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Phonological investigation of speech sound
errors in children with autism spectrum
disorders
Lesley Wolk1, Christine Brennan 2
1
Long Island University, New York, 2Northwestern University, Illinois

Few studies have explored the comorbidity of autism and articulation/phonological disorders. In this study,
phonological analyses were performed on eight children with autism. Speech elicitation included object
naming and a connected speech sample. Data analyses involved phonetic inventory, phonological
process analyses, and percentage consonants correct. Results showed that all eight children exhibited
both delayed phonological behavior as well as some atypical phonological processes. Findings also
revealed a strong relationship between severity of phonological behavior and severity of language
impairment. Group comparisons showed that children with moderate–severe language impairment
exhibited more typical and atypical phonological processes than children with mild–moderate language
impairment, and overall correlation between phonological severity and language impairment was high.
The findings contrast with some earlier studies but support and extend recent research showing unusual
phonological trends in some children with autism.
Keywords: Phonological disorder, Speech sounds, Phonological process, Autism

Introduction speech elicitation tasks. Third, there may be difficulty

Children with autism spectrum disorders (ASDs)
exhibit communication difficulties that include impair-
ments in receptive language, expressive language, and
pragmatic abilities. Problems in functional communi-
cation are often central. Typically, these children
lack the desire and/or skills for communicative
effectiveness, often resulting in severe difficulty estab-
lishing social connectedness. Research and interven-
tion pertaining to communication deficits in children
with ASD usually focus on improving receptive
and expressive language and pragmatic abilities.
Historically, there has been a paucity of research inves-
tigating the articulatory/phonological aspects of
childhood autism, and only recently has this important
area begun to receive empirical attention.
Several reasons for the paucity of research have been
suggested. First, research has indicated that articula-
tion is a relative strength in this population when
compared to other speech and language behaviors
(e.g. Rapin and Dunn, 2003). Second, it is challenging
to collect speech sound data from this population due
to both cognitive and social/behavioral limitations.
These limitations may include cooperation, desire,
attention span, echolalia, and other factors impeding
Correspondence to: Lesley Wolk, PhD, Long Island Univ, CW Post
Campus, 720 Northern Boulevard, Brookville, NY, 11548, USA. Email:
lesleywolk@sbcglobal.net
obtaining a representative speech sample due to
limited speech output. Fourth, accurate transcription
of data may be complicated by frequent use of
jargon and poor intelligibility. Fifth, verbal self-stimu-
latory behavior and extraneous noises could also nega-
tively affect the accuracy of data analysis. Finally, it
stands to reason that in the more severely impaired
less verbal children, articulatory skills would be less
of a priority than simply stimulating language output
(Wolk and Giesen, 2000).
Several earlier studies noted the presence of articula-
tory difficulties in children with autism (e.g. Boucher,
1976, Largo and Schinzel, 1985). From these studies, it
was concluded that the articulatory development in
children with autism may be slower than in normally
developing children (e.g. Bartak et al., 1975; Roberts
et al., 2005, Wilkinson, 1998). By contrast, some
researchers found autistic children’s articulatory and
phonological skills to be normal (e.g. Bartolucci
et al., 1976; Kjelgaard and Tager-Flusberg 2001).
Tager-Flusberg (1981, 1996) studied early com-
munication behavior in infantile autism. Kjelgaard
and Tager-Flusberg (2001) studied the speech behavior
of 89 children with ASD, using a one-word naming
task to elicit speech sounds. They concluded that
‘among the children with autism there was significant
heterogeneity in their language skills, but across all the

