Speech Therapist for Autism

Abstract

Autism Spectrum Disorder is a condition that consists of various challenges to an individual such as social skills, nonverbal communication, repetitive behaviors and difficulties with speech. So far doctors have not been able to find out what causes autism although it is believed that it involves both environmental and genetic factors. Autism can usually be detected at an early age, therefore giving the patient and therapist an early start to improve their verbal skills. Speech language pathologists also known as a “speech therapist” help to develop their communication and verbal skills.

These therapists are required to have a master’s degree in Speech Language Pathology and pass the Praxis exam in order to not only diagnose autism on a person, but to work with them as well. One way that speech therapists can determine what type of therapy to use is by conducting an augmentative and alternative communication or AAC evaluation on the patient. To determine what would be the best type of treatment for autism patients. The experiment lasted a year and required 160 autism patients that varied from ages 3 to 20 years; all subjects had to go through aided AAC system, unaided AAC system and both systems. The results varied as the aided system had a positive impact on the older group of subjects, and the younger group subjects received the unaided system very well. Speech therapists concluded that there is no specific therapy that is better than the other because there are factors must be taken in consideration such as age, how advanced is the patient in autism, and if him/her had received any type of therapy as soon as they were first diagnosed. Interprofessional education (IPE) is essential in improvement of health care because when everyone works cohesively it enhances the quality of the care of the patient as well as their safety; decreases medical errors and may reduce medical expenses. ("Preventing Medical Errors in Speech-Language Pathology", 2015)

Keywords: autism spectrum disorder, speech therapists, augmentative and alternative communication (AAC), aided, unaided, therapy, communication, social skills, verbal, non-verbal.

Introduction

Speech language pathology originated its roots of elocution also known as speech perfection which began in the 18th century from England ("History of the Professions", 2016). The United States continued their prominence on elocution; yet the focus began more on communication disorders after Samuel Potter, MD, published a book in which he describes various types of language and speech disorders. ("History of the Professions", 2016) Speech production remained the focus in this field and in 1925, the American Academy of Speech Correction was established ("History of the Professions", 2016). Its mission is to empower and support audiologists, speech-language pathologists as well as language, speech, and hearing scientists. It is the nation’s leading professional, credentialing and scientific organization for professionals in these fields. Many WWII soldiers returned with brain injury resulting in a dramatic increase in individuals with aphasia ("History of the Professions", 2016). During the 1940’s and ’50s, speech-language pathology researchers and practitioners began to focus more on “mentalism” or brain processing abilities. ("History of the Professions", 2016) Also, during this time, brain studies, technological advances, and development of standardized testing procedures gave rise to more useful receptive and expressive language assessment and treatment techniques. The field of speech pathology became speech-language pathology during this time. ("History of the Professions", 2016)

Autism spectrum disorder (ASD) is a neurological and developmental disorder that can begin as early as a child’s life and it can last for the rest of their lives. Autism affects a person’s actions and ability to communicate, learn and interact with others. The causes of autism remain unknown; yet some researchers believe that it has a connection with genes and environment. Some ways to signs of knowing when a person has autism is when the individual does not make eye contact when being spoken to, has repetitive behaviors, repeating the same sentences over and over or having issues when communicating with someone. Some challenges a person with autism faces are understanding gestures, tone of voice and body language, in most cases they are not able to determine if the other person is angry, sad, happy, etc. There is not an exact standard treatment for autism, but in a child’s case; there are various ways to develop their ability to learn and grow different skills. This can lead to better results as they get older.

[bookmark: _Hlk534628100] Speech therapists play a critical role in the life of an individual with autism. They help develop the individual’s verbal and communication skills since speech delay is very common among persons with autism. For therapists to help these individuals, they must have a series of requirements that can qualify them to do this job. In order to become a speech therapist, the person must have an undergraduate degree in communication sciences and disorders (CSD), which include foundational courses related to linguistics, phonology and language disorders, anatomy of speech mechanisms and hearing as well as normal language development ("How to Become a Speech-Language Pathologist"). After obtaining their bachelor’s degree, the next step is to complete a master’s degree program that is accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). The graduate degree program includes clinical and academic coursework; some students opt for doing research-related activities to enhance their program skills ("How to Become a Speech-Language Pathologist").

