Your child doesn't seem to speak as often or as fluently as other children. Or your child doesn't speak at all. Does that automatically mean that your child has autism?
Speech delays and autism often go hand in hand. In fact, delays in speech development are used as autism diagnostic tools. But many other conditions that have nothing to do with autism can also cause speech delays.
If you're concerned about your child's speech, talk with your child's pediatrician, and ask for a formal screening. Early diagnosis of any type of speech delay can help to ensure that your child gets necessary and critical help from experts.
How Common Are Speech Delays?
Most children learn to talk just as they learn to walk: one small step at a time. They begin by babbling, and they build on that skill by learning one meaningful word at a time. In time, they develop an extensive vocabulary of words they can string together.
Children with autism rarely follow this pattern , and the American Speech-Language-Hearing Association (ASHA) says about 75% of them have some type of delayed speech. On average, ASHA says, they talk one to two years later than other children.
While autism causes some speech delays, it doesn't cause all of them. Experts explain that children can develop these issues due to:
- Hearing loss. Children who can't hear their parents model language don't develop the skills themselves.
- Deprivation. The child doesn't spend enough time talking with adults, so the child doesn't learn the language.
- Choice. Children with selective mutism don't speak, even without a medical reason for it.
- Disease. Children with some movement disorders or intellectual disabilities may struggle to speak.
- Bilingual homes. Children in homes like this must understand two languages at once, and it can take longer for them to pick up the nuances of both.
In general, ASHA says, parents grow worried when their children don't speak by age 2 . Some parents may develop concerns even earlier in the child's life.
What Does a Speech Delay Look Like?
Children are individuals, and they develop at their own rates. Some simply talk earlier than others do, while others hang back. If your child can't keep up with a chatty neighbor, you might be worried, but your fears are likely to be minor. Speech delays are different.
Experts explain that there are two main types of speech delays :
- Developmental: A child like this is following a typical speech development pattern, but the child is just moving slower than peers typically do.
- Apraxia: A child like this has a motor disorder that impedes the ability to make meaningful sounds. They may understand speech, and they often have plenty to say, but they can't make the words come out.
Children with autism can have one or both forms of speech delays. Often, the differences are severe. When placed in a room with children developing on schedule, children with autism can seem remarkably quiet and non-communicative. Their issues are hard to ignore.
Diagnostic Tests for Speech Delay vs. Autism
A child who isn't developing critical speech skills needs help, and the sooner that intervention starts, the better. Parents may spot the signs at home, but they can't diagnose the issue without an expert's help. If a child isn't developing speech patterns on par with their peers, an appointment is in order.
Researchers say doctors can use plenty of tools to determine if speech delays are caused by autism or something else. They might assess a child's:
- Social skills. Does the child make eye contact? Does the child respond to their name? Does the child respond to emotional cues, like smiling?
- Physical responses. Does the child point to desired objects? Does the child look at things when the doctor points at them? Does the child use objects in play?
- Word understanding. Can the child identify an object by pointing at it, even if the child doesn't speak?
Children with autism tend to react differently than their peers in these tests. Many of these children can't tackle the tasks outlined in the questions.
A child with hearing loss, for example, might react quite differently. That child might look intently at the doctor, pointing at a needed object and smiling when it's handed over.
We know, from extensive research , that children with autism have brains that set them apart from their peers. For example, brain scans show dampened activity in two language centers in children with autism. Those with a different language delay don't have the same type of brain scan.
Brain scans, blood tests, and genetic scans aren't widely available to help doctors determine whether issues are caused by autism or something else. They rely on observations and parent reports to make a diagnosis.
Expect your child's doctor to visit with your child on many occasions, and know you'll see a few specialists too. At the end of this extensive testing, you'll know whether the team suspects autism or another form of language delay.
Speech Therapy Is Critical
Some forms of speech delay are relatively easy to fix. For example, give a child with profound hearing loss a set of hearing aids, and that child can quickly catch up with their peers. But children with autism tend to need a little bit more help to develop the skills they need.
People with autism can learn to speak. As Autism Speaks explains, children who didn't talk by age 4 or even 5 can grow into literate and articulate adults . But they need help to get there.
Speech therapy sessions help children with autism to:
- Understand the mechanics of speech. Therapists can help children learn how to move their lips, teeth, and tongue when they speak. Experts can assign exercises to help children build muscle.
- Learn critical words. Therapists use flashcards, books, and more to help children associate a sound with an object. Repetition, persistence, and patience help them connect with their clients.
- String words together. When a child has many words at hand, therapy shifts to using them in sequence. Short, two-word phrases kick off the process. As the child grows, longer phrases take center stage.
- Listen to others. Therapists can also help children with autism learn about the give-and-take of a conversation.
This therapy works, and researchers stress that appropriate treatment can mean the difference between a child who can speak and one who cannot. Children may not pick up on these skills without help. When they're connected with the right resources, they can thrive.
- Untangling the Language Challenges of Autism. (April 2017). American Speech-Language-Hearing Association.
- Speech and Language Delay . (May 2020). American Academy of Family Physicians.
- Speech Issues in Autism. The Autism Community in Action.
- Brain, Behavior Distinguish Autism From Language Delay . (September 2017). Spectrum.
- Verbal and Nonverbal Outcomes of Toddlers With and Without Autism Spectrum Disorder, Language Delay, and Global Developmental Delay. (April 2018). Autism and Developmental Language Impairments.
- Study Shows That Many Nonverbal Autistic Children Overcome Severe Language Delays. (March 2013). Autism Speaks.