Reflecting on Autism and communication diversity

Over the course of my lifetime, I have noticed a huge shift in the way we understand and conceptualise the autism spectrum. When I was formally diagnosed as Autistic, it was during the days of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). I was classified as "high functioning" (whatever that means). As Rebecca Burgess illustrates beautifully in their comic titled “Understanding the Spectrum”, Autism used to be viewed as a linear scale based on perceived severity.

Similarly, the communication profiles of Autistic people have traditionally been characterised as either “nonverbal” or “verbal”. The perspectives of Autistic advocates with a range of communication access requirements have shown that, in fact, Autistic communication styles are more diverse than was once thought.

Multimodal communication refers to the way we interact, express ourselves, and understand others. We all use various forms and combinations of multimodal communication every day. For example, I am using written communication to share my reflections with you in this article. It can also include gestures, facial expressions, and body movement. Some people may need additional multimodal or adaptive communication methods to meet their daily communication needs. This is often referred to as “Augmentative and Alternative Communication (AAC)”. I prefer to adopt the term “Augmentative and Adaptive Communication”, which I first heard from Autistic advocate and AAC user Tiffany Joseph. Forms of AAC include speech-generating devices (SGDs), manual communication boards, and Key Word Sign (KWS).

Multimodal communication and AAC supports are commonly implemented for individuals who are unable to use oral speech as their primary method of communication. This may include nonspeaking or minimally speaking people. This is also reflected in most of the existing research, which tends to focus on individuals who use six or fewer spoken words.

My own understanding of communication styles shifted dramatically when I came across a wonderful article written by Alyssa Hillary Zisk, an Autistic researcher, advocate, and AAC user, and Elizabeth Dalton in 2019. In this article, they discussed that within the speaking Autistic community, there is a huge diversity of communication styles, strategies, and methods employed. Until reading this article, I had not realised that I too used multimodal forms of communication when oral speech simply was not accessible or sufficient to explain myself to other people.

In the article, three communication styles discussed were:

• Intermittent speech: Oral speech may not always be accessible due to factors such as stress, sensory overwhelm, and the impact of co-occurring neurotypes, disabilities, and/or medical conditions.

• Unreliable speech: What is said using oral speech may not match the person's intended meaning or preferences.

• Insufficient speech: Oral speech may not be enough on its own to express everything required for daily communication. Certain topics of conversation may be more challenging than others. 

In addition, Endever Corbin, an Autistic AAC user, has used the term 'expensive speech' to describe how exhausting using oral speech can be to communicate, even if it is technically possible or effective for some Autistic people. Endever discussed how the effort and energy required to use oral speech means there is an increased cognitive load and a reduced capacity to learn new skills, interact with other people, maintain attention, and to self-advocate (corbin, 2025). Endever also explained how difficult it was to have the opportunity to trial multimodal communication methods. This experience was also commonly reported by other Autistic adults in an article by Donaldson and colleagues in 2021.

This really hit home for me. There may be a lot of Autistic people in our lives who are facing invisible struggles, who may be appearing to communicate effectively but at a huge cost. It made me think about the times, as a Speech Pathologist, I have been asked, "Why can X talk to me at home but cannot talk to other people?" or questioning why a communication device was required, despite being able to use oral speech some of the time. This really reflects the dynamic nature of being Autistic and Disabled, and why at times it may seem contradictory from an outsider's perspective.

My key takeaways:

• Oral speech is one form of communication, but it is by no means the only valid mode of communication.

• Candidacy and prescription of multimodal communication and AAC supports should not be based on the degree of oral speech the person has.

• Autistic people should be involved in all decisions made about communication supports and should be offered the opportunity to trial assistive and adaptive methods. 

• When considering multimodal communication and AAC, it is not a one-size-fits-all. Access can be impacted by a variety of factors, which may influence what strategies work when and with whom.

• Nothing about us without us. I encourage you to follow Autistic non-speaking, minimally speaking, and AAC users to learn more about this topic. I have personally found it incredibly helpful and insightful to follow other members of our Autistic community.

A non-exhaustive list of resources and additional readings:

• Endever Corbin: https://anotherqueerautistic.wordpress.com/

• Alyssa Hillary Zisk: https://yesthattoo.blogspot.com/

• CommunicationFirst: https://communicationfirst.org/

• Tiffany Joseph (Nigh Functioning Autism): https://tiffanydjoseph.substack.com/

• Maxfield Sparrow (Unstrange Mind): https://unstrangemind.com/

 References

corbin, endever. (2025). Speech is exhausting. Augmentative and Alternative Communication, 41(3), 245–247. https://doi.org/10.1080/07434618.2025.2513907

Donaldson, A. L., corbin, endever, & McCoy, J. (2021). “Everyone Deserves AAC”: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Communication. Perspectives of the ASHA Special Interest Groups, 6(2), 315–326. https://doi.org/10.1044/2021_PERSP-20-00220

Gray, J.D. (Host). (2023, January 18). Why Some Autistic People Choose AAC and Oral Speech [Audio podcast episode]. In ASHA Voices. American Speech-Language-Hearing Association [ASHA]. https://leader.pubs.asha.org/do/10.1044/2023-0119-transvoices-autism-AAC-choice

Zisk, A. H., & Dalton, E. (2019). Augmentative and alternative communication for speaking Autistic adults: overview and recommendations. Autism in Adulthood, 1(2), 93–100. https://doi.org/10.1089/aut.2018.0007