“After we got the diagnosis, my child was recommended developing classes with a speech therapist. I know that a specialist is working on pronunciation and correct speech. However, at the age of 4, the son has not yet said a word. Why should we waste time on a teacher who has nothing to work on? Maybe we should wait until the speech appears?”
Such fears often torment the parents of “special” children. But doctors and therapists argue that these fears are groundless and wrong. The fact is that autism spectrum disorders are conditions affecting a complex of pathologies of a child’s development – from cognitive functions of the brain to physical developmental delays. Even though autism manifests itself in different ways and two identical children with ASD do not exist in nature, nevertheless, the therapy should cover all areas of development of each child – just with a greater emphasis on those areas where the largest defect is manifested.
For example, a non-speaking child should work with both a psychologist and a physiotherapist, and not only with a speech therapist, because the reason for the lack of speech in such children is ‘eliminated’ due to the development of both the psyche and physics. With the right integrated approach to the problem of absence or speech defects, different methodologies will accelerate the development of areas that ‘slowed down’ the appearance of speech.
The main problem of autistic children is often not just the lack of speech with the complete safety of the vocal apparatus, but the lack of the need to use it to communicate with others, since there is simply no last need due to the diagnosis. Therefore, the main task of a speech therapist with autistic children is to develop this desire and teach the child to use this natural communication tool correctly. How and by what means does this happen? And why is language development so important for autistic children?
Features of the speech of an autistic child and the tasks of speech therapy
Autism is a lifelong disorder. It cannot be cured, forgotten, or ignored, especially when the child enters a period of active socialization. Unfortunately, autistic children demonstrate neither desire nor social communication skills at the level of neurotypical children. And this is a double-edged sword. On the one hand, a kid with ASD does not need to communicate with anyone (even with highly functional autism children avoid people). On the other hand, the lack of constant communication training (understanding the speech of others and using it to express own thoughts and needs) leads to delays in the development of the child. A kid who is self-centered and does not communicate with others suffers from physical and mental retardation. If at the age of 5 the kids on the playground cheerfully throw the ball to each other, then an autistic child may not even catch it and do not understand the rules of the game.
Each child with ASD is unique, therefore speech therapy classes are different and depend on the autism group:
- The representatives of the first group include non-speaking children – kids do not use a speech at all or pronounce individual words or sounds in a state of strong emotional affect. This suggests that a child understands speech at least partially.
- Children of the second category of autism ‘communicate’ with echolalia, phrases from cartoons or speech of adults without realizing the meaning. In familiar situations, such kids use the simplest phrases like ‘want to eat’, in which the verb is put in the infinitive, and they address themselves in the 3rd person. But in most cases, they express themselves by screaming.
- Children of the third group calmly quote book chapters or recite a cartoon from memory without a single mistake, but they are completely incapable of dialogue. Communication with such children is like listening to a lecture at the university when the interlocutor acts as a listener.
- In children of the 4th group, speech is developed, but not enough. They use phrases and sentences, understand the addressed speech, but they are not clear, sometimes they use echolalia, cannot retell the story.
The above confirms the fact of the colossal difference in the speech development of children with ASD, and also demonstrates the main thing: any methodology for the development of speech in autistic children is aimed not at setting the correct speech (in the absence of such this task is generally impossible), but at the development of speech mechanisms inherent in nature, with that, step by step to help a child use speech as a communication tool. Therefore, the work of a speech therapist with 5-6-year-old children often looks like a speech game with neurotypical 2-year-olds, because the child needs to go through all the normal stages of speech development.
Thus, the main tasks of speech therapy with autistic children are:
- determination of speech dysfunctions caused by ASD and related diseases;
- establishing contact is a guarantee of inclusion and perception of the therapy by the child;
- activation of speech activity in an autistic child at all levels: in everyday life, playing, learning.
Speech therapy: diagnostics, stages, results
Before starting speech therapy intervention, it is necessary to diagnose speech disorders to determine their causes and, accordingly, the suitable course. For the effectiveness of the event, the speech therapist follows the principles that allow analyzing all aspects of the disorder:
- an integrated approach – determination of all factors affecting the speech development of autistic children, including medical ones;
- analysis of the mental development of a child with ASD according to age norms, which will increase the effectiveness of speech therapy intervention and help to separate the consequences of the underlying disease from the related ones, including the result of the child’s social conditions (pedagogical neglect, for example);
- determination of the defect’s or delay’s structure, which will help to understand how the child has adapted ‘to life’ without speech and in the future to work with the development of other mechanisms.
A speech therapist often becomes the connecting link that ‘collects’ all the puzzles into a single picture of the child’s psychophysiological development, determines the place ‘where it broke’, and works to eliminate the breakdown. However, parents should remember that a speech therapist is not omnipotent and cannot influence some of the problems of an autistic child. So, in the presence of physical pathologies of the brain (trauma, for example) or underdevelopment of its parts, even a ‘golden’ speech therapist can do little without medical or psychological intervention.
Therefore, an integrated approach is important, in which several teachers work with the child – a speech therapist, a psychologist, etc. – helping each other. Also, without training and consolidating the material at home with parents in everyday situations (at the table, on the playground, or visiting grandmother), any intervention will be ineffective or the results will be short-term.
Speech therapy diagnostics is conventionally divided into several parts, each of which is related to the other:
- Study of the child’s understanding of speech, auditory attention, and phonemic perception. At this stage, the speech therapist determines the amount of the child’s vocabulary, the perception of the emotional and semantic meanings of speech, as well as the child’s readiness to develop the language system.
- Analysis of non-speech functions. The speech therapist examines the child’s sensorimotor perception, the level of concentration on the object, and purposeful activity.
- Observing the non-verbal components of speech. The therapist looks at facial expressions and gestures, determines the level of potential speech development and spontaneity in acquiring communication skills.
These diagnostic components show the existing level of the child’s development and indicate the predictions of speech therapy in the future, after which work with a ‘special’ child is built in the following directions:
- the development of a child’s understanding of speech through emotional-semantic commentary – it is a significant word or phrase to attract attention to include the child in work and gradually ‘build up’ the speech muscles;
- narrative story – teaching a child to ‘puzzle up’ the objects around in a coherent picture, for example, through plot drawings;
- disinhibition of external speech through imitation of an adult, provoking involuntary verbal reactions and repeating what was said after the child, transforming it into real words and expressions;
- teaching meaningful reading and writing.
The ‘Child with Future” kindergarten for children with special needs offers 10 years of experience in the successful therapy of speech defects. However, for those who cannot attend the kindergarten, there is a distance program with high efficiency.
As a rule, at the first stages, the child is dealt with individually, then the skills are honed in groups. It is also important to rely on the child’s existing mechanisms of perception and elementary communication – if the child perceives pictures or signs, then this particular tool should be used in the work at the first stage. And there are several stages of developmental work: preparatory, initial, training.
- Preparatory stage.
At this stage, the speech therapist develops the prerequisites for communication through strengthening the emotional and search response to everyday stimulation: the voice of parents, toys, household items, animals. The child is taught to distinguish a lexical unit among the flow of words and expressions, to look for it in space, to listen attentively to the speech of an adult, the rudiments of voluntary attention appear, although speech (if any) is still poor in verbs. It is important to support successes with emotional and semantic commentary. To do this, you should:
- make eye contact;
- choose the appropriate stimulation option taking into account the interests of the child;
- set the child up for an emotional response;
- work to increase engagement and general activity;
- to increase the level of concentration, distribution of attention between different objects and types of activity.
At the preparatory stage, it is important to select those communication options that are understandable and accessible to the child, so that the interaction between the kid and the speech therapist brings results, and not wasted time. At the same time, it is important to use different types of stimulation – not only pronunciation but also sensing (modeling, for example) and other activities (drawing, playing, etc.)
The main task of the stage is to carefully include the child in the work using available means, causing and not losing interest and desire to study. The difficulty of this stage lies in the fact that children with ASD get very tired of communicating with people, so a child needs breaks and time to recuperate. This affects the duration of the stage, which can last either a month or half a year.
- First stage.
At this stage, the speech therapist helps to develop language skills and sensorimotor standards, which allow you to communicate with others in the future. The therapist teaches a child with ASD to consciously transfer sound to real objects (‘the bear is asleep,’ ‘the ball is rolling,’ ‘look at the red ball,’ etc.) Kids learn to highlight the names of objects and actions from the flow of speech, react and complete tasks with a subject, focus on the task, pronounce with the correct timbre of voice and build grammatically correct and conscious phrases, memorize stories and describe plots, express feelings and attitude to what is happening.
As a result, field behavior is observed less and less; more often children act purposefully and meaningfully. Imitation of speech sounds increases, the ear more and more separates them from non-speech sounds. Also, at the initial stage, children can use adequate gestures for communication (nod or shake their head, for example), meaningful raising and lowering of their voice, pronunciation of words as they exhale. An active vocabulary appears from communicatively meaningful words (‘yes’, ‘I want’, ‘I will’, etc.), although it is still poor and the child often makes grammatical mistakes.
- Training stage.
At this stage, the speech therapist consolidates and expands the skills acquired in the previous ones. Passive vocabulary is transformed into active, speech is enriched with new phrases and meaningful expressions, the child actively uses facial expressions and gestures, initiates communication with requests and expression of needs. The use of, if not all, but basic speech structures and skills is brought to automatism and the child uses speech not only in the speech therapist’s class but in life. Children with ASD demonstrate the skills of analysis and synthesis, figurative (mental) change of real objects, vocabulary is actively replenished, meaningfulness increases, fine motor skills improve, and the range of emotional color of speech expands. Now the number of mistakes in gender, number and cases is much lower, the child builds two-syllable sentences, listens to the end and understands the adult.
The ‘Child with Future’ kindergarten for children with special offers kids a full cycle of speech therapy with professionals. However, the ‘icing on the cake’ is that the kindergarten has been dealing with children from the age of 1, which contributes to the serious prevention of speech delays in children. For older kids, we offer complex therapy for speech defects, because specialists of different profiles work with the child for 10 hours a day.