Nonverbal Autism (Nonspeaking): Communication

Nonspeaking describes people who use few or no spoken words; in autism research the usual term is minimally verbal. It describes speech, not understanding or intelligence, both of which vary widely among nonspeaking autistic children. Many children gain speech later in childhood, and AAC, from picture boards to speech-generating devices, supports communication without holding speech back.⁠^{1,2,3,4,5,6,7}

What is nonverbal autism, and is it the same as nonspeaking?

Nonspeaking describes an autistic person who uses no spoken words or very few. It is not a separate type of autism: the DSM-5 criteria, as the CDC reproduces them, ask clinicians to specify whether autism comes with or without a language impairment.⁠¹³ Nonverbal autism, nonspeaking autism and minimally verbal autism are three names for overlapping groups, and studies define them in many different ways.⁠⁴

The word matters to many of the people it describes. In Merriam-Webster, verbal first means relating to or consisting of words, and only in a later sense means spoken rather than written, so a person who types or signs words is verbal in the first sense even without speech.⁠¹⁴ Writing by and with autistic self-advocates uses nonspeaking and minimally speaking, and a 2025 commentary in Autism by Bottema-Beutel and colleagues argues for moving on from verbal, minimally verbal and nonverbal altogether.⁠^8,15 Individual preference varies, and the research literature still mostly uses minimally verbal.⁠^4,6

What does minimally verbal mean in research?

There is no single definition. A 2020 systematic review found large inconsistencies in how studies defined nonverbal and minimally verbal, in the measures they used and in the ages they studied.⁠⁴ When one research team applied five common instruments to 1,470 school-aged autistic children, 257 counted as minimally verbal on at least one, and the overlap between definitions ranged from 3% to 100%.⁠⁵ Stricter definitions, few or no words, picked out a more consistent group than definitions that included children with some words.⁠⁵

Age matters too: nearly all toddlers younger than about 18 months are nonverbal or minimally verbal, so the term only means something once a child is past the age when speech usually starts.⁠⁴ Most preschool autistic children who are not yet talking are preverbal and go on to speak.⁠¹

Why do some people avoid the word nonverbal?

Because the label has gone with low expectations. Minimally verbal children have often been assumed to be profoundly cognitively impaired, and children who did not respond to standard tests have often been left out of research, so the most communicatively complex autistic people may be the least studied.⁠^4,5 Researchers who listen to nonspeaking autistic people describe paying attention to every way a person communicates, including gestures and nonspeech sounds.⁠⁸

How many autistic children are nonspeaking or minimally verbal?

About a quarter to a third, depending on the definition and the age. The figure quoted most often, from a 2013 review by Helen Tager-Flusberg and Connie Kasari, is that about 30% of autistic children remain minimally verbal even after years of intervention, and that about 25 to 30% are nonverbal or minimally verbal by the time they enter kindergarten.⁠¹ Exact numbers are unknown partly because studies often exclude children with limited speech.⁠¹⁶

How many autistic children are nonspeaking or minimally verbal, by study
Study	Who	What it found
Tager-Flusberg and Kasari, 2013	A review of research on school-aged children⁠¹	About 25 to 30% nonverbal or minimally verbal by kindergarten; about 30% remain minimally verbal after years of intervention⁠¹
Norrelgen and colleagues, 2015	165 children aged 4 to 6 in a community sample, followed for 2 years⁠¹⁷	15% nonverbal and 10% minimally verbal at follow-up⁠¹⁷
Hughes and colleagues (CDC), 2023	Records of 20,135 autistic 8-year-olds in the US, 2000 to 2016⁠¹⁸	3,085 described as nonverbal or minimally verbal (2,049 plus 1,036 who also had an IQ under 50), about 15% of all⁠¹⁸
Chen and colleagues, 2024	A summary figure from the research literature⁠⁶	About one third of autistic people have considerable difficulty acquiring spoken language⁠⁶

What percentage of autistic people remain nonspeaking?

About 30% is the answer usually given, as a figure for children who remain minimally verbal into the school years.⁠^1,19 It is lower than older estimates that over half of autistic children never acquired speech; the 2013 review attributes the fall to broader diagnostic criteria, earlier diagnosis and better access to early intervention.⁠¹ A CDC study that classified children from their records found a lower share, about 15%.⁠¹⁸

What is profound autism?

