“Don’t tell me the moon is shining; show me
the glint of light on broken glass.”
ANTON CHEKHOV
Speech-Language Therapy (SLT) plays a vital role in the intervention of neurodevelopmental disorders, which affect communication, social skills, and cognitive functioning. These disorders, including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and specific language impairment, can significantly impact an individual's ability to communicate effectively.
For many, sharing their thoughts and feelings in a world full of words can be challenging, but this journey can lead to meaningful connections and enhance their relationships with others.
SLT aims to improve communication skills, enhance social interactions, and support overall development. The therapy is usually tailored to each child’s needs and may include the following components:
Assessment and Diagnosis:
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SLTs conduct thorough evaluations to identify specific communication challenges and strengths. This may involve standardized tests, observational assessments, and discussions with caregivers.
Individualized Therapy Plans:
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Based on assessment results, SLTs develop personalized therapy plans that target specific areas such as speech clarity, vocabulary development, and social communication skills.
Targeted Interventions:
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For ASD: Therapies may focus on improving social skills, such as taking turns in conversation and understanding nonverbal cues. Techniques like social stories and role-playing can be effective.
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For ADHD: Interventions may address attention control during conversations, helping individuals stay on topic and listen actively.
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For SLI: Strategies often emphasize vocabulary building, sentence structure, and comprehension skills through engaging activities and games.
Family Involvement:
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SLT encourages active participation from family members. Educating families on communication strategies can enhance practice at home and provide support for the individual.
Use of Technology:
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Incorporating technology, such as speech-generating devices or apps, can be beneficial, especially for non-verbal or minimally verbal individuals. These tools can facilitate communication and encourage engagement.
The impact of SLT interventions for many children with neurodevelopmental disorders can be profound. Key benefits include:
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Improved Communication Skills: Enhanced abilities in both expressive (speaking) and receptive (understanding) language.(1)
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Social Skill Development: Increased confidence in social interactions, leading to better peer relationships and reduced anxiety.
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Academic Support: Improved communication skills can contribute to better academic performance, particularly in literacy and verbal tasks.
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Enhanced Quality of Life: Effective communication fosters independence, self-expression, and social connections, significantly improving the individual's overall well-being
While the primary aim of speech therapy for developmental disorders is to improve a child's communication abilities, it goes beyond simply learning to say words. Here is an in-depth look at why speech therapy can play a crucial role for a child with neurodevelopmental disorders (NDD):
Pre-linguistic skills:
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SLT can help children develop foundational skills such as eye contact, gestures, and vocalizations, which are essential for effective communication. By fostering these skills, children learn to engage with others, express their needs, and convey emotions, laying the groundwork for more complex language development and social interactions as they grow.
Nonspeaking communication:
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Children affected by ASD may struggle to pick up subtle social cues in body language. Speech-Language Pathologists (SLPs) can assist in recognizing these signals and exploring augmentative and alternative communication (AAC) methods, including gestures, picture cards, and electronic devices, as well as the Picture Exchange Communication System (PECS). These systems can be particularly important for non-verbal children, as they provide essential tools to express their needs and feelings, reducing frustration and facilitating social interactions. This, in turn, can significantly enhance their overall quality of life and ability to integrate into various environments.(2,3)
Speech fluency:
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SLT can address fluency issues, such as stuttering and cluttering, helping children speak more smoothly and effortlessly.
Articulation:
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Effective speaking requires the coordination of various articulatory structures. SLPs can help improve a child’s control and coordination, strengthening the muscles in the mouth, jaw, and neck to enhance sound production.
Functional speech:
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Some children may repeat words or sounds, a phenomenon known as echolalia. Research suggests that echolalia serves as a coping mechanism for communication when spontaneous speech is challenging. SLPs can help these children move beyond echolalia to develop functional speech.
Social Skills:
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SLPs can help children learn how to communicate well in different situations, similar to the work of an Applied Behavior Analysis (ABA) therapist. This support focuses on teaching children how to adjust their communication style based on the context, whether they are talking to peers, family members, or teachers. The therapy typically includes a mix of one-on-one sessions, where the SLP works directly with the child to practice specific skills, and social skills groups, where children interact with peers in a structured environment. In these groups, they can practice conversation, turn-taking, and understanding social cues in real-life scenarios. This combination helps children build confidence and competence in their communication abilities, allowing them to express themselves more clearly and effectively in everyday interactions.(4)
Social Communication:
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Children with ASD often experience difficulties in social communication and interaction that impact their daily lives. These difficulties may manifest in various ways, such as trouble understanding social cues, initiating conversations, or responding appropriately in social situations. SLPs play a crucial role in helping these children learn to use language effectively for different purposes. For instance, they can teach children how to make requests, such as asking for help or expressing a need, as well as how to share information or express feelings.
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SLPs also emphasize the importance of adapting language based on the listener. This means understanding how to change the way they speak depending on whether they are talking to a friend, a teacher, or a family member.
