Autism Awareness Month: Speech and Language
Mackenzie Siders is a childhood friend and this past November, she joined me on the podcast, Two Kids and A Career. In Episode 53: Don't Let An Autism Diagnosis Swallow You Whole, Mackenzie talked about life as a mom of two kiddos with autism. I asked if she would write a series of blogs for Autism Awareness Month. Here's the third one:
OMG you’re back and I’m totally excited you’re here and interested in learning more about autism! This article is really geared toward parents who have a child who has been recently diagnosed with autism and will hopefully be a solid starting point to help you find the right treatment for your child.
If you happened to stumble punch-drunk on parenting-swagger into this series on Autism Awareness, you may want to check out the first article, which will give you background information on my experience with autism (and cover the fascinating subject of “stimming”) and my second article, which dives ass-first into emotional dysregulation.
Moving on, ASD is a veritable alphabet soup of acronyms so I’m going to run them down one by one, beginning with speech-language pathology, or SLP (which can also refer to a speech-language pathologist). Since speech and language delays tend to be among parents’ earliest developmental concerns, an SLP is often among the first clinicians to work with a child who has undiagnosed autism. An SLP can be a key part of the multi-disciplinary team that makes the diagnosis and determines a treatment plan.
If you’re not familiar with the “SLP” terminology, you may have heard the reference “speech therapist”. Speech-language pathologist is more accurate because it more fully describes the training and education, not to mention the wealth of services they provide. Further, many SLPs specialize within specific disorders or impairments, so it’s pretty important to find an SLP with training and expertise helping children and/or adults with autism.
An important distinction I did not fully appreciate when my sons were first diagnosed is that, while both are components of communication, speech is different from language:
● Speech is the expression-of or the ability-to express thoughts and feelings by articulating vocal sounds. You need to be able to use your voice and coordinate the parts of your mouth to make sounds and communicate verbally. You probably know somebody with a speech impediment of some type; not all speech impairments are developmental. For example, stroke survivors sometimes develop speech impediments despite having normal language function.
● Language is the understanding and use of a spoken, written, and/or other communication symbol systems (e.g., American Sign Language). This is an important distinction since some people with autism may be non-verbal, or not able to speak, but they can understand and use language to communicate, often with help, such as pictures and words on cards or assistive technology.
Your kid (whether autistic or not) can have a speech disorder without any language problems, and vice versa.
Both speech and language are part of communication, which is the successful conveying or sharing of ideas and feelings. Communication is something most of us do naturally and effortlessly without having to think about it. Humans are social creatures that evolved to live in cooperative communities, so communication is a natural instinct hard-wired into us. If you stop and think about it, communication is the cornerstone of how we conduct most of our social business, and, together with physical appearance, the primary way we subconsciously assess and evaluate people we’ve just met.
As part of a treatment team, SLPs regularly assess a child’s development. They look for skills that demonstrate the development of speech and language skills, such as interactive play, turn-taking, and joint attention (sharing focus with another person on an object or activity). SLPs are thus in an ideal position to spot early warning signs of autism and collaborate in a full evaluation when needed. If you have concerns about your child’s development, getting an SLP involved can provide an earlier diagnosis which hopefully leads to early intervention. Early intervention is proven to support brain development and improve outcomes for children with autism.
But communication is not just speech and language. It includes gestures, facial expressions, body language, voice inflection, etc. A great example of this is a crying infant. He’s not using words but he’s communicating something by crying, stiffening his body, and sucking on his fists. Fortunately, babies usually have simple needs so they’re easy to troubleshoot, though this can be a very stressful situation for new parents who haven’t learned their baby’s language yet. Remember when you learned the difference between a hungry cry and a poopy cry? It was like you discovered the Rosetta Stone!
Okay, now that the technical word-salad is out of the way, here’s what I really want you to know about speech and language. Speech is developmental which just means that we’re not born knowing how to speak perfectly. It takes several years to learn that skill and, while we’re learning, some sounds develop quicker than others. This is important because sometimes the best course of action for a speech impairment is simply to give your child more time to naturally develop the correct sounds. This was really difficult for me to accept at first.
My middle son substituted Ws for Ls (such as “wook” instead of “look”) and he also couldn’t make an “R” sound for a long time. For a period of time, these types of speech errors were considered developmental, meaning that most kids experience delays in producing the same sounds, and the delays are not, by themselves, a speech “error.” But, at some point, the delayed development of these sounds becomes an issue. I am not a doctor or SLP so please do not quote me and instead check with your professional expert of choice, but, as I recall, around 4-ish years old, the W for L substitution was no longer “developmental,” meaning that, on average, the majority of kids have the ability to make that sound by that age and because my kid was still having trouble, he was far enough outside the norm that speech therapy became an appropriate intervention.
