“It was such a pleasure to hear all of the wonderful things Generation Rescue has to offer. I am thrilled to have the opportunity to work with such an amazing organization. I look forward to helping families of children with Autism Spectrum Disorders.” -Nicole Butler, M.A., CCC-SLP
We are proud to highlight Nicole and her expertise in our newest feature, “Q & A with a Specialist.” In this feature, Nicole talks about the benefits of Speech-Language Therapy for children with autism and some of the strategies she has used with her clients.
GR: What are some of the benefits of speech therapy for children with autism?
NB: The difficulties communicating that these children often face, frequently affect all aspects of their daily lives. Speech-Language therapy can improve their overall quality of life by increasing their comprehension, communication and social skills.
GR: What are some of the areas of speech and language that can be affected by an Autism Spectrum Disorder?
NB: Many different areas of speech and language can be affected but frequently the social aspects of communication are the most noticeable. For example, your child may have difficulty providing eye contact, maintaining topic, or initiating conversation. Expressive language and comprehension are also typically affected. Expressive language difficulties can be exhibited when attempting to communicate with others. Comprehension difficulties are observed when your child struggles to understand what others are attempting to communicate to them, or when interpreting the world around them.
GR: What techniques or methods do you implement when working with children with autism?
NB: Every child has different needs depending on their communication level. Some techniques and approaches I have used in the past include ABA (Applied Behavior Analysis), PECS (The Picture Exchange Communication System), TEACCH (Treatment and Education of Autistic and Related Communication of Handicapped Children), DIR/Floortime (Developmental Individualized Relationship based approach), RDI (Relationship Development Intervention), sign language and singing.
DIR/Floortime stresses the importance of using positive social reinforcement (e.g., praise) as well as building a relationship with each child. This approach also suggests learning communication skills in functional environments or during daily living skills such as while washing hands, brushing teeth, and things they do everyday. DIR/Floortime takes their sensory needs into consideration such as the volume and pace of your voice, temperature and lighting of the room. The child should be regulated (e.g., calm state) and comfortable within the setting before they are expected to participate and engage in activities and interactions. RDI approach aims at developing the ability to think flexibly and form personal relationships through a family-based, behavioral treatment.
ABA focuses on using immediate positive reinforcement (e.g., token) for a desired behavior to increase the likelihood of it being repeated. This is frequently done through discrete trials, in very structured settings. PECS or a modified version of PECS is often incorporated across these different approaches. It uses small laminated squares with pictures or symbols paired with the corresponding label/word (e.g., table) on it to communicate. The child can point, exchange or pair multiple pictures together to communicate their wants and needs. PECS can be used with non-verbal children or those with limited verbalizations as a way to expand their communication skills and decrease frustration. These pictures are also extremely helpful with transitions, when utilized in an individual schedule for the child as seen with the TEACCH approach. TEACCH’s goal is for the child to be as independent as possible utilizing a visual and/or written schedule, as well as work stations. The TEACCH approach can also be incorporated with other approaches. This approach takes into consideration the culture of Autism and the physical arrangement of the room.
GR: What are some steps that families can implement at home to help improve speech and language?
NB: Therapy is individualized to each child’s specific needs because Autism is a spectrum disorder. Below are some strategies that have been successful in the home.
- Keep directions short and to the point because long sequences can be confusing. If the child doesn’t follow the direction after stating twice, show the child what to do such as “picking up the books” together.
- Often children with an Autism Spectrum Disorder have specific interests that become a “passion” or “fixation” (e.g., maps and trains). These interests are great ways to motivate them to communicate and learn. For example, put their favorite object out of reach and then require them to communicate to get the object.
- Children with an Autism Spectrum Disorder can be described as visual thinkers, so set up your home for visual learning. If your child is not speaking or has limited verbalizations, then pictures and/or sign language/gestures can be used to communicate. For example, place pictures on various objects around your home (e.g., table, bed). Walk around daily with your child saying the names of the items repeatedly and pointing to the pictures. Initially it is common for your child to point to the pictures then use those words that are most reinforcing such as basic wants and needs frequently used throughout the day (e.g.,“bathroom”, “drink”, and “food”). They will soon progress to more specific words such as “juice” and “milk”, and continue to increase their vocabulary.
