Understanding Language in Autism: Alexithymia, Echolalia, and Beyond

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.  

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.  

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.   

Inferencing can be a challenge for some autistic people. Recalling and categorizing facts may be easy, but it could be harder to comprehend: 

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.  

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).   

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 

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.