“Do You Need Something or Am I Just Listening to You?”: A Qualitative Content Analysis of Prosody-Related Social Communication Challenges in Autistic Young Adults

Prosody—the rhythm, timing, and intonation of speech—helps listeners interpret a speaker’s emotion and intent, yet autistic people’s lived experiences of prosody-related misunderstandings remain poorly understood. This study examined how autistic young adults experience prosody-related communication challenges in daily life and identified priorities for future research. Participants were 69 autistic young adults who completed survey items assessing perceived difficulty understanding prosodic cues and the frequency with which these difficulties created problems in daily life, followed by open-ended questions. Quantitative responses were summarized descriptively and compared with a non-autistic comparison group ( N = 39), and autistic participants’ free-text responses were analyzed using inductive qualitative content analysis. Autistic participants reported significantly greater difficulty understanding prosody and more frequent prosody-related problems than non-autistic participants. Qualitative analysis organized responses into five descriptive domains: types of interactions in which difficulties occur, focus of misunderstanding, contextual factors shaping these difficulties, communication strategies used to mitigate misunderstandings, and social impact. Participants described challenges interpreting emotional tone, sarcasm, teasing, and question–statement distinctions across social and professional contexts, as well as the importance of speaker variability, familiarity, environmental demands, and collaborative repair strategies. Prosody-related misunderstandings were described as affecting self-confidence, relationships, and workplace functioning. Participants also emphasized the need for future research to examine prosody using more naturalistic, bidirectional, and context-sensitive methods. These findings suggest that prosody-related challenges in autism are heterogeneous and context-dependent, with important implications for research and support.