How does speech and language therapy approach literal interpretation and figurative language in autism?
Autism can affect how people understand spoken language, and the NHS explains that many autistic people take phrases literally, find sarcasm difficult to interpret and may miss clues in tone or facial expression. According to the NHS, these challenges can affect communication at school, work, home and in healthcare, and speech and language therapy can support understanding in ways that reduce stress and misunderstanding.
Understanding the concept
Literal interpretation is a natural communication style for many autistic people. The NHS notes that autistic people may take everyday idioms or jokes at face value and may need extra processing time or clearer wording. The National Autistic Society adds that sarcasm, implied meaning and indirect hints can be confusing or stressful, and that autistic communication is often more direct, precise or detailed than non autistic styles.
The National Autistic Society also highlights the double empathy problem, where communication difficulties arise between autistic and non autistic people. This means support should focus on mutual understanding rather than attempting to change autistic communication into something it is not.
Evidence and impact
Guidance from the NICE adult autism guideline recommends avoiding metaphors, idioms and jokes and using concrete, unambiguous language because many autistic adults interpret language literally. NICE also advises that interventions should include explicit rules, structured tasks and clear explanations, supporting understanding of figurative expressions that might otherwise be confusing or overwhelming.
Evidence reviewed by NICE shows that social learning and psychosocial interventions can improve communication, although studies targeting figurative language directly are limited. According to the National Autistic Society, autistic people may struggle with sarcasm, jokes and “reading between the lines”, meaning therapy often focuses on building comprehension through clear examples, visuals and strong context rather than expecting intuitive inference.
Peer reviewed research provides additional insight.
- A 2022 cognitive-linguistic study found that autistic adolescents showed reduced accuracy in interpreting metaphors and idioms when tasks relied heavily on contextual inference, supporting SLT use of explicit teaching and visual scaffolding.
- Another study examining figurative-language processing in autistic children and adults reported that metaphors and irony were more difficult when understanding required integrating emotional cues or social context. The authors concluded that structured explanation and concrete supports improved comprehension.
Together, these findings sit alongside the approaches recommended by the National Autistic Society, the RCSLT and NICE: communication should be adapted to the autistic person’s preferred style, with therapy focused on supporting understanding rather than forcing neurotypical communication norms.
Practical support and approaches
Speech and language therapists, as outlined by the RCSLT, work with autistic people of all ages to support understanding, expression and social communication in ways that feel authentic and respectful. Therapy may include:
- explaining figurative expressions with real examples, visuals or scenarios
- identifying ambiguous phrases used in school, work or healthcare
- developing scripts or preferred responses for confusing situations
- supporting the person to ask for clarification confidently
- encouraging communication partners to use clear, direct wording
The National Autistic Society advises that non autistic people should avoid idioms or sarcasm unless explained, while the Newcastle Hospitals guidance recommends concrete language, extra processing time and visual tools such as social stories and comic strip conversations. These strategies help reduce misinterpretation without encouraging masking.
Challenges and considerations
The National Autistic Society warns that stereotypes, such as assuming autistic people lack humour or empathy, often arise from misinterpreting literal responses. The Newcastle Hospitals guidance suggests that teaching someone to mimic non autistic communication styles can increase stress and mental health risks. NICE notes that evidence for adults is limited, so therapy should be individualised, transparent and co produced.
How services can help
The NHS explains that reasonable adjustments such as clear language, written information and extra processing time can support autistic adults in education, work and healthcare. Speech and language therapists, guided by the RCSLT and NICE, help autistic people understand figurative language when they choose to work on it, develop self advocacy skills and communicate preferences to others. This can also include communication passports and collaboration with family, schools or employers to reduce ambiguity in day to day interactions.
Takeaway
Literal interpretation is a valid and often effective communication style. When figurative language causes stress or misunderstanding, speech and language therapy can offer practical, neuro affirming tools to support clearer communication. Drawing on guidance from the NHS, NICE, the National Autistic Society, the RCSLT and Newcastle Hospitals, therapy focuses on reducing barriers and promoting understanding. This article provides general information and is not a substitute for individual clinical advice.
If you or someone you support would benefit from early identification or structured autism guidance, visit Autism Detect, a UK-based platform offering professional assessment tools and evidence-informed support for autistic individuals and families.
