Communication, whether through gestures, eye gaze, or speech, is impaired to one degree or another in all children with autism. Some children may be mute, others may have relatively minor limitations of their ability to speak, but all lack awareness and use of the social meaning of language and nonverbal communication.

Conclusions:

• The ability to communicate is key to improving behaviour.

• Core communication skills developed in natural settings are more useful to the child and family than "cue-dependent" responses.

• Progress in language acquisition should be seen within 2 to 3 months; otherwise a new intervention should be tried.

• Naturalistic approaches work best to help generalize language from clinic to home, school, and community.

Recommendations:

• The focus should be on the individual child using single-case design research to determine his/her needs and then design a treatment program.

• Research is needed to determine whether the child’s ability to engage in joint attention and to use symbols is predictive of what program would produce the best outcomes for the child and for the family.

• Research is needed to find out which interventions lead to spontaneous use of language and the ability to generalize other skills.

• Research is needed into what family variables enhance or detract from a child’s success in learning communication skills.