A child with autism may have difficulty expressing needs, initiating and maintaining conversations, and have repetitive use of language (echolalia). Keep in mind that speech is the actual production of sounds that produce words, language is the underlying meaning behind those words, and communication is any modality that is used to give and receive a message. Thus, communication can be verbal and nonverbal. Hearing is frequently one of the parent's initial concerns, although tests often show that it falls within normal limits. However, despite adequate hearing, individuals' responses to auditory information are frequently poor.