A proposed category, not a diagnosis. A Lancet commission defined profound autism as autism with an IQ under 50 or being nonverbal or minimally verbal, and in CDC surveillance data 26.7% of autistic 8-year-olds met that definition.⁠¹⁸ The study calls the definition new and highly debated.⁠¹⁸ Of the 3,085 nonverbal or minimally verbal children in that study, 2,049, about two thirds, met the definition through speech alone, with an IQ above 50, so being nonspeaking and having a profound intellectual disability are different things.⁠¹⁸ Why labels like this are contested is the subject of the guide to functioning labels.⁠¹⁸

Is nonverbal autism permanent?

Often not. Many autistic children who are not speaking at 4 go on to speak, and some begin later still. For others, speech stays limited, and communication grows through other means.⁠^1,2,9 Outcomes vary widely from child to child, which is why researchers urge individualized support for each child’s strengths and needs.⁠⁶

How many children gain phrase speech after age 4?

Most, in the largest study. Wodka and colleagues looked at 535 autistic children aged 8 or older who had not used phrase speech before age 4: 372 (70%) went on to phrase speech and 253 (47%) to fluent speech at or after age 4.⁠² Higher nonverbal IQ and less social impairment predicted speech and earlier speech; repetitive behaviors and sensory interests did not.⁠²

The children came from the Simons Simplex Collection, a US research sample, and had at most a few single words at age 4. Speech was judged from a parent interview and a clinician’s observation, and 70% had reached phrase speech by age 8.⁠²

Can children start speaking after age 5?

Some do. A 2009 review found 167 reported cases of autistic people who began speaking at 5 or older; most were younger children, and no case older than 13 was reported. Its authors concluded that the outlook for late speech may be better than once thought.⁠⁹ In the reported cases, most people who started speaking did so between 5 and 7 and had nonverbal IQs over 50, and about one third progressed to phrase speech.⁠¹⁶

Language development changes most before age 6. A study that followed 192 children referred early for possible autism from age 2 to 19 found wide variation in progress between 2 and 6, and parallel progress across groups after 6, with understanding and expression developing largely together.⁠²⁰

What predicts whether a child gains speech?

Nonverbal thinking skills. Higher nonverbal IQ predicted phrase and fluent speech, and in a preschool study cognitive level was the factor most closely linked to expressive language.⁠^2,17
Social engagement. Less social impairment predicted speech.⁠²
Imitation. The ability to imitate sounds and simple movements is a key predictor of expressive language.⁠¹
Having some words. Preschoolers with even one consistent spoken word seem to have better outcomes than those with none.⁠⁴

These are group findings. They describe odds, not what a particular child can learn.⁠^2,6

Does nonspeaking mean a child does not understand?

No, but it does not mean a child understands everything either. Some minimally verbal children have low receptive and expressive language, and others with very little speech have good receptive language.⁠¹ The honest answer for any one child is that speech alone cannot show what they understand.⁠^1,6

How much do minimally verbal children understand?

It varies widely. In a 2024 study of 1,579 minimally verbal autistic children and teenagers aged 5 to 18, the group as a whole understood more than it could say, but scored well below age norms in understanding, and the gap widened with age. About 25% understood significantly more than they could say.⁠⁶ Better motor skills went with a bigger gap between understanding and speech.⁠⁶

A community study found that every nonverbal or minimally verbal child in its preschool sample had an intellectual disability, while a US study of 257 minimally verbal school-aged children found abilities ranging from profound impairment to average intelligence, with 16% at a nonverbal IQ of 70 or above.⁠^5,17 Intellectual disability and autism frequently co-occur, and when they do, both can be diagnosed.⁠¹³ The guide to intellectual disability explains how it is assessed.⁠¹³

Why is understanding so hard to test?

Because most tests depend on speaking, pointing on request or sitting through a standard procedure. It is extremely challenging to give reliable or valid assessments to minimally verbal children, which is why researchers have turned to eye-tracking and brain imaging that need no spoken response.⁠¹ About half of minimally verbal children in one study had speech well below their nonverbal reasoning, so a test that relies on speech can understate what a child can do.⁠⁵

What is presuming competence?

An approach to deciding what to assume when the evidence is incomplete. In 1984 Anne Donnellan proposed the criterion of the least dangerous assumption: without conclusive data, decisions should rest on the assumption that does the least harm if it turns out to be wrong.⁠²¹ For a nonspeaking child, assuming understanding and teaching accordingly costs little if wrong; assuming none and withholding teaching and communication tools costs a great deal if wrong. ASHA’s position that AAC has no prerequisites applies the same logic.⁠^7,21 Presuming competence does not mean assuming that a message produced with a helper’s physical support is the person’s own.⁠¹²

Why do some autistic children not develop speech?

