulties, but recognize that effective communication is important for everyone, and that speech is not the only way to communicate. It therefore makes sense to look beyond speech and enable everyone to find a channel of communication, using augmented and alternative communication (AAC) as necessary. AAC is a broad category that includes sign language, gestures, pictures, written words, and electronic devices.

This is not to say that speech is not necessary or important. Speaking and understanding spoken language can make life significantly easier for people on the spectrum and their families. However, considering the difficulties they have with communication and speech, limiting oneself to speech-only approaches can be counterproductive. It is advisable to explore the use of AAC for communication, as early as possible.

AAC can provide a communication channel for people on the spectrum who have difficulties with speech and communication. It has been shown that even with people who speak, the use of AAC can make communication more effective, by providing a necessary scaffold. Also, the common apprehension that use of AAC stops children from acquiring speech is not true, as shown by a 2021 study, among others.

In summary, communication is a key element of working with autism and needs to be highly prioritized. People who find it difficult to speak should be supported with augmented and alternative communication as needed.

Video - Make it Visual - help your child understand you

In the video below, Dr. Nanditha De Souza of Sethu talks about how visual support help a child understand information better. Visual support is a form of AAC that helps a child communicate easily.

Speech Therapy is not just about speech

Yes, speech therapy and speech therapists are not all about “speech.” A speech therapist is really a speech language pathologist (SLP), but they are not just about language either. The overall goal of SLPs is to help a person communicate in functional ways.

Communicating in functional ways certainly includes learning to use speech and language for communication but may also include learning to read nonverbal communication like facial expressions and gestures, learning to communicate in social situations etc. When working with people on the spectrum, the focus of SLPs is to holistically improve the ability to communicate and that may include using augmented and alternative communication (AAC).

Communication and speech related challenges vary widely from person to person on the autism spectrum. Some individuals may not be able to produce any sounds, some may be able to produce speech but may not be able to use it to communicate, and at the other end, some may be able to speak fluently yet may have difficulty sticking to a topic or communicating appropriately. Accordingly, SLPs perform a variety of functions.

Functions of Speech Therapists

Prelinguistic skills – help children learn skills like eye contact, gestures, vocalizations
Nonverbal communication – help people learn to notice nonverbal signs in a conversation
Feeding interventions – some individuals tend to have difficulties with chewing, swallowing etc. Some SLPs are trained to help in these areas.
Assisted and Augmented Communication (AAC) - SLPs can also train people in using AACs to communicate. These may include Picture Exchange Communication System (PECS), sign language or electronic devices.
Speech fluency – SLPs can help people on the spectrum with speech clarity, and fluency.
Articulation – Speech requires coordination of different structures. SLPs can help improve the muscle strength, coordination and manipulation needed to produce speech.
Grammar – many children on the spectrum struggle with grammar and sentence structure. SLPs can help them understand language
Functional Speech – echolalia, repetition of sounds, words and phrases is a common coping mechanism. SLPs can help in building functional speech.
Social skills – SLPs can help coach people on the spectrum to communicate in different settings, either in one-to-one sessions or group sessions.
Social communication – SLPs can help children use language for different purposes like demanding, informing, commenting.
Transition to work – SLPs can also continue to help as the individual transitions to a work environment by coaching how to communicate in written and spoken forms.

When working with an individual on the autism spectrum, SLPs assess strengths and challenges and develop a program with goals for the person and the approaches to achieve them. This program then becomes the basis for working together and assessing the effectiveness of the therapy.

Parents of children on the spectrum should understand that the goal of the SLP is to facilitate communication and be willing to prioritize functional communication. A two-way channel of communication is the most important need of a child on the spectrum.

Choosing an SLP

SLP is an important member of the team of experts working with your child. Choose someone whose program matches your priorities and goals.
Remember that functional communication is the priority, over speech or being able to repeat rhymes or learning alphabet.
Ensure the SLP is willing to work with other experts either directly or through you.
Work towards building transparency in your relationship with the SLP. You should know what is happening in the session and be trained to carry out some interventions at home, as needed.
Choose someone who can help with AAC as needed, training you, the child and others who interact with the child.

In summary, speech therapy is not just about speech or language but about holistic communication. A speech therapist is an important member of the team working with your child and should be chosen carefully to align with the child’s goals and requirements.

Early Intervention