Speech Language Pathologists

What is the role of a Speech and Language Pathologist (SLP) in working with a child with Autism Spectrum Disorder (ASD)?

  • The role of the SLP when working with a child with ASD is to assess their speech, language, and communication skills and provide services to effect significant changes within the following areas:
  • Speech – articulation and intelligibility of speech
  • Language skills – the understanding and use of language (also known as receptive/comprehension and expressive skills)
  • Communication skills - requesting skills, commenting, conversational skills, etc.
  • The social use of language - pragmatic language skills
  • Reading skills – the ability to decode words and read with meaning/comprehension
  • Written language skills – the ability to write for a variety of purposes
  • Vocal quality – the rate, rhythm, and speaking style
  • Augmentative and alternative communication (AAC) – sign language, Picture Exchange Communication System, voice-output devices such as GoTalk or iPad/iPhone with Proloquo2go.

What are some signs a child may require the assistance of a SLP?

The child may exhibit one or more of the following signs:

  • The child is not using any spoken words or is not using spoken language in a meaningful way
  • The child is not understood by unfamiliar people (e.g., babysitter, daycare provider, teacher, relatives, etc.) 
  • The child is not combining words to form lengthy phrases in order to request/ask for items that he/she wants
  • The child is not using aspects of grammar that would be expected at their chronological age (e.g, pronouns – I, you, he, she, we, they, etc.; past tense verbs – jumped, ate, drank, etc.; present progressive tense verbs – is [verb ing, for example, The dog is barking.)
  • The child is not using language for a variety of purposes such as requesting items, requesting attention, requesting help/assistance, answering yes/no questions, answering and asking Wh-questions (who, what, where, and when), requesting information, and for conversation purposes

Can a child see a SLP through the school board? Who would pay for this?

The child can often see an SLP through the school board; however, the type of intervention/services provided varies from school board to school board throughout Ontario. Many school boards have SLPs on specialized ASD teams. These professionals most typically offer only consultation services to the classroom teacher or training to the school staff on speech, language, and communication deficits in children with ASD.

There may also be school-based SLPs who may see the child for direct therapy, group therapy, assessments, consultation, or on a monitor-only basis.

There is also another service available to children within the school system and that is provided through CCAC (Community Care Access Centre). The school board SLP must make a referral to CCAC for specific disorders only such as articulation, voice problems, or stuttering. The services offered by CCAC SLPs also vary within the province. This service is also typically restricted to a set number of visits per child.

Can a child with Asperger Syndrome, who has advanced vocabulary, benefit from seeing a SLP?

Children with Asperger Syndrome may also demonstrate deficits in other areas of language and communication. Many children with AS require intensive intervention in order to develop appropriate conversational skills and social skills. They may also have difficulty extracting higher-level/abstract meaning from spoken language and/or written language (i.e., reading comprehension skills). Often their reading (decoding of words) is at a much higher level than their understanding of what they have read.

Can a SLP help teach a non-verbal child to speak?

There are emerging evidence-based approaches that do help some children acquire functional spoken communication such as the Picture Exchange Communication System (PECS). Unfortunately there is not a single method that can reliably teach non-vocal children to speak. The main concern is that the child has a functional communication system so that they can learn to request items and participate in their environments (e.g., PECS, sign language, voice output device, written language, etc.) even in the absence of speech or while speech is developing.

Can a SLP fill out and sign forms, such as Assistance for Children with Severe Disabilities and the Disability Tax Credit?

The SLP can fill out the Disability Tax Credit form but they can only comment on the area of the form specific to speech and communication skills. The disability must be significant and long lasting in order for the child to qualify under the program. The SLP has an ethical responsibility to accurately report the speech, language, and communication deficits for their clients and could jeopardize their registration to practice in Ontario if they are not honest in signing the form.

Can a SLP work with other professionals in supporting a child, such as an Occupational Therapist, or an ABA therapist?

The SLP can be a valuable team member in supporting the child with ASD. The SLP brings to any team the knowledge of typical speech and language development and the ability to assist the OT and ABA therapist/team with determining appropriate speech, language, and communication goals for programming purposes.

