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How Autism Affects Speech, Language and Eating

With so much information out there in recent years about autism I thought it would be beneficial to get back to the basics.

Much of the information in today’s news usually relates to causes, treatments, and statistics.  I want to talk more about how autism affects speech and language and often eating in individuals who have an autism spectrum disorder.

While many of you reading this article are dealing with autism first hand, many of you are not and only know what you have read.

Autism and Language Skills
First let’s talk about language.  Language can be divided into 2 main parts: expressive and receptive.

Expressive language is our ability to convey our thoughts into words with meaning. Basically our ability to talk.  Receptive language is our understanding of what is being said to us.  Both expressive and receptive language skills are necessary to be an effective communicator.  When either is impaired our ability to communicate is impacted.  Children on the autism spectrum will always have some sort of a language deficit depending on their actual diagnosis.

Very often expressive language is impacted to a greater degree than receptive language.  This is the reason why augmentative communication with these children is so important. Augmentative communication is another means of communication which can involve pictures, picture boards or talking computers (communication devices).

One exception to this is found in children with Aspergers.

These children will usually have advanced language skills both expressive and receptive; however their pragmatic language skills are impacted to a degree which makes understanding the world around them difficult.

Pragmatic Language and Autism
All children on the autistic spectrum will have deficits in pragmatic language to some degree.

Pragmatic language refers to the social use of language.  The ability to use the language skills you have to interact with the world around you.

These deficits may be subtle to an outside observer but can be profound to a child experiencing them.

Social skills deficits are very complex and they are usually mistreated and misunderstood.  They are also a very emotional issue to all involved.

Imagine spending years watching your child struggle to learn to communicate and once he does you realize he still can’t use these skills to make friends.

Autism and Speech Skills
Another area that is not part of autism but quite often coexists is speech disorders.

Childhood Apraxia of Speech is a severe motor speech disorder that is believed by some to occur in higher percentage of children on the autistic spectrum than in the general population.  This speech disorder makes it even more difficult for these children to learn to communicate.  Therapy for a severe speech disorder should be intensive and is often not very exciting.

This being said children on the autism spectrum who have other behavioral challenges will have a harder time making progress than a child who does not have an autism spectrum disorder.  Minor articulation errors such as lisps will often get overlooked as they are not priorities when looking at the child as a whole.

Autism and Eating
Eating is another area that is very often impacted with a child on the autistic spectrum.

While it is not a speech or language issue it is often treated by a speech language pathologist. It is one of my areas of specialty; so, I thought I would discuss it as well.

Children on the autistic spectrum often fall into the category of resistant or problem eaters.

The most important distinction between a picky eater and a resistant eater is severity.  A child who is a resistant eater could put his life at risk by refusing to eat or drink when pushed in the wrong direction by well meaning parents or uninformed therapists.

There is a lot of information out there on picky eating and you will rarely read anything about a child starving himself if not treated properly.  This is putting children’s lives at risk.  While a typically developing child may not starve himself, a resistant eater might.

The Central Concern of Autism
If you are a parent of a child with autism or a professional working with these children I am sure you realize the importance of getting the right and the best speech language pathologist you can find.

While these children definitely have other significant issues that need to be addressed by other experts, we can all agree that communication is the central concern in autism spectrum disorders.

I have worked with hundreds of children on the autistic spectrum over the years and as a whole they are the most challenging to work with but in turn are the most rewarding.

About the author: Isa Marrs is a board-certified speech-language pathologist who specializes in articulation, pragmatic language and feeding disorders in children. She is an expert in the field who is frequently sought after by institutions and therapists to provide training for working with these and other disorders. Isa also served as a guest expert on Nickelodeon’s ParentsConnect.com, and has been quoted by numerous top media such as Disney’s BabyZone.com, LoveToKnow.com, and Univision. She can be reached at 914.488.5282

  • Sylvia

    My Grandson is 20 months and I noticed a new behaivor…..He likes to run in circles, around the furniture or big toys, and I tell him not to do that, and I simply can’t reach him, like he is kind of hypnotized…….he likes books sometimes. or plays with blocks putting them in order, like triangles,circles,stars and others…….sometimes he eats great, but sometimes just picks…..he eats meats, cheese, cereal like cherioous by hand, he loves avocados, tomatoes, bananas and lot of different berries……he points a lot of what he wants but does not talk except mom,dada…….It worries me that he might be autistic…….thank you for helping……… sylvia

  • Lisa

    Hi! How would you differentiate a 6 year old typical child’s language compared to a 6 year old child with autism?

