Speech, Language and Communication

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Speech and language deficit is one of the defining characteristics of autism. We often hear the terms speech and language used interchangeably. They might mean the same thing when we are generally talking about communication. But the terms speech and language have different meanings.

SPEECH– refers to the actual sound of spoken language. Simply put, ability to speak or talk. It is oral form of communication. It requires using muscles of the tongue, lips, jaw and vocal tract in a coordinated way to produce sounds that make language.

LANGUAGE– refers to the system of words or symbols – written, spoken or expressed with gestures or body language- that is used to communicate meaning.

A child lacking speech can still use language, not in a spoken form but in written or gestural form. On the other hand, a child having speech can still struggle to use language effectively to communicate what he means. Thus, speech and language are mutually exclusive. Presence of one does not guarantee presence of other. Similarly, absence of one does not mean absence of other.

Just as speech and language differ, there is a difference between speech disorder and language disorder.

Speech disorder usually indicates someone has trouble producing sounds accurately.

Language disorder means difficulty in understanding the meaning of what is being said (receptive language deficit) or expressing their own thoughts (expressive language deficit).

Speech and language disorders can occur separately or some individuals may have both together.

Children with speech difficulties are far more likely to be noticed, and more likely to be referred to speech and language pathologist. While speech problems are easy to spot, we should be alert to subtle problems with language and communication in those with clear speech.

Speech and language by themselves are not useful unless they are used for communication.

COMMUNICATION is any behavior exchanged with another person that produces related or direct social rewards.

  • A baby cries ….. mom gives milk. Crying is a behavior to communicate hunger.
  • A small child points to apple when hungry, he gets apple. Pointing is a behavior to communicate wanting to eat apple.
  • A little older child says ‘’apple’’ and gets apple. Saying apple is a behavior to communicate wanting to eat apple.
  • Grown ups say ‘’I am hungry’’ to communicate wanting food.

In all of the above examples the individuals engaged in the act of communication. As a baby the communication was pre-intentional and then more intentional when they grow up. Simply put, as a baby we pre-intentionally communicate by crying.This behavior is not directed to another person. It requires people in our environment to interpret what we are communicating. Then we learn the power of gestures and words. This involves intentional directed communication towards another person.

For children on the spectrum, this understanding that communication produces positive outcomes maybe absent. It is common to see a 4 year old child with autism crying to ask for food. A 6 year old biting for not wanting to do work.

Thus, teaching communication to children on the spectrum is vital. They need to be taught the positive outcomes of communication. However, the misconception is that communication has to be spoken verbal speech. This can be challenging for kids with speech disorder. A child not having speech does not mean he doesn’t have anything to say. Imagine the frustration of wanting to communicate your thoughts, wants and needs to other people and not being able to do so.

Under these circumstances, waiting for the child to speak and eliminating other means of communication would result in increased frustration. Some kids can make some sounds or can speak but the speech is not clear should also be taught other means of communication for them to communicate effectively and clearly.

Other means of communication could be using pictures, signs, writing or typing.

Learning to communicate is considered to be an indispensable individual right and an essential life skill. Empower the child with the ability to communicate whether or not they have speech. No matter how many higher level or functional skills a child might have, if he or she cannot communicate his thoughts, all the other skills are a waste.

Communication is the real power.

 

 

 

 

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ABA Therapy – What to Expect?

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ABA (Applied Behavior Analysis) has become the most popular intervention for autism since it developed because it is evidence – based and the results are observable and measurable. ABA has been around since 1960s and since then volumes of research has been done to establish the effectiveness of its principles. It entails application of principles of learning and motivation to bring changes in socially significant behaviors and enhance learning. Although it is most popularly known as the intervention for autism, it can be used with any individual to bring positive changes in behaviors.

Due to its widespread use and different practitioners using different approaches to ABA, it has become a little confusing. Many people associate ABA to a narrow set of practices rather than understanding the wealth of applications it offers and the ways in which it can be used to improve children’s lives. Its scope is very wide – addressing behaviors, developing speech and language, play and leisure skills, functional and daily living skills and improving gross and fine motor skills, ABA can be applied to teach almost anything provided the practitioner has the expertise to do so. Different practitioners have different levels of training claiming to do ABA and the parents are clueless as to what to expect from therapy or how to tell whether their child is getting effective treatment.

