Communication support for autistic children who speak very little: what the research found

In one sentence

A Cochrane review found that some communication approaches may help autistic children who speak very little, but the current research is still too limited to show strong or long-lasting results.

What the researchers did

Some autistic children use very few spoken words or do not rely on speech as their main way of communicating. Researchers wanted to understand which communication supports actually have solid scientific evidence behind them.

After reviewing the research, the Cochrane team found only two high-quality studies that met their standards.

One study from the United States taught parents how to use structured play techniques at home during regular interaction with their child.

The second study from the United Kingdom looked at PECS — the Picture Exchange Communication System — where children learn to communicate by handing over picture cards to express needs or requests.

Together, the studies involved 154 children between roughly 3 and 11 years old.

What they found

The overall evidence was considered very uncertain because there were only two small studies and each tested a different method.

In the parent play-training study, children did not show a clear overall improvement in spoken language immediately after the program ended. However, children who started with more limited language sometimes appeared to benefit more than children who already had stronger communication skills.

In the PECS study, children became more likely to start interactions using picture cards or gestures shortly after the intervention. Some children also initiated communication more often using words or nonverbal signals.

But those improvements were not clearly maintained many months later.

The review also found no strong evidence that PECS increased overall spoken language, vocabulary size, or broader social communication skills in a lasting way.

Neither study gave enough information about quality of life, daily functioning, or possible negative effects for the reviewers to draw conclusions.

What this means for families and therapists

For families, this review is an important reminder that communication support is highly individual.

Some children may benefit from systems like PECS or from parent-led communication practice, especially for helping them start interactions and express needs more independently. But no single approach works equally well for every child, and progress may happen slowly and unevenly.

The review also suggests that communication tools often work best when they are part of everyday life — at home, at school, and during real interactions — rather than used only during therapy sessions.

For therapists and educators, the findings support realistic expectations and careful tracking of individual progress instead of assuming that one popular method will reliably improve speech for most minimally verbal children.

Limitations and what we don't know yet

Only two studies met the review’s quality standards, even though many communication programs are widely used in practice.

The studies were relatively small and followed children for a limited amount of time, so researchers still know very little about long-term outcomes.

There is also not enough evidence yet to say which children are most likely to benefit from specific communication approaches, or how to best combine speech, visual supports, gestures, and technology over time.

More large, well-designed studies are still needed.

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This is a simplified summary of Communication interventions for autism spectrum disorder in minimally verbal children by Brignell A, Chenausky K.V, Song H, Zhu J, Suo C, Morgan A.T, Cochrane Database of Systematic Reviews (2018).

Source license: CC-BY-NC-4.0.

This is not medical advice. Please consult a qualified healthcare professional before making therapy decisions.