An autistic child interacting with a horse on June 5, 2025, in Hangzhou, Zhejiang. On that day, a clinical trial project for equine-assisted intervention in autism, led by the Children’s Hospital of the School of Medicine at Zhejiang University, was officially launched in Hangzhou. Photo: IC PHOTO 

Autism spectrum disorder (ASD), commonly known as autism, is characterized by a range of neurodevelopmental challenges. According to the Morbidity and Mortality Weekly Report published on April 17, 2025—based on statistical analyses from 16 sites across the country in 2022—approximately one in every 31 children aged eight was diagnosed with ASD, reflecting a prevalence rate of 3.2%. This marks an increase from one in 36 in 2020 and has renewed public attention and discussion around the condition. 

In China, a 2020 study estimated the prevalence of autism among children aged 6 to 12 at 0.7%, though some researchers suggest the actual rate may be similar to that of the US. Differences in reported prevalence can be attributed to factors such as diagnostic criteria, sample selection, and parental awareness. Among neurodevelopmental disorders, autism consistently draws the most public attention—yet misunderstandings about the condition remain widespread.

Non-verbal not equal to being autistic 

ASD is classified as a neurodevelopmental disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in 2013. Its core features fall into two main domains: deficits in social communication and interaction, and restrictive and repetitive behaviors (RRBs).

Two common misconceptions about autism relate to the core issue of impaired social communication. The first assumes that, because language is the primary medium of social interaction, communication difficulties must necessarily stem from language deficits. Some people mistakenly believe that being non-verbal is synonymous with being autistic. Statements such as, “I’ve recently developed autism; I don’t want to talk or go out,” or “I must have autism because I feel uncomfortable in crowds, even finding it hard to breathe, let alone engage in conversation,” reflect a fundamental misunderstanding of what autism is. 

Many individuals may experience a desire to withdraw from social interaction due to stressors related to work or life changes, leading to temporary emotional difficulties that can develop into conditions like depression. However, such emotional struggles are not the same as autism. Autism is, at its core, a neurodevelopmental disorder involving atypical brain development, with symptoms typically manifesting in early childhood or the preschool years, and affecting cognitive, social, and motor functions. Depression, by contrast, is classified as a mental disorder, generally arising from a combination of neurotransmitter imbalances and psychosocial pressures. A voluntary refusal to speak may resemble “autistic-like” behavior, but it does not signal a sudden onset of autism; someone with a history of typical social interaction does not become autistic due to a few isolated experiences.

The second misconception arises from comparisons with DSM-4, which categorized language impairments as a distinct diagnostic criterion, leading to the perception that DSM-5’s omission of language as a standalone criterion diminishes its importance. This misunderstanding stems from a lack of clarity regarding the relationship between language and social interaction. Social communication entails the sending and receiving of signals, information, thoughts, and emotions through multiple senses—auditory, visual, tactile, olfactory, and gustatory—resulting in a multisensory experience. It encompasses both linguistic and non-linguistic elements, including posture, gestures, and facial expressions. While these non-linguistic signals convey meaning, they cannot match the range and precision of language, which remains the most vital tool for social exchange. 

As such, social communication deficits often involve language problems. Although DSM-5 places greater emphasis on the severity spectrum of functional impairments, language challenges remain common among autistic individuals. Rather than eliminating language impairments from consideration, the updated framework incorporates them into the broader category of social communication difficulties. This shift highlights the fact that language deficits in autism are not isolated symptoms, but rather integral to broader difficulties with social interaction.

Social communication impairment independent of language ability

Autism is a spectrum disorder, meaning there is substantial variability among individuals, with both core symptoms and intellectual functioning ranging from mild to severe. Roughly half of all children with autism do not develop functional spoken language, and some individuals with more severe forms may never acquire speech. At the other end of the spectrum are individuals with extraordinary language skills. Around 75% of people with autism also experience intellectual disability; those who do not are categorized as having “high-functioning autism.” While it is understandable that intellectual disability often coincides with language impairments, it is more difficult to explain why high-functioning individuals also encounter language-related challenges. Typically, these individuals may experience delays in language acquisition during early childhood, but later achieve fluent speech alongside typical cognitive development. Notably, individuals with Asperger’s syndrome—a subgroup of high-functioning autism—may show no delays in language development at all. A well-known example is the case of Daniel Tammet, a British writer known for his remarkable linguistic abilities: He taught himself Icelandic in one week and demonstrated fluency on television. He is proficient in 10 languages and even invented one of his own, “Manti,” with more than a thousand words. His case raises an intriguing question: How can such a language prodigy still experience language impairments?

