A recent study has found that strengthening inner speech through a guided self-talk intervention may help autistic children better manage their emotions, pointing to a promising new direction in autism care. Published in Autism Research on June 15, this pilot study introduces the “Thinking in Speech” (TiS) therapy—a novel approach that could address one of the most persistent daily challenges for children on the autism spectrum and their families: emotional dysregulation (source).
Emotional dysregulation, which includes difficulty recognizing, expressing, or soothing emotions, is a common hurdle for autistic children. In the Thai context, where familial harmony and collective well-being are highly valued, outbursts or visible distress can place tremendous strain on caregivers and social relationships. Traditional autism interventions often focus on managing behaviors, but this new research suggests that helping children develop the internal ability to “talk themselves through” challenges could have lasting benefits—especially in cultures, like Thailand’s, that place emphasis on social composure from an early age.
The TiS therapy, pioneered by an autistic speech-language pathologist, intentionally avoids prescribing how children should feel, opting instead to model self-awareness and problem-solving through inner speech. In a typical session, a trained therapist might observe a child’s frustration and verbalize, “This is what hard feels like,” then guide the child to articulate a coping strategy, such as, “I need help.” Over time, children are encouraged to internalize this approach, ultimately fostering independence and emotional resilience. The method is reminiscent of traditional Thai mindfulness practices, which also emphasize awareness and gentle self-guidance in moments of difficulty.
The pilot study involved 22 verbal autistic children, aged 7 to 11, randomly assigned either to begin therapy immediately or after a ten-week waiting period. Each child participated in sixteen 30-minute sessions delivered remotely—a practical advantage for families living far from specialized clinics, including those in rural Thai provinces. The therapists administering the sessions underwent an 11-hour virtual training, ensuring that both theoretical knowledge and practical skills were covered. Sessions were designed to be child-centric, with the children choosing their preferred activities to encourage collaboration and engagement.
To evaluate therapy effectiveness, researchers utilized caregiver-completed questionnaires at three points: before treatment, after ten weeks, and at a twenty-week follow-up. The primary measurement tool was the Emotion Dysregulation Inventory, assessing both dysphoria (feelings of unease or low mood) and reactivity (the speed and intensity of emotional upset). A separate scale measured daily emotional control. Findings revealed that children who received TiS therapy experienced a measurable reduction in dysphoria, and while improvements in reactivity were less pronounced overall, they were significant for those starting treatment later, suggesting therapy exposure time might influence outcomes.
Interestingly, the study found that while TiS helped lower emotional distress, it did not significantly improve broader behavioral control, as measured by executive functioning tasks. This distinction is important, as it highlights the therapy’s targeted effect on how children feel internally—a shift that may precede outward behavioral change. “Autism is neurological, not ‘behavioral,’” the study’s corresponding author is quoted as saying. “This therapy reduces emotional dysregulation because it focuses on problem-solving, not on suppressing problematic behaviors. And it can be taught and delivered remotely”—a key consideration for expanding access in regions where specialist resources are stretched thin.
Therapists in the study demonstrated high fidelity in applying the TiS method, completing most key tasks across sessions. However, researchers noted that communication with caregivers about therapy strategies was less robust than anticipated, underscoring an area for improvement in future trainings. This resonates with ongoing debates in Thai special education—where many caregivers express a desire for more transparent, collaborative partnerships with their children’s clinicians.
No adverse events occurred during the study, and families were generally able to complete all scheduled sessions—a positive indicator for feasibility and safety. However, the study did acknowledge limitations: the small sample size, lack of diversity among participating therapists (who were all non-Hispanic white females), and the inclusion of only verbal children with internet access, which limits the applicability of findings to nonverbal children or those lacking digital connectivity.
The researchers advocate for larger, more diverse future trials and the addition of self-esteem assessments, positing that the therapy’s supportive, child-centered style may also benefit how children see themselves. “Maintaining the child’s self-esteem is a critical part of the therapy, but we did not measure this,” the principal investigator noted.
For Thai families, these findings prompt several reflections. First, integrating inner speech development into special needs therapies could align well with cultural practices that value calm, self-awareness, and problem-solving—attributes promoted both in Thai Buddhism and in contemporary Thai educational priorities. TiS’s remote delivery potential is particularly relevant in Thailand, where metropolitan centers like Bangkok have more autism resources compared to smaller cities or rural areas. Additionally, the collaborative, non-prescriptive style of this therapy stands in contrast to more didactic or compliance-based approaches sometimes still found in regional support programs.
As Thailand’s autism prevalence continues to rise—with growing public awareness and improved diagnosis rates—it is important for policymakers, educators, and health practitioners to consider interventions that target both emotional well-being and autonomy. While further evidence is needed before widespread adoption, this study hints at a cost-effective therapeutic model that could be adapted to the Thai context. For instance, schools and clinics could train staff in TiS’s core techniques, using them to enrich both individual sessions and group activities focused on emotional literacy.
Looking ahead, the researchers hope to expand their work, recruiting more therapists and children and testing the approach in broader settings. “We’d like to continue this research with more therapists, more children, and more sessions,” said the principal investigator, acknowledging the challenges faced by independent researchers in securing funding. While the pilot’s remote format offers flexibility, any Thai adaptation would need to ensure equal access for children outside of major urban centers and consider local language and cultural nuances.
Thai policymakers and advocacy groups might take inspiration from this research by funding pilot programs in both public hospitals and schools, collecting local data to assess effectiveness and refine training. Additionally, stakeholders could explore partnerships with technology firms (including Thai language developers) to ensure that online delivery platforms are accessible and culturally appropriate.
In summary, while further, larger-scale research is necessary, TiS therapy introduces a new avenue for emotional support in autistic children—one that empowers them to use inner speech as a problem-solving tool rather than simply managing outward behaviors. For Thai families and practitioners, the results offer both hope and guidance: fostering emotional growth from within is a goal well worth pursuing, one that complements both local traditions and modern health science.
Thai parents and educators interested in supporting emotional regulation can begin by gently modeling self-talk, encouraging children to identify and verbalize their feelings and strategies. Accessible resources, including websites of local autism advocacy organizations and the Ministry of Public Health, can provide updates as this research area grows. Finally, ongoing community dialogue between professionals and families will be essential for adapting and successfully implementing new therapies like TiS in the Thai context.
For further details and the original research report, see: psypost.org.