An Interview with a Speech-Language Pathologist

1.) Who are you and why are you qualified to talk about children with Aspergers children?

I am Caroline L. Bias, M.S., CCC-SLP, Speech-Language Pathologist. I am qualified to talk about children with Asperger’s because I work with children with various ASDs and their families on communication, play, and social interaction skills.

2.) How did you get started working in this area?

I became interested in this area during my early work experience in a school comprised completely of children with exceptional needs. During graduate school I worked for the Center for Autism and Related Disorders.

3.) What type of formal education do you have in this area?

Master of Science Speech-Language Pathology, Florida State University, 1998. Bachelor of Science Speech-Language Pathology, Oklahoma State University, 1995

I take continuing education courses about Autistic Spectrum Disorders and read a lot to stay abreast of current research. After earning my Bachelor of Science degree in Speech-Language Pathology from Oklahoma State University, I began my career as a bachelor’s level speech teacher in a public school exclusively for students with exceptional needs.

After getting a fast, hands on, real life education, I attended graduate school at Florida State University where I took courses from Dr. Amy Wetherby. While at Florida State University I worked at the Center for Autism and Related Disorders on grant funded projects related to Autistic Spectrum Disorders. I made learning materials, created effective visual supports, and developed ways to help the child be fully included in society.

After earning my Master of Science degree, I moved to Texas and worked in an Early Intervention (birth to three) program where I initiated the development of an Autism team and was involved in the evaluation and treatment of many newly diagnosed and not yet diagnosed children with Autistic Spectrum Disorders. I subsequently went into private practice and provided evaluation and treatment services to preschool and school age children.

In 2004 I moved to Florida and established a private practice in Orlando. I see many children with Autistic Spectrum Disorders for evaluation and some for ongoing treatment.

4.) What are the 5 biggest mistakes that you see families or parents of Asperger’s children making?

1) Waiting too long to take action.

a) I have worked with children who were diagnosed very early with ASD’s and looked like severe Autism (banging head into the wall, screaming, and flapping arms all day with no initiation of communication) at ages 2 and 3 but with early intervention and treatment looked like mild Asperger’s or even normally developing by the time they were five. When I first see children who are already early elementary school aged and never had services because people thought they were just late talkers, they have missed the optimal time for intervention and the prognosis for improvement is not as good.

b) Early Intervention is the best thing we can do for children.

We absolutely must catch them when they are very young and provide treatment. We need to get the message out that it is better to help kids who would have been fine either way than to overlook kids because we think they will “grow out of it”. Time and again I get kids who are 5 years old and the parents have known something was not coming together right for years. We have to get rid of the stigma/fear and show people that getting help early works and is worth stepping through the fear and advocating for the services their child needs.

2) Overlooking the benefits of routines and consistency.

a) Example: Johnny wakes up one morning and eats breakfast, brushes teeth, gets dressed, then goes to school. The next morning Johnny wakes up and is surprised to find that he has to take a bath before getting dressed. Johnny has a tantrum and becomes aggressive, hitting, putting holes in walls, and the whole family is late to school and work and stressed out.

b) Building predictability into Johnny’s day is critical.

If you don’t build in the predictability where it is possible, he has to find ways to cope and you might not like his preferred coping mechanisms (rocking, flapping, withdrawing, tantrum). Certainly, we cannot predict every situation in life, but having a core routine within the family is usually very helpful for the child with Asperger’s. Preparing a child for changes in the routine is also helpful.

In Johnny’s case, perhaps the water was not working the night before and you had to get the bath before school. If Johnny retains verbal information it is important to tell Johnny the night before what to expect the next morning. Ideally you would make a schedule (written, pictures, photos depending on his abilities) so he can visually see what to expect out of the day.

