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April is National Autism Awareness month, so there will be lots of information in the news about autism and autism spectrum disorder (ASD). One of the first signs of autism is late onset of talking. Indeed, this is perhaps the most salient feature parents notice--and report to pediatricians—when they are concerned about their child's development and ASD. If a child does have autism it is very important to get an accurate diagnosis as early as possible and to get the right treatment. On the other hand, it can be difficult to diagnose autism in toddlers, so parents should become informed as they seek answers as to why their child is late to begin speaking.
For most children, first words emerge at about 12 months of age. But, for up to 10% of toddlers, their first birthday comes and goes without starting to say “mama” or “dada” or any other word.
Do these late talking children have some form of ASD? After all, late talking can indeed be a symptom of ASD. But it can also be a sign of another developmental disability such as language disorder, speech disorder, intellectual disability or even hearing loss. Importantly, late talking can also simply be a passing developmental stage, with no long-term adverse consequences whatsoever. It may surprise some to learn that the odds of the late talking being ASD—or some other dire condition is much less than 50-50.
Indeed, studies of late talking children—those who are not yet speaking at 12, 14 or even 18 months of age, show that 70%--or even more—do NOT have ASD or any other lasting developmental problems.[1] [2] On the other hand, this does mean that up to 30% do have ASD, speech disorder, language disorder, intellectual disability or another condition requiring treatment. No parent should ever assume their late talking child will simply grow out of the late talking.
Therefore, if a child is late to begin speaking, parents should discuss this with their pediatrician or family physician to rule out any medical conditions that may be causing the late