Unit I: Speech, Language and Communication Therapy

1. Speech, language and communication: Implications for across the spectrum

2. Development of Language: receptive and expressive

3. Development of communication and conversation skills.

4. Alternative & Augmentative Communication Systems Communication aids & devices: Scope & limitations

5. Role of speech & language therapist: early childhood to school years





1. Speech, language and communication: Implications for across the spectrum

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioral challenges. The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment that people with ASD can have.

ASD affects people in different ways and can range from mild to severe. People with ASD share some symptoms, such as difficulties with social interaction, but there are differences in when the symptoms start, how severe they are, the number of symptoms, and whether other problems are present. The symptoms and their severity can change over time.

The behavioral signs of ASD often appear early in development. Many children show symptoms by 12 months to 18 months of age or earlier.

The word “autism” has its origin in the Greek word “autos,” which means “self.” Children with ASD are often self-absorbed and seem to exist in a private world in which they have limited ability to successfully communicate and interact with others. Children with ASD may have difficulty developing language skills and understanding what others say to them. They also often have difficulty communicating nonverbally, such as through hand gestures, eye contact, and facial expressions.

What is speech? Speech is the common term that we use to refer to what’s known more technically as articulation. In other words, it is the process of physically expressing a sequence of sounds, which, through the process of hearing, convey a message. So, speech is definitely a physical process involving the muscles of the respiratory system and the vocal tract, or, in the case of people with speech disabilities, a speech-generating device or AAC 

What is language? Language is shared meaning — “an agreed-upon set of symbols that enable people to interact and communicate with each other”1. The core property of language, then, is its symbolic nature — our ability to name and remember names of objects and actions in the world around us, so that we can ‘talk’ about them with each other. The names, by themselves, are more or less arbitrary. For instance, the object which we call a door, by any other name, would still open and close. But language is a way to put these words together to create meaning. Language is either sound-based (for verbal communication) or gesture-based (like sign language); and for many people with autism (and other disorders), it could be picture-based, too.

And what about communication? Communication is a medium of interaction between people that allows them to direct the emotions and actions of others. We communicate to convey information, to get people to do things, to express approval or disapproval, and to express our needs and wants. In short, we communicate so that we are able to live socially. All social creatures must communicate with each other — whether by the grunts and roars of tigers, or by the scent trails of ants, or by messages written on Facebook by human beings.

The ability of children with ASD to communicate and use language depends on their intellectual and social development. Some children with ASD may not be able to communicate using speech or language, and some may have very limited speaking skills. Others may have rich vocabularies and be able to talk about specific subjects in great detail. Many have problems with the meaning and rhythm of words and sentences. They also may be unable to understand body language and the meanings of different vocal tones. Taken together, these difficulties affect the ability of children with ASD to interact with others, especially people their own age.

Below are some patterns of language use and behaviors that are often found in children with ASD.

Communicative behavior can be observed at birth in the intense mutual eye gaze that connects neonates to their parents, sealing the bond between them. Communication thus precedes language developmentally, and any difficulties can serve as early red flags so that preventative steps may be taken to engage the baby actively in reciprocal exchanges and shared attention. Early in infancy the establishment of joint attention is particularly important. It starts as mutual gaze between caregiver and infant and then proceeds to incorporate shared attention on a third object, person, or family pet, with the parent often commenting verbally as well as gesturally on the thing that is the focus of the child’s attention. If development proceeds typically, the infant soon learns to recruit the attention of the caregiver by using body orientation, vocalization, and shifting gaze (ie, first looking at the parent and then the object of interest). The parent can use similar means to recruit the child’s attention to new events or phenomena. The unfolding of this dance of social interaction requires the ability to coordinate visual attention around an object or activity and share an interest with another person.

Research has shown that young children with ASD are less likely to use joint attention acts and gestures and are less able to coordinate their vocalizations, eye gaze, and gestures than typically developing peers and children with other developmental disabilities. Poorly developed joint attention communicative acts are predictors of later language outcomes, and they have implications for development of conversational language. The level of communicative competence achieved by individuals with ASD predicts their long-term positive outcomes. These findings have led to a high interest in providing early interventions that teach parents to foster joint attention, with some promising results.

2. Development of Language: receptive and expressive

Language is generally divided in to two categories: receptive and expressive. Receptive language is essentially understanding the expressions and words of others. Children begin to develop this skill first. Expressive language is the child’s ability to express themselves. As children improve their language skills, they tend to understand more than they can say. In other words, their receptive language is almost always better than their expressive language.

Young children with language difficulties may have:

Preschool-aged children with language difficulties may have difficulty:

School-aged children with language difficulties may have difficulty:

Language development in autistic children

All children start developing language from the day they’re born. This happens through relationships and play with other people.

