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IAN Research Findings: Speech and Language Therapy

Date First Published: January 31, 2008
Date Last Updated: February 25, 2008 

With special thanks to Jennifer S. Pannone, M.S., CCC-SLP, of the Center for Autism and Related Disorders at the Kennedy Krieger Institute, for her contribution to this article.

Speech and Language Therapy: A Key Intervention for Individuals with ASD

Speech and language therapy, considered an essential intervention for any child with speech and language deficits, is mandated by the Individuals with Disabilities Education Act. 1  It is generally provided by a speech-language pathologist (SLP) -- a professional expert in communication and social development. This person does much more than help a child learn to form words. The field of speech-language pathology is concerned with the study of communication, disorders of communication, and assessment and treatment of these disorders. The following are areas targeted by an SLP:

• Articulation/Phonology (movement of muscles used to produce speech; production of speech sounds)
• Morphology (grammatical rules)
• Syntax (sentence structure)
• Semantics (language content/meaning)
• Pragmatics (social use of language)
• Fluency (flowing, effortless speech)
• Prosody (variations in pitch, volume, and rate of speech)

A large percentage of people with autism do not use language functionally, that is, to communicate basic needs and wants. Even those who can speak will likely have difficulties with the pragmatic, or social, use of language, which includes understanding social cues, using appropriate conversational rules, and understanding age-appropriate humor. Whether a child is nonverbal or has a large vocabulary, has cognitive delays or has above-average intelligence, speech and language therapy can be a valuable piece of the therapeutic puzzle.

 

The setting for speech and language therapy will likely change as a child ages. Clinical services, school-based services, social skills groups with peers, and community training all may be part of the spectrum of therapy over time.

In the section that follows, we share the experience of families participating in IAN with regard to this crucial intervention.

IAN Families and Speech and Language Therapy

Families participating in IAN Research have the opportunity to list all autism treatments they use, and to rate these. The IAN Research team then ranks all the treatments in two different ways. The first time, each individual treatment is ranked, so that every separate medication, vitamin, diet, or other intervention stands on its own. (See Table 1.) When ranking treatments used by IAN families this way, speech and language therapy holds first place.

Table 1. Top Treatments Used by IAN Families
Individual Ranking
Rank Treatment
1
Speech and Language Therapy
2
Occupational Therapy (OT)
3
Applied Behavior Analysis (ABA)
4
Social Skills Groups
5
Picture Exchange Communication Systems (PECS)
6
Sensory Integration Therapy
7
Visual Schedules
8
Physical Therapy (PT)
9
Social Stories
10
Casein-free Diet
11
Gluten-free Diet
12
Weighted Blanket or Vest
13
Risperdal
14
Melatonin
15
Probiotics

Next, treatments of a similar type or class are grouped together before being ranked. For example, Risperdal and Ritalin no longer appear separately, but are included with all other drugs under "Prescription Medications." In this grouped ranking of treatments used by IAN families, speech and language therapy is only second from the top. (See Table 2.)

Table 2. Top Treatments Used by IAN Families
Group Ranking
Rank Treatment
1
Prescription Medications
2
Speech and Language Therapy
3
Occupational Therapy (OT) 
4
Applied Behavior Analysis (ABA) and Related Therapies
5
Treatments for Sensory Integration Dysfunction
6
Casein/Dairy-free and/or Gluten-free Diet
7
Social Skills Groups
8
Picture Exchange Communication System (PECS) 
9
Visual Schedules
10
Essential Fatty Acids
11
Physical Therapy (PT)
12
Social Stories
13
Greenspan -- Floortime/Developmental Individual Differences Relationship-Based Approach (DIR)
14
Melatonin
15
Probiotics

Who recommends speech and language therapy to families? This varies quite a bit. Most commonly, this recommendation is made by a team of professionals (30%), a pediatrician (19%), or a speech-language pathologist (15%).

Obtaining the Therapy

One of the positive aspects of speech and language therapy is that most parents find it relatively easy to obtain. Gaining access to some therapies requires a Herculean effort, but this did not seem to be the case for speech and language therapy, probably because it is an intervention mandated by the Individuals with Disabilities Education Act (IDEA). (See Table 3.)

