You’ve noticed that your child isn’t speaking as fluently as other kids his/her own age. Maybe he/she hasn’t even said their first words. Could this delay in their speech development be a sign of autism spectrum disorder (ASD)? Not necessarily.
While speech delays, language delays, and learning differences are often a hallmark of ASD, a speech delay by itself does not mean a child has autism. In fact, there are key differences between communication delays caused by autism and other types of speech-language disorders.
Educating yourself on speech developmental patterns, monitoring and identifying any abnormalities, and seeking professional help from your pediatrician or speech-language pathologist can help keep you informed so you can make the most appropriate treatment decisions. Let’s start with the basics.
What is considered a speech or language delay?
Speech and language delays are common amongst young children. A child may have a speech or language delay if he/she is not meeting appropriate developmental milestones typical for his/her age. While speech and language delays are often confused and used interchangeably, there are distinguishing characteristics.
Speech refers to how children verbalize, articulate, and manipulate the sounds that are used in words. For example, poor pronunciation of hard-to-say sounds like /s/ and /z/ can make it difficult for them to be understood. Speech delays can be developmental in nature, meaning your child is following typical speech patterns but at a slower rate than his/her peers. They can also be due to a speech motor disorder (ex: apraxia of speech) that impedes their ability to coordinate their lips, jaw, and tongue to make accurate sounds.
A language delay doesn’t necessarily affect “how” children say things, but “what” they say. This is referred to as an expressive language disorder. These children may be able to pronounce sounds and words perfectly, but have trouble forming them into coherent phrases to communicate their ideas. Additionally, a receptive language delay can affect how children process information. They often have difficulty comprehending what people are trying to say, learning new vocabulary, and deriving meaning from verbal and written communication.
How do speech delays differ from autism?
Typical childhood development, even before a child’s first words are spoken, generally follows similar stages. In their toddler years children start experimenting with their voice by making babbling and cooing sounds. They use a variety of nonverbal language to communicate their needs and establish strong social connections, such as making eye contact, pointing, and gesturing. Overtime, they begin to learn sounds and use them to form their first words. Eventually, as they continue to associate communication with positive results (i.e. getting what they want), they start to string words together in phrases and acquire more complex linguistic abilities.
A child that is speech or language delayed typically follows the same developmental patterns as their peers, but is slower to reach these milestones. However, they are still strongly motivated by social responses, like hugs and smiles. They desire to build strong social bonds with their parents and peers, respond positively to attention, and are inclined to mimic the actions of people around them.
In addition to speech and language delay, children with autism may experience additional challenges related to their communication, socialization, and behavior. These can disrupt their ability to build meaningful social connections and relationships with people. These can include:
Other communication issues
In addition to being a late talker, there are other communication-related challenges that may be signs of autism, including:
- Being non-responsive to his/her own name
- Trouble getting your child’s attention
- Slower development of gestures to communicate his/her needs
- Babbling in his/her first year and then stopping
- Repetitive usage of a single word or phrase
- Using a robotic-sounding speaking voice
Social challenges
Some children with autism have difficulty relating to – and associating with – other people. Signs can include:
- A general lack of social awareness
- Being unresponsive to social cues, like waving “hi”
- Inability to focus on the same object with someone else (called joint attention)
- Difficulty with social skills, such as sharing, taking turns, and maintaining friendships
- Avoiding eye contact
- Limited or restricted interests in particular toys or activities
- Decreased interest in engaging in play routines with others
Behavioral Challenges
A child’s inability to adequately express him/herself can lead to a wide range of possible behavioral issues, including:
- Repetitive behaviors or hand and body movements, like rocking his/her head back and forth or lining up his/her toys
- Aversion to being touched or held
- Getting easily upset for unknown reasons
- Strong attachment to certain objects, like toys or a television show
- Having trouble staying still
- Being easily upset or distressed when there is a sudden change to his/her daily routine
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When to seek professional evaluation
For children who aren’t developing critical speech skills, or those who are lagging behind their peers, it’s important to seek a professional evaluation from a doctor or speech-language pathologist.
A developmental screening and evaluation can help you determine whether your child is speech delayed, has ASD, or both. Better understanding your child’s conditions and risk factors can bring you peace of mind and, as mentioned, help you make the most informed treatment decision moving forward.
