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What is this topic about?

This topic is about therapy and assistive technology. Therapy includes things like speech and language therapy, occupational therapy, and mental health counseling. Assistive technology helps people do things they could not do without the technology. Speech devices, wheelchairs, and electronic reminder programs are examples of assistive technology.

Whether or not to have therapy should always be your choice. Therapies and assistive technologies are not always perfect solutions to address disability-related challenges. The therapies and assistive technologies discussed on this page are not meant to cure or stop someone from being autistic. They are instead meant to provide ideas for ways to accommodate or relieve challenges that are common among individuals on the autism spectrum.

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Why might I be interested in therapy or assistive technology?

Therapy or assistive technology might help with certain autism-related challenges. Examples of reasons someone on the autism spectrum may choose to explore therapy or assistive technology include:

  • Sensory integration or sensory sensitivity
  • Motor skills and motor planning
  • Communication difficulties
  • Challenges with typical social interaction
  • Difficulty with sequencing or planning activities
  • Assistance with self improvement and achieving personal goals
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Mental Health Therapy

Life can be challenging and stressful for anyone, and especially so for many individuals on the autism spectrum. Mental health is a person's emotional and mental well-being. Mental health therapy is used when a person is having difficulty with emotional or mental well-being, or when a person wants to feel more satisfied with life but doesn't know how. A person might seek mental health therapy for a mental health problem, like anxiety, depression, pervasive fears (for example, fear of leaving the house), obsessive compulsive disorder, eating disorders, post-traumatic stress disorder, or a personality disorder.

A person might also seek mental health therapy for help with changing unwanted behaviors, meeting goals, or finding strategies to improve life. Mental health therapists may be able to offer strategies, scripts (things you can memorize and say in specific social situations), or ideas for accommodations to help with communication, organization, or sensory sensitivities. Some mental health therapists assist with learning ways to understand and manage social situations. People may find therapy helpful in finding ways to understand and respond to negative emotions or to help prevent melt-downs. They may also use therapy to identify behaviors they wish to change and find ways to change them (for example, ways to stop smoking, change rituals that are interfering with life, or have more productive reactions in negative situations). Different mental health therapists may have different approaches to therapy, resources, or tools available to help address their clients' specific needs. It's important to find a mental health therapist whose ideas about therapy fit well with your own goals.

To find a mental health therapist in your area, ask your doctor or healthcare provider for a referral, or search the Internet for professionals in your area. Also, many of the tips in Finding a Healthcare Provider also apply to finding a mental health therapist.

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Occupational Therapy

All people need skills for the "job of living." Occupational therapy (OT) helps people do things that they need and want to do. Occupational therapy is used to develop, recover, or maintain the daily living and work skills of individuals with physical, mental, or developmental conditions.1 Occupational therapy also can help with adapting environments, modifying tasks, teaching new skills, and educating clients and their families.

People might seek occupational therapy if they are having difficulty with personal care tasks, motor movements, staying organized, or sensory processing. A person might also see an occupational therapist if they have difficulty with eating or drinking, balance and coordination, or with skills that are needed to do a job. Occupational therapists have a big-picture perspective and often focus on changing the environment to fit the client. Occupational therapists consider the client an important part of the therapy team.

Different occupational therapists will have various approaches, resources, and tools available to help address their clients' specific needs. It's important to find an occupational therapist whose ideas about therapy fit well with your own goals.

Occupational therapy services often include:

  • An individualized evaluation, during which the client and occupational therapist determine the client's goals
  • A customized plan to improve the client's ability to reach their goals
  • An outcomes evaluation to make sure the goals are being met and/or to make changes to the plan
  • Possible evaluations of the client's home and other environments (for example, the client's workplace)
  • Recommendations for assistive technology and training in its use
  • Guidance and education for the client's family members and/or caregivers.

To find an occupational therapist in your area, ask your doctor or health care provider for a referral, or search the Internet for professionals in your area. Another resource is the America Occupational Therapy Association (AOTA). Also, many of the tips in Finding a Healthcare Provider may also apply to finding an occupational therapist.

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Speech and Language Therapy

Most people find useful speech and language skills important for standing up for their rights and having a good life. Speech-language pathologists (SLPs) can help autistic adults with a variety of speech and language related difficulties. Speech-language therapy is used to develop, recover, or maintain speech and language and social communication skills. Speech-language pathologists also work with people who have trouble swallowing.

An autistic person might seek speech and language therapy for speech difficulties and difficulties with using language in a social context. Speech production refers to the ability to make sounds, voice quality, and fluency. Some people have a hard time making specific sounds or combinations of sounds, difficulty modulating vocal quality or intonation (such as use of a "monotone" voice), and stuttering.

Language refers to one's understanding and communication of thoughts, ideas, feelings, wants, and needs. Understanding and using words and grammar are part of language. Trouble with language can lead to communication breakdowns.

