IJLCD: Speech sound error patterns may signal language disorder in Swedish preschool children with autism

In this podcast we chat with Carmela Miniscalo and Anna-Clara Reinholdson about their research which looks at speech sound ability in relation to language ability and non-verbal ability in Swedish pre-school children with ASD.

The paper is:

Miniscalco, C., Reinholdson, A.-C., Gillberg, C. & Johnels, J.A. (2024) Speech sound error patterns may signal language disorder in Swedish preschool children with autism. International Journal of Language & Communication Disorders, 59, 2516–2527. https://doi.org/10.1111/1460-6984.13099

Please be aware that the views expressed are those of the guests and not the RCSLT.

Transcript

Transcript Name: 

ijlcd-speech-sound-error-patterns-may-signal-language-disorder-in-swedish-preschool-children-with-autism        

Transcript Date: 

9 June 2026

Speaker Key (delete/anonymise if not required): 

HOST:                         JACQUES STRAUSS

CARMELA:                 CARMELA MINISCALCO

ANNA-CLARA:           ANNA-CLARA REINHOLDSON

MUSIC PLAYS: 0:00:00-0:00:13

HOST:                      0:00:13 Welcome to the RCSLT podcast. My name is Jacques Strauss. This is an IJLCD edition in which we talk to authors of articles that have appeared in the International Journal of Language and Communication Disorders. Today, we are looking into research that connects the dots between autism, how kids pronounce words, and their overall language development. 

We’re joined by two of the authors of the paper titled, Speech Sound Error Patterns May Signal Language Disorders in Swedish Pre-school Children with Autism – Carmela Miniscalco and Anna-Clara Reinholdson. I started by asking them to introduce themselves.

CARMELA:              0:00:53 My name is Carmela Miniscalco and I’m a speech and language pathologist since more than 40 years and I work both clinically and at the university here in Gothenburg. I am a professor in logopedics but mainly work with children with neurodevelopmental disorders. My interest in clinical research and teaching are language and communication development and the occurrence of language difficulties and language disorders in children with autism and in other clinical groups. I also have been working within the child healthcare services for many years.

ANNA-CLARA:        0:01:34 I am Anna-Clara Reinholdson and I am also a speech and language pathologist or therapist and I have worked for almost 40 years. We have known each other for a very long time and worked together. I am working clinically and interested in speech, language and communication problems with children, severe problems, and also in the field of neuropsychiatric, neurodevelopmental disorders. I’m working at our clinic here for almost 20 years as a speech and language pathologist.

HOST:                      0:02:18 I asked Carmela and Anna-Clara about the clinical question they were trying to answer and what the existing literature had to say. For a long time there was an assumption that children with autism either didn’t speak or if they did their speech was actually better than their overall language skills.

ANNA-CLARA:        0:02:36 Well, the literature is saying that children with autism, they always have communicative problems, as Carmela said, and always also language problems. There have been studies about this but it’s not so well known about their problems with speech sounds. There is also some literature about that but it’s not clear what the incidence of it is and how it’s related the speech output from the children to language and also to the nonverbal abilities, cognitive abilities [to the 0:03:24] children. 

There are in the literature something when we started with this, well, about ten, more than ten years ago, there was things written about it in the international literature, in Swedish literature not as much. We had an assumption that the speech was related to language. It was before often said that the children had either not any speech with autism or if they had speech it was often better than their language.

CARMELA:              0:04:07 Or only delayed, not deviant.

ANNA-CLARA:        0:04:10 Right.

HOST:                      0:04:10 Right.

ANNA-CLARA:        0:04:11 But our clinical experience was that it is much like the DLD children. 

CARMELA:              0:04:19 Language disorder.

ANNA-CLARA:        0:04:20 Language disorder children without autism, we could see similarities.

HOST:                      0:04:26 To get to the bottom of this the researchers looked at a cohort of 73 pre-school children with autism aged between 4 and 6 years old. To understand the nuances of their language, they divided these children into three distinct groups based on their nonverbal abilities and their language abilities. Here is how that breaks down. First, we have the autism language normal group, or ALN. These children had both normal nonverbal abilities and normal language abilities and they made up about 23% of the study. Second there is the autism language disorder group, or ALD. These children had normal nonverbal cognitive abilities but showed a language delay or disorder. This was the largest group representing 40% of the kids. Third, the autism and general delay group, or AGD. These children experience both a nonverbal cognitive delay and a language delay or disorder, making up the remaining 37%. 

