Speech Delay vs Autism: How to Differentiate

You have noticed that your child isn’t speaking as much as their peers. It may be possible that your 2-year old hasn’t said their first words yet. This begs the question: is it autism or speech delay?

A speech delay may be a sign of autism. However, it is not always the case. So, how do you understand autism vs speech delay?

What Is Speech Delay?

Speech delay or alalia is the delay in the development of speech or delay in the use of articulators to produce speech.

Speech is a part of the language. It is the process of making sounds using the lungs, voice box, vocal cords, tongue, lips, and teeth.

Experts consider a child to have delayed speech if the rate of development of their speech is slower than the normal rate of children their age.

What is Normal Speech Development in Children?

The rate of speech development is measured against age-related milestones. These milestones can act as references for determining the normal rate of speech development in a child.

Between 1 month and 6 months

• A child should be able to coo in response to voice.

Between 6 months and 9 months

• A child should begin to babble in response to voice and on their own.

By 12 months

• By their first birthday, children should be able to say "mama/dada" with meaning. Some children often begin to imitate two- and three-syllable words that they hear the adults saying repeatedly.

Between 13 to 15 months

• Children typically acquire a vocabulary of four to seven words. Around 20% of their speech should be understood by strangers as well.

Between 16 to 18 months

• An 18-month old should have a vocabulary of at least ten words. You should expect some echolalia (repetition of what you are saying) and extensive use of jargon.

Between 19 and 21 months

• By the time your child is between 19 months and 21 months old, their vocabulary should expand to twenty words. Strangers should be able to understand around 50% of their speech.

By 24 months (2 years)

• By their second birthday, children should have a vocabulary of at least fifty words. A 24-month old should be able to use two-word phrases. Strangers should be able to understand around 70% of their speech.

By 36 months (3 years)

• By the time they are 3, children begin to use plurals and past tenses in their sentences. 3-year olds should be able to count at least three objects correctly. They should use three to five-word sentences. Strangers should be able to understand around 80% to 90% of what your 36-month old is saying.

Between 3 and 4 years

• Children between 3 and 4-years old should be able to form 3 and 6-word sentences. They should be able to ask questions, relate experiences, narrate stories, and hold conversations. Strangers should understand almost 100% of their speech.

If your child hasn't reached these milestones at the right age, then you have every right to be worried and anxious. Speech delay and autism share an intricate relationship.

However, instead of worrying alone, you should take the help of a speech therapist or speech-language pathologist to determine if  it is autism or speech delay.

What Is Autism?

Autism or autism spectrum disorder is a developmental disorder.

The estimated prevalence of autism spectrum disorder is 1 in 54 children as of 2016 in the US population. Genetics plays a significant role in the cause of autism. However, it is a heterogeneous disorder and multiple mutations, linkages, and variations have been associated with autism in the last few years.

Autism spectrum disorder (ASD) is an umbrella term that includes a wide range of early-appearing social communication deficits. Repetitive sensory-motor behaviors often characterize autism spectrum disorder.

Speech Related Signs Of Autism

Speech delays are common among children. Nonetheless, speech delays may also indicate autism. Thankfully, it is possible to tell the difference between speech delay and autism.

Here are the telltale signs of autism-related speech delays –

• The child is typically slow in responding or shows no response to parents or caregivers calling their name.
• The toddler may not gesture (point) towards objects or people.
• They may show a slower rate of language development. A one-year-old may coo and babble during the first year and then stop entirely.
• There may be signs of repeated words and phrases (echolalia).
• Most of the time, the child may be speaking in single words only.
• They tend to use words and phrases that seem out of place or have meaning only the child and their caregivers understand.

Why Do People Confuse Speech Delay with Autism?

Speech delays characterize autism spectrum disorder. Some toddlers with ASD who develop speech at a normal rate often face challenges using spoken language as they grow older.

It is easy to confuse the signs of speech delay and autism. With speech delays, children may reach the age-related speech and language milestones at a slower rate as compared to other kids their age.

Parents of toddlers with ASD report delays in their children’s speech development. Yes. Speech delay is an early indicator of autism in young kids, but it is NOT the only signifier.

Children with ASD may use varying vocal patterns, have a tough time using gestures and reading expressions. Experts note that some children also use repeated sounds and words for self-stimulation.

Symptoms of Autistic Speech Delay

Let us consider the cases of Charlie and Jaimie.

Charlie is currently 2-years old. He isn't talking at all. While he is a quiet child, he grabs his mother's fingers, tugs at daddy's sleeve, and cups his mother's face when he wants attention. He engages with his parents and interacts with other children his age during playdates. He dislikes naps because his parents leave him alone in his room.

Jaime, on the other hand, does speak a few words. Interestingly, he doesn't use these words to communicate. He repeats those few words and cannot use or understand gestures. He doesn't point towards something he wants or needs. Jaime doesn't engage with other children his age. However, he is quite content when his parents leave him alone. His parents find it difficult to capture his attention for longer than a few seconds.

If you think your child is more similar to Jaime than Charlie, it may be wise to consider having them evaluated for ASD.

Some children with ASD who are on the high functioning end of the spectrum may be more social compared to children with severe ASD.

Almost all children with autism face social communication challenges. However, with extended speech therapy and behavioral therapy, social communications may become somewhat easier for children with autism.

Autism vs. Speech Delay

Children learn pretty quickly that they need to communicate to receive what they want. In the cases of neurotypical children, they learn to make eye contact, babble, point, and tug on fingers or sleeves to communicate their needs long before they learn to speak.

Neurotypical children learn spoken language over time because they receive positive results from using it. While neurotypical children may experience speech delays, they exhibit the following behaviors –

• Children are motivated by smiles, hugs, and other social responses.
• Kids are naturally prone to imitate the actions of grown-ups around them.
• Children are more likely to observe people than inanimate objects.
• Neurotypical children prefer the company of people. They may tend to get lonely and bored when left alone.
• A child with autism has social communication challenges. These act as hindrances in establishing meaningful social communication.
• A child with ASD may be more motivated by their own interests as compared to social interactions.
• They may not imitate others' actions or rarely do so.
• Children with autism may show more interest in things rather than people.
• They may even be content when left alone.

Any child may face some level of speech development delay in their life. However, a child with autism will exhibit additional signs like difficulty in understanding non-verbal communication.

Hearing Problems Can Cause Autism-Like Symptoms

Sometimes, repeated infections in the ear and other factors can cause hearing loss in children before acquiring speech. In such cases, the symptoms of speech delay may mimic the early signs of autism spectrum disorder in toddlers. So, you may confuse speech delay with autism in this case.

If your child is showing signs of speech delay, you should book an appointment with an ENT(ear, nose, throat) doctor. Children with compromised hearing often make up with increased visual engagement.

Children with hearing disorders and no ASD typically have no problems understanding non-verbal communication and following social cues.

Vision Problems Can Look like Early Signs of Autism

Neurotypical babies should be able to follow their parents’ gaze or look where their parents are pointing.

The only exception is when the child's eyesight is impaired, or their vision isn't developing correctly. While it can mimic some signs of autism in children, a visit with the pediatrician and a simple vision test may resolve the parents' doubts.

What Should We Remember As Parents?

No two children with autism have identical signs and symptoms. Every child is unique. Kids with autism tend to experience speech and language development that is slower than neurotypical children. Special educators and speech-language pathologists can help children with ASD to explore their true potential.

Most importantly, ASD is not a psychological disorder. There is no cure for autism. With the right help and guidance, many children with mild to moderate ASD can manage their symptoms and become independent and functioning members of society.