Speak, or Remain Undiagnosed

A Familiar Answer

More and more adults are only beginning, in their late twenties or thirties, to suspect that they might be autistic — sometimes alongside ADHD, or trauma that was never named. When they look for an assessment, many make what sounds like a small request: could we do this in writing? Send the history in advance, and handle the questions as an exchange of text?

The answers tend to sound alike. The clinician can be genuinely accommodating. You may turn your camera off. You may type your answers in the chat. You may use live translation. If a question is unclear, I can type it out. But one thing is not negotiable: there must be a scheduled, live video consultation in which the clinician asks the questions aloud. The reasons usually come in three words: clinical, legal, billing.

At first glance this seems reasonable. Diagnosis is serious; a face on a screen feels more reliable than a few emails. And the patient is allowed to type — so where, exactly, is anyone being made to speak?

The answer is that "speaking" here is not one requirement but three. The patient may have to answer with their voice. The patient may have to take in questions that arrive mainly as speech. And the patient may have to understand, organise and reply on someone else's clock, in a live exchange that does not wait. Permission to type removes the first. It does not necessarily remove the other two. Even when patients are allowed to type, the consultation may still require them to process spoken questions and respond in real time. When this essay says speak, it means that whole package.

Put the people being assessed next to the method of assessment, and an awkward structure appears. For some of the people seeking assessment, rapid, live, spoken exchange is itself a substantial barrier; and the entrance to assessment is precisely rapid, live, spoken exchange.

When Live Speech Becomes a Barrier

This is not rhetoric. Over the past decade and a half, a number of researchers — many of them autistic themselves — have studied what actually makes healthcare hard for autistic adults.

The AASPIRE team at Portland State University, led by Christina Nicolaidis and Dora Raymaker, works through community-based participatory research, with autistic people involved from design to publication. In a 2015 qualitative study, participants explained bad healthcare experiences in many ways, but one explanation recurred with particular frequency: "Providers' unwillingness to allow patients to communicate in writing" (Nicolaidis et al., 2015). The study itself allowed participants to be interviewed by email and instant messaging. The researchers practised what they were studying.

Two years later the same group published a barriers-to-healthcare checklist. Among autistic respondents, 32% endorsed this item: "not being able to process information fast enough to participate in real-time discussions about healthcare" (Raymaker et al., 2017). Another item on the instrument reads almost as if written for this essay: a provider not being willing to communicate in the way the patient needs — for example, writing things down rather than saying them.

Mary Doherty, Sebastian Shaw and colleagues — a team that includes autistic doctors, based in Ireland, the UK and the US — ran an international online survey of 507 autistic adults in 2022. Seventy-eight percent tried to avoid phone calls; 30% tried to avoid face-to-face verbal communication; 41% found written communication easier (Doherty et al., 2022). At the University of Bristol, Philippa Howard and Felicity Sedgewick titled their study "Anything but the phone!" and concluded that "services should move away from a reliance on phone calls for communication" (Howard & Sedgewick, 2021).

There is a further layer that is easy to miss. It is tempting to assume that anyone who can speak has no difficulty speaking. Alyssa Hillary Zisk and Elizabeth Dalton point out that "Autistic people who use speech may experience intermittent, unreliable, and/or insufficient speech," and their recommendation is direct: "Overall communication-rather than speech-should be prioritized" (Zisk & Dalton, 2019). When AASPIRE defined autistic burnout, loss of skills — including speech — was one of its core features (Raymaker et al., 2020).

A boundary should be stated here. ADHD and trauma bring communication difficulties of their own, and they are not necessarily the same as those described above; the research cited in this section is overwhelmingly about autistic adults. The argument is sharpest where the evidence is deepest, and this essay does not assume it transfers unchanged to other groups.

Put these findings side by side and the shape is clear. For a substantial share of the people seeking assessment, keeping up with a live, spoken exchange with a stranger — whether or not they answer aloud — is exactly where the difficulty lives. Making it the condition of entry turns the symptom into the gate.

What Does "the Law" Actually Require?

The word that most deserves scrutiny is "legal." Patients who hear "this is a legal requirement" usually stop asking. So what does the law require?