Once receiving the Master of Science degree in Speech Pathology, the graduate student must complete 36 weeks or 1,260 of speech language clinical fellowship. This clinical fellowship is mandatory before taking the state board test. ("How to Become a Speech-Language Pathologist"). During this time, the student is to be mentored by an ASHA-certified speech language pathology professional and have about eighty percent of clinical contact related to diagnosis, evaluation, counseling and screening. Any person that has a graduate degree in speech pathology must take and pass a national educational testing services called Praxis II: Subject Assessment in Speech-Language Pathology to get state licensure. The minimum passing score is a 162 ("Speech-Language Pathology Praxis Exam").

A speech pathologist practice involves providing prevention, screening, assessment and diagnosis, consultations, treatments, counseling in various disorders. The therapist also establishes augmentative and alternative communication (AAC) techniques and strategies which include developing, choosing, and recommending which systems and devices are suitable and effective for the therapy of the individual. Speech therapists not only serve individuals with autism, they also work with families, groups and general public through a series of professional activities. Some examples of these activities are educating and training caregivers, families and other professionals. Speech language pathologists also conduct research that is related to communication disorders, swallowing and other upper aerodigestive functions.

Speech therapists work in various setting such as schools, office, individual’s home, etc. Most therapists believe that the setting where the therapy takes place can have an impact on how the person will respond to the therapy. Before the speech therapist decides what technique she/he will use to work with their autistic patient, they take factors in consideration such as age, what level in autism they are at, records from the patient’s previous speech therapist (if they had one). Afterwards they are given a test which will help the therapist decide if the patient needs aided therapy or unaided therapy. This questionnaire includes questions about general health and specifics about speech and hearing status. Depending on the answers to these questions, further observations or assessments may be warranted to rule out hearing impairment or structural defects as a contributing factor to minimal verbal status. The test also helps the speech therapist determine if they can do one-on-one sessions or group sessions with other people that have autism.

Materials and Methods

The purpose of this experiment is to determine which augmentative and alternative communication (AAC) works better based on the age group. Forms of AAC are divided into two broad groups known as aided and unaided. This experiment was conducted for 12 months yet obtaining results quarterly. It consisted of four groups with ages ranging from 3-20 years old. 160 participants with autism were selected and were separated into four groups. The groups were separated as follows: 3-5 years old, 6-10 years old, 11-15 years old and 16-20 years of age; each age group had a total of 40 participants. Some things that had to be taken into consideration were the location where the sessions would take place and family involvement and the level of autism the participant was at to determine whether the sessions would be one-on-one or in groups.

The experiment began on October 2017, all sessions took place at a learning facility that had speech therapist who were certified to work with AAC system. Each session was 1.5 hours in which 15 minutes was spent preparing and documenting a session. Since the therapists would obtain official results quarterly, they decided to separate the experiment into four categories: aided, unaided, or both. Because there were 40 participants per group, two speech therapists were assigned to each group.

The first session conducted which began on October 2017 to February 2018 had the participants work with aided augmentative alternative communication. This consisted in the use of technology such as voice augmentation, picture exchange cards, tablets, etc. The youngest age group of 3-5 years had alphabet letters, animal pictures as well as object pictures, colors and numbers. The following group of 6-10 years of age had more defined images such as signs, words, images of people with various facial expressions and gestures and had the use of a tablet. The teens group of 11-15 years of age had a more in-depth aided therapy, they not only had images, they were also shown videos of people doing different actions such as walking, running, etc. The last group which the ages ranged from 16-20 years, had similar aids as the teens group, yet their therapy also included television shows, songs and identifying between right and wrong and communication with someone via skype to develop their vocal skills.

The second quarter of this experiment was conducted from March 2018 until June 2018. This time the unaided AAC system was used, meaning no technology was used. This time therapists would use their own bodies. Even though the same strategy was used, the level of training was different. For the ages 3-5 included sign language, body language, gestures and facial expressions. The training for this group age was more extent because since they are so young, they can grasp the content more. The age group of kids 6-10, therapist used more facial expressions, gestures and body language since they were at the age where they could understand and since they have already been having therapy since they were first diagnosed with autism. For the participants of the age group of 11-15 years the training dealt with more of interaction with their family and their therapist together. This age group’s therapy also taught body gestures and facial expressions such as when a person is happy, sad, and angry. The last group of ages 16-20 also had therapy that included their family; because they are the oldest group out of all the participants, some of them were diagnosed with autism at a later age which made it difficult for them to develop language, so all unaided resources are used with them.