© W. S. Maney & Son Ltd 2013

DOI 10.1179/2050572813Y.0000000020 Speech, Language and Hearing 2013 VOL. 16 NO. 4 239
Wolk and Brennan Phonological investigation in autism
children, articulation skills were spared’ ( p. 287).
Shriberg et al. (2001) compared 15 males with high
functioning autism (HFA) to 15 males with Asperger
Syndrome (AS) and 53 comparison subjects. In
addition to measures of prosody and voice, six
indices of phonological behavior were used, including
percentage of consonants correct, occurrence of errors
involving diphthongs, and an intelligibility index.
They found no significant differences in severity of
sound errors across the three groups. However, the
mean age of participants in this study (19 years in
the AS and HFA groups) was significantly older
than in many other studies of children with ASD. In
addition, more in-depth analysis of phonological pro-
cesses was not reported.
McCleery et al. (2006) compared the consonant
production patterns of 14 severely language delayed
children with autism to those of 10 typically develop-
ing children. Speech elicitation was done primarily by
single consonant imitation, and sounds produced were
rated based on the extent to which they were develop-
mentally early sounds versus later sounds. In-depth
phonological investigation, including a phonological
process analysis, was not used. Although the sample
size is somewhat small, results suggested that this
severely impaired group of children exhibited the
same general speech sound patterns typically seen in
normally developing and language learning impaired
children.
In a recent study to investigate articulation/
phonological impairments and language function in
children with ASD, Rapin et al. (2009) used cluster
analysis to evaluate both language and phonology in
62 children (mean age = 8.6 years). Findings suggested
two main subtypes of language disorders, one with
severe impairment in expressive phonology (24%)
and the other with borderline/normal phonological
skills but impaired comprehension (76%). Thus, one
in four children with ASD showed significant phono-
logical impairment. However, because detailed analy-
sis of sound errors was not reported, this study does
not provide information about the extent to which
these children presented with normal delayed versus
unusual/disordered patterns of phonological behav-
ior. However, given the relatively large sample size
used, it is an interesting finding.
In another study addressing the relationship
between language function and articulation in
autism, McCann et al. (2007) investigated prosody
and language skills in 31 children with high-function-
ing autism. They found that all children had at least
one aspect of prosody affected, and that prosody
correlated highly with language abilities. However,
results suggested little impairment in phonological be-
havior in these children. Although data on the
relationship between language measures and
240 Speech, Language and Hearing 2013 VOL. 16
articulation were not clearly reported, the authors
suggested that there was no relationship between
language and phonological impairment. They con-
cluded that ‘phonology is not a common area of diffi-
culty in children with autism’.
In contrast, several studies using more detailed pho-
nological analyses have suggested more significant
speech sound impairment in children with ASD. In
one of the first papers to use a detailed phonological
analysis, Wolk and Edwards (1993) reported a case
study of an autistic child (B.D., age 8.3 years) with
both delayed receptive and expressive language skills.
Phonetic inventory data showed that all stops, front
nasals, glides, and one liquid /l/ were present in his
repertoire. Approximately half of all possible frica-
tives, both affricates, velar nasal /ŋ/, and liquid /r/
were absent in his phonetic inventory. Some later to
develop sounds were present whilst earlier ones were
absent. B.D. exhibited both typical (e.g. final conso-
nant deletion) and atypical phonological processes
(e.g. glottal replacement and atypical cluster
reduction). The evidence of multiple phonological pro-
cesses, process interactions, use of homonymy, and the
use of jargon, resulted in severely reduced intelligibil-
ity. Wolk and Edwards concluded that B.D. was
acquiring his phonological system in a unique way,
with a pattern of acquisition rarely seen in normally
developing children. This was an important early
finding on a single case of childhood autism.
In a later case study design, Wolk and Giesen (2000)
studied four siblings with autism. All four siblings
exhibited a well-structured, rule-governed phonologi-
cal system. Phonetic inventory data showed wide
individual variation. However, each child showed aty-
pical speech sound development not commonly
observed in normally developing children. For
example, in one child the bilabial nasal /m/, a
sound very early to develop, was absent from his
inventory, whereas other nasals, several fricatives, as
well as affricates were present. Phonological process
analyses across all four children showed both typical
(e.g. liquid cluster reduction, liquid gliding, final con-
sonant deletion) and atypical (e.g. velarization, frica-
tion of stops and liquids, segment coalescence)
phonological behavior. Interestingly, the speech of
the sibling with the mildest symptoms of autism was
characterized mainly by typical phonological pro-
cesses that would be seen in normal development. In
contrast, the speech of the more severely impaired sib-
lings was characterized by both typical and atypical
phonological processes. These findings supported
those of the single case study reported above.
Few studies have used an in-depth phonological
approach to examine speech sound production in
larger samples of individuals with autism. Cleland
et al. (2010) used a one-word naming task in 69
NO. 4

