AUTISTIC COMMUNICATION
Historically, society has framed Autistic people as “impaired” in communication and labelled them as having social deficits. The problem is that these judgments are based on neurotypical standards of how a person “should” behave. The Medical Model of disability ignores Autistic styles of communication and reinforces harmful narratives that marginalise and oppress us.
Social anxiety
Autistic people often experience high levels of daily anxiety. Navigating a neurotypical world that isn’t designed for them can feel overwhelming, leading to replaying social interactions repeatedly as a form of self-protection. Masking — like forcing eye contact, nodding or smiling at the “right” moments, moderating tone of voice, or controlling speech pace — are all strategies used to fit in, and they are deeply intertwined with anxiety. These things require constant vigilance and energy. Autistic people may monitor every word, gesture, and facial expression to avoid being misunderstood or judged. Even minor mistakes can trigger intense self-criticism and rumination. Over time, the cumulative effect of masking contributes to exhaustion, emotional burnout, and heightened mental health challenges, including depression, social withdrawal, and a diminished sense of identity.
Literal understanding of language
Autistic people may find abstract or figurative language — like idioms, metaphors, double meanings, or sarcasm — difficult to understand. This can lead to misunderstandings and communication breakdowns, especially when interacting with neurotypical people whose communication and processing styles differ. Neurotypical communication often relies on indirect language, implied meanings, or subtle cues, which can create multiple possible interpretations. For Autistic people, this ambiguity can cause confusion, frustration, and stress. Clear, direct, and concrete communication helps reduce misunderstandings and makes interactions more accessible, respectful, and effective.
Pragmatics
Pragmatics is the use of language in context, such as interpreting body language, knowing when to speak in conversations, asking questions, understanding implied meanings, and picking up on social and emotional cues. While differences in these areas are often labelled as “impaired” in Autistic people, this framing is misleading. Traditional assessments of pragmatic language are based on neurotypical norms, so Autistic communication that doesn’t align with these expectations is often interpreted as a deficit, even though it may simply reflect a different, valid style of interaction. Autistic people may communicate effectively in ways that are not recognised by neurotypical standards. Pragmatics, as a field in Speech and Language Therapy, should focus on supporting communication differences rather than assuming impairment, recognising that Autistic people’s pragmatic language is not inherently “broken,” just different.
Eye-contact
Eye-contact can be uncomfortable or even painful for Autistic people. The common myth that “if you can make eye-contact, you can’t be Autistic” is inaccurate, as many Autistic people have trained themselves over years of social pressure to force eye-contact—a form of masking. Some avoid it entirely, some can manage it briefly, and many do so to appease others, often with their eyes moving around the room while speaking. Autistic children may make eye-contact in predictable, short interactions, but for many, prolonged eye-contact increases anxiety due to overactivation in certain parts of the brain (Hadjikhani, 2017; Dalton et al., 2005; Madipakkam et al., 2017). Forcing eye-contact, particularly during stress, meltdowns, or while managing complex verbal tasks, can be harmful and counterproductive, as it adds physical and cognitive strain rather than improving communication.
SOURCES
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
Working memory allows us to temporarily hold information in our minds, helping us remember spoken instructions, follow directions, keep track of a shopping list, or answer multi-part questions, such as in a job interview. Many Autistic people experience difficulty holding multiple pieces of information at once. For example, if a child is told, “Go upstairs, brush your teeth, put your toys away,” they may forget the first instruction by the time they hear the third. This challenge is often misunderstood as not listening, forgetfulness, or misbehaviour, when in reality it reflects a difference in cognitive processing rather than intent or attention.
Processing speed
Autistic people may need more time to process language and spoken information, due to differences in auditory, language, or sensory processing. When someone speaks too quickly, provides excessive information at once, asks multiple questions in rapid succession, or doesn’t allow enough time to respond, it can lead to frustration, anxiety, sensory overload, and even meltdowns. During times of distress, the ability to access and process spoken language is significantly reduced, and fatigue can make word-finding, organising thoughts, and recalling information even more challenging. Providing ample processing time and clear, paced communication is crucial to support understanding and reduce stress.
Alexithymia
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.
SOURCES
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