The following therapies may be used in the early years as part of intensive programs, and at any stage throughout a person’s lifetime.
Until recently, older children, teenagers and adults with ASD had limited access these therapies, being hampered by a lack of funding to help pay for them.
Fortunately, the advent of the NDIS and its whole-of-life approach means that more people can now access these therapies as part of their individualised funding packages, to help support their needs and goals.
Speech and language therapy
Communication impairments are one of the core distinguishing features of autism spectrum disorder, and can severely impact how a person interacts with the world.
When a child is first diagnosed with ASD, many families do not at first grasp that communication is much more than being able to understand and use the spoken word. Communication begins with non-verbal communication — babies learn to shake their head for ‘no’ and nod for ‘yes’ very early in life.
Joint attention and sharing experiences through looks and gestures (such as pointing) are the foundations of early communication. These skills are often absent or reduced in young children with autism but can be taught.
Most children on the autism spectrum will learn to talk, but the ability to understand and use spoken language can vary considerably from one person to the next.
Speech and language therapy can be used throughout life. All aspects of communication can be addressed through speech and language therapy:
- receptive language — understanding what others say and mean
- spoken or expressive language — putting your own words together
- pragmatic language — the social conventions of language, such as volume of speech and the ‘to and fro’ nature of reciprocal conversation.
In the school years, a speech pathologist may help your child with their written English work as well as assisting with the more complex language and communication skills. Small changes in a person’s communication ability, no matter their age, can mean huge improvements to family life.
Social Skills Learning
Social difficulties affect all people on the spectrum, regardless of their IQ and overall level of functioning.
Social skills training can help children and young people to develop social skills in a structured way. Social skills training can be included as part of an early intervention program and then continued at school and beyond. Training may be facilitated by a psychologist, a behavioural therapist, a speech pathologist or special education teacher. Social skills training is most effective if it takes place in natural settings (such as the home or school) and within regular routines and activities, rather than in an artificial ‘clinic’ situation.
Some psychologists, early intervention groups and speech pathologists offer social skills training in groups. The Program for the Education and Enrichment of Relational Skills (PEERS®) is an evidence-based, social skills training intervention for adolescents and young adults with ASD who have problems with friendships and interacting with peers.
Social Stories™, the telling of short simple stories, can be written by parents, teachers and therapists to help explain the social rules. Video-modelling can also be very effective for teaching social skills.
Augmentative and Alternative Communication
Speech pathologists may introduce systems of communication that assist or replace spoken language. Typically, these start with photographs or picture communication symbols, the best known being PECS, (Picture Exchange Communication System) and more recently, apps like Proloquo2Go.
Hand signing is often used with very young children to augment and promote the development of speech. For adults who do not use speech, signing can remain helpful.
Speech generating devices are now in common use. There are standalone devices which generate speech, as well as apps for tablets and phones. Again, use of these can encourage spoken language, a fact which often surprises parents.
Although motor skills are generally less affected than communication skills in people with ASD, some children and young people can have significant problems in this area. Occupational therapists (OTs) work with these people and their families to improve their ability to participate in activities of daily living, play, school and work. An occupational therapist with experience in working with children on the autism spectrum will start with a full assessment of the child. An individualised program can assist with:
- Gross motor skills, like running, riding a bike and catching balls
- Fine motor skills like handwriting, using scissors or a knife and fork
- Low muscle tone and motor planning (the ability to plan and execute a series of movements)
OTs will also consult with schools and advise on classroom modifications, such as the use of a keyboard in class or exams for someone with poor handwriting. Many OTs can also assist with management of sensory processing issues.
For visual learners, video-modelling may be a highly effective way to teach skills. Research has shown that video-modelling is an efficient way to teach language, social skills, self-help skills and play skills. It is also used to help prepare children for new situations or activities.
You can read about video-modelling on many websites and can even buy some simple video models to use.
Video self-modelling is when children are filmed doing activities and the non-successful parts are edited out. They are then shown the videos of their successful interactions or abilities. It can be used to improve social skills, sports skills, play skills and even gross motor activities.
As children enter the school years, having a psychologist to work with can be very beneficial. Psychologists can assist with social skills training and coping skills for regulating emotions. Ideally, a family can build a relationship with a therapist before any difficulties occur.
Sadly, school life can be difficult for many children and teenagers and they may need assistance from a psychologist to navigate their difficulties. Psychologists can also consult with schools and teachers to put in place strategies to assist their students on the spectrum.
As young people with ASD enter puberty and the teenage years, it is very common for families to face challenges, some of these typical teen issues, others relating to autism. Having an experienced psychologist to talk to can be invaluable for parents, children and siblings.
CBT, Cognitive Behaviour Therapy
Cognitive Behaviour Therapy (CBT)
For older children, teenagers and adults on the spectrum, Cognitive Behaviour Therapy (CBT) can be a very useful tool.
CBT aims to replace negative thinking with positive and realistic thoughts, in turn helping a person feel better about themselves and difficult situations. There are now CBT programs that have been specifically designed for young people on the autism spectrum.
Relaxation techniques and strategies to cope with anxiety are often also taught as part of CBT programs. CBT is a ‘talking therapy’, which means a young person needs to have an adequate understanding of language to use it.
Interventions for Older Children with ASD — Raising Children Network