Duties of a Speech-Language Therapist

In the hierarchy of needs, communication is the toughest. SLTs must serve with the realization that their work can pull families out of the depths of suffering, can usher joy where there is despair

For Speech and Language Therapy, a common parental refrain is - no outcomes achieved despite months and years of therapy. If the autistic child is non-verbal, all the more worse, he is denied the prospect of expressive language. Speech is expected to subsume language and equivalence is struck between ‘not talking’ and no language. Unfortunate, but that’s the way it is. Language is a basic need – for meeting physical, safety, spiritual and emotional needs. And yet, scant attention is paid to the ethical moorings that should govern this domain. A therapist with ethical awareness can bring forth life changing experiences for the child. But to reach this state the therapist must have emotional connectedness with autistic children and their families. This is the basis of high-level performance. Therapy should not only mean minutes of session but active learning and measurable outcomes.

The Ideal Therapist

Among the matrix of teachers who make up an autistic child’s educational sphere, the Speech Therapist has a pivotal role. The Speech Therapist’s output and curriculum sessions are a bridge for other departments as the therapist addresses the most fundamental human trait, the ability to communicate.

For an autistic child with missing speech and language milestones, therapy should begin early and be organized in an organic manner around the items and routines of the child’s life. A Speech Therapist work is a continuum of skill building in speech and language learning –from building phonological awareness, identifying the separate speech sounds within a word, teaching how letters represent those sounds, word formation to the more complex tasks of sentence formation. This calls for a great deal of systematic and structured practice.

In addition to teaching the child, the Speech Therapist has to work with other teachers to ensure that a system of core vocabulary emerges and is maintained across settings thus creating multiple opportunities for word trials. The parent is a key focus. Most parents of autistic children are at high sea, because there is simply no way they can get through to their child who responds with grunts, noises and goes on a rampage in the house.

Concept learning is a struggle. The Speech Therapist must sit with the parent and make a list of priorities and employ multisensory strategies to develop basic communication and concept learning so that the family has methods to train their autistic child and get some semblance of a domestic routine and calm. In this, the therapists can take the assistance of special educators. A commonly used technique is using pictures to connect words, using attractive writing frames to get attention to words for building receptive language, which in turn helps create sequence, memory and organizing skills for the child – all vital building blocks of a learning trajectory.

Both the therapist and the Special educator ought to remember at all times that the autistic child may have co-occurring conditions and may experience eye strain, fatigue and frustration while attending to a visual processing task. The child’s learning behavior is to be observed and assessed and wherever required, the plan has to be tweaked in terms of giving breaks or pacing it in small parcels, it should be done.

There are many inter-linkages between the teaching tasks performed by the special educator and the speech therapist, therefore live feedback reporting and information sharing about the autistic student is vital. For example, developing phonological awareness is a prime duty of the speech therapist, making the child move the articulators to produce the sound system etc, this then can be harvested by the Special Educator to initiate phonics training with the alphabet and even step up the plan with specific practice sessions. Parents should not feel that the Speech Therapist and the special educator are implementing the same program or are being repetitive, they need to be explained the nuances of the integration.

The practice of speech and language therapy calls for high levels of motivation and patience on part of the therapist. It involves the use of specific skills combined with an aptitude to take a holistic view of the child through interactions with other teachers, parents, caregivers and observation.

An autistic child can present difficult situations for the therapist: unresponsiveness, exhibit fight or flight behaviours and in extreme situations could even resort to injurious actions. The therapist has to strike a balance between compassion and discipline and should know when to enlist physical restraint services to keep self and the child away from harm’s way. The therapist has to be agile, active, communicative, creative and smart to handle the entire spectrum of situations. At the same time, they have to help families not to feel overwhelmed by the daunting challenges that lack of speech and communication poses and gradually empower them. 

The 5-Skills Checklist

There are 5 key skills that a therapist must possess; these are not only desirable but also essential.

(i) Interpersonal skills: The integration of receptive and expressive skills, attentive listening, absorbing and gathering information through interactions is a starting point. The therapist should be able to pick up body language, other non-verbal or monosyllabic responses while interviewing parents and present a picture of empathy thereby establishing a rapport, which in turn would encourage the parent to make fuller and honest submissions.

The therapist must have the ability and the mental agility to migrate this information into expressive forms either spoken or written to broadly perform three roles- teaching the child, explaining the therapy plan to the parent including guidance for practice sessions at home and working collaboratively with others. Overall, the Speech therapist has a key role in guiding the communication planning process.

(ii) Information gathering skills are the factual basis for decision-making. They are a complex set of skills involving observation, interviewing, questioning, researching assessment, analysis and interpretation. The purpose of observation should be clear and appropriately structured, for this helps to confirm or contest the working hypotheses.

To gain a holistic picture of any child referred for therapy, information needs to be gathered from a variety of sources, such as, the child, parents, educational staff and medical professionals, as well as researching existing records and reports.

Gathering information usually involves taking a full case history. It is important to be sensitive to parents’ perceptions and feelings about their child’s difficulties and the speech and language therapy process. Queries have to be posed professionally and yet reassuring tonality. For example, closed questions that don’t allow for expanded answers may provide specific information but will not necessarily help parents to feel relaxed and may even prevent free-flowing conversation. It is important to consider how questions may be interpreted as this may affect their response. Answers cannot be hurried, and sometimes it is important to leave a silence to allow time for reflection.

(iii) Interpreting Skills: When carrying out an assessment, the primary focus is on managing the interaction and materials, while achieving the purpose of the assessment. The data from all sources then needs to be collated, analyzed and  reported as results so that decisions can be made regarding therapy and further management.

(iv) Therapy Skills: The skills required for carrying out therapy are varied, complex and several skills need to be employed simultaneously. In a school set-up, the therapy aims of individual children have to be achieved along with some group aims. At the same time, therapy goals must include socially desirable behavior modifications and stimulation of the child’s interest. A must-have technical skill is the ability to deliver speech and language therapy as required into its phonetic, linguistic, non-verbal and interactional components. Additional technical skills may be required in particular areas of specialism, for example, in using instrumentation related to voice work, or dysphagia, or knowledge of communication aids. The therapist must have the ability to innovate, use tech and dynamically increase or decrease the levels of difficulty of the task.

As per the scientific literature on Speech anatomy, speech production requires the activity of approximately 100 muscles distributed across the different physiological systems involved in speech production: the respiratory, laryngeal, and oral- articulatory systems. Upto 15 speech sounds per second are produced. Vowels are created by the changing configuration of the vocal tract while consonants are more complex and require one or more of the speech articulators.

Speech production is a combination of complex skill movements. The underlying neural control processes are similarly complex. Several hierarchically organised cortical and subcortical structures of the brain interacting with sensory feedback from peripheral speech structures are involved. Speech-Language impairments in autism are both physiological and cognitive. It are these rough waters that the Speech Therapist must navigate to produce results.

(v) Problem-Solving and Decision-Making Skills

Speech and language therapy is more than ‘correct practice’, it is lot of informed ‘trial and adjustment’. Practitioners need to develop creative problem-solving skills, and of course loads of patience, from teaching the correct placement of articulators, with or without therapy tools to repeated auditory processing exercises. The onus of perseverance is on the therapist, which then through a continuous learning osmosis passes onto to the child.

Conclusion

The combination of attitude, assessment and specialist action leads to therapy success with the child.