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Hot Topic Blog - Autism


By Diane Bahr, MS, CCC-SLP, CIMI

January 2015


Children on the autism spectrum frequently have speech and language disorders with related attention and sensory processing problems. This combination of factors makes speech development and learning particularly complex.

Speech & Sensory Systems

Speech is one of the most refined fine-motor functions in the body. Several sensory systems need to work together for speech to develop and progress. These include the auditory (listening), visual (looking), tactile (touch), and proprioceptive (inner awareness in the muscles and joints) systems. When the sensory systems work together, a child’s attention can also improve. Attention, focus, and concentration are needed for all motor learning (including speech). Pediatric occupational therapists assess and treat sensory processing disorders.

Speech & Motor Function

Based on my 35 years of experience as a speech-language pathologist (SLP), I have found that children with autism tend to have mild muscle function disorders. From an early age, they do not practice speech movements enough to develop what SLPs call the “motor plans” or “motor gestures” for speech. These children usually do not “babble, babble, babble,” or “practice, practice, practice” speech sounds and sound combinations from the time they are small. Parents, pediatricians, and others can discretely track a child’s speech development from birth if they have an appropriately detailed checklist (Bahr, 2010).

Speech-language pathologists often receive speech referrals for children (at risk for being) on the spectrum when they are 18-months of age or older. Many of these children are saying few sounds and producing no words. Speech sound development began at birth, so these children have a lot of “catching up” to do. This frequently requires special methods and intensive treatment.

Hearing Test?

A hearing test may be the first order of business. A properly trained pediatric audiologist can usually obtain some general results by watching how the child reacts to various sound levels and locations. If this is not possible, the child may be tested (by a doctor) for brainstem auditory evoked responses to determine if the hearing pathways in the brain are working. A pediatric audiologist should also be able to assess a child’s central auditory processing skills, once the child is responding to sound and language. This is crucial because children on the spectrum tend to have impaired auditory processing skills.

“Oral Placement Therapy”

Children with autism usually do not respond to traditional methods of speech treatment where the child is asked “to do what I do, say what I say, or follow these instructions.” Sara Rosenfeld-Johnson coined the term “oral placement therapy” to describe special methods used by many SLPs to help children develop appropriate speech motor plans and gestures (Bahr & Rosenfeld-Johnson, 2010).

I use a systematic combination of speech treatment approaches in my own “oral placement” work. I generally begin with a “bottom-up” method where we work on vowel sounds, then consonant-vowel words, then vowel-consonant words, etc. I also capitalize on the speech sounds a child can already make. If the child can say “ah,” “ee,” “m,” or “h,” then we can work on words or word approximations containing these sounds. I use a hands-on approach where I gently move the child’s jaw, lips, and tongue to specific locations for sounds and words (if the child allows touch). Imitation is usually very difficult for children with autism, so I begin saying/facilitating speech sounds and words in unison with the child. We then work systematically from unison, to imitation, to using words functionally during play. This often requires weekly speech therapy sessions with daily practice at home and several years of treatment.

I encourage parents and care providers to be partners in treatment. Just like every other sensory-motor function in the body, speech needs to be practiced every day for improvement. A child’s SLP can help parents and care providers do this.


Bahr, D. (2010). Nobody ever told me (or my mother that)! Everything from bottles and breathing to healthy speech development. Arlington, TX: Sensory World.

Bahr, D., & Rosenfeld-Johnson, S. (2010, February). Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges. Communication Disorders Quarterly, 31, 131-138.

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