                                 What’s immediately striking here is that when you combine those last groups around 75% of the children in this autism cohort had some form of language delay or disorder. The researchers then tested these children using three different speech sound measures, including looking for atypical speech sound error patterns. I asked Anna-Clara what they found.

ANNA-CLARA:        0:05:54 The findings was that both the children which were generally delayed and the children which was language delayed but not generally delayed they showed atypical speech error patterns significantly more often than children with normal language and normal non-verbal abilities.

CARMELA:              0:06:19 We believe that this measure has not been used in Sweden at least in order to describe the phonological system among children with ASD. What this paper adds, as we write in this paper, is that children with ASD and language disorders also had problems with speech sound error patterns. Because when we collapsed the two groups, autism with language disorder and autism with general delayed, they constituted 75% of this group that we looked into.

ANNA-CLARA:        0:06:56 What is also interesting is that the two other measures PCC, percentage of consonants correct, and consonant inventory didn’t differentiate the children, the groups, in that way. It was this third measure with the processes, speech pattern processes, that differentiated and that we found very interesting.

HOST:                      0:07:28 Atypical speech sound errors were a major red flag for broader language disorders. I asked Carmela why it’s so important for speech and language therapists to be aware of this and she introduced a fascinating concept, diagnostic overshadowing.

CARMELA:              0:07:44 If you have autism, you stop looking at every other aspect of a child’s functioning and we think it’s important to acknowledge all areas of a child’s functioning in order to direct intervention. I know [research has talked about 0:08:04] when comorbidity occurs it is likely to require separate treatment so that makes a rationale for SLTs or SLPs to be in these kind of multidisciplinary teams that we have been working in for more than 20 years. 

I think the SLTs should make use of the DSM-5 that indicates that you must specify not only intellectual or cognitive level among these children, as has been done for many, many years by psychologists, but also you have to specify language level. I think we should take that ball and use that in order to have access to these children because they need us. 

HOST:                      0:09:00 To give a practical sense of just how profound these language differences were at age five, Carmela highlighted the results of a narrative assessment they used.

CARMELA:              0:09:09 I think we need to address the result on the bus story mean length of utterance or sentence length because at five years of age I think the autism generally delayed group spoke in one word sentences and the ALD group, autism with language disorder, used three words per sentence. This is a finding that shows that they have a lot of problems also with grammar and structure but we haven't looked into this right now in this paper.

HOST:                      0:09:46 You said it’s similar to developmental language disorder patterns?

CARMELA:              0:09:49 Yeah.

ANNA-CLARA:        0:09:50 Yeah.

HOST:                      0:09:51 While the study was incredibly revealing the authors did note that a limitation of this kind of research is the sheer diversity of the children involved. Some children were minimally verbal while others were highly verbal which meant different assessment tools had to be used. Finally I asked, what is the take home message for therapists working with these populations today?

ANNA-CLARA:        0:10:12 Well, as you said, Carmela, not letting the autism diagnosis overshadow the language problems and the speech problems, that you should address them, work with them. Also it’s important to be acquainted and to have knowledge about autism when you are making intervention because you have to think about being, for example, more concrete in your language and to really show, not just talk, and think of…

CARMELA:              0:10:49 Exactly, because we talked the other day about a patient who was here because he had reading and writing difficulties. Then when I assessed this child I just said, you have to put your finger between the words when you write. Then he started to have spaces between the words and it was just out of the blue that I said this but it helped him to understand. We need to take the autism into account because they have problem with auditory attention, auditory awareness, rigidity, and they have this detail-focused style. One word can only mean one thing and not synonyms for example. We have to both be very skilled in autism and in language in order to help these children I think.

HOST:                      0:11:49 A very big thank you to Carmela and Anna-Clara for joining us. You can find the link to the full paper in the show notes. Until next time, keep well. 

MUSIC PLAYS: 0:11:58-0:12:05

END OF TRANSCRIPT: 0:12:10