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Speech Delay vs Autism: Recognize the Signs to Delayed Speech in Children

Dr. Mary Barbera

Have you noticed a speech delay in your child or clients? Many toddlers have a speech delay or speech disorder, and sometimes it is a symptom of something bigger, like autism spectrum disorder. Not knowing if it’s “just” a speech delay vs autism can be confusing and overwhelming, especially to parents who are on waiting lists for autism evaluations. I know this from experience – especially since these waiting lists grow longer and longer each day. This guide will break down what speech delay is and how it can relate to autism. I’ll also tell you what you can do no matter what the diagnosis is for your child or clients.

Speech Delay vs Autism

When I assess a child for delays and autism spectrum disorder, I want to look at the child as a whole so I can get a full picture of what’s really going on. This means looking at much more than the number of words a child says compared to typical milestones. We want to assess things like pointing, whether a child responds to their name, their self-care skills and much more. Important behavioral signs like eye contact and body language can offer valuable insights. By looking at the whole picture, we can see much more clearly if a child has “just” a speech delay vs autism. 

What is Speech Delay or Delayed Speech?

Normal speech develops from cooing and babbling to using words in complete sentences. Looking at a typical child’s speech milestones will help determine if a child has a speech delay. According to Healthline, a typically developing two-year-old can say about 50 words. This increases to about 1,000 words by the time he turns three. A child may have trouble pronouncing words or forming the correct sounds. This is different from a language delay, where he would have trouble understanding words and using them correctly in a sentence. 

A speech delay can be caused by hearing loss, neurological disorders, lack of stimulation, and even a physical problem with the mouth like a tongue-tie. A speech-language pathologist can help diagnose and treat a speech delay. They will look at what your child understands, what they can say, how clear the speech is, and their oral-motor status.
Young girl sitting alone in the park showing signs of speech delay and autism.
Young girl sitting alone in the park showing signs of speech delay and autism.

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What is the difference between Speech Delay and Autism?

A language delay is different from a speech delay. A language delay may mean a child has some words, usually labels, but they don’t communicate their wants and needs to adults or use words functionally. Children with autism spectrum disorder or autistic children often have language problems or developmental delay, and they can also have speech delay. Social communication problems can also result from speech delay and autism spectrum in children. 
One way to assess whether a child is a late talker or has more than a speech delay is to look at their imitation skills, pointing, and whether they respond to their name. A good tool to use is the M-CHAT. The Modified Checklist of Autism in Toddlers is a list of 20 questions that can help you determine if your child is showing signs of autism.
You might be wondering if your child has a speech delay vs autism because of all the isolation they are experiencing due to Covid-19. A speech delay can develop because of a lack of social interaction, though you may not notice the signs of a speech delay or autism if your child spends most of their time at home as well. There are many strategies that you can use at home to help develop speech, including singing songs, reading books, and talking with your toddler.
I go over all of these strategies and many more in my online autism courses as well as my book, Turn Autism Around: An Action Guide for Parents of Young Children with Early Signs of Autism.
Mary Barbera and young Lucas after a speech delay therapy session.
Mary Barbera and young Lucas after a speech delay therapy session.

The Story of Lucas and His Journey with Speech Delay and Autism

I started looking into the early signs of autism because of Lucas. Like many children with autism, my son got started with just a speech and language delay. He went to a typical two-year-old preschool and didn’t cry or fuss much. He also went weekly to speech therapy when he was two. Initially, the SLP seemed optimistic that he would improve, and everything would be fine.

As a first-time mom with a nursing background, I didn’t know much about typical milestones. I knew nothing about the early warning signs of autism. But in my defense, it was the late 1990s before Google searches or Facebook and the rate of autism back then was 1 in 500, not 1 in 44 like it is today.

Once Lucas was diagnosed with autism, I made it my mission to learn the early warning signs and to train pediatricians around the state of Pennsylvania through an early detection grant from First Signs. I can’t diagnose autism, but as a Registered Nurse, and a Behavior Analyst with a strong background in autism spectrum, I do look for early warning signs of autism with a child. Such as an 18-month-old or two-year-old who’s not talking much or at all. And if your child is having these early warning signs of autism, please know not to panic. No matter the actual diagnosis, I’m going to tell you some things that you can do today to start helping turn things around.

Causes and Signs of Delayed Speech in Children

I would look for warning signs of a speech delay in an 18-month-old by looking first at pointing. By 18 months – or at least by two – a child should be pointing. Not just once a month pointing but pointing a decent amount. They should be pointing out things that they want like juice or a toy.
But they should also be pointing to get your attention – which is what we call joint attention. A child does this by pointing to show you things, like pointing to an airplane that’s flying up above. Even if they don’t have the language to say airplane, if they’re pointing with their index finger to show you the airplane, that’s a good sign that it might not be autism because that lack of pointing is such a critical red flag for autism.
In addition to pointing, I also look for a child, even a child that’s not talking, to understand some language. I remember when Lucas was two, I had a photographer come to the house to try to get some pictures. The photographer gave Lucas a film canister and said, “Here buddy, throw this away.” Lucas had no idea what the guy was talking about. The photographer looked at him like you should know this, you’re old enough. But he didn’t understand the language.