Language impairments encompass multiple dimensions and levels. According to the American Speech-Language-Hearing Association, such impairments involve difficulty understanding or producing the symbolic systems of language, typically in three domains: form, content, and use. Language form pertains to phonological rules, vocabulary construction, and syntactic structure; difficulties in producing correct speech or sentence structures fall within this category. Language content involves the meaning of words and sentences; difficulties with synonyms, antonyms, or hyponyms indicate impairments in this area. Language use refers to the practical application of language, encompassing a broad range of challenges in appropriately producing or comprehending language in context. Importantly, intact language form and content do not guarantee effective language use —which explains how linguistic prodigies can still display language impairments. 

For instance, publicly available accounts suggest that Daniel Tammet, often described as “one of the smartest people in the world,” struggles with non-literal expressions. For example, upon hearing the phrase “take a seat,” he initially interprets it as “take a chair away,” rather than an invitation to sit. He also finds idiomatic expressions challenging, taking phrases like “to kill a chicken to scare the monkey” at face value. Tammet’s experience illustrates that linguistic talent and language impairment can coexist. For high-functioning individuals like Tammet, possessing a comprehensive language structure does not guarantee effective social communication. This group serves as evidence that “social communication impairment” exists independently of language ability, with challenges in understanding intent not merely confined to linguistic interpretation but also extending to non-verbal cues such as posture, body language, and eye contact. Tammet acknowledges difficulties in discerning emotions through eye contact and expression, requiring deliberate practice to understand “when to smile.” During adolescence, he often misunderstood his classmates’ intentions—interpreting their mimicry of his clapping or lip-pulling as friendly behavior, only to realize later that they were teasing him.

Another core characteristic of autism, the RRBs, is also reflected in language use and can further disrupt social interaction. Individuals with autism frequently exhibit a phenomenon known as “echolalia,” mechanically repeating the utterances of others rather than responding appropriately within the context of the conversation. This repetition can occur immediately, meaning they echo what has just been said, or it can be delayed, manifesting hours or even days later. For instance, some children may recite lengthy passages from advertisements they have previously seen on television. They might also repeatedly ask the same question, such as “When can I make a phone call?” even after receiving a clear answer. Others may respond to all inquiries with a fixed template, like “My brother is writing,” regardless of the question posed. These behaviors differ significantly from typical speech patterns and are easily identifiable as atypical. 

In contrast, the RRBs in high-functioning individuals may be more subtle. Their extreme literalism, as previously discussed, can be seen as a form of cognitive rigidity. Additionally, these individuals often display an intense focus on obscure or technical subjects, such as outer space events, subway lines, or the chronological order of historical events. In conversation, they may monopolize the discussion, persisting with a topic regardless of the other person’s interest or attempts to shift the subject. This obsessive behavior tends to disregard the feelings of others and is marked by a strong self-centeredness, which aptly illustrates the social communication challenges associated with autism.

Public awareness of autism is currently high, and early intervention for children with autism is widely endorsed. While the quality of support services available still needs improvement, access to rehabilitation in major cities is generally adequate, enabling a high proportion of lower-functioning individuals to receive therapy. However, high-functioning children, who may express themselves fluently and demonstrate normal or even above-average cognitive abilities, or even savant-level skills, are often overlooked when it comes to their social difficulties, particularly in contexts like China, where culture highly values academic performance. However, being “high-functioning” does not mean intervention is unnecessary. Ideally, individuals with autism require a lifelong support system, and high-functioning individuals are no exception. Unfortunately, the specific types of support they need are not always readily available, which represents a significant area for future development.

Liang Dandan is a professor of neurolinguistics from the School of Chinese Language and Literature at Nanjing Normal University.

Edited by REN GUANHONG