Joanne Neill Smith, Principal Speech and Language Therapist and Clinical Lead at the National Autistic Society, describes the role speech and language therapy plays in supporting autistic pupils within National Autistic Society schools.

Autism is a lifelong developmental disability characterised by differences in social communication and interaction, and restricted and repetitive behaviours (which may include sensory differences). These can affect a person’s communication style and social confidence, impacting on their day to day lives.  

The role of the speech and language therapist (SALT) is key in supporting all children and young people (CYP) within an educational setting. This may involve delivering different models of intervention.

• Working with pupils that have been referred by parents/carers or teacher.
• Working in the classroom using a collaborative model with other education staff.
• Working at a whole school level e.g. establishing a communication friendly environment/culture.
• Pupils may receive individual therapy sessions.
• Groups of pupils may be seen away from the rest of the class or in the classroom.

Speech and language therapy within specialist schools

For the purpose of this article I will be describing the model we use in National Autistic Society schools, where all pupils have an EHCP and speech and language therapy provision is required.

SALT’s are highly skilled professionals with an in-depth knowledge of a wide range of speech, language and communication needs. A SALT will assess the communication differences of autistic pupils via case history taking, observation and some direct interactions with the pupil. This will develop a detailed profile of a CYP’s communication strengths and needs. This then informs what personalised support strategies should be in place. 

Differences in social communication and interaction will present in a variety of ways, from those pupils that are pre-verbal with a learning disability, to those that are extremely articulate with advanced language and vocabulary skills.  For those with good language skills, there remains the possibility that they may misinterpret ambiguous language, idioms and inference. This can affect their confidence in reciprocal conversations.

Understanding and responding to the non-verbal communication of others and reading social situations in a range of settings, can also be different for autistic people.

SALTs can support pupils within schools in a number of ways using evidence- based approaches and working collaboratively with parents/care givers, teaching staff and other therapists.

Speech and language support

Speech and language support can be delivered at various levels:

• whole school (universal)
• class and group (targeted)
• individual (specialist). 

Embedding speech and language therapy strategies into the school curriculum provides the foundations for learning and engagement. 

Whole school level

Speech and language therapy support at a whole school level will support an inclusive communication environment. Visual supports should be consistent and available in all areas of the school. The following approaches can promote a shared understanding of communication differences amongst autistic pupils:

• identifying pupils’ communication strengths and learning needs, to support staff training
• working with families to support communication needs
• working in a transdisciplinary way to support communication in a person-centred way. 

Group or class level

SALT support delivered at a group or class level can involve several methods.

• Modelling a wide range of strategies that support language and communication.
• Coaching staff how to implement strategies to support the pupils to develop and optimise their communication opportunities.
• Assessing a pupil’s understanding of vocabulary and language which can provide teaching staff with information to help pupils access to curriculum learning.  

SALT’s work with a wide range of people involved in supporting CYP’s language and communication differences. This can include teaching staff, OT’s, psychologists and other therapists, and the pupils’ families. They share their knowledge and skills around interventions used with autistic children, such as:

• Social Communication, Emotional Regulation and Transactional Support (SCERTS)- a framework for developing communication and social emotional abilities in autistic children
• Attention Autism: an intervention model aimed at developing spontaneous and natural communication through the use of highly motivating and visual activities
• PECS (Picture Exchange Communication System): an alternative and augmentative communication system using pictures to develop functional communication skills
• Intensive Interaction: a practical approach to develop interaction skills and the fundamentals of communication, such as turn taking through imitating behaviour and responding to any interaction in a highly responsive way.

Speech and language therapists can also develop pupils’ emotional literacy and life skills by targeting differences in social understanding via social thinking groups. 

Individual level

SALT support at an individual level may mean delivering therapy for a prescribed amount of time in school. This may include interventions listed above as well as:

• communication passports or profiles 
• devising communication programmes
• writing Social Stories
• ensuring that pupil voice is heard, their opinions and choices are enabled and advocacy is promoted. 

Applying and using a range of augmentative and alternative communication systems (AACs) and communication aids also falls within the SALTs remit.

Guidelines

The Royal College of Speech and Language Therapists (RCSLT) (2013) describe five communication standards that autistic people should expect in residential settings.

• Detailed description of how best to communicate with individuals.
• Services will show how individuals are involved with decisions about their care and their services.
• The best communication approaches are used with each individual.
• There are opportunities and relationships that make individuals want to communicate.
• Individuals are supported to understand and express their needs in relation to their health and wellbeing.

These are at the heart of what we are aiming to achieve in positively supporting autistic children and young people.

Advice for professionals

• Consider using visual supports such as objects of reference; photographs; symbols; written word; diaries and calendars; Social Stories and comic strip conversations, to help pupils understand and prepare for changes and new events.
• Allow time for processing information.
• Match your communication to the child and young person’s communication style and developmental level.
• Avoid giving too much information and using complex language.
• Use the child and young person’s own interests to support motivation and engagement.
• Be aware that too many choices and open questions can cause anxiety.
• Be mindful of individual sensory needs. Sensory processing differences can affect social communication. 
• Use language that is not ambiguous - say what you mean and mean what you say.