This is so helpful when changes in routines are necessary. That being said, it is also possible to OVER schedule the routine. I have found that children with Asperger’s are often so dependent on their routines that it can be very disruptive to alter them when life happens. For this reason, many parents have found it helpful to build adaptations and variations into their regular routines. They teach their child to cope with the many changes in routines that happen all the time.

3) Friendship Failure

a) Failing friendships are a challenge some higher functioning children with Asperger’s can face.

For example, Jane, a 7 year old, is friends with Leanne. Jane has Asperger’s and does not like to be in large groups of people. Leanne is also 7 and is the daughter of Jane’s mother’s best friend. Jane likes to swim, Leanne likes to talk to her friends. Jane often becomes frustrated and is not sure what to say when Leanne is around. She doesn’t read her social cues and does not know how to get into the conversation, nor does she have a desire to talk about what Leanne and her friends are talking about.

b) Find activities that your child is truly interested in and help them cultivate friendships within those activities. In Jane’s case, she enjoys swimming so finding a swimming team or class that she can attend regularly and then role playing and coaching her to help her with social skills related to those relationships will evolve into people who know Jane and share an interest with her. Ideally, in the future those friendships will turn into a network of advocates and friends who will share Jane’s interests and appreciate who she is as a human being.

4) Expecting the child to know what to expect when they don’t, this is particularly true in social situations.

a) Imagine how a birthday party must seem to a child who has never been to one.

People singing while a large bright colored blob that is on fire is brought out in the dark (the cake with candles). Imagine how it would feel to go to your first day of Kindergarten when you don’t know where to go to use the toilet, are not sure how to ask other people if you can play with them, and don’t particularly care much for being in a room full of people.

b) I find that children with social skills challenges do best when placed first into social situations that interest them AND have lots of structure. For instance, even an uncoordinated child will often enjoy non-competitive group sports when the rules are very clear.

Ideally as they age you expose the child to more social situations and provide them with information about what to expect and how to behave. For instance, if they are meeting their teacher, you let them know that they will be meeting the teacher and what it involves. Meeting the teacher involves going to the school, walking into the classroom, saying “Hello, my name is Joe”, making eye contact, and shaking the teacher’s hand. It also involves listening to the teacher introduce themselves, and answering a question or two if the teacher asks. Joe might also have questions about the class that can be answered then, but his parents must be familiar enough with his needs to help him know what to ask. Carol Gray’s Social Stories are a great resource for children learning to interact socially and role playing is often helpful.

5) Jumping on the latest thing instead of analyzing their child’s needs and finding the right tools to help them as an individual.

a) Sarah’s family is well educated and has the means to provide her with whatever she needs. They see many specialists and try every new thing that comes out to “fix” Sarah.

b) It is critical to really think about what you know about your child before selecting different treatment options. Each child is so different and certainly there will be some trial and error, but there are often clues/indicators of what will work best for a particular child. Parents often disregard their parental instincts because they have heard something worked for someone they know and the child got much better.

The families I see who have the most success seem to be the families who know their child’s strengths and needs and have found a combination of strategies that are a good match for their child.

5.) What advice would you give to a parent who had just found out that their child had Aspergers?

I advise new parents to find support online and in person and refer them to various support groups and books.

6.) If you had to choose your career all over again would you still do the same thing?

YES, I love what I do. My greatest love professionally is getting children who are preverbal/non-verbal and giving them the desire and skill to talk and interact with other people. I have a firework on my business car to represent the “communication burst” that I love to progress “non-verbal” children to and through.

7.) What do you think are the five biggest issues facing people today working professionally in the area of Aspergers?

Keeping current on new research and information. Keeping up to date on new treatment techniques and who they are useful for. Helping people with Aspergers integrate into their community, educational setting, and workplace. Finding the right balance between Early Identification and creating unneeded concern. Networking and sharing information between disciplines.

8.) What educational resources do you look for in keeping abreast of developments in the area of Aspergers (eg journals, websites, authors).