For the final quarter of this experiment which was from July 2018 to October 2018. The groups decided to see how much effect it would make on the participants if both types of AAC were used. The sessions lasted for 1 hour. The therapists used the same techniques they used for each age group aided and unaided, just the difference this time was that it was combined.

Results

All experiments had different results. For the first quarter which was from October 2017 to February 2018, therapists used AAC aided system. To determine if the therapy was successful, the participants were given an evaluation test which consisted of being 40 questions and the passing score had to be an 75% or higher. The test consisted of the participants pointing out and saying what was happening in the image. The purpose of this test was for speech therapists to determine if aided therapy is useful. For the group of ages 3-5 only 15 participants were able to pass a test with an average of 82%, unlike the other 25 participants that did not pass. In the group of 6-10 years of age only 18 out of the 40 participants passed the test. 30 participants from the age group of 11-15 years who received the therapy passed the test with an average score of 80%. The oldest group of participants from ages 16-20 had the highest test score average out of all the other groups with a total of 35 subjects successfully passing the test.

In the second quarter which was from March 2018 to June 2018, the speech therapists decided to use the AAC unaided system. This system had a major impact when it came to the group of ages 3-5 years with a total of 33 out of the 40 passing the evaluation. For the following group of ages 6-10 there wasn’t much of a difference compared to when they did the aided treatment the first quarter, only 25 participants did well with the unaided treatment. For the teen’s group of 11-15 years of age, the number of participants who passed the unaided therapy evaluation test was only 17, which are 13 participants less than the aided therapy. The subjects from age group 16-20 years had 19 out of the 40 participants that did good on the evaluation test.

For the last quarter of this experiment which was conducted from July 2018-October 2018, speech therapists decided to use both aided and unaided AAC systems to see if it would work for the participants instead of just using one AAC system. Out of all the age groups the only one who had the maximum test score average of 87% when using both systems was the age group of 6-10 with 30 participants passing the test. Right behind them were those within age group 11-15 years; this group had 23 out of the 40 participants who did well using both systems. Only 19 participants of the age group 3-5 years old passed the test, making them the group with the lowest test score average of 65%. The participants of ages 16-20 who had 19 participants out of the 40 that did not do well on the evaluation test with the scores averaging at 70%.

Conclusion

Overall, this study indicates that the type of speech therapy that can be successfully applied to the treatment of patients with autism depends on the age of the patient. In the first quarter that dealt with the aided AAC system, the age group with the highest success rate was from ages 16-20 years. This was because many of the participants had already received speech therapy since they were first diagnosed with autism at a young age, therefore developing their communication, vocal and thinking skills. What helped this age group be successful were the devices that were used in the therapy sessions. For instance, they had tablets which were used for the participants to connect with someone via facetime or skype, so they could work on their communication skills; this gave them a sense of confidence and motivation. On the other hand, the AAC aided system did not make a positive impact among the participants from the age group of 3-5 years. Speech therapists concluded that it was because they would easily get distracted with the pictures and the colors, making it impossible for them to grasp and concentrate on what the therapist would try to teach them. Another factor of this age group not being successful with the aided system was because since they did not understand what was happening in the images, they grew a sense of frustration which led to many of the young participants to not want to continue therapy. The age group of 11-15 years had 30 participants whose passing score averaged 80%. Not only was this a successful first quarter for them, this also indicated speech therapists that the aided system did have a positive effect on teenagers within ages 11-15 and that they can continue to use this therapy technique. The other group that was not as successful was the participants within the age range of 6-10, they only had 23 people that were able to pass the quarterly test, even though it was still more than half of the participants, speech therapists were still not impressed.

