The term “minimally verbal autism” describes individuals on the autism spectrum who use a very limited number of understandable, functional words, often fewer than 30. This is distinct from being “nonverbal,” which refers to individuals who use no or almost no functional words for communication.
For autistic individuals who are minimally verbal, the number of words they use may be inconsistent or only appear in specific situations. It is important to understand that a limited ability to speak does not equate to a lack of understanding or intelligence. These individuals often comprehend language and have thoughts they wish to express, relying on other methods to do so.
Potential Reasons for Limited Speech
A factor contributing to limited speech in some autistic individuals is a co-occurring motor speech disorder called childhood apraxia of speech (CAS). CAS is a neurological condition where the brain struggles to plan and coordinate the muscle movements of the lips, jaw, and tongue needed to produce clear sounds. This makes forming words physically difficult, and studies show a high rate of comorbidity between autism and apraxia.
Sensory processing differences also play a part in why spoken language may be limited. Many autistic individuals experience hypersensitivity to sounds or other environmental stimuli. The auditory feedback of their own voice or the oral-motor sensations involved in speaking can be overwhelming, making the act of producing speech a distressing experience.
Differences in social motivation can also impact the development of spoken language. The desire to communicate is a driving force for language acquisition, but for some on the autism spectrum, social interactions may not be as inherently rewarding. This can lead to fewer opportunities and less motivation to practice and develop verbal communication skills.
Key Therapeutic Approaches
To support communication development, a team of professionals often collaborates, with speech-language pathologists (SLPs) at the forefront. An SLP’s role extends beyond speech sounds; they assess all aspects of an individual’s communication abilities. They work on oral-motor skills to improve control over the muscles used for speech and help develop a comprehensive communication plan.
Applied Behavior Analysis (ABA) is another therapeutic approach used to build communication skills. Modern, naturalistic ABA therapies focus on creating motivating learning opportunities within a person’s daily routines and interests. Therapists use the individual’s own initiations to teach and reinforce communication, breaking down complex skills into smaller, manageable steps. This method aims to make communication more spontaneous and functional.
Occupational therapy (OT) addresses challenges that can indirectly impact communication. An occupational therapist can help with sensory regulation, developing strategies to manage sensitivities that might make speaking or interacting stressful. OT also focuses on improving fine motor skills, which are necessary for using communication tools like pointing to pictures, using sign language, or operating a tablet.
Essential Communication Systems and Tools
Augmentative and Alternative Communication (AAC) is an umbrella term for methods that supplement or replace spoken language when it is not a reliable option. These systems are not one-size-fits-all and are chosen based on an individual’s skills and needs after assessment by a professional like an SLP.
AAC systems are categorized as either low-tech or high-tech. Low-tech options do not require electronics and include tools like the Picture Exchange Communication System (PECS). PECS is a structured system that teaches individuals to initiate communication by exchanging a picture of a desired item with a communication partner. This process begins with simple requests and progressively builds to forming sentences and commenting. Basic sign language is another form of low-tech AAC.
High-tech AAC refers to electronic devices, often called speech-generating devices (SGDs), which produce a digitized or synthesized voice. These can range from simple buttons with pre-recorded messages to sophisticated applications on tablets. Apps like Proloquo2Go and TouchChat offer robust vocabularies with symbols, allowing users to construct detailed sentences. These tools can be customized with personal photos and vocabulary.
Using AAC does not prevent speech development and, in some cases, may even support it. The primary goal is to provide a reliable method of communication, reducing frustration and enabling fuller participation in daily life. High-tech aids, in particular, have been found to be effective in increasing social communication and interaction.
Receptive Language and Presumed Competence
Understanding the distinction between receptive and expressive language is important for supporting minimally verbal individuals. Receptive language is the ability to understand and comprehend information, while expressive language is the ability to communicate thoughts and feelings. Many autistic individuals have receptive language skills that are stronger than their expressive abilities, meaning they understand much more than they can say.
This understanding leads to the principle of “presuming competence.” This is the practice of assuming that an individual is intelligent and capable of learning and understanding, regardless of their ability to speak. It means speaking to them in an age-appropriate manner, not talking down to them or speaking about them as if they are not there.
Presuming competence influences every interaction and educational decision. It means providing access to age-appropriate information and ensuring robust communication systems are always available. By assuming an individual understands, we create an environment that encourages engagement and provides the necessary tools for them to demonstrate their knowledge and express their unique personality. This approach respects the individual as a whole person whose potential should not be limited by their verbal output.