  • Mariya

    My 28 month girl is not speaking. she hardly vebalises. all she says is ba.she points to things she wants.Her sound seems to be too harsh as if coming from throat?it is hard to make her eat. she cant sip water from a straw,sometimes she chokes on foods. we have to place the food back in the mouth otherwise everything comes out. she still drools a lot. She walked around 16 months, sometimes i see her doing tippy toes.it is hard to get her to sleep at night, frequently wakes up and wants to hug and sleep throughout the night . I had gestational diabetes on insulin at pregnancy.she was a low birth weight 2.2 kg.
    I am concerned if this is autism?does tongue tie cause problems like this?can you advice as how should i go about?

  • cheryl

    My 3 and a half year old grandson has been tested for autism. The doctor says he does have it but waiting on the results. After reading the above comments he does a lot of what’s been posted. He only eats bread waffles cereal bananas strawberrys fries…mostly all starch..he will not eat any kind of meat..he loves cartoons and can sing to them but he can only say few words..but if you ask him to say something he will repeat you…he’s very active..he plays usually by himself. .he can’t carry on a conversation..but he learns fast like playing on my cell phone..I’m just praying when results come back that its a mild case and reverseable. Does anyone know what type it sounds like he has?

  • http://www.speechlanguagefeeding.com/autism-affects-speech-language-eating/#respond Nabeela

    Hi, My dayghter will be 4 on oct 20 2013. She have been receiving speech therapy for more than a year now. Although she knows many words and rhymes and repeats them, she does not communicate with any body elase. Not even me ( her mom). I am really worried. The teacher said she is improving at school from where she started. She is s good eater and eats healthy. She screams loud and laugh sometime for no specific reason. She have also been diagnosed with a lot of ear fluid. Is she autistic? please help me out. I am very concerned. Thanks.

  • Margaret

    Hello – I had a hunch that my grandson had some form of autism very early around 18 mos. He always needed a background noise, focused only on one thing, didn’t respond to his name being called .In other ways he adores classical music, did well 1:1 and could read by 18 mos. We would ask him a word and he would point to it with other words around or make us stop on the word flash card. I never knew that food was a symptom of autism. H only eats foods that look bland, chicken nuggets, french fries, milk,apple slices (no peel), pancakes, bananas etc. I too worry about his diet. He’s 6 now and still only eats these foods. He never really ate baby food. He went from bottle to table food. Of course I tried all the usuals, sweet potatoes, peas, green beans but he wouldn’t eat any of it. It all makes sense now.

  • Hayley warburton

    Hi my son is 2 and has been referred to a specialist as possibly on the autistic spectrum( he has an older sister 6 , who has asd) he is also dairy intolerant so lives off a child soya milk , he will occasionally eat a bite of sausage, salty crisps or pretzels, or mashed potato with carrots and plenty gravy( only if his siblings also eating this) he mostly survives off the. Milk , although his weight is only just below average for his age oferl it should be higher as he was (10lb) when he was born, also over the last few weeks his energy levels seemed to have dropped ( we used to xall hom the duracell bunny!) although still very active is allowing us to put him in his buggy for a rest or is just lying down on the floor Ian worried he is not getting enough calories in the day he does tale a vitamin drop