It can be harder for autistic children to learn and use language than it is for typically developing children.

Autistic children might have difficulty learning language because they tend to show less interest in other people in the first 12 months of life. They might be more focused on other things going on around them. Because they might not need or want to communicate with other people as much as typically developing children do, they don’t get as many chances to develop their language skills.

For example, a three-month-old baby who is distracted by a ceiling fan is less likely to tune into a smiling and tickling game with their parents. By nine months, if the baby still isn’t tuning into parents, the baby is less likely to point at things they want to share with parents. The baby is less likely to listen to their parents as they name things. This means the baby misses these chances to build vocabulary.

·       Supporting language development for autistic children

·       Creating reasons to use language
If autistic children have reasons to use language, they’re more likely to try using it.

You can create reasons for your autistic child to use language as part of your everyday activities together. For example, you could put your child’s favourite toy out of reach so your child needs to ask for it. Or you could take turns opening picture book flaps and talking about or showing each other what you’ve found. It’s important to pause long enough for your child to say what they’re thinking or feeling.

As your child learns, you can gradually make the activities harder. For example, you could start with your child just saying ‘ball’ when they want you to give them the ball. The next step might be saying ‘push the ball’.

·       Using play
Play is how children learn, including how they learn language. By playing games with your child, or just by making play part of your everyday activities, you can create opportunities for your child to develop language.

For example, if you’re doing a jigsaw with your child, you could hand your child a piece of the puzzle when they ask for it with eye contact.

·       Modelling language
You can show your child how to respond or ask for something by using modelling. Modelling involves speaking and using facial expressions and gestures in front of your child. It also means giving your child examples of what you want your child to learn, at a level that’s right for them.

For example, you could comment on what you’re doing, like saying ‘open’ as you open the car door. You can also comment on what your child is doing, like saying ‘stuck’ as your child tries to open a zipper on a bag.

If your child is trying to say something, you can model the words that you think your child needs, like ‘help’ as your child holds up a packet of food that they can’t open.

It’s best to use phrases that contain 1-2 more words than your child is currently using in their own speech. For example, if your child isn’t yet talking, model 1-2 word sentences. If your child is speaking in 2-3 word sentences, repeat what they say but add a couple more words to show your child how to build bigger sentences.

·       Building your child’s skills
To develop language, your child needs regular, meaningful and motivating opportunities to practise particular language skills.

For example, you could work on a skill like greeting people. Your child could start with greeting Mum with eye contact when Mum gets home from work. The next step could be eye contact and a cuddle, then eye contact, a cuddle and saying ‘hi’. Then you could work on transferring the skill to saying ‘hi’ when Grandma comes to visit.

·       Rewarding language use
You can reward your child when they listen, understand or express themselves. You could do this by using a natural consequence like giving your child the next piece of the puzzle when they make a request, or smiling and making a comment to let your child know you’re interested when they show you a toy.

3. Development of communication and conversation skills.

Communication is the exchange of thoughts, messages, or information through verbal or nonverbal means. Communication is a social event. Communication is not static. It does not follow a predetermined plan and it is often not organized, and shifts a lot. That is why many individuals with autism find communication so confusing.

It is only with people with autism that the development of comprehension does not precede production of language. Between 20 to 50 percent of individuals with autism remain nonverbal, i.e. they do not use speech. Even those who are verbal have difficulties in communication. They may learn the language system, but may not know how to use it.

For effective communication to take place there has to be a reason to communicate, something to communicate about, the means to communicate and the communicative environment.

Teaching language and communication skills to persons with autism needs to be concentrated on teaching the above mentioned aspects of communication

Teaching communication

Behaviours necessary to be a communicator

There are a number of important elements children with autism need to have in order to be successful communicators:

Understanding cause and effect: It relates to the child understanding that his behaviour can have a clear outcome. It is important to surround the child with daily activities that will expose him to cause and effect events such as playing with pop-up/musical toys that are activated by the push of the button. While exposing the child to such activities the child can be exposed to any form of communication systems mentioned below to pair it with some form of communication exchange.

Desire to communicate: It is necessary for parents and teachers not to anticipate the needs of the child with autism. Daily routines and communicative exchanges should be planned where the child is required to interact with others. This can be done by ‘engineering’ many of these situations throughout the day e.g. the desired item should be clearly in the control of someone whom the child must then ask in order to obtain it (e.g. on a high shelf or locked away when the person has the key). Sometimes even though the adult may know what the child wants it is important to delay meeting the child’s needs so that he is placed in situations that require him to interact with others to get his needs met.