Can the Direct Funding Option (DFO) from the government for an IBI program be used to pay for a SLP who is working with a team of professionals?

No. The Direct Funding Option (DFO) can only be used to pay for Intensive Behaviour Intervention provided by qualified individuals. If the SLP is also dually certified as a BCBA (Board Certified Behavior Analyst) or has the equivalent qualifications then they may be paid by the parents through the DFO program. However, this SLP would then be acting as either the Senior Therapist or Clinical Supervisor on the IBI team and not solely as an SLP and therefore would be providing services encompassing many other areas of functioning beyond speech, language, and communication.

What questions should I ask a SLP when I contact them to provide service to my child?

There are a number of questions that a parent should ask the SLP in order to determine if the SLP is practicing within their ‘scope of practice’ and following the ethical guidelines of the College of Speech Pathologists and Audiologists of Ontario (CASLPO):

  • What training have you had specifically in Autism Spectrum Disorders?
  • How many children, approximately, have you treated with ASD?
  • What ages of children have you treated with ASD?
  • Have you had experience in providing service to non-vocal children or minimally vocal children with ASD?
  • Have you had formal training in evidence-based treatment such as the Picture Exchange Communication System, Pivotal Response Therapy, or Verbal Behaviour Therapy?

Can a SLP diagnose ASD? Can a SLP make a diagnosis that other professionals cannot?

SLPs practicing in Ontario cannot diagnose ASD, nor can they diagnose any disorder, including speech, language, and communication disorders. The act of diagnosing and communicating the diagnosis rests with physicians and psychologists within the province of Ontario. This is not the case elsewhere in Canada and the USA where SLPs can provide diagnoses for ASD and all other speech, language, and communication problems. It is not a matter of training as SLPs in this province undergo the same rigorous training as other SLPs. Rather, the Regulated Health Professions Act, 1991, has controlled the act of diagnosis and restricted SLPs from performing this Controlled Act.

Should a SLP provide written documentation of the assessment or treatment they provide?

Yes, the SLP should provide written documentation of the assessments and treatments provided. They are required by the College of Speech-Language Pathologists and Audiologists to keep detailed records of all contact with clients and the outcome of all assessments and treatment sessions. If a parent requests this information in writing then the SLP is obligated to provide the information.

What are different types of intervention a SLP would provide to a child with ASD? Are some therapies proven to help more than others?

There are many different types of intervention that can be provided to a child with ASD, among those are:

  • Direct one-to-one therapy
  • Small group therapy
  • Large group therapy
  • Consultation to other professionals (OT, teacher, IBI (Intensive Behaviour Intervention) team, ABA (Applied Behaviour Analysis) team)

There are also different types of therapy/treatment that may be provided. As a professional, the SLP is required to provide evidence-based practice. This means that where evidence exists for specific difficulties then the SLP must provide that treatment. However, many areas of speech, language, and communication lack evidence to guide the SLP. In these cases, the SLP must inform the client (or their parent if they are a minor) of the lack of evidence for the specific treatment that they are proposing and then they must document their own evidence through careful data collection and analysis. Currently the majority of evidence-based treatments for children with ASD fall under behaviour therapy practices. The current evidence for treatment of speech and language disorders for children with ASD can be found at: American Speech and Hearing Association (ASHA): www.ncepmaps.org/Autism-Spectrum-Disorders.php and at speechBITE: www.speechbite.com.

Are there an expected number of sessions for children with ASD?

There is no way to determine an ‘expected number of sessions’ for children with ASD. ASD is a genetic disorder with lifelong ramifications in the area of communication. All individuals with ASD are unique and present differently. Currently, there are no accurate tools or symptoms that can assist the SLP with identifying which children will become vocal/verbal and which children will make the most progress. The research and evidence for effects of intervention clearly state that early and intensive intervention offers the bests outcomes for children with ASD.

What else do I need to be aware of when working with or hiring an SLP?