  • Jo

    Dear Isa,
    I really hope you can offer some help! Our eldest Daughter is 2 years old, speech delayed, a picky eater (at best – she eats porridge & prunes for breakfast, toast/banana & milk mid-morning, cheese sandwich at lunch, biscuit mid afternoon & maybe toast & fromage frais if we’re lucky for dinner – only this everyday, refuses to feed herself mostly & has to ‘taste’ every food – even though she has it everyday, as if we’re trying to trick her), suffers meltdowns/tantrums on a regular basis, doesn’t give much eye contact, stares into space a lot & screams & shakes if we try to bath her (although she likes swimming!). I am going out of my mind with worry as we have been told by our developmental paediatrician to wait and see how she develops before we can find a diagnosis when she’s around 30 months old. But I know this means we will be losing a small window of opportunity to help our Daughter’s symptoms. We live in the UK & are getting more & more frustrated everyday with a total lack of guidance or direction. We receive 30 mins of speech & language therapy per week (this started 1 month ago after starting the process of requesting help 7 months ago) & having found your website I feel finally someone understands the problems we’re facing – we’re just separated by a few thousand miles! Please please can I ask you what you think is a minimum of what we should be asking/doing for our Daughter (I understand you haven’t met her but I feel the US is so much more progressive than the UK in treating the above symptoms I’ve described). Thanks in advance, Jo

  • mo

    I’m not sure if anyone still gets on here. My child is 2. She was evaluated for autism in february and they said she has anxiety disorder and sensory issues. She goes to o.t. once a week and the therapist thinks I should have her evaluated again. She only eats a handful of smooth foods. She finally had a feeding evaluation and they also think she should be evaluated again. They suggested aspergers,a psychological problem or she’s a genius. She says ten word sentences and has an amazing memory. While I am waiting for the appointment for the second autism evaluation I just wanted to know if its possible that if she has aspergers they could have missed it on february? She makes normal eye contact and seems fine to me just quirky and doesn’t eat much. Thank you

  • Carol K

    Dear Isa,
    I am the grandmother of a beautiful 25 month old grandson. He is still eating baby food. If we try to give him solid food, he gags and vomits. He drinks soy mild and juice. He had several ear infections and now has tubes in his ears. We were told he hears high tones and low tones. He babbles,laughs,is very verbal, but has not spoken one word. We live in Boston and we were told to see a developmental physician. Every hospital had a 10 to 12 month waiting list! I finally demanded my grandson be seen and we have an appt July 19th at Boston Medical. We also have Early Intervention come to the house but I fear he has more serious issues. I’m wondering if all this is related to his hearing impairment, or autism. He is very lovable with family, but does not make eye contact with others. Any advice?

  • kelly drysdale

    hi there my 6yr old sons speech is really slow he finds it hard to explain things and find the right sentence hes very emotional with alot of things and when u try to ask him something he just bursts out crying im starting to get concerned with this.he does so well at school work at school and when hes home he gets so distracted when i talk to him he seems to stare into space as if its not registering right could this all be signs of some autism? it would be great to have your opinion on this.

  • Tasha

    My 2 year old son was diagnosed with PDD-NOS. He only eats dry cereal and drinks milk and water. On certain days, he will only want to drink milk. He wakes up in the middle of the night crying because he is so hungry. We took the doctor’s advice and did not give him milk in the hopes that he will be so hungry he will eat other foods. That day, he starved the whole day and was crying due to hunger. He is currently getting ABA, OT, and Speech. They are supposed to be focusing on his eating; however, he has not improved. His eating habit is getting worse. Providing him rewards does not work either. I am not sure if it is because he does not understand or he is just refusing to eat. Is there a way or a special method to get him to eat something else that will fill his stomach? Thank you in advance.

  • Isa Marrs

    In a young child with Autism it would be extremely difficult to address these sounds. It would be impossible for me to give you tips without learning more about this child. My suggestion would be to have them see an SLP in their area.

  • Isa Marrs

    It is great to hear that your son has made progress with his eating. He will probably always have a somewhat limited diet however if he keeps improving that is all you could ask for. Because of his diagnosis it is recommended to continue to work on speech and language as well as feeding. I would discuss with your therapist her ability to address both needs.

  • Isa Marrs

    I definitely recommend both Speech Language Therapy and Occupational Therapy with a diagnosis of Autism. It is expected that your son would be delayed with potty training as it often goes along with language development. An ABA therapist could work with you on these skills in your home.

