Historically society has viewed autistic people as 'impaired' when it comes to communication, and labelled as having social deficits. The problem with this is that it stems from the non-autistic, non-disabled person's standards of what a person "should" act like. The Medical Model of disability does not consider autistic styles of communication and serves to perpetuate harmful narratives that oppress and marginalise us.
Autistic people often experience high levels of anxiety on a daily basis. Navigating a neurotypical world which isn't set up for you can be paralysing and the autistic person may re-play interactions over and over in their heads in a way to self-protect. We can go to great lengths to not come across as rude, awkward, we may try to make eye-contact at regular intervals to show the other person that we're listening. We may nod and smile at the appropriate times and make sure our tone of voice is acceptable...our rate of speech isn't too fast or too slow. These masking behaviours are interwined with anxiety.
Literal understanding of language
Autistic people may have difficulties understanding abstract language / figurative language such as idioms, metaphors, double meanings, and sarcasm. It can lead to frequent misunderstandings and breakdowns in communication which mostly happens when interacting with non-autistic people who have different communication and processing styles. Often there are many different interpretations of what people might mean when they communicate using body language and words. Differences in NT and Autistic communication styles often lead to misunderstandings because it's common for NTs to speak in indirect ways which lack clarity and concreteness, leaving us in a state of confusion and frustration. This is why Autistic people need you to be direct and clear.
This is what's frequently labelled as impaired in Autistic people. Pragmatics is the 'use of language' - it's language in context, interpreting body language, knowing when it's your turn to speak in conversations and jump in, initiating interactions, how to ask questions, understanding language in context, picking up on socio-emotional cues. Pragmatics involves inferring information and reading between the lines. Whilst it is common for Autistic people to struggle with this. Pragmatics is a field of Speech and Language Therapy that is based on NT pragmatic language development, and so we should not - and cannot assume Autistic people have impaired pragmatic language.
Eye-contact can be physically painful for an Autistic person. The myth that 'if you can make eye-contact then you can't be Autistic' is hugely inaccurate (remember many of us have trained ourselves over the years to force eye-contact as a conditioned response to years of social rejection: (see masking). Some Autistic people avoid it altogether, some can do it but it's fleeting, and many force it to appease the other person. You'll often see an Autistic person's eyes move around the room when they speak. Autistic children may be able to make eye-contact if the interaction is predictable and short.
Research shows that despite neurotypicals perceiving a lack of eye-contact as rude, in reality, eye-contact increases anxiety for an Autistic person due to excessive arousal / overactivation in parts of the brain (Hadjikhani, 2017; Dalton et al., 2005; Madipakkam et al., 2017). So forcing an Autistic person to make eye-contact can cause harm. It can be exceptionally hard to make eye-contact during times of stress, during a meltdown, or if we are trying to verbally explain something and we're managing all the executive functioning demands.
Hadjikhani, N., Åsberg Johnels, J., Zürcher, N.R. et al. Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Sci Rep 7, 3163 (2017). https://doi.org/10.1038/s41598-017-03378-5
Dalton KM, Nacewicz BM, Johnstone T, Schaefer HS, Gernsbacher MA, Goldsmith HH, Alexander AL, Davidson RJ. Gaze fixation and the neural circuitry of face processing in autism. Nat Neurosci. 2005 Apr;8(4):519-26. doi: 10.1038/nn1421.
Madipakkam, A.R., Rothkirch, M., Dziobek, I. et al. Unconscious avoidance of eye contact in autism spectrum disorder. Sci Rep 7, 13378 (2017). https://doi.org/10.1038/s41598-017-13945-5
Working memory helps us store information in our brains temporarily. It helps us remember spoken instructions, map directions, a shopping list, and multiple pieces of information. It helps us answer multi-part spoken questions like in a job interview. A common difficulty for Autistic people is keeping hold of multiple pieces of information in our heads. Example: a child being told "go upstairs, brush your teeth, put your toys away". By the time they've heard the 3rd piece of information they've likely already forgotten the 1st. But this is frequently misunderstood as "you're not listening", forgetfulness, or bad behaviour.
Another example - an Autistic adult is in a job interview and they've been asked a multi-part question e.g. "tell me a time when X, what you learnt, and how you can bring that to this job". For neurodivergent brains it can be too much information to hold. Another example - you're in a cafe with friends and you offer to take everyone's orders and go to the till - when you get to the counter you've already forgotten what they said and have to come back and ask. This is why writing things down can be such supportive strategies for autistic people, because it makes things concrete and hellps the information stick around longer.
It can take Autistic people much longer to process language and spoken information. This can be down to auditory processing / language difficulties and sensory processing. Autistic people often need PLENTY of processing time. If someone speaks too fast, uses too much language, gives too much information in one go, asks too many questions or doesn't give enough time to respond, it can lead to dysregulation, frustration, anxiety, sensory overload and meltdowns. If the person is in distress then their ability to access / process spoken language is significantly reduced. If fatigued, word-finding is more challenging, as is organising thoughts and recalling information.
What is alexithymia? Alexithymia was first coined in the 1970s by psychiatrist Peter Sifneos. Alexithymia literally means "no words for feelings" and is characterised by: difficulty identifying emotions, expressing emotions, describing emotions, identifying physical sensations associated with emotional states. Alexithymia is very common among Autistic people and has also been found in psychiatric populations e.g. frequently co-occurs with anorexia and personality disorders. Alexithymia can be assessed using a self-report measure (TAS-20, Bagby et al., 1994). The ability to express emotions requires linguistic level processing and it is suggested that shows a proportion of people with language difficulties also show features of alexithymia. People with alexithymia show difficulties with emotion vocabulary (Suslow & Junghanns, 2002). Interpersonal relationships tend to be more difficult due to the struggle of talking about emotions.
Sifneos, P., Apfel-Savitz, R., & Frankel, F. (1977). The Phenomenon of 'Alexithymia': Observations in Neurotic and Psychosomatic Patients. Psychotherapy and Psychosomatics, 28(1/4), 47-57. Retrieved April 16, 2021, from http://www.jstor.org/stable/45114843
R.Michael Bagby, James D.A. Parker, Graeme J. Taylor (1994) The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure, Journal of Psychosomatic Research, Volume 38, Issue 1 - https://www.sciencedirect.com/science/article/abs/pii/0022399994900051?via%3Dihub
Suslow, T., & Junghanns, K. (2002). Impairments of emotion situation priming in alexithymia. Personality and Individual Differences, 32(3), 541–550. https://doi.org/10.1016/S0191-8869(01)00056-3
Hobson, Hannah & Brewer, Rebecca & Catmur, Caroline & Bird, Geoffrey. (2019). The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia. Emotion Review. 11. 10.1177/1754073919838528. - Link