children with HFA or Asperger syndrome. They
reported that although 41% of children showed some
speech sound errors, only 12% of children scored in
the range indicating a phonological disorder.
Phonological process analysis showed gliding, cluster
reduction, and final consonant deletion occurred
most frequently. Interestingly, atypical processes or
‘non-developmental error types’ were also evident,
including phoneme specific nasal emission and initial
consonant deletion. The authors note that these pro-
cesses were evident not only in children with severe
phonological impairment, but even in some with pho-
nological behavior in the ‘normal’ range.
The literature review to date, as discussed above,
shows how several of the group studies have failed to
carry out sufficiently detailed phonological analyses.
It is important to note that further investigation is
needed to evaluate the power of the findings from
larger sample studies against the predominantly
smaller case studies which did use detailed analyses
and found some unusual phonological behavior.
Furthermore, these studies that used detailed analyses
did not make comparisons with phonologically disor-
dered children without autism. Thus, there is no clear
information to date about how children with autism
may differ from phonologically impaired children
without autism on the evidence of atypical phonologi-
cal features. However, there are data to support evi-
dence of a smaller likelihood of atypical features in
normally developing children (Bernthal et al., 2009).
In summary, there is growing support to suggest evi-
dence of disordered phonological patterns in some
children with autism. Further, while some children
with autism may exhibit the same general speech
sound production patterns as typically developing
and language learning impaired children, there is evi-
dence from studies utilizing in-depth phonological
analyses that some children with autism may also
exhibit more atypical speech patterns (Cleland et al.,
2010; Wolk and Edwards, 1993; Wolk and Geisen,
2000). Existing research on phonological disorders in
children with autism is still very preliminary and
more studies including children with more severe
deficits and larger sample sizes are needed.
The primary purpose of the current investigation
was to extend previous work on articulatory/
phonological behaviors in children with ASD. The
hypothesis was that at least a subgroup of these chil-
dren exhibit not only delayed but atypical phonological
patterns. In-depth phonological analysis of the speech
sound production was conducted in order to better
understand the specific sound errors in eight children
with autism. Second, because research on the relation-
ship between cognitive/language measures and phono-
logical behavior has been mixed, a secondary purpose
Wolk and Brennan Phonological investigation in autism
was to examine the relationship between phonological
behavior and language measures in children with ASD.
Method
Participants
Participants were eight children (five male, three
female) with ASD, ages 5.3–15.1 years (M = 7.9).
Participants were from different schools and different
families except for two who were siblings. Each child
was diagnosed with ASD between ages 3 and 6
years. All participants were currently receiving
private speech therapy and ongoing special education
services at school. All children communicated verb-
ally, although two used supplemental Augmentive
and Alternative Communication (AAC) technology
to support language development and communi-
cation, primarily during school activities.
Participants were recruited from the private speech
and language clinic of the second author. Of 15
clients in this clinic who had a diagnosis of ASD, 14
were verbal. Three of the 14 were exceptionally high
functioning and exhibited no language or speech
impairment, and were not recruited for participation.
Of the 11 remaining, 8 agreed to participate in the
study. Notably, none of the children who were
recruited for this study had phonological impairment
as part of their current treatment program at the
clinic or at their respective schools.
Language assessment
All participants completed standardized language
testing. For the two youngest children, the Preschool
Language Scale – fourth edition (PLS, 2002) was
used to obtain receptive and expressive language
scores. The PLS was also used for two older children
who, due to cognitive and language limitations, were
unable to participate in tests standardized for their
ages. Thus, although age equivalencies were obtained,
standardized scores could not be determined due to
the age limitation of the tests. The Clinical
Evaluation of Language Fundamentals-Preschool
(CELF-P, 2004) was administered to three partici-
pants, and for the oldest child the Clinical Evaluation
of Language Fundamentals-4 (CELF-4, 2003) was
administered. All testing was conducted by the
second author, a certified and licensed speech-
language pathologist.
Speech assessment
In-depth assessment of speech production was
conducted by two trained speech-language pathol-
ogists. Two methods were used for speech elicitation:
(1) object naming, using the Assessment of
Phonological Processes (APP, Hodson, 1986); and (2)
conversational speech sample. For the children who
demonstrated higher language formulation skills,
Speech, Language and Hearing 2013 VOL. 16 NO. 4 241
Wolk and Brennan Phonological investigation in autism
