Many parents wonder when their speech therapist will start to help their child with apraxia and autism produce more verbal speech. Even though we are called “speech” therapists, the full name of our title is speech-language pathologist. Although verbal speech is one of our priorities, helping children communicate using language is also of high importance. Language is not only verbal speech. Language consists of understanding spoken words, understanding gestures/body language, using gestures, writing, reading, using AAC (augmentative alternative communication), speech generating devices, and more.
Communication goes beyond just making a request such as “I want” or “more” and expands into great detail such as making comments, questioning, labeling, protesting, affirming, and much more. As speech-language pathologists, we work with our autistic clients to become total communicators. Being a total communicator means using a variety of ways to communicate such as using a mix of verbal speech, gestures, pictures, AAC etc to improve communication skills and reduce frustration. This is so important for the autistic clients we work with because it is estimated that 25-30% of autistic people are non-speaking (less than 30 verbal words) and may not develop consistent verbal communication abilities.
Our goal is to help children access communication in various ways, not just through verbal speech, since verbal speech might not develop for some autistic individuals for various reasons.
One of the reasons why verbal speech may not develop is due to the child having severe apraxia of speech that co-occurs with their autism diagnosis. It is important to understand that speech-language pathologists cannot help a child improve or produce verbal speech if the child does not have certain prerequisite skills that are absolutely necessary for apraxia therapy. Below, specific skills are listed that are necessary to develop before apraxia therapy is going to be most effective.
Joint Attention and Intrinsic Motivation: The child must have joint attention skills that are accompanied by an intrinsic motivation to communicate purposefully and socially with another person. Joint attention is when one person purposefully coordinates his/her focus of attention with that of another person. Joint attention often looks different in autistic children than it does in neurotypical children. Joint attention goes beyond only using communication to get a certain want/need met; joint attention consists of sharing a joint interest in something in a social way (ex. A child bringing a parent a new toy just for them to make a comment/look at it because the child seeks the engagement from an adult to share the joy). If a child is not sharing attention with the speech therapist yet during a session, it will be very difficult to achieve any imitation (verbal, gestures, play imitation, etc). In order to improve speech sound difficulties, the child must have solid joint attention skills and consistently attempt to communicate with others for a variety of purposes. For these reasons, joint attention and engagement would need to be targeted in therapy to improve before verbal imitation. This can often take a while to establish with an autistic child, patience is key during this time! This foundation must be established for future success.
Consistent Verbal Imitation: The child must be able to verbally imitate and do this consistently. This means if the therapist says "up" the child consistently tries to also say "up." Verbal imitation is a prerequisite skill to being able to improve speech productions in children with apraxia of speech. Speech-language pathologists cannot get a child to verbally imitate until the child has mastered many other pre-linguistic skills which need to be developed beforehand. Your child may have some of these skills, but if they are not mastered and fully developed, consistent verbal imitation will not be present. The key word here is consistency, so think, 80% of the time or more my child does these skills. If the skill is emerging or occurs infrequently, more time should be spent developing these areas.
These skills are:
Responds to people
Takes turns
Has joint attention
Initiates interactions with others
Responds to the environment
Develops a longer attention span
Plays in a variety of different ways
Understands words and follows directions
Vocalizes purposefully
Imitates gestures
3. Desire to Improve Verbal Speech: The child must have a desire to want to improve their verbal speech. If your child does not yet have a desire to produce verbal speech, it’s not because they’re “lazy” or “difficult.” It is simply because it’s not a skill they have developed yet. Improving a desire to verbally imitate can be worked on in speech therapy to build confidence and hopefully improve the child’s interest in exploring improvements in verbal speech. However, it should be noted that autistic individuals have differences in social language skills. Verbal imitation is a type of social language skill, and some autistic individuals may not develop this skill despite intervention due to differences in neurology.
4. Motor Planning Skills: The child needs to have foundational and solid gross and fine motor planning skills first. Gross motor planning is a prerequisite to fine motor planning skills, and speech is a fine motor skill. If a child is significantly struggling with gross and/or fine motor planning, they will likely struggle with fine motor planning for speech. Working with an Occupational Therapist can help improve global motor planning difficulties, laying the foundation for fine motor speech skills.
5. Foundational Communication Skills: The child needs to have some foundational communication skills which will reduce frustration and improve outcomes. This is often why speech therapists will recommend using AAC or a speech generating device during therapy sessions while the child develops in therapy. As the child’s communication skills grow stronger, therapy may shift and work more directly on verbal speech. However, remembering that not all children will develop access to verbal speech, it is so important to provide access to a robust AAC system to ensure no time is wasted in developing communication.
Overall, there are many skills that are needed to be mastered before a child is ready to improve their verbal speech production. If your child has not mastered the skills discussed above, targeting them in speech and occupational therapy is crucial to see if more verbal speech will develop.
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