  • Isa Marrs

    Can you get an outside private evaluation for a second opinion?

  • Isa Marrs

    There is no question that most children these days watch too much TV. If there is any question that a child might be on the Autistic Spectrum I always say that they should watch as little TV as possible. Time interacting with real people in the real world is invaluable.

  • Isa Marrs

    Without meeting your son I can’t give you my opinion. I am happy to hear that you will be taking him for a developmental evaluation. Please keep in touch.

  • Isa Marrs

    Have you had him evaluated? It seems from your post that he definitely need speech and language therapy. Where do you live?

  • Isa Marrs

    Kat F,
    Without seeing your son I cannot give my opinion regarding Autism. However I can say that Autism effects much more than speech, as social skills and relatedness are impacted as well as behavior. However I would not recommend waiting to seek guidance if you are concerned. I would have him evaluated by a Speech Language Pathologist as soon as possible.

  • Isa Marrs

    I see from your post that you probably had your son evaluated by now. The best thing you can do is find an excellent therapist(s) to help him and guide you through this process. He is still young and doing lots of great things. So hopefully by now you have seen some nice progress.

  • Isa Marrs

    I would recommend having him evaluated by a Psychologist or Neurologist as soon as you can. If there is anything going on developmentally with your Grandson you want to start addressing it as soon as possible.

  • Isa Marrs

    Children with Autism vary greatly when it comes to language development however they always have delayed/disordered language. When they do use language they often use echolalia meaning they will repeat back what was just said to them. Children with Autism may also use “Scripting” which means they repeat things they have heard in the past often from TV shows. Sometimes they will try to use these scripts appropriately in real life situations. If you have any concern that a child you know might have an Autism spectrum disorder you should have him evaluated as soon as possible so proper treatment can begin.

  • Isa Marrs

    It seems that you have many concerns about your daughter’s development. I would recommend having her evaluated by a Pediatric Neurologist as soon as you are able to.

  • Isa Marrs

    Without meeting and evaluating your Grandson it is not possible to give you my opinion on his diagnosis. However, I do recommend starting therapy regardless of what the evaluation says. His speech is significantly delayed and he would benefit greatly from intensive speech and language therapy.

  • Isa Marrs

    Unfortunately, without evaluating your Granddaughter I am unable to give you any opinions on her diagnosis. I would recommend asking her Speech Language Pathologist to refer you to a Pediatric Neurologist or Psychologist for proper diagnosis. Does your therapist have an opinion?

  • Isa Marrs

    I would recommend seeing a nutritional specialist who works with children with developmental disabilities. If he has issues with milk he could possibly have issues with other foods which could cause the lethargy. They could also help you with supplements. Where do you live?

  • Isa Marrs

    I would recommend a minimum of 2x weekly speech therapy. I never recommend 1x a week. It is just not enough to make any progress at such a young age. Are they working on feeding? I would also recommend an Occupational Therapy Evaluation. This could address some of the sensory concerns you are reporting as well as some of the behaviors. This is where I would start. Please keep in touch.

  • Isa Marrs

    Aspergers is always a possibility however that diagnosis is most often given to older children. At your daughter’s age they usually say PDD-NOS. Without meeting your daughter I can’t give my opinion on diagnosis. If you do not get a diagnosis this time I would just keep doing what you are doing and addressing the areas that she is having difficulty with. Unfortunately, diagnosis vary greatly depending on which specialist you see. I often see children here who have been given several different diagnosis from several different professionals.

  • Isa Marrs

    Carol K,
    It seems that you are covering all your bases. The only recommendation I have is to start therapy immediately. Early intervention may make you wait, and precious time is ticking every day. If EI does not start right away I would find a private therapist in your area and get started.

  • Isa Marrs

    Kelly Drysdale,
    It is rare that a child gets to 6 and has undiagnosed Autism. Not to say it doesn’t happen. I would recommend seeing a Pediatric Neurologist to rule out any Neurological conditions that could be causing staring episodes. I would also recommend a speech and language evaluation to determine whether your son has a language disorder of any kind.

