Autism Spectrum Disorder (ASD) is a complex neurological condition that affects an individual’s communication, social interaction, and behavior. While each child with autism is unique, many face challenges in developing and using language effectively for reasons like developmental delays, speech articulation or pronunciation issues, sensory sensitivities, and more. Speech therapy is extremely helpful for children with autism, as it can support them during a critical time in language development. By providing strategies to manage the challenges faced in language acquisition and utilization, speech therapists can help children with autism manage frustration, communicate more effectively, improve academic success, and build self-confidence.
But because of the nature of speech therapy and the frustration inherent in miscommunication, it’s important to keep key goals in mind when providing your services to children with autism. These pillars will help you remember the big picture even as you encounter various challenges during each session.
Please note that these steps do not have to be followed in exact order. Depending on the child’s age and development, they may already possess the skills outlined below. You should assess the child’s ability to communicate before deciding how much time you should spend on each step. A data collection tool like Catalyst can help you keep track of skill mastery and graph progress to individualize behavioral plans.
1. Spontaneous and Functional Communication
What does it mean to communicate functionally and spontaneously? It means that the child should be able to communicate effectively and without being prompted. For example, if a child is hungry, the goal would be for the child to express that they are hungry in a manner that is understood by parents or caregivers without being asked. That might seem simple, but this can be a huge source of frustration for a child.
For example, if a child cries when they’re thirsty, the parent or caretakers might have to ask multiple questions while trying to ascertain why the child is upset, which could make the child more upset because they’re not being understood.
Spontaneous communication is also important because some children might not tell an adult they’re distressed or hurt unless prompted to do so. If an adult thinks a child is simply shy, they may not realize the child needs assistance.
Spontaneous and functional communication does not have to be verbal. Children with autism may be non-verbal for a variety of reasons, including factors outside of their autism diagnosis. A child may start as non-verbal and gradually improve.
Assistance for Functional Communication
Some children may be verbal but need additional assistance, like Augmentative-Alternative Communication (AAC). Sign language has proven to be extremely popular and effective. Some children respond so well that they can become much more communicative using sign language instead of verbal communication, even if they are capable of speaking.
Another AAC method is using pictures. How you use it depends on the child, with some only needing a simple communication board (“Hello”, “Hungry”, “Help” “Thank You” etc.) while others may need a more complex Picture Exchange Communication System (PECS). These methods are not meant to replace communication (including non-verbal communication methods) but rather to act as a bridge to fill the gaps between non-communication and functional, spontaneous communication. So, while you want the child to be able to express that they are sleepy, until they can do so, you can use pictures to help them communicate without frustration.
Some speech therapists use devices that allow children to push a button or switch and have a voice speak a message. Nowadays, a child may have an iPad or tablet with an AAC app or even a tablet fully dedicated to AAC. The type of device depends on the child’s needs. Contrary to popular belief, these tools do not hinder a child’s ability to learn how to speak. Like the picture method, this is meant to fill the communication gap. It does not replace functional, spontaneous communication, but it can help children communicate until they have the ability to do so. The type of device and its capabilities depend on the child’s needs.
Please note that if you choose to use an AAC device, there is a slight learning curve. As a speech therapist, you should be intimately familiar with their device and how it works, as you may have to provide guidance to the child and the parents or caretaker, not to mention the fact that the child may use it to communicate with you during sessions.
How to Improve Spontaneous Communication
Children with autism often have difficulty speaking unprompted (without being asked to), even if they need something or feel upset. This can be a source of discomfort for the child and impact their social life. In the beginning stages, the therapist (and parents or caregivers) can prompt the child, sometimes with questions (“Are you hungry?” “Are you cold?”) then move on to more general prompts (“Use your words”, “Tell me why you’re upset”). Once again, please note that this doesn’t mean communication should be verbal; a child may use sign language or a device to communicate spontaneously.
Once the child is starting to respond to the prompt effectively, it’s time to start “fading” their use (i.e. use prompts less often). For example, instead of telling a child “use your words”, you may point to a picture indicating the child should tell you. You could also use a hand signal. Whatever means of prompt fading you choose, the goal is to have the child express themselves without one.
