Running Header: AGE, AUTISM SEVERITY AND SPEECH THERAPY

Whether Age or Autism Severity Has More Influence

on the Efficacy of Speech Therapy in Children.

Rachel Martinez
Psychology 3620 section 853
18 November 2013

AGE, AUTISM SEVERITY AND SPEECH THERAPY

Introduction
Autism is a disease that not very much is known about. Autism is defined as a pervasive
developmental disorder that is characterized by difficulties with social interaction, problems with
verbal and nonverbal communication, and deficits in symbolic and imaginative play, (Levine
2011). Since the cause of autism is unknown, all that can be done to help children with autism is
to implement different types of therapy. A form of therapy that is most often used is speech
language therapy. There are a lot of varying factors in autism and how a child can react to
therapy. Two big factors are age and the severity of autism, whether its low functioning or high
functioning. It is important to discuss if and how age and the critical windows of development
affect speech therapy results. It is also important to discuss whether the severity of autism makes
more of an impact on speech therapy. But the most important question is which factor changes
the efficacy of speech therapy the most, whether age or the severity of autism changes the
efficacy of speech therapy.
Professionals in the field of speech language pathology need to be able to fit certain types
of therapy to certain children. With autism there are so many varying factors, and so little is
known that making therapy effective can be difficult. So it is important for professionals to
understand what varying factors can change the efficacy of speech therapy, so that way they can
contour their therapy to fit the needs of a specific child. It is also necessary for people, even
those not in the professional field, to understand how certain things like age and autism severity
can change the efficacy of speech therapy. It especially important for parents of autistic children
to realize that there is not a one size fits all approach to therapy, and each child needs
individualized care and attention.
April Doyle is a speech language pathologist currently working in Plano ISD. She
graduated with a Bachelor degree in communication disorders from the University of Texas and

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graduated with a Master of Science degree in speech language pathology from the University of
Texas in Dallas. Doyle has been working in the Plano district for four years. She is now working
at four different schools, mainly focusing on treating autistic children. She works with an age
range of early elementary to high school.
Summarization of Interview
The interview started by asking about autism in general, what it causes and the language
problems associated with it. Mrs. Doyle explained that the cause of autism is unknown, however
there are many theories, and it causes a lack of language development. Autistic children will
often reach the babbling stage and either regress or not progress. They also will often times have
difficulty responding to stimuli, like their name, and will get overly frightened by loud noises.
The difference between high functioning and low functioning autism was also discussed. Mrs.
Doyle explained that high functioning autism creates more of a problem with social skills, and
children will often not engage in formalities and cannot hold a conversation. Doyle also
explained that children with low functioning autism often cannot communicate simple requests,
and they act out physically with tantrums or biting and scratching.
The interview then moved on to the different kinds of therapies Doyle uses on a day to
day basis, and how they differ for different ages and autism severity levels. Doyle described the
therapy used for low functioning autism, which includes a communication device and working
towards getting the child to make simple requests for wants. Low functioning autistic children
usually start out with just the device and pictures and they work on adding new pictures for
things and creating a communication book. Then they work up to expressing wants and making
requests. First they start with a food that they like and learning how to express a desire for that
food, then onto other things like toys then onto requesting needs, like when they need to go to the
bathroom. They learn to make requests first with their communication devices and then try to
make requests without them. Doyle expressed that the goal for children with low functioning

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autism is to eventually get them to use their communication devices less and less as they grow
up, however they will never have the speech skills that higher functioning autistic children have.
As far as therapy for higher functioning autism, Doyle explained that therapy is much
different. The therapy is mostly focused towards gaining social skills and social communication.
A lot of the therapy is also done in groups with children having similar social problems, and it
involves acting out and rehearsing certain situations. Doyle explained that a lot of therapy
utilizes the fact that children with autism tend to like routines and scripts. So they practice scripts
for different situations and work on being able to have conversations. Doyle gave an example of
a girl who sits alone at lunch and doesnt know how to approach other people. So what Doyle
does, is gather the group of high functioning autistic adolescents/teenagers with similar problems
and work out the situation with conversation and focusing on body language and facial
expression.
Doyle works with a range of ages from early elementary to high school. Doyle described
that the differences between the therapies used arent significantly different for early elementary
and high school ages. What is different though, is how the students react. Early elementary
school children tend to be more excited about therapy but they also havent had a lot of years of
therapy so they have to have multiple therapy sessions a week. High school students have had
many years of therapy and theyre on their out of therapy so they meet only once or twice a week
for a short amount of time a week. Also by the time a student gets to high school theyve had
enough therapy to function well (if theyre high functioning) and they know what to do, but they
could just not want to do it and if thats the case, then theres nothing left to do. For low function
autistic students, however, therapy has to last as long as they can get it, normally until about age
twenty-one.
When asked about how age affects therapy, Doyle explained that early intervention is
always best however she has not seen much of a difference between the students who had

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intervention at the age of two versus those who dont get diagnosed until kindergarten age. Doyle
explained that when autistic children start school, their autistic behavior is noticed by the
teachers so the student gets tested. Therefore, there are hardly any cases in the US of autistic
children not starting therapy when theyre very young. Doyle explained that even if a student
starts therapy at school age, their brains still have enough plasticity for therapy to be effective.
Doyle went on to explain that therapy is cumulative, however sometimes students need
breaks from therapy and breaks can be very useful, before going back to therapy. Doyle gave an
example of a low functioning autistic child that she had treated for many years that started out
using only a communication device and by the end of the year he didnt need the device, and
three years later he was saying simple sentences.
When asked about the plasticity of the brain and whether or not she had any experience
with the critical window of language development, Doyle said that it is a very dependent
situation. Doyle explained that therapy itself is made to get children past those critical windows
so they can learn and develop language. However, depending on the type of autism that the child
has, therapy may or may not be as effective. Doyle also said that effectiveness also depends on
the child, sometimes their behavior is worse but their language develops, or their behavior
improves but their language does not. Doyle made a point to say that progress through therapy
depends mostly on the child and their individual needs and characteristics.
Personal Thoughts
I found Doyles views and experiences to be really interesting. I learned in my first
psychology class that the first rule of psychology is that everyone is different. I found this to be
exemplified by Doyles experiences. Especially with autism, progress depends on the child and
there are so many factors that can play into any form of therapy, not just speech therapy. Before
going into the interview I thought there was just going to be one concrete answer, but I couldnt
be more wrong. My original questions were actually all about age, because I thought that was the

