Mitchell: A Boy with Autism Spectrum Disorder
Mitch was six years old when his family contacted me. He had been diagnosed as having autism spectrum disorder two years earlier by a multi-discipline clinic at a university medical school. Autism spectrum disorder (ASD) is a developmental neurological disorder characterized by atypical development in social interactions and in communication. Mitch had trouble making eye contact with listeners. His expressive language was vague: his sentences were long enough and had the right grammar and syntax (word order) but the words he chose did not quite communicate his meaning and the listener had to work extra hard at decoding the message. It was hard to have a conversation with Mitch: he tended to monopolize the taking, worked hard to steer it toward one of his favorite subjects and did not appear to be listening when it was the other person’s turn to talk. He had trouble with focus and attention: he was quite distractible. He had two favorite subject (farm tractors and the carved images at Mt. Rushmore)) and didn’t really talk much about anything else. He did not play very much with other children at school or in the neighborhood and interacted mainly with adults. Mitch periodically had bouts of anxiety and if was much harder for him to focus when that was happening. In speech therapy, among other objectives, we practiced looking at the listener and using just exactly the right word(s) to answer questions.
Children on the autism spectrum vary widely. However, we usually see some difficulty with language pragmatics, the social rules of conversation, including making eye contact, taking turns talking and listening, responding appropriately to questions, knowing how to insert oneself into a group, knowing what to talk about, and when older, knowing how to lead a conversation. There may be an intense desire to talk about one specific subject over and over. Often with children on the spectrum, we also see difficulty being specific with word use and difficulty organizing one’s thoughts into clear, concise sentences. The goals for Mitch fell into these two areas. Mitch was also receiving speech therapy at his school. His school speech language pathologist and I tried to talk by phone at least once every two or three months.
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The following are example case studies that illustrate some of the kinds of children and adults I see with communication disorders. These are combinations of real individuals, each study presenting some characteristics of therapy for that particular communication disorder. Remember, no two people are exactly the same nor do they respond the same in therapy. That, in fact, is one of the joys and challenges of helping people improve their communication. Remember also that an experienced clinician has a number of tools at his/her disposal. The methods illustrated here are not the only effective ways to facilitate change. Finally, the cases illustrated here have mostly successful outcomes but there are children and adults who do not make the amount of change we would like, for a variety of reasons. There are no guarantees in speech therapy. As I tell parents, if you find someone who guarantees a particular result in speech therapy, run the other way.
Below are a few composite examples of the type of people I see in my speech therapy case load. I also work with people with oral myofunctional disorders (including tongue thrust swallow problems), voice disorders, cerebral palsy, speech problems as a result of cleft lip and palate, a relatively rare fluency disorder known as cluttering, and people with acquired brain damage due to strokes or closed head injuries. These individuals often have aphasia (loss of language due to brain damage) or dysarthria (difficulty with articulation due to neurological damage, often resulting in muscle weakness).
Speech therapy is a relationship between the clinician and the patient that has to be built and maintained, and the therapy process has to be rewarding, either for the result it will produce (older children, teens, and adults) or because the therapy itself is fun and interesting.
I have assigned names to each example, but the names do not refer to particular persons.
Jay: A Preschooler with Stuttering »
Mitchell: A Boy with Autism Spectrum Disorder »
Sophie: A Little Girl with an Articulation Disorder »
Jeffrey: A Toddler with Down Syndrome »
Charles: An Adult with Developmental Disabilities »
Albert: A Second Grade Boy with an Expressive Language Disorder »
Henry: A 35 year old Adult with Stuttering »
Jasmine: A Three Year Old Girl with Childhood Apraxia of Speech »
Linda and Jeff: Parents of a 26 Month Old Boy Slightly Behind in Talking »