Germany as a case

German physicians are bound by the professional code of their regional medical chamber. In Bavaria, § 7(4) of the current code reads, in essence: doctors advise and treat patients in personal contact and may use communication media in support; exclusive advice or treatment via communication media is permitted in individual cases if this is medically justifiable, provided due care is maintained in how findings are gathered, advice and treatment are given and documentation is kept, and the patient is informed about the particularities of exclusively remote care (Bayerische Landesärztekammer, 2025).

This wording comes from the 2018 loosening of Germany's former ban on exclusively remote treatment (Deutsches Ärzteblatt, 2018). The crucial question is what "communication media" means. The Federal Medical Association's official commentary lists them plainly: telephone calls, emails, video telephony, text messages, letters (Bundesärztekammer, 2019). At the level of professional regulation, there is no rule that the medium must be video. Written care is permissible in principle, provided the doctor judges it medically justifiable.

Where, then, does "spoken" come from? The only binding legal provision found in this research that explicitly requires something to be oral is the Civil Code's rule on informed consent: before a patient consents to a medical measure, the treating professional must inform them orally, supplemented by written material where appropriate (§ 630e BGB). The Federal Medical Association considers telephone or video sufficient for this, and email alone insufficient (Bundesärztekammer, 2019, 2021).

Three limits on this provision are rarely spelled out:

1. It is a duty of disclosure tied to consent to a medical measure. That can include diagnostic measures, so the diagnostic process is not automatically outside it; but it regulates what the doctor must explain, not how the patient must answer the questions of an assessment.
2. The party who must speak is the doctor, not the patient. The law wants the doctor to explain and the patient to have the chance to ask; nothing in it requires the patient to answer aloud.
3. The duty can lapse if the patient expressly waives the disclosure (§ 630e(3) BGB). This is not a shortcut around the rest of the assessment: waiving a disclosure does not waive the clinical assessment, identification or any other step the doctor considers necessary. The point is only that this provision, too, is about the doctor's explanation, not the patient's answers.

At most, this supports scheduling a stretch of the doctor speaking. It does not, on its face, require that the entire assessment consist of the doctor asking questions aloud and the patient answering in real time.

As for billing: German private fees may only be charged for services the doctor has "personally" provided (GOÄ § 4(2)) — but "personally" does not mean "synchronously." The Federal Medical Association's 2020 billing recommendations include an item for consultation by email (Bundesärztekammer, 2020). The real difficulty is that an in-depth written psychiatric assessment has no ready-made entry in the fee schedule and would have to be billed by analogy, which may be disputed by insurers. That is billing inconvenience, not legal prohibition. For a self-paying patient who will not claim reimbursement, the risk of an insurer disputing the bill largely disappears — though the fee schedule itself still governs how the doctor may charge.

Beyond these provisions lies individual caution. Whether professional liability insurance covers remote care is, by the Federal Medical Association's own account, not assured, and doctors are told to check with their insurer beforehand (Bundesärztekammer, 2021). That is reasonable self-protection. It is not a "legal requirement."

Not just Germany

One might object that Germany is a special case. So set several countries side by side. A caution first: the rows do not compare like with like. They mix statute, professional regulation, clinical guidance, payer conditions and licensing rules, because the constraint sits at a different level in each place. The table shows where it sits, not that the eight systems are equivalent.

Jurisdiction	General requirement of live video or speech found in the rules reviewed?	Written / asynchronous care	What actually constrains it
Germany	None found	Permitted if medically justifiable	Unclear billing route; insurance
United Kingdom	None found	Remote formats are recognised; suitability, adequate assessment and two-way dialogue remain required (GMC guidance on prescribing)	Regulator guidance — which also requires "reasonable adjustments" for communication needs
United States	None found for diagnosis as such; federal law targets online prescribing of controlled substances	Widely permitted by states; California law expressly includes asynchronous store-and-forward	Medicare requires real-time interaction — audio-video, or audio-only at home when the patient cannot use or does not consent to video; licensure follows the patient's state
Canada (Ontario)	None found	Permitted; the regulator's definition includes email, text, non-real-time	Licensure follows the patient's location
Australia	None found (guidance only)	Asynchronous prescribing where the doctor "has never spoken with the patient" is not supported	Public insurance covers video and telephone items
Netherlands	None found	Written e-consultation is a routine form	None identified in the sources reviewed
France	Not found for care as such — the Code says telemedicine may be used to establish a diagnosis, without fixing the medium; synchronous oral communication is required in prescription-related rules	For doctor–patient care, the medical council and health authority call for audio-video	Rules on online prescribing platforms and on reimbursement of prescriptions
Japan	Yes, for online care. From April 2026 the Medical Care Act defines online care by "video and audio"	Online care may not be completed by text, photos or recorded video alone; such exchanges are allowed only as supplements (ministry guidelines)	The law and ministry guidelines

