Whether therapists encounter clients with an autism diagnosis or whether they suspect a client might be autistic, it is important for clinical psychologists to understand how autism could impact communication during therapy. Of course, when the 10 different ways, we’ll look at in today’s podcast episode alone individually or in smaller groups, they aren’t always exclusive to autism, so it is critical that a therapist doesn’t jump to the conclusion that a client is autistic. Yet when these 10 different impacts could negatively impact communication between the therapist and autistic client in therapy, so it’s important to be aware of them and how to overcome them in therapy. Therefore, if you enjoy learning about autism, clinical psychology and therapy then you’ll this clinical psychology podcast episode.
Today’s podcast episode has been sponsored by Developmental Psychology: A Guide To Developmental and Child Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also, you can buy the eBook directly from me at https://www.payhip.com/connorwhiteley
Note: and as always the references for this podcast episode can be found near the bottom of the episode.
How Can Autism Affect Communication Therapy?
Autistic Clients Might Avoid Eye Contact In Therapy
Whenever we think about autism, the idea of eye contact always comes up first in people’s minds and this is because autistic people tend to have problems with eye contact. For example, I cannot remember the last time I made eye contact with either of my therapists and to be honest, anyone in my life. I simply don’t like it and I have no intention of making eye contact with someone.
Equally, some autistic people don’t look sidewards or away from therapists for long periods of time, because some autistic people stare intensely at someone to the point where the therapist might be uncomfortable. These are common in autistic people.
Although, some autistic people have learnt to “mask” their symptoms by making eye contact in a natural way in an effort to hide their autism. This does have negative consequences but it is a survival technique to help autistic people “blend” into this neurotypical world.
Overall, if a client is avoiding eye contact with you or staring at you intensely, they could be autistic.
Autistic People Provide A Lot of Detail And Talk Excessively
In addition, autistic people could talk to you for long, excessive periods of time as well as include a lot of detail that takes the conversation off on a lot of tangents. This could happen because the autistic client wants to share information about one of their special interest or they might want to share something they’re recently become passionate about.
Also, this “infodumping” could happen because the client hasn’t picked up on communication cues from the therapist about them wanting to talk or talk about something else.
Personally, I think whether or not this is a “problem” really depends on the therapeutic model being used. For example, Cognitive Behavioural Therapy is extremely structured and rather rigid so these tangents wouldn’t be good, but for counselling or humanistic approaches, I don’t think this would be a problem at all. In fact, I know in some of my own therapy sessions, these tangents can be rather golden for learning more about my mental health difficulties.
Apparently Being “Rude”, Direct or Blunt
Of course, I use the word “apparently” more for myself than anything else because I was a so-called rude child at times because of my undiagnosed autism. But anyway, one of the biggest communication challenges that autistic people face is coming across as rude to other people when in their mind, what they have just said is the truth and it sounds okay to them.
That was basically the story of my childhood.
Therefore, the vast, vast majority of autistic clients prefer to communicate in a simple, direct and effective way but this can sadly come across as rude to other people. As well as autistic people might struggle to understand metaphorical or vague language, so they communicate directly because it matches how they prefer to be communicated with.
However, I will admit that this flat out doesn’t matter autistic people cannot understand metaphors and imagery in therapy settings. Since my current counsellor uses a lot of metaphor and imagery and he mentions how autistic clients are actually really good at it, so I just wanted to clear that myth up.
Overall, autistic clients might prefer to communicate directly and effectively with you as their therapist. So just bear in mind if they’re being direct, they are just talking and not trying to be rude or blunt with you.
Autistic People Might Talk Over or Interrupt You
Similar to what I mentioned earlier, because autistic people tend to struggle with how much detail to add, picking up on social cues amongst other communication cues, they might interrupt or talk over you. As well as because autistic people can find it difficult to know when to join a conversation, they might say nothing, wait a while for a chance to speak or interrupt you.
My point is if the client interrupts you, again they are not being rude. They are just being their authentic autistic self. Which is actually one of the entire points of therapy, we want to help our current or future clients be themselves and help them deal with whatever mental health difficulty they’re facing.
