For people with autism, speech therapy can greatly improve communication skills, especially when paired with other treatments such as ABA therapy. This therapy can treat a range of issues, such as helping kids to form sentences and understand the context of another person’s words.
Autism’s Effect on Speech
Autism, or autism spectrum disorder (ASD), is a developmental condition that affects how a person socializes, behaves, and communicates. These groups of symptoms show up in different ways, and they often affect speech.
Some children who begin to show signs of autism may not have trouble learning to speak. Other children may understand speech but not speak for many years of their childhood. Others may always have difficulty speaking and understanding speech.
If someone is on the autism spectrum , they may have trouble with speech and language skills in childhood. They may:
- Repeat words or phrases over and over, a condition known as echolalia.
- Reverse pronouns, such as saying “you” instead of “I.”
- Not respond to gestures like waving or pointing.
- Speak in a monotonous voice.
- Speak in a sing-song type of voice.
- Give unrelated answers to questions.
Behavioral therapy addresses several of the differences between people with autism and neurotypical individuals. Speech therapy is one form of behavioral therapy.
How Speech Therapy Helps Common Communication Issues Related to Autism
Speech therapy for people with autism addresses many potential communication issues. These may include learning how to pick up on social cues, learning how to speak, and improving vocabulary and sentence structure.
Working with a speech therapist at any point can be beneficial for someone on the autism spectrum. But the earlier in childhood this work begins, the better outcomes the individual will experience.
Children and adolescents with autism benefit from individual speech therapy as well as related interventions in school, at work, and in their community.
Speech problems that are common among autistic individuals can be addressed with speech therapy.
- Repetitive or rigid language: Autistic children and adolescents who are verbal may say things that are not related to their conversations with others or that have no meaning. For example, a child may list colors they know several times in a conversation that doesn’t have anything to do with colors.
- Children with autism may have echolalia, which means they repeat words or phrases they hear, including catchphrases or jingles they hear in movies or on television.
- Older children, adolescents, and adults may use stock phrases when they start a conversation. For example, they may always say, “My name is John,” when starting a conversation, even if they already know the person to whom they are speaking.
- Narrow interests and exceptional abilities: Children who speak may be interested in only one or two fields. They may deliver extensive monologues on a topic that holds their interest. This makes a two-way conversation difficult to hold since there is little space for the other person to interject or comment.
- Other children with autism may have poor verbal skills, but exceptional musical or mathematical abilities. About 10% of people who have autism have “savant” skills, or extremely high abilities in specific areas that hold their interest.
- Poor conversation skills: Gestures may not coincide with speech, or the person may not understand a gesture like waving or pointing as related to someone else’s speaking. They may also avoid eye contact or find it uncomfortable, which can make them seem rude, inattentive, or uninterested.
- Because they do not associate body language and spoken language in the same way, children with autism may become upset when they attempt to make their feelings, thoughts, or needs known to others. This may lead to frustration in the form of outbursts or other inappropriate behaviors.
- Uneven language development: Young children will not develop natural language abilities at the same rate as their neurotypical peers. For example, a child with autism may learn to read at a young age, but they may not be able to speak the words on the page even though they understand them.
- They can develop strong vocabulary around specific areas of interest. They often have good memory capacity for new information they just learned, so they can speak extensively about that knowledge.
- Despite these strengths, they may not respond to their own names or to speech directed at them, including speech from their parents. In very young children, this may seem like a problem with hearing at first.
Young children with speech and language development problems benefit from working with speech therapists as early as possible.
Speech therapy and other forms of treatment to address communication issues can still be effective later in life, for those who are not diagnosed with autism until adulthood.
Speech Therapy to Develop Both Verbal & Nonverbal Skills
Speech therapy for people on the autism spectrum addresses both spoken or verbal and nonverbal communication issues. Verbal skills that may be addressed in speech therapy include:
- Correctly naming people or things.
- Explaining feelings or emotions.
- Using words and sentences more effectively.
- Improving the rate and rhythm of speech.
Nonverbal communication skills that are addressed in speech therapy include:
- Using hand signals or sign language.
- Using picture symbols to communicate (Picture Exchange Communication System).
- Social skills, such as eye contact and standing at a comfortable distance from another person.
Speech therapists, also called speech language pathologists (SLPs) , are important in an overall behavioral treatment plan. They help people with autism understand the communication structures and social skills needed in different settings, like home, work, and school.
Speech therapy can occur on a one-on-one basis with just the therapist and client. The therapist can also oversee a group, allowing group members to practice skills with each other.
Speech therapy programs will address a range of skills, depending on the individual’s needs. These skills may include:
- Understanding and getting along with others in a variety of settings.
- Using appropriate communication behaviors.
- Taking turns in conversation.
- Transitioning from one task to another.
- Accepting change and expanding interests.
- Improving reading and writing skills.
- Improving vocabulary and sentence formation.
When someone is diagnosed with autism, especially in adolescence or adulthood, a speech language pathologist will test the person’s ability to use augmentative and alternative communication (AAC) . This is a term for different systems of communicating for people who struggle with verbal communication.
