Purpose: The aim of this review is to illuminate the connection between inferential skills and spoken language idiom comprehension (SLIC) with a focus on autism. Idioms are frequently occurring figurative expressions, such as feeling blue, on cloud nine, and all tied up, that have literal and nonliteral meanings. Method: In this review article, an overview of SLIC is provided, highlighting the importance of inferential skills and other pertinent factors and theories contributing to idiom acquisition in autistic children. The search criteria used included peer-reviewed journal articles from 1982 to 2021 to synthesize both seminal and current research on this topic. Though some articles selected for this review did not focus on idioms in spoken language, they were deemed necessary for analyzing various aspects impacting idiom development and comprehension. Results: Research shows that figurative language differences are a hallmark feature of autism, causing idioms to be interpreted literally. Occurring in everyday spoken and written language, idiom comprehension is essential for adequate communication in daily interactions. Poor inferential abilities directly impact SLIC and have negative implications on social and academic outcomes. Several factors contributing to SLIC have been highlighted in the literature, including transparency (semantic analyzability), familiarity, and context. Conclusions: The comparable skills underpinning inferential comprehension and SLIC raise the argument that SLIC is incumbent upon intact inferential abilities. As such, autistic children will benefit from utilizing inference from context to deduce idiomatic meanings. Future directions for research and recommendations for improving SLIC in clinical practice are offered.