I also learned, much to my surprise, that the “R” sound is considered developmental until age 8! What this means in practical terms is that my eight-year old could mispronounce words with an “R” in the front, middle, or end until age 8, and it was not considered by the educational system to be a speech error that merited any type of therapy or invention. This, of course, means that the school district wasn’t required to work on that speech error until my son was at least 8 years old. As you can imagine, that was frustrating to me, and I did ultimately seek out private speech therapy much earlier than age 8. For the record, he’s 11 now, he still receives speech services at school, and the speech therapy he did receive for the “R” sound between 4 and 8 years old didn’t do much. Seriously, between his speech errors and his habit of appending an “uh” syllable to his words, he sometimes sounds like John Cleese doing a terrible French accent; and if it sounds adorable, that’s only because it totally is OMG!).
My experience was that speech errors were relatively easy to spot. A speech error is usually noticeable and you have some idea of what the problem is and how to find treatment. If not, start with your pediatrician. Language, on the other hand, is a whole different can of sardines. Two of my boys have diagnosed expressive (speaking) and receptive (understanding) language impairments. While you shouldn’t generalize too much from popular depictions of autism, it is true that one frequent symptom is some degree of communication deficit.
But, my youngest daughter, who has ADHD but not autism, also has a diagnosed receptive/expressive/reading/writing language impairment. She struggles to express her thoughts both verbally and in writing, and she also has a difficult time understanding information that she hears or reads. To put it simply, she has the same type of language impairment as my boys, and she also has dyslexia on top of that.
These articles are about autism generally, and I don’t want to stray too far from that topic, nor do I want my kids’ specific diagnoses to be what you take away from this series. The reason I mention these two different diagnoses is that language impairments can camouflage themselves and look to the rest of the world like something else. This makes them difficult to uncover without professional training, and, it can lead to misunderstandings over why your child is acting the way he is. For example, you could easily mistake a language impairment for something mischievous or intentional, like willful disobedience or other misbehavior. Obviously, we don't want to give our kids a complex by disciplining them over things beyond their control.
My son Hayden doesn't pick up on body language. This means that, to him, spoken language comes across without any context and feels like a Facebook post from your crazy uncle who shares conspiracy theories about how aliens from Rigel X built the Pyramids and the moon landings were faked. Lacking the full context provided by body language, facial expressions, voice inflection, etc., Hayden requires extra processing time to organize and make sense out of that language. This extra processing time looks, to the rest of us, like something is wrong with him while he stares blankly at us and doesn't respond, even to a direct question. Maybe he didn't hear? Does he have a sensory problem? No, he DID hear and he's ignoring me! Anchors away and full steam ahead on the S.S. Indignant Rage!
This is the complexity of language; it's difficult to sort through what is happening and tease apart whether your child has a language impairment or is just being …
If they have a speech impairment as well, that compounds the problem since you likely can’t understand what they’re even trying to tell you! And - not to freak you out too much - but, sometimes, kids with speech and language issues are also very bright and can develop coping mechanisms that can, for a while at least, get them through the day. Even now, it can be challenging to determine when my little guy is slow to react because he's processing information or if he's slow to react because he is, in fact, ignoring me because he's too engrossed in a YouTube video of the top 100 llama fails of 2013. The bottom line is that you will need the help of an expert, so make sure you ask about speech and language because they are two distinct issues.
Look, every parent of a special needs child (autism or otherwise) goes through this “journey” to varying degrees; you have your own unique path to follow. But my hope is that by mapping out the years-long process of advocacy and self-education I went through for my children, not just for services, but to understand them better and to adjusting my parenting based on their specific needs, I’ve illustrated the conceptual framework you need to create one for your own circumstances. I also want you to know that you’re not crazy or ridiculous for having these concerns and for tirelessly advocating for your child. This journey can be lonely and solitary at times, and it can undercut and challenge your confidence in your instincts. Don’t let it. Trust your guts, your Mom-Fu. It will lead you to the pediatrician more times than you can count on both hands for an illness that you are certain requires an antibiotic, only to be told it’s just a nasty virus and be turned away empty-handed. But, those same instincts will keep you awake at night and relentlessly prod you when something just isn’t right so be sure to listen to your instincts and follow your Mom-Fu right down whatever rabbit hole Web MD sucks you into.
Stay tuned for more down and dirty on the importance of Occupational and Behavioral therapies for kiddos with ASD, What to Expect From Your Friend with ASD, and The Importance of Mental Health: AKA Am I Okay? Should I Join a Wine Club? Is Seven Too Many Dogs? as well as the very important role that melatonin gummies will play in the preservation of whatever is left of your sanity.
Finally, as a reminder to all parents, federal law mandates free evaluation for developmental delays and delivery of appropriate early intervention services for children. For a guide on how to get help for your child, click here. For more information on your state’s early intervention program, click here.
Mackenzie is a SAHM to five beautiful, hysterical, annoying-as-f#@k-sometimes kids. She worked so super hard in her twenties to earn an MBA only to retire and become her kids’ bitch. Now she spends her days dashing into the fray and taking power naps. You can catch her tossing quarters into her swear jar on her blog Mommy Needs A Swear Jar and on Facebook. She is confused by Twitter.