Certain systems are associated with AAC.
- Unaided systems: These do not require anything except the person’s body. They include facial expressions, body language, gestures, and sign language.
- Aided systems: These systems involve external devices. This ranges from a pen and paper, words or pictures to point to, or a computer system that can create sentences from information input by the autistic individual.
SLPs help autistic individuals and their families find the right system to use to enhance speech and written communication.
It is possible that some adolescents and adults do not have autism, but another social (pragmatic) communication disorder, which may have some behavioral patterns in common with autism. A speech therapist or SLP can provide information that is crucial to this final diagnosis.
Early Interventions With a Speech Therapist Help Children at All Levels
Medical studies show that children with autism benefit greatly from more intensive speech and behavioral therapy, especially at an earlier age. The more inclusive the therapy, the better the outcomes.
One study, published by the University of Michigan in 2011 , collected data from 1,000 children and adolescents with ASD. Researchers measured 15 social communication skills, including:
- Gestures and signs.
- Facial expressions.
- Language understanding.
- Sharing enjoyment.
- Suitable social responses.
When researchers examined these skills before and after therapy, 95.4% of the participants reported improvements in those areas. The response to therapy was highest among those with nonverbal IQs. However, researchers noted that having a higher nonverbal IQ could indicate some specific areas where a participant might excel, but did not automatically mean overall excellence.
Controlling for symptom severity and age, children who received treatment more intensively at an earlier stage of their development had greater advances in social-communication skills. For example, in children who were nonverbal at 5 years old, researchers found that the combination of higher IQ and intensity of speech therapy would most significantly predict whether the child would become verbal or not.
Depending on a child’s level of severity, they will require different approaches to managing any communication or speech differences. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines these levels.
- Level 1: These are mild cases of autism. The person may struggle in social situations, have some repetitive behaviors, and express some concerns over restrictive or rule-focused behaviors, but they only require minimal support for daily activities, including communication.
- Level 2: This group of people struggles more with social skills and communication, and their challenges may be more noticeable. They may or may not communicate verbally. If they are verbal, their conversations tend toward their interests rather than a wider range of topics.
- Level 3: This group has strong problems understanding social situations and communicating effectively. They also struggle with restrictive or repetitive behaviors, and they have trouble functioning in daily activities. They may not be verbal, or they may struggle with echolalia.
Early intervention is always important, but it’s particularly crucial for children who may be Level 3. This allows them to develop communication skills to interact with others in a way that is the most comfortable and effective for them.
Insurance to Cover Speech Therapy & Other Autism Treatments
Speech therapy is a medical intervention , and it is commonly covered by health insurance. While there may be some out-of-pocket costs that apply, insurance providers often cover a large portion of the bill.
The overall costs of autism can get expensive for families. The Centers for Disease Control and Prevention (CDC) estimates that caring for a child with autism costs on average $17,000 more per year than caring for a neurotypical child.
In 2017, 46 states banded together to make insurance coverage of autism-related medical treatment mandatory. This includes required developmental screening and treatment from specialists. The specifics vary from state to state. In many states, speech therapy is included under required coverage.
If you are concerned about health insurance coverage for speech therapy for your child, work with your pediatrician to get a referral to a specialist in your network. You can also work with your insurance provider to find the right speech therapist provider that accepts your insurance.
Since most states require insurance companies to cover vital interventions and therapies for autistic individuals, your insurance carrier will be able to offset the cost of speech therapy in most cases. You can also inquire with specific therapy providers regarding how they work with your insurance plan and what you will be expected to pay out of pocket for sessions.
An Essential Therapy
Ultimately, speech therapy can greatly help your child to improve their speech, language, and communication abilities. While speech therapy isn’t the only treatment autistic children need, it can greatly enhance an overall care plan.
- What Is Autism Spectrum Disorder? (March 2020). Centers for Disease Control and Prevention (CDC).
- Signs and Symptoms of Autism Spectrum Disorders. (August 2019). Centers for Disease Control and Prevention (CDC).
- Treatment and Intervention Services for Autism Spectrum Disorder. (September 2019). Centers for Disease Control and Prevention (CDC).
- Autism Spectrum Disorder: Communication Problems in Children. (April 2020). National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH).
- Speech-Language Therapy for Autism. (January 2017). Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHHD), National Institutes of Health (NIH).
- What Is Speech Therapy? Autism Speaks.
- Autism (Autism Spectrum Disorder). American Speech-Language-Hearing Association (ASHA).
- Augmentative and Alternative Communication (AAC). American Speech-Language-Hearing Association (ASHA).
- Children With Autism Benefit from Early, Intensive Therapy. (September 2011). Science Daily.
- Levels of Autism: Understanding the Different Types of ASD. (November 2019). Psych Central.
- The Role of the School Speech Language Pathologist and the Student With Autism. Indiana Institute on Disability and Community.
- Autism and Insurance Coverage | State Laws. (August 2018). National Conference of State Legislatures (NCSL).