Most of the time, prompting a child to communicate spontaneously starts with basic requests (“I’m thirsty” or “I’m tired” for example ) since they’re a great source of frustration and can be effective motivators. From there, the child can be taught to greet spontaneously (“Hello” or “goodbye”), ask questions, or make comments (for example, if you say “it’s nice outside today”, the goal would be for the child to respond or comment on the statement you made).
If the child is older or is more comfortable communicating effectively, you could also show interest in something they like, such as books, shows, or hobbies, as the child may feel more comfortable discussing something they’re interested in instead of learning small talk.
2. Regular Social Communication
Children with autism often struggle with understanding social and behavioral clues, which can prevent them from learning socially acceptable behavior. This can make school and other learning activities more challenging, particularly because children with autism tend to have problems transferring skills from one setting to the next. Basically, while the child may learn a behavior in therapy, they may need help using the behavior at home, school, or in other settings.
Part of what makes regular social communication challenging is that every child and their situation is unique. The type of technique used to help a child regularly communicate socially depends on their needs, but there is one thing you can do regardless of circumstance: continue throughout the day. That means giving parents or caregivers instructions on improving social communication wherever they bring the child and possibly having on-site therapy sessions or “field trips” where the therapist supervises the behavior in a common setting. An EHR with a strong Home Exercise Program, like Fusion, can be invaluable when working on social communication.
Teaching Socially Acceptable Behaviors
Of course, to behave properly, a child must know which behaviors are appropriate or not. Don’t forget that because children with autism lack the understanding of social cues, especially subtle ones, they should not be expected to naturally understand what is acceptable and what isn’t. It might be helpful to explain to parents, caregivers, or siblings that it’s a little like going to a foreign country: you may not realize some words or gestures are inappropriate because you’re unfamiliar with their social behaviors. A child with autism isn’t being malicious or rebellious, they simply do not realize their behavior might be disturbing others, for example.
The tools to teach a child with autism about socially acceptable behaviors differ depending on their social skills. Still, some ways have been proven helpful for most children—for example, visual reminders in your room or in the child’s home. A picture might show something like “inside voice” to remind them not to yell inside. A pool might have a sign showing “no diving” or “no running”. The reminders should be tailored to the child. If a child has no problem speaking quietly indoors, they probably don’t need the reminder. But they may need a visual cue letting them know they cannot get up from their school desk during an assignment or that they should ask a teacher if they need to go to the bathroom.
Social stories are frequently used as well (and not just for children with autism). The book (could be a simple picture book for young children or a more advanced book for older children) includes various situations and explains how the child should behave in each situation. Using the behavior in the book, the child can learn to mimic the behavior in similar situations. Don’t forget that some children with autism struggle with skill transfer, so behavior learned in class might need to be learned again during recess, for example.
You may also show videos of the behavior you want the child to adopt. Like with the book, the child watches the video to learn how to behave in specific situations. Depending on the child’s learning style, a video could be effective in helping them copy the right behavior. Just make sure the video is distraction free (no ads, no switching playlists or games waiting to be played).
Lastly, a great way to help children learn socially acceptable behavior is role-playing. You can set up controlled situations where the child can practice social skills they can then use in real life. This can be helpful to share with parents or caregivers as well in order to keep practicing various skills in various settings.
3. Peer Communication
Challenges in functional, spontaneous communication and learning socially acceptable behaviors can make socializing with peers difficult for children with autism. The type of skills you should teach will depend on the child’s age and developmental level. Helping children with autism learn these skills can help them make friends and reduce their feelings of isolation or loneliness. It also means that they can join social activities they’re interested in, like sports or clubs.
A common myth about people with autism is that most of them are introverted, but there is no correlation between the two. A child may struggle with spontaneous communication or social skills while being extraverted. Developing peer communication skills is important even if a child is shy or introverted.
