context: Autism is a developmental disability that usually shows up before age 3. Autism is part of a group of neurological disorders that may involve impaired communication as well as impaired social interaction and cognitive skills. Known as autism spectrum disorder or ASD, autism may be linked with a wide range of traits. These include: Repetitive activities Extreme resistance to changes in daily routines Unusual responses to things such as touch Inability to interact with environment People with ASD may have major problems with both speech and nonverbal communication. They may also find it very hard to interact socially. For these reasons, speech therapy is a central part of treatment for autism. Speech therapy can address a wide range of communication problems for people with autism. Autism can affect speech, language development, and social communication in many ways. Speech problems. A person with autism may: Not talk at all Utter grunts, cries, shrieks, or throaty, harsh sounds Hum or talk in a musical way Babble with word-like sounds Use foreign-sounding "words" or robotic-like speech Parrot or often repeat what another person says (called echolalia) Use the right phrases and sentences, but with an unexpressive tone of voice About one out of three people with autism has trouble producing speech sounds to effectively communicate with others. The person's language, if present, is simply too hard to understand. Communication problems. A person with autism may have one or more of these communication challenges: Trouble with conversational skills, which include eye contact and gestures Trouble understanding the meaning of words outside the context where they were learned Memorization of things heard without knowing what's been said Reliance on echolalia -- the repeating of another's words as they are being said -- as the main way to communicate Little understanding of the meaning of words or symbols Lack of creative language Because of these challenges, a child with autism must do more than learn how to speak. The child also has to learn how to use language to communicate. This includes knowing how to hold a conversation. It also includes tuning into both verbal and nonverbal cues from other people -- such as facial expressions, tone of voice, and body language. Speech-language pathologists are therapists who specialize in treating language problems and speech disorders. They are a key part of the autism treatment team. With early screening and detection of people at risk, speech therapists often lead the way in helping with the diagnosis of autism and in making referrals to other specialists. Once autism is diagnosed, speech therapists assess the best ways to improve communication and enhance a person's quality of life. Throughout therapy, the speech-language pathologist also works closely with the family, school, and other professionals. If someone with autism is nonverbal or has major trouble with speech, the speech therapist may introduce alternatives to speech. Speech therapy techniques might include: Electronic "talkers" Signing or typing Using picture boards with words, known as picture exchange communication systems that start out using pictures instead of words to help a child learn to communicate Using sounds to which a person is over- or under-sensitive to expand and compress speech sounds Improving articulation of speech by massaging or exercising lips or facial muscles Having individuals sing songs composed to match the rhythm, stress, and flow of sentences Some of these techniques are supported more by research than others. Be sure to discuss them thoroughly with the speech-language pathologist and your child's pediatrician. Speech therapy can improve overall communication. This makes it possible for people with autism to improve their ability to form relationships and function in day-to-day life. Specific goals of speech therapy include helping the individual with autism: Articulate words well Communicate both verbally and nonverbally Comprehend verbal and nonverbal communication, understanding others' intentions in a range of settings Initiate communication without prompting from others Know the appropriate time and place to communicate something; for example, when to say "good morning" Develop conversational skills Exchange ideas Communicate in ways to develop relationships Enjoy communicating, playing, and interacting with peers Learn self-regulation The earlier, the better. Autism spectrum disorder is usually evident before age 3, and language delays can be recognized as early as 18 months of age. In some cases, autism can be identified as early 10 to 12 months of age. It is very important to start speech therapy as early as possible, when it can have the greatest impact. Intensive, individualized treatment can help lessen the disabling isolation that may result from this social communication disability. With early identification and intervention, two out of three preschoolers with autism improve communication skills and their grasp of spoken language. Research shows those who improve the most are often those who receive the most speech therapy. To find a speech-language pathologist, go to the American Speech- Language- Hearing Association's web site at www.asha.org. There are other sources, so ask your pediatrician for suggestions.