Understanding Language in Autism: Alexithymia, Echolalia, and Beyond
Friday, May 02, 2025
Autism involves many potential differences in speech and language. For example, social communication differences are a core autism characteristic. Another core trait—repetitive behaviors—can include repetitive speech patterns such as echolalia. In some instances, autism affects another speech characteristic called prosody—the small ways we vary our tone, rhythm, and emphasis to add meaning to our speech. And of course, some autistic individuals use very few or no spoken words to communicate. For these reasons, most validated autism assessments contain measures of speech and language that enable practitioners to find out how autism is shaping the way a person communicates and interacts.
Depending on the individual in your care, it may be a good idea to widen the autism evaluation to include more specialized speech and language assessments.
Here’s an overview and introduction of unique communication strategies in autistic and neurodiverse individuals.
What Is Alexithymia?
Alexithymia is a difficulty in recognizing and describing emotional states. It’s more common among autistic individuals than it is in the general population. Research suggests that between 45% and 60% of autistic individuals experience alexithymia, compared to roughly 10% in the general population (Oakely et al., 2022). Alexithymia has also been linked to sensory sensitivities, which often occur alongside autism (Yorke et al., 2025).
Alexithymia affects social communication, not only because a person may have trouble expressing their own emotional states and needs, but because it’s harder to “read” the emotion in words, expressions, and body language of other people. In one long-term study conducted as part of the EU-AIMS Longitudinal European Autism Project (LEAP), autistic people with alexithymia said their difficulty in recognizing emotion disrupted their everyday social functioning (Oakely et al., 2022).
Alexithymia has also been linked to anxiety and depression (Mason & Happé, 2022). Because this skillset affects so many areas of daily life, understanding it may help you to better support relationships, mental health, and quality of life.
What Is Echolalia?
Echolalia is repeated or imitated speech. Someone may repeat words or phrases they’ve just heard in conversation or heard at an earlier time from some other source, possibly in media. Sometimes echolalia contains gestalts, or groups of words that stand in for a single concept. A child might call a jacket a “coat on nice and warm,” for example. Once, echolalia was a verbal behavior practitioners and families sought to change or erase. Increasingly, echolalia is seen as “a bridge to meaningful, self-generated speech with communicative intent” (Davis, 2017).
What Is Hyperlexia?
For many autistic individuals, written language is an area of strength or focused interest. For example, hyperlexia—the ability to read at levels well beyond what is typical for one’s age—is more common among autistic individuals than in the general population. Researchers think between 6% and 20% of autistic individuals have advanced reading skills. One important note: hyperlexia doesn’t necessarily lead to a larger vocabulary or better reading comprehension (Ostrolenk et al., 2024).
Assessing speech and language can help you discover more about these strengths so you can use them to set goals and plan interventions, as well to validate and celebrate them.
Read about focused interests: Autism in Women and Girls: A Look at Special Interests
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Structural Language and Autism Difficulties with structural language are not considered a core autism trait. Even so, some experts say that around half of autistic individuals have impairments in this skillset (Georgiou & Spanoudis, 2021). Structural language includes grammar, vocabulary, morphology (how words are built), and syntax (how sentences are built). |
What Is Inferencing?
Inferencing is reaching a reasoned conclusion or opinion using information that isn’t explicitly stated. It’s sometimes described as reading between the lines. When people infer, they rely on nonverbal cues, figurative language, social norms, background knowledge, and other contextual information to grasp what people intend but may not be saying out loud.
Inferencing can be a challenge for some autistic people. Recalling and categorizing facts may be easy, but it could be harder to comprehend:
- causes and effects;
- motives, goals, and emotional states of characters; and
- predictions based on background knowledge (Westerveld et al., 2021).
Inferencing abilities can also affect people in conversation. Researchers say autistic people prefer literal language, so idioms and figurative language may be harder to understand (Martelle & Namazi, 2022).
And then there’s social inferencing: detecting the unspoken feelings and intentions of other people, which can be a real challenge (Loukusa et al., 2023). This skill is important in building and sustaining relationships. It also keeps people safe from exploitation. Research shows that autistic people often feel vulnerable to manipulation and deception because of their social communication differences. In one small study, for example, a group of autistic young adults watched videos and then decided whether the speaker was lying or telling the truth. The study participants briefly explained their reasoning. Those who said there were observable details, like a hesitation, to indicate a lie were more accurate than those who relied on nonverbal cues and other subjective impressions (Coburn et al., 2024).
Language, reading, and some autism assessments can provide reliable information about inferencing skills so you can plan appropriate supports.
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Pragmatics and Social Communication When practitioners assess social communication in an autism evaluation, one area of focus is pragmatics—the language we use to communicate in social contexts. Such assessments generally measure skills like these:
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How Do Non-Speaking Individuals Communicate?