The outcome was different for the unaided AAC system. The age group that had the most success with the system were from the ages 3-5. 33 out of the 40 participants passed the quarter evaluation test. Speech therapist believe it was because since they are so young, they can grasp to things if shown physically rather than technology which can be somewhat confusing for them. Therapist also believe that since these children have been diagnosed with autism at an early age in their lives, it includes a more hands on interaction. Not only is the speech therapist involve but this is the perfect time to have the families get involved by continuing the therapy at home. The next successful group were the participants from ages 6-10, with 25 out of the 40 participants passing the quarterly evaluation. Even though majority of the participants in this age group had been dealing with unaided therapy since they were first diagnosed with autism, speech therapists have confidence that this system is still very much useful since they are at the stage where their communication and verbal skills start developing as they began to interact with other kids at their school, birthday parties, parks, etc. For the other two age groups (11-15 and 16-20), this unaided system was not much a success for them because they were already passed the phase where they needed to learn about body language, different gestures and facial expressions. Many of them were either in high school, going to college or working.

Speech therapist decided to have all the groups do both the aided and unaided AAC systems therapy. This was the last quarter for this experiment and after doing the evaluation test, it was proven that the therapy worked best for the subjects from ages 6-10 and 11-15. Therapist say that the reason for this result is that since that these are the ages in which kids and teenagers try and make friends and be like their friends, they are motivated to learn as much verbal and social skills as possible. It does not work well with the children from the age group 3-5 years because they are in the beginning stages of learning and using both types of systems can at times be more confusing than helpful. And for the older age group of 16-20, they were already advanced with their verbal and social skills and therefore the need of using both systems was unnecessary since they were either in high, college or had jobs so they had a better response to using technology.

When a child is first diagnosed with autism spectrum disorder, parents have trouble figuring out what is the next step they need to take. Since autism still has no cure, there is no exact medication that can be given to avoid or treat autism. Doctors know that a symptom of autism is lacking verbal and communication skills, therefore they refer the parents or family of the patient to go see a speech therapist. Speech therapy is very important in the life of a patient with autism; it develops not only their oral skills it also helps them with communication skills which will later help them advance their social skills. According to an article on autismspeaks.org, scientists and researchers did a study on 500 children of different ages who had autism with severe language delay and had them undergo speech therapy. The researchers found that majority of the children went on to acquire language kills. The results also showed that some who had speech therapy had become fluent speakers and others could talk using simple phrases.

Medical errors are very common in the health profession, due to lack of knowledge, teamwork and communication ("TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM", 1999). Because of this, wrong diagnosis often occurs as well as the patient being given the wrong medication because of lack of communication. Most medical errors occur in intensive care units, emergency departments and operation rooms. Not only does medical errors affect the life of the patient, it also has an impact on medical costs. In an article published by the institute of medicine in 1999, stated that medical costs were estimated to be between $17 billion and $29 billion dollars ("TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM", 1999). These costs often include lengthy hospital stays, which causes the patient to miss work which can the lead to the patient losing its job. The Quality of Health Care in America Committee of the Institute of Medicine designed a system that could reduce medical errors as well as decreasing the rate of patients being harmed ("TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM", 1999). This system has different strategies that focus on creating leadership, research, protocols and tools as well as protocols which can enhance knowledge about safety. Another strategy to reduce medical errors is using those errors that were made in the past and learning from them as well as identifying those errors. This strategy is going to develop a nationwide mandatory reporting system which will be used to collect information about medical occurrences that can result in serious death or harm. Other strategies to improve medical errors are increasing performance standards and expectations for enhancing safety through the actions of oversight organizations, professional groups, and group purchasers of health care. ("Preventing Medical Errors in Speech-Language Pathology", 2015)

Interprofessional education is an important approach that helps student in health professions deliver a positive outcome in patient care when working in a combined team environment. Some positive factors of having a positive IPE are enhancing the quality of patient care, reducing the patients stay in the hospital and most importantly is the decrease in medical errors. For instance, when it comes to autism, interprofessional education has helped by doing pre-screening tests which shortens the wait for autism diagnosis. Author Trisha Self and colleagues Douglas F. Parham and Jagadeesh Rajagopalan did a research project and it revealed that family physician and pediatricians have not been screening young children for autism which is required by the American Academy of Pediatrics (Self, T. 2015, September 25). Interprofessional education (IPE) can help improve medical errors in autism is by teaching graduate and undergraduate students to better identify the characteristics of ASD and to be able to partake in screening, assessment and referral of children who reveal early signs. Another way IPE can help improve autism is by providing high services to children and families throughout the country. Faculty, clinical educators and students from different departments that deal with communication and syndromes such as audiology, speech-language pathology, early childhood unified special education, clinical psychology, physical therapy, dental hygiene, physician assistant, nursing and public health have participated (Self, T. 2015, September 25). Since the introduction of autism interdisciplinary diagnostic team about 133 students, faculty, clinical educators and community professionals have been able to assess 24 young children who present with characteristics of autism, and around 85 percent of these children have acknowledged a confirming medical diagnosis (Self, T. 2015, September 25).

