Speech delay and basics of
autism care
AUTISM CONCEPT
MADE SIMPLE FOR PARENTS CHANGED AFTER 2013, SO
QUESTIONS AT THE END OF OLD TIMERS STILL FEELL IT
SESSION ONLY AS A NON MODFIABLE
INFORMATION IS BASED ON REAL DISABILITY.
LIFE EXPERIENCES BY DOCTOR IN Dr Kondekar SV 9869405747 ACCEPT AUTISM
1000s OF AUTISM KIDS MD DNB, DDN, Fellowship Neuro/Epi DON’T ACCEPT
Associate Professor Pediatrics DISABILITY
Topiwala National Medical College Mumbai
www.neuropediatrician.com to see concepts, videos, goal directed care and cure,
Fortnightly symptom diary and free autism helpline
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This is part 2 of the previous talk ln autism by
dr kondekar
• First talk is available at www.neuropediatrician.com as a video link
• Current talk boosts further understandings and makes black and
white suggestions to help parents get queries solved.
• List your questions, ask at the end of the talk.
Free whatsapp answers to queries 9869405747
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What are we going to learn?
• Speech Language and Communication
• Delay, Deficit, Disorder All are one time insults
• Stages of Speech
• Why the child could not learn speech like others
• Speech regression
• Autism as a social communication deficit Plus
• Why and what of autism basics : DSM V
• Why there always is some hope…
• Therapies , curators, Pundits and Parent support groups
• NEED FOR SPEED
• Medications? Myths about them
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Accept autism, don’t accept a speech deficit
• Don't accept a speech delay, work on it. It's not just "mic receiver
recorder and speaker each time"; there is a main switch too.
Work hard turning a child from from screen learner to
auditory learner,
Ears help you learn how to speak
Eyes teach you how to do.
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To make life simpler for parents, I classify
speech delays in toddlers into four main types
1.Speech delays without any of the following
2. Speech delay with social communication deficit with or without behavioral and activity issues
3. Speech delay with obvious neurological damage or handicap or milestone delay
4.Speech delay with hearing deficit with proven BERA test abnormal
Though speech therapy may be useful in all four types:
1. Needs detailed assessment for hidden issues by ped neuro
2. Needs assessment for autism by ped neuro with specific medicine and sensory integration therapy as
early as possible
3. Needs detailed neurological evaluation by ped neuro. Imaging studies and more complex
multidisciplinary management
4. Needs hearing aids of different types. To save time and speed up development.
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Dr Kondekar's 21 Stages of speech: each 1-3 mths
• 1. Getting ready to listen – arousal
Receptive speech
• 2. Understanding speech –initiation
• 3. Following speech – regulation
• 4. Obeying commands- Converting to nonverbal communication
• 5. Non verbal communication expertise
• 6. Vocalisation
• 7. Meaningless sounds Expressive speech
• 8. Meaningful sounds
• 9 Vowels - phonemes
• 10. Meaningless words then meaningful word
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Speech : Form, Content and Use
• 11. Echolalia – repetitions, copying, meaningless copy, meaningful copy
• 12. Prosody – rhythmic humming trying to understand sounds
• 13. Jargon
• 14. Meaningless joining words then meaningful joining words
• 15. Learning verbs
• 16. Understanding and copying actions in words
• 17. Joining two words to make a sentence. Verbal expressive
• 18. Many sentences
speech
• 19. Poems and rhymes
• 20. Stories and speech fluency
• 21. Imaginative stories*
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Language developments
• Phonetics / phonology : all sounds, system sounds
• Morphology : forms and words
• Syntax: clauses and sentences
• Semantics: Meanings of various kinds
• Pragmatics: use of language in tone, rhythm
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Pathogenesis
May be genetic, genetic Not so obvious Can be unknown, and as insult
doesn’t mean bad or no Insult to a is minor, neuroimaging is often
recovery normal
developing brain
Social and
Often blamed to nuclear families, mobile,
environmental language cnnfusion etc NOT TRUE
SO THE REGRESSED
stimulation
AFFECTS
AFFECTS AFFECTS
COGNITION & SOCIALISATION BEHAVIOUR
COMMUNICATION
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So where in the brain?
IT HAS TO BE THAT AREA OF BRAIN
THAT DOESNOT INVOLVE MOVEMENTS, WALKING AND MAJOR
MILESTONES. [MOTOR CORTEX, AS IN CEREBRAL PALSY]
ADVANCED CONNECTIONS
BUT LIKELY INVOLVING TO UNDEVELOPED BRAIN IN
SENSORY NETWORK.. FROM SEARCH OF REPAIRING
INPUT PROCESSING TO COGNITION CONNECTIONS MAKES
AUTISM BRAIN LOOK
TO LEARNED/ EXECUTIVE FUNCTION LARGER
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DEFICITS /DISORDER IN ANY OR ALL
AFFECTED INPUT PROCESSING
IN AREAS OF
COMMUNICATION
COGNITION- RECOGNITION SOCIALISATION
EMOTIONS
BEHAVIOUR
LEARNING/ EXECUTION
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AND THAT IS WHAT IS DSM 5 DEFINITION
And the recovery can be planned in same way. BEHAVIOURAL
THERAPIES
SENSORY
INTEGRATION
NEURONAL
PLASTICITY
MODIFIERS
OT /ST THERAPISTS
AND EDUCATORS
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Many specialists feel that its only their job alone
Holistic multidisciplinary approach is needed and no
specialist can functionally optimally modify these
kids excluding others.