they were engaged in conversation. For children with
greater language impairment and mean length of
utterance less than three, language samples were
obtained using a picture description task. During the
APP, an attempt was made to elicit 50 words per
child. Because of the inherent difficulties obtaining a
speech sample from children with ASD, some items
were elicited using delayed imitation. Additionally,
some items were deleted if too unintelligible to
analyze accurately or if it was unclear if the child
was using the correct word. All speech elicitation
was video-recorded for later transcription and coding.
Behavioral assessment
For the purpose of this study, only a perfunctory
behavioral assessment was believed to be necessary,
to enhance the overall understanding of the partici-
pants. Behavioral information was collected for all
participants, including spontaneous communication
and sentence production, self-regulation of behavior,
comprehension of stories, comprehension of abstract
language, sensory integration issues, and presence of
echolalia. Analysis of behavioral information was
predicted to be associated with the severity of language
and/or phonological difficulty.
Language delay
Because different language assessments were used
based on individual age or ability, a measure of
percent language delay was used to quantify language
impairment and to have a means to compare the
children across ages and test measures. All participants
exhibited some degree of impairment on expressive
and receptive language measures. Percent was calcu-
lated using age equivalencies on assessment batteries
completed. The percentage below age expectations
were calculated for receptive and expressive language.
Each participant had comparable delay in receptive
and expressive language; therefore, the mean was
used as the index of language delay.
The eight participants were then divided into two
groups using a median split based on severity of
language impairment. The mild language delay
group (MLD, n = 4) had a language delay less than
38%; participants in the severe language delay group
(SLD, n = 4) had a language delay 42% or higher
(see Table 1). Mean age for the MLD participants
was 6.6 years (range 5.25–7.42) and included two
females and two males. SLD participants were older,
with a mean age of 9.4 years (range 5.25–15.08) and
included one female and three males.
Data analysis
Three levels of analyses were conducted: (a) phonetic
inventory, (b) phonological process analyses, and (c)
percent consonants correct (PCC; see Shriberg and
242 Speech, Language and Hearing 2013 VOL. 16
Kwiatkowski, 1982). Inter-rater reliabilities for
coding participant responses were 100%. The phonetic
inventory established a baseline for which sounds each
child was able to produce and were evident in his/her
productive speech output. The criterion used for pres-
ence or absence in the phonetic inventory was more
than one instance of use. The phonological process
analysis determined which phonological processes were
exhibited, and frequency and percentage of occurrence
were calculated. A phonological process was considered
present if it occurred more than once. Furthermore,
every time a particular sound, for example fricative,
was present in any position in the target word, it was
considered an opportunity for the particular process to
occur. For example, in the case of final consonant del-
etion, if a fricative was deleted in word final position,
it could also have had the opportunity for stopping of
fricatives and therefore been counted as part of the stop-
ping process. Phonological processes were divided into
common (typical) and uncommon (atypical) phonologi-
cal processes. Common processes refer to those that are
more typically present in normally developing children,
whereas uncommon processes refer to those processes
less likely to occur in normally developing children
(Bernthal et al., 2009). Percentage occurrence was calcu-
lated based on the number of opportunities for each
process to be exhibited. For example, if 20 words had
final consonants and a child deleted a final consonant
in 10 words, the percentage occurrence would be
coded as 50%. The number of phonological processes
along with the percent language delay appears in
Table 1.
Results
Typical and atypical phonological processes
All children showed evidence of some normally devel-
oping but delayed phonological processes (Table 2).
Across children, 11 typical delayed phonological
processes were observed, as follows: stridency deletion,
liquid assimilation, fronting, gliding, stopping, post-
vocalic devoicing, reduplication, final consonant
deletion, weak syllable deletion, vowelization, and
pre-vocalic voicing. All participants also exhibited
some atypical phonological processes not often
observed in typical development. Specifically, the
following 13 atypical processes were observed across
children: deaffrication, migration, palatalization, pre-
vocalic devoicing, post-vocalic voicing, syllable
coalescence, backing, metathesis, epenthesis, initial
consonant deletion, medial consonant deletion, and
vowel deviations (see Table 2).
An analysis of the data using the PCC yielded
similar results. Across participants there was a wide
range of PCC, ranging from a low of 0.27 to a high
of 0.90. A group comparison using the
NO. 4
 Wolk and Brennan Phonological investigation in autism