Following are the guidelines for parents in choosing the correct practitioners and knowing what to expect for quality services:

  1. The Center/Organization/Program should be headed by a BCBA (Board Certified Behavior Analyst) / BCBA-D (Board Certified Behavior Analyst – Doctoral). In case, the program is not directly headed by a BCBA or BCBA-D, it should be supervised or overseen by one.
  2. In case of doubt, one can request the ABA provider to show their certification document. Alternately, you can also check whether the practitioner is certified on the Boards website: http://www.bacb.com under certificant registry. Every certified individual is listed there.
  3. Direct staff should be properly trained and should be able to discuss treatment plan with you.
  4. Data is collected, reviewed and the changes in program/treatment is data based.
  5. Progress or regression is discussed with you regularly.
  6. There is an Individualized Educational Plan (IEP) and you know the entire program and behavioral intervention.
  7. You are encouraged to participate in therapy and observe the sessions. Your input and participation is requested and welcome.

Apart from choosing and having an effective ABA treatment for the child, there is huge responsibility that lies with parents as well. Sending the child to ABA therapy alone will not miraculously bring changes in the child. Parents also need to be willing to learn from the sessions and adopt the ABA principles in their lives.

Lovaas, the pioneer of ABA treatment, believed that applying ABA principles at all waking hours by therapists and then by parents remainder of the day can lead to life altering progress for young children with autism…and nothing can be closer to truth than this.

ABA therapy is lifestyle change. It is not something you do just to fill in time left after various other therapies. ABA therapy doesn’t take a day off. It should not stop because it is vacation time, guests are visiting, child is sick or school has started. It is 24/7 therapy that goes on every waking hour of a child. When the therapist is not working one on one with your child, then it is the parents who take over. If you do not have a commitment to ABA therapy or do not understand and agree with it, you will not see the progress you are expecting to see from ABA therapy.

Suruchi Sancheti, MS, MS, BCBA

Director, Hope Center for Autism

Autism – The Fad Magnet

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Autism diagnosis in itself is perplexing and distressing for parents. To add to that is plethora of interventions or “treatments” which have no scientific support of any kind, prescribed by so called “experts”. These treatments sound promising and claim to bring fast and amazing results playing on the desperation of parents to “cure” autism.

Why is autism diagnosis fraught with such fad treatments? It could partly be because there is no clear cause of autism. There are only theories as to what may cause autism and therefore, there are a lot of non-evidence based treatments that relate to those theories. The other reason could be that these unproven treatments offer quicker results, are less expensive, get a lot of media attention, have emotional appeal and are vouched by other parents as opposed to research-based and proven early intervention treatment (ABA) which is highly structured, expensive and requires several hours of therapy per week over several years requiring patience, perseverance and consistency from parents.

The only intervention that will actually be effective is the one that is backed by scientific evidence  and DOES NOT rely on your having faith in it or accepting anecdotal proof. ABA is one such intervention that has volumes of research to prove its effectiveness. It is validated by repeated and consistent replication of beneficial results in the scientific literature.

There are a lot of treatments that use scientific words or present theories that are plausible but have not been proven by scientific research. This is called PSEUDOSCIENCE – something that sounds/appears like science but actually is not. These treatments come under biomedical treatments which have not yet been subjected to repeated and rigorous research. Thus, conclusion regarding their effectiveness cannot be made. Biomedical treatments treat chemical imbalances in the body that are believed to (not proven) to cause autism.

Some of the biomedical treatments are:

Gluten Free – Casein Free Diet (GFCF): number 1 on the list of biomedical treatment is GFCF diet. It goes hand in hand with the diagnosis and is the the default treatment prescribed by all practitioners along with a number of others. There is no evidence to verify that GFCF diet has any effect on autism symptoms. These diets have been found to cause lower bone density and low immunity, not to mention being a trigger for a lot of inappropriate behaviors stemming from child’s awareness that he cannot have the food that others are having.

Chelation Therapy : it claims to clean body of toxic chemicals and heavy metals. FDA-approved chelation agents are approved for specific uses that do not include the treatment or cure of autism.

Vitamin B-6 and B-12 Supplements

Antifungal treatments : to treat overgrowth of fungus candida that may contribute to behavioral and digestive problems associated with autism.