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Moreover, SLPs guide children in following social rules, which are essential for successful interactions. This includes taking turns during conversations, staying on topic, and using appropriate body language. By practicing these skills in structured settings, children can become more confident and capable communicators, improving their ability to connect with others in everyday situations.
Downsides of Speech-Language Therapy
While speech therapy offers many benefits, there are potential downsides that families should consider.
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Time Commitment: Attending speech therapy can be time-consuming for both parents and children. In addition to therapy sessions, parents are often required to implement activities and strategies at home, which can add to their daily responsibilities.
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Disruption of Routine: For children receiving therapy through their school, sessions may interrupt their academic schedule, leading to missed classes and potential gaps in learning. This can be particularly challenging for children who thrive on routine and structure. However, integrating therapy into the school day can also save time by reducing the need for additional appointments outside of school. Conversely, if parents must take their child for speech therapy after school, this can disrupt the child's after-school activities and impact their siblings, adding complexity to family schedules.
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Cost Concerns: The cost of speech therapy can be a significant concern, especially if parents choose private therapy over services covered by health insurance.(5) In some countries, the only accessible services available are private, leaving families with limited options. The average price for a session can reach as high as USD 130 (approximately AED 480) for just 45 minutes, and many children require a minimum number of hours each month over an extended period, often spanning several years. For some families, this financial burden can become overwhelming, making it nearly impossible to access the necessary support for their child's communication needs. This situation can lead to disparities in care, as those without the means to pay for private therapy may struggle to provide their children with the interventions they require.
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Variable Outcomes: For some children, particularly those who are non-verbal, the journey can be particularly challenging; despite years of dedicated speech-language therapy, some may never develop the ability to speak. Additionally, children with complex pathophysiology may show only minimal improvement, which can lead to frustration for both the child and their families. This variability in outcomes highlights the importance of setting realistic expectations and recognizing that each child's progress is unique, shaped by a combination of their individual circumstances and the effectiveness of the therapeutic interventions they receive.
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Availability of Services: In some regions, access to qualified speech-language pathologists may be limited, making it difficult for families to find appropriate therapy. Long waiting lists and insufficient service hours can delay essential interventions. Unfortunately, in many cases, speech-language therapy has become a business, leading to a proliferation of therapists who may not have the necessary qualifications or experience. This situation makes it challenging for families to identify skilled practitioners, as the more qualified therapists often have long waiting lists, further complicating access to effective care. Consequently, families must often rely on word-of-mouth recommendations and community resources (if any) to navigate a crowded field, highlighting the urgent need for transparency and standards in the profession to ensure that children receive the quality support they deserve.
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Emotional Impact: Children may feel anxious or frustrated about attending therapy, especially if they do not see immediate results. This emotional response can affect their willingness to participate and may require additional support from parents and therapists.
To sum up, speech-language therapy can be a valuable component in supporting children with communication challenges, providing potential benefits that enhance their ability to express themselves and engage with others. However, it is essential to recognize that SLT alone may not yield the desired outcomes for every child, and individual responses to therapy can vary widely.
Therefore, SLT should be viewed as part of a comprehensive, integrative approach to a child's development, working in conjunction with other interventions and support systems. By combining SLT with various therapeutic modalities, families can create a holistic framework that addresses the diverse needs of the child, ultimately fostering their overall growth and well-being.
References:
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Gillon, G., Hyter, Y., Fernandes, F. D., Ferman, S., Hus, Y., Petinou, K., Segal, O., Tumanova, T., Vogindroukas, I., Westby, C., & Westerveld, M. International Survey of Speech-Language Pathologists’ Practices in Working with Children with Autism Spectrum Disorder. (2017) Folia Phoniatrica Et Logopaedica, 69(1–2), 8–19. https://doi.org/10.1159/000479063
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Syriopoulou-Delli, C.K., Eleni, G. Effectiveness of Different Types of Augmentative and Alternative Communication (AAC) in Improving Communication Skills and in Enhancing the Vocabulary of Children with ASD: a Review. (2022) Rev J Autism Dev Disord 9, 493–506. https://doi.org/10.1007/s40489-021-00269-4
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Pope, L., Light, J. & Laubscher, E. The Effect of Naturalistic Developmental Behavioral Interventions and Aided AAC on the Language Development of Children on the Autism Spectrum with Minimal Speech: A Systematic Review and Meta-analysis. (2024) J Autism Dev Disord. https://doi.org/10.1007/s10803-024-06382-7
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Murphy, S., Joffe, V., Donald, L. et al. Evaluating ‘Enhancing Pragmatic Language skills for Young children with Social communication impairments’ (E-PLAYS): a feasibility cluster-randomised controlled trial. Pilot Feasibility Stud 7, 5 (2021). https://doi.org/10.1186/s40814-020-00724-9
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Höfer, J., Hoffmann, F., Dörks, M. et al. Health Services Use and Costs in Individuals with Autism Spectrum Disorder in Germany: Results from a Survey in ASD Outpatient Clinics. J Autism Dev Disord 52, 540–552 (2022). https://doi.org/10.1007/s10803-021-04955-4