Speech and Communication in Autism

People diagnosed with an autism spectrum disorder (ASD) can have a wide range of verbal abilities. Some may be entirely nonverbal, some may have limited useful speech, and some may speak fluently and intelligibly. Yet challenges with language and communication are hallmark autism traits.

When a person's verbal abilities are limited, they may sound and behave differently than their neurotypical peers. It can make it hard to communicate—to express ideas appropriately so that others understand them. Depending on their level of support needs, an autistic child can improve their verbal and communication skills with therapies designed to address these challenges.

This article discusses the ways in which it can be hard for autistic kids to express ideas appropriately so that others understand them. It offers information about some of the therapies used to help autistic people to communicate.

Speech and Language in Autism

Common characteristics of speech and language among autistic children include:

• High-pitched or flat intonation: Some autistic children speak in a high-pitched or sing-song voice, or may sound flat and robotic.
• Recitation: It is not uncommon for autistic children to recite lines from a movie word-for-word, or talk endlessly about a favorite topic that is irrelevant to the larger conversation.
• Lack of ability to understand slang: Autistic kids tend to treat language as literal and may not understand slang or the "kidspeak" of their peers.
• Repetition: Often, autistic kids repeat the same phrase over and over. For example, counting from one to five repeatedly or asking questions to which they already know the answer.
• Echolalia: Echolalia occurs when the child echos what someone has just said or asked them. For example, if someone asks "do you want a snack?" They will respond with "do you want a snack?" Or, they may develop "stock phrases" that they use in various situations.
• Uneven verbal and language development: An autistic child with lower support needs (formerly called Asperger's syndrome or high-functioning autism) may develop a strong vocabulary or be a precocious reader, but often only pertaining to a specific interest.

Communication Problems

Verbal skills are only one aspect of effective communication. Body language—such as hand gestures, body stance, and making eye contact—conveys to others whether someone is joking or being serious, or angry or happy.

All of the skills involved with social communication presuppose an understanding of complex social expectations, coupled with an ability to self-modulate based on that understanding. Autistic people don't always have those abilities.

Sometimes, autistic people with low support needs find themselves frustrated when their attempts to communicate are met with blank stares or laughter. They may also be mistaken as rude. This is due to:

• A lack of understanding of physical gestures. Autistic children are often unable to give meaning to what they're saying through gestures, such as pointing to an object or using a facial expression.
• An inability to use the right type of speech at the right time. Communicating also requires an understanding of which type of speech is appropriate in a particular situation (known as pragmatic speech). For example, using a loud voice at a funeral can be interpreted as disrespectful, while very formal speech at school can be read as "nerdy." Using the appropriate type of speech involves an understanding of idioms, slang, and an ability to modulate tone, volume, and prosody (ups and downs of the voice).
• Difficulty making eye contact, which can be misinterpreted when autistic people try to communicate

Autistic people often find it challenging to "see" another's perspective. This inability to put yourself in someone else's shoes is often referred to as a lack of "theory of mind."

Addressing Speech and Communication Skills

Many autistic people are able to improve social communication by learning rules and techniques for better social interaction. Most children (and some adults) participate in treatment programs aimed at improving social communication through a combination of speech-language therapy and social skills therapy.

Speech-language therapy focuses not only on correct pronunciation, but also on intonation, back-and-forth conversation, and other aspects of pragmatic speech. Social skills therapy may involve role-playing exercises and group activities that require practicing collaboration, sharing, and related skills. 

Ideally, treatment should begin during the preschool years, when language development occurs. Generally, autistic kids respond well to highly-structured, specialized programs. Parents and those involved in the care of these children should integrate treatment strategies so they become part of the child’s daily life.

Autistic children with intense traits and high support needs may never develop oral speech and language skills. Treatment goals then involve learning to communicate using gestures (such as sign language) or by means of a symbol system in which pictures are used to convey thoughts.

Summary

Communication difficulties are a key trait of autism, though they vary depending on the individual and their diagnosis. Some autistic people are nonverbal. Others develop language skills, although often these skills develop or are expressed in a neurodivergent way.

Speech is a factor, with many autistic people finding it hard to modulate speech or understand the patterns of prosody and eye contact. Just as challenging can be the things autistic people talk about, with the repetition of echolalia a common feature.

Speech therapy and other interventions can help autistic kids to develop language and communication skills. Contact your healthcare provider with any concerns about autism, the earlier the better, in order to ensure an accurate diagnosis and treatment.