Children with autism may have major problems with both speech and nonverbal communication. They may also find it very hard to interact socially. Speech-language pathology can address a wide range of communication problems for people with autism. Speech-language pathology is concerned with issues surrounding human speech and language communication disorders and works to help people with such problems to speak more clearly. For these reasons, speech-language pathology is a major part of treatment for autism at the Cornerstone Autism Center.
Robert Kurtz is Cornerstone’s speech-language pathologist for the Greenwood and West Lafayette centers. He has been in the profession for almost 10 years and has nearly 20 years experience working with children who have speech and language conditions. Currently Robert is finishing his PhD in Speech, Language & Hearing at Purdue University.
Jarrad: As a speech-language pathologist you do more than just treat the symptoms, you also diagnose the child. How does that process develop?
Robert: Most of the children I work with at Cornerstone have already been diagnosed with a communication disorder through First Steps, the public schools, or some other service provider. So my focus isn’t really on seeing if they qualify for services. It’s more about determining what their needs are, so I know what goals to set for them.
I also want to know what the child can do, because this is just as important as what he or she can’t do. I can often use these abilities as “hooks” to pull out the sounds, words, or social interactions, or whatever it is we’re looking for.
J: Depending on the child’s age there’s an approximate standard that he or she is likely to be at. What’s a general course that you take evaluating a child with autism, and are there specific tests or scales you use to help you narrow down where treatment should begin?
Robert: There’s no test that can tell you everything you need to know about a child, so I mainly use them to provide me with information about the child’s ability. I spend time observing the child working or playing, and I talk to people who know the child better than I do. At Cornerstone, that usually means one of the ABA therapists, mentors, or team leads who have been working with the child. If I can talk to the parents as well, that’s ideal. After all, parents know their children better than anyone else in the world.
Every therapy session is also an evaluation session. Whenever I work with a child, I’m analyzing and assessing as we go. This is partly to see what kind of progress the child is making on the goals we’re targeting, but also to watch out for stuff that might not have been obvious in previous assessments.
J: So, once you’ve assessed their current speech and language progression, what’s the next step to assisting them?
Robert: The next step is to write up developmentally appropriate goals and design a treatment program. Research on child speech and language development has allowed us to predict pretty well the order in which children will master various components of language. We know kiddos generally start putting words together into two-word phrases when they have an expressive vocabulary of about fifty words. So if a child is only producing ten or twenty words independently, I don’t waste time and energy trying to get two-word phrases. Instead, I work on helping the child acquire more words. In that way, it’s a bit like piano lessons—if you can’t play Mary had a Little Lamb, you’re probably not ready to tackle Bach’s Well-Tempered Clavier. Yet.
The ABA programming at Cornerstone already addresses a lot of speech and language goals, so I want to be aware of what those are for each child so I’m not “reinventing the wheel” with that kiddo. This is really nice, because I can serve as a consultant on goals the ABA therapists are working on and add goals of my own that complement and supplement what they’re accomplishing.
J: I’ve been very lucky to be able to interact with some of these wonderful kiddos. One in particular was here for about 5 months and seemed to be more of a challenge in the speech arena then others for you and the two ABA therapists that worked with this one. Can you briefly tell me what techniques the two ABA therapists and you utilized to encourage and foster language development?
Robert: We made use of what I call “communicative temptations”. These are things like bubbles, balloons, spinning tops, or little wind-up toys—stuff that toddlers find fascinating but can’t produce or operate by themselves because they don’t have the fine motor skills yet. For this particular child a favorite thing of theirs was having me blow up a balloon, then holding it as the air rushed out when I let go of the neck, or watching it fly around when I released it. I made the kiddo say “balloon” before I would put it to my lips, “blow up” before I would blow it up, and “let go” before I’d release it. So that was three new vocabulary items with one humble little balloon! The two ABA therapists who worked with the child were really great at identifying things the kiddo liked and would ask for, and they were consistent about waiting for the child to say the word before giving up whatever it was that was wanted. And it wasn’t just toys and fun stuff, either. They got the child to say “open” whenever they needed to go through a door, and they even had the kiddo counting to ten when needed to wait for something. As a result, this child went from having no words when first starting at Cornerstone to beginning to repeat two-word phrases by the time they left!
September 4, 2012, cornerstoneac