Thinking in Speech (TiS): A Promising New Approach for Emotional Dysregulation in Autistic Children
Tuesday, June 17, 2025 this is for Vinny, who is like a grandson to me.
A new study in Autism Research shows that a novel self-talk therapy called Thinking in Speech (TiS) may reduce emotional distress in autistic children.
Let’s explore why strengthening inner speech might support emotional regulation—and why this approach could transform autism therapy as we know it.
What if the missing link in helping autistic children manage their emotions isn’t stricter rules or more behavioral charts—but language?
Not scripted language. Not “use your words” when the meltdown is already happening.
But the private kind of language: the inner monologue most neuro-normative folks take for granted.
Such as:
“This is hard, but I’ve got this.”
“I feel overwhelmed— and I need help.”
A New Voice for Emotional Regulation
A new pilot study in Autism Research finds that autistic children who strengthen their inner speech may improve their ability to regulate emotions.
The intervention at the heart of the study, called Thinking in Speech (TiS), offers a humanizing, practical way to support emotional well-being in neurodivergent children—and it was created by an autistic therapist herself.
Thinking in Speech: Modeling, Not Managing
Janice Nathan, a speech-language pathologist who received her autism diagnosis in adulthood, developed TiS based on her private practice with autistic children. The therapy doesn’t aim to “fix” behavior. It aims to build an internal toolkit for emotional reflection and problem-solving.
Instead of instructing children on what to think or feel, TiS therapists model how to respond when emotions rise. For instance:
Therapist: “This is what hard feels like.”
Child (guided): “I need help.”
Over time, children begin to internalize these reflections, using them to guide themselves through distress.
This isn’t ABA. It’s not sticker charts. It’s reflective language as emotional scaffolding.
Study Design: What the Research Found
Researchers tested TiS on 22 verbal autistic children, ages 7–11, all with formal diagnoses.
Each received 16 half-hour therapy sessions via telehealth. The children were split into two groups: one started therapy immediately; the other began after a 10-week delay.
Sessions were delivered by certified speech-language pathologists who underwent an 11-hour training in the TiS method.
Caregivers were present during sessions, and children chose from preferred activities to ensure a child-centered, collaborative approach.
Measures included:
Executive functioning questionnaires
Repeated caregiver feedback at 3 time points (pre-, mid-, and post-therapy)
Key Results:
Dysphoria (emotional unease) significantly decreased after therapy.
Emotional reactivity also improved, especially in older children.
Executive control did not change significantly—but children felt better emotionally.
No adverse effects were reported, and engagement was high.
The goal wasn’t to make kids act better. It was to help them feel better—and that’s where true regulation begins.
Why Inner Speech Matters in Autism
Research has shown that autistic children may develop inner speech differently than their neurotypical peers.
A 2012 study found that autistic children were less likely to use inner speech for planning or problem-solving (Williams et al., 2012), which may contribute to difficulties with emotional regulation.
But inner speech isn’t fixed—it can be taught, modeled, and strengthened.
Inner speech helps with:
Self-soothing in stressful moments
Problem-solving through emotional overwhelm
Delay of gratification
Planning and reflection
By making inner speech explicit and teachable, TiS empowers children to develop their own emotional compass.
From Compliance to Communication
Traditional behavioral therapies often emphasize compliance—reducing meltdowns or increasing "appropriate" behavior. But TiS flips the script:
It assumes the child is trying, not defiant.
It prioritizes internal process, not external performance.
It’s about language, not obedience.
As study co-author Barry R. Nathan put it:
“Autism is neurological, not ‘behavioral.’ There’s a lot of research that backs this up.”
When a child melts down, they aren’t choosing chaos. They’re reaching the edge of their current regulatory vocabulary—and TiS helps expand that vocabulary from within.
Caveats and Next Steps
This was a small pilot study, and its limitations are important:
All participants were verbal, white, and had access to telehealth.
The study did not directly measure inner speech.
Self-esteem, a core value in Janice Nathan’s work, was not measured.
Therapists often failed to communicate strategy clearly to caregivers, something the authors plan to address in future training.
Still, therapist fidelity was high, family engagement was strong, and the results point toward a potentially transformative intervention.