You need to be aware that many individuals working with children with ASD (SLPs, OTs, teachers, etc.) do not have specific training in dealing with problem behaviour and may inadvertently reinforce inappropriate behaviours while providing therapy/intervention services. It is also your right to have informed consent for all aspects of assessment, goal setting, and treatment, meaning that the SLP should explain all assessment results fully, all goals should be explained and measured to determine progress, and the evidence for all treatment/intervention should be discussed prior to intervention.

What is the typical fee for a SLP? Is there funding available to families for SLP services?

There is not a ‘typical’ fee for private SLP services in Ontario. The Ontario Association of Speech- Language Pathologists and Audiologists (OSLA) does publish a fee schedule yearly to assist SLPs in determining appropriate fees. If the SLP you are working with is a member of OSLA then they may be able to provide the fee schedule to you for information. The 2010 OSLA recommended rates were $180.00 per hour for one-to-one services (including assessment, preparation and analysis for assessment/treatment, therapy/treatment, travel time, report writing, and telephone or e-mail consultations) and $90 - $125 per hour per client for group therapy.

  • There are some programs and charities that will fund SLP services:
  • Many families have extended health benefits that will cover a portion of SLP services.
  • Private SLP services can also be claimed under Medical Expenses on your Income Tax.
  • The Jennifer Ashleigh Children’s Charity will fund for SLP services for some families within a specific income bracket - http://www.jenniferashleigh.org/what.html.
  • The President’s Choice Children’s Charities will also fund for developmental therapies for children with Autism for some families within a specific income bracket - www.presidentschoice.ca/LCLOnline/aboutUsCharityHowWeHelp.jsp.

Will a SLP see my child in their office, in our home, or in the community?

Some SLPs may see your child in their office, clinic, in your home, or out in the community (e.g., daycare). When contacting the private practice SLP, enquire as to where they provide services and if they would provide services in alternate locations such as a daycare setting. There may also be extra travel charges (travel time + Km) for providing services out of the SLPs typical therapy setting.

Private practice SLPs are typically not allowed to provide speech and language services within publicly funded schools. However, many private schools do allow private practice SLPs to provide services within their schools.

Are there organizations or associations a SLP has to be, or may want to be affiliated with?

In Ontario the SLP must belong to the College of Speech-Language Pathologists and Audiologists of Ontario (CASLPO) as this is a regulatory body which provides public protection. The SLP may also want to be affiliated with the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) for federal representation, as well as, the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA) for provincial representation.

If they are working primarily with children with ASD then they may also want to be affiliated with the organizations that support Autism such as Autism Ontario, Association for Science in Autism Treatment (ASAT), and Autism Speaks, to name a few.

What education must a person have to call themselves a Speech and Language Pathologist?

In order to call yourself a Speech-Language Pathologist in Ontario you must hold a Master’s degree in Speech-Language Pathology from an accredited University and be registered with CASLPO.

In order to meet the registration requirements of CASLPO, the SLP must have acquired in their academic program:

  • 270 hours of course work in basic communication
  • 200 hours of course work in related areas
  • 360 hours of course work in the major professional area which provides in-depth study of disorders of speech and language and clinical evaluation and treatment of communication disorders
  • 90 hours of course work in the minor professional area which provides study in audiology for speech language pathology majors, and
  • 300 hours of supervised university accredited clinical practicum with both children and adults representing a wide variety of communication disorders
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Interviewee: Tracie Lindblad, Reg. CASLPO, M.Sc., M.Ed., BCBA

Tracie is a Board Certified Behaviour Analyst (BCBA) with over 20 years experience working with children and youth with Autism Spectrum Disorders (ASD). Tracie is also the founder and President of Four Points, a private centre providing intensive Applied Behavioural Analysis (ABA) therapy to children with ASD. She is the Clinical Director within the ABA programs for the centre-based clients and functions as the Clinical Supervisor for clients in funded (DFO) home-based programs. Tracie has presented workshops and training sessions to numerous school boards, agencies, and organizations throughout Canada and the United States on a variety of topics related to the fields of speech-language pathology. Tracie is also a research investigator on a number of current projects within the field of ASD, ABA, and Developmental Disabilities through various agencies such as Surrey Place Centre and York University.

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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