We combine discussion of behavioral and communication approaches here because they are so closely connected. In practice, behavioral and communicative therapies are usually presented simultaneously. Many troubling behavioral issues disappear once children can communicate their wants and needs. Children who understand what to expect from their environments and what is expected of them are less likely to display obsessive behavior or to have a tantrum.
Speech and Occupational Therapy
Speech, as well as occupational therapies (OT), are frequently offered simultaneously. Speech therapists will prompt children to use words or sign language while they are engaged in activities designed to promote fine or gross motor development which have been organized by occupational therapists. This dual therapy presentation is effective as well as efficient. However, it is not appropriate for every child. In some cases, it is best to keep children focused on one task at a time. When this is the case, speech and OT therapies can be presented separately.
Occupational therapies focus on helping children develop self-help skills so that they can ultimately perform activities of daily living with maximum independence. The development of these skills requires a lot of practice with fine and gross motor coordination. Some children with autism spectrum disorder resist engaging in activities like coloring, cutting and beading while others are very motivated to complete them. These sorts of activities help children develop the skills necessary to dress and feed themselves, and to complete school work.
When speech and OT are combined, occupational therapists will often engage children in an enjoyable sensory activity, like swinging. The therapist will stop the swing and prompt the children to say "more" or "swing" before they will resume the swinging. The sensation of swinging back and forth is frequently motivating for children on the spectrum because they find it a comforting source of stimulation. With their attention focused on the swinging sensations, children are better able to attend to the speech therapist's word use prompts. Children who cannot use words are often prompted to imitate simple sounds.
Since language development is severely delayed in many cases of autism spectrum disorder, speech therapists may engage children in preverbal imitation activities. The therapy begins with therapists helping children form simple mouth movements, like opening, sticking out the tongue, and puckering. These oral movements are often difficult for children with autism spectrum disorder to copy. Some speech therapists incorporate mirrors into the therapy to help children with these mouth movements.
The muscles used to operate the mouth are very complex and difficult to learn to operate. In some cases, it is best to begin speech therapy with sign language which is visual and concrete, and often simpler to learn to perform than oral speech. Speech and occupational therapists can use hand-over-hand prompts to help children sign accurately. They cannot physically prompt them to speak. Opponents of the use of sign language have argued that children who learn and use sign language to communicate will not later become motivated to learn to speak. This worry is unfounded, however, as it has been found that sign language helps to facilitate spoken words in children with autism spectrum disorder.