Everything to know about nonverbal autism

As nonspeaking autism is not a specific diagnosis, definitions vary.

Some people consider nonspeaking autism to mean that a person does not spontaneously speak in sentences or words that others can understand. Others consider it as having the ability to speak meaningfully at times but not being able to speak at all at other times.

Having nonspeaking autism does not mean that a person does not communicate, cannot communicate, or does not understand language.

Some nonspeaking autistic individuals write and verbally communicate in other ways, such as via typing or special communication devices. The absence of speech does not mean a lack of understanding.

People should not presume that a nonspeaking autistic person does not understand speech because they cannot speak themselves or that they are incompetent.

Autism is a spectrum diagnosis, which means that a person may have a range of symptoms that affect daily life in ways ranging from mild to severe. A person may have significant difficulties in one area, such as verbal communication, while their other abilities remain intact.

Nonspeaking autism affects a person’s verbal skills. Some symptoms include:

• not spontaneously initiating or responding to conversation
• using only a few words or not speaking in complete sentences
• using sounds as opposed to words to communicate — although, in some cases, parents and caregivers may understand the meaning of these sounds
• not relying on spoken language as a primary form of communication

A lack of speech does not necessarily mean that a person cannot understand language. However, there is still much that researchers do not understand about nonspeaking autism.

In a 2021 paper, autism researchers called for a clearer definition and criteria to explain nonspeaking autism. They also mentioned the need for more research to find more neurobiological factors that can explain the diversity of communication among autistic people. This knowledge may, in turn, help scientists design more appropriate supports for autistic people who may need them.

Autism is a complex condition. The diagnosis does not provide much information in itself, as autism causes a spectrum of symptoms.

Researchers are still not sure what causes autism and whether different factors might increase the chance of different symptoms.

The development of autism also varies from appearing quickly over a few days or weeks to developing slowly over time.

Some potential factors in the development of autism include:

• Genetics: Researchers have identified some genetic factors that appear to increase the likelihood of autism. A person is also more likely to be autistic if a close family member is autistic.
• Genetic and chromosomal disorders: People with certain genetic or developmental disorders, such as tuberous sclerosis and fragile X syndrome, are more likely to be autistic.
• Development during pregnancy and in infancy: Exposure to certain drugs while in the womb may increase the chance of autism.

There is still no evidence to suggest that vaccines cause autism, even in people with an increased likelihood of having the condition.

Research indicates that no specific factor is likely responsible for language development in autistic people. However, it is likely that early intervention supports that target an autistic child’s play, attention, and imitation abilities may help increase their communication abilities.

Nonspeaking autism is not a distinct diagnosis from ASD. Instead, it is a description of a person’s symptoms. Nonspeaking autism includes a continuum of behaviors, from never speaking at all to only speaking in some situations.

No single test can diagnose autism. Instead, a healthcare professional diagnoses autism based on a person’s symptoms.

The diagnostic criteria for autism specify that a person must have ongoing difficulties with social interaction in multiple contexts. Some examples include difficulties with:

• the back-and-forth of communication
• sharing interests or emotions
• understanding or responding to social interactions
• nonverbal communication, such as the inability to understand gestures or subtle body language or make eye contact
• developing, understanding, or maintaining relationships with others

A person must also have a restricted range of interests and behaviors, which may be highly repetitive. Some examples include:

• stereotypical behaviors or movements, such as repeating things that other people say, lining up toys, flapping the arms, or using objects in atypical ways
• difficulty with change and a high need for a routine
• hyperfocus on particular interests
• over- or underreactivity to sensory input, such as being very sensitive to light or sound

For a person to qualify for a diagnosis, the symptoms must:

• be present in early childhood
• cause impairments in one or more areas of daily life or functioning
• not be due to another diagnosis, such as a head injury

Certain characteristics can indicate that an infant or young child is autistic. Although these characteristics vary among individuals, a child may be autistic if they:

• have delayed language skills or language skills that appear and then disappear
• do not use gestures to communicate by 12 months
• do not understand pointing by 18 months
• are not interested in other children
• do not engage in pretend play by 2.5 years
• do not have typical happy, sad, or angry facial expressions by 9 months
• do not respond to their name by 9 months
• are unable to maintain eye contact or actively avoid it

Support for ASD focuses on caring for people with the diagnosis and helping them learn new skills. Some options include:

• Therapy: A wide range of behavioral therapies can help autistic people learn new skills. Speech therapy, occupational therapy, and similar interventions may help them function more independently. Behavioral therapy can focus on the development of social skills.
• Psychotherapy: Psychotherapy can help autistic people understand their diagnosis and deal with symptoms of anxiety, depression, and other common issues. Family therapy may help a family better support an autistic person while offering parents or caregivers new skills for managing the child’s condition.
• Accommodations: Autistic people may need certain accommodations at work or school.
• Medication: Medication can help with symptoms that tend to co-occur with autism, such as anxiety, attention issues, and depression. There is no approved medication that can treat all of the symptoms of autism.

Applied behavioral analysis

Applied behavioral analysis (ABA) is one of the most common support interventions for autistic people. However, it is also controversial, potentially because of its origins. A psychologist developed ABA in the 1960s and referred to it as discrete trial training (DTT). At that time, this intervention used aversive or punishment-based methods to get people to stop exhibiting socially unwanted behaviors.

Although modern ABA therapy has significantly evolved since that time and rarely uses aversive therapy, modern critics of the ABA approach argue that as its goal is still to induce more “normal” behavior, it may punish typical autistic behavior.

These days, in many cases, ABA therapy tends to be play-focused, especially when it is for autistic children. Supporters of ABA therapy argue that rather than trying to force an autistic person to behave like a neurotypical person, it helps them develop the skills they need to live as independently as possible while still remaining true to their identity. It can do this by, for instance, helping them improve their language and communication skills.

People considering autism interventions such as ABA should weigh the risks and benefits, including:

• its effect on the autistic person’s mental health
• whether or not it stigmatizes harmless behaviors
• how the autistic person feels about it

A person should also keep in mind that the increase in the number of support providers means that their quality may vary. It is important to monitor the intervention to make sure that it is positive and helpful rather than aversive.

There is no cure for autism, but various interventions and ongoing accommodations at work or school can make life easier for autistic people.

Some autistic children have few or no symptoms in adulthood, especially if they get supportive therapy. However, this is rare.

Other autistic people may mask their symptoms as they get older. As a result, clinicians might not see as many characteristic behaviors in an autistic adult, even though autistic traits persist.

The notion of autism as a disease or disability is controversial among some autism advocates. Some autistic people prefer to think of it as an alternative way of thinking and being.

They believe that autism poses some challenges but also comes with some benefits. For example, autistic people may be highly adept at detecting patterns or memorizing long strings of information.

Having nonspeaking autism can make certain interactions more difficult, and it may change the way in which people respond to others. It does not, however, mean that a person cannot communicate.

With the right support and the acceptance of alternative forms of communication, many nonspeaking autistic people become exceptional communicators, with or without verbal language.