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Challenges in verbal communication are a prominent feature of autism. However, gene regulatory programs in speech-related cortical regions remain poorly characterized. In parallel, it remains unclear whether the heterogeneous genetic factors underlying autism converge on shared neurobiological mechanisms. To address these gaps, we generated paired transcriptomic and epigenomic data from post-mortem human brain tissue across 100 donors. Here, we show that transcriptional differences in the speech-related Brodmann Area 22 in individuals with neurodevelopmental conditions, including autism, are strongest among those with a known genetic diagnosis. A similar but attenuated signature is observed in those without a genetic diagnosis. These transcriptional differences are most pronounced in neurons, with glutamatergic L4/5 intratelencephalic neurons affected across multiple modalities. Finally, multimodal analysis implicates altered -dependent networks as a central hub in autism, particularly among L4/5 intratelencephalic neurons in non-verbal individuals. Together, our study identifies regulatory architecture linking chromatin state, transcriptional output, and variation in verbal ability in autism.