Speech pathologists

Speech pathologists are tertiary educated professionals who have completed a minimum four year undergraduate degree or two year graduate-entry masters degree. Speech pathology courses provide extensive training in the areas of child development, disordered and delayed speech, and language development, including social communication and interaction skills, and appropriate remediation and intervention. It is important to seek a practitioner who has the skills and expertise to provide assessment and treatment for children with ASD. The Speech Pathology Australia website provides a list of members who have a special interest in working with children who have developmental disorders such as ASD.

The role of speech pathologists
The speech pathologist plays an integral role in the assessment and treatment of children with an ASD, and reports the assessment results and clinical information to other members of the interdisciplinary team. The speech pathologist has expertise in the areas of social communication, speech and language development, learning and cognitive abilities, and play skills. As a member of the interdisciplinary team, the speech pathologist uses developmental and social interactive interventions in the child’s natural environment. These interventions are supported by the implementation of visual aids and strategies to enhance the child’s communication, social, behavioural, and play skills in all facets of his or her life.

When should a child see a speech pathologist?
Referral to a speech pathologist is appropriate when a parent, teacher, or other professional is concerned because a child is demonstrating any of the following difficulties:
• delayed onset or delayed development of speech and language;
• regression or loss of communication skills;
• problems with understanding spoken language;
• frustration and challenging behaviours resulting from communication difficulties;
• difficulty with conversation, forming relationships, and socialising with peers, family members, and others; and
• learning difficulties.

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 shows signs typical of ASD.

What does an assessment involve?
The speech pathologist will interview the parents and observe how the child interacts with family members and other people in different contexts such as home, preschool, or school. Adequate hearing is crucial to the development of speech and language. If the child’s hearing has not been formally assessed by an audiologist, then a referral should be arranged for this assessment. The type of assessment and the tools required to assess the child will vary greatly depending on the age and skills of the individual child. The assessment usually incorporates examining the areas of speech, receptive and expressive language, and pragmatics (social communication).

Developmental assessments and observation of play and interaction are used by the speech pathologist to assess verbal and non-verbal early communication skills such as:
• Joint attention – whether the child uses eye gaze for directing another person’s attention to objects and events for the purpose of sharing;
• Gestures – whether the child uses gestures to communicate, or understands common gestures, for example, puts arms up to indicate the desire to be picked up, responding to the wave, ‘bye bye’;
• Pointing – does the child use pointing to indicate when he wants things or to show things of interest?
• Vocalisation – does the child use sounds, words or word combinations? If not, what other ways does the child convey a message?
• Echolalia – does the child repeat language he has heard which may be used in context or for no apparent reason?
• Receptive language – does the child respond to his or her name? Does the child demonstrate age appropriate comprehension?
• Pragmatic use of language - can the child use language for a variety of reasons, for example, requesting, greeting, asking for help, and protesting?
• Initiation – does the child initiate interactions with people, either verbal, non-verbal or social?
• Play – Is the child developing age appropriate play - is it pretend or imaginative, repetitive or unusual?

Formal assessment
Speech pathologists use tests such as:
• The Clinical Evaluation of Language Fundamentals – 4 (CELF - 4);
• The Preschool CELF - P2;
• Rosetti Infant-Toddler Language Scale; and
• Preschool Language Scales - 4 (PLS - 4)

Pragmatic language is assessed in a variety of ways including parent and teacher reports and the completion of profiles and questionnaires; observations of the child in a range of different environments as well as through the use of formal pragmatic language tests, such as:
• The Children’s Communication Checklist -2 (CCC – 2),
• The Test of Problem Solving – 3 (TOPS-3), and
• The Test of Pragmatic Language – 2 (TOPL - 2).
Additional assessment may investigate whether the child:
• Understands inference
• Understands humour, and double meanings
• Interprets other people’s language literally.
• Uses pedantic or “adult-like” language
• Demonstrates unusual prosodic features such as a monotone voice, an unusual accent or poor volume control. 

The information gained from the speech pathology assessment will be considered in conjunction with information from the other members of the multi-disciplinary team to determine whether a child is given a diagnosis of ASD.
 

What kind of treatments do speech pathologists provide?
The speech pathologist will use the multi-disciplinary assessment information to establish goals and plan an individual communication program for the child. Because ASD is complex, therapy needs to address a number of different areas but will vary, depending on the child’s current skills. Areas of therapy may include the development of:

• alternative communication systems for the child who isn't talking eg. photos, pictures, signing,
• vocabulary, syntax, semantics, and articulation for the child who is verbal
• receptive language skills
• play skills
• use and understanding of body language and facial expression
• conversation skills – initiation, turn taking, topic choice and maintenance;
• social skills
• prosodic features such as intonation, volume and tone of voice
• higher level language skills, such as inference, humour, sarcasm,
• the use of visual aids such as timetables, schedules, behavioural scripts and social stories to assist the child with organization and to cope with change and transitions

Speech pathology sessions can be delivered in a variety of ways including individual therapy, working in small groups, and working within a preschool or classroom setting. Speech pathologists also work in home-based programs to train parents to use communication strategies in everyday situations and incorporate predictable routines and motivating activities to help with the generalisation of skills.

State/Territory autism associations
Allied health providers
Useful links
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