Welcome to the March edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this,  Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to [email protected].

Q: I am a teacher, and I have an 8th grade student who has autism, does not speak, and uses an augmentative speech device to communicate at school. will keep him from developing speech. This student’s parents are requesting another SLP evaluation to see if he possesses the mechanics to speak. I have two questions: First, can a child who is not speaking in the 8th grade eventually develop language? Second, does using a speech device diminish one’s ability to develop language?


A: Let me get right to it. First, every individual can learn to communicate. But communication does not necessarily translate into spoken words. Whether it is with verbal speech, sign language, use of a picture exchange system, or use of an augmentative speech device, depends on the individual. It is extremely difficult to predict whether a child will verbally speak or not. However, we know for sure that every child can learn to communicate, so intervention for children with limited speech abilities often begins with teaching a child to use pictures or a device in place of spoken word.

Now on to your second question. The science tells us that using a speech device actually sets the foundation for learning and using spoken language (rather than the other way around). The parts of the brain used to communicate using an augmentative speech device are some of the same parts we use to speak. So rather than hindering speech development, augmentative speech devices promote language development, while also, allowing an individual to communicate their needs and wants.


Q: How can you distinguish between when a child with autism spectrum disorder (ASD) is perseverating and when a child with ASD is engaging in true OCD behaviors?


A: If an individual with ASD has true OCD, their compulsive (i.e., repetitive and non-functional) behaviors would be accompanied by obsessions (intrusive thoughts) that are distressing to the individual (like thinking that something bad will happen if you do not indulge your urge). Most of the time, compulsive behaviors in individuals with ASD are not accompanied by these distressing thoughts, but if they are, they may meet criteria for OCD, in addition to ASD. Often the interventions take a similar approach, whether the behaviors are “true OCD” or repetitive behaviors associated with ASD. If you are concerned about OCD, discuss your concerns with your pediatrician who can make a referral for assessment and necessary treatment.