  • Isa Marrs

    Have you had a nutritional evaluation by someone who understands Autism Spectrum Disorders? There may be a reason he does not want to eat. I would definitely explore this. I would also recommend talking to the therapists and finding out how they are addressing the eating issues and if at all possible work directly with you.

  • EthansMom

    Nabeela, if you haven’t already, I would definitely consider finding an Ear,Nose & Throat specialist because sometimes the fluid is the issue where speech delays are concerned.

  • Annie

    My grandson is 10 and has autism. He is very thin – you can see the bones in his chest and back. He is not too interested in eating and as with most autistic children, has only certain items he’ll eat. Such as waffles, cereal, pancakes, fish sticks, chicken nuggets, macaroni & cheese, spaghetti, some fruit in cups (pears, peaches and apples) He likes chocolate milk and juice. Big water drinker. When I look at what I just wrote, I realize he eats more of a variety than he used to, but wants to stop eating after one bite. When he is at my house I fix Carnation Instant Breakfast Essentials to go along with the little he eats, but it takes all day to get one glass down him. I just put it in the refrigerator and offer it off and on all day long. He likes milkshakes. Is there anything you can put in a milkshake that would given him nutrients he needs, and help him gain weight?

  • Jane

    I have a six year old grandson that will get in the car and say he is hungry. I’ll ask him what he’s hungry for. He says, I’m hungry. I say, honey, would you like Cheeto’s or something like a sandwich or a pizza lunchable. He says, I’m hungry. I say, I heard you say that you are hungry. But I can’t solve your problem unless you can help me by telling me what you want to eat. He says in a frustrated tone, I’m hungry. I’m hungry. Once again I try to explain that I can’t help him if I don’t know what he wants. Anger, tears, and the same response, I’m hungry.
    This kind of thing has happened many many times.
    His mother has been very ill over the last year and a half but it was happening before she got sick.
    He seems to have anxiety issues as well.
    Where do I need to take him for an evaluation? What kind of evaluation do I need to do?
    There is something “off” but I can’t figure out what it is.
    His entire family has been in crisis over the last year and a half . I think they suspect something but are too overwhelmed to deal with it along with everything else.
    Was hoping someone here could offer some suggestions.

  • carla

    hello my daughter is 3 yrs 8 months and im not too sure what to do, she cant hold conversations with other children, she is great at copying the things people say and learning new songs to sing, she is also really good with numbers and counting. One of her teachers pulled me aside today and said that they will keep an eye on her for a bit because she cant hold conversations with the other children, me and my husband were a bit worried about this ages ago but I pushed it out of my mind because she seemed to be fine to me, but the teacher saying that today shook me and I thought she actually doesn’t hold conversations she just copies what we say. can someone please give me a bit of advise because I don’t know what to do thank you.

  • Isa Marrs

    I would recommend speaking to a nutritionist about this. There are many nutritional supplements on the market however it is important for someone to look at your Grandson’s nutritional needs.

  • Isa Marrs

    I would recommend talking to both a Psychologist and a Speech Language Pathologist. If the family is in crisis your Grandson may need some emotional support from a therapist such as a Psychologist. Also if he is unable to express his needs and answer questions he could have a language disorder. Both professionals could assess him and determine the best type of treatment to help him and you.

  • Isa Marrs

    It is good to hear that a preschool is talking to parents about their concerns. You should definitely have your daughter evaluated by a Speech Language Pathologist. If she has any other concerns about your daughter’s development she can refer you to other professionals. I would recommend that you do this right away. If there is a concern of any kind the sooner treatment is started the better the outcome is for the child. Please let me know how it turns out.

