A Speech and Language Therapist does exactly what it says on the tin. She helps people with speaking, understanding and general communication. This may involve helping a person learn to talk again after a stroke, or early intervention for child with developmental delays, or an older child with a speech impediment.

Jargon:

SLT – short for Speech and Language Therapist.

Receptive language – how well a person understands what other people are saying, often assessed by seeing how well someone can follow simple demands.

Expressive Language – how well a person can express their wants and needs.

Social Skills – how well a person can interact with other people. For SLT’s this focuses on skills needed for conversation, including taking turns, the rhythm of conversation, nonverbal communication, tone and cadence, listening. For other therapists social skills mean other things. This is important for you as a parent, to understand how each therapist might help your child.

Tone & Cadence – how a persons voice sounds and its pace/rhythm. So some children might talk in constant monotone because they find it difficult to control the muscles in their face to change it, a speech therapist might help with that. Tone is really important for social conversations

PECS – Picture Exchange Communication Sysytem.

Visual Supports – pictures (either drawings of things or photos) which communicate to a person what is expected or planned.

When do you need a SLT?

When another professional refers you or your child – a G.P or community nurse might refer you onto a community Speech therapist if your child is showing any difficulties around talking. This does not mean the worst thing you can think off. A few sessions might be enough to kick start a child, or you might get a home program to help a child with a lisp or a stutter. You might get referred in hospital after a stroke. A teacher might notice they need support.

If your child is getting frustrated by not being able to speak, you can check in with a private speech therapist. If they are avoiding talking because of a speech impediment, are embarrassed or conscious of it, a speech therapist can help. If your child has a delay learning words, or used to have words and then they seem to fade away, always check in with a G.P to see if there is anything to worry about.

Should every Autistic child go to a speech therapist?

One of the areas that can be difficult for Autistic people is communication. I would expect every autistic person to have had some contact with a speech therapist at some point. This does not mean every child HAS to go , and if they don’t they are suffering horribly. When we are on long waiting lists for services, you can get worried that your child is missing out. Sometimes they are and you might need to find a private therapist, sometimes they aren’t. How do you know?

By looking at how a speech therapist can help you can get an idea if your child needs to see one right now, rather then in a year when they get to the top of the list. Lets start at the begining, with assessment and early intervention.

Ideally every child with a diagnosis of autism should have the support of an early intervention team which should include speech therapy. The speech therapist can then decide how much or little input she needs. This is not often the case, but DON’T PANIC. Early intervention is all about little goals repeated slowly at the child’s pace, not huge intensive life changing work. I know of one speech therapist who, for children under a certain age, would give the parents a home program and check in with them every six weeks. Another therapist advises parents to do the Hanon ‘More than Words’ course and apply those principles at home before she will do anything else. Early intervention its small changes repeated daily and gradually increased in complexity.

Some of those changes might be :

Learning to use PECS – this is a full training program with different stages for the children and parent to learn. In its simplest form a child exchanges a photo of an object for the object itself. It means Kids or adults that don’t have a lot of words can still express themselves. You do need to have some training to start doing this with your child. Having photos of things stuck up on your fridge isn’t really going to do it. Kids need to learn how to use it.

Learning to use Visuals (different from PECS). – PECS are pictures that the person uses to express themselves, visuals help us communicate to them. Visuals can let kids know that we are going to granny’s house now, by showing a picture of granny, or that now its time to go home, by showing a picture of home. They are amazingly useful in so many ways, helping to bring some order to chaos for kids with language difficulties and helping the world seem less terrifying for kids with anxiety. Yes you can do these more easily yourself, simply by showing the photo when it’s time to go, or having two or three things stuck up on the fridge as your to do list for today. Lots of stuff available out there on the web for visuals. Just remember they are different ot PECS. If your child starts taking a picture off the fridge and giving it to you to ask for something, its time to go start learning how to use PECS properly. It is worth finding this out, because if you don’t your visuals will get all mixed up with PECS, and your child won’t understand which bits he has control over and which bits he doesn’t. So when you show him the bedtime picture, he’ll just go take the TV picture down and give it to you, then what? Chaos! End of the world! But mostly confusing for him. So learn how to keep them seperate.

Interactive play. – all communication is based on play, the interaction and back and forth of mother and baby I will have a few posts about this, including rough and tumble, songs, messy play, sensory boxes etc.

OWL, -observe, wait, listen. Slow down, watch your child, wait and see how they are trying to communicate, listen to them with more then your ears, because communication isn’t just with words. This is the foundation of Hanon ‘more then words’ and so useful.

For me these are the really important ones. That being said, it’s not an essential to be able to use PECS before age 6 yrs old. Not every family has to have a visual support system up and running before kids start school. If you are worried about supporting your young child and you are waiting for Speech and Language intervention, try and find a Hanon course near you, or read the book . For me that is the bible for encouraging early speech, maybe because it’s based on play, song and routine.