There is no single reason. The 2013 review concluded that no single underlying mechanism explains why minimally verbal children do not learn to speak, because their cognitive and language profiles vary so much.⁠¹ Speech depends on hearing and processing sound, on understanding and planning language, and on the motor control to produce it, and studies have found differences at each step in some children.⁠^6,19,22

Can motor speech difficulties, such as apraxia, be part of it?

For some children, yes. A 2024 study of 54 low or minimally verbal autistic people aged 4 to 18 found evidence of a motor speech disorder, with reduced intelligibility and less precise consonants and vowels, and interpreted it alongside childhood apraxia of speech and dysarthria; its authors say the results need replicating.⁠²² Motor speech difficulty (apraxia of speech) is worth asking a speech-language pathologist to assess.⁠²²

What does brain research show about hearing and language?

A 2019 study by Roberts and colleagues measured how the brain responds to tones in 105 children aged 8 to 12, 16 of them minimally verbal or nonverbal. The auditory responses of the minimally verbal children were significantly delayed compared with typically developing children, and tended to be more delayed than in speaking autistic children; across groups, longer delays went with weaker language and communication skills.⁠¹⁹ The study was small and does not show cause.⁠¹⁹

What is AAC, and how does it help nonspeaking autistic people?

Augmentative and alternative communication (AAC) is any way of communicating other than speech. It is augmentative when it adds to speech a person has, and alternative when it replaces speech that is absent or not functional.⁠⁷ Many people use more than one form, depending on where they are, who they are with and what they want to say.⁠⁷

What types of AAC are there?

Unaided: manual signs, gestures and finger spelling.⁠⁷
Low-tech aided: objects, line drawings, picture communication boards and letter boards, including the Picture Exchange Communication System (PECS).⁠^1,7
High-tech aided: speech-generating devices and communication apps on tablets or phones, with text-to-speech.⁠⁷

Are there prerequisites for AAC?

No. ASHA’s practice guidance states that there are no prerequisites for AAC intervention and that anyone whose communication does not meet their needs is a candidate; the time and effort involved should not be a reason for exclusion.⁠⁷ It also says that people who use AAC should always have access to their communication tools, and that screen-time worries do not apply to screens used as AAC.⁠⁷

Does AAC stop a child from learning to speak?

No. A 2006 review of AAC and speech in people with developmental disabilities found that none of 27 well-studied cases showed less speech after AAC, 11% showed no change and 89% showed gains, mostly modest.⁠¹⁰ A 2008 systematic review in autistic children found that AAC interventions do not impede speech and that most studies reported an increase in speech, again with gains modest enough that its authors advise keeping expectations measured.⁠³ There is no basis in this evidence for withholding AAC while waiting for speech.⁠^3,7,10

How well does AAC work for autistic children?

Well for the skills it is used to teach, with less certainty about broad, lasting change. A 2012 meta-analysis of 24 single-case studies found large effects of aided AAC on targeted outcomes, larger for communication than other skills, and larger for PECS and speech-generating devices than for other picture systems.⁠²³ A 2018 Cochrane review found only two randomized trials in minimally verbal children: in the PECS trial, children used more spoken initiations and symbols right after the program, but the gains were not maintained 10 months later, and the reviewers rated the evidence very low in quality.⁠²⁴

A 2014 trial with 61 minimally verbal children aged 5 to 8 compared a play-based communication intervention with and without a speech-generating device. Starting with the device produced more spontaneous communication, more new words and more comments, and the authors concluded that minimally verbal school-aged children can make significant and rapid gains in spoken language.⁠¹⁶

What makes AAC work in daily life?

Constant access. The system goes everywhere, not only to therapy.⁠⁷
Modeling. Adults point to symbols on the child’s system while they talk, called augmented input or aided language modeling, which can increase symbol understanding and use.⁠⁷
Everyday routines. Teaching built into the child’s natural environment and activities through the day, not only at therapy time.⁠⁷
Waiting. An expectant look and a pause can be enough to prompt communication.⁠⁷
Literacy. AAC can support reading and writing, which children who use AAC often get less exposure to.⁠⁷

Can AAC be used for more than requesting?

