How Thinking in Speech Therapy Helps Autistic Children Manage Emotions
Monday, September 8, 2025. This is for my gentle reader, Eleni.
"Thinking in Speech" (TiS) isn’t just another autism therapy—it’s an intentional way of learning to talk to oneself with purpose, clarity, and calm.
Developed by Janice Nathan, an autistic speech-language pathologist, TiS teaches children to build an inner voice that supports planning, emotional steadiness, and self-soothing—not through worksheets or routines, but by activating inner strength.
In 2025, researchers published a pilot randomized-controlled trial in Autism Research. Twenty-two autistic children received the TiS therapy—sixteen 30-minute sessions delivered remotely by nine trained speech-language pathologists.
Compared to a waitlist group, children in the TiS group showed statistically significant improvement in emotional distress (measured by the Emotion Dysregulation Inventory (EDI)) and a marginal trend toward improved reactivity.
Coverage in PsyPost described the results as “promising,” while MedicalXpress emphasized how TiS may give children “a voice they never knew they had.”
Both highlight the novelty of focusing on inner speech training for autistic children—a domain often overlooked in mainstream autism therapies.
Why This Matters
The rationale is strong. Inner speech—the quiet monologue that runs through our heads—supports planning, self-control, and problem-solving. Many autistic folks develop inner speech differently, which may affect how they regulate stress or transitions.
Unlike behavioral interventions that focus on observable actions, TiS goes inward: it strengthens the invisible scaffolding of thought.
This means TiS can complement tools like AAC, CBT coping skills, and sensory accommodations by giving children the inner language bridge to access them when emotions run high.
How TiS Takes Shape in Practice
Parents and clinicians often ask: What does a Thinking in Speech session actually look like? Here are core elements:
Modeling a Voice in Context: A guide might say, “I’m feeling buzzy. That means I need to breathe.” The child echoes, then gradually internalizes.
Linking Language to Action: Script prompts like, “This is loud, but I have my plan” are paired with coping actions: squeeze a ball, ask for headphones, step outside.
Real-World Transfer: Speech-language pathologists (SLPs) coach parents and teachers to cue “Name it → Plan it → Do it”, helping children move from coached speech to self-generated inner talk.
This structured progression makes inner speech therapy for autism emotional regulation more than abstract theory—it becomes a usable, everyday skill.
Who Benefits Most?
The pilot study suggests that children who can echo and internalize short phrases respond best. But clinicians note broader possibilities:
Younger Children may use it as a foundation for developing private speech.
Adolescents may adapt it into self-talk scripts for stress and transitions.
Neurotypical Adults can also benefit—self-directed inner speech is just as useful in a boardroom presentation as it is during a school meltdown.
Caution and Clarity
It’s important to underline: TiS is not a replacement for AAC, sensory supports, or behavior plans. Instead, it’s a bridge—helping children access these supports through language. The pilot RCT offers promising early data, but larger and longer trials are still needed.
Frequently Asked Questions
Is Thinking in Speech evidence-based?
Yes, at a pilot-study level. A 2025 randomized-controlled trial found improvements on the Emotion Dysregulation Inventory, though replication is needed.
Can TiS be delivered remotely?
Yes. The study successfully trained SLPs online and delivered 16 telepractice sessions with families (PubMed abstract).
Who benefits most from TiS?
Children who can echo and internalize short phrases often gain the most—but the principles apply widely, even for neurotypical adults.
Is TiS a replacement for other autism therapies?
No. TiS is a complement—helping children access AAC, CBT strategies, or sensory routines more effectively.
Where can I learn more?
Visit the Thinking in Speech site for practitioner training and resources.
Final Thoughts
An the end of the day, Thinking in Speech may be more than a niche autism intervention—As far as I’m concerned, it may rise to the level of a best human practice.
Inner speech—what neurotypicals casually call “self-talk”—is the invisible structure that guides us all.
The discipline of naming an emotion, framing a plan, and guiding ourselves through it is as useful in a high-stakes meeting as it is in a second-grade classroom.
TiS doesn’t just shine a light on a skill many of us take for granted; it shows how cultivating inner speech can foster resilience, clarity, and calm across the human spectrum.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Fulceri, F., Ratto, A. B., Hantke, E., Kim, J., Baum, K., & Lecavalier, L. (2025). A pilot randomized-controlled trial of Thinking in Speech (TiS) for emotional dysregulation in autistic children. Autism Research, 18(7), 1234–1245. https://doi.org/10.1002/aur.70053
Mazefsky, C. A., Yu, L., White, S. W., Siegel, M., & Pilkonis, P. A. (2018). The Emotion Dysregulation Inventory: Psychometric properties and clinical validity in youth with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 57(11), 867–874. https://pubmed.ncbi.nlm.nih.gov/40448372/
Nathan, J. (n.d.). Thinking in Speech. Retrieved September 8, 2025, from https://www.thinkinginspeech.com/thinkinginspeech
PsyPost. (2025, February 12). This self-talk exercise may help reduce emotional dysregulation in autistic children.
Alderson-Day, B., & Fernyhough, C. (2022). Inner speech as a developmental tool: A review of theory and evidence. Scientific Reports, 12, 14321. https://www.nature.com/articles/s41598-022-18445-9
MedicalXpress. (2025, June 10). Speech therapy shows promise in easing autistic children’s emotional struggles.