Table 1 Percent language delay and total number of phonological processes for participants in the MLD and SLD groups

MLD (mild–moderate language delay) SLD (severe–profound language delay)

Participant # Percent delay Number of processes Participant # Percent delay Number of processes

1 0.17 10 2 0.88 18
3 0.34 7 4 0.42 17
5 0.33 10 7 0.70 18
6 0.38 5 8 0.75 19

Mann–Whitney test was significant, with MLD par- compared to participants in the SLD group (M =
ticipants having a higher PCC than SLD participants 5.75; Z = 2.381, P < 0.05). Similar differences were
(P < 0.05). observed for atypical processes, with MLD children
exhibiting fewer atypical phonological processes
(M = 3.25) than SLD children (M = 7.25; Z = 2.323,
Relationship between language impairment and
P < 0.05). Results are illustrated in Fig. 1.
phonological processes
To examine language delay as a continuous
When divided into MLD and SLD groups, differences
variable, correlation coefficients were computed to
emerged in terms of number and nature of phonologi-
examine the relationship between percent language
cal processes. Because of the small sample size and use
delay and the number of phonological processes exhib-
of percentage data, group comparisons were calculated
ited by all eight participants. There was a strong
using non-parametric T-tests with Bonferroni correc-
significant positive correlation (r = 0.77, P < 0.025),
tion. MLD participants exhibited fewer typical/
showing that the children with the greatest percent
delayed phonological processes (M = 3.00) as

Table 2 Proportions and percentage occurrence of typical processes, atypical processes, and cluster reduction, per child by
group