Slower Verbal Processing Times
Interestingly, Haigh et al. (2018) found that autistic people might take longer to process verbal information. This is important for therapists to beware of because if you tend to ask your clients a lot of multi-part questions then this might work for neurotypical clients. Yet you might be disadvantaging your autistic clients by accident, so asking single part questions might be better.
Lack Of Facial Expression
Now I will be the first to admit that most forms of emotional processing are a massive difficulty for autistic people, to the point that it can be funny talking about it with other autistic people. For example, I asked a friend out on a date the other week and they rejected me. And we were talking about it the next day and I said I thought I was fine after the rejection emotionally but my body was shaking (probably in upset) and I just couldn’t sleep that night. It was a nightmare, and my friend basically said “yes I’d had that before and I can’t understand my own emotions so I have to listen to my body to tell me how I’m feeling”.
Also, I find it rather funny how me, my friend and all the other autistic people I know, we can all show “limited” expressions of emotion in-person. But if we text each other and so on, we are a lot more expressive because it’s just easier to be emotional with word choice, emojis and more in text.
Anyway, I think we can all understand that many autistic adults don’t use their faces to express emotions the same way neurotypical adults do and some autistic people might look extremely serious regardless of the situation and informality of the situation they are in.
Loudly or Quietly Talking or a Strange Pitch, Rhythm or Tone
This was something I was very surprised to learn about a few years ago but I think there tends to be two types of “voice categories” autistic people fall into. There is the “monotone” camp or there is the type of camp where the autistic person speaks in a certain rhythm. I think I’m in the latter category because my voice does change but there are certain sounds, words and ways I talk without fail.
Granted, that can make editing the podcast a nightmare at times.
Anyway, Bonneh et al. (2011) suggests that autistic people might struggle to control their voices so this could make a client talk loudly, quietly, have an intonation in a strange place or have little to no intonation.
Not Being Able To Talk During Sessions
On the other hand, there might be some autistic people who aren’t non-verbal but they find it very hard to talk about themselves. This could be because they find it difficult to articulate their feelings and thoughts or they might spend less time than a lot of other people talking and this make them struggle to answer questions. Resulting in the client giving short, sharp answers or being very uncomfortable in the session.
Internal Lack Of Confidence In Communication
I’m definitely not surprised to learn this but a lot of autistic people during therapy sessions actually “check in” with the therapist to see if they’re answering the question correctly. Now I do get this sense a lot because I am somewhat mildly autistic and when I am in these therapy sessions I do get concerned about my answers. Like “am I giving him enough information”, “am I understanding the question” and so on. Therefore, I’m not surprised to learn that in autistic people this all stems from an internal lack of confidence about our ability to communicate.
I think this is even more important when we acknowledge that most autistic people have probably been moaned at for being rude or blunt or not understanding a question before. This doesn’t help an autistic person feel like they have a good sense of communication. I think this is why my friend prefers to only deal with and become friends with other neurodivergent people.
Which I can understand but I like neurotypicals too much to not at least try a little.
Using Gestures
We have all probably heard of the rough fact that something like 90% of communication is non-verbal. I am not sure if that is the “true” statistic and I don’t care enough to actually double-check but the point is gestures are important in human communication. Yet autistic people might use gestures a lot more or a lot less than expected and they might use gestures in unusual ways.
I know I love talking with my hands even when I seriously shouldn’t.
Whereas there are other autistic people that never use a single gesture and others still don’t use gestures but instead use repetitive behaviours that other people think are gestures. Therefore, this can create a lot of communication problems for autistic clients, so I suppose that part of a therapist’s job is to understand how the client is using gestures (if at all) to understand if they have any importance to what the client is trying to tell them about their life, mental health and so on.
Clinical Psychology Conclusion
We’re all aware that autism results in someone having communication difficulties and most of the time, this is the end of how we think about them. Unless we come into contact with autistic people regularly this isn’t something a lot of us concern ourselves with, but as current or future clinical psychologists, it is always useful to be aware of how autism could impact therapy. As well as I mentioned earlier, I don’t think there is a single one of these symptoms that is unique to autism when looked at individually. For example, some of these could be applied to trauma, anxiety or depression.
Therefore, being aware of how these symptoms impact therapy helps us to be prepared for helping an autistic person whenever they come into our therapy room. Autism shouldn’t be a barrier to therapy and if you’re more aware and informed then you can help change an autistic person’s life for the better just like a neurotypical person.
