Autism spectrum disorder (ASD) is a disorder that is behaviorally diagnosed and characterised by deficits in social communication and restricted and repetitive patterns of behaviour. Children with ASD often face challenges with speech and language disorders such as topic maintenance, greetings and farewells, appropriate turn-taking, and conversational repair strategies. This means that when parents bring their children to social occasions, such as Christmas parties or reunion dinners, the children with ASD may inevitably cause friction in relationships with their relatives and friends. Therefore, these speech and language disorders may affect social, behavioral, emotional, and academic development.
What Are The Speech And Language Delays?
There is no universally accepted definition of “delay” in developmental conditions. However, approximately 15% of children reported experiencing delays in initial language learning and speech globally. Currently, speech and language delays are the most common reasons for the enrollment of children aged 3-5 years in special education services. Here are some atypical speech and language developments:
- Developmental Speech and Language Delay: Development of speech and language skills is slower than expected for age but follows the usual developmental pattern.
- Expressive Language Disorder: The ability to produce or use language. Their clinical presentation is variable, but difficulties with syntax (grammar or rules for combining words to form sentences) are prominent.
- Receptive Language: The ability to understand language. They have a deficit in comprehension. For example, they do not look at or point at objects named by their parents.
- Stuttering:nondevelopmental disorder of fluency
- Articulation Disorder: Motor speech disorder that involves difficulty producing specific sounds of language
- Dysarthria: Disorder of muscle movements required for speech production
- Childhood Apraxia of Speech: Severe and persistent motor impairment that affects planning and execution of speech sounds
- Intellectual Disability: Not only language and speech delay, but also the use of gestures and other developmental milestones
Milestones Related To Speech And Language
| Age | Milestones for the English Speaker |
|---|---|
| Birth to 5 months | Coos Vocalizes pleasure and displeasure sounds differently (laughs, giggles, cries, or fusses) Makes noise when talked to |
| 6 to 11 months | Understands “no-no” Babbles (says “ba-ba-ba”) Says “ma-ma” or “da-da” without meaning Tries to communicate by actions or gestures Tries to repeat your sounds Says first word |
| 12 to 17 months | Answers simple questions nonverbally Says 2 to 3 words to label a person or object (pronunciation may not be precise) Tries to imitate simple words Vocabulary of four to 6 words |
| 18 to 23 months | Vocabulary of 50 words, pronunciation is often unclear Asks for common foods by name Makes animal sounds, such as “moo” Starting to combine words, such as “more milk” Begins to use pronouns, such as “mine” Uses 2-word phrases |
| 2 to 3 years | Knows some spatial concepts, such as “in” or “on” Knows pronouns, such as “you,” “me” or “her” Knows descriptive words, such as “big” or “happy” Uses 3-word sentences Speech is becoming more accurate, but may still leave off ending sounds. Strangers may not be able to understand much of what is said. Answers simple questions Begins to use more pronouns, such as “you” or “I” Uses question inflection to ask for something, such as “my ball?” Begins to use plurals, such as “shoes” or “socks” and regular past tense verbs, such as “jumped” |
| 3 to 4 years | Groups objects, such as foods or clothes Identifies colors Uses most speech sounds, but may distort some of the more difficult sounds, such as l, r, s, sh, ch, y, v, z, th. These sounds may not be fully mastered until age 7 or 8. Uses consonants in the beginning, middle, and ends of words. Some of the more difficult consonants may be distorted, but attempts to say them Strangers are able to understand much of what is said Able to describe the use of objects, such as “fork” or “car” Has fun with language; enjoys poems and recognizes language absurdities, such as, “Is that an elephant on your head?” Expresses ideas and feelings rather than just talking about the world around him or her Uses verbs that end in “ing,” such as “walking” or “talking” Answers simple questions, such as “What do you do when you are hungry?” Repeats sentences |
| 4 to 5 years | Understands spatial concepts, such as “behind” or “next to” Understands complex questions Speech is understandable, but makes mistakes pronouncing long, difficult, or complex words, such as “hippopotamus” Uses some irregular past tense verbs, such as “ran” or “fell” Describes how to do things, such as painting a picture Lists items that belong in a category, such as animals or vehicles Answers “why” questions |
| 5 years | Understands time sequences (for example, what happened first, second, or third) Carries out a series of 3 directions Understands rhyming Engages in conversation Sentences can be 8 or more words in length Uses compound and complex sentences Describes objects Uses imagination to create stories |
Possible Causes Of Speech Delay
The primary causes of speech and language disorders may be multifactorial and involve interactions among genetic, environmental, and medical factors.
