Rethinking Motor Speech Intervention: Embracing Neurodiversity with the MIND-AP Framework

As rehabilitation professionals, Education Resources, Inc. embraces multidisciplinary collaboration in service of improved client outcomes. Laura Strenk’s guest blog speaks to speech language professionals, and to occupational and physical therapy providers because of the universal need and drive to communicate effectively. Take a read, share with colleagues, and see below for more multidisciplinary pediatric continuing education.   

Laura StrenkGuest Blog By Laura Strenk, MS, CCC-SLP 

As a clinician who has always had strong clinical interests in both Childhood Apraxia of Speech (CAS) and child-led therapy, I cannot count the number of times I have sat in continuing education courses on CAS feeling confused about how to apply what I have learned in a way that is efficacious while still consistent with my values and individual treatment style. Traditional motor speech therapy is typically very stringent in terms of (1) intensity, requiring long, drill-based sessions with high repetition, (2) target selection, with some programs requiring use of flashcards or nonsense words, and (3) cueing, with some programs requiring focus on the clinician’s face or touch input to the articulators. As a speech-language pathologist (SLP) at a DIR-Accredited outpatient clinic serving mostly autistic children, these features of motor speech therapy did not seem to fit neatly into my treatment toolbox, as they were created for allistic children. As a result, I found myself modifying what I was learning and then wondering if my use of these modified treatment approaches was “enough.”      

Currently, research shows that up to 65% of autistic children may have CAS (Tierney, Mayes, Lohs, Black, Gisin, et al., 2015). Additionally, SLPs report suspecting CAS in 1 of 6 autistic children on their caseloads (Dawson, 2010). For these reasons, it is vital that we re-think motor speech intervention utilizing the broader principles of Neurodiversity-Affirming practice. The field of speech-language therapy is always evolving, and it is crucial that our practices evolve with it, particularly when working with neurodivergent individuals. That is why I am so excited to share a new framework that takes this need for change into account: the Motor Speech Intervention for Neurodiversity Affirming Practices (MIND-AP) Framework, developed by Moore, Boyle, and Namasivayam (2024). 

The MIND-AP Framework encourages the use of connection-based, child-centered practice in which intervention progresses from core levels to higher levels, with maintenance of each level as one progresses higher and higher. The three levels of the MIND-AP Framework are:  

Level 1 (Foundational Skills): Body Autonomy and Self-Regulation  

This level highlights the importance of ensuring that clients feel a sense of autonomy over their own bodies and achieve sensory regulation prior to targeting language or motor speech skills. Strategies for honoring bodily autonomy may include: asking permission/receiving consent, providing advanced warning, providing rationale for actions, opting for hand-under-hand prompting if needed (vs. hand-over-hand), and honoring all forms of communication. These strategies are of the utmost importance when providing any sort of touch input to aid with motor planning, in particular. Strategies for addressing sensory regulation may include: integrating sensory motor activities into therapy sessions, providing consistent access to sensory supports, adjusting touch cues to match the preferences of each individual (e.g, selecting firm vs. light touch), and tuning into a client’s regulation moment-to-moment.  

Level 2: Language and Communication 

This level emphasizes the communication differences present in autistic individuals and how these differences can be utilized to support language and overall communication within motor speech practice. In order to support language and communication, clinicians should provide strengths-based therapy, respect communication preferences, and help establish a meaningful lexicon. In order to support these areas, clinicians should use special interests and consider daily activities. Additionally, it is important to offer and model Alternative and Augmentative Communication (AAC) within therapy sessions, respecting each child’s communication choices.   

Level 3: Motor Speech intervention  

This level focuses on how to modify traditional motor speech strategies to be more affirming. These changes may include the following:  

  • Balancing demands (e.g., decreasing dosage based on the impact a high number of trials may have on regulation)  
  • Utilizing motivating activities  
  • Providing alternatives to watching the clinician’s mouth (e.g., mirrors, videos, pictures, having the clinician wear sunglasses)  
  • Utilizing comfortable, preferred sensory input when providing multisensory input  
  • Providing increased processing time and presuming competence 
  • Balancing feedback (e.g., decreasing auditory feedback based on impact on regulation)  

This framework is the first of its kind, as it marries traditional motor speech intervention with Neurodiversity Affirming principles. By utilizing this framework, SLPs can more confidently provide high quality motor speech intervention in ways that affirm and support their neurodivergent clients.    

Laura Strenk, MS, CCC-SLP is a pediatric speech-language pathologist who has built a career committed to providing children from diverse backgrounds and with a wide range of communication differences access to the most current and effective evidence-based practices. Laura’s passions lie in the areas of autism, neurodiversity-affirming care, apraxia of speech, and literacy. In addition to providing treatment in a private, outpatient clinic for children from ages 1-16+, Laura serves as her clinic’s Program Development Coordinator, allowing her to support the growth and development of a variety of programs, including student programming (including internships, fieldwork placements, etc.) and clinical/advocacy programs (including social clubs, DEI committees, etc.). Through this position, Laura developed a love for educating others, which led her to an Adjunct Teaching position within UNC-Chapel Hill’s Division of Speech and Hearing Sciences, where she taught a Pediatric Speech-Sound Disorders course to first-year graduate students. 

Citations:  

  1. Moore J, Boyle J, Namasivayam AK (2024) Neurodiversity-Affirming Motor Speech Intervention for Autistic Individuals with Co-Existing Childhood Apraxia of Speech: A Tutorial. Int J Autism & Relat Disabil 7: 168. https://doi.org/10.29011/2642-3227.100068 
  2. Dawson EJ (2010) Current assessment and treatment practices for children with autism and suspected childhood apraxia of speech: A survey of speech-language pathologists. Doctoral Thesis, Portland State University, Portland, Oregon. 
  3. Tierney C, Mayes S, Lohs SR, Black A, Gisin E, et al. (2015) How Valid Is the Checklist for Autism Spectrum Disorder When a Child Has Apraxia of Speech? J Dev Behav Pediatr 36: 569-574.  
     

Upcoming ERI Courses related to autism for PTs, OTs, and SLPs: 

November brings together all the related service disciplines at our Live Virtual Conference!   

Therapies in the School Conference – November 20 and 21.  

Check out Tanna Neufeld Tanna Neufeld’s Plenary Session on Day One:  
 From Movement to Meaning: Creating Connection  
 and Communication with Complex Communicators   
 Tanna Neufeld, CCC-SLP 

Looking for more from Lauren Strenk? Check out her on-demand Birth-to-Three Conference sessions