  • Kris

    Hi There, My son is 26mon, has always been ahead developmentally ie) walked at 9.5 mon etc. He had a terrible virus at 14mons & stopped mimicking words and new speech dev slowed. At 2omon I realized his little friends were wayyy ahead re speech. I put him in private speech therapy to avoid a 6mon wait list for public, I had a pediatrican assess him (but she doesn’t specialize in the area), finally saw an ENT, bc no one had seen in his ears in 1yr due to wax impaction. Everyone felt our issues were due to hearing impairment. He recently had ear surgery to remove wax, put tubes in due to fluid &infection, & fixed his minor tongue tie. He has some beh probs, hitting, pinching, scratching towards parents and other kids. In my opinion due to lack if speech and sometimes he’s good & other times I can’t have him around other kids. He’s a very picky eater & we resort to putting his fav show on & feeding him to get food into him most days. He’s allergic to peanuts, eggs & is milk intolerant. He has about 25 words and has added a few more since surgery. He’s loving, makes lots of eye contact, always talking me for walks to see things, he’s close to being potty trained, he’s partaking in imaginary play, still loves peekaboo, he sings part of wheels on the bus etc. He also has a great understanding if lang. He just saw an actual dev pediatrican yesterday and she kept saying autism over and over…sigh…we’re moving to the US fr Canada in a few weeks and I don’t know the system down there…if possible could you email me? Thank you!

  • Isa Marrs

    Where in the US are you moving. While similar each state has a different system and I am only familiar with New York’s system.

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  • Liz

    Liz, Hi Everyone, I have a four year old son who was diagnosed at 3.5 y by a neurologist as autistic. He was born a normal child, nothing of concerns. My husband and I started to notice that something was not right with when he was 2 .5 yrs old. He started to talk few words when he was one. At age 2 begin to loose al his speech. He used to eat meal-meal porridge, purity, wheat-beex, isomil formula, ect but he stopped eating all that. He does not eat solid food , at the moment he only eat yoghurt and nespray milk. He recently saw a dietitian who prescribe Promise PE supplement and few other food to try on him. My son is very sensitive to loud noise but we seeing great improvement on that. A speech therapist sees him on a routine basis and will recently be seen by an OT. Please Help.

  • luis marquez

    I am a single father of a five year old autistic child and new to the whole parent bit ..
    My son only wants to eat breakfast sausages chicken nuggets and romoen noodles and snack chips all day I am concerned cuz I do belive he needs to eat so much better and feel he isnt getting the right amount of nutrition for him to grow a progress in his growing stages of life .. can some one please help me and share any info on teaching a child with autism to expand his eating habits I truly want nothing but the best for my lil man any info would be greatly appreciated !!!!! Sincerely a concerned father .

  • Aubrey Hopkins

    Hi, My baby sister has ASD, NOS, PDD, and ADHD.
    She has dropped an enormous amount of weight within the last month or so. She weighed 68 pounds, she now weighs 47 pounds. She is so scrawny, you can see her bones. She is 6 years old, and about 3 feet, 10 inches tall. Her doctors are saying that she is going to end up sick if she doesn’t gain weight, but no matter what we try to do, she either won’t eat it or runs back and forth over-stimulating. I don’t know what to do, and I’m so worried. Do you have any advice/suggestions? Anything would help.

  • Aminah


    My 4 year old also regressed with eating and still have strong eating aversions. He sees a feeding therapist every week (speach therapists also
    Do feeding therapy). It got so bad last summer that he was hospitalized for 3 weeks and had to get a G-Tube placed. He continues with his therapies and tube feedings while we work on getting him to tolerate textures, smells, colors etc. I hope it gets easier for you guys!

  • Isa Marrs

    Hi Luis,
    As I am sure you know, children with Autism are often selective eaters. With this population of children I do feel that in order to make real progress, professional guidance on an on going basis is necessary.I would be happy to help you find a provider in your area who specializes in feeding if you let me know where you live.

  • Isa Marrs

    Hi Aubrey,
    Often children on the Autism Spectrum require a behavioral approach to feeding therapy. Sometimes that is provided by a Speech Language Pathologist, and sometimes by an ABA therapist. I would recommend finding a therapist who can work with your sister directly at least 2 times weekly. If you tell me where you live, I may be able to find a program in your area.

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  • Isa Marrs

    Thanks Deanne!