Speech Therapy and Its importance in treating ASD

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By Neha Kekade, Speech Therapist, Child Guidance Centre and Department of Behavioral Sciences and Mental Health, Sahyadri Hospitals Pune

When we talk of speech therapy it actually has a hidden language component in it. Speech mainly suggests the pronunciation abilities (phonology) whereas language suggests the vocabulary content (semantics) and grammaticality (syntax) of what is spoken. Two areas which are taken for granted by every human being are the effective use of language (pragmatics) and the intonation and rhythm of speech (prosody).

As the name suggests, Autism Spectrum Disorders have a varied clinical presentation and so is the nature of communication problems in children with ASD. These communicative problems have a wide range, which extends from non-verbal to verbal communication. Some children with ASD may be unable to speak but they may hum or occasionally utter simple sounds, whereas others may have a huge vocabulary and are able to talk about topics of interest in great depth. Those who are verbal may largely have echolalia (verbatim repetition of what is said by those around them), either immediate or delayed. For example, immediate echolalia is when the child repeats the question, "Do you want something to eat?" instead of replying with a "yes" or "no." and delayed echolalia is when the child may say, "Do you want something to eat?" whenever he or she is asking for food. In echolalia, the child is just not repeating the words but also the intonation and the rhythm with which the sentence was said. Many a times it is the intonation and rhythm of speech that interest the child to repeat the words or sentences. Even correct use of pronouns is a problem. For example, when asked “Are you playing a ball?” the child may say “you are playing a ball” instead of an affirmative sentence “Yes, I am playing with a ball.” Their ability to comprehend abstraction is also compromised and hence understands literal meaning of the sentence. For some children completing a conversation is difficult and hence will jump from one topic to another whereas others may have difficulty shifting their topic and hence will talk on the same topic despite their listener getting bored or initiating a new topic of conversation. Thus their major difficulty is the effective use of language. It is seen that many children with ASD develop language but not at its fullest level. These children are termed not to have delayed language but deviant language. This is because there are loop holes in their language output. They may produce a certain complex form of language but not a simple one. Despite these variations, the majority of these children have little or no problem with pronunciation.

Instead of terming this as speech and language disorder, it is mainly a communication disorder which is evident in children with ASD.

It is necessary that a child with ASD should be able to communicate meaningfully and contextually. Considering communication as a goal speech and language pathologists work with children with ASD. Depending on the abilities and needs of the child a tailor-made program is made. The program can range from emphasis on verbal communication to non-verbal communication. The non-verbal mode of communication is used to augment as well as alternate the verbal mode of communication.