Until recently, ASD was rarely diagnosed before 3-4 years old. However, current research supports lowering the age of identification, mostly due to the effectiveness of early intervention. Around the age of 18 months to two years is also when speech and language delays become most noticeable. While parents may be able to spot many important signs at home, this is generally the most ideal time to have your child professionally evaluated.
There are a number of tools and methods your doctor or speech-language pathologist will use to determine if a child’s speech delay is caused by autism or is unrelated. These include testing and examining his/her social skills (i.e., eye contact, emotional cues, name recognition), physical responses (i.e. ability to point, using objects to play), and language comprehension (i.e., identifying objects, understanding basic directions).
How speech-language therapy can improve communication skills
It’s important to remember that no two children are the same. Communication issues, just like autism symptoms, can vary dramatically from person to person.
Speech-language pathologists, along with other care providers such as teachers, counselors, and psychologists, play a key role in a child’s treatment plan. Speech therapists are experts at diagnosing and treating communication-related challenges that present with autism. They help develop an individualized treatment plan specialized to each child’s specific needs that can improve their verbal and nonverbal communication. They help individuals express themselves, improve their personal and social relationships, and better function in day-to-day activities.
Even if your autistic child is nonverbal, or was diagnosed later in life, it’s important not to lose hope. This doesn’t mean he/she won’t be able to become a literate and articulate adult. In fact, studies have shown that autistic children aged four and five with severe language delays went from being nonverbal to acquiring language skills with proper treatment. Your child is destined for great things – he/she may just need a little more help getting there.
With that said, here are some of the communication skills that can be improved with intervention from a speech therapist. They work closely with children, their families/caregivers, and other provide to help improve:
- Verbal Communication: Speech therapists can help children with autism better articulates and verbalizes sounds and words. This can give children the strategies and mechanisms to better express their thoughts, ideas, and feelings. As children become more effective communicators, it can also help reduce behavioral problems.
- Social Pragmatics: This skill involves how and when children use communication in social settings. For example, while a child with autism may know how to say the word “hello,” they may not understand that this word is used as a greeting (and therefore may randomly insert it into a sentence). Speech therapists can help children learn the appropriate social context in which to use certain words and phrases.
- Body Language: Facial expressions, hand movements, and gestures are some of the most expressive parts of language. Unfortunately, some children with autism may have trouble interpreting their meaning. A speech therapist can help match emotions with proper facial expressions and recognize subtle signals that can indicate whether a person is happy, sad, or angry.
- Prosody: This fancy word simply means the volume and intonation of our voices in conversation. When we talk, the sound of our voice naturally goes up and down. Some children with autism have flat prosody, which can make their voice sound robotic and emotionless. A speech therapist can help children modulate the tone and volume of their voice when they speak.
- Grammar: Some kids with autism may frequently make grammar mistakes or refer to themselves in the third person. A speech therapist can help address these common issues and promote correct word tenses.
- Social Skills: As mentioned, a lack of social cues and awareness can be one of the most obvious telltale signs of autism in young children. Speech therapists can help children recognize and build their social communication skills, including how they interact with other people, conversational turn taking, standing at appropriate distances when talking, and more.
- Conversational Skills: While many children with autism can make simple and short statements, they may struggle to carry a conversation. This includes responding to their conversational partner, not interrupting, initiating dialogue, and engaging in the natural back-and-forth of discourse. Speech therapists can help children with their conversation skills so they can implement these practices in everyday situations.
- Questions: The ability to formulate questions and understand answers is key to social interactions. Practicing the question-answer format in a structured environment with a speech therapist can help prepare them for daily interactions.
- Alternative/Augmentative Communication (AAC): For nonverbal children, there are certain communication technologies and assistive devices that can help children express their needs independently. These tools are collectively referred to as alternative or augmentative communication devices. Your speech therapist can recommend whether one of these tools is appropriate and how to correctly use them. They can include sign language, speech output devices, picture systems, and communication apps on tablets.
To sum-up, although speech delay can come hand-in-hand with autism spectrum disorder, it is not always the case. A speech delay by itself does not mean a child has autism and, by working with experts and doing the right research, you can ensure your child gets the best support.
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Charles Tiayon
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