(Sources for each row are listed under References.)

In the sources reviewed, only Japan, of the eight, writes real-time audio-video into the legal definition of online care and its ministry guidelines say that online care may not be completed by text, photos or recorded video alone. France writes "oral communication" into law, but only in rules about prescriptions: online services whose main business is issuing prescriptions may do so only after a "communication orale synchrone, en vidéotransmission ou téléphonique" with the patient (CSP L6316-1), and prescriptions made in a teleconsultation are reimbursed only on the same condition (CSS L160-8). The same article says telemedicine "permet d'établir un diagnostic" — it allows a diagnosis to be made — without naming a medium. That shows only that French law recognises remote diagnosis; it does not by itself rule out constraints set elsewhere, and the implementing decrees beyond R6316-1 were not reviewed in full here. Elsewhere, regulatory documents tend to count email, messaging or asynchronous formats as forms of remote care, or at least do not exclude them. What they guard against is "a questionnaire with no two-way dialogue," not "a patient who does not speak." The UK's General Medical Council goes further: doctors "must take steps to meet patients' language and communication needs" and should "offer reasonable adjustments that are proportionate to the circumstances" (GMC, 2024).

What actually narrows the door are three kinds of rule: payers that only reimburse video or telephone (the US, Australia, France), licensure tied to where the patient is, and rules on prescribing, especially controlled drugs. Each has its reasons. They can bind diagnostic services too — a doctor without the right licence may not assess at all. But none of them, in the sources reviewed, requires the patient to answer aloud — and none establishes one universal format for the whole assessment either. That does not mean a live session is never required; it means the requirement has to be located. A clinic should be able to say which rule applies, to which part of the assessment, and why. Collapse all of this into one phrase and it becomes the sentence "the law requires a live spoken consultation."

To be fair: doctors are generally free to decline a patient (in Bavaria, BO § 7(2)), and declining a fully written assessment is very likely not unlawful. The argument here is not that any clinician breaks the law. It is, first, that "legal requirement" tends to bundle real but specific constraints together with convention, billing convenience and risk aversion, and present the bundle as a single non-negotiable rule; and second, that the practical effect is to keep out precisely those who most need to communicate in writing.

Two Objections

Objection one: direct observation cannot be replaced.

This is the strongest argument. The UK's NICE guideline on autism in adults does recommend that assessors "carry out direct observation of core autism features especially in social situations" (NICE, 2021). That should be conceded.

But the same guideline also asks assessors to take communication needs into account and to provide communication aids where needed (NICE, 2021). And a single observation in an unfamiliar setting has its own bias. A case report — of a preschool child, so its reach is limited — warns that selective mutism and severe social anxiety "can mimic autism spectrum disorder (ASD) when assessment relies heavily on observations in unfamiliar contexts" (Dowling et al., 2026). The general lesson is modest but relevant: behaviour observed in one unfamiliar setting may need checking against other settings. Fifty minutes in front of a stranger's screen is not a neutral window.

Conceding the value of observation also does not settle what form the whole assessment must take. It helps to separate three things. Much of the diagnostic information — developmental history, current difficulties, accounts from people who know the patient — can be gathered in writing beforehand. Some observation may genuinely require synchronous contact. And synchronous contact need not take the form of rapid spoken question and answer. The objection supports the second point; it does not, by itself, require the first and third to be done by voice. Others have noted that procedures such as the ADOS-2 "are rooted in the medical model and do not always sit comfortably alongside the neurodiversity paradigm" (Curnow et al., 2023).

