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Children on the autism spectrum often have difficulty understanding the communication of others and communicating effectively with others. This means that the speech and language therapist (SALT) may be one of the first professionals to meet the child especially if the child’s spoken language is delayed.
Children on the autism spectrum often have communication problems which are wider than speech and language, for example, problems with the way the brain develops interferes with their ability to interpret and interact with the world and imagine another individual's state of mind. This may be evident in the way they fail to make eye-contact, use hand gestures, or understand body language. A child on the autism spectrum may not see any reason to communicate with other people and this may delay their language acquisition and lead to frustration when they cannot make their needs understood. If they have difficulty with or avoid play and social situations, the opportunity to learn language is also restricted.
Specialists in speech and language are key professionals involved in assessment and intervention. Assessment of a 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.
Some children on the autism spectrum have limited or no speech and their understanding of speech may vary enormously so 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. A few have problems with pronunciation. Some have difficulty effectively using language and many also have problems with word and sentence meaning, intonation, and rhythm or may say things that have no content or information. 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 ‘st..st..story’. 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 – like they have a cold or they 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
There is a shortage of therapists but access is either directly or via GP referral for an NHS SALT; or via a statement of special educational needs. The Association of Speech and Language Therapists in Independent Practice can provide contact details for SALTs working in private practice.
Following the review of services for children and young people with SLCN by John Bercow MP, the Government published Better Communication: An Action Plan to Improve Services for Children and Young People with Speech, Language and Communication Needs (SLCN) on 17 December 2008.
The 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. This includes:
- 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 for 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 the statement. It is important that this is detailed in parts 2 and 3 of the statement, as an educational need, for the provision to be enforceable.
Although some speech and language therapy provided in schools and settings are 1:1 sessions with a therapist, 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.
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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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The Bercow Review report into speech, language and communication needs, released on 4 July 2008 set out 40 recommendations. The report, chaired by John Bercow, MP, highlights that the needs of children are not being met because of weak planning and poor coordination of services across health, social care and education.
NAS information sheet on speech and language
Information on professional development from TeacherNet
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.
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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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