225. Under the Iceberg: Why Isn't Speech Developing in Autism, with Dr. Karen Chenausky

We learned in grad school that working on joint attention and language will lead to speech development. But for the estimated 30% of autistic children who never develop functional, fluent speech, that's not the whole story. Dr. Karen Chenausky, PhD, CCC-SLP, is a speech scientist, SLP, and director of the SPAN Lab at the MGH Institute of Health Professions. She takes us beneath the iceberg to explore the hidden contributors to speech development in autism, including the motor-speech disorder component our field rarely talks about. In this episode, you'll learn: -Challenges that can limit spoken language in autism include joint attention, receptive language, speech perception, sensory differences, fine/gross motor cascades, and motor speech challenges -Minimally speaking vs. minimally verbal vs. pre-verbal: what each term really means, and why we wait until about age 5 to classify a child as 'minimally verbal' -How Dr. Chenausky identifies suspected Childhood Apraxia of Speech (CAS) in minimally speaking children using Iuzzini-Siegel's (2015) criteria, plus the catch-22 when a child doesn't produce enough speech to diagnose speech motor disorders -What to evaluate in a minimally speaking preschooler: the motor component of speech, language comprehension and expression, nonverbal IQ, and gross/fine motor skills -An invaluable assessment tool you may not know SLPs can use: the Vineland Adaptive Behavior Scales for capturing fine and gross motor performance -Auditory-Motor Mapping Training (AMMT), the intonation-based treatment inspired by Melodic Intonation Therapy, and the promising findings on who benefits most (hint: phonemic repertoire and readiness-to-learn skills mattered) -JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation), Connie Kasari's play-based intervention that builds the prerequisite skills for language -A Monday-morning session framework: three-tiered tasks (mastered, on-the-cusp, challenge) that keep the child at a 70-80% success point in their zone of proximal development -Writing pivotal speech goals that expand the phonemic repertoire while diversifying language expression -When to prioritize robust AAC, because every child deserves access to all the ways of communicating -Dr. Chenausky's call to the field to develop more reliable methods to assess nonverbal IQ and receptive language in children with motor praxis and visual processing/visualmotor challenges Research referenced in this episode Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2018). Behavioral predictors of improved speech output in minimally verbal children with autism. Autism Research, 11(10), 1356-1365. Free link: https://pubmed.ncbi.nlm.nih.gov/30230700/ Chenausky, K., Brignell, A., Morgan, A., & Tager-Flusberg, H. (2019). Motor speech impairment predicts expressive language in minimally verbal, but not low verbal, individuals with autism spectrum disorder. Autism & Developmental Language Impairments, 4. Free link: https://pubmed.ncbi.nlm.nih.gov/35155816/ \*To connect with Dr. Chenausky, Google search "Karen Chenausky SPAN Lab"