Updated: Mar 4, 2020
Update Edit: March 31, 2019: Advocacy works! The Ontario government has reversed it's previous decision to include speech therapy in its autism funding plan, details to come! Advocacy works! Ontario Autism funding to now include speech therapy https://www.huffingtonpost.ca/2019/03/21/ontario-to-tweak-autism-plan-after-heated-protests_a_23697781/?utm_hp_ref=ca-homepage #slpeeps #ontario #autism #asd
Ask a parent of a child with autism if they ever needed speech therapy for their child. The answer is likely 'yes', hours and years of working directly with a Speech Language Pathologist to develop language skills. Under the provincial funding model, parents are now not allowed to use their autism funding for speech therapy in Ontario.
In 2017, Ontario’s autism funding handed money directly to parents to be spent on a list of professional services, one that included speech therapy. Families benefited from being able to make that choice for themselves. On February 6, 2019, Ontario’s Minister of Children, Lisa MacLeod, announced new autism funding changes that took that choice away from parents.
What is the right therapy for children with autism? It seems that health professionals don`t agree on an answer. The new Ontario autism funding can solely be used for Applied Analysis Behaviour (ABA) therapy, an approach that focuses on modifying a child’s behaviour to increase positive behaviour and decrease harmful or unwanted behaviour. ABA therapy can certainly play a key role in developing early language and social communication skills, support academic goals, and help manage difficult behaviours in order to enable a child with the skills for further learning. However, the development of more complex language skills, which includes the development of literacy skills, require direct intervention from Speech Language Pathologists. Unfortunately, this service is no longer funded by Ontario's autism program.
Delayed language is one of the earliest flags for autism, so it’s natural that Speech Language Pathologists are often the first health professionals to identify the red flags and direct parents to the resources they need. The key point to consider here is that many children on the autism spectrum do not have behaviour concerns- so they continue to work only with their Speech Language Pathologist to develop language and social communication skills. Other children may require intensive ABA therapy to help with negative or harmful behaviours and may not be ready for an intervention from an SLP while behaviour management is a priority, or may require significantly more resources placed in ABA than speech therapy. Another group of children benefits most from both ABA and speech therapy concurrently. The choice of therapy should be individual to each child and not directed by a blanket policy.
With the new Ontario autism funding policy, what happens to that child that has no behaviour concerns and only delayed language and social skills? The family will receive $20,000 a year to spend on ABA services that are unnecessary for them and $0 for speech therapy that may have been vital to developing their language. With the previous autism funding, many families chose to spend all of their funding on speech therapy exclusively.
Nothing has changed in the research in the last two years to state that ABA therapy trumps speech therapy for all children on the spectrum. So why did the announcement on February 6th tout reduced wait lists while quietly not mentioning the exclusion of speech therapy?
The differences between the two therapy types are significant. While there is some language development overlap between an ABA therapist and a Speech Language Pathologist, more complex language and communication skills are only targeted by a Speech Language Pathologist.
Some example speech therapy goals for children with autism include:
Saying their first words
Putting two words together
Understanding more complex language
Using eye contact and gestures
Using short phrases and grammatically-correct sentences
Turn taking on conversation
Understanding and interpreting emotions
Pragmatics, like understanding sarcasm and jokes
Reading and writing
Augmentative and alternative communication devices
The only public speech therapy options left for parents of children with autism is through a short term workshop from the Hanen Organization called More than Words, which is for parents only. The only direct therapy that children with autism can access is the same public speech therapy for children without autism, which is generally a maximum of 18 sessions total until the age of 6. That is a significant concern and discussion in its own right for all kids with speech delays. But for children with autism and delayed language, the reality is that most need weekly speech therapy for years to develop appropriate speech and language skills.
There are some benefits to the funding changes announced. Decreasing wait lists for autism diagnosis and ABA therapy is definitely a win for many, as evidence in the field across all therapy types strongly agree on the benefits of early diagnosis and any intensive intervention. However, there are not enough ABA therapists in Ontario to meet the immediate demand, there is a long-term cut to overall hours of therapy for all children, and speech therapy is excluded. These directives are not decisions based in evidence or what most parents of children with autism will tell you they need.
Children with autism deserve appropriate therapy for them and families deserve the right to choose. Families and Speech Language Pathologists will advocate for these children, but is anyone listening?
_________________________________________________________________________________Andalusia Speech Therapy has two Toronto speech therapy clinics and offers speech teletherapy to anywhere in the world.