Combined therapies responf faster, but the role and
weightage of each one needs to be discussed with
developmental paediatrician in monthly assessments.
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Technically autism is a sensory issue..
Inability to sense the senses
And make sense of it
And use it sensibly
without sensory behaviours
Assessment tools are only for documentation
and monitoring
Use Dr Kondekars autism monitoring chart for both assessment and fornightly monitoring to adjust or titrate
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External versus internal sensory integration
To tackle sensory issues your occupational therapists will give
multisensory inputs… External Sensory Integration
Same way, the sensory centers in brain need to communicate with each
other to generate integrated cognition of the inputs. .. Internal Sensory
Integration
To develop new neuronal connections… both chemical and physical /
synaptic, Occupational Therapies and neuronal nutrition is of equal
help.
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Auditory intervention therapies
• Speech therapist role is more important to develop speech when
cognition develops
• To some extent every expert including parent uses some degree of
auditory commands.
• But its not enough. Make every child an auditory learner first
• A non verbal child will attempt to speak early only when the child
does maximum learning by ears and not by eyes.
• Passive auditory therapy.
• I recommend daily six hours of radio on wall, six days a week for six
months, for auditory multi frequency 9869495747 modulation.
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How does radio work?
• The music trains the auditory pathways by focusing on the frequency
envelope of human speech.
• As child learns to process these speech-related frequencies, they
improve the functioning of two cranial nerves that are important for
promoting overall social behavior.
• Cranial Nerve VII (Facial Nerve) helps clients focus on human voice
and tune out irrelevant frequencies.
• Cranial Nerve X (Vagus Nerve) enables self-soothing and autonomic
regulation.
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Passive AIT: Radio rules
• Keep in mind its not forced, its passive
• No head phones: child should hear other sounds too
• Not to loud or soft, optimal speech frequency
• Adjust to sound sensitivity of child
• Daily morning 6 hours, from 30 min before sleep till lunch
• Six days a week for six months
• Single radio channel preferably vocal like All India radio /Vividh Bharti
• Any channel is ok, at least one family member should be able to
understand language in family
• Titration for Sensory overload
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If a child doesn’t sit for therapy
It’s the job of neurodevelopmental paediatrician to help make a child
1. Sit for therapy
2. Establish eye contact
3. Listen to commands
4. No attention means no cognition,
5. no cognition means poor therapy results
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Settling hyperactivity.. Its not ADHD here
• So actually no ADHD meds, but meds are recommended for autism
• Hyperactivity, hitting, meltdowns etc are actually like volcanoes
disrupting the learning process.
• It needs to be tackled on war footing instead of wasting time keeping
hands crossed doing .
• Hyperactivity actually is a chaos of senses in brain due to
increased curiosity that goes unfruitful due to cognitive
block, and this child behaves socially unacceptable.
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Behavioural issues
There will often be any 2 of the following behavioural issues in most of the autism cases and it's management may change
from OT-Si Medicines-Behavioural tricks-Conditioning-Diverting-Deviating:
1. *Repetitive movements /objects/sounds
2. *Restricted:* Objects/interests/areas
3. *fixed:* concepts, acts, behaviour (stubbornness)
4. *Harmful:* hitting,biting,pushing,pressing, at times as a part of miscommunication/frustration/sensory issues
5. *Sensory issues:* hypo or hyper response to any known or unknown sense that makes the child to seek or avoid
specific sense environment act or object
#makingsense
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Diet
As circulated by many. Diet is not the root cause of autism.
Dietary issues. Indigestion and constipation are a part of sensory
issues of gut being misinterpreted by brain.
This does result in restlessness and hampers learning and milestones
Its important to keep gut clear when hyperactivity is noted.
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4 d minus diet works.. No special plan/costs
3 months to show change in constipation related hyperactivity and
appetite
Skip from diet for 3 months
D1 – Doodh, Cheese, Paneer
D2 – Dry Fruits of any sort any form
D3 - Small seeded fruits
D4 - Hard Pulses and Daals
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Stages of habilitation in autism
• Independence of eating, Activities of Daily living
• Functionality
• Concrete operations
• Learning
• Creativity
• Socialisation . Behaviour and confidence
• Getting close to age appropriateness
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Childhood Autism Neuronal
Nutrition
Neuromodulation in
Autism
Therapists Developmental Neuro
Educators
Pediatrician
Hopes Parents and
Determination Home based
Therapies/
Persistence education Care and Cure
Positivity
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