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My seventeen year old brother is severely autistic and unable to communicate. He can produce sounds, and imitate words, but he doesn't respond to words in a way that suggests he understands them. His imitations are always imperfect, and this is what interests me most. For example, he can sort of say the first twenty numbers ('ah', 'tih', 'ee', 'hoh', that sort of thing.) He sort of gets rhythm, but not intonation or pitch.

Of course, every child is different, but are there reasons why an autistic teen who can clearly hear words has never in 17 years learned to accurately reproduce them? Dad once speculated that it was auditory, that he can't hear the sounds properly, but I suspect that it's physiological. I'd like to hear thoughts from people who know what they're talking about.

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Difficulties with language is not actually a symptom of autism. Autism Spectrum Disorder involves difficulties in social communication and interaction, as well as restricted and repetitive interests or behaviours (DSM-V, 2013). The term "social communication" is referring to difficulties in the social aspects of language and other communication, such as matching verbal and non-verbal behaviour, rather than difficulties in language.

The language difficulties as described in the question sound like they could be related to the age-equivalence of the individual, although of course physiological hearing difficulties can't be ruled out until it is assessed. All children progress through a sequence of language development (Tager-Flusberg et al., 2010):

  1. Pre-Verbal

    • Babbling, gestures
    • Typically developing children aged 6-12 months
  2. First Words

    • Non-imitated, spontaneous single words
    • Some of the speech is intelligible, and uses consonant sounds typical in babble
    • Typically developing children aged 12-18 months
  3. Word Combinations

    • 2 and 3 word combinations, including nouns, adjectives and verbs
    • Typically developing children aged 18-30 months
  4. Sentences

    • Children create sentences, now using plurals and prepositions
    • Typically developing children aged 30-28 months
  5. Complex Language

    • Language for a range of topics, using complex grammar, in different discourse contexts
    • Pre-school aged typially developing children

Tager-Flusberg et al. (2010) have a great table (Table 1) in their article outlining their proposed benchmarks for each of these phases. As the child progresses, their phonology (speech sounds) improves as well as their vocabulary, grammar, etc. Thus, your brother may be imitating the sounds he hears as best he can within his level of language development.

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But are these stages applicable when he's 17 years old? He's long passed those benchmarks, and is almost certainly never going to learn to speak. It may not be a symptom of autism, but it is a symptom of my autistic brother, and some other autistic children. I'm curious as to why that's the case. – Leo King Jul 26 '14 at 9:50
Chronologically he may be 17, but mentally he may still be at an earlier age equivalence. So yes, I believe these stages can be applicable even if he is 17. – ashatte Jul 26 '14 at 12:36
Okay, so the averages aren't referring to physical age, but mental development? – Leo King Jul 27 '14 at 7:31

There are often motor control issues, the case study below exemplifies these and an approach to overcoming them with help from technology. As well as the below, there are many personal accounts such as those of Carly Fleischman and Tito Mukhopadhyay that describe the struggle to align output with inner thought.

Language is More than Speech: A Case Study Morton Ann Gernsbacher, Ph.D. Abstract: Some individuals face severe challenges with producing oral language (i.e., speech). In this article a case study of a child who experienced severe challenges with speech development is presented. Medical records, historical home videos, audio recordings, and photographs, in conjunction with an extensive journal maintained by the child’s mother provide the basis for this report, which profiles the child’s development from birth to age 8;0. This child’s development demonstrates the necessity of distinguishing between language—the mental representation of concepts and their relations—and speech—one means for communicating mental representations. Journal of Developmental and Learning Disorders, Vol.8, 81-98.

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