Communication disorders and autism spectrum disorder (ASD) often co-occur, but they are distinct conditions. A communication disorder refers to difficulty with using language to communicate, while ASD is a developmental disability characterized by challenges with social communication and interaction, as well as restricted and repetitive behaviors. However, the overlap in symptoms can make differential diagnosis challenging. This article will examine the relationship between communication disorders and ASD and discuss whether communication disorders should be considered a form of autism.
What are communication disorders?
Communication disorders refer to impairments in a person’s ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. There are many different types of communication disorders, including:
- Speech disorders – Difficulties producing sounds, fluency or voice, such as stuttering, apraxia of speech, dysarthria.
- Language disorders – Impairment in understanding and/or using spoken or written language, such as aphasia, dyslexia.
- Hearing loss – Partial or total inability to hear.
- Central auditory processing disorders – Difficulty understanding speech even when hearing is normal.
- Social communication disorders – Difficulty with pragmatics and social aspects of communication.
The most common communication disorders in children are speech sound disorders, language delays, and fluency disorders like stuttering. In adults, some of the most prevalent communication disorders are aphasia, dysarthria, and hearing loss. Communication disorders can vary widely in severity and impact on a person’s ability to function and participate in daily activities.
What is autism spectrum disorder?
Autism spectrum disorder (ASD) is a complex developmental disability that involves challenges with social skills, speech and nonverbal communication, and restricted/repetitive behaviors. There are three main characteristics that define ASD:
- Persistent difficulties with social communication and social interaction.
- Restricted and repetitive patterns of behavior, interests or activities.
- Symptoms present in early childhood that limit or impair everyday functioning.
ASD encompasses a broad range of symptoms and severity levels. There are three levels of autism spectrum disorder:
- Level 1 – Requiring support
- Level 2 – Requiring substantial support
- Level 3 – Requiring very substantial support
Some individuals with ASD, particularly those on the high-functioning end of the spectrum, have average or high intelligence. Autism affects individuals differently and to varying degrees. Early intervention and appropriate support services may improve development and daily function.
Is there an overlap between communication disorders and ASD?
Yes, there is considerable overlap between communication disorders and autism spectrum disorder, since communication and social deficits are core symptoms of ASD.
It is estimated that between 30-50% of children with ASD have some degree of language impairment, compared to 7% in the general population. Even those with fluent speech may struggle with the social pragmatics of communication.
Some specific overlaps include:
- Delayed language acquisition
- Impaired non-verbal communication, such as abnormal eye contact and body language
- Echolalia – repeating words or phrases
- Difficulty understanding figurative language
- Challenges initiating or sustaining conversations
- Stereotyped or repetitive speech
- Hyper- or hypo-sensitivity to sounds
Up to 50% of people with ASD remain nonverbal or have very limited speech throughout their lives. Even those who develop fluent language tend to have abnormalities in the social use of language.
However, a communication disorder alone does not necessarily mean a child has ASD. Only a comprehensive evaluation by a multidisciplinary team can diagnose ASD.
Key differences between communication disorders and ASD
While there is significant overlap, there are also key differences between communication disorders and ASD:
| Communication Disorders | Autism Spectrum Disorder |
|---|---|
| Main deficit is in speech and/or language. | Main deficit is in social communication and social interaction. |
| No restriction in interests and behaviors | Restricted interests and repetitive behaviors present. |
| May not be present in early childhood. | Symptoms present in early childhood. |
| Intellectual disability not required for diagnosis. | Around 50% have intellectual disability. |
In essence, someone can have a communication disorder without meeting criteria for an autism diagnosis. But for those with ASD, some type of language or communication impairment is invariably present, even if it’s just difficulties with the social aspects of communication.
Can communication disorders be an early sign of autism?
Communication disorders that emerge in early childhood can be an early sign of autism, since language and communication deficits are core features of ASD.
Some communication disorders that may indicate risk for ASD include:
- Delayed onset of speech and babbling.
- Limited vocalizations and gesturing by 12 months.
- Difficulty using or understanding nonverbal communication.
- Not responding to name by 12 months.
- Loss of previously acquired speech.
- Echolalia.
- Pronoun reversal.
- Abnormalities in tone, pitch or rhythm of speech.
