Many children on the spectrum start speaking at late milestones.
Pediatricians often tell parents of autistic children not to worry if their child isn’t speaking. Just because your child isn’t babbling at the developmental milestone that’s listed in a book or on a parenting website doesn’t indicate a problem.
It’s suggested that children start cooing at two to three months. Babbling starts around four months, and talking at 12 months. For parents of children on the autism spectrum, those milestones can vary greatly.
Robin Monahan’s son Rory didn’t speak until he was almost five. “Of course I was worried,” she said. “Rory’s my first child. I didn’t know what to expect, but I knew that not talking this late in his life was wrong. I also had him enrolled in a nursery school with kids his age. They all talked.”
Monahan’s pediatrician kept her fears at bay. Still, she felt that something was amiss.
“Delayed language in young children is not an uncommon concern of parents,” said Donna S. Murray, PhD, CCC-SLP, vice president, and head of clinical programs at Autism Speaks. “Speech delays can present themselves independently or be part of other occurring disorders.”
In Monahan’s case, her son, who was later diagnosed with autism spectrum disorder, had otitis media, an ailment where fluid builds up in the middle ear making it hard to hear. Hearing loss can affect speech and language development. It’s easily corrected; a doctor will place tubes in the ears to clean them out.
For children on the autism spectrum, “we typically see disordered communication,” Murray said. “The reasons and severity of communication issues in children on the spectrum may stem from a number of reasons. Although communication disorders are a part of the spectrum, communication difficulties could be exacerbated by otitis media or motor delays.”
According to Murray, in autism spectrum disorder, “communication difficulties are seen in how the child acquires and understands words, or how they use the words they have. A child learning language may not use words appropriately.”
For instance, a child may have a green sippy cup that she knows is a cup. She may even label it a cup. However, when someone asks her to point to a cup — one that is not her green sippy cup — she can’t because she associates the word “cup” with her green cup.
Children also develop language when they play with others. “Many children on the autism spectrum don’t always understand social cues and how to interact with others,” Murray said. “They frequently don’t mirror other children’s behavior.”
“There are lots of reasons why language is delayed,” she added. “I think of our children who fall at the high end of the spectrum, even if words are in place, they often lack the flexibility of understanding. It becomes even more confusing when figurative language is used.”
Children with autism can improve social skills and language by enrolling in social skills and speech intervention programs. “Communication and social skills can be taught,” Murray said.
If your child is missing speech and language milestones, and you are concerned, Murray suggests pushing for a full evaluation even if your child’s pediatrician thinks everything is fine. As a parent, you can get a second opinion from a different pediatrician. You should also have your child’s hearing tested to rule out any hearing problems. If his hearing is fine, talk to a speech language pathologist who will evaluate and test your child’s communication skills.
Taking a wait-and-see approach won’t give your child the skills he needs to interact with others. A good early intervention program provides children with much needed instruction for boosting language, communication, and social skills. “These programs also offer parents and their children the support and resources they need,” Murray said. “An early intervention program should be implemented as soon as possible.”
August 26, 2016
Janet O’Dell, RN