The communication of people with autism spectrum disorder (ASD) is characterized by a qualitative impairment in verbal and non-verbal communication. In past decades a growing body of descriptive studies has appeared on language and communication problems in ASD. Reviews suggest that the development of formal and semantic aspects is relatively spared, whereas pragmatic skills are considered to be specifically impaired. This unique profile was interpreted mainly within the framework of the theory of mind hypothesis, which links the social-communicative problems of people with autism to an incapacity to attribute mental states to themselves and others. This approach has proven useful, but has also left many questions unanswered. In more recent publications, limited intentionality and symbol formation have been identified as core problems in ASD. Problems in symbol formation in particular might be better understood from the viewpoint of the central coherence hypothesis, which conceptualizes ASD as a weaker drive for the integration of information. Possible links between cognitive findings and communication evoke new perspectives with respect to the complex of communication problems in ASD. The reader of this manuscript will be able to (1) describe the communication deficit in ASD; (2) discuss the central coherence account of ASD in relation to problems in sense-making; and (3) explain how these difficulties might lead to problems in communication in autism.
