Speech and language therapy

The NAS Autism Helpline often receives calls from parents who are concerned about the level of their child's speech and language. This fact sheet is a guide to speech, language and communication and the services and resources that parents/carers can access for their children with regards to their speech and language. Details of how to access help from a speech and language therapist (SALT) are provided at the end of this information sheet.

Development of speech, language and communication

Speech is a large part of a language that people use on a daily basis. However, language is more than speech alone. It encompasses elements of communication such as body language, gesture and eye-contact. As a child develops, so does their use of language to communicate. The speech and language development of a child would normally be as follows:

A child's acquisition of language can be broken down into different segments:

• Phonology - a person's use of speech sounds, for example, /t/ in the sound /tea/.
• Syntax - the rules of grammar, for example knowing which order to place the subject, object and verb in a sentence, "[Subject] Daddy [verb] jumped over the [object] chair".
• Semantics - a person's ability to understand and create the meaning of language.
• Pragmatics - the ability to use language for the purpose of communication.

Breaking down language into these different segments allows professionals to clarify to what extent and which aspects of, the language and communication of a child with an autism spectrum disorder (ASD) is impaired.

Reasons for a delay in speech, language and communication in a child with an ASD

Children with an ASD often fail to communicate using speech or any other type of language, for example eye-contact, hand gestures, body language. If a child does not wish to communicate intentionally (a trait of ASDs) they will not explore their ability to vocalise, learn new sounds or listen to the language spoken around them. This will ultimately result in a delay in their language acquisition. Without this means of communication, a child will find it difficult to express themselves. This often leads to frustration for the child.

A child with an ASD may not see any reason to communicate with other people. Without a reason there is no point in communicating or no need to communicate.

A child with an ASD may also remove themselves from situations that require communication, limiting their opportunities to communicate. Without opportunities there cannot be a development in communication.  

The following diagram explains the complexity of how people use communication and highlights the limitations of a child who does not adhere to the model.

Means, reasons and opportunities model

Common speech, language and communication problems in children with an ASD

1. Social communication
   A child with an ASD is often unable to use or understand social communication. The term social communication encompasses both verbal and non-verbal communication. For example, gestures, facial expressions, tone of voice, rate and fluency of speech.
   
2. Echolalia ("parroting")
   This is when a child repeats what they have heard rather than giving an appropriate response to what has been said to them. For example:

   Mother: "Hello Tommy"
   Tommy: "Hello Tommy"

   When a child is using echolalia they are copying speech alone and showing no understanding of what has been said to them. Therefore it is most likely that the echolalia is not being used to show communicative intent.

3. Idiosyncratic language
   This is when a child associates a particular word or phrase to an event or object in such a way that it is inexplicable to the listener. Uta Frith, 1989, uses the following anecdote to explain this phenomenon:

   "Paul was two years old when his mother used to recite to him the nursery rhyme Peter, Peter, Pumpkin Eater. One day, when she was doing this she dropped a saucepan. Paul, from that day on chanted Peter Eater whenever he saw anything resembling a saucepan."

4. Literal language
   A child with an ASD will often find it difficult to understand sarcasm or metaphorical phrases. For example, if a child with an ASD is told to "pull your socks up" or that its "raining cats and dogs" it is likely that they will take the phrase very literally.

The role of the speech and language therapist when working with people with an ASD

Speech and language therapists work to assess, diagnose and develop a programme of care to maximize the communication potential of the people under their care. When working with people who have an ASD, a speech and language therapist will adapt the therapy given according to the presenting problem. It is likely that the SALT will work on one of the following when giving therapy to a person with an ASD:

• listening and attention skills
• play skills
• social skills
• social understanding
• understanding of language
• expressive language.

The above list may seem far removed from actually 'teaching a child to speak'. However, what must be remembered is that children develop speech, and learn to use speech appropriately through skills such as play and listening/paying attention to other peoples use of communication.

It is also important to remember that a child who does not communicate is unlikely to speak. Therefore, any therapy offered by a SALT is initially likely to focus on getting the child to communicate using something such as a signing system, symbols system or picture system, rather than focusing on speech alone.

How to contact a speech and language therapist

There is no procedure for referral to a speech and language therapist (SALT). For an NHS appointment you can either contact the speech and language therapist direct yourself or your GP will be able to refer you. If you would like to contact a SALT in your area without going through your GP, contact The Royal College of Speech and Language Therapy and they will give you the contact details of the appropriate person in your area.
 
For a private speech and language therapy appointment you can contact Association of Speech and Language Therapists in Independent Practice, who will be able to supply you with the SALTs who are working in your area.

Access to a SALT can also be gained through a Statement of Special Educational Needs. If the local education authority recognises that the child needs the input of an SALT as an educational need, this should be written in part 3 of the child's statement. For further information on this please contact the Autism Helpline.

Resources:

Speech Therapy Activities
www.speechtx.com/index.htm

The Makaton Vocabulary Development Project
01276 61390
www.makaton.org
mvdp@makaton.org-trainingopps

Picture Communications Symbol Clipart
www.setbc.org/res/equip/boardmaker/default.html

Picture Exchange Communication System
01273 609555
www.pecs.org.uk/asp/home.asp

Contacts:

The Royal College of Speech and Language Therapists
2-3 White Hart Yard
London
SE1 1NX
www.rcslt.org.uk
Tel: 020 7378 1200

The Association of Speech and Language Therapists in Independent Practice
WWS
Coleheath Bottom
Speen
Princes Risborough
Buckinghmashire
HP27 0SZ
www.helpwithtalking.com
Tel: 01494 488306

ICAN - UK charity that helps children with speech and language difficulties throughout the UK
Central Offices
4 Dyers Buildings
Holborn
EC1N 2QP
www.ican.org.uk
Tel: 0845 225 4071

Afasic - UK charity representing children and adults with communication impairments
2nd Floor
50-52 Great Sutton Street
London
EC1V 0DJ
www.afasic.org.uk
Tel: 0845 3 55 55 77

www.talkingpoint.org.uk - the first stop for information about speech and language development in children.

Relevant information sheets available through the Autism Helpline

• Communication and social interaction
• Social skills in young children

If you require further information please contact the NAS Autism Helpline.

Tel: 0845 070 4004 (open 10am-4pm, Monday-Friday)
Email: autismhelpline@nas.org.uk

Last updated: August 2006
© The National Autistic Society 2006