Question
Can you please suggest a strategy for encouraging an adolescent male with autism to speak louder? The young man in question is or will soon be 21 and is indeed verbal. Up until roughly 4 years ago he communicated primarily through PECS (Picture exchange
Answer
Thank you for the most interesting question. I would offer two actions.
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.
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.
Because of the specificity of the program, LSVT is to be carried out by an individual trained and certified in the program. You can check with the LSVT website to find an individual in your area.
I hope you find these suggestions helpful. Please let me know if I can offer additional help.
Lisa Thomas is an Assistant Professor in the Department of Communication Disorders at Marshall University and a doctoral candidate (under mentor Joe Stemple) at the University of Kentucky. She has provided care to voice patients for 15 years and has recently published voice-related articles in Communicative Disorders Review, Journal of Voice, Laryngoscope, and Annals of Otology, Laryngology, and Rhinology.
Lisa Thomas, M.A.,CCC-SLP
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