Speech and Communication in Autism

People with autism spectrum disorder (ASD) can have a wide range of verbal abilities. Some may be entirely non-verbal, some may have limited useful speech, and some may speak fluently and intelligibly. When a person's verbal abilities are limited or atypical, it can make it hard to communicate—to express ideas appropriately so that others understand them. Challenges with using language and difficulty communicating are hallmark symptoms of ASD and typically go hand-in-hand.

To a greater or lesser extent (largely dependent on which level of autism they have been diagnosed with) children can improve their verbal and communication skills with therapies designed to address these challenges.

Speech and Language in Autism

Common characteristics of speech and language among children with ASD include:

• High-pitched or flat intonation: Some children with ASD speak in a high-pitched or sing-song voice or may sound flat and "robot-like."
• 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 or "kidspeak"
• Repetition: Often, kids with ASD 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: A child with higher-functioning ASD (formerly called Asperger's syndrome, and now falling under level 1 ASD) 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, for example, 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. People with autism commonly lack those abilities.

Sometimes people with high-functioning autism 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: Children with ASD 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
• The inability to take another's perspective. This inability to put your self in someone else's shoes is often referred to as lack of "theory of mind."

Addressing Speech and Communication Skills

Many people with autism are able to compensate for social communication deficits 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, children with autism 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.

Children with severe (or level 3) autism may never develop oral speech and language skills, in which case treatment goals 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.

A Word From Verywell

If your child's doctor suspects your child has ASD, they will likely refer you to a speech-language pathologist, who will perform a comprehensive evaluation of your child’s ability to communicate and will then come up with an appropriate treatment program.

Teaching children with ASD to improve their communication skills is essential for helping them function to their full potential. The reality, however, is that many people with autism will always sound and behave differently than their neurotypical peers.