What about an older autistic child? Maybe your child is full of chat and has never needed a speech therapist, but struggles in the yard and has lots of anxiety, finds it hard to make friends. Then a speech therapist can help you figure out a couple of things . How is their receptive language? Just because someone is full of chat doesn’t mean they understand everything everyone has said to them. Maybe they don’t understand the rules being explained, so they play wrong? Maybe they aren’t hearing their name being called or are overwhelmed by everyone talking at once so they can’t hear anyone. If a speech therapist has assessed your child as struggling with receptive language and how they are struggling with it, the school can help. Your child’s SNA can explain the rules of the games separately, using pictures. The other kids can be told to slow down, to take turns talking, to make the rules simpler. It may not be the speech therapist doing these things, but knowing that your child has difficulty with receptive language helps those around him make it easier and clearer for him. We don’t expect him to work harder, we do that. But first we need to get an idea of their needs and a speech therapist can do that. They don’t need to keep working with them though, unless there is something specific to work on.

You can ask a speech therapist what their goals are for your child. Make sure you understand what the therapist is doing with your child, so you can do the same at home and so you can have an idea of when that goal is reached, as well as making sure you agree with that goal. You should always have a program to work with at home, even if it is just the direction to slow down, use less words.

Should you always agree with your therapist? Approaches to working with autistic community in particular has changed radically over the last twenty years, especially as we learn to listen to them rather than the experts. Remember that your speech therapists does not know your child like you do. Let me give you a little example.

Joseph has a stutter. He’s eight years old and embarrassed about it, so doesn’t talk much in school. He plays GAA and has a group of friends who he’s comfortable with and doesn’t mind talking in front of. His teacher is a bit worried because he won’t talk in the classroom. He is referred to speech therapy and assessed. His parents choose to take him to a private speech therapist who agrees to see him weekly. He is given exercises to do during the week, practising saying different words and sounds and breathing exercise. He hates them and it always ends up in a fight to get them done. He complains and shouts about going to the speech therapist, but is ok when he’s there. Joseph’s Mam can see that when he is doing his exercises with the therapist, he is improving, but his behavior in general is hard going. He is fighting with his siblings more, refusing to do his homework and is talking about giving up GAA. The speech therapist suggests he goes to a play therapist for support.

The speech therapist doesn’t get to see Joseph at home. She doesn’t see this change in his behaviour, doesn’t even recognise it as a change in behaviour because she didn’t know him before. Of course she won’t connect it with what she is doing, because with her he is happy. Mam can see it, but as parents we are told to listen to the experts, that this work is really important. And it is, but it is for your child and it has to benefit him in all ways. When Josephs Mam does says it to the therapist, the therapists racks her brains and thinks how she can help, but this is an emotional issue, not about speech, so she send him on to someone else, which is the correct and professional thing to do.

So Joseph ends up with me. Ideally after a chat with Mam, before I ever meet Joseph, we will wonder if maybe all the focus on his speech was hard for him, making him feel like there was something wrong with him. Ideally Mam might decide to lay off the speech therapy for awhile, make a deal with Joseph that if he keeps going to GAA (which supports his social, physical and emotional needs) that he no longer has to go to speech therapy. Maybe we look at other ways he can do the same exercises without even realising it, like swimming lessons to learn to control his breathing, or singing while learning the guitar, or drama classes, or creating a you tube channel. Ideally Joseph never comes near me and he and his Mam decide together when to go back to speech therapy, do a few sessions, and when he’s had enough. Giving him more control and also helping Mum feel like its okay to take a break from it.

What I am saying, I guess, is that it’s ok to say slow down. It’s ok to ask a therapist if there are alternatives that you can do at home or through ordinary activities like swimming etc. Its ok to ask a therapist to take a break. Its ok to listen to your kids and if they hate something to find another way of doing it.

Speech and Language and Social skills

So this is one of those places where I stick my play therapy hat on. For autistic children social groups can be hard. There can be lots of reasons for this, sensory, emotional processing, language processing overload, just generally being an introvert and not liking large groups, not liking some kids in the group, social anxiety. Whatever the reason when someone is under stress and they go in to survival, flight or fight mode, the part of their brain that deals with social interaction and communication shuts down (check out Dr. Siegals Hand Model of the brain (https://www.youtube.com/watch?v=gm9CIJ74Oxw). So by putting an autistic child into a stressful situation of a social group we are straight away shutting down their skills. When a speech therapist works on ‘social skills’ with autistic kids they are working on taking turns, practising scripts, choosing topics, trying to build theory of mind. These are all great things. As a play therapist I say they should all be done only when a child isn’t under stress, which means they should be playing, because when you play your full brain is switched on. Play is defined not by the presence of a game on the table, but by being self directed. You are only really playing if you get to choose to do it, If you don’t have a choice then it’s an activity which means there is a right way and a wrong way, which means you are stressed, which means your brain is slowly going in to fight or flight.

There are loads of opportunities in life to practise waiting and taking turns. Loads of times when it’s done in a structured safe way. The whole structure of school is around waiting and taking turns! There isn’t as many chances for an autistic child to get to play in group and feel safe and learn that they can play with other kids without it all going wrong. So for me speech and language social skills groups are a bit like Joseph and his stammer. Yes, there are wonderful skills kids can learn in them, but there are lots of other more natural places they can learn those skills. Parents can help them learn them if they can understand what those skills are, help structure the environment so their kids don’t get stressed and shut down or overload, and if they have the confidence to do this, or the energy! So there will be another post on how to support social play at home – watch out for that.

So there is my brain splurge on Speech and Language therapy. I’ll add more if it comes to me or if anyone asks any questions.