Group MLD MLD MLD MLD SLD SLD SLD SLD

Participant 1 3 5 6 2 4 7 8
Total number of processes 10 7 10 5 18 17 18 19
No. of typical processes 3 2 4 3 6 5 6 6
No. of atypical processes 5 3 4 1 7 7 6 9
No. of cluster reductions 2 2 2 1 5 5 6 4
Stridency deletion (%) 0 0 0 0 0 0.316 0 0
Liquid assimilation (%) 0 0 0.083 0 0 0 0 0
Fronting (%) 0 0 0 0 0 0.017 0 0
Gliding (%) 0.11 0.167 0 0 0.063 0 0.02 0.133
Stopping (%) 0.031 0.07 0.02 0 0.097 0 0.068 0.019
Post vocalic devoicing (%) 0 0 0 0.012 0 0.017 0.02 0.057
Reduplication (%) 0 0 0 0 0.2 0 0.02 0.038
Final consonant deletion (%) 0.105 0 0.025 0.323 0.708 0.044 0.09 0
Weak syllable deletion (%) 0 0 0.167 0.217 0.161 0 0.4 0.05
Vowelization (%) 0 0 0 0 0 1 0 0.9
Pre-vocalic voicing (%) 0 0 0 0 0.032 0 0 0
Deaffrication (%) 0 0 0 0 0 0.6 0.09 0
Migration (%) 0 0 0 0.012 0.129 0.017 0 0.075
Palatization (%) 0 0 0 0 0 0.017 0 0
Pre-vocalic devoicing (%) 0.038 0 0 0 0 0 0.045 0.057
Post Vocalic Voicing (%) 0 0 0 0 0 0 0 0.019
Syllable coalescence (%) 0 0 0.055 0 0.067 0.158 0.13 0.05
Backing (%) 0.02 0.045 0.02 0 0.194 0.017 0 0.018
Metathesis (%) 0.02 0.045 0.058 0 0.067 0.017 0 0.057
Epenthesis (%) 0 0 0 0 0.032 0 0.16 0.339
Initial consonant deletion (%) 0.04 0 0 0 0.31 0 0.02 0.019
Medial consonant deletion (%) 0 0.143 0 0 0 0 0
Vowel deviations (%) 0 0.136 0 0 0.387 0.1 0.34 0.245
Affrication (%) 0.02 0 0 0 0 0 0 0
Atypical ICR (%) 0 0 0 0 0.643 0.39 0.59 0.25
Typical MCR (%) 0.286 0.2 0.11 0 0 0.143 0.222 0.375
Atypical MCR (%) 0 0 0 0 0.57 0 0.555 0.375
Typical FCR (%) 0.3 0 0.455 0.07 0.25 0.286 0.286 0
Atypical FCR (%) 0 0 0 0 0.625 0.143 0.429 0

Note: The number of processes, typical and atypical processes and cluster reduction are presented in proportions and the specific
processes are presented in percentages.
MLD, mild language disorder; SLD, severe language disorder; ICR, initial cluster reduction; MCR, medial cluster reduction; FCR, final
cluster reduction.

Speech, Language and Hearing 2013 VOL. 16 NO. 4 243

Wolk and Brennan Phonological investigation in autism
Figure 1
language delay also exhibited the highest number of
phonological processes (Fig. 2). Additional correlation
coefficients were computed to examine the relationship
between severity of language impairment and the
percent occurrence for both typical and atypical
processes. Percent language delay correlated signifi-
cantly with the percentage occurrence of three atypical
phonological processes: metathesis (r = 0.739), vowel
deviations (r = 0.883), and atypical initial cluster
reduction (r = 0.878). It should be noted, for
example that since the highest use of metathesis in
any of the eight children was 0.067 ( just under 7%)
and the total sample from the APP was limited to
100 words or less, the total opportunities for potential
targets for metathesis may have been only a few words.
Total number of target words differed for the potential
for each process to occur and this is the nature of this
type of analysis. Thus, for example atypical cluster
reduction was much higher for these children, but
also had a larger number of opportunities for
occurrence.
Figure 2
244 Speech, Language and Hearing 2013 VOL. 16
Cluster reduction
Due to the number and importance of cluster
reduction, these data were analyzed separately.
Cluster reduction was categorized into typical and aty-
pical patterns based on the patterns typically observed
in normal development. MLD participants exhibited
fewer cluster reduction processes overall than children
in the SLD group (Z = 2.381, P < 0.05). However,
when broken down by cluster reduction process type,
SLD children exhibited more atypical cluster reduction
processes than MLD children (Z = 2.494, P < 0.025),
while the difference in typical cluster reduction pro-
cesses was non-significant (see Fig. 3).
Discussion
The purpose of this study was to investigate the speech
sound production abilities in eight children with ASD.
Results showed that all eight children exhibited
delayed phonological behavior, consistent with pre-
vious findings (e.g. Bartak et al., 1975; Cleland
et al., 2010; Paul, 1987; Wolk and Giesen, 2000).
Further, the current findings support prior research
showing that some children with ASD also exhibi
some atypical phonological processes not commonly
observed in normal but delayed development
(Cleland et al., 2010; Wolk and Edwards, 1993;
Wolk and Geisen, 2000). Specifically, the following
eight atypical phonological processes were observed:
initial consonant deletion, epenthesis, metathesis,
syllable coalescence, post vocalic voicing, prevocalic
devoicing, and vowel deviations.
This study reveals that some children with ASD
exhibit unusual phonological trends. This finding cor-
roborates the findings in two earlier studies (Wolk
and Edwards, 1993; Wolk and Giesen, 2000). It is par-
ticularly interesting that in the study on multiple sib-
lings, Wolk and Giesen (2000) found that among the
four siblings studied the more severe cases (referring
to non-linguistic autistic features) exhibited more
Figure 3
NO. 4