Secondary causes are varied and include hearing loss, intellectual disability, genetic conditions, developmental problems, brain injuries and other neurologic conditions, infection, structural anomalies or changes, and psychological conditions.
For the most part, children with ASD have receptive and expressive language impairments. Their profile of language impairment varies with age and developmental level. When people talk about people with autism spectrum disorder, they are pictured as people who speak little and do not look at people. It seems that autism is equal to speech and language delay in certain aspects. Now we are going to discuss those myths.
Does Every Autistic Person Have A Speech And Language Delay?
Although language and social communication impairments are included in the primary diagnostic criteria for ASD, not every child with ASD will have a speech and language problem. Their language abilities may range from nonverbal to highly idiosyncratic language with echolalia and unusual prosody.
Is every speech and language delay related to an autism spectrum disorder?
A speech delay does not necessarily mean a child has an ASD. Children with speech or language delays may eventually reach these milestones slower than their peers. What slows them down is the ability to coordinate using their jaw, tongue, and lips to produce sounds and form words. And they always want to build strong connections with the people around them. Therefore, even if they cannot speak several verbal words, they will still use nonverbal language to mimic other people’s actions.
Nevertheless, children with ASD face social communication challenges. What hinders them is their low interest in building any meaningful social connection with other people. They are rarely inclined toward others’ actions.
When To Intervene When A Speech And Language Delay Occurs?
The best age for speech therapy is the age your child is at when they start to fall behind or when you notice they’re not meeting milestones.
Interventions for children with speech and/or language disorders may be carried out directly or indirectly and in a range of settings, such as the home, healthcare service provision, early years setting (nursery/school), school or private practices, by the specialist professionals themselves or through proxies such as parents, teachers or teaching assistants
Speech and language therapists commonly use a range of behavioural techniques, including imitation, modelling, repetition, and extension, to draw the child’s attention.
The frequency, intensity, and duration of interventions vary considerably.
Conclusion
A speech and language delay does not always mean an autism spectrum disorder. As parents, we always keep our children’s health in mind, and there are some actions we can take. Routine health visits to the paediatrician could help to detect speech and language disorders in advance. Parents can identify some red flags such as lack of frequent participation in social interaction, regression of previously acquired speech and language skills, and inability to meet certain speech and language milestones; while these red flags show up, take them to seek professional medical advice. No matter the final diagnosis, parents and caregivers should always tell their children that they will always be there for them during their growing up and learning journey.
References:
- https://www.stanfordchildrens.org/en/topic/default?id=age-appropriate-speech-and-language-milestones-90-P02170
- https://www.mayoclinic.org/zh-hans/healthy-lifestyle/infant-and-toddler-health/in-depth/language-development/art-20045163
- Friedman L, Sterling A. A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder. Semin Speech Lang. 2019 Aug;40(4):291-304. doi: 10.1055/s-0039-1692964. Epub 2019 Jul 16. PMID: 31311054; PMCID: PMC7012379.
- https://otsimo.com/en/difference-between-speech-delay-autism/
- Mody M, Belliveau JW. Speech and Language Impairments in Autism: Insights from Behavior and Neuroimaging. N Am J Med Sci (Boston). 2013;5(3):157-161. doi: 10.7156/v5i3p157. PMID: 24349628; PMCID: PMC3862077.
- Law J, Dennis JA, Charlton JJV. Speech and language therapy interventions for children with primary speech and/or language disorders. Cochrane Database Syst Rev. 2017 Jan 9;2017(1):CD012490. doi: 10.1002/14651858.CD012490. PMCID: PMC6464758.