Advocating For Speech Services For The Student With An Autism Spectrum Disorder

By Louis Geigerman

The necessity of speech services for individuals with autism spectrum disorders is well documented. The DSM IV criteria for an Autistic Disorder diagnosis includes at least one of the following symptoms:

Qualitative impairments in communication as manifested by at least one of the following:

a. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

c. stereotyped and repetitive use of language or idiosyncratic language

d. lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level

Clearly, speech development plays an important role in this population. In my advocacy practice, I have found it often to be a source of disagreement regarding eligibility between school based personnel and parents.

Generally, in the more severe cases where there is limited or the absence of speech altogether in the student, controversies exist more on the how to serve the client through proper methodologies rather than denying eligibility to the student. On the higher functioning end of the spectrum however, I routinely encounter speech pathologist arguing whether students qualify for services. The problem in the higher functioning student centers on speech pragmatics.

Speech Pragmatics is defined as language that is used to communicate and socialize. Most people think of speech therapy as a tool for improving pronunciation, reducing stutters, or simply building the ability to use words at all. Many people with autism do have the ability to talk, and some talk a great deal, but almost all can benefit from therapy focused on speech pragmatics.

Since difficulty with social communication is a hallmark of autism spectrum disorders, literally everyone with an autism diagnosis will need some level of pragmatic speech therapy. According to the American Speech-Language-

Hearing Association, people with pragmatic speech issues may:
•say inappropriate or unrelated things during conversations
•tell stories in a disorganized way
•have little variety in language use (1)

Pragmatics also involves difficulties in problem solving and perspective taking. Unfortunately, these deficits quite often lead to social isolation and bullying if they are not properly identified and treated. A good source to refer to regarding this issue is Michele Garcia Winner’s, CCC SLP, book “Thinking About You, Thinking About Me.” According to Ms. Winner, pragmatic difficulties are at the very root of social difficulties in this population.

The problem that I frequently see in my practice is that many school based speech pathologists do not use the proper diagnostic tools to assess this problem. A frequently used assessment in the ASD population is the Test of Pragmatic Language (TOPL) which unfortunately is a rather poor indicator of the true difficulties. This assessment provides a series of questions that have a tendency to mask the bigger issue of problem solving and social naiveté. The higher functioning ASD student can effectively ace the TOPL leading the evaluator to believe that a pragmatic language deficit does not exist. A better tool is the Test of Problem Solving that provides real world experiences for the student to solve. In the overwhelming majority of cases the student will show significant difficulties in giving solutions to the various scenarios.

Here are a few resources that I recommend every parent with a child with an autism spectrum disorder check out:

Michele Garcia Winner’s website:
http://www.socialthinking.com

The American Speech & Hearing Association website:
http://www.asha.org/public/speech/development/Pragmatics.htm

Caroline Brown’s website:
http://speech-language-therapy.com/spld.htm

As I have stated in my previous articles, it is vital to have an accurate assessment to determine eligibility. If you disagree with the school based assessment, let the school know that you disagree in writing, but you do not have to tell them why you disagree. Parent attorneys will tell you that it is better to not explain the nature of your disagreement as it can complicate your case should it go to due process.

Exercise your right to obtain a second opinion by requesting an independent educational evaluation (IEE) at public expense from someone that is not employed with your school system. After receiving your request the district has only two options:

1. Yes, we will approve your request using our criteria for the evaluators.

2. No, and we will initiate a due process case to prove our evaluation was proper. If that happens, they are the ones that have the burden of proof to show that their evaluation is proper and that may be difficult.

Finally, the district will likely provide you with a list of providers for the IEE. Not only are you not required to use clinicians from their list, but I recommend that you do not as it highly likely that those clinicians are less than objective. You can use anybody you like as long as they are qualified to perform the evaluation.

The importance of properly identifying students with speech impairments and designing appropriate individual education plans is paramount in assuring a successful outcome for the student with an autism spectrum disorder.

Louis H. Geigerman
National ARD/IEP Advocates
P.O. Box 16111
Sugarland, Texas 77496-6111
http://www.narda.org
email: louis@narda.org
281-265-1506