unusual sound patterns whereas the milder ones
showed more normal processes typical of delayed
phonological behavior. It is possible that some pre-
vious studies may not have shown the same finding
of unusual phonological trends because they did not
include more severely impaired children. This issue of
severity is critical for future studies to examine. When
phonological processes were evaluated in more detail
by examining cluster reduction separately, particularly
interesting findings emerged. In children with mild–mo-
derate language impairment, no atypical cluster
reduction processes were observed. However, children
with severe language delay exhibited an equal
number/frequency of typical and atypical cluster
reduction processes. It is noteworthy that out of all
eight children, for all processes examined, there are
only five instances where a child is using any process
more than 50% of the time. Apart from clusters, 92%
of the cells show less than 20% occurrence of that
process. This may be partially affected by the relatively
limited verbal output of some of these children.
The current investigation also reveals a strong
relationship between severity of phonological behavior
and the severity of language impairment. This is a
replication and extension of the classical correlation
seen in developmentally delayed children. Group com-
parisons revealed that children with mild–moderate
language impairment (MLD) exhibited more phono-
logical processes overall when compared to the more
severe language impaired group (SLD). When
broken down by process type, this pattern held true
for both typical and atypical processes. Participants
with more severe language delay also exhibited a
higher occurrence of cluster reduction processes with
more atypical cluster reduction patterns than children
with more mild language impairment. Analysis using
the PCC as an overall index of phonological impair-
ment yielded consistent results. Future research inves-
tigating the relationship between phonological and
language behavior and severity will help to confirm
and extend these findings. Future studies would need
to look in similar detail at children with language dis-
order without autism to see whether similar findings
on cluster behavior may be evident.
Clinical observation suggested that the MLD group
exhibited milder behavioral characteristics than the
SLD group. These included self-regulation of behav-
ior, comprehension of abstract stories and complex
rules/routines, and mild sensory integration difficul-
ties in the MLD group. Behavioral characteristics in
the SLD group include poor self-regulation of behav-
ior, poor comprehension of stories, marked difficulty
with abstract language, moderate–severe sensory inte-
gration issues, and echolalia in the SLD group.
In addition to the primary findings regarding
phonological processes and relationship to language,
Wolk and Brennan Phonological investigation in autism
we observed that two participants exhibited unusual
voicing patterns. Consistent with the findings from
Wolk and Geisen (2000), which noted unusual
voicing patterns in some participants, the current
investigation also found unusual voicing in two
participants (one in the MLD and one in the SLD
group). Both of these participants exhibited an
unusual pattern of devoicing words, with some
words produced completely without voicing, regard-
less of articulation error. For both children, speech
was more like a whisper for those words. The partici-
pant with less delayed language exhibited devoiced
words in 35% of elicited words, while the subject
with a greater language delay exhibited devoiced
words in 88.6% of elicited words. Although making
a comparison of only two subjects results in very
limited conclusions, these findings in voicing dysfunc-
tion were consistent with other trends observed in this
study regarding relationship between speech sound
production and language delay.
The findings of this study contrast with some earlier
studies, but support and extend the findings of other
studies showing unusual phonological trends in some
children with autism. Previous work using in-depth
phonological analyses used primarily single subject
designs (e.g. Wolk and Edwards, 1993), and few have
examined the relationship between speech sound and
language behavior in this population. Studies using
larger sample sizes or comparison group designs
have typically relied on one-word naming or imitation
tasks to elicit speech (e.g. Kjelgaard and Tager-