They might need a little more support or a slightly different way of working, but autistic people are just as bright, brilliant and wonderful as everyone else. So let’s help them decrease their distress, come up with better coping mechanisms and improve their lives.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Developmental Psychology: A Guide To Developmental and Child Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also, you can buy the eBook directly from me at https://www.payhip.com/connorwhiteley
Have a great day.
Clinical Psychology References
Bonneh, Y. S., Levanon, Y., Dean-Pardo, O., Lossos, L., & Adini, Y. (2011). Abnormal speech spectrum and increased pitch variability in young autistic children. Frontiers in human neuroscience, 4, 237.
Conlon, O., Volden, J., Smith, I. M., Duku, E., Zwaigenbaum, L., Waddell, C., ... & Pathways in ASD Study Team. (2019). Gender differences in pragmatic communication in school-aged children with autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 49, 1937-1948.
Cummins, C., Pellicano, E., & Crane, L. (2020). Autistic adults’ views of their communication skills and needs. International journal of language & communication disorders, 55(5), 678-689.
De Marchena, A., Kim, E. S., Bagdasarov, A., Parish-Morris, J., Maddox, B. B., Brodkin, E. S., & Schultz, R. T. (2019). Atypicalities of gesture form and function in autistic adults. Journal of autism and developmental disorders, 49, 1438-1454.
Grossard, C., Dapogny, A., Cohen, D., Bernheim, S., Juillet, E., Hamel, F., Hun, S., Bourgeois, J., Pellerin, H., Serret, S., Bailly, K., & Chaby, L. (2020). Children with autism spectrum disorder produce more ambiguous and less socially meaningful facial expressions: an experimental study using random forest classifiers. Molecular autism, 11(1), 5. https://doi.org/10.1186/s13229-020-0312-2
Haigh, S. M., Walsh, J. A., Mazefsky, C. A., Minshew, N. J., & Eack, S. M. (2018). Processing speed is impaired in adults with autism spectrum disorder, and relates to social communication abilities. Journal of autism and developmental disorders, 48, 2653-2662.
Morrison, K. E., DeBrabander, K. M., Jones, D. R., Faso, D. J., Ackerman, R. A., & Sasson, N. J. (2020). Outcomes of real-world social interaction for autistic adults paired with autistic compared to typically developing partners. Autism, 24(5), 1067-1080.
Ritvo, R. A., Ritvo, E. R., Guthrie, D., Ritvo, M. J., Hufnagel, D. H., McMahon, W., ... & Eloff, J. (2011). The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): a scale to assist the diagnosis of autism spectrum disorder in adults: an international validation study. Journal of autism and developmental disorders, 41, 1076-1089.
Rundblad, G., & Annaz, D. (2010). The atypical development of metaphor and metonymy comprehension in children with autism. Autism, 14(1), 29-46.
Senju, A., & Johnson, M. H. (2009). Atypical eye contact in autism: models, mechanisms and development. Neuroscience & Biobehavioral Reviews, 33(8), 1204-1214.
Sturrock, A., Adams, C., & Freed, J. (2021). A subtle profile with a significant impact: Language and communication difficulties for autistic females without intellectual disability. Frontiers in Psychology, 12, 621742.
Sturrock, A., Chilton, H., Foy, K., Freed, J., & Adams, C. (2022). In their own words: The impact of subtle language and communication difficulties as described by autistic girls and boys without intellectual disability. Autism, 26(2), 332-345.
Sturrock, A., Foy, K., Freed, J., Adams, C., & Leadbitter, K. (2023). The impact of subtle language and communication difficulties on the daily lives of autistic children without intellectual disability: Parent perspectives. International Journal of Language & Communication Disorders.
Sturrock, A., Marsden, A., Adams, C., & Freed, J. (2020). Observational and reported measures of language and pragmatics in young people with autism: a comparison of respondent data and gender profiles. Journal of Autism and Developmental Disorders, 50, 812-830.
Sturrock, A., Yau, N., Freed, J., & Adams, C. (2020). Speaking the same language? A preliminary investigation, comparing the language and communication skills of females and males with high-functioning autism. Journal of autism and developmental disorders, 50, 1639-1656.
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