I read books, magazine articles, journal articles, conference notes, and websites. Parents are always finding new things and I am constantly reading. In addition to more scholarly articles and resources, I like to read the more generic magazine articles as well as watching TV programs so that I can then review the research and data on whatever the program or magazine brought up since inevitably parents have seen the show and have questions or want to try it with their child.

9.) What changes do you see in the future that will affect things for parents and their children with Aspergers?

I think the increasing awareness is helping and I hope that as we learn more about Asperger’s and other ASDs we can get better at identifying and differentiating them in very young children so that we can begin teaching them the needed social skills for living in our society earlier. I also think that as we move to a more technologically advanced world you will see some of the milder social skills issues begin to look more normal and easily accepted or worked around.

10.) What 5 tips or techniques could you give us to help parents who are struggling to cope with their children who have Aspergers?

Visual supports, calendars, routines! Role Play Social Skills. Teach them when social skills matter and when they don’t. Seek out friendships with people who share their interests regardless of age differences. Get a comprehensive evaluation so that you know what other things may co-exist with the Asperger’s, such as Oppositional Defiant Disorder, know what you are treating. Learn to help your child cope with their feelings and diffuse aggression.

11.) What advice would you give to siblings or other family members of a child with Asperger’s to help them understand and be better at connecting with the child?

As with anyone, you have to meet the child where they are at. You absolutely are not going to connect to a child who is obsessively interested in trains by taking the trains away. If you are not interested in what he is interested in and can’t get interested in what he is interested in, find something related (perhaps you like to paint and you could paint trains together) to do together.

12.) What are your thoughts on why children with Aspergers have particular obsessions (e.g. collecting toy trains) and the fact that they will often tell people about them in huge detail which can become very boring for the other person?

I love to talk about what interests me and I have met people who bore me to tears even though they don’t have Asperger’s so I’m not convinced the obsession itself is the challenge. Understanding the social cues and knowing what to do about them is the challenge. I believe what kids with Asperger’s don’t understand is a) how to know when someone has lost interest, and b) what to do about it.

I’m not typically out to change who a person is at the core. I believe if they are madly obsessed with trains then we let them be but we find ways to expand that love to include other people and expand that love to include other things related to that obsession. We also need to teach them how to know when someone doesn’t want to hear about what they have to say and to provide them with other ways to interact with those people while seeking out people who share their interests.

13.) If there was one thing out there that would enhance your work with parents of Aspergers children or the children themselves, some magic wand or tool, what would it be?

I would make the whole world more tolerant of people’s more visible social differences. Unfortunately, that is a very gradual shift.

14.) Can you give any examples of success stories when working with parents to help their children with social difficulties, for example saying inappropriate comments out loud or the importance of personal hygiene?

What I like about working with many children with Asperger’s is that they so often do well with rules and routines. I have success with personal hygiene because I work with very young children and it is part of their daily routine, they just do it because it is part of their day and on their schedule. In the instance of saying inappropriate comments I once had a child whose mother was terribly offended by this. She began to anticipate and cringe and even apologize before he had it out of his mouth.

Since she was so good at anticipating these comments, we set up a system where she cued him… at first it was a touch cue, she put her hand on his shoulder, then we removed the touch and had her just put her hand to her lips in a “be quiet” motion. Obviously there is a difference between when a 4 year old says “oh mom, that lady is really fat” and when a 15 year old says “look at that fat lady, she smells nasty”. In those situations teaching empathy is so important. E.g., “How do you feel when people say things about you, even if they are true…. How do you think she feels when you say she smells nasty, even if it is true?

They don’t get it at first or even for the first few years you teach empathy…it is a process for every human being, but it has to be repeated. In the meantime, I have seen cueing and practice with social skills to be very helpful. I like Carol Gray’s work with Comic Strip Conversations and Social Stories.

The Parenting Aspergers Resource Guide: A Complete Resource Guide For Parents Who Have Children Diagnosed With Aspergers Syndrome.