Parents looking to cure autism need to accept that there is no “cure” for autism. Same is true for many methods that claim to “treat” autism-related symptoms. Parents should make educated decision regarding effective and proven intervention for autism and be wary of pseudo-scientific methods that may carry significant health risks.

By: Suruchi Sancheti, MA, MS, BCBA

 

 

 

Look at me…..

 

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They say – Eyes are windows to the soul but some are uncomfortable with what they see in there.

“Ethan, look at me and say Hi”.

“Arvi”… “Nice job looking at me, here is your toy!”.

“Nice job looking at me and saying good morning!”.

These are some common phrases we hear during therapy sessions of children on autism spectrum.

Eye contact is considered as one of most important nonverbal communication behaviors that suggests interest in social interaction. It also shows that one is paying attention to what is being said.

Absence of or limited eye contact is so pervasive among individuals on the spectrum that it is one of the diagnostic criterion for the disorder. It is such a common social behavior that most people do not understand why making eye contact is so difficult for this population. If an individual is not making eye contact when we are talking to him, we doubt if he has understood the instruction or heard what we have said. Often, if a child on the spectrum greets without eye contact we either feel offended or take it as he is not interested in greeting us. Some individuals who do make eye contact upon insistence have it as a staring gaze than as a communicative exchange.  Some gradually learn to make eye contact as their comfort and competency increases in social situations. All in all, eye contact is not a natural skill that develops in this population.

Teachers are trained to get child’s attention before giving instruction and to recapture attention to task during therapy session if their demeanor suggests waning attention. To do that we mostly hear them cuing “look at me” assuming that the child is paying attention and understanding the instruction if he makes eye contact and cannot be paying attention if he does not make eye contact. Getting eye contact sometimes becomes a power struggle between the teacher and the child with teacher getting more insistent about it and the child more reluctant about it. Demanding that an individual make eye contact may have more to do with making the speaker feel heard and shows no understanding of actual experience for the individual in question. They often have to tune one sense down in order to give another sense more focus. A lot of individuals are able to focus more on what you are saying when they are not looking at you because making eye contact is so over stimulating for them that they cannot really attend to anything else.

Many individuals on the spectrum have unusually developed peripheral vision. I know one student who would be walking straight in the hall way without looking sideways but could tell exactly what was written on the notice boards outside all the classrooms.

A lot of individuals have given their reasons as to why it is difficult for them to give eye contact:

“Eye contact has been a problem throughout my life. My best thought about it is you can have my attention or you can have my eye contact, you cannot have both. If I am looking at you I am noticing things about your face and that is where my attention is focused, I am not listening to a word you are saying. Conversely if I am paying attention to what you are saying my eyes may be closed,”

“My eyes take pictures of the things I see, and I can mentally go back and revisit these pictures in my mind for a very long time. If I look into your eyes for too long, I become overcome with so many pictures of your eyes. It is overwhelming, and I have to look away to give my mind something else to process.”

“When I make eye contact, the world around me blocks out. I can only process the immense pain and discomfort that comes to my brain. This pain goes if I look away.”

So, should eye contact be insisted upon?

Eye contact and autism are a very controversial and complex issue but in my opinion it should NOT ALWAYS be insisted upon.

Eye contact is socially appropriate but can be hugely uncomfortable for some. It is imperative to understand idiosyncratic ways in which individuals take in and process information. If you see that an individual’s attention and responsiveness is better with eye contact then demanding eye contact is necessary. However, we also need to realize how conventional social expectation can interfere with learning. Guiding individuals in focusing and engaging in tasks specifically related to the activity at hand is often more effective than trying to obtain attention through eye contact and then expecting that the person can quickly shift attention to a set of task-related stimuli.

Instead of insisting upon looking into the eye during social interactions  teach them to orient their bodies towards the speaker or look at other parts of the face like forehead, bridge of the nose, lips.

Teach them to give initial eye contact when a person starts interacting with them and then look away to concentrate on they are saying, not insisting on maintaining it throughout the interaction.

Get to their eye level while talking to young children and “catch their eye” instead of constantly badgering them with “look at me”.

Forcing individuals with autism to look someone in the eye may cause lot of stress and anxiety for them. Instead, slow habituation towards eye contact may be a more appropriate way to deal with it in the long run.

By: Suruchi Sancheti, BCBA