We’ll focus on the basics for young children who have just begun to learn about peer interaction. Think of skills taught to neurotypical children in kindergarten or daycare: playing nice with others and being aware of other children, for example. These skills should help them share with others, navigate disagreements (“Sally wants to play with your toy” or “Salim has snacks you like”), play, and tune in to social cues.
One key skill that children with autism may struggle with is responding to their name. Teaching them early is important, as it can help teachers, parents, and caregivers care for the child. It’s also helpful for social situations since other children may be too young to understand that a child with autism isn’t ignoring them on purpose.
Once a child can play well and respond to cues, there are two next steps. The first one is to build their conversational skills. Children with autism can struggle during ordinary interactions with peers or adults, so you can help them by teaching them conversational skills like staying on topic, waiting for their turn to speak, or watching body language.
Another helpful skill? Teaching children with autism to view things from another perspective. Basically, help a child put themselves in someone else’s shoes. This can be basic (“I know you don’t like it when babies cry but imagine if you couldn’t speak and you were very hungry”) or more advanced (like having them explain why a character in a story behaved a certain way, or discuss the impact of discrimination).
4. Generalized Communication
Earlier in this post, we mentioned that children with autism could struggle with transferring skills. This applies to communication skills. So, you might have taught a child to communicate spontaneously and effectively at therapy or at home, but they may not know how to apply it in school. This part can be a huge challenge for your clients because they cannot rely on you. The child must be able to communicate without a speech therapist. It can be frustrating because parents or caregivers can feel that all the progress accomplished during sessions suddenly vanished.
To minimize the issues at that stage, you should include sessions outside of the therapy room. Sessions should be conducted at the child’s home and, if possible, in a few settings where the child must frequently put these skills into practice (like school).
The best way to mitigate issues at this stage is for various adults (including, but not limited to, parents or caregivers) to participate in teaching these various skills. If a child stays with grandparents or a babysitter twice a week, they should be taught social and communication skills with these people and in these settings. Telehealth can be helpful in these times since clients can have sessions outside of your office. Another great way to help without direct involvement? The client portal. Clients can message you about situations or check notes to keep their child on the right track. Fusion’s portal even allows users to launch telehealth sessions (in addition to other helpful tools, like paying bills or filling forms out).
5. Remaining Communication Issues
Last but not least, once the child has mastered the skills outlined earlier, you can now check for any remaining speech or language deficit. These are smaller issues that can impact communication, but they are not the primary cause. Depending on the child’s age or development, it could be things like grammatical mistakes, sounds or articulation problems. Some children may require additional assistance with questions, from using the proper tone to indicate they’re asking, not telling them, or answering questions properly.
One thing that often trips up children with autism is figurative language. Figurative, or non-literal language, is especially challenging because it’s abstract and often cultural. Ever thought modern slang is confusing? This can be exacerbated because children are always jumping to new topics and trends that make no sense outside of very specific contextual clues (try figuring out what “sussy baka” means without checking your phone…) or idioms originating from old technology or social cues (“the bee’s knees” does not refer to an actual bee’s joints).
You can teach a child about comparisons and abstract thinking for things like metaphors or similes. For example, have them read a story and guess the meaning of a comparison. They can watch a video with a person being sarcastic or hyperbolic and learn which visual cues or body language can help them learn if someone is being facetious or exaggerating.
Idioms can be a little more complicated. It can be helpful to have them think about it. For example, if you say “That was a piece of cake,” you can then help the child think that eating cake is easy, meaning a task took no effort. Encourage the child to ask about idioms when they hear them and to write them down in a journal. If an idiom comes up frequently, you might want to make sure the child can explain its meaning.
Speech therapy for children with autism comes with its own set of unique challenges. You need knowledge, empathy, and persistence to help your clients pass hurdles. But it’s all worth it to see them thrive. Therapy Brands understands the power of speech therapy for children with autism, and we know that every minute spent counts. We offer Fusion, an EMR dedicated to physical, occupational, and speech therapists, with all the tools you need to run your practice more effectively. And for data collection, we created Catalyst, a mobile-friendly software that allows you to automate data collection, analysis, and graphing. Using them in tandem can help you get more time back to spend with the little clients who need you.