AGE, AUTISM SEVERITY AND SPEECH THERAPY

most important factor due to what Ive learned about the critical windows of development.
However, what Doyle presented me with was a simple idea that I hadnt even considered, that no
two children are alike, especially when it comes to autism. Autism affects behavior as much as it
affects language, and both factors have to be considered when deciding the best course of
therapy. With autism, age doesnt really play as big of a factor because like Doyle said, most
children get diagnosed when they enter kindergarten, which is still early enough to catch the
window of brain plasticity. What does play a big role though, is the behavior and level of autism
severity that the child has.
What I learned during the interview inspired me to do more research into autism and
speech therapy. I found out that there have been many studies in the area of autism and speech
therapy, as well as autism and the effects of different types of therapy. There was one study done
about treatment approach, autism severity, and intervention outcomes in children done by Ditza
Zachor and Ben Itzchak in Israel. In the study different types of therapies were tested along with
different autism severities to see how much any one factor affected the children (Itzchak 2010).
Their results were that the childs baseline social behavior played a major impact on the outcome
of their therapy (Itzchak 2010). Another study was done by Cardoso on the variance of language
progress rates with different language therapy consistency (Cardoso 2013). One group of autistic
children stayed in therapy for 12 months with no therapist change and the other groups stayed in
therapy for 12 months with a therapist change at 6 months (Cardoso 2013). The study did not
show any significant difference in the language progress rates in either of the group of autistic
children, but did notice a better functional profile of communication with the group that had no
therapist change (Cardoso 2013). These studies, along with others that Ive read seem to all say
the same thing as Doyle, that progress and efficacy really does just depend on the child.
Future Actions

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The future of autism is fast approaching since there are constantly new studies coming
out examining it. However, before any concrete changes in therapy are made, the cause of autism
has to be found. Until then there are too many varying factors that could change the efficacy of
any type of therapy used for autism. As of now, there are too many different correlations and not
enough concrete data to even assume the cause of autism, other than it is something wrong with
the brain. However, new studies are coming out every year and with the increase of technology
that is available for use, a cause of autism is surely to be found within the next decade or two.
Until then psychologists will continue to study different types of therapy, such and music and
sensory therapy, in the hopes of relieving the symptoms of autism and providing people who
have it with a better quality of living.
Conclusion
Autism is a developmental disease that is currently being heavily researched. No cause of
autism has yet to be found however, so treatment options for autism are limited. One treatment
method that is commonly used is speech therapy. Speech therapy has been shown to be effective
for the treatment of language problems associated with autism; however the approach has to be
individualized for treatment to work. April Doyle is a speech language pathologist working in
Plano ISD who shared her thoughts and experiences with autism and speech therapy. Her
interview, along with other supplementary resources has lead to the conclusion that the efficacy
of speech therapy is not solely dependent on age or autism severity but is dependent on the
individual child. Until more progress in autism research is made, therapists like Doyle will have
to continue doing very individualized therapy in order to help children with autism. Not only is
the importance of individualized therapy valid for professionals, it is also necessary for parents
of autistic children so that they understand that there is no one way to treat autism. Autism is as

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varied as the children who have it and that idea is crucial when talking about any form of
therapy, including speech therapy.

References
Cardoso, Carla, and Melaine Luz Montenegro. "Speech and language pathology and autistic
spectrum." Spanish Journal of Psychology 12.2 (2009): 686+. Health Reference Center
Academic. Web. 11 Nov. 2013.
Itzchak, Esther Ben and Zachor, Ditza A., Treatment approach, autism severity and intervention
outcomes in young children, Research in Autism Spectrum Disorders, Volume 4, Issue 3,
JulySeptember 2010, Pages 425-432.
Levine, Laura E., and Joyce Munsch. Child Development: An Active Learning Approach.
Thousand Oaks, CA: SAGE, 2011. Print.

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Copy of Interview Questions

Questions:
1)
2)
3)
4)
5)
6)

How does autism effect language development?

What is the age range that you work with and well as the range of autism severity?
What are the normal types of treatment or therapy exercises that you use?
What are they aimed at?
How well do they usually work?
For a while you only worked with younger children. Now that youre working at a high
school, are there any noticeable differences with the type of exercises you use?
7) Is it easier to work with younger or older children? How/why?
8) Are there differences in the way that high school students react to therapy versus
elementary students?
9) Would you say that the length of total therapy years plays a role in the effectiveness of
what you do?
10) How about the age at which the therapy starts?
11) Have you worked with any older students who havent had much or any previous
therapy?
12) Is improvement more likely at a younger or older age?

AGE, AUTISM SEVERITY AND SPEECH THERAPY

13) Have you had any experience with critical windows of development?
14) Does the idea of critical windows apply the same to children with autism as it does with
children without autism?
15) Do you feel like age effects the ability of a child to receive help from treatment?
16) Have you experienced any examples of this?
17) Any last thoughts?