Red flags for ASD usually emerge before age 2, so early intervention can greatly improve outcomes. If a toddler is not reaching communication milestones, it is wise to have them evaluated by a speech-language pathologist and developmental pediatrician.
However, many conditions can cause language delays in young children, so an autism evaluation is needed to confirm ASD. Early treatment for any developmental disorder can make a significant difference in the child’s progress.
What disorders commonly co-occur with communication disorders?
There are a number of conditions that commonly co-occur with communication disorders:
- Autism spectrum disorder
- Intellectual disability
- Learning disabilities like dyslexia
- Sensory processing disorder
- ADHD
- Anxiety disorders
- Hearing impairments
- Childhood apraxia of speech
- Cleft lip and palate
- Selective mutism
- Traumatic brain injury
- Stroke and other neurological disorders
When a child has a communication disorder, it is important to screen for these co-occurring conditions which may need additional treatment. Early intervention can greatly help children attain optimal communication abilities.
Should communication disorders be considered part of the autism spectrum?
This is a complex issue without consensus among experts. Some argue that communication disorders share underlying traits with ASD and should be part of an expanded autism spectrum. They point out that language impairment and social communication deficits are core features of ASD that warrant inclusion on the spectrum.
However, others contend that placing all communication disorders under the autism umbrella would be too expansive. The autism spectrum is already broad, ranging from mild Asperger’s to severe nonverbal autism. Further expanding it could render the terminology less precise in determining specific treatment needs. They argue communication disorders should remain a distinct diagnostic category.
Ultimately, there are reasonable arguments on both sides of this issue. Communication disorders have considerable overlap with ASD, but also have distinct features. Individualized assessment and treatment is important, regardless of how conditions are categorized. More research is needed to better understand the relationship between these disorders.
Arguments For:
- Communication deficits are a core feature of ASD.
- Language disorders and ASD have shared genetic risk factors.
- Overlap may reflect an etiological continuum between disorders.
- May reduce stigma by being part of a broader spectrum.
- Diagnostic terminology has evolved over time and remains fluid.
Arguments Against:
- Further expanding the autism spectrum could make terminology less precise.
- Not all kids with communication disorders have autism.
- It could limit or delay access to language interventions.
- More evidence needed before changing established diagnostic categories.
- Risk of overdiagnosing or mislabeling autism.
Overall, while a definitive consensus has not yet emerged, recognizing the overlap between these disorders can help promote early screening and access to services. More interdisciplinary collaboration in research and clinical practice regarding communication disorders and ASD would benefit families facing these developmental challenges.
What role do speech therapists play with autism treatment?
Speech-language pathologists (SLPs), also known as speech therapists, play a very important role in the treatment of autism. Common goals they may work on include:
- Improving verbal and nonverbal communication skills.
- Increasing social interaction abilities.
- Enhancing play skills.
- Developing joint attention.
- Promoting language comprehension.
- Expanding vocabulary.
- Remediating speech sound errors.
- Teaching strategies to initiate and maintain conversation.
- Helping transition to using an alternate communication device if needed.
Speech therapy activities and techniques may include:
- Modeling correct pronunciation.
- Using pictures, gestures or sign language to improve comprehension and expression.
- Role playing social situations.
- Reading books and singing songs to expand linguistic skills.
- Auditory training for listening and processing skills.
- Offering rewards to motivate verbal communication.
- Functional communication training.
- Social stories and video modeling.
An SLP will collaborate closely with the child’s therapy team to set and monitor progress toward language goals. Ongoing speech therapy is important for many children on the autism spectrum to continually build their communication capacities over time.
Conclusion
While autism spectrum disorder and communication disorders are distinct diagnoses, they have considerable overlap due to shared difficulties with social communication and language. Communication impairments are very common as part of an autism diagnosis. At the same time, not all children with a communication disorder meet the full criteria for ASD.
Early identification of delays in communication milestones may help detect autism or other developmental conditions that require intervention. Increased collaboration between speech-language pathologists and autism specialists could enhance outcomes for children facing these challenges. More research is needed to continue clarifying the relationship between communication disorders and the autism spectrum.
Ultimately, individualized assessment and access to appropriate services are most crucial, regardless of exact diagnostic terminology. Raising awareness of early warning signs for social communication deficits and language delays can help all children get assistance needed to promote positive development.