How Speech Patterns in Autism Can Affect Communication

Nearly all autistic people have communication challenges and problems with spoken language. This is true even for those people who have no speech delays or difficulty with pronunciation.

That's because spoken language involves more than the use of words. We vary our pitch, loudness, tempo, and rhythm in our speech in order to convey different meanings. These changes are called "prosody," and even autistic people with low support needs may not truly recognize patterns to grasp what is being said or avoid speaking in ways that make them easily misunderstood.

This article explains what prosody is and why recognition of these speech patterns is important. It also presents some resources to help autistic kids build their prosody skills.

autistic boy receiving speech therapy.

Getty Images

How Prosody Works

Prosody is an important tool used to communicate meaning. In fact, without an understanding of prosody, it's easy to misunderstand another person's words completely. To better understand how prosody works (and why it's so important), try saying the word "really" five times in a row, changing the meaning each time as follows:

  • How cool is that!
  • I don't believe you.
  • I'm shocked.
  • I'm delighted.
  • I'm telling the truth.

If you did this exercise, you changed your prosody at each repetition of the word, even though your pronunciation of the word (REE-lee) remained the same. Your voice went up or down on different syllables or to a varying degree, and your voice was louder, quieter, faster, or slower.

Why Autistic People Can Find Prosody Confusing

When autistic people use spoken language, they usually use it quite literally. As a result, speech that's used for sarcasm, irony, idiom, metaphor, and simile may go right over their heads, as do subtle differences in meaning.

It's easy to understand why this would be the case. Prosody is learned through observation and imitation rather than through instruction. Autistic people rarely learn social communication skills through imitation alone.

If they're not actively taught rules of prosody that are taken for granted among neurotypical people, they may never learn them.

While there are rules of prosody, they are rarely expressed aloud. They also may vary depending on the situation or the cultural setting. Many autistic people need to be actively taught their prosody skills.

Why Prosody Matters

Many autistic people with verbal skills have high IQs and huge vocabularies. Therefore, difficulties with prosody and language use aren't always obvious. The outcome of their "hidden" language limitations is that conversational partners may be unintentionally offended or confused, resulting in hurt feelings and negative interactions.

For example, the following statements can mean many different things depending on the tone, context, and body language. Misunderstanding the intent can have serious consequences.

  • A friend says "I love you!" But they mean, "I love the fact that you agreed to do something for me."
  • A co-worker asks, "Are you really done with this project?" But they mean to state that "you didn't finish this project and should recheck for errors."
  • A store clerk said, "You have to buy this." But their speech is meant to persuade and really means "I want you to want and buy this."

In addition:

  • Autistic people may find it very hard to use prosody to express multiple or subtle meanings, thus limiting their own ability to communicate. This can lead to a myriad of social communication issues ranging from embarrassing gaffes to accusations of verbal assault or stalking.
  • It's extremely easy for autistic people to misunderstand how language is being used. This can lead to serious relationship problems and can make autistic people vulnerable to those who wish to mislead them.

Autism and Voice Affect

Many autistic people lack the ability to use prosody and thus have what is often described as a "flat" voice. This can be misinterpreted as a lack of interest, intelligence, humor, or emotion.

In fact, many autistic people are extremely emotionally sensitive; some are artists, poets, and composers whose emotional sensitivity comes out in their art. They have terrific senses of humor. But a flat voice, combined with a lack of verbal expressiveness, can easily be misinterpreted.

Resources for Improving Use and Understanding of Prosody

There are no full-fledged therapies developed to help autistic people overcome their prosody challenges. Experimental approaches are under investigation. If you are interested in possible directions for improving prosody, you may wish to explore:

  • Music therapy to work on rhythm and pitch
  • Pragmatic speech therapy to expand conversational skills
  • Social skills therapy to improve the understanding of body language and context
  • Drama therapy to practice interaction in a safe, scripted manner
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Key AP, D’Ambrose Slaboch K. Speech processing in autism spectrum disorder: An integrative review of auditory neurophysiology findings. J Speech Lang Hear Res. 2021;64(11):4192-4212. doi:10.1044/2021_JSLHR-20-00738

  2. Kalandadze T, Norbury C, Nærland T, Næss KAB. Figurative language comprehension in individuals with autism spectrum disorder: A meta-analytic review. Autism. 2018;22(2):99-117. doi:10.1177/1362361316668652

  3. Heikkinen J. et al. Perception of basic emotions from speech prosody in adolescents with Asperger's syndrome. Logoped Phoniatr Vocol. 2010;35(3):113-120. doi:10.3109/14015430903311184

Additional Reading
Lisa Jo Rudy

By Lisa Jo Rudy
Lisa Jo Rudy, MDiv, is a writer, advocate, author, and consultant specializing in the field of autism.