Rethinking Communication: How Do I Support Nonverbal Autistic Individuals in Mental Health Care?

Dr. Daniel Masud, Consultant Psychiatrist

Each year, National Non-Speaking and Nonverbal Awareness Day invites us to pause and reconsider how we define communication for those with nonverbal autism. It is a day dedicated to raising awareness about the lives and challenges of individuals who are nonverbal or nonspeaking¹. Connection, expression, and autonomy are as vital for those with nonverbal autism as for those that can communicate verbally. So, the day shines a light on the importance of inclusive, alternative communication methods: from sign language to assistive devices, behavioural cues to facial expressions¹.

Autism is one of the conditions that can be commonly associated with nonspeaking communication², though the experience varies widely. Some may point, use head movements, reach, or use facial mimicry to express themselves; others may make sounds or rely on eye contact to signal a need³.

Understanding what nonverbal autism means, is about noticing difference. And for healthcare professionals in particular; this requires patience, presence, and a readiness to meet people on their terms.

This article offers an informed, compassionate guide to supporting individuals with nonverbal autism, with a particular focus on mental health support for nonverbal autism and the communication methods that enable their voices to be heard.

What Does ‘Nonverbal’ Mean in Autism?

When people ask, “What is nonverbal autism?”, it’s often misunderstood as a lack of communication altogether. In reality, being nonspeaking simply means that an individual does not use speech as their primary form of communication⁴. For some, this may mean speaking only a few words and, for others, speech may not develop at all; around 25–30% of autistic people fall into these categories⁴

Importantly, nonspeaking autism does not mean non-thinking. Nonspeaking autistic individuals still have strong cognitive abilities, deep emotional lives, and a clear desire to connect^5-6. The reason that nonverbal autism occurs isn’t due to a lack of intelligence or lack of desire to communicate, but rather a complex interplay of neurological and developmental differences that includes motor planning challenges, sensory sensitivities, and anxiety⁶.

Some research suggests that disruptions in early brain development, particularly in areas responsible for language and auditory processing, may be part of the reason why some autistic individuals do not speak⁶. One study, for example, found differences in how the auditory cortex processes information in nonverbal and minimally verbal autistic children⁷. These challenges can make it difficult to form words or regulate speech, even when thoughts and feelings are fully present. This is why supporting someone with nonverbal autism requires nuance, patience, and a redefinition of what communication looks like.

When we understand that speech is just one form of expression, we open the door to more inclusive, respectful, and responsive care.

The Mental Health impacts of Nonverbal Autism

Understanding the emotional strain on those with nonverbal autism is too often overlooked. While every person’s experience is unique, being unable to express distress verbally may increase the risk of developing or worsening mental health conditions. This is something that can be compounded by diagnostic challenges – as one study noted, parents frequently struggled to identify anxiety in their nonspeaking children due to overlapping behaviours and communication barriers⁸.

Autistic individuals who use few or no words remain significantly under-researched, particularly in relation to co-occurring mental health conditions⁸. However, anxiety is one of the most frequently reported concerns^8-12. Prevalence rates for anxiety disorders in autistic populations – both verbal and nonverbal – are estimated at around 20–40%^10-11. Yet, the way anxiety presents can differ in nonverbal individuals⁹, making it harder to spot, and even harder to treat. And what’s more, when interventions are available, they are often aimed at verbal individuals¹². For those with nonverbal autism, treatment is frequently behavioural or medication-based, with limited focus on the emotional roots of distress¹².

How to Support Those with Nonverbal Autism: Listening Without Words

Supporting a nonverbal autistic individual begins with presence. How to support nonverbal autistic individuals best often starts by attuning to subtle forms of expression, be it gestures, body language, patterns of movement, or other emotional cues¹³. These non-verbal cues provide a unique lens into a person’s inner world and challenge conventional ideas of communication in autism¹³.

Some researchers have even explored the concept of telepathic connection — not as science fiction, but as a way of describing the deep attunement families often develop when words aren’t available¹³. This perspective invites clinicians and carers alike to pay close attention to emotion, rhythm, and relational dynamics.

This though, requires more than observation. It calls for curiosity, patience, and respect. In person-centred care, “listening” means staying open to all the ways a person might be trying to connect.

Tools and Approaches to Support Nonverbal Autistic Individuals

There is no one-size-fits-all method for supporting communication – but communication tools for nonverbal autism can make a profound difference. Augmentative and Alternative Communication (AAC) systems like the Picture Exchange Communication System (PECS), speech-generating devices, and tablet-based communication apps offer ways for nonspeaking individuals to express needs, feelings, and preferences.

These best communication aids for nonspeaking individuals can enhance mental wellbeing by reducing frustration and promoting independence. With consistency, curiosity, and patience, these tools can become powerful bridges between individuals and the world around them.

Why Environment Shapes Communication

For many with nonverbal autism, a familiar, low-stress environment can unlock meaningful attempts at connection. Home settings – where sensory stimuli can be managed and routines are predictable – can reduce anxiety and allow for clearer expression; whether through behaviour, gestures, or assistive tools.

Environmental factors like noise, lighting, and unfamiliar textures can have a profound effect. Around 90% of autistic people experience some form of sensory processing disorder, which can interfere with both communication and emotional regulation¹⁴. In hospital or clinical settings, this can be overwhelming – particularly for individuals who do not rely on speech.

In contrast, creating space for interaction in settings where individuals feel safest and most regulated can foster a deeper sense of autonomy, trust, and clarity. For some, this might be a quiet corner of their own home. For others, it’s simply being surrounded by familiar rhythms and people who listen.

True Connection Begins Before Words

Supporting nonspeaking autistic individuals begins with respect not for what they say, but for how they communicate. Whether through gestures, behaviours, or assistive tools, every individual has a voice. It’s our responsibility to listen.

Clinicians, families, and carers must remain attuned not only to needs, but to patterns, signals, and preferences … especially when words aren’t available. This requires patience, flexibility, and a deep commitment to person-centred care that adapts to the individual, rather than expecting the individual to adapt to the world.

Because sometimes, the most profound communication doesn’t involve speech at all.

“Understanding someone begins with truly listening to what isn’t said.”

References

1. https://www.awarenessdays.com/awareness-days-calendar/national-nonspeaking-nonverbal-awareness-day/
2. https://www.nm.org/healthbeat/healthy-tips/nonverbal-autism-what-it-means
3. https://circlecareservices.com/non-verbal-autism-know-the-signs-why-it-occurs-how-to-communicate/
4. https://www.healthpolicypartnership.com/reimagining-communication-for-people-with-non-verbal-autism/
5. https://goldencaretherapy.com/why-are-some-autistic-non-verbal
6. https://www.crossrivertherapy.com/autism/what-causes-non-verbal-autism
7. https://molecularautism.biomedcentral.com/articles/10.1186/s13229-019-0283-3
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC7874371/
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC5441227/pdf/nihms859304.pdf
10. https://discovery.ucl.ac.uk/id/eprint/10081954/7/Mandy%20THELANCETPSYCH-D-19-00008R4_.pdf
11. https://www.canonsociaalwerk.eu/1988_Comorbiditeit/1988%20Simonoff%20ea.pdf
12. https://www.psychologytoday.com/ie/blog/autism-and-anxiety/201910/how-manage-anxiety-in-nonverbal-people-autism
13. https://www.autismdigest.com/post/exploring-telepathy-understanding-non-verbal-communication-in-non-speaking-autism
14. https://www.mastermindbehavior.com/post/the-connection-between-autism-and-sensory-processing-disorder