Yes, though research has focused on requesting. AAC is best supported for teaching autistic children to request preferred items and activities, and when language improves in studies, the function taught is nearly always requesting.⁠^1,25 A 2017 systematic review found 30 interventions that targeted other functions, such as commenting, but flaws in many studies limited the certainty of the evidence.⁠²⁵ A system that only lets a child ask for snacks does not give them a way to comment, protest, ask questions or joke, so it is worth asking any professional which communication functions are being taught.⁠^7,25

What about letter boards, spelling to communicate and FC?

Letter boards are a recognized form of AAC when the person uses them independently.⁠^7,12 The concern is with methods in which another person physically supports the typing or prompts each response. ASHA’s 2018 position statements say facilitated communication is a discredited technique that should not be used, and that the Rapid Prompting Method, including letterboarding and Spelling to Communicate, is not recommended because of prompt dependency and the lack of scientific validity.⁠^11,12 A systematic review found unequivocal evidence that messages produced through facilitated communication are authored by the facilitators.⁠²⁶ The RPM statement does not apply to independent typing without instructor influence.⁠¹²

What helps a nonspeaking child day to day?

Treat every way your child communicates, including gestures and sounds, as communication worth answering.⁠⁸
Give time: an expectant pause can be enough to prompt a response.⁠⁷
Keep the AAC system within reach at all times, and use it yourself as you talk.⁠⁷
Assume understanding when unsure, the least dangerous assumption.⁠²¹
Build communication into everyday routines and interests rather than separate drills.⁠⁷
Ask for literacy teaching with AAC supports, not only symbols.⁠⁷

What should an AAC assessment and school plan include?

ASHA’s guidance gives a speech-language pathologist a wide brief, including the person’s current communication, vision, motor skills, means of access to a system and goals.⁠⁷ Questions worth asking:

How was my child’s understanding assessed, given that standard tests can understate it?⁠^1,5
Has a motor speech difficulty such as apraxia been considered?⁠²²
Which AAC options were tried, and how does my child access them (touch, pointing, eye gaze or scanning)?⁠⁷
Which communication functions beyond requesting are being taught?⁠²⁵
Are speech, language, literacy and AAC goals written into the IEP, and is the system available all day?⁠⁷

The guide to speech therapy explains what a speech-language pathologist does and how to find one.⁠⁷

Where does sensory processing fit in nonspeaking autism?

Sensory differences are part of autism itself: the DSM-5 criteria include hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.⁠¹³ In a large study of children without phrase speech at 4, sensory interests did not predict whether speech came later.⁠² Sensory needs still matter for communication: ASHA lists the integrated sensory system, the ability to regulate and ready the body for communication, among the things an AAC assessment covers.⁠⁷ See sensory processing and autism and sensory processing differences.⁠¹³

Frequently Asked Questions

When should we start AAC?

As soon as a child’s communication does not meet their needs. ASHA says there are no prerequisites for AAC, and reviews find it does not reduce speech, so there is no reason to wait for speech first.⁠^3,7

What does nonspeaking autism mean?

An autistic person who uses no or very few spoken words. It describes speech, not understanding or intelligence, and research usually calls it minimally verbal. About 25 to 30% of autistic children are minimally verbal by kindergarten.⁠^1,4

Will AAC stop my child from talking?

No. Reviews of AAC and speech found no cases of reduced speech, and most studies reported modest gains in speech alongside AAC.⁠^3,10

Does nonspeaking mean intellectually disabled?

Not necessarily. Many minimally verbal children do have an intellectual disability, but abilities range up to average intelligence, and standard tests can understate what a nonspeaking child can do.⁠^1,5,17

Is 'nonverbal' or 'nonspeaking' the right term?

Both are used. Research mostly says minimally verbal or nonverbal; writing by and with autistic self-advocates says nonspeaking or minimally speaking, since verbal can mean using words in any form, not only speech. Follow the person’s own preference.⁠^4,8,14

Can nonspeaking autistic children learn to speak?

Many can. In a study of 535 children without phrase speech at age 4, 70% gained phrase speech and 47% fluent speech later. Some children stay minimally verbal and communicate in other ways.⁠^1,2

Will using AAC stop my child from learning to speak?

The evidence points the other way: AAC interventions do not impede speech, and most studies report an increase, although the gains are modest.⁠^3,10

What's the difference between nonspeaking and selective mutism?

A child with selective mutism can talk but does not in certain places or with certain people, often because of anxiety, and the silence is not explained by autism or another condition. Minimally verbal describes how much spoken language a child uses at all. See selective mutism.⁠^4,27

Can a nonspeaking autistic person learn to read and write?

