The Role of Speech-Language Therapists in Autism

Speech-language therapists (SLTs) are healthcare professionals who help support individuals in speech-language, communication, voice, and swallowing/feeding. In Malaysia, with growing awareness and resources for autism, SLTs can be helpful in supporting autistic children and adults in optimising and improving those skills and overall quality of life.

SLTs work in collaboration with a multidisciplinary team to help autistic individuals achieve their goals. Sometimes, SLTs work with occupational therapists (OT) to understand and support sensory needs, leveraging preferences during intervention sessions to maximise the learning experience. Additionally, SLTs may work with physiotherapists (PT) to integrate communication goals and practise into mobility and functional exercises.

Understanding Autism

Autism, or Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder that affects how a person communicates, interacts with others, and experiences the world. The support an autistic individual needs vary widely, but common challenges include difficulties with speech, language, and social interactions.

Neurodiversity Affirming Support

“Wow, I cannot tell you/your child is autistic!” might not be the compliment we think it is. We understand autism better as neurodivergence now.

Before this, autistic individuals are taught to act like a neurotypical person (i.e. maintain eye contact, stop stimming/hand flaps etc.) to communicate effectively. These approaches have been proven to cause a lot of harmful stress and anxiety to autistic individuals1,2.

Adopting neurodiversity-affirming practices means we understand that autistic ways of communicating are different, but not wrong.

Early Intervention & Detection

Autism is not ‘treatable’.

SLTs work to highlight the autistic individual’s differences as strengths instead of acknowledging these differences as traits that need to be fixed and ‘normalised’.
Early detection and intervention can help to:
  • Identify the types of support needed
  • Provide preferred communication systems and improve functional communication (e.g. speaking, non-speaking, or a combination)
  • Build language to express needs and feeling
  • Reduce frustrations in school/work and other social situations
SLTs are often among the first professionals involved in a child’s care after an autism diagnosis. They assess the child’s communication abilities and design tailored therapy plans to address their specific needs.

However, not all autistic individuals will need speech therapy, or need it in the long term. Their needs for support are dynamic and might come and go with age, demand of social situations, occupation, and other factors in the future.

Neurodiversity-affirming Support

For many autistic individuals, functional communication can be a significant challenge. SLTs can help in:

Play Skills

Play is powerful. It is a child’s way of interacting with the world. There is no right or wrong way to play as long as it is safe.

SLTs work with autistic children to connect, learn, and have fun in extended ways within the play context that they already enjoyed. The goal is not to teach them to play the ‘normal’ way.

Example of Goals

Child will stay engaged by joining in / observing / copying extended ways of playing with the same toys (e.g. stacking /  throwing / sorting).

Preverbal Skills & Engagement

Preverbal skills include:

  • Eye-contact
  • Imitation (copying)
  • Turn-taking
  • Joint-attention
  • Gestures/facial expression

Some autistic individuals might display preverbal skills differently from neurotypical people. If they do it differently, it does not mean that it is wrong or needs to be fixed.

SLTs support autistic individuals in engaging others in interaction with their preferred communication methods (e.g. speaking or non-speaking options).

Social communication such as initiating, maintaining, and ending interactions can also be supported through speech therapy.

Example of Goals

Child will initiate an interaction on a shared interest with the communication partner through any preferred preverbal skills (pushing, pulling, tapping), during various social interactions, in 4 out of 5 opportunities.

Functional Communication Skills

Functional communication skills include:

  • Requesting (I want…)
  • Protesting (I don’t want…)
  • Negotiating (If… then…)

…and many more! These functions are not limited to spoken-language only. It can also be through texting, pointing at pictures, or gesturing.

For children who are non-speaking or have limited speech, SLTs can help support the development of functional communication language by exploring a variety of augmentative & alternative communication (AAC) systems. This might include using visual aids, sign language, communication devices, or a mixture of these systems.

Example of Goals

Child will state how they are feeling and if there is anything they need (e.g., “I feel anxious. I need my fidget spinner.”), during a feeling scan activity or spontaneously, in 4 out of 5 of opportunities.

Feeding

Food and mealtimes could be stressful for some autistic individuals. SLTs work to support those with sensory sensitivities, limited food preferences, chewing and swallowing, and the difficulty with the social aspects of eating.

Example of Goals

Child will state foods that they like / dislike, when presented with menu options, across structured / unstructured settings, in 90% of opportunities.

Supporting Families

Communication is a bridge that goes both ways! On the other side of the bridge, SLTs support families of autistic individuals by building skills and communication strategies with them. As families are often the main communication partners, equipping families with these skills can help create a consistent and supportive environment for autistic individuals.

The burden to communicate and interact is not on the autistic individual alone.

School Readiness

For autistic children, preparing for school can be challenging as there are not many neurodiversity affirming policies available in our public education system.

SLTs play a key role in school readiness by working on communication skills that are essential for classroom participation. They will also help children learn to advocate for their communication accommodation and needs (e.g. telling teachers they need a sensory break, prefer to communicate through AAC instead).

Conclusion

SLTs are essential in supporting autistic individuals but not everyone might need this service. They help improve communication skills, support families, and prepare children for school and social interactions.

Individualised, neurodiversity-affirming, culturally sensitive care are important aspects of SLT support.

The ultimate goal is to help autistic individuals communicate and navigate social interactions with confidence, in their preferred way, as well as understand and advocate for their own needs and preferences.

References

  • Gaddy, C., & Crow, H. (2023). A primer on neurodiversity-affirming speech and language services for autistic individuals. Perspectives of the ASHA Special Interest Groups, 8(6), 1220-1237.
  • Izuno-Garcia, A. K., McNeel, M. M., & Fein, R. H. (2023). Neurodiversity in promoting the well-being of children on the autism spectrum. Child Care in Practice, 29(1), 54-67.

Author bio

This article is written by Tay Chia Yi, a hospital-based speech-language therapist (SLT) specialising in acute care. She also works in community rehabilitation with NGOs, supporting care partners and people living with dementia. With a passion for neurodiversity-affirming approaches, she advocates for inclusive, tailored, empathetic approaches to supportive therapy. Currently, Chia Yi serves as the President of the Malaysian Association of Speech-Language & Hearing (MASH), championing the rights and well-being of disabled communities and their care partners. Dedicated to amplifying the lived experiences of marginalised groups, she strives to create inclusive and supportive environments, particularly through advocating for Augmentative & Alternative Communication (AAC). She is able to communicate in Malaysian Sign Language (MySL)

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