Autism Spectrum Disorder: Perspectives From A Neurodiversity-Affirming SLP Part 2
Author: Kendra Wormald, Reg. CASLPO Speech Language Pathologist
Date: Wednesday, November 27, 2024
Table of Contents
Speech
Voice
Listening and Comprehension
Social Communication
The Role of an SLP in Adult ASD
Speech-Language Pathologists play integral roles in supporting challenges living with Autism Spectrum Disorder, as it relates to building communication and social skills in different contexts, across the lifespan.
Target Areas for SLP Support:
a) Speech
Articulation: ASD may be related to difficulties with movement and coordination of the lips, tongue, jaw and associated breath support mechanisms. Oral-motor function can be targeted with your SLP, through building awareness of placement, tension and movement of the tongue, jaw and lips in different areas of a word (beginning, middle and end). Structure of intervention is rooted in progressive difficulty. Therefore, we always begin at the most basic level, which would be focused on tongue, lips, and jaw placement and airflow, then progressively applying these foundation skills to reading, spontaneous speech then in conversational speech.
Intervention Example
You say the /s/ with your tongue between the teeth, or at least behind where the teeth meet.
Your tongue starts at the bottom or top of your mouth where it should be, but when making the noise you slide your tongue closer to where your teeth meet each other, which changes the airflow, making the sound 'slushy’ or more like a /th/ sound
You may be cued to hold the tip of your tongue where your front teeth meet the gums (either top or bottom teeth), and add more tension with your tongue tip, while pushing relatively hard against that spot. Repeat this several times without making the actual /s/ sound
Take a big breath then when exhaling, put your tongue tip to where it was in the above step as you say 'ssssss - with that extra tension, ensuring your tongue isn’t movement half way through the sound
With success, you can move into a word, then at different places such as at the beginning, middle or end of the word. You may also be cued to hold the /s/ longer
As you progress, you can bring practice to reading at the sentence and paragraph level, then progressively applied to spontaneous speech level
Clarity of Speech: Reduced oral-motor control and movement may also impact how clear speech is produced. With this reduced movement. you may come across as ‘mumbling’. The mouth may not be opening wide enough, is moving too quickly or you may even skip over speech sounds within more complex words and slide words together - referred to as reduced word boundaries.
Intervention Example
An SLP may prompt you to overdo your mouth movement, look in a mirror for feedback, and practice transitioning from one sound to another such as saying "PTK” and tongue twisters slowly then quickly, while maintaining clarity.
b) Voice
Tone: Emotion and message intention can be expressed through the tone of your voice. You may have received feedback that you sound ‘uninterested’, 'mad’ or ‘unimpressed’, however you don't actually feel this way. Often with ASD, it is common for voices to be monotone; lacking pitch variability. This may result in losing the attention of your listener. Tone variability can be used to direct focus to key words in your message, which could help the listener's understanding.
Intervention Example
An activity to support this may look like saying the same brief sentence two times, while attempting to express a certain emotion each time, through your pitch. For instance:
“I got the job”: Said in a surprised and then a confident voice.Your SLP will facilitate reflective conversations to support understanding of what you did with your voice to portray a certain emotion
Modeling will also be provided so the client can take a listener perspective and discuss the impact of the vocal tonality used by the SLP
c) Listening and Comprehension Skills
Attending and Remembering What's Been Said: It may be more challenging for an adult with ASD to focus on a conversation, especially if it's not interesting to them.
Intervention Example
Strategies to support attention and understanding may look like:
Key Wording
While listening to a podcast, movie or a communication partner:
1) Practice writing down key words that are necessary to understand what they said
2) Visualize the words in your head
3) Visualize images of the information they're telling, but only the KEY info
* Consider: If I came back to the keywords tomorrow, would I be able to repeat the message?
Doodling
Freely drawing, or simply engaging more of your senses while trying to focus has been found to support attention, memory and reduce stress.
“…paying continuous attention places a strain on the brain, and doodling may be just the break your brain needs to keep attending without losing total interest.” (Harvard Health Publishing, 2024)
Reduce Sensory Input
Imagine trying to have a conversation in a coffee shop with the sound of coffee being ground, the blender on, people taking orders, multiple small talk conversations occurring around you, a strong coffee smell, a cold environment and bright overhead lights. This environment may be a nightmare for someone sensitive to sensory input. What may be simple to ignore for a neurotypical, being exposed to excess sensory stimulation while trying to understand a verbal or written message can be extremely challenging for individuals with ASD.
Intervention Example:
Sunglasses, choosing your environment for conversation very intentionally, wearing earbuds or headphones that reduce background noise while allowing you to still hear your conversation partner, consider how close you are to the other person, dress in layers, use fidgets to ease stress and support focus
Understanding Non-literal Language: Adults with ASD may have difficulty focusing and understanding information particularly non-literal language. A lot of phrases and language used in North America consists of idioms, sarcasm, humor, figurative and abstract language. Adults with ASD may struggle with rigidity and flexible thinking leading to language being taken at face value. This may limit the ability to fully participate within conversation as your understanding may be significantly different than the intended message.
Intervention Example
Using context will often support understanding of abstract language. An SLP may present you with a situation that contains an idiom. Interpretations may be offered for you to choose from, or you can practice generating your own interpretation. Your SLP may encourage you to use the idiom in your own example.
Idiom Examples:
“It’s raining cats and dogs”
Literal Interpretation: There are actual dogs and cats falling from the sky
Non-literal Interpretation: It’s raining really hard
“Cat nap”
Literal Interpretation: A cat that is sleeping
Non-literal Interpretation: A short rest or sleep
“Take the cake”
Literal Interpretation: Grab the cake and take it away
Non-literal Interpretation: To be really good or outstanding at something.
Expression: Adults with ASD may experience challenges expressing themselves effectively, which may be especially imperative in times of emergency or when needs are not being met. If output of communication is challenging, it may be supported with Augmentative and alternative (AAC). AAC comes in many different forms, and may be more supportive for an individual at certain times or, consistently. An SLP has the skill to support you in providing education and determining a good fit. AAC can be altered with your challenges and new learning.
Examples of AAC Types
(FluentAAC, 2024)
NO TECH: This may include body language, verbalizations, vocalizations, manual signs, gestures, facial expressions
LOW TECH: This may include writing, referring to photographs, objects, or a communication board
HIGH TECH: This may include speech generating devices (like a talking keyboard), Recording devices, devices that output one specific message, software that uses symbol/language representation used on a device such as a tablet, smartphone or computer, An example of this device may be the programs, Proloquo2go, TouchChat, and Avaz.
d) Social Communication Skills:
Find out more here about whether you would benefit from social skills training
Commenting: Offering comments on what others say may be limited. Reduced acknowledgement of what others say may insinuate that you warrant listening, or don't care about what they said.
Conversations: Initiating and maintaining conversations appears to be a significant challenge for adults with ASD. Often my ASD clients have in some form expressed the negative impact these challenges have had such as feeling like you're not being understood and avoiding conversation which overall reduces your social connections. Your SLP may facilitate mock conversations with you with a structure such as the framework found below.
Example: HandSpeak Framework
This framework has supported several of my clients who express social communication challenges. It supports the steps of how to start a new conversation, how much information to share at one time, how to ask questions, and how to move a conversation forward. Your SLP may use a similar framework to provide structured steps in how to facilitate conversations.
Conclusion
Through this article, it has been made apparent the vast challenges experienced by adults living with Autism Spectrum Disorder. The next article in this series will discuss nonverbal communication including the expression and understanding of written communication and body language. Discussion will also be facilitated around ways to self-advocate, and optimize on accommodations and supports for both your social and professional life.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