Many can, and AAC can support literacy. Children who use AAC often get less exposure to reading and writing, so ASHA recommends literacy teaching adapted to AAC, such as shared reading and letter boards or keyboards.⁠⁷

Does an iPad count as AAC?

Yes. Tablets and phones running communication apps are high-tech AAC, and ASHA says screen-time concerns do not apply to screens used as part of an AAC system.⁠⁷

Is nonspeaking autism the same as profound autism?

No. Profound autism is a proposed category that includes being nonverbal or minimally verbal or having an IQ under 50. In CDC records, two thirds of the nonverbal or minimally verbal children did not have an IQ under 50 recorded.⁠¹⁸

Is facilitated communication the same as AAC?

No. In facilitated communication another person physically supports the typing, and research shows the facilitator authors the messages. ASHA says it should not be used.⁠^11,26

Is apraxia the reason some autistic children do not speak?

For some, possibly. A 2024 study found signs of a motor speech disorder in low and minimally verbal autistic children and teenagers, but no single cause explains every case.⁠^1,22

Should therapy focus on getting my child to speak?

Communication comes first. The best trials are few: one found faster gains in spoken language when therapy included a speech-generating device from the start, and a Cochrane review rated the evidence very low.⁠^16,24

Sources

Tager-Flusberg H, Kasari C. Minimally verbal school-aged children with autism spectrum disorder: the neglected end of the spectrum. Autism Research. 2013;6(6):468-478. PMID 24124067. Checked October 11, 2026.
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“It is currently estimated that about 30% of children with autism spectrum disorder remain minimally verbal, even after receiving years of interventions”; “while most preschool aged children with ASD are preverbal” and eventually speak, about 25 to 30% “will be nonverbal, or only minimally verbal by the time they enter Kindergarten”. “while some minimally verbal school aged children have low receptive and expressive language skills, other children with minimal expressive language scores have good receptive language abilities”; “no single underlying mechanism will explain why these children do not” learn to speak; “it is extremely challenging to provide reliable or valid assessments of their developmental functioning”. “The ability to imitate sounds and simple movements is one key predictor of expressive language”. On AAC: “PECS does not appear to inhibit the development of spoken language”; “when language is targeted or is reported to improve, the language function is nearly always limited to requesting”; “AAC systems encompass any non-speech means for expressive and receptive communication including sign language, visual systems, and speech generating devices”. “Older statistics suggest that over half of all children with autism failed to acquire spoken language”; the figure is now “around 30%, in part because of the broadening of diagnostic criteria”, earlier diagnoses and “greater access to more effective early interventions”; “eye-tracking and brain imaging methods that do not require overt responses”.
Wodka EL, Mathy P, Kalb L. Predictors of phrase and fluent speech in children with autism and severe language delay. Pediatrics. 2013;131(4):e1128-e1134. PMID 23460690. Checked October 11, 2026.
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“535 children with ASD who were at least 8 years of age ... and who did not acquire phrase speech before age 4”. “A total of 372 children (70%) attained phrase speech and 253 children (47%) attained fluent speech at or after age 4.” “higher nonverbal IQ and less social impairment were both independently associated with the acquisition of phrase and fluent speech”; “Stereotyped behavior/repetitive interests and sensory interests were not associated with delayed speech acquisition.” Children came from the Simons Simplex Collection (SSC), with phrase speech judged by the ADI-R and “clinician observation via the ADOS”; “attainment of phrase and/or fluent speech was achieved by the majority (70%) of participants by age 8 years”; severe language delay meant “having only few single words at most” at age 4.
Schlosser RW, Wendt O. Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review. American Journal of Speech-Language Pathology. 2008;17(3):212-230. PMID 18663107. Checked October 11, 2026.
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“Results indicated that AAC interventions do not impede speech production. In fact, most studies reported an increase in speech production. However, in-depth analyses revealed that the gains were rather modest.” “the modest gains observed require realistic expectations among clinicians and other stakeholders.”
Koegel LK, Bryan KM, Su PL, Vaidya M, Camarata S. Definitions of nonverbal and minimally verbal in research for autism: a systematic review of the literature. Journal of Autism and Developmental Disorders. 2020;50(8):2957-2972. PMID 32056115. Checked October 11, 2026.
