It is so important that you talk to and about your patient with kindness and respect. With individuals who lack expressive language, you will need to talk “about them” in front of them. You will interview the parent/caregiver to find out what you need to know about medical history, pain, habits, etc. just as you do with small children. I cannot stress enough the importance of speaking positively and respectfully. Yes, many individuals with autism also have cognitive impairments and may not understand what we say. On the other hand, so many of these individuals do understand what we say and it can be harmful to your relationship with them and their self-esteem when the clinician says things like, “it must be so hard to have a child with autism,” or “you have a real challenge here.”
Remember these concepts are not black and white. I have several patients with very low expressive language and fairly good receptive language but struggle to understand what I am asking them to do. They smile or giggle when I tease them and understand when I am asking them to choose between two different options (like a toothbrush), but when I ask them to complete a task (turn your chin towards me, open wide) they may not initially respond to what I am asking them. It takes practice. I have also noticed individuals with autism understand more when it is coming from someone they know. For example, my son and I can be in an appointment with a therapist and the therapist may say to my son, “sit down” and he may stay standing, and then I will say the exact phrase, “sit down” and immediately he sits. For the first several visits it may be you, the clinician, giving an instruction, and the parent or caregiver repeating it, and then the patient completing the task. Be patient and consistent and soon they will be “in tune” with your voice and understand your instructions.