‘Nonverbal’ Autism: What It Means
Guidance From an Expert Physician
Published March 2023
Autism, or autism spectrum disorder (ASD), is a neurodevelopmental disorder that can be characterized by a variety of challenges with social and nonverbal communication, interaction with others and repetitive or restricted patterns of behavior.
Each person with ASD is unique, though some general signs of the disorder in children are:
Focus more on the broader idea of communication.— Meghan O’Neill, MD
- Not sharing and/or playing the way other children do
- Being noticeably sensitive to sounds, touch, smells or tastes
- Wanting to be alone rather than with others
- Having difficulty while learning to talk
- Challenges with nonverbal communication, such as using and understanding eye contact, pointing, gestures, facial expressions, and body language
- Reduced back-and-forth exchanges and limited showing and sharing of objects of interest with others
- Engagement in frequent repetitive behaviors which might include atypical patterns of movement, play, or speech
- A rigid preference for routine and sameness
Some individuals with ASD have significant challenges with communication and may be referred to as “nonverbal” or nonspeaking.
Understand Nonspeaking Habits
“When a person with autism is nonspeaking, they do not communicate using spoken language, including vocalizations or sounds which have symbolic meaning,” explains Meghan O’Neill, MD, a neurodevelopmental disabilities physician at Ann & Robert H. Lurie Children's Hospital of Chicago and an assistant professor of Pediatrics at Northwestern University Feinberg School of Medicine. “But when someone is nonverbal, this does not mean that the individual cannot engage in communication, which broadly represents the exchange of messages or information between two people.”
In fact, many ASD advocacy groups are pushing to retire the term “nonverbal”, Dr. O’Neill explains, largely because those outside of the community tend to equate being nonverbal with a reduced understanding of language and a general inability to communicate, sometimes leading to incorrect assumptions about a nonspeaking individual.
Children with ASD often have difficulty learning to talk because of primary, brain-based deficits in understanding the social, back-and-forth nature of communication.
“We have to learn to communicate before we can move to the next step of learning to use language,” Dr. O’Neill explains.
Some people use the term “preverbal” to refer to children who do not use words but who otherwise intentionally communicate with the use of gestures or nonverbal communication. This is an initial step on the path toward learning to talk.
“In addition to social communication, we know that many children with ASD also have difficulties understanding symbols and what they represent, which impacts both language acquisition, word learning as well as the ability to engage in symbolic play such as feeding a doll or talking into a banana as if it were a telephone,” says Dr. O’Neill.
Children with ASD who are experiencing delays in learning to speak may have a variety of outcomes depending on the development of their social communication skills and symbolic understanding, both of which may be influenced by innate abilities as well as therapy and other supports.
Some children may catch up over time to eventually become fully conversational, Dr. O’Neill says, while others may develop basic verbal communication skills such as using single words or short phrases. Some may never use verbal language.
“With time and support, many individuals who remain nonspeaking can still learn to communicate with other modes of communication, including sign-language systems or gestures, picture-based systems or augmentative or technology-assisted options such as speech-generating devices,” she says.
For young children with ASD, there are everyday things that adults can do to facilitate language development during early childhood. This may include:
- Using highly motivating objects and activities to make a social connection and reinforce communicative intent
- Providing or even manufacturing opportunities that require communication for a child to get something that they want
- Rewarding social interactions that use positive social communication skills or language
- Working on the development of symbolic play skills
- Modeling clear and concise language in everyday life
- Providing support for challenging behaviors, such as labeling emotions and finding more functional ways to communicate
All individuals have the potential to communicate, but whether children and adults with ASD are able to do so successfully depends on a combination of innate abilities, acceptance and promotion of particular preferences and sufficient environmental supports and services.
Above all, Dr. O’Neill reminds families and support systems that language is complex and communication is much broader than just speech.
“Remember that learning to speak is actually one of the most neurologically complicated processes we carry out as human beings,” she says. “It is often more productive to focus instead on the foundational skills that are needed to learn to talk, especially the broader idea of communication.”