All parents eagerly anticipate the moment their baby speaks for the first time. Maybe you have a baby journal with a blank space to write down that first word and all the other milestones. Maybe you sit up and pay attention every time your child gurgles and babbles. Maybe you’ve been waiting…and waiting…and waiting…and you’re starting to worry that those first words may never come.
Or maybe your child has started to speak, but has difficulty pronouncing certain sounds, only repeats others’ speech, and/or generally doesn’t seem to be building the skills needed for communication.
According to the Centers for Disease Control and Prevention, most infants should start to say “mama” or “dada” around the age of one year. By 18 months, most will say other short words like “no”.
If your child is slow to develop language, it can be a sign of autism spectrum disorder or a developmental disability. Parents may be tempted to take the “wait and see” approach if they have concerns that their child may be delayed, but it’s best to reach out for help as soon as possible.
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Autism Therapies and Solutions
Talk to your child’s doctor about a developmental screening test. The CDC recommends that young children be screened for autism at 18 months and two years old. You can also ask for a referral to a specialist, like a psychologist or neurologist, who can determine if your infant just needs time to catch up, or if his/her speech delays indicate something more.
If you live in the United States, your state is required to have a public early intervention system under the Individuals with Disabilities Education Act. This system provides a range of resources for children under three years of age, and a doctor’s referral isn’t needed to reach out. These services include help with vision problems, nutrition, physical therapy, speech pathology, and more.
When you reach out to the early intervention program, your child will be given an evaluation to see if he/she is eligible for services. Professionals will observe and talk with your child and have him/her perform tasks to see if he/she has significant delays or is developing normally. The standards for eligibility are a little different in every state, but children don’t necessarily need to have disabilities or disorders to qualify for intervention.
Let’s say your child does need early intervention for language delays—what is that process like? Let’s take a look.
How early should speech therapy begin for autistic children?
There’s really no such thing as “too early” to begin therapy. After all, early intervention is available for young children from birth to age three. Kids are typically diagnosed with autism when they’re toddlers, but can also be diagnosed as early as two years old. Language problems often become evident even before a diagnosis is certain.
The Individual Family Service Plan (IFSP)
An important part of early intervention is the family service plan. This document lists all of your child’s treatments and when he/she will receive them, along with specific goals for your child and his/her current state of development.
The IFSP is put together by a team of professionals and, of course, the child’s family. Since you’re reading this article, you’ll probably have a speech therapist on the IFSP team. Depending on what your child with autism needs, you may also have a physical therapist, a psychiatrist, a family advocate, etc.
In most states in the US, early intervention services end after the age of three. But if children need resources past then, the IFSP team will help create a transition plan.
The family service plan will most likely be reevaluated and updated every six months based on your child’s progress. Ultimately, this plan will determine how early and for how long your child will receive speech-language services.
What does early intervention with a speech-language pathologist involve?
A speech therapist, also called a speech-language pathologist (SLP), can address a wide variety of communication-related issues, from a lack of speech to difficulty with social skills in conversation. They are highly educated, holding at least a master’s degree and a state certification, as well as a certificate of clinical competency (CCC) from the American Speech-Language-Hearing Association.
The initial assessment
The early intervention therapist can use an array of techniques to examine the severity and type of speech-language issues your child has.
Informal tests are when the therapist simply chats, plays, and interacts with your child. This can provide important insights into the quality of your child’s speech and understanding of language. The SLP will probably also examine the patient’s mouth, including the tongue, lips, and palate (the roof of the mouth).
Formal tests are exactly what they sound like: standardized assessments that score children’s strengths and weaknesses in different areas.
Some of the most common formal speech-language tests are…
- The Preschool Language Scales – Fifth Edition (PLS-5) is designed for children from birth to seven years old. It prompts pointing or verbal responses to objects and pictures and takes about 45 minutes to an hour to complete.
- The Bayley Scale of Infant and Toddler Development – Third Edition (Bayley-III) addresses speech and other issues (such as motor skills, cognitive development, and social skills) to screen for general delays in development. It’s used for children aged 1-42 months and takes between 30-90 minutes to complete.
- The Goldman-Friscoe Test of Articulation 3 (GFTA-3) assesses how well a child articulates different sounds, how intelligible his/her speech is, and what specific sounds give him/her trouble. It can be used for ages 2-21 years and can take around 15 minutes to complete.
The therapist will also want to speak with you, the parents. Be prepared to share your observations, concerns, your child’s relevant schoolwork and medical history, etc. You and the speech-language pathologist will be a team, so don’t be shy about sharing your thoughts!
What comes next?
Therapy sessions will look different depending on your autistic child’s age and the specific skills he/she needs to build. Sessions may take place one-on-one, in small groups, in the classroom, or a combination.
Early intervention speech-language pathologists typically help the patient…
- grow his/her vocabulary
- improve articulation
- stimulate receptive language (what the child understands)
- stimulate expressive language (how the child uses words for communication)
- strengthen mouth and jaw muscles, if necessary
A delay in speech and language looks different for every autistic child, so the SLP will create an individualized treatment plan based on the initial assessment.
Play therapy
For toddlers, early intervention tends to involve lots of games and toys. This creates a fun, trusting environment between the patient and the therapist, but it serves larger purposes, too.
Oftentimes, the game itself is the point—play encourages the child to request things, take turns, and pay attention to nonverbal forms of communication, like body language and facial expressions. It can also be used as a reward when the child successfully completes other activities, like practicing vowels and consonants.
What does research suggest about early intervention speech therapy?
There is a long history of research showing that autistic children who receive early intervention have a better chance of leading independent lives later on.
Early Intervention in Autism, an article by Christina M. Corsello, PhD, reviewed multiple studies about the effectiveness of intervention in early childhood. There was “evidence that children who enter programs at younger ages make greater gains than those who enter programs at older ages.” The most significant difference was between those who entered programs younger than four or five and those who didn’t.
According to Corsello, the majority of evidence-based studies about early intervention for autism address Applied Behavior Analysis (ABA) therapy. She writes that ABA has shown promise in “teaching language content, including single word vocabulary, describing objects and pictures, responding to questions, and increasing the intelligibility of speech.” Programs that include classroom settings also tend to have good outcomes, as the children can transfer skills learned from adults to organic social interactions.
Interventions to Improve Communication by Rhea Paul, PhD discusses the three different types of early intervention speech approaches for kids with autism: didactic, naturalistic, and developmental/pragmatic.
- Didactic: according to Paul, this approach involves “high levels of adult control, repetitive periods of drill and practice, precise antecedent and consequent sequences, and a passive responder role for the client”
- Naturalistic: this approach tries to use more natural reinforcers to encourage behavior, such as “the satisfaction of achieving a desired goal through communication (the client says, “I want juice” and gets juice), rather than more contrived, extrinsic reinforcers such as getting a token…” Applied Behavior Analysis usually falls under this category.
- Developmental/pragmatic: this approach prioritizes functional communication, not just speech and language. It “encourage[s] the development of multiple aspects of communication, such as the use of gestures, gaze, affect, and vocalization, and holds these behaviors to be necessary precursors to speech production.”
Didactic treatment seems to be most useful for initial attempts at language. Because it’s highly structured, it’s also easy to teach parents how to replicate the exercises at home. However, it may not help a child learn to initiate speech his/herself or transfer new skills to other contexts.
Like didactic therapy, naturalistic therapy relies on reinforcers, but the reinforcers should be intrinsic to the situation. The patient may be taught in everyday environments and complete activities regularly, not just during a designated therapy session. According to Paul, there has been some evidence that this approach can produce language in nonverbal kids and improve development in those who are already speaking.
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The developmental-pragmatic approach is even more child-led. It involves lots of play and social interaction, and emphasizes using natural opportunities to teach instead of a strict curriculum. For now, there’s less empirical research to support this method, but it has shown promise.
Conclusion
It’s normal to be frustrated and worried if your kid has a speech and language delay. You want nothing more than for him/her to experience those first milestones. All children develop at different paces, but children with ASD or other disorders/disabilities might need extra help.
Luckily, at least if you live in the US as well as some other countries, an early intervention program is available to you. You can collaborate with your child’s SLP, teachers, and the rest of the team to help him/her achieve goals.
Of course, the journey doesn’t end at the first word—verbal kids with autism may still struggle with various speech and language issues. But research consistently shows that early intervention improves outcomes for children on the spectrum.
And if your child never speaks? It’s hard, but it’s not the end of the world. Plenty of autistic adults live happy, productive lives using alternative communication methods.
It’s important to access the resources and services available to you as early as possible—but remember to breathe. No matter what, there’s a community of spectrum families to support you.
References
Center for Parent Information and Resources. (2017, October). Overview of Early Intervention. Center for Parent Information and Resources. https://www.parentcenterhub.org/ei-overview/
Centers for Disease Control and Prevention. (2019, December 9). What is “Early Intervention”? Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/parents/states.html
Centers for Disease Control and Prevention. (2021, January 22). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/index.html
Centers for Disease Control and Prevention. (2021, March 12). Concerned About Your Child’s Development? Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/concerned.html
Corsello, C. M. (2005). Early Intervention in Autism. Infants & Young Children, 18(2), 74-85. https://journals.lww.com/iycjournal/Fulltext/2005/04000/Early_Intervention_in_Autism.2.aspx
Paul, R. (2008). Interventions to Improve Communication. Child and Adolescent Psychiatric Clinics of North America, 17(4), 835-856. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635569/
Pearson. (n.d.). Bayley Scales of Infant and Toddler Development | Third Edition. Pearson. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Behavior/Adaptive/Bayley-Scales-of-Infant-and-Toddler-Development-%7C-Third-Edition/p/100000123.html?tab=overview
Pearson. (n.d.). Goldman-Fristoe Test of Articulation 3. Pearson. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Developmental-Early-Childhood/Goldman-Fristoe-Test-of-Articulation-3/p/100001202.html?tab=overview
Pearson. (n.d.). Preschool Language Scales | Fifth Edition. Pearson. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Speech-%26-Language/Preschool-Language-Scales-%7C-Fifth-Edition/p/100000233.html?tab=overview
Special Education Guide. (2013). The Who, What, Why of an Individualized Family Service Plan (IFSP). Special Education Guide. https://www.specialeducationguide.com/early-intervention/the-who-what-why-of-an-individual-family-services-plan-ifsp/
Speech & Occupational Therapy of North Texas. (2020). WHAT HAPPENS IN SPEECH THERAPY. Speech & Occupational Therapy of North Texas. https://www.speechandot.com/happens-speech-therapy/
