13 Speech and Communication Problems in Autism


Most people with autism (though by no means all) do have the ability to talk. Most of the time, though, people with autism talk differently from their neurotypical peers. Some of those differences relate to actual production and use of spoken language while others relate to challenges with non-verbal “body language” and other social and cultural cues and expectations.


What Is a Pragmatic Speech Delay?

The American Speech-Language Hearing Association (ASHA) describes pragmatic speech as having three components:

Using language for different purposes, such as

  • Greeting (e.g., hello, goodbye)
  • Informing (e.g., I’m going to get a cookie)
  • Demanding (e.g., Give me a cookie)
  • Promising (e.g., I’m going to get you a cookie)
  • Requesting (e.g., I would like a cookie, please)

Changing language according to the needs of a listener or situation, such as

  • Talking differently to a baby than to an adult
  • Giving background information to an unfamiliar listener
  • Speaking differently in a classroom than on a playground

Following rules for conversations and storytelling, such as

  • Taking turns in conversation
  • Introducing topics of conversation
  • Staying on topic
  • How to use verbal and nonverbal signals
  • How to use facial expressions and eye contact

Of course, the rules of speech and communication vary from community to community and may be completely different from nation to nation. But the ability to observe, make sense of, and use these rules (and make appropriate changes in different social settings) is the key to pragmatic speech and communication.

How Autism Affects Pragmatic Speech

For people with autism, pragmatic speech is almost always a challenge at some level. Obviously, a non-verbal person is struggling with very different challenges than a highly verbal person, but both are likely to need help in understanding facial expressions, non-verbal cues, turn taking, and so forth. While autistic speech patterns vary from person to person, individuals with autism may:

  1. Be louder or quieter than is culturally expected
  2. Speak in a flattering voice or use a different intonation than usual
  3. Repeat entire chunks of scripts from television shows, videos, or movies
  4. Talk about what seems to be an off-topic subject
  5. Dominate the conversation with talk about a topic of interest only to themselves
  6. Say the same things over and over again (either literally stating the same facts over and over or using the same phrases in the same way over and over; for example, saying “that’s great” in response to every statement)
  7. Ask questions or volunteer information about topics that are usually considered taboo or sensitive (for example “So, are you really upset about your recent divorce?” or “I went to the doctor yesterday and had to give a urine sample.”)
  8. Enter conversations when they are not invited, and/or leave conversations before the discussion appears to be over
  9. Have a hard time recognizing sarcasm, jokes, idioms, and expressions such as “the pot calling the kettle black” unless they are explained
  10. Use language that seems inappropriate to the situation (too formal, too informal, trying to be funny in a serious situation or trying to be serious in a silly situation)
  11. Ask questions simply in order to state their own ideas or opinions (for example “Do you like telescopes? I like telescopes; I have three of them. One of them is a Celestron…”
  12. Tell the truth, without awareness of whether truth-telling will have a negative outcome (“yes, that dress does make you look fat”)
  13. Have difficulty with or refuse to engage in the type of small-talk that usually smooths interactions among new acquaintances or in highly tense situations (weather talk, for example)

How Therapists Can Help With Pragmatic Speech

Both speech therapists and social skills therapists work with autistic children and adults to overcome pragmatic speech delays. Family and friends can also help by actively teaching, modeling, and role-playing appropriate speech patterns and language use. Unlike some therapies, speech and social skills therapies can make a significant difference for both children and adults.

Improvements in pragmatic speech skills can make a huge positive difference in others’ response to people with ASD. It’s important to note, however, that it is possible to “overtrain” autistic children, in particular, to the point where their language use is technically correct but socially “off.” Strange but true, a child with autism who shakes hands with an adult, looks him in the eye, and says “It’s a pleasure to meet you” is behaving, not like a child, but like a business peer!

Related Articles
Foods to Avoid If You Have Dry Mouth From Radiation

Dry mouth (xerostomia) is a common side effect of radiation therapy for people undergoing treatment for head and neck cancer. Read more

Thyroid adenoma: Causes, Treatment, and Diagnosis

The thyroid is a small, butterfly-shaped gland in the front of your throat that produces hormones affecting a number of Read more

NSAIDs and You Thyroid Function

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently taken over-the-counter medications. Due to their systemic or whole body effects, it's Read more

How Doctors Are Failing Thyroid Disease Patients

The thyroid disease community has continually mentioned the lack of support they experience and the difficulty they have navigating the Read more