Language pragmatics refers to how language is used socially or in a social context. Issues with pragmatics are common in the autistic population. An individual with pragmatic difficulties might say atypical or unrelated things during conversations, or tell stories in a jumbled way, or take language very literally. Pragmatic disorders often coexist with other language-related issues, and they can interfere with social acceptance, as people might avoid conversation with someone who struggles with pragmatics.

Speech language therapy services often include:

  • An individualized evaluation, during which the client and speech language pathologist determine the client's goals
  • A customized plan to improve the client's ability to reach his or her speech or language goals
  • An outcomes evaluation to make sure goals are being met and/or to make changes to the plan,
  • Recommendations for assistive technology and training in its use
  • Guidance and education for family members and/or caregivers.

To find a speech-language therapist in your area, ask your doctor or health care provider for a referral, or search the Internet for professionals in your area. The American Speech-Language Hearing Association (ASHA) provides many resources, as well a feature to help you find a qualified SLP in your area. Also, many of the tips in Finding a Healthcare Provider may also apply to finding an occupational therapist.

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Assistive Technology for Communication

Everyone deserves access to communication that works for them. Alternative and Augmentative Communication (AAC) gives many people the ability to communicate in a way that works best for them. It involves communication methods that aid or replace speech and/or writing with other kinds of communication like pictures or sign language. AAC can be a temporary or a permanent feature in a person's life. Some individuals are full-time AAC users and others are part-time users. It is OK to only use AAC when you need it. Speech and Language Pathologists (SLPs) and Occupational Therapists are the kinds of therapists who usually help people get set up with AAC.

Reasons why a person might seek AAC include challenges related to communicating with speech, either sometimes or all the time. There are a lot of different kinds of AAC. Which kind of AAC will work best for a person will have to do with his or her own personal strengths and motor, visual, cognitive, language, and communication styles.

Some high-tech AAC solutions might include:

  • Dedicated speech devices (for example, devices by Dynavox)
  • Multi-purpose devices such as a laptop computer or an iPhone that has an AAC program installed (for example, Assistiveware's products)

Some low-tech or no-tech AAC solutions might include:

  • American Sign Language (ASL), which is commonly used by Deaf people (Check your local community college or university for classes.)
  • Communication boards or books with letters, words, phrases, and/or photos
  • Notebooks or notepads

Some people will find a combination of AAC strategies useful.

It is important for environments to support communication and foster interaction of AAC users. Activities might need to be adapted in order to be inclusive of people who use AAC. Non-AAC users might need help understanding how to accommodate an AAC user in business, conversations, entertainment, schooling, and other settings.

To find out more about AAC, ask your doctor or health care provider for resources or referrals, or search the Internet for AAC devices that are sold either online or in your area. Speech language pathologists and occupational therapists are both trained to recommend, provide, and teach people with disabilities about AAC.

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Other Types of Assistive Technology that May Be Useful

Assistive technology helps people to do things they could not do without the technology. Some assistive technology is so common that most people don't even think of it as special, like eyeglasses. Other kinds of assistive technology might be more rare or highly specialized, like a machine that translates typed text into Braille.

There are a lot of reasons why people on the autism spectrum might find assistive technology helpful. Here are some ideas:

  • To help with sensory issues
    • Headphones and music players, ear muffs
    • Sunglasses, tinted glasses, and hats with brims
    • Chewing gum or other chewable items
    • Stress balls or other "fidgets"
  • To help with motor skills
    • Mobility devices like wheelchairs or scooters
    • Computer keyboards or speech-to-text programs as alternatives to handwriting
    • Tools designed with large grips, often made for people who have arthritis
  • To help with communication
    • Alternative and Augmentative Communication (AAC) strategies and devices (see Assistive Technology for Communication)
    • Speech to text programs for people who can express themselves with speech better than writing
    • Screen readers (text-to-speech) programs for people who have trouble reading
    • TTY (telecommunications device for the deaf) machines or relay services for telephone communication
  • To help with organization and other learning disabilities
    • Smart phones, tablets, and computers with programs for organizing, managing calendars, setting reminders, and keeping instructions
    • Paper-based organizers, like day planners or visual schedules
    • Calculators
    • Egg timers, visual timers, programmable watches, and other kinds of clocks

Some assistive technology is easy to get, like day planners or sunglasses. For other equipment, a prescription from your doctor may be needed. For example, some mobility devices require a prescription.

Talk to an occupational therapist, speech-language pathologist, disability services professional, other people on the autism spectrum who use assistive technology, or your healthcare provider for more information or ideas.

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Service Animals

Some individuals on the autism spectrum find that service animals help them to be more independent, or live safer or happier lives. Though service animals do not replace human reasoning and judgment, they can be trained to help humans in many ways.

