Quality of life for minimally speaking autistic people is underpinned by the same human needs we all have as people – the need to feel safe, be understood, included, and supported, and to experience connection, autonomy, and joy. However, so many assessment tools to measure quality of life rely on spoken self‑report, which has led to less research knowledge about how to increase quality of life for this group. In this blog we summarise current research and draw on our clinical experience to inform parents and professionals caring for minimally speaking autistic individuals aged 6 years and over.
One of the strongest areas of research for this group has been about communication because communication underlies virtually every other domain of life quality.
Access to Communication
Importantly, communication does not necessarily mean speech. Research supports the use of augmentative and alternative communication (AAC), including picture systems, tablets, speech‑generating devices, and emerging technologies such as augmented reality. Parents can fear introducing AAC because they are concerned that it will inhibit speech. However, using AAC stimulates the centres in the brain responsible for speech and language, and also delivers the rewards inherent in good communication, including having one’s needs better understood and hence met, feeling validated and included, and accessing more resources to enhance autonomy
Key findings include:
- PECS and symbol‑based AAC can increase communication initiations in children, though long‑term evidence is mixed (Jamie & Mecca, 2021).
- Aided Enhanced Milieu Teaching (AEMT) shows promising, real‑world gains because it embeds AAC into everyday routines rather than isolated therapy sessions (Logan et al , 2023).
- Tablet‑based AAC apps improve requesting, commenting, and social interaction, while reducing cognitive load for caregivers (Choi et al , 2024, Edgar et al 2024).
- Augmented Reality (AR) and holographic systems like the HoloBoard allow nonspeaking autistic people to spell independently and access remote support, which is important for autistic adults living remotely (Alabood et al. 2024).
What type of AAC is best?
There is no one AAC that suits everyone. The best outcomes happen when communication support uses multiple methods, is woven into real life, and is tailored to the individual’s needs, preferences, and strengths.
Multiple Methods of Communication
Multiple methods mean using more than one way to communicate, because the information communicated will likely be richer and more accurate, and some methods work best for some settings and not others.
For minimally speaking autistic people, this might include using pictures or symbols, a speech generating device, or typing. In addition, it means interpreting single and whole-body movements, facial expressions and eye gaze.
A multimodal approach recognises that communication is flexible. People can switch between methods depending on the situation, their energy, their sensory load, or what feels easiest in the moment.
Naturalistic Communication
This means communication support happens in everyday life, not only in structured therapy sessions. For example:
- using AAC during meals, play/leisure, routines, and outings
- modelling language while doing activities in the real world in multiple settings
- responding to the person’s interests in the moment
- embedding communication into meaningful interactions
Naturalistic approaches tend to work better because communication is inherently social and contextual. People learn best when the communication has a purpose, not when it’s drilled or forced.
Person‑centred Communication
This means the approach is built around the individual, not around a programme or a professional’s school or organisation’s preference.
Person‑centred AAC considers:
- the person’s sensory needs
- their motor profile
- their interests and motivations
- their cognitive load
- their cultural and family context
- their preferred communication methods
- their autonomy and agency
It also means involving the autistic person (as much as possible) and their family in decisions, co‑designing rather than prescribing.
Relationships Matter as Much as Technology
Communication is, by its nature, relational. AAC tools alone don’t create connection, but people do. Our own clinical experience and recent research indicate that a better quality of life for minimally speaking autistic people is associated with the quality of their relationships.
Studies show that:
- The responsiveness and attunement of communication partners (parents, teachers, peers, therapists) directly influence communication growth (Kilili-Lesta, & Voniati 2026).
- Parent‑mediated coaching reduces parental stress and increases child engagement (Dufek et al . 2025).
- Peer‑based school programmes help reduce social isolation and increase meaningful interaction (Dufek et al. 2025).
When parents, extended family members and professionals become attuned to the person’s communication preferences and style, the relationship they have with that person is enhanced. The available research and our own clinical experience suggest that minimally speaking autistic people are not “lacking” communication, but they can lack access to communication partners who understand and support their communication style.
In this blog we have focussed on communication as a foundation to quality of life for minimally speaking autistic people. Other factors are just as important. These include accommodations tailored to the person’s autistic characteristics, reducing the background stressors and understanding their stress responses. As important is supporting, training and including caregivers in the creation and implementation of any therapeutic programmes.
We Need Better Tools to Measure Quality of Life
A major gap in the research is the lack of validated tools for measuring quality of life for minimally speaking autistic people. Newer caregiver‑reported measures are emerging, but more work is needed, especially tools that allow nonspeaking autistic people to contribute directly through AAC or alternative formats.
A Hopeful Path Forward
Despite gaps in the evidence, our message is a hopeful one: communication, connection and a good life are possible, and these outcomes are not dependent on speech. They are built through access, respect, co‑design, and environments that honour the person’s sensory and communication needs.
In summary, when we honour communication in all its forms, nurture relationships, and create environments that fit the person, minimally speaking autistic people are given the best chance to thrive.
Learn More
These issues sit at the centre of our webcast, Masterclass Day 2: Support and Therapy for Autistic People who have Minimal Speech* (6 years+). Designed for parents, carers, psychologists, allied health professionals, educators, and medical professionals, the course explores communication, emotional regulation, multidisciplinary support, daily living skills, autonomy, preferred activities, and quality of life for autistic people who require substantial lifelong support.
References
Alabood, L., Dow, T., Feeley, K. B., et al. (2024). From letterboards to holograms: Advancing assistive technology for nonspeaking autistic individuals with the HoloBoard. *CHI Conference on Human Factors in Computing Systems*. https://doi.org/10.1145/3613904.3642626
Choi, D. H., Park, S., Lee, K., et al. (2024). AACessTalk: Fostering communication between minimally verbal autistic children and parents with contextual guidance and card recommendation. *arXiv*. https://doi.org/10.48550/arxiv.2409.09641
Dufek S, Stahmer AC, Vivanti G, Hassrick EM. Exploring social network factors impacting the implementation of communication supports designed for minimally verbal autistic preschool children: a study protocol. BMC Pediatr. 2025 Dec 26;26(1):93. doi: 10.1186/s12887-025-06439-1. PMID: 41454265; PMCID: PMC12882290.
Edgar TC, Schlosser R, Koul R. (2024) Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers. Am J Speech Lang Pathol. Jul 3;33(4):1619-1638. doi: 10.1044/2024_AJSLP-23-00313. Epub 2024 May 21. PMID: 38771825; PMCID: PMC11253647.
Jamie H.L. & Mecca C. (2021). The picture exchange communication system and adults lacking functional communication: A research review, European Journal of Behavior Analysis, doi: 10.1080/15021149.2020.1815507.
Kilili-Lesta, M., & Voniati, L. (2026). Concurrent developmental language level change for children with autism spectrum disorder using alternative and augmentative communication systems: a cross-sectional study in Cyprus. Disability and Rehabilitation: Assistive Technology, 21(1), 325–334. https://doi.org/10.1080/17483107.2025.2555538
Logan, K., Iacono, T., & Trembath, D. (2023). Aided enhanced milieu teaching to develop symbolic and social communication skills in children with autism spectrum disorder. *Augmentative and Alternative Communication*, 39(4). https://doi.org/10.1080/07434618.2023.2263558