Warning Signs in Play and Imitation

In addition to looking at pointing and language, I also want to look for things like playing. Does the child play with more than just one toy? Or is he super focused on one object and needs to carry it around all the time? Does he play with things over and over again, like stacking blocks, not just for a couple of minutes while you do something quickly, but for hours and hours? If a child can be content not using language but is engaging in repetitive playing, this could be a red flag for autism.
And finally, a child of 18 months or two years should naturally start to imitate some things, like waving or making an airplane fly. So, it’s not just if they’re talking or not, we also really need to look at things like play, imitation, and whether or not the child understands language. If he doesn’t have any imitation play, and he doesn’t understand language, it may be more than a speech delay.
Important steps to building language - keep a list of sounds, words and approximations that you have heard your child say.
Important steps to building language - keep a list of sounds, words and approximations that you have heard your child say.

Top 3 Recommendations for Children with Signs of Speech Delay

I have some good news. After working with hundreds, if not thousands of autistic children, as a Behavior Analyst, I learned that no matter if it is a speech delay or autism, putting the same proven ABA strategies in place can help increase talking and decrease tantrums.
Here are the 3 things I’d recommend you do if you’re concerned about your young child who is either speech delayed, showing some signs of autism, waiting on an evaluation, or has a diagnosis.

Step 1: Milestones for Speech Delay and Learning Skills

It’s important to learn the typical milestones for speech and language skills and compare them to your child’s development. The CDC has a great index of milestones on its website of what is expected at every age. So, if your child’s 4 months old, 9 months old, or 2 years old, you can look and see what the child should be doing physically, cognitively, socially, and language-wise. You can use this site to answer questions such as when should a child be putting two words together, when should they be pointing or even feeding themselves.
All parents should monitor their child’s speech development as closely as they would other health parameters. A 12-month-old, 13-month-old, or 15-month-old not talking is not something out of the ordinary but when an 18-month-old is not talking or using words and just babbling, it becomes a matter of more concern. Experts say that the 18-month milestones up to the age of 23 months old, toddlers should have around a 50-word vocabulary though the pronunciation might be unclear. It is also around this 18-month speech development milestone that children normally start to combine words such as “more milk”.
However, it’s important to look at more than just a child’s language milestones. We also want to look at self-care skills like the ability to feed themselves, drink out of an open cup, and the ability to self-regulate. Do they get so upset that they can’t calm themselves down? Are they having frequent tantrums and problem behaviors?
If you have a two year old child, you’ll want to look at both the two-year-old milestones as well as the 18-month milestones. If you look at the two-year-old milestones and your child is not meeting them or missing several, but you look back at the 18-month milestones and they’re able to do all of them, then this may be considered just a minor delay.
It is important to not to panic, if the same two year old child has reached the 18-month milestones expected of him/her but somewhat struggling to reach the 24-month-old milestones. This could just be indicative of a  speech delay, and there is so much that you can do to help your child with delays.
If there are discrepancies between what your child is doing and the milestones they should be meeting, I’d go on to step number two, which is to make a sick appointment with your child’s pediatrician. This is something that I never thought to do especially when I was still in denial that my oldest son had autism.

Step 2: Make an Appointment with Your Child’s Pediatrician

Before going further, let me briefly explain what autism is. Autism refers to a broad range of conditions that inhibit social skills, speech, and non-verbal communication and can show repetitive behavior. It is a developmental disability caused by differences in the brain.
Signs of autism and symptoms can be confusing, which is why it is important to pay attention to your child’s ability to meet expected milestones. Some of the early signs of autism in children include not responding to their names, avoiding eye contact, repetitive movements like flapping their hands or rocking their bodies, and getting very upset if they do not like something. The signs of autism in 18 months and 2-year-olds are similar.
When I think back to before Lucas’s diagnosis there were no well-visits between ages two and three, and while my husband and I had some concerns, we never thought about going to the doctor specifically to discuss what those were. It is important to get a screening done by a professional, as soon as possible when you begin to have concerns. The earlier a child can begin with early intervention, the better.
Also, in addition to contacting your pediatrician, if your child goes to day-care or preschool, you may want to talk to your child’s teacher too. See if they’re falling behind in the classroom and whether they are meeting important milestones similarly to their same-aged peers.

Step 3: Get Informed about Applied Behavior Analysis (ABA)

You need to learn all you can about the science of Applied Behavior Analysis (ABA) and my child-friendly, 4-step Turn Autism Around® approach. Using my proven strategies, especially when a child is very young, can turn around both speech delays and excessive tantrums by increasing language skill and improving things like picky eating, sleeping and potty training.
For example, in cases where a 17-month-old is not talking or there is a 23-month-old with a speech delay, parents and early intervention professionals can see rapid gains in children with or without a diagnosis of autism.  But in order to see the change you have to get started with the Turn Autism Around® approach as soon as possible. This will teach you proactive strategies that you can do with your child within your own home.
My approach, which is based on all of the science of ABA, can help children with speech delays, early signs of autism in toddlers and other related disorders. I cover my approach extensively in my book and my online courses, and I believe this is the best path forward for turning around autism and signs of autism in your child or clients.

Free Workshop to Learn to Turn Autism (or Signs of Autism) Around

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Helping your child or infant with speech and development delay – the next steps

In summary, if you are concerned about your child or toddler, and you can’t tell if it’s a speech delay vs autism, first learn typical milestones and warning signs. Visit the CDC website and MaryBarbera.com for helpful resources to compare what the child is doing. Then talk to your child’s pediatrician and their preschool teacher and get a screening done. Start early intervention as soon as possible. Finally learn about my unique, child-friendly, ABA approach. 
You can learn even more by downloading my free guide: Is it Autism, ADHD, “Just” a Speech Delay, or Typical Toddler Tantrums?
You can learn more by attending a free workshop: Stop Waiting and Worrying About Autism: 3 Secrets to Turn Autism Around in any Toddler or Preschooler.

Helpful Resources: