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Speech and language therapy

Please be aware that this section contains information prepared in 2009 and may now be out of date. Some links may no longer work. We are reviewing this section.


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Communication difficulties

Children on the autism spectrum often have difficulty understanding the communication of others and communicating effectively with them. In fact a child on the autism spectrum may not see any reason to communicate with other people. This may delay their language acquisition and lead to frustration when they cannot make their needs understood. If they find play and social situations difficult and so avoid them, they also have fewer opportunities to learn language.

Children on the autism spectrum often have communication problems more complex than straightforward speech and language difficulties. Characteristically they can find it hard to interpret social behaviour and imagine another individual's state of mind. Reluctance to interact with the world may be evident in the way they fail to make eye contact, use hand gestures, or understand body language.

A delay in spoken language may be the most obvious indication that something is wrong, and the speech and language therapist (SALT) may be one of the first professionals to meet the child. It is vital, however, that the assessment of the child should take into account all aspects of communication and social functioning, not just speech and language. The assessment should be part of a co-ordinated multi-disciplinary assessment which considers how aspects of the assessment relate to and influence one another. Specialists in speech and language are, therefore, key professionals when it comes to assessment and intervention.

Some children on the autism spectrum have limited or even no speech, and their understanding of other's speech may vary enormously. In such cases therapists may focus on getting the child to communicate using visual methods such as signing, symbols and picture systems. They may spend time helping the child develop listening and attention skills; play and social skills; social understanding; understanding of language and expressive language.

At the opposite end of the spectrum, some children have good vocabularies and can talk on particular topics in great depth. Some, but not many, have problems with pronunciation. Many have difficulty using language effectively, and many also have problems with word and sentence meaning, intonation, and rhythm or say things that have no content or information. In its information sheet on speech and language therapy, the National Autistic Society gives a useful description of the most common communication problems experienced by children on the autism spectrum.

For children with some speech, therapists can provide help with:

•    Articulation disorders: some children have trouble saying some sounds or words correctly. For example, ‘run’ might sound like ‘won’ or ‘say’ might sound like ‘thay’. Lisps are a common articulation disorder.
•    Fluency disorders: some children repeat some sounds or have trouble saying complete words. For example, the word ‘story’ might come out sounding ‘’. A stutter (or stammer) is a common fluency disorder.
•    Resonance or voice disorders: some children talk in a way which makes it difficult for people to understand them – as if they have a cold or are talking through their nose. Some individuals on the autism spectrum speak in a high-pitched voice or use robotic-like speech.
•    Language disorders: some children find it very difficult to understand what people are saying to them as they don’t understand the meaning of words. Some children have trouble making themselves understood as they find it difficult to put words into sentences correctly. Children on the autism spectrum may have a very literal understanding of language or use their own idiosyncratic language. The correct use of pronouns is also often a problem.


Access to speech and language therapy

If you feel your child needs speech and language therapy, you can either contact the Royal College of Speech and Language Therapy to find an NHS therapist in your area, or get a referral via your GP.  If your child has a statement of special educational need, the local authority may make a referral. There is, however, a shortage of therapists. The Association of Speech and Language Therapists in Independent Practice can provide contact details for SALTs working in private practice.

In July 2008 the Bercow Review found that the needs of many children and young people with speech, language and communication needs (SLCN) were not being met, particularly with regards to access to speech and language therapy. In response to this review, the Government published Better Communication: an Action Plan to Improve Services for Children and Young People with Speech, Language and Communication Needs (SLNC). This Action Plan provides details of a range of initiatives across Government to improve services for children and young people with SLCN, culminating in the National Year of Speech, Language and Communication in 2011-12. These initiatives include

•    Up to 20 local area pathfinders to develop good practice guidance and a supplemental joint commissioning framework on SLCN;
•    Up to £1.5 million invested in grants to the alternative and augmentative communication sector;
•    Up to £1.5 million invested in a research programme looking at SLCN over the next three years.

To provide ongoing support to the delivery of these initiatives over the next three years, the Government will form a Communication Council and appoint a Communication Champion in 2009. The Communication Council will provide Government with ongoing advice and support on how best to develop effective services for children with SLCN.

Speech and language therapy at school

Children with a statement of special educational needs may have speech and language provision specified in their statement. It is important that this is detailed as an educational need in parts 2 and 3 of the statement for the provision to be enforceable.

Some of the speech and language therapy provided in schools and settings takes the form of one to one sessions with a therapist. But very often the SALT will devise a programme for a child to be delivered by class teachers and teaching assistants. The SALT will provide training for the school staff and suggest communication targets for the child’s individual education plan which should be integrated into the curriculum.

With the Government now placing greater emphasis on early treatment and intervention, many early years settings are also providing access to speech and language therapy. This may take the form of one-to-one sessions, or more commonly group work.

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Afasic Youth Zone is a UK charity which helps children and young people with speech, language and communication impairments, and their families and the professionals working with them. Provides information, training, courses and conferences.

ICAN is a UK children’s communication charity which works to foster the development of speech, language and communication skills in all children with a special focus on those who find this hard: children with speech, language and communication needs. ICAN provides resources for schools and others and has developed a network of Early Years Centres across the UK which provide specialist teaching and SALT for pre-school children with speech, language and communication needs.

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Creating enabling communication environments for children with autism and minimal or no speech: a Joseph Rowntree-funded study, by Carol Potter and Chris Whittaker, 2001, which explores children's communication capabilities and the ways in which communication environments in schools can enable or disable them in their attempts to become spontaneous communicators.

Talking Point from ICAN has information designed specifically for parents and professionals about a range of communication difficulties in children.

The Communication Trust A range of downloadable information for parents and professionals about Speech and Language Therapy.

Speech and Language Therapy Information from the National Autistic Society about childhood development of speech and language and reasons for possible delays in children and young people on the autism spectrum

The Communication Consortium A comprehensive list of links to all UK charities and organisations involved in helping children and young people with their speech and language problems.

Speech and language delays and disorders Information from the University of Michigan about speech and language delays and disorders in children including those on the autism spectrum

Delayed speech or language development Information from Kids Health (American website) for parents and carers

Baby BumbleBee American company offering a range of resources including DVDs to help with child speech development, including a number of resources specifically for children and young people on the autism spectrum. (American website)

Speech for Kids Canadian website offering information, advice and resources for parents and professionals. (Canadian website)

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Case studies

New package of care in East Kent The story of how the speech and language department of the East Kent Coastal Teaching Primary Care Trust developed a package of care including social skills therapy in response to a sudden increase in demand for support. The project has benefited their department as well as young clients with Asperger’s and their families

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