Something to communicate about: If the child with autism does not have something to communicate about, he will remain non-communicative. Let the child determine what to communicate about. Follow the child’s lead. If the child shows a real interest in a toy or running water, start with it. After communication has begun the teacher or parent can then work on extended vocabulary.

Use social stories: Social Story is an effective tool to help individuals on the autism spectrum disorder to have a better understanding of different situations and help children to interact and behave in an appropriate manner. Social stories model the appropriate social interaction by describing a situation with relevant social cues, other’s perspectives, and a suggested appropriate response.

Use video modelling:  In video modelling, you demonstrate a person modelling proper social behaviour and help the child to imitate the behaviour.  

Role play: One of the best ways to help children with autism to learn communicational and social skills is to practice these skills in an imaginary scenario. During the role playing, you can be an imaginary character and the child can practice conversational skills with you as they have learned through conversation starter or video modelling. To role play:

1.     Try to play the role of a person or a character who is interesting and engaging for the child.

2.     Try to choose a topic that the child is interested in. Also, in the beginning, pick a topic that the child already has information about, so he can comfortably participate in the discussion. For example, you can say I saw that you have a Spiderman T-shirt. Do you like Spiderman?

3.     To role-play always ask open-ended questions, so you can ask more questions afterwards.

Positive Reinforcement: Reinforcements are the foundation of the learning process in a child with autism. Positive reinforcement helps the child to learn which behaviours are appropriate and favourable. Giving positive reinforcement is also important to create a fun and motivating environment for the child.

In the next blog post, we will focus on how to use conversation starters to help children with autism improve their communicational skills.

4. Alternative & Augmentative Communication Systems Communication aids & devices: Scope & limitations

Augmentative and alternative communication is a type of communication that combines gestures, eye pointing, vocalisations and pointing to symbols as communication for people with limited speech abilities.

Augment means to add to or to enhance. For example, we can augment speech by using gestures, eye pointing and body language.

Alternative means a choice or a substitute. We can use alternative communication to speech by pointing to symbols, signing or by spelling.

Communication means to send and receive messages with at least one other person.

This means augmentative and alternative communication (often shorted to AAC) is the term for all communication that is not speech, but other types used to enhance or to replace speech.

Augmentative and alternative communication systems can assist people who cannot speak to develop language skills and increase participation and inclusion in daily activities.  It’s an important tool that can give people more communication control and decrease frustration.

Therapists may suggest an augmentative and alternative communication system if speech is slow to develop or non-existent, or as a back-up if speech ability is very limited or difficult to understand.  An AAC system may be either a short or a long-term solution to communication difficulties being experienced.

Types of AAC 

Do you or your loved one have difficulty talking? There are options that might help. There are two main types of AAC—unaided systems and aided systems. You may use one or both types. Most people who use AAC use a combination of AAC types to communicate.  

Unaided Systems  

You do not need anything but your own body to use unaided systems. These include gestures, body language, facial expressions, and some sign vocabulary.  

Aided Systems 

An aided system uses some sort of tool or device. There are two types of aided systems—basic and high-tech. A pen and paper is a basic aided system. Pointing to letters, words, or pictures on a board is a basic aided system. Touching letters or pictures on a computer screen that speaks for you is a high-tech aided system. Some of these speech-generating devices, or SGDs, can speak in different languages.  

Augmentative and alternative communication covers a large number of ways of communicating. It can include one or more of the following, and NovitaTech clinicians can work with you and your family to find the right combination of methods:

Signing – this involves the use of a formal set of signs, or signs which are particular to an individual. Signing is useful to understand language. The sign can be seen and held for slightly longer if needed, whereas speech disappears as soon as it is spoken. Signing can also be used as a means of expression with other people who know signs.

Object symbols – these are objects such as smaller replicas or parts of objects which represent an activity, object or person (for example, a set of keys represents that it’s time to go in the car)

Photos, drawings, symbols – these are used like object symbols to represent words in a visual way

Communication boards and displays – these are sets of photos, drawings, symbols or words that are used by an individual for communication

Chat books – these are small books (often a photo album) that may contain photos, pictures, symbols, words and messages about a person

Speech generating devices – communication boards or displays on a machine which speak a message when a particular button is pressed

Spelling – using an alphabet board or typing device to spell out words and messages

PODD Communication Books – ‘Pragmatic Organisation Dynamic Display’, is a way of organising whole word and symbol vocabulary in a communication book or speech generating device, for users to select a word or symbol in communicating. They can have different formats, depending on the individual physical, sensory and communication needs of the person who will use it.