A Humanizing Shift in Autism Therapy
TiS doesn’t ask children to be more "normal." It asks adults to become better models of emotional language—to speak their thoughts out loud in moments of difficulty so children can learn how that’s done.
It’s respectful, developmentally thoughtful, and radically child-centered.
TiS is not about suppressing feelings. It’s about teaching kids how to name them, navigate them, and ask for what they need.
And in a world where so many autism therapies still focus on performance over experience, that shift is long overdue.
Call to Action
Parents, therapists, and educators: If you work with autistic children who struggle with emotional distress, consider this question—
Are you trying to manage their behavior, or are you helping them build the language tools they need to manage themselves?
Want a simple way to learn more?
Drop me a line for a free guide to this compelling new language tool.
And I’ll send you a step-by-step printable guide on the argument for trying TiS-style prompts with the kids in your care.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Alderson-Day, B., & Fernyhough, C. (2015). Inner speech: Development, cognitive functions, phenomenology, and neurobiology. Psychological Bulletin, 141(5), 931–965. https://doi.org/10.1037/bul0000021
Baumann, B. L., Nathan, J., Nathan, B. R., Sheynblyum, M., Copeland, V. C., Mazefsky, C. A., & Eack, S. M. (2024). Developing inner speech to help autistic individuals improve their self-regulation ability: A pilot randomized-controlled trial. Autism Research. Advance online publication. https://doi.org/10.1002/aur.3155
Fahy, J. K. (2014). Language and executive functions: Self-talk for self-regulation. SIG 1 Perspectives on Language Learning and Education, 21(1), 61–71. https://doi.org/10.1044/lle21.1.61
Kimhi, Y. (2014). Theory of mind abilities and deficits in autism spectrum disorders. Topics in Language Disorders, 34(4), 329–343. https://doi.org/10.1097/TLD.0000000000000032
Lidstone, J. S. M., Meins, E., & Fernyhough, C. (2012). Verbal mediation of cognition in children with specific language impairment. Development and Psychopathology, 24(2), 651–660. https://doi.org/10.1017/S0954579412000226
Lombardo, M. V., Chakrabarti, B., Bullmore, E. T., Sadek, S. A., Pasco, G., Wheelwright, S. J., Suckling, J., & Baron-Cohen, S. (2010). Atypical neural self-representation in autism. Brain, 133(2), 611–624. https://doi.org/10.1093/brain/awp306
Mazefsky, C. A., Yu, L., White, S. W., Siegel, M., & Pilkonis, P. A. (2020). The Emotion Dysregulation Inventory: Psychometric properties and item response theory analysis in youth with and without autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 49(4), 529–543. https://doi.org/10.1080/15374416.2018.1561296
Mizuno, A., Liu, Y., Williams, D. L., Keller, T. A., Minshew, N. J., & Just, M. A. (2011). The neural basis of deictic shifting in linguistic perspective-taking in high-functioning autism. Brain, 134(8), 2422–2435. https://doi.org/10.1093/brain/awr171
Sinha, P., Kjelgaard, M. M., Gandhi, T. K., Tsourides, K., Cardinaux, A. L., Pantazis, D., ... & Held, R. M. (2014). Autism as a disorder of prediction. Proceedings of the National Academy of Sciences, 111(42), 15220–15225. https://doi.org/10.1073/pnas.1416797111
Uddin, L. Q. (2011). The self in autism: An emerging view from neuroimaging. Neurocase, 17(3), 201–208. https://doi.org/10.1080/13554794.2010.509320
Wallace, G. L., Peng, C. S., & Williams, D. L. (2017). Interfering with inner speech selectively disrupts problem solving and is linked with real-world executive functioning. Journal of Speech, Language, and Hearing Research, 60(11), 3456–3460. https://doi.org/10.1044/2017_JSLHR-L-17-0011
Westby, C., & Robinson, L. (2014). A developmental perspective for promoting theory of mind. Topics in Language Disorders, 34(4), 362–382. https://doi.org/10.1097/TLD.0000000000000034
Williams, D. M., Bowler, D. M., & Jarrold, C. (2012). Inner speech is used to mediate short-term memory, but not planning, among intellectually high-functioning adults with autism spectrum disorder. Development and Psychopathology, 24(1), 225–239. https://doi.org/10.1017/S0954579411000788