Introduction to the Forum: Intersectional Approaches to Language in Autism

As members of the allied health professions, speech-language-hearing professionals have an ethical responsibility to serve all in the population who seek clinical services and engage in research activities without discrimination (American Speech-Language-Hearing Association [ASHA], 2023). This duty is explicated within the ASHA Scope of Practice in Speech-Language Pathology (ASHA, 2016) and Audiology (ASHA, 2018), as well as the certification standards for each discipline (ASHA, 2020a, 2020b). These professional guidelines and standards have significant implications for providing quality of care to an increasingly diverse population. According to estimates derived from the 2020 Census (U.S. Census Bureau, 2021), the U.S. population is increasingly diverse, with over 40% of a racial or ethnic background other than White and non-Hispanic.¹ Globally, people of color are the majority (Henrich et al., 2010). These increases in racial and ethnic diversity coincide with increases in the diagnosed prevalence of autism. In the United States, this includes one in every 30–34 racially and ethnically minoritized youth and one in every 41 White youth (Maenner, 2023). Globally, approximately 15%–20% of the population is neurodivergent, which includes conditions where brains are wired and function differently in development, such as autism and attention-deficit/hyperactivity disorder (Centers for Disease Control and Prevention, 2024a, 2024b; Doyle, 2020). Altogether, this is the population we must serve. Given this charge, this forum focuses on new conceptual and methodological approaches to autism in speech-language-hearing practice and research.

These approaches are important, because while health and healthcare equity gaps for autistic people have been reduced, many gaps remain (Hughes et al., 2023; Liu et al., 2023; Kasambira Fannin et al., 2024; Schott et al., 2021; Shaw et al., 2022). Currently, ASHA-certified practitioners and members are not demographically representative of the U.S. population, with just 9.5% belonging to racially minoritized groups and 7% of Hispanic, Latinx, or Spanish origin (ASHA, 2024a). This nonrepresentativeness limits our quality of care. For instance, only about 8% of ASHA members are multilingual (ASHA, 2024b), even though 22% of people in the U.S. population speak a language other than English at home (U.S. Census Bureau, 2022). Autism research is similarly nonrepresentative, as reflected in school-based, evidence-based practice (Steinbrenner et al., 2022; West et al., 2016) and language studies (Girolamo et al., 2024). To provide quality of care, we must strive to incorporate diverse worldviews and emerging practice strategies (McNeilly, 2018). The experiences of each individual are not representative of those across the world or even similar to the experiences of another person (Tervalon & Murray-Garcia, 1998). This forum focuses on perspectives from multiple disciplines, personal and professional experiences, and methodologies for approaching language and communication in autism.

We begin with a viewpoint by Coles-White et al. (2025), who outline key considerations for the provision of neurodiversity-affirming care to Black autistic clients. As in autism research more broadly, even as attention to neurodiversity grows, there is inadequate attention to the intersectionality of race with autism (Jones & Mandell, 2020; Maye et al., 2022). While prior work brings attention to structural inequity for minoritized people in U.S. legal history and special education (Annamma et al., 2013; Crenshaw, 1989, 1991), Coles-White et al. highlight ways that experiences of Blackness can intersect with experiences of autism and other neurodivergences and how these intersections should inform clinical practice. Importantly, there is no one-to-one correspondence between race and experience (Plaut, 2010). Rather, to promote health equity, practitioners must approach service delivery from a place of cultural humility (ASHA, n.d.; National Institute on Minority Health and Health Disparities, 2024). It is this mindset that promotes ethical care.

Next, Coburn (2024) presents considerations for how speech-language pathologists may support autistic adults, regardless of whether they have been formally diagnosed. Per the Scope of Practice in Speech-Language Pathology and Audiology, practitioners and researchers must support communication access needs for each individual (ASHA, 2016, 2018). If we do not assess all areas of communication where a person may want support—regardless of formal diagnosis— we will not see those areas of need (Adlof & Hogan, 2019). As Coburn (2024) notes, speech-language-hearing professionals must be ready to work with self-diagnosed autistic people, which includes treating them with respect and dignity. Neither speech-language services nor federal legislation for disability (U.S. Department of Justice, n.d.) require a formal medical diagnosis of autism. Rather, we must support people where they are now by attending to individual communication profiles to inform clinical planning.

Then, Abubakare and Snedeker (2025) describe the results of a study investigating personal pronoun comprehension and how it relates to theory of mind (ToM) in autistic adults. Using experimental psycholinguistic tasks, findings showed that autistic and non-autistic adults each interpreted ambiguous pronouns with high levels of accuracy. Inspection of performance patterns revealed similar strategies, and groups had similar language skills. These findings provide an empirical example of how to intentionally reconsider stereotypes about autism, ToM, and language skills. While these skills are closely intertwined (e.g., Gernsbacher & Yergeau, 2019), speech-language-hearing professionals have the responsibility of integrating new research evidence with clinical expertise and client perspectives to update our understandings and provide the highest possible quality of care.

Addressing a key gap in the research literature on experiences of autism across cultures and languages, Papas et al. (2025) report a qualitative study about the experiences of an indigenous Yucatec Mayan family with a minimally-speaking autistic child. Using ethnographic interviews and natural language processing, this study examines their experiences, perspectives, and needs. It is not that these considerations only apply to one specific language or to Maya languages and cultures. Rather, this study provides a critical lens for evaluating how individual communication patterns interact with multiple levels of environment: interpersonal interactions, community access, and social norms (Bronfenbrenner, 1977; Hernández et al., 2023). Parental and cultural expectations for the development and treatment of autistic children vary across the globe, but the vast majority of participants in autism-related research belong to Western, English-speaking cultures (de Leeuw et al., 2020).

Moving into clinical assessment, Steinbrenner et al. (2025) explore the use of the Early Communication Indicator–Autism (ECI-A) across racial and ethnic groups. Findings from 215 racially and ethnically diverse caregivers of young autistic children (ages 1–5 years) showed that use of the ECI-A was feasible, and researchers and caregivers across racial and ethnic groups each reported similar ease of use. However, careful inspection of data revealed racial disparities in researcher-reported ease of use for Black and White caregivers, as well as fidelity for Latino and non-Latino caregivers. These findings from the ECI-A have broader implications for careful interpretation and use of assessment (Messick, 1989), especially amid recent reports of practitioner bias in health-care interactions with Black and minoritized families (Onovbiona et al., 2024; Weitlauf et al., 2024). Altogether, lifelong reflection is needed to provide effective, equitable services to all in the population (ASHA, 2023; Tervalon & Murray-Garcia, 1998).

Our hope is that this forum spurs discussion on the many aspects of identity that influence working with autistic people in practice and research. From scholarly perspectives on intersectional considerations for serving Black autistic clients to responsivity to the individual goals of people seeking communication support, readers may update their thinking about what it means to provide neurodiversity-affirming care. In turn, empirical studies of theory of mind and language in autistic adults, experiences of autism across languages and cultures, and use of communication assessments across racial and ethnic groups provide important new evidence for speech-language-hearing professionals. Together, these articles offer new directions for thinking about how to improve health equity (National Institute on Minority Health and Health Disparities, 2024).