Language assessment sheds light on specific support needs. Roughly 30% of autistic individuals use very few or no spoken words—yet they may be able to communicate using gestures, sign language, visual aids, or assistive and augmentative communication (AAC) devices (Schaeffer et al., 2023).
It’s important to note that expressive language and receptive language abilities can differ from one another; that is, a person may understand more language than they can verbalize. Furthermore, researchers emphasize that “language can be impaired or even absent in some children on the autism spectrum with otherwise intact intellectual abilities” (Schaeffer et al., 2023).
What Other Speech Differences Might Occur With Autism?
Autism can co-occur with other conditions that affect speech and language. It may overlap with or occur alongside these conditions:
- Developmental language disorder (DLD)
- Speech sound or fluency disorders
- Auditory processing disorders (APD)
- Childhood apraxia of speech
A thorough speech and language evaluation can help you distinguish between conditions, identify the accommodations that best suit each person, and train that person’s communication partners.
Learn more: Autism Assessment Tool Kit
Key Messages
All people, including autistic people, communicate in highly individual ways. While autism assessments are designed to identify speech and language patterns that are characteristic of autism, other speech and language differences might need more specialized assessments.
Speech and language disorders, hyperlexia, alexithymia, inferencing difficulties, and other variations affect the way people function in many important areas of their lives. The more we understand about each individual’s speech and language capabilities, the better we will be at co-creating an accepting, supportive path forward.
Research and Resources:
Coburn, K. L., Miller, G. N.; Martin, L. A. & Kana, R. K. (2024). A mixed-methods analysis of deception detection by neurodiverse young adults. Topics in Language Disorders, 44(1), 63-79. https://doi.org/10.1097/TLD.0000000000000329
Georgiou, N., & Spanoudis, G. (2021). Developmental language disorder and autism: Commonalities and differences on language. Brain Sciences, 11(5), 589. https://doi.org/10.3390/brainsci11050589
Grace, K. G. (2017). Echoes of language development: 7 facts about echolalia for SLPs. https://leader.pubs.asha.org/do/10.1044/echoes-of-language-development-7-facts-about-echolalia-for-slps/full/
Loukusa, S., Gabbatore, I., Kotila, A. R., Dindar, K., Mäkinen, L., Leinonen, E., Mämmelä, L., Bosco, F. M., Jussila, K., Ebeling, H., Hurtig, T. M., & Mattila, M. L. (2023). Non-linguistic comprehension, social inference and empathizing skills in autistic young adults, young adults with autistic traits and control young adults: Group differences and interrelatedness of skills. International Journal of Language & Communication Disorders, 58(4), 1133–1147. https://doi.org/10.1111/1460-6984.12848
Martelle, S. N., & Namazi, M. (2022). Feeling Thrown for a Loop? The Effects of Inferencing on Spoken Language Idiom Comprehension in Autism. Language, Speech, and Hearing Services in Schools, 53(2), 584–597. https://doi.org/10.1044/2021_LSHSS-21-00100
Mason, D., & Happé, F. (2022). The role of alexithymia and autistic traits in predicting quality of life in an online sample. Research in Autism Spectrum Disorders, 90, None. https://doi.org/10.1016/j.rasd.2021.101887
Oakley, B. F. M., Jones, E. J. H., Crawley, D., Charman, T., Buitelaar, J., Tillmann, J., Murphy, D. G., Loth, E., & EU-AIMS LEAP Group (2022). Alexithymia in autism: Cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychological Medicine, 52(8), 1458–1470. https://doi.org/10.1017/S0033291720003244
Ostrolenk, A., Gagnon, D., Boisvert, M., Lemire, O., Dick, S. C., Côté, M. P., & Mottron, L. (2024). Enhanced interest in letters and numbers in autistic children. Molecular Autism, 15(1), 26. https://doi.org/10.1186/s13229-024-00606-4
Schaeffer, J., Abd El-Raziq, M., Castroviejo, E., Durrleman, S., Ferré, S., Grama, I., Hendriks, P., Kissine, M., Manenti, M., Marinis, T., Meir, N., Novogrodsky, R., Perovic, A., Panzeri, F., Silleresi, S., Sukenik, N., Vicente, A., Zebib, R., Prévost, P., & Tuller, L. (2023). Language in autism: Domains, profiles and co-occurring conditions. Journal of Neural Transmission, 130(3), 433–457. https://doi.org/10.1007/s00702-023-02592-y
Westerveld, M. F., Filiatrault-Veilleux, P., & Paynter, J. (2021). Inferential narrative comprehension ability of young school-age children on the autism spectrum. Autism & Developmental Language Impairments, 6, 23969415211035666. https://doi.org/10.1177/23969415211035666
Yorke, I., Murphy, J., Rijsdijk, F., Colvert, E., Lietz, S., Happé, F., & Bird, G. (2025). Alexithymia may explain the genetic relationship between autism and sensory sensitivity. Translational Psychiatry, 15(1), 75. https://doi.org/10.1038/s41398-025-03254-1