This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Autism: Many Therapists / Many Opinions
By Pam Marshalla
Q: I work in a school and I have an autistic student 4;0 with limited verbalizations. She also sees a private therapist who keeps telling the parents that my methodology isn’t right, and that is why the girl isn’t making progress. She says that apraxia therapy has to be done a certain way. The child actually is making progress but limited, and the parents are saying that the progress is due to the child’s own development and not because of anything I am doing. I am feeling frustrated. How should I view this situation?
I’ll bet you are feeling frustrated!
As my readers know, I do not usually answer questions about autism, but I will, when I think I have something to offer.
In my opinion this private therapist is way out of line in making disparaging remarks about your therapy. Therapists in private practice need to be careful about this type of superior attitude over school therapists. Let’s consider why this particular therapist is way off base…
First, Van Riper said that every therapist does therapy his or her own way. There are no right ways and there are no wrong ways. There are just ways. You have your ways, I have my ways, and this other therapist has her ways, and all have value. Van Riper said, “There are many roads to Rome, many paths to success” (Van Riper and Irwin, 1958, p. 162).
Second, let’s be real and face the fact that some children with autism remain non-verbal or minimally so their entire lives no matter what we do. How well the child does depends to a large extent on the child herself. All autistic kids are not alike. Some become very verbal and others remain essentially non-verbal. I have worked with many autistic kids and thought that all the progress the child was making might be due to simple development and nothing that I was doing. The problem is that we never know for sure. The only way to test this observation is to discontinue therapy for a period and see what happens.
Third, according to Temple Grandin (1996) some children with autism have more cognitive-social issues and others have more sensorimotor issues and are more apraxic in nature. If your client leans more to the apraxia side, then this is even more reason to discount what the other therapist says because there is no one single proven way to work with apraxic children! No one has found “the answer” for this problem including this haughty therapist who thinks she knows everything. Read any textbook on apraxia and/or the motor speech disorders and you will find that every author says the same thing: There are many ways to view this problem and many proposed solutions. (e.g., see Velleman, 2002).
My mother used to tell me that there are two ways to elevate oneself. You can lift yourself up or you can tear the other person down. This therapist is trying to look better by putting other therapists down. This is unprofessional. There is no need to do this. All it does is worry and confuse parents.
I would tell the parents that there are no single solutions for any child with a speech and language disorder, that all methods work for the right child at the right time, and that the child herself will be the one to show all the adults what works for her. If they ask why the other therapist is saying these things simply tell them that every therapist has his or her own opinion about these issues. Invite them to go online and search around themselves (they probably already have). Help them come to realize that there is no one solution.
Finally, this may be the best answer to your question––
You might ask the parents if they want to discontinue therapy for a while, say 6 months or a whole school year. Then everyone would know for sure if all the child’s progress was due simply to her own development. Then tell them, “Wouldn’t it be marvelous if she was doing this all on her own and didn’t need anyone’s help any more?” My bet is that if you offer this as part of the treatment plan that they will opt to stay in therapy and they won’t give you any trouble any more.
- Grandin, T. (1996). Thinking in Pictures. USA: Vintage Press.
- Van Riper, C. & Irwin, J. (1958). Voice and Articulation. Englewood Cliffs: Prentice-Hall.
- Velleman, S. L. (2002). Childhood Apraxia of Speech: Resource Guide. NY: Thomson Delmar.
4 thoughts on “Autism: Many Therapists / Many Opinions”
Thank you! I couldn’t agree more. Undermining colleagues is tacky. We are on the same team.
Perfect response. I fiind this supercilious condescending attitude among early intervention therapists of the same and even different professions. Frequently special instruction teachers vs. speech pathologists.
While undermining colleagues is a bad idea, I think we should consider that there are more effective ways to work with certain clients. Confusing parents further by suggesting stopping therapy for a young autistic child seems unethical to me. I would prefer showing them research about what you are doing and it’s proven results or showing them your data and specific goals. Finally, it may be worth considering trying a different methodology when working with this student that may yield more positive results
I work in early intervention (birth-3 yrs) and often ask the parents if it is okay for me to call the private therapist. I simply introduce myself, explain my strategies and intervention goals, and ask the therapist what she is working on. We can usually find a balance between relationship-based goals and clinic-based goals. So far, “nipping it in the bud” has worked wonders for me, and the child seems to get the most benefit from both therapy approaches.