- If your child is communicating with one or two words, you may increase their sentence length by adding words such as colors and numbers (e.g., red car).
- Children with an Autism Spectrum Disorder may be more responsive to singing than speaking.
- To decrease your child’s anxiety level, it may initially be appropriate for them to follow a routine. Give your child expectations of what will happen throughout the day by using a picture schedule. This will help prepare for transitioning from activity to activity. Giving a five-minute warning will also help the child to prepare for the change.
- -Children with an Autism Spectrum Disorder may be hyper or hyposensitive. If they are hypersensitive, you will want to minimize distractions in the home including noise, lights and clutter. If your child if hyposensitive, they may often seek hugs for sensory input. It is ideal to have an Occupational Therapist to consult with to address your child’s sensory needs.
- If your child is using lengthy and complex utterances, however frequently misses the nuances of communication such as humor then addressing idioms (e.g., break a leg), homophones (e.g., peace or piece), and sarcasm to increase their understanding of abstract thinking can be implemented.
Nicole is a certified Speech-Language Pathologist with a Clinical Certification of Competence (CCC) through the American Speech-Language-Hearing Association (ASHA) since 2004. Nicole specializes in working with children with an Autism Spectrum Disorder, as well as deaf and hearing impaired children.
Nicole earned a Bachelors of Science degree from the honors program at Purdue University in 2001, with a major in Speech-Language Pathology and a minor in Psychology. In 2003, Nicole graduated from New York University with a Masters of Arts in Speech-Language Pathology. During her graduate program, she studied at Lund University in Sweden, where she enrolled in classes about dysphasia (in children and adults) and speech disorders. After graduate school, she completed her Clinical Fellowship Year at a primarily Autistic Spectrum Disorder program in New York City. Nicole is certified to work in Early Intervention (birth to three year olds) as a Therapist and an Evaluator in California, New York, and Illinois. Nicole holds a Teaching Certification (Type 10 and Type 73) in Illinois and in New York (TSHH). She worked as a Clinical Fellowship supervisor, where she taught treatment, evaluation, and diagnosis to Speech-Language Pathologists who are working towards ASHA certification and state licensure.
Nicole has extensive experience in TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children), PECS (Picture Exchange Communication System), SOS Feeding Approach (Sequential Oral Sensory), PROMPT technique (Prompts for Restructuring Oral Muscular Phonetic Targets), American Sign Language, ABA (Applied Behavior Analysis), RDI (Relationship Behavioral Intervention) and the Touch Cue method.
Nicole has worked with a large range of individuals, from newborns to adults, with speech and language delays and disorders, learning disabilities, cochlear implants, deaf and hearing impaired, stuttering, developmental delays, accent modification, congenital disorders (e.g., Down Syndrome), DIR/ Floortime (Developmental Individualized Relationship based approach), AAC (Augmentative and Alternative Communication) devices, Apraxia, Cerebral Palsy, Autism Spectrum Disorders, neurogenic disorders, neurodegenerative disorders (e.g., ALS), dementia (e.g., Parkinson’s), psychological disorders (e.g., Schizophrenia), dysphagia, motor delays (e.g., dysarthria), voice disorders, expressive and receptive aphasia, and cognitive linguistic deficits. Nicole has conducted formal (e.g., Videofluoroscopic Swallow Study x-ray) and informal evaluation measures of speech and language delays and disorders. She has counseled primary caregivers, patients, and staff at length regarding evaluation results, swallow precautions, treatment options and treatment progress. She has collaborated with registered nurses, medical doctors, dietitians, physical therapists, and occupational therapists regarding patient’s status and progress. Nicole continues to expand her knowledge within Speech-Language therapy and related fields, by taking continuing education courses each year.
For more information or to contact Nicole directly, please email to: [email protected]