Flusberg, 2001; McCleery et al., 2006) or have
lacked detailed phonological analysis beyond general
indices of speech sound errors (e.g. Rapin et al., 2009;
Shriberg et al., 2001). Other studies (e.g. McCann
et al., 2007) investigated speech errors only among chil-
dren with high-functioning autism, and thus a restric-
tion in range may have limited the ability to find a
relationship among these measures. Only one study
has examined the extent to which phonological impair-
ments relate to language delay in children with ASD
(Rapin et al., 2009) but, again, detailed analysis of pho-
nological behavior was not reported.
Future research employing larger sample sizes
would help to (a) clarify the nature of the speech
sound difficulties in children with autism; (b) continue
to explore the differences between mildly and more
severely language impaired children with respect to
speech sound production skills; (c) determine
whether detailed phonological investigations may be
useful for diagnostic assessments; and (d) determine
whether phonologically based treatment programs
may be optimal for at least a subset of children with
ASD. Many of these clinical implications are appli-
cable to all children with speech disorders.
Speech, Language and Hearing 2013 VOL. 16 NO. 4 245
Wolk and Brennan Phonological investigation in autism
Generalization of the present findings is limited due
to small sample size. In this context, it should be noted
that three potential participants were not recruited for
the study because of no obvious phonological impair-
ment. Thus, the present sample was skewed in the
direction of children exhibiting a phonological dis-
order. However, the three children not recruited for
study also had stronger language skills; thus, their
inclusion would have reduced the overall occurrence
of phonological impairments but would have
preserved or even strengthened the relationship
found between phonological and language delay. It
should also be noted that there are limitations in the
method that was employed in this study for calculating
the degree of language impairment. This is because
some of the older children were not within the age
range of some of the tests administered and therefore,
standardized scores were not available for all children.
The limitations of age equivalent scores are well
known, so that a 2-year delay in a 5-year old may be
more significant than a 2-year delay in a 15-year old.
Given the large age range of the sample used in this
study, there are limitations in the use of the age-
based delay measure that should be noted for future
studies using similar methodologies.
Despite these limitations, the data provide evidence
that children on the autism spectrum with more severe
language impairments exhibit more speech sound
difficulties, exhibit more phonological processes,
have a higher frequency of occurrence of these pro-
cesses, and exhibit more atypical phonological pro-
cesses than children with more mild forms of autism.
It should be noted that insufficient empirical evidence
exists to date to comment on whether the rate of occur-
rence of phonological processes discussed, especially
atypical processes, are significantly higher or lower
than would be expected in a sample of children with
speech sound disorders without autism.
Clinical implications of the present findings extend to
both diagnosis and treatment. Diagnostic assessments
of children with ASD, who exhibit speech sound diffi-
culties, should include detailed phonological investi-
gations, just as would be indicated for any child where
speech intelligibility limits his/her communication.
Clinicians should be aware that children with more
severe forms of autism, especially those with more
severely impaired language and behavior, may some-
times exhibit more atypical phonological processes. If
children with ASD present with speech sound difficul-
ties, it stands to reason that detailed phonological inves-
tigations would be helpful in the diagnostic assessment
and inclusion of the phonological component in treat-
ment would be implied.
246 Speech, Language and Hearing 2013 VOL.
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Acknowledgments
The authors wish to thank Dr Andrew Meisler for his
comments and suggestions as well as much appreci-
ated support and guidance in the final drafts of this
manuscript. The authors also thank Dr Robert
Domingo for his thoughtful suggestions.
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