Addressing Speaking Volume in Individuals with Autism

Question

Answer

Thank you for the most interesting question. I would offer two actions.

1. As with all voice cases, the first step would be referral to an otolaryngologist. While the young man's occasional use of appropriate volume indicates that his laryngeal structures are likely fine, it is necessary to rule out any anatomical or physiological cause of the loudness problem.
   
   
2. After clearance from the otolaryngologist is received, I would suggest the Lee Silverman Voice Treatment (LSVT) program. While this program was originally designed to address voice/loudness concerns of individuals with Parkinson's disease, it has now been found useful in treating other disorders as well. I suggest LSVT for several reasons:
   
   
   
   • It is drill based. As such, I believe it would be appropriate for a young man who experiences difficulty generalizing newly learned behaviors.
     
     
   • The intensity of the program (sessions 4X week for 4 weeks with home practice) would be helpful in building the skill and reinforcing it often.
     
     
   • The program simplifies the instruction to one basic component "Be Loud." There are not a lot of extraneous instructions or focus points in therapy, but rather a consistent focus on loudness using very simple language.
     
     
   • While not studied with the disorder specified in your question, LSVT has a nice collection of evidence to support its effectiveness in increasing loudness.