Table 3. Action Taken to Obtain
Speech and Language Therapy
Extra Action Taken to Obtain Therapy
Number of Families Who Took this Action
Move to another state
5%
Move within a state to another county
5%
Enroll in a research study
5%
Travel more than 100 miles to see a professional or therapist
6%
Pursue legal action
7%
Go to a new doctor or specialist
12%
Put child in a different school
16%
Quit job or reduce hours to take child to therapy or do treatment at home
18%

 

The action taken most often to make speech therapy possible was "quitting job (or significantly reducing hours) to take child to therapy or arrange treatment at home." Still, only 18% of families say they have taken such action. This compares with 31% of families who are using, for example, an intensive therapy like Applied Behavior Analysis (ABA).

 

Funding the Therapy

 

What financial burden does providing speech and language therapy for their children with ASD place on families? Of those who answered questions about the cost of this therapy, 74% report obtaining it at no cost, while the remaining 26% report paying some portion of the expense. Of those who do pay something, more than half pay between $100 and $500 a month; overall, some pay as little as $1 and others pay in excess of $2,000.

 

How do so many families obtain this therapy at no cost? Many receive the therapy via an early childhood program or a public school. (See Figure 1.)

 

Figure 1.
Pie chart shows public funding for speech therapy from schools, early childhood intervention programs, etc.

 

 

 

As might be expected, 91% of those who report receiving this therapy at no cost receive it via a publicly funded program. In addition, 53% of families who pay something for speech and language therapy also receive it through a publicly funded program. It may be that some parents, considering language a crucial part of their child's ability to progress, seek out additional speech therapy beyond that offered by schools or early intervention programs.

 

Does health insurance help parents pay for speech therapy for their child? Not often. Such costs are covered to some extent by private insurance or Medicaid in only 37% of families (19% have private insurance; 11% have Medicaid; and 7% have both). The remaining 63% of families report no insurance coverage for speech therapy costs.

 

Hopes and Results

 

As a child begins this therapy, how optimistic do parents feel? As treatment progresses, are their expectations for their child's progress met?

 

Parents are hopeful at the outset, with 90% expecting at least a moderate level of improvement in their child's communication and social interaction. Similarly, 90% report definite improvement in their child's skills. Of all parents rating their child’s progress due to speech and language therapy, 42% reported a high or very high level of improvement. This compares to only 30% of parents reporting a high or very high level of improvement for all other current treatments being used by IAN families.

 

(Please note: the information reported here reflects only parents’ evaluation of current treatments. Because any treatment a child is currently receiving must be considered worthwhile by parents, we expect ratings to be fairly high at this point. As data is collected over time, and families can report on treatments they have dropped, there will likely be more negative reports.)

 

The data make it clear that there are several reasons that speech and language therapy is in use by more than 2,000 of the families participating in IAN:

 

  • It addresses key concerns in autism, including the ability to communicate and to interact socially.
  • Fully 99% of parents feel that the therapy involves no, or very little, risk.
  • Nearly 73% of parents feel that carrying out the therapy involves no, or very little, burden or difficulty.
  • 81% of families receive at least some public funding for the therapy.
  • 90% of families expected it to have a positive effect at the outset.
  • 90% feel that it has alleviated their child's symptoms or improved his or her skills.

 

 Stay tuned for additional IAN Research findings on a variety of autism treatments!

 

 

 

Please Note: These Findings Are Preliminary

 

The analyses presented here by the Interactive Autism Network are preliminary. They are based on information submitted via the Internet by parents of children with autism spectrum disorders (ASDs) from the United States who choose to participate. They may not generalize to the larger population of parents of children with ASDs. The data have not been peer-reviewed -- that is, undergone evaluation by researchers expert in a particular field -- or been submitted for publication. IAN views participating families as research partners, and shares such preliminary information to thank them and demonstrate the importance of their ongoing involvement.

We encourage autism researchers investigating these topics to apply for access to the IAN database. Contact researchteam@ianproject.org.

 

References

 

  1. National Research Council. (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press, pp. 138-139.
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