Many toddlers have speech delays, and sometimes a speech delay is a symptom of something bigger, like autism. I know from experience that it’s often confusing and overwhelming to parents who are on waiting lists for autism evaluations. Especially since these waiting lists grow longer and longer each day. So today, I’m breaking down a speech delay vs autism and what to do no matter what the diagnosis is.
Like many children with autism, my son Lucas 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 a speech therapist 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 50 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, 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.
Identify signs for delayed speech in children
So, I assess an 18-month-old or a two-year-old by looking first at pointing. I never realized how important pointing is, but it’s very important. And by 18 months, or at least by two, a child should be pointing. Not just once a month pointing, but like pointing a decent amount. They should be pointing for things that they want like juice or a toy.
But they should also be pointing to get your attention, for joint attention is what we call it, by pointing to things 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, like, “oh, oh,” 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 my boys were two years old and six months old, I had a photographer come to the house to try to get some pictures. This is back in the late 1990s. I remember the photographer giving Lucas a film canister and saying, “Here buddy, throw this away.” And he had no idea what the guy was talking about. The guy looked at him like you should know this, you’re old enough.
I just kind of brushed it off. I didn’t know if he should or shouldn’t know it. But he didn’t understand language. It wasn’t just an expressive language delay, it was also a receptive language delay, which doesn’t have to be autism. A child can have both and not have autism. But Lucas has a very severe expressive and receptive language delay.
Identify warning signs in play and imitation as well
So in addition to looking at pointing and language, I also want to look for things like playing. Does the child play with some toys, more than just one toy? Or is he super focused on one object, or needs to carry it around all the time? Or plays with things over and over again, like stacking blocks, not just for a couple of minutes while you do something quickly, but like hours and hours, they can be content not using language, but like spinning things or lining things up. These are all red flags for autism.
And finally, a child of 18 months or two years old, should be naturally starting 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.
Action steps to take whether it’s a speech delay vs autism
But, I have some good news. After working with hundreds, if not thousands of children, as a Behavior Analyst, I learned that no matter, if it is autism or just something like a speech delay, putting the same proven ABA strategies in place can help increase talking and decrease tantrums. I’ve also worked with kids where I know we’ve prevented the diagnosis of autism or turned it around so quickly that they caught up before kindergarten.
So, 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, maybe they already have a diagnosis of autism but are waiting for treatment, or they could be waiting for an autism evaluation. And even if it is just a speech delay, learning these 3 things can help you and your child get started today.
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I want you to learn typical milestones for speech and language skills and compare them to your child’s development. The CDC has a great index of milestones on their website that are expected at every age. So if your child’s 4 months old, 8 months old, 18 months old, 2 years old, you should be able to look and see what the child should be doing physically, cognitively, language-wise, when should they be putting two words together for instance, when should they be pointing, when should they be feeding themselves. And it’s important not just to look at the language milestones, we want to look at self-care, when can they feed themselves, drink out of an open cup, self-regulation skills, do they get so upset that they can’t calm themselves down, are they having frequent tantrums and problem behaviors because they don’t understand the world around them?
You’ll also want to compare the milestones of typically developing two-year-olds, and there’s going to be a range. It’s not going to be like, every two-year-old needs to be doing this. But if you look at the two-year-old milestones and your child is not doing any of them, but you look back at the 18-month milestones and they’re doing all of them, then it may just be a little bit of a delay.
If there are delays between what your child is doing and the milestones, I’d go on to step number two. Make a sick appointment with your child’s pediatrician. This is something that I never thought of. There were no well visits between two and three, and I had some concerns. My husband had some concerns, and we just never thought about going to the doctor specifically to discuss those concerns. I would recommend that. You want to get a screening done by a professional because as a parent, you just want everything to be okay. But get a professional to help you screen the child and see if you can start early intervention.
Also, in addition to contacting your pediatrician, if your child goes to daycare or preschool, you may want to talk to your child’s teacher too. See if they’re falling behind in the classroom. She can give you input potentially on how he’s doing with group responding, waiting in line, or getting into trouble at preschool. And this can also give you an idea of what is happening.
You need to learn all you can about the science of Applied Behavior Analysis or ABA for short. Because with intensive ABA therapy, when a child is very young, even some with severe autism can lead normal lives. But you have to get on it. Even if it’s just speech delay, ABA is always going to help the situation, never hurt the situation. Especially if you learn proactive strategies that you can do with your child right in your own home. ABA can help kids with any kind of disorder and speech delays, and they can learn language a lot more quickly.
Let’s summarize how to tackle a speech and language development delay
So, in summary, if you are concerned about your child or any toddler that you know and you can’t tell if it’s a speech delay vs autism, Step #1, learn typical milestones. Google the CDC website, learn the milestones, compare them to what the child is doing. Step #2, talk to your child’s pediatrician and their preschool teacher and get a screening done. Start early intervention as soon as possible. And step #3 is you need to learn about ABA. And one of the best places to start is by going to marybarbera.com/toddler. Click the link below to get more information today.
And if you like this video blog, I would love it if you would leave me a comment, give me a thumbs up, and share the video with others who might benefit. Don’t forget, you can download my free toddler guide called, “Is It Autism, ADHD, or Typical Toddler Tantrums? 3 Steps You Can Take Today Instead of Worrying” at marybarbera.com/toddler, and I hope to see you right here next week.
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