Speech pathologists

Speech pathologists have been trained to assess and treat people of all ages who have problems with communication. These people include children who have developmental delays and disorders. Speech pathologists play an important role in the assessment, diagnosis, and treatment of individuals with ASD. The communication skills of a child with ASD can vary. For example, one child may have no speech and may not appear to respond when spoken to, whereas another child may have good language skills but have difficulty with conversations, making friends, knowing how to play with others, and explaining feelings.

When should a child see a speech pathologist?
It is important to seek professional help if a parent or carer is worried because a child:
• appears to not hear others or is unresponsive to communication,
• has difficulty understanding language,
• has not started to talk at the expected age,
• is not talking as much or as clearly as other children of the same age,
• has limited play skills or has trouble
• playing with other children, or
• is having problems at school with learning and socialising.

Speech pathologists are specialists who are able to identify whether a child’s language and communication development is delayed or different from that of other children and, in particular, whether a child is showing signs of ASD.

What roles do parents, family, and carers play in the work of a speech pathologist?
The parents and family play an important role in a child’s assessment, diagnosis, and treatment. A speech pathologist works in partnership with parents or carers to determine a child’s needs and implement an intervention program to develop language and communication skills in everyday situations.

What would an assessment involve?
Assessment of the language and communication skills of a child suspected of having ASD involves a number of steps. The speech pathologist interviews parents or carers to find out how their child interacts with them, with family members, and with other people in different places such as the home, preschool, or school. Adequate hearing is crucial to the development of speech and language, so if a child’s hearing has not been formally assessed by an audiologist, a doctor or speech pathologist may recommend that this be undertaken.

Assessment by a speech pathologist varies depending on a child’s age and skills. If a child is very young, the speech pathologist assesses early communication skills through developmental assessments and observation of play and interaction. The speech pathologist also observes a child’s use of eye contact when playing or interacting with others. In addition, assessment includes whether a child responds to his or her name, seeks comfort when upset, or shows enjoyment when playing with others. Parents or
carers are also asked about a child’s use of gestures to communicate. These gestures include raising arms to be picked up and using pointing to tell others what they want or to identify things of interest.

Many children with ASD have difficulty understanding what other people say and mean, so the speech pathologist will assess a child’s comprehension of spoken language. It will also be important to know if a child uses a range of sounds, words, and word combinations in a meaningful way, or if the child often repeats exactly what parents, carers, or others have said. Social communication is a key area of difficulty in children with ASD. Parents or carers are therefore asked how a child communicates for different purposes such as greetings and farewells by saying ‘hi’ and ‘bye bye’, asking for things or actions, commenting, calling out to get attention, asking for help, and saying ‘no’ to protest or refuse.

Young children use play to be social. The speech pathologist will therefore observe the nature of a child’s play to determine whether it is pretend, imaginative, unusual, or repetitive?

At a stage when a child has developed speech and language, developmental checklists and formal language tests may be used to determine whether the child’s understanding, use of spoken language, clarity of speech, and tone of voice are typical for a child of his or her age. Some children with ASD speak with a monotone or with an unusual accent. Older children with ASD have difficulty understanding humour or abstract language, and they think literally. Additional assessment will also determine whether a child is able to start and continue a conversation and how he or she uses language to express thoughts and feelings, and to interact with others. The information gained from the speech pathology assessment will be considered in collaboration with the other members of the multi-disciplinary team to determine whether a child is given a diagnosis of ASD.

What happens next?
The speech pathologist works with parents or carers to design an intervention program that best meets a child’s communication needs. Therapy will be designed to develop the child’s language, social communication, and play skills. The speech pathologist will provide resources, information and advice to help parents, other carers, and other professionals working with a child. As a parent, it can be a difficult and daunting task to work out how best to help a child. An important part of helping a child is knowing how to use the specific therapeutic strategies and ideas in everyday life. For the child who is not yet talking, this may involve teaching another way of communicating through the use of photos, pictures, or signs. This form of therapy also aims to improve children’s understanding of language and the world around them.

Intervention for a child who has developed some speech may include teaching words and sentences that assist with communication, as well as helping the child to make his or her speech easier to understand. Other areas of focus may include teaching a child how to communicate effectively by developing listening skills and comprehension, turn taking, conversation skills, and the use and understanding of facial expression and body language. Speech pathology sessions can be delivered in
a variety of ways, including individual therapy, working in small groups, working within a classroom, or becoming involved in home-based programs. Speech pathologists often work with other professionals in ASD-specific programs to help achieve a child’s individual communication goals. The speech pathologist will work in consultation with parents, carers, and any other family members, along with other professionals such as psychologists, occupational therapists, and educators to help develop a child’s full potential.

State/Territory autism associations
Allied health providers
Useful links