Inner speech therapy shows promise for easing autistic children's emotional dysregulation

Children on the autism spectrum, often at odds with their own emotions, may find help in an unlikely place: their own inner voice, according to MedicalXpress.

A team from the University of Pittsburgh and collaborators tested a novel intervention designed to train autistic children in developing internal speech—and the results suggest it may reduce emotional dysregulation.

Emotional outbursts and difficulty with self-control can disrupt the lives of many autistic children and their families. Traditional therapies rarely focus on the language children use with themselves, the internal dialogue that helps regulate emotion and behavior in neurotypical development.

Prior research has shown inner speech supports problem-solving and self-regulation, yet many autistic individuals seem to lack this internal toolset.

In the study, "Developing Inner Speech to Help Autistic Individuals Improve Their Self-Regulation Ability: A Pilot Randomized-Controlled Trial," published in Autism Research, researchers designed and evaluated a new therapy called Thinking in Speech (TiS), aiming to teach autistic children how to engage in inner speech to manage emotional reactions.

Twenty-two autistic children, ages 7–11, were recruited from the Pitt+Me Registry and randomized into immediate or delayed therapy groups. Nine certified speech-language pathologists, who had completed an 11-hour TiS training, delivered the intervention through sixteen 30-minute telehealth sessions across eight to 10 weeks.

Therapists modeled internal dialogue for the children during challenging moments, helping them recognize frustration cues and verbalize problem-solving strategies. For example, when a child struggles, the therapist might say, "This is what 'hard' feels like," followed by prompting the child to say, "I need help." The approach centered on affirming the child's perspective and offering language as a coping tool.

Caregivers completed standard emotion regulation measures before and after the sessions. The study used a crossover design in which each child eventually received the therapy, allowing researchers to compare periods with and without TiS for the same participants.

Significant improvements appeared on the Emotion Dysregulation Inventory's Dysphoria scale (F=5.49, p=0.008), and marginally on the Reactivity Index (F=2.57, p=0.089). Improvements were observed in both groups once TiS was introduced, although gains in the immediate group were not maintained at the 10-week follow-up.

With a small cohort, no active comparison group, and no direct measurement of inner speech, the results remain preliminary. Still, the initial result is intriguing and a fully developed TiS may offer a way to help autistic children name and navigate their emotions. By modeling how to speak to oneself, therapists could be giving children a voice they never knew they had—inside their own minds.