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“we found large inconsistencies in measures used, definitions of ‘nonverbal’ and ‘minimally verbal’, and ages targeted”; “nearly all toddlers younger than about 18 months of age are NV or MV”; “the apparent presence of cognitive impairment or lack of responsiveness during standardized testing precludes many NV children from being included in some research studies”; “preschoolers with even one consistent expressive verbal word seem to have better outcomes than those with no expressive words”.
Bal VH, Katz T, Bishop SL, Krasileva K. Understanding definitions of minimally verbal across instruments: evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry. 2016;57(12):1424-1433. PMID 27473432. Checked October 11, 2026.
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“Minimally verbal (MV) children with autism spectrum disorder (ASD) are often assumed to be profoundly cognitively impaired”. Of 1,470 school-aged children, “257 children were classified as MV on at least one instrument. Proportion of overlap between definitions ranged from 3% to 100%.” “Cognitive abilities ranged from profoundly impaired to average intelligence; 16% had NVIQ” of 70 or more; “Approximately half exhibited verbal skills commensurate with nonverbal cognitive ability, whereas half had verbal abilities significantly lower than their estimated NVIQ.”
Chen Y, Siles B, Tager-Flusberg H. Receptive language and receptive-expressive discrepancy in minimally verbal autistic children and adolescents. Autism Research. 2024;17(2):381-394. PMID 38149732. Checked October 11, 2026.
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1579 minimally verbal autistic children and adolescents aged 5 to 18: “MV autistic children and adolescents demonstrated significantly lower receptive language compared to the norms”; “their receptive language gap widened with age”; “only about 25% of MV autistic children and adolescents demonstrated significantly better receptive language relative to their minimal expressive levels”; “motor skills were the most significant predictor of greater receptive-expressive discrepancy”; “the approximately one-third of autistic individuals who experience considerable challenges in acquiring spoken language”.
American Speech-Language-Hearing Association. Augmentative and Alternative Communication (AAC). ASHA Practice Portal. Checked October 11, 2026.
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AAC includes “manual signs”, “gestures”, “picture communication boards and letter boards” and “speech-generating devices”; it is augmentative when it adds to existing speech, and “alternative when used in place of speech that is absent or not functional”. “There are no prerequisites for AAC intervention”; “All individuals are considered candidates for AAC intervention if their communication abilities do not meet communication needs.” “People who use AAC should always have access to their communication tools or devices. Concerns about the overuse of screen time, particularly for young children, do not apply to the use of screens as part of an AAC system.” Augmented input, “the communication partner provides spoken words along with AAC symbols”, “can lead to increased symbol comprehension”. Milieu methods are “integrated into a child’s natural environment”; “an expectant look and a time delay might be sufficient to prompt language use”. “AAC may also serve as a tool to aid in expressive and receptive language acquisition and literacy development”; “Children who use AAC often receive less exposure to language and literacy”; literacy supports include “access to letter boards or adaptive keyboards via direct or indirect selection”. Assessment covers “means of access to the AAC system (positioning, fine motor, gross motor)”; in schools, “Collaboratively write and implement goals related to speech, language, literacy, participation, and use of AAC as part of the individualized education program (IEP) team.”
Lebenhagen C. Including speaking and nonspeaking autistic voice in research. Autism in Adulthood. 2020;2(2):128-131. PMID 36601567. Checked October 11, 2026.
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“Ethical listening happens when a person pays attention to all of the ways someone is communicating, including both speaking and nonspeaking forms of language. For example, they pay attention to a person’s gestures and nonspeech sounds.” “Autistic self-advocates challenge researchers to make sure that they consider the authentic experiences and diverse perspectives of non- and minimally speaking autistic individuals.”
Pickett E, Pullara O, O'Grady J, Gordon B. Speech acquisition in older nonverbal individuals with autism: a review of features, methods, and prognosis. Cognitive and Behavioral Neurology. 2009;22(1):1-21. PMID 19372766. Checked October 11, 2026.
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“The search identified a total of 167 individuals with autism who reportedly acquired speech at age 5 or older. Most of the cases of reported late speech development occurred in the younger age groups; no case older than 13 was reported.” “the prognosis for late development of speech in such individuals may now be better than was historically thought to be the case.”
Millar DC, Light JC, Schlosser RW. The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review. Journal of Speech, Language, and Hearing Research. 2006;49(2):248-264. PMID 16671842. Checked October 11, 2026.