Jim Sinclair, an autistic self-advocate, disability educator, rehabilitation counselor, and long-time private animal rescuer has worked with and written a lot about service animals, namely SSigDOGs (Sensory Signal Dogs or Social Signal Dogs). Sinclair notes many reasons1 a person might want to use a service animal:

  • Managing sensory and motor behavior; for example, a service dog can be trained to stop at all street corners, to lead its owner out of harm's way, or to pull its owner out of the path of obstructions.
  • Orientation to social environments; for example, an office worker might have a good relationship with coworkers in the work environment, but might have trouble recognizing them outside of a work environment. A service dog can be trained to alert its owner to the presence of familiar people, or to people calling the owner's name.
  • Help with routines and changes; for example, the dog's owner might struggle to remember necessary steps to get ready for work. A service dog can prompt the owner to dry off after a shower before getting dressed.

There are many types of service animals, including dogs, cats, birds, monkeys, and horses. The Americans with Disabilities Act (ADA) says that service animals must be allowed to accompany their owners in many settings, but it only recognizes specially trained dogs as service animals. So, for example, other animals may not necessarily be allowed in public buildings or at a job site.

To find out more about service animals, ask your healthcare provider's staff or therapist for resources, or search the Internet for service animals near your area. For example you might search for "certified service dogs Portland Oregon" if you lived near Portland, Oregon.

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What qualities might I look for in a therapist?

If you are interested in therapy, it is highly recommended that you search for a therapist who has both a strong and positive history of working with autistic individuals. Not all therapists understand autism and the unique ways it can appear in individuals. Some therapists might have negative attitudes about autism, or might have been trained to communicate in ways that do not work well with autistic clients.

You may also want to think about the things in "How do I know if a healthcare provider is a good choice?"

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How might I pay for therapy?

If you have insurance:

Not all insurance will pay for all kinds of therapy. Before you go to your first therapy appointment, consider doing the following:

  • Find out if your insurance company will cover the kind of therapy you want.
  • If the therapy is covered, find out if you need a referral to a therapist from your primary care provider, and try to get one if needed.
  • Find out how much of the appointment will be covered by the insurance and how much you will need to pay "out of pocket" or "co-pay." Make sure you can afford this.
  • Find out if there is any additional paperwork, communications, or forms that the insurance company needs in order to agree to pay for the therapy.

If you do not have insurance or insurance won't cover the type of therapy you want:

You still might be able to get the therapy you want even if you don't have insurance, or if the insurance won't cover the therapy. Some options to ask about:

  • Ask the therapist or their office staff if they will see uninsured or self-pay patients.
  • Ask the therapist or their office staff if they have a sliding scale or other low-cost option for self-pay patients.
  • Find out how much it would cost for you to see the therapist, and consider if you can afford it.
  • If there is a university in your area that trains therapists, find out if you can see a therapist in their program for a lower cost.
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Consent and Self-Advocacy in Therapy

All people are worthy of inclusion and respect, regardless of what a person's support needs may be. Autistic individuals deserve helpful and respectful therapy.

Self-advocacy is important in therapy. Many autistic people are concerned about scientifically unproven treatments. Others are concerned about therapists who care more about making an autistic person look "normal" than they do about that person's self worth and quality of life. Meaningful therapy works with an autistic person's natural way of being instead of trying to "intervene" against, change, or wipe out who they are. Respectful therapy plans do not make autistic people feel bad, guilty, or inferior.

It is important that you know your rights and how to advocate for them. There are some situations where your rights may be limited. For example, if you have a conservator or guardian, that person may make decisions about your therapy that you do not always agree with. Or if a professional is concerned that you might be suicidal or dangerous to others, he or she may have the right to take actions that you don't agree with to ensure your safety.

However, in most circumstances, you should not be forced into a therapeutic situation without your permission. If you are uncomfortable with a healthcare provider, therapist, or mental health professional, then you have the right to say no to their services and to seek therapy from someone else. If a professional makes you feel uncomfortable or does something you feel is wrong, bring it up to him or her. Make it known that you are uncomfortable and that you would appreciate if they would respect your boundaries and concerns. Your therapist should always be able to explain to you why they are doing something and how it relates to what you want out of therapy. If your therapist cannot respect your wishes, you do not have to continue seeing them and you can look for another therapist.

If you feel you have been treated wrongly by a therapist, three places to try asking for help are:

  • Your state's Protection and Advocacy (P and A) program.
  • The therapist's professional licensing board in your state; for example, search for terms like "speech language pathology licensing board Arizona" or "occupational therapy licensing board Oregon."
  • A primary care provider (a "regular doctor") who you trust, if you have one. Tell him or her what happened, and ask for advice.
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Links and Resources

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References

1Sinclair, Jim. "What Is A SSIG (Autism) Service Dog? by Jim Sinclair." Http://www.inspire.com. N.p., n.d. Web. 23 May 2013.