Natural communication methods – this includes pointing and gestures, mime, facial expressions and body language

Sign Language:
There are many pros to using sign language. First, it is a common form of communication as we all rely on the use of gestures to communicate. For example, I might put my finger up to my lip to indicate I want a person to be quiet or I might point to an item I want. Second, for the person to use sign language, he or she does not need any additional tools or devices to communicate. A third benefit is that signs actually "look like" the object that the gesture represents. For instance, the sign for ball looks like the person is holding a ball in his or her hands. Finally, when using sign, the person can learn to put multiple words together in a sequence and can eventually sign full sentences and use this system for many different functions of communication including requesting, commenting, and asking questions. Research indicates that sign language is a beneficial communication system for children with ASD and that those who use sign language may learn spoken language at a faster rate. This is likely because sign language requires the child to engage in motor planning just like speaking does.

While there are many pros, there are a few cons to using sign language as a communication system. The general public does not understand sign language, thus reducing the number of communicative partners that the child might have. Additionally, a child who has difficulty with motor imitation skills might have difficulty with learning the signs and performing them accurately.

Determining whether to use sign does require taking these factors into consideration; however, they should not be deterrents to using this system. Typically, those who will be communicating with the person with ASD can learn the signs needed to communicate effectively, and can learn to interpret the signs even when they are not performed perfectly.

Exchange Communication:
Exchange communication is a popular system because of the many benefits. First, it is a visually based system. Since many individuals with ASD process visual information effectively, this system can be learned very quickly. Second, it can be tailored to the learning needs of the person as the person can learn to exchange objects, pictures, drawings, or text. Third, exchange communication uses concrete visual representations that are easily understood by the communication partners.

While the system can be very effective, there are some important considerations. Not all individuals with ASD will be able to easily discriminate the objects or pictures they are to exchange to receive a desired item. For some, this step takes considerable time to learn. Additionally, when using an exchange system, it can be cumbersome and difficult to ensure the communication items are always accessible in every environment. Certainly, with any communication system one must make certain that the person can communicate no matter where he or she is, even if on the playground or at the grocery store. Exchange communication systems also require constant maintenance and upkeep such as taking new pictures or gathering new items. However, this often means the person is learning and building communication skills!

Speech Generating Devices (SGDs):
The SGDs have the same pros and cons that the exchange system has and they have some additional benefits. Since they have auditory output, they provide a way for the person with ASD to gain attention from the communicative partner without requiring visual proximity. This may be important for some individuals who struggle with interactions. Additionally, SGDs can be programmed to communicate long messages more closely approximating conversation. When using SGDs, it is important to consider the durability of the device to ensure they can withstand any bumps or knocks inflicted as well as the cost because many can by quite expensive. Furthermore, SGDs will need to be programmed and maintained, requiring frequent upkeep from caregivers and teachers.

Benefits of AAC

Many people who cannot rely on speech, could benefit from AAC. And there are challenges when people do not have AAC.

People who use AAC describe benefits

These include:

Challenges for people without AAC

There are often difficulties without AAC, when someone cannot talk reliably.

People who use AAC say that, prior to having a communication system, they experienced:


5. Role of speech & language therapist: early childhood to school years

Children grow and develop at their own rate. Although some children walk and talk early, others may be delayed in learning certain skills. If you have any concerns about your child’s development, the earlier you seek help, the better.

Early intervention is for children ages birth to 3 and their families. Early intervention is available in every state under federal law. In some states, early intervention programs may continue until a child is age 5.

Families and professionals, including audiologists and speech-language pathologists, are part of an early intervention team. They help children develop skills such as

Early intervention is different for each child and family depending on the child’s needs and the family’s priorities. The most important step is to start early.

Speech therapist or speech-language pathologists are trained personnel who work with children having speech-related disorders. They also provide screening, consultation, assessment, diagnosis, treatment, management and counseling services for children with special needs. Speech therapy plays an important role towards the holistic development in a child with autism spectrum disorder. It improves overall communication, enhances social skills, enables to cope up better with the society and function in day-to-day life. It should be started as early as diagnosis is made.

What Are Speech Disorders?

A speech disorder refers to a problem with making sounds. Speech disorders include:

What Are Language Disorders?

A language disorder refers to a problem understanding or putting words together to communicate ideas. Language disorders can be either receptive or expressive:

What Are Feeding Disorders?

Dysphagia/oral feeding disorders are disorders in the way someone eats or drinks. They include problems with chewing and swallowing, coughing, gagging, and refusing foods.


Role of speech therapist

Speech therapist does much more than simply teaching a child to correctly pronounce words. In fact, a speech therapist working with an autistic child may work on a wide range of skills including:

Therapists use a variety of strategies, including: