Tips for therapists in structuring sessions continued F leadto generalization. Therefore, engagement is key. N For example, if the childis engagedandmotivated For more information on ASDs... l National Institute of Child Health and Human Development to have a snack, have her practice speech tools when Clearinghouse asking for the snack. For more information, visit: Provides information on autism and autism research. http://icdl.com/staging and search for the Greenspan 2001 800-370-2943 research document, The Affect Diathesis Hypothesis. E-mail: [email protected] Web site: www.nichd.nih.gov/autism Keep instructions simple, clear, andconcise. Be sure 1 that the childis engagedwith you, andpresent Asperger’s Syndrome Education Network directions multiple times if necessary. If there is no A national non-profit organization that provides education and support response, try simplifying the directions and/or adding to families and individuals affected with Asperger’s Syndrome, PDD- NOS, High-Functioning Autism, and related disorders. visual/contextual cues. For example, simplify “Get your 9 Aspen Circle, Edison, NJ 08820 coat so we can go outside” to “Going outside. Get 732-321-0880 coat” while pointing to the child’s coat. E-mail: [email protected], Web site: www.aspennj.org

Provide visual cues, concrete examples and draw- Autism Society of America 2 ings to increase comprehension. For example, try 7910 Woodmont Ave., Suite 300, Bethesda, MD 20814-3067 800-3-AUTISM, 301-657-0881, Fax: 301-657-0869 stretching Playdough® while practicing easing in to a Web site: www.autism-society.org speech sound“e e e a s y.” References and Resources about ASDs and Stuttering Increase the child’s self-monitoring skills and American Psychiatric Association (2000). Diagnostic and Statistical 3 awareness of how behaviors affect interactions Manual of Mental Disorders (4th ed.), text revision, Washington, D.C. with others. Focus on the accuracy of self-assessment of his speech in simple andcomplex speaking situa- Scaler Scott, K., Grossman, H., Abendroth, K., Tetnowski, J.A. & tions. Then teach problem solving to allow him to Damico, J.S. (2006). Asperger’s Syndrome and Attention Deficit Disorder: Autism change his speech accordingly. Clinical disfluency analysis. Proceedings of the 5th World Congress on A Fluency Disorders. Dublin, Ireland: International Fluency Association. Spectrum Keep in mindthe child’s level of functioning: some Shriberg, L.D., Paul, R., McSweeny, J.L., Klin, A,. Cohen, D.J., & 4 are quite literal andneedmore concrete examples, Volkmar, F.R. (2001). Speech andprosodycharacteristics of adolescents such as rating their use of speech tools “thumbs up” or andadultswith High-Functioning Autism andAsperger’s Syndrome. “thumbs down,” while others can use more cognitively- Journal of Speech, Language, and Hearing Research, 44, 1097-1115. Disorders basedrating systems, such as using a scale from 1-5. Sisskin, V. (2006). Speech disfluency in Asperger’s Syndrome: Two cases of interest. Perspectives on Fluency and Fluency Disorders, 16(2), 12-14. Address overall communication skills. By intro- and Stuttering 5 ducing and modeling appropriate skills such as eye Wetherby, A.M. & Prizant, B.M. (2000). Autism Spectrum Disorders: contact, volume, rate, andlistening skills yourself, A TransactionalT Development Perspective. Baltimore: Paul H. Brooks. you will help to increase the child’s confidence and THE THE self-esteem while reducing speech-related anxiety. STUTTERING STUTTERING FOUNDATION® FOUNDATION ® Young people with ASDs benefit from working with A Nonprofit Organization 6 socially stronger peers who can act as role models. Since 1947—Helping Those Who Stutter A Nonprofit Organization To foster generalization of new skills, explore grouping 3100 Walnut Grove Road, Suite 603 Since 1947— Helping Those Who Stutter P.O.i Box 11749 • Memphis, TN 38111-0749 the individual with others who have similar speech [email protected] characteristics andwho are goodsocial models.This 800-992-9392 www.stutteringhelp.org will provide an optimal setting to practice fluency tools, www.stutteringhelp.org www.tartamudez.org www.tartamudez.org social skills, andoverall self-monitoring. Contributions are tax-deductible and help us continue our work. 1/08 may decide to test word finding or narrative language to Tips for parents If your child is stutter- What are Autism Spectrum determine whether accompanying language deficits are ing, treat him as you would any other child: with kindness Disorders?AAutism Spectrum Disorders (ASDs) present. If both formal testing andobservation of the and respect. Above all, convey total acceptance. Working include Autism, Pervasive Developmental Disorder Not child’s speech in everyday settings reveal an underlying on communication and fluency skills is a challenge that Otherwise Specified, and Asperger’s Syndrome. All three language deficit, the SLP should address the language is- affects all areas of a child's day; therefore, the child needs are characterizedby impairments in 1) social interaction, 2) sues along with the stuttering. as much support, encouragement and acceptance as possi- communication, and3) restrictedinterests/repetitive behav- ble. When he is speaking, try to focus on the following: iors. Specific criteria distinguish one subgroup from another. Treatment Treatment shouldalways be based ASDs are often first diagnosed in childhood, and intelli- upon each client’s needs, and this is particularly true Listen to what your child has to say. Use facial gence ranges from below to above average. There is no de- with ASDs. Because stuttering interferes with effective 1 expressions and other body language to convey that finitive research regarding the cause of ASDs. conversation skills andtherefore social interaction, you are listening to the content of the message and not to Although there are no specific statistics on the number treatment is crucial. Social interaction andself-monitor- how your child is talking. Maintain eye contact. of people with ASDs who stutter, there have been numer- ing can be more difficult for those with ASDs. So treat- ous documented cases of stuttering in ASDs. These range ment will often focus upon use of fluency tools in social Allow your child the time he needs to finish his from typical forms of stuttering, such as repetitions, e.g. exchanges. Tools may include: 2 thoughts. c-c-cup, prolongations, e.g. cuuuup, or blocks, i.e. sound Ⅲ Traditional stuttering tools, such as easy onset or gets “stuck,” to less typical stuttering, such as repetitions prolonged speech. How the tools are taught will depend Help all members of the family learn to take turns of the last syllable of a word, e.g. sound-ound. upon the child’s level of comprehension. Those with a 3 talking and listening. Objects such a microphone or a Speech may also sound disorganized due to a higher than higher comprehension level will benefit from a description salt shaker at the dinner table can be passed to indicate average number of normal disfluencies, interjections, repeti- of techniques either written or in picture form coupledwith each person’s turn. This provides a good model for the child tions of phrases, and/or revisions of thoughts. Individuals practice. Carol Gray’s model for Social Stories,TM with an ASD and helps her to feel like your family is “in may show different combinations and levels of awareness of www.thegraycenter.org andwww.autism.org/stories.html, is this together.” these symptoms. often helpful for describing stuttering tools for those with ASDs. Children with a lower comprehension level will Choose specific and brief times to work on strategies Diagnosis A professional specializing in pediatric benefit from less description and more imitation of therapist 4 in the midst of everyday activities, such as 5-10 min- development typically makes the diagnosis of an ASD. models. Concrete visual models, such as stretching modeling utes during bath time. Short consistent practice is often Diagnosis often occurs between the age of two and clay for “stretchy,” prolongedspeech, are often helpful to most effective. eight years. However, a speech-language pathologist demonstrate the skill. Self-monitoring in context can be (SLP) typically diagnoses stuttering. Because children difficult for those with ASDs, so consistent repeated practice with ASDs have many ongoing issues with social inter- is often necessary for mastery. To help ensure carryover action andcommunication, stuttering is not always no- to everyday environments, teachers, parents and others Tips for therapists ticedanddiagnoseduntil a childreaches school age. who interact with the childshouldgently remindhim about in structuring sessions Interactions between ASDs andstuttering present a tool use. StructureS activities according to a consistent, complex combination of disorders for which research is Ⅲ Tools for organizing thoughts, such as visual organizedschedule that the young person has ongoing. An SLP who has expertise in the area of flu- organizers. Story webs andvisual mapping programs helpedto create. Post these routines in the therapy ency shouldevaluate stuttering in this population; such as Inspiration® or Kidspiration,® www.inspiration.com, room so he is aware of the schedule and what those also familiar with ASDs are ideal evaluators. The can be helpful in organizing thoughts. Once skills are comes next. The ASD population benefits most evaluation should help distinguish typical disfluencies demonstrated, they should be practiced in more to less from direct engagement; this is contrary to the from stuttering and determine whether difficulties lie structuredsettings. ADHD population who respondto rewards. in speech production or other areas, such as organiza- Increase pausing to allow extra time to: Therefore, you shouldteach andpractice tools Ⅲ in the context of play or preferredactivities to tion of language. It is important to determine if the • organize thoughts, problem is motor and/or language-based because treat- breath in appropriate places, and keep the young person engaged, and to make ac- • tivities meaningful. If activities are meaningful, ment will be basedupon this determination.After lis- apply fluency tools, such as easy onsets, easy starts, or • she will remember anduse them outsidetherapy. tening to the organization of a child’s language during prolongedspeech. Research indicates if children with ASDs are not conversation and/or story retelling activities, an SLP Pausing can be introduced by inserting visual markers to first engaged, all the rewards in the world will not indicate where to pause when reading sentences or paragraphs. Compiled by Kathleen Scaler Scott, M.S., CCC-SLP Model pausing if the child has difficulty with reading tasks. Continued University of Louisiana at Lafayette