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“The review identified 23 studies, involving 67 individuals.” In the 27 best-evidence cases: “None of the 27 cases demonstrated decreases in speech production as a result of AAC intervention, 11% showed no change, and the majority (89%) demonstrated gains in speech. For the most part, the gains observed were modest”.
American Speech-Language-Hearing Association. Facilitated Communication (FC). Position statement, 2018. “Facilitated Communication (FC) is a discredited technique that should not be used. There is no scientific evidence of the validity of FC, and there is extensive scientific evidence ... that messages are authored by the ‘facilitator’ rather than the person with a disability.” Checked October 11, 2026.
American Speech-Language-Hearing Association. Rapid Prompting Method (RPM). Position statement, 2018. Checked October 11, 2026.
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“It is the position of the American Speech-Language-Hearing Association (ASHA) that use of the Rapid Prompting Method (RPM) is not recommended because of prompt dependency and the lack of scientific validity. Furthermore, information obtained through the use of RPM should not be assumed to be the communication of the person with a disability.” It applies to “‘letterboarding,’ and ‘Spelling to Communicate,’” and “does not pertain to independent typing without instructor influence.”
Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Autism Spectrum Disorder. CDC. The DSM-5 criteria as reproduced: “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment”; specify “With or without accompanying language impairment”; “Intellectual disability and autism spectrum disorder frequently co-occur”. Checked October 11, 2026.
Merriam-Webster. Verbal. Merriam-Webster Dictionary. Sense 1a: “of, relating to, or consisting of words”; sense 3: “spoken rather than written”. Checked October 11, 2026.
Bottema-Beutel K, Zisk AH, Zimmerman J, Yu B. Conceptualizing and describing autistic language: moving on from ‘verbal’, ‘minimally verbal’ and ‘nonverbal’. Autism. 2025;29(6):1367-1373 (online April 12, 2025). PMID 40219738. A commentary; the index record carries no abstract, and the title states its argument. Checked October 11, 2026.
Kasari C, Kaiser A, Goods K, Nietfeld J, Mathy P, Landa R, Murphy S, Almirall D. Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2014;53(6):635-646. PMID 24839882. Checked October 11, 2026.
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Approximately 25 to 30% of children with ASD “remain minimally verbal, even after years of intervention”. A review “reported on 167 individuals who started speaking after age 5. The majority of individuals who acquired spoken language did so between 5 and 7 years of age and had nonverbal IQs over 50”; “Only one third who began to use spoken language progressed to phrase speech.” In the trial, 61 minimally verbal children aged 5 to 8: “improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD”; “Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language”.
Norrelgen F, Fernell E, Eriksson M, Hedvall A, Persson C, Sjolin M, Gillberg C, Kjellmer L. Children with autism spectrum disorders who do not develop phrase speech in the preschool years. Autism. 2015;19(8):934-943. PMID 25488002. Checked October 11, 2026.
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A community sample of 165 children aged 4 to 6, followed for 2 years: “The proportion of children who met the criteria for nonverbal, minimally verbal, and phrase speech were 15%, 10%, and 75%, respectively. The single most important factor linked to expressive language was the child’s cognitive level, and all children classified as being nonverbal or minimally verbal had intellectual disability.”
Hughes MM, Shaw KA, DiRienzo M, Durkin MS, Esler A, Hall-Lande J, Wiggins L, Zahorodny W, Singer A, Maenner MJ. The prevalence and characteristics of children with profound autism, 15 sites, United States, 2000-2016. Public Health Reports. 2023;138(6):971-980. PMID 37074176. Checked October 11, 2026.
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Records of 20,135 children aged 8 with autism: “Children were classified as having profound autism if they were nonverbal, were minimally verbal, or had an intelligence quotient <50.” “The percentage of 8-year-old children with profound autism among those with autism was 26.7%.” Of those, “42.7% had met only the IQ score <50 criterion and 38.1% met only the nonverbal/minimally verbal criterion; 19.3% met both criteria” (2049 and 1036 children). The definition is “new and highly debated”.
Roberts TPL, Matsuzaki J, Blaskey L, Bloy L, Edgar JC, Kim M, Ku M, Kuschner ES, Embick D. Delayed M50/M100 evoked response component latency in minimally verbal/nonverbal children who have autism spectrum disorder. Molecular Autism. 2019;10:34. PMID 31428297. Checked October 11, 2026.
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105 children aged 8 to 12, 16 of them minimally verbal or nonverbal: “ASD-MVNV children showed significantly delayed M50 and M100 latencies compared to TD. These delays tended to be greater than the corresponding delays in verbal children with ASD. Across cohorts, delayed latencies were associated with language and communication skills”; “Recent estimates indicate that 25 to 30% of children on the autism spectrum are unable to use verbal language to communicate or are minimally verbal”.
