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Understanding Autism

Communication and Language Issues

Communication and language issues are one of the core areas of difficulty for individuals with ASDs.1 Considering the extent of the social deficits they face, this is not surprising. After all, communication, whether verbal and nonverbal, is social. If you tend not to look at faces, if you tend not to pay attention to the human voice, and if you tend not to tune in to verbal and nonverbal feedback from other people, it will be hard for you to acquire speech and to use it naturally. It will also be hard for you to somehow acquire body language, facial expressions, and other nonverbal forms of communication that are the rule for your culture

Speech Itself

Just as with social issues, there is a range of communication and language difficulty across the autism spectrum. Some individuals with an ASD never speak, behaving as though they are deaf, even though hearing tests show they can hear in the normal range. Some experience significant speech delays or ongoing speech impediments. For another group, a few words or phrases are gained only to be lost during the toddler years - a process called regression. This is a "red flag" for autism, because such a loss is practically unknown in other developmental disorders. It is thought to occur in about 25% of children with ASDs.2

Many children, both typically developing and non-autistic but developmentally delayed, have speech problems of some kind. Research has shown, however, that some specific speech difficulties are more common in children with ASDs than in children with other issues. Among these are echolalia -- where children repeat words or phrases that have been spoken by someone else either immediately or later -- and pronoun reversal, which is when a child says "you" when they should be saying "I" or "me".3 For example, a child might say, "You want a cookie" instead of "I want a cookie" when he's trying to get a caregiver to give him a treat.

Peculiar Ways of Speaking: Pragmatics and Prosody

Even individuals with a normal IQ and rich vocabulary may have a hard time not only with what they are saying, but with how they say it, or prosody. They may speak in a monotone, fail to put the rising inflection in their voice that usually comes at the end of questions, speak very slow or fast, and otherwise sound strange to other people's ears. Just as they are not focused on others' body language, it is likely they may not clue into others' intonation patterns and so fail to copy or fully understand them. Says one group of researchers, "Odd intonation patterns associated with autism seem to be one of the most immediately recognizable clinical signs of the disorder." 4

Individuals with ASDs are also known for taking speech very literally, struggling to make sense of puns, sarcasm, humor, metaphors or any other play on words that even very young "typical" children understand intuitively. If someone who had made a major mistake at school or work said, "I'm in hot water now!" a person with an ASD might be puzzled. The speaker was not standing in any water, so how could it be hot?

Pragmatic language, which is sometimes referred to as the "art of conversation," is also a challenge for people with ASDs. When to enter a conversation, taking turns controlling the topic, taking turns speaking, making comments to show interest in what the conversational partner is saying, and gracefully exiting the conversation -- all of these are part of pragmatic language. Individuals with ASDs often talk on and on about a topic that is their passion, regardless of the interest of the listener. It is often said that they tend to talk at other people instead of with them.5 Individuals with Asperger's syndrome are particularly known for using "pedantic" speech, that is, for using advanced vocabulary words and complex phrases to hold forth on a beloved topic like a "little professor" -- something which, at least in childhood, does not endear them to their peers.6


Where a person falls on the autism spectrum will likely determine what kind of language and communication challenges they face, but there is little doubt that there will be challenges in this area. Those who are supporting a person with an ASD need to keep in mind that the person they care about is challenged not just in language, but in grasping what language is about: communication and connection between different minds. (See Social Issues.)

Communication and Language - References

  1. American Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington DC: Author.
  2. Lord, C., Shulman, C., & DiLavore, P. (2004). Regression and word loss in autistic spectrum disorders. Journal of Child Psychology and Psychiatry 45(5): 936-955. Abstract
  3. Tager-Flusberg, H., Paul, R., & Lord, C. (2005). Language and communication in autism. In F. Volkmar et al. (Eds.), Handbook of Autism and Pervasive Developmental Disorders (pp.650-681). Hoboken, NJ: John Wiley & Sons. Page 347
  4. Tager-Flusberg, H., Paul, R., & Lord, C. (2005). Language and communication in autism. In F. Volkmar et al. (Eds.), Handbook of Autism and Pervasive Developmental Disorders (pp.650-681). Hoboken, NJ: John Wiley & Sons. Pg. 348
  5. Paul, R. (2005). Assessing communication in autism spectrum disorders. In F. Volkmar et al. (Eds.), Handbook of Autism and Pervasive Developmental Disorders (pp.799-816). Hoboken, NJ: John Wiley & Sons. Page 807
  6. South, M., Ozonoff, S., & McMahon, W.M. (2005). Repetitive behavior profiles in asperger syndrome and high functioning autism. Journal of Autism and Development Disorders, 35(2), 145-158. Abstract




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