References

American Speech-Language-Hearing Association. (2007). Scope of Practice in Speech-Language Pathology [Scope of Practice]. Retrieved from https://www.govst.edu/uploadedFiles/Academics/Colleges_and_Programs/CHHS/Departments/Communication_Disorders/Master_of_Health_Science_in_Communication_Disorders/Scope%20of%20Practice%20in%20Speech%208-26-09.pdf

American Speech-Language Hearing Association. (2001). Scope of practice in speech language pathology. Rockville, MD. Retrieved from http://staff.washington.edu/jct6/ASHAScopeofPracticeSLP2001.pdf

Assessment and Evaluation of Speech-Language Disorders in Schools. (n.d.). Retrieved from https://www.asha.org/slp/assessment-and-evaluation-of-speech-language-disorders-in-schools/

Children's Hospital. (2017, June 09). Evidence-based Treatment Options for Autism. Retrieved from https://www.chop.edu/news/evidence-based-treatment-options-autism

Florida Board of Speech-Language Pathology & Audiology. (n.d.). Speech-Language Pathologist. Retrieved from https://floridasspeechaudiology.gov/licensing/speech-language-pathologist/

Lofland, K. (n.d.). Indiana University Bloomington. Retrieved from https://www.iidc.indiana.edu/pages/should-all-nonverbal-young-children-with-autism-immediately-have-aac-taught-to-them

Herbert, M., Kehayia, E., Dauphinee-Wood, S., & Snider, L. (2014, January 27). Benefits of Occupational Therapy for Autism. Retrieved from https://www.webmd.com/brain/autism/benefits-of-occupational-therapy-for-autism

History of the Professions. (n.d.). Retrieved from https://hsl.lib.unc.edu/speechandhearing/professionshistory

How to Become a Speech-Language Pathologist. (n.d.). Retrieved from https://www.speechpathologygraduateprograms.org/how-to-become-a-speech-language-pathologist/

Hsieh, M. (2018, August 8). Intervention Techniques Used with Autism Spectrum Disorder by Speech-Language Pathologists in the United States and Taiwan: A Descriptive Analysis of Practice in Clinical Settings. Retrieved from https://ajslp.pubs.asha.org/article.aspx?articleid=2680409

Jordan, K. A., & Lofland, K. (n.d.). Indiana University Bloomington. Retrieved from https://www.iidc.indiana.edu/pages/collaborative-teaming

Kasari, C., Brady, N., Lord, C., & Tager-Flusberg, H. (2013, October 29). Assessing the Minimally Verbal School-Aged Child with Autism Spectrum Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139180/

Preventing Medical Errors in Speech-Language Pathology. (2015, July 29). Retrieved from http://www.pdresources.org/blog_data/preventing-medical-errors-in-speech-language-pathology-4/

Rudy, L. J. (2018, April 30). Why Your Autistic Child Will Benefit from Seeing a Speech Therapist. Retrieved from https://www.verywellhealth.com/speech-therapy-for-autism-the-basics-260577

Self, T. (2015, September 25). Interprofessional Pre-screening Shortens the Wait for Autism Diagnoses. Retrieved from https://blog.asha.org/2015/04/07/interprofessional-pre-screening-shortens-the-wait-for-autism-diagnoses/

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Both AAC System Therapy

Jul '18 - Oct '18

Participants that passed test 3 to 5 6 to 10 11 to 15 16 to 20 19 30 23 21 Age Groups

Number of Participnts that

passed test

AAC Aided Therapy

Oct '17- Feb '18

Participants that passed the test 3 to 5 6 to 10 11 to 15 16 to 20 15 18 30 35 Age Groups

Number of participants that passed test

AAC Unaided Therapy

Mar '18- Jun '18

Number of Particpants that passed test 3 to 5 6 to 10 11 to 15 16 to 20 33 25 17 19 Age Groups

Number of participants that

passed test

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