Pickles A, Anderson DK, Lord C. Heterogeneity and plasticity in the development of language: a 17-year follow-up of children referred early for possible autism. Journal of Child Psychology and Psychiatry. 2014;55(12):1354-1362. PMID 24889883. Checked October 11, 2026.
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192 children followed from age 2 to 19: “Between age 6 and 19, all classes tracked in parallel. Between ages 2 and 6, development was more heterogeneous with considerable variation in relative progress. In all groups, receptive and expressive language developed very largely in tandem.”
Donnellan AM. The criterion of the least dangerous assumption. Behavioral Disorders. 1984;9(2):141-150. doi:10.1177/019874298400900201. Checked October 11, 2026.
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“The criterion of the least dangerous assumption holds that in the absence of conclusive data educational decisions ought to be based on assumptions which, if incorrect, will have the least dangerous effect on the likelihood that students will be able to function independently as adults.”
Maffei MF, Chenausky KV, Haenssler A, Abbiati C, Tager-Flusberg H, Green JR. Exploring motor speech disorders in low and minimally verbal autistic individuals: an auditory-perceptual analysis. American Journal of Speech-Language Pathology. 2024;33(3):1485-1503. PMID 38512040. Checked October 11, 2026.
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Fifty-four low or minimally verbal autistic individuals aged 4 to 18: “Our findings provide evidence of a motor speech disorder in this population, characterized by perceptual speech features including reduced intelligibility, decreased consonant and vowel precision, and impairments of speech coordination and consistency.” “Oromotor deficits were significantly associated with expressive and receptive language skills.” “These results, if replicated in future studies”.
Ganz JB, Earles-Vollrath TL, Heath AK, Parker RI, Rispoli MJ, Duran JB. A meta-analysis of single case research studies on aided augmentative and alternative communication systems with individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders. 2012;42(1):60-74. PMID 21380612. Checked October 11, 2026.
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“Twenty-four single-case studies were analyzed”. “Results indicated that, overall, aided AAC interventions had large effects on targeted behavioral outcomes in individuals with ASD.” “effects were greater for communication skills than other categories of skills. Effects of the Picture Exchange Communication System and speech-generating devices were larger than those for other picture-based systems”.
Brignell A, Chenausky KV, Song H, Zhu J, Suo C, Morgan AT. Communication interventions for autism spectrum disorder in minimally verbal children. Cochrane Database of Systematic Reviews. 2018;11:CD012324. PMID 30395694. Checked October 11, 2026.
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“This review includes two RCTs (154 children aged 32 months to 11 years)”. “The PECS study found that children enrolled in the AAC intervention were significantly more likely to use verbal initiations and PECS symbols immediately postintervention; however, gains were not maintained 10 months later.” “There is limited evidence that verbally based and ACC interventions improve spoken and non-verbal communication in minimally verbal children with ASD”; “we considered the overall quality of the evidence to be very low”.
Logan K, Iacono T, Trembath D. A systematic review of research into aided AAC to increase social-communication functions in children with autism spectrum disorder. Augmentative and Alternative Communication. 2017;33(1):51-64. PMID 28040991. Checked October 11, 2026.
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AAC interventions “have been shown to be effective in supporting children with autism spectrum disorder (ASD) to communicate, particularly to request preferred items and activities”. “A systematic search and application of inclusion criteria yielded 30 interventions that focused on communication functions beyond object requests. In many of the studies, flaws detracted from the certainty of evidence”.
Schlosser RW, Balandin S, Hemsley B, Iacono T, Probst P, von Tetzchner S. Facilitated communication and authorship: a systematic review. Augmentative and Alternative Communication. 2014;30(4):359-368. PMID 25384895. “Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities.” Checked October 11, 2026.
Communication Health Support Association. Selective Mutism. Checked October 11, 2026.
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CHSA (ASHA’s former public page on selective mutism redirects here). “Children with selective mutism can talk, but they don’t talk in certain places or around certain people.” “Your child’s silence is not due to autism, stuttering, not knowing the language used, or other conditions.” “it’s often linked to anxiety or social anxiety”.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. If your child has lost skills they previously had, contact their doctor promptly.

Nonspeaking Autism: Communication and Support

Key takeaways