5 Things I No Longer Do As A Neurodiversity Affirming Speech Therapist
If you’re looking to start speech therapy for your child or your child is already in speech therapy, you may be wondering how neurodiversity affirming speech therapy differs from traditional speech therapy. Is there really a difference? The answer is yes!
I know because I provided what I would now call “traditional” speech therapy services for many years of my career because that’s what I was trained to do. Many aspects of it never felt right to me deep down, but I was so entrenched in the medical model that pathologizes communication differences that it was hard for me to really see what I was doing.
However, after years of taking trainings by autistic and neurodivergent individuals and listening to the autistic community speak about how traditional speech therapy has harmed them, my practice now centers on a strengths-based approach. I’m continually unlearning the ways I was taught to think about and “help” autistic and neurodivergent kids.
Here are the ways I’ve changed my practice and how neurodiversity-affirming services can differ from traditional speech therapy approaches.
I no longer use the strategy of withholding toys, treats and activities to get kids to communicate.
I did this for many years. I would have an enticing toy in a clear box with a lid, and I wouldn’t open it until the child said “open,” gestured, or pressed “open” on their communication device. Sometimes kids would get frustrated with me because I did this, and I would continue to do it genuinely thinking I was helping them by creating an “opportunity” for them to communicate. Now I can see how misguided this is, and how much stress this created for the kid (and me). Now, instead of withholding items, I provide free access to anything a kid might want to play with, and then we talk about it! For example, they go up to a box of Legos, we open it together and I model language such as “open” or “Let’s open it!” and then we play together! I don’t make them communicate “more” for each block they want, but they can get as many blocks out as they’d like and we talk about it! “Red block” or “It’s a red block!” This feels so much better to me as a clinician and I know that it feels better to the kids I’m working with. We just don’t need to use withholding to model language.
I no longer do traditional “social skills” training.
For many years, I thought it was my job and duty as a speech therapist to teach autistic kids neurotypical social skills in a way that completely ignored neurodivergent communication styles and taught them to hide and suppress their authentic selves. I used popular social-emotional curriculums that taught “expected” and “unexpected” ways of being in the social world that aimed to teach autistic and neurodivergent kids that their natural way of communicating was “unexpected” and should be changed. I taught kids that they should always make eye contact when they are speaking to others and sit completely still when listening. I created goals for children to take an arbitrary number of turns in a conversation, whether they wanted to talk to that communication partner or not. Now that I’ve learned more about autistic and neurodivergent social communication styles, I cringe at these practices. I was teaching kids to hide their true way of communicating (called masking), which is associated with negative mental health outcomes. I now provide social-emotional support for autistic and neurodivergent kids using materials created and informed by autistic and neurodivergent individuals, like the SEA Bridge. This type of support is informed by the Double Empathy Problem. I honor autistic communication styles, and instead of teaching autistic kids to learn how to fit in with the neurotypical world, I believe that neurotypical people should be educated on autistic communication styles so that there is greater understanding and empathy between everyone.
I no longer treat analytic and gestalt language processors in the same way.
Before I learned about gestalt language processing a few years ago, I didn’t understand echolalia. I was taught that it was a disordered way of communicating and that it should be “extinguished” or ignored. I believed that analytic language processing was the gold standard for every kid and any communication style that differed from that was disordered. I know now that there are two ways to learn to use novel language, analytic processing and gestalt processing, and that there are different assessment and treatment approaches for both language styles. Shifting this approach has been vital to the communication progress and growth in self-confidence that I’ve seen in kids that use echolalia to communicate.
I no longer make cookie-cutter standardized scores the focal point of my evaluation reports.
I was trained to use standardized assessments on every child who presented with what could be a speech or language disorder so that I could qualify them for services. I am aware that insurance reimbursement and eligibility for public school services often depend on these scores. At the same time, though standardized assessments can be an important tool in a clinician’s toolbox to assess speech and language skills, I believe they shouldn’t be relied on so heavily to characterize the skills of kids, especially autistic and neurodivergent kids. We now know that standardized tests do not always accurately measure language skills in gestalt language processors in the beginning stages or in kids with pervasive demand avoidance (PDA) or motor planning difficulties, for example. Gathering information from a variety of contexts and using play-based language sampling is an important part of my evaluation process.
I no longer only listen to the mostly neurotypical voices in the field of speech-language pathology, but I prioritize trainings and information from autistic and neurodivergent individuals.
During the entirety of my years studying speech-language pathology and in my earlier working years, I can’t recall a single time when I was encouraged to learn from an autistic or neurodivergent person. The research or information that I did read and study was written by neurotypical people studying autism in a way that pathologized it. I hope this is changing for new students and clinicians entering the field now. I prioritize learning from autistic and neurodivergent adults, both from formal trainings and lived experience. This has made such a difference in my practice as I center kids’ authenticity and positive self-identity in speech therapy. I ask myself what I can do differently to support kids to communicate more successfully and navigate a world not built for them, instead of trying to change them.