Objection two: there is no evidence for written assessment.

This is half right. Peter Yellowlees's group at UC Davis has studied asynchronous telepsychiatry for more than a decade. In their model, "asynchronous" still involves speech: a trained interviewer conducts a spoken interview on video, and the psychiatrist reviews the recording later (Yellowlees et al., 2021). Within that model, in a randomised trial, asynchronous and synchronous telepsychiatry produced no significant difference in clinical outcomes (Yellowlees et al., 2021). A systematic review concluded that such services improve access to care (O'Keefe et al., 2021). Text-based mental health interventions have shown improvement "equivalent but not superior to treatment as usual," including face-to-face and telephone counselling (Hoermann et al., 2017; see also Dwyer et al., 2021).

These studies do not establish the reliability of text-only diagnosis: the telepsychiatry model still uses spoken interviews, while the text-based studies concern therapeutic interventions. In the UC Davis trial, satisfaction was high in both arms — 84% (asynchronous) and 97% (synchronous) were somewhat or completely satisfied at six months — but patients in the synchronous arm were more likely to be completely satisfied (Yellowlees et al., 2024). The studies reviewed here provide little direct evidence on the reliability of purely text-based psychiatric diagnosis.

That is exactly the problem. Whatever explains this gap, patients who need written assessment are left without a well-established pathway — and the default patient, the one the existing pathways were built for, can talk.

Who Is the Default Patient?

Step back from a single consultation and "you must speak" turns out to be one corner of a larger default.

From phone booking and reception desks to the five-minute spoken summary in the consulting room and "tell the doctor what's wrong," the whole flow of care is designed around one kind of patient: someone who can phone, queue, organise language quickly in front of strangers, and answer follow-up questions on the spot. Shaw, Doherty and colleagues describe a chain — "communication mismatch; doubt - in oneself and from doctors; helplessness and fear; and healthcare avoidance and adverse health outcomes" (Shaw et al., 2024). Research at the University of Pennsylvania found that most barriers in community mental health services "involved clinicians' limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults" (Maddox et al., 2020).

In this design, a person who cannot speak in the moment looks "uncooperative." They are not uncooperative. The process simply never counted them in.

There is also a quieter cost. A live consultation assumes the patient can search memory, organise a narrative, follow a question and compress a complicated history into a short answer, on the spot, in front of a stranger. That performance is itself shaped by anxiety, trauma, processing speed, language and setting. So the format does not merely collect information; it influences which information can be expressed at all.

A clinic that fixes the format in advance has already made a decision about what kind of account counts as evidence.

The UN Convention on the Rights of Persons with Disabilities defines communication to include display of text and treats denial of reasonable accommodation as discrimination (CRPD, Art. 2). It requires states to ensure that health professionals provide care "of the same quality to persons with disabilities as to others," including in private healthcare (CRPD, Art. 25(d)). The Convention places obligations on states — including, under Article 4, to take measures against discrimination by private organisations and enterprises; how patients can enforce these rights against a clinic depends on domestic law. But it establishes a principle: choosing a mode of communication is not a patient's whim. It is part of access.

The Ramp

The conclusion of the Doherty study contains a sentence worth quoting as it stands:

"Adjustments for autism-specific needs are as necessary as ramps for wheelchair users."

Nobody would tell a wheelchair user: we can make the steps lower, we can send someone to help you, but you must walk up yourself — those are the rules.

What would the ramp look like? It need not be a full protocol. It could start with the obvious: accepting a detailed written history; allowing questions to be sent and answered in writing; giving more time to process and reply. Where direct observation is genuinely needed, it could mean saying what information is needed and why, and agreeing on a way to obtain it that the patient can bear, rather than defaulting to a single live session.

The demand is not for a guaranteed diagnosis by email, but for an assessment pathway that does not make rapid spoken exchange the price of entry. Written consultation, in that sense, is not special treatment. For some patients it is the ramp. Until it exists, the door to diagnosis stays half open for them, and the other half is held shut with the words "the law requires."

References

Regulations were read on official sites; research articles were checked against PubMed records and, where available, full text. French provisions were read in their versions in force as of October 2026 via Pappers Justice, which reproduces Légifrance texts (Légifrance itself was behind a bot check). California B&P Code § 2290.5 was read via the Medical Board of California.

Regulation and guidance

Bayerische Landesärztekammer. Berufsordnung für die Ärzte Bayerns, as amended 11 October 2025, § 7(2), § 7(4). https://www.blaek.de/kammerrecht/berufsordnung-fuer-die-aerzte-bayerns

Bundesärztekammer. Hinweise und Erläuterungen zu § 7 Abs. 4 MBO-Ä – Behandlung im persönlichen Kontakt und Fernbehandlung. 22 March 2019. doi:10.3238/arztebl.2019.mbo.fernbehandlung

Bundesärztekammer. "Abrechnungsempfehlungen der Bundesärztekammer zu telemedizinischen Leistungen." Deutsches Ärzteblatt 117, no. 26 (2020): A1358.

Bundesärztekammer. Fragenkatalog zur Fernbehandlung. 8 January 2021. https://www.bundesaerztekammer.de/recht/publikationen/fragenkatalog/

Bürgerliches Gesetzbuch (BGB), § 630e. https://www.gesetze-im-internet.de/bgb/__630e.html

Gebührenordnung für Ärzte (GOÄ), § 4. https://www.gesetze-im-internet.de/go__1982/__4.html

Deutsches Ärzteblatt. "Bayerischer Ärztetag macht Weg für ausschließliche Fernbehandlung frei." 29 October 2018.

General Medical Council. Good medical practice (2024), paras 32–33. https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/domain-2-patients-partnership-and-communication

General Medical Council. Good practice in prescribing and managing medicines and devices, paras 20, 37. https://www.gmc-uk.org/professional-standards/the-professional-standards/good-practice-in-prescribing-and-managing-medicines-and-devices/deciding-if-it-is-safe-to-prescribe

42 CFR § 410.78 (Medicare telehealth services). https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.78

21 U.S.C. § 829. https://www.law.cornell.edu/uscode/text/21/829

Medical Board of California. "Telehealth." https://www.mbc.ca.gov/Resources/Medical-Resources/telehealth.aspx

College of Physicians and Surgeons of Ontario. Virtual Care (policy, updated June 2022). https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Virtual-Care

Medical Board of Australia. Guidelines: Telehealth consultations with patients. https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Telehealth-consultations-with-patients.aspx

MBS Online. Medical Practitioners – Non-Referred MBS Telehealth Services (fact sheet).

KNMG. "E-consult." https://www.knmg.nl/actueel/dossiers/digitale-zorg-1/hybride-zorg/e-consult

Code de la santé publique, art. L6316-1 (as amended by Loi n° 2026-534 of 25 June 2026, in force 27 June 2026) and art. R6316-1 (as amended by Décret n° 2021-707). https://justice.pappers.fr/loi/LEGITEXT000006072665/article/LEGIARTI000054336504 ; https://justice.pappers.fr/loi/LEGITEXT000006072665/article/LEGIARTI000043600549

Code de la sécurité sociale, art. L160-8 (as amended by Loi n° 2026-794 of 18 August 2026, in force 20 August 2026), final paragraph. https://justice.pappers.fr/loi/LEGITEXT000006073189/article/LEGIARTI000054711241

Conseil national de l'Ordre des médecins. Rapport 2026 Télémédecine — Recommandations du Conseil national. https://www.conseil-national.medecin.fr/sites/default/files/CNOM-RECOMMANDATIONS-TELEMEDECINE.pdf

Haute Autorité de Santé. Fiche mémo: Téléconsultation et téléexpertise — mise en œuvre. 2019. https://www.has-sante.fr/upload/docs/application/pdf/2019-07/fiche_memo_teleconsultation_et_teleexpertise_mise_en_oeuvre.pdf

厚生労働省. 『オンライン診療の適切な実施に関する指針』（令和8年4月改訂）. https://www.mhlw.go.jp/content/001685701.pdf

National Institute for Health and Care Excellence. Autism spectrum disorder in adults: diagnosis and management (CG142), updated 14 June 2021, recs 1.1.5, 1.2.7. https://www.nice.org.uk/guidance/cg142

United Nations. Convention on the Rights of Persons with Disabilities (2006), Arts. 2, 4(1)(e), 25(d). https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

Research

Curnow, E., Utley, I., Rutherford, M., Johnston, L., & Maciver, D. (2023). Diagnostic assessment of autism in adults — current considerations in neurodevelopmentally informed professional learning with reference to ADOS-2. Frontiers in Psychiatry, 14, 1258204. doi:10.3389/fpsyt.2023.1258204

Doherty, M., Neilson, S., O'Sullivan, J., Carravallah, L., Johnson, M., Cullen, W., & Shaw, S. C. K. (2022). Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open, 12(2), e056904. doi:10.1136/bmjopen-2021-056904

Dowling, A., Moxey, E., Keenan, M., & Hong, J. S. (2026). A preschooler with severe social anxiety and selective mutism versus autism spectrum disorder. Clinical Case Reports, 14(10), e73706. doi:10.1002/ccr3.73706

Dwyer, A., de Almeida Neto, A., Estival, D., Li, W., Lam-Cassettari, C., & Antoniou, M. (2021). Suitability of text-based communications for the delivery of psychological therapeutic services to rural and remote communities: scoping review. JMIR Mental Health, 8(2), e19478. doi:10.2196/19478

Hoermann, S., McCabe, K. L., Milne, D. N., & Calvo, R. A. (2017). Application of synchronous text-based dialogue systems in mental health interventions: systematic review. Journal of Medical Internet Research, 19(8), e267. doi:10.2196/jmir.7023

Howard, P. L., & Sedgewick, F. (2021). 'Anything but the phone!': Communication mode preferences in the autism community. Autism, 25(8), 2265–2278. doi:10.1177/13623613211014995

Maddox, B. B., Crabbe, S., Beidas, R. S., Brookman-Frazee, L., Cannuscio, C. C., Miller, J. S., Nicolaidis, C., & Mandell, D. S. (2020). "I wouldn't know where to start": Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults. Autism, 24(4), 919–930. doi:10.1177/1362361319882227

Nicolaidis, C., Raymaker, D. M., Ashkenazy, E., McDonald, K. E., Dern, S., Baggs, A. E., Kapp, S. K., Weiner, M., & Boisclair, W. C. (2015). "Respect the way I need to communicate with you": Healthcare experiences of adults on the autism spectrum. Autism, 19(7), 824–831. doi:10.1177/1362361315576221

O'Keefe, M., White, K., & Jennings, J. C. (2021). Asynchronous telepsychiatry: A systematic review. Journal of Telemedicine and Telecare, 27(3), 137–145. doi:10.1177/1357633X19867189

Raymaker, D. M., McDonald, K. E., Ashkenazy, E., Gerrity, M., Baggs, A. M., Kripke, C., Hourston, S., & Nicolaidis, C. (2017). Barriers to healthcare: Instrument development and comparison between autistic adults and adults with and without other disabilities. Autism, 21(8), 972–984. doi:10.1177/1362361316661261

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. doi:10.1089/aut.2019.0079

Shaw, S. C., Carravallah, L., Johnson, M., O'Sullivan, J., Chown, N., Neilson, S., & Doherty, M. (2024). Barriers to healthcare and a 'triple empathy problem' may lead to adverse outcomes for autistic adults: A qualitative study. Autism, 28(7), 1746–1757. doi:10.1177/13623613231205629

Yellowlees, P. M., Parish, M. B., Gonzalez, A. D., et al. (2021). Clinical outcomes of asynchronous versus synchronous telepsychiatry in primary care: randomized controlled trial. Journal of Medical Internet Research, 23(7), e24047. doi:10.2196/24047

Yellowlees, P. M., Burke, M. M., Gonzalez, A. D., et al. (2024). Patient and provider satisfaction with asynchronous versus synchronous telepsychiatry in primary care: a secondary mixed-methods analysis of a randomized controlled trial. Telemedicine and e-Health, 30(4), e1049–e1063. doi:10.1089/tmj.2023.0238

Zisk, A. H., & Dalton, E. (2019). Augmentative and alternative communication for speaking autistic adults: overview and recommendations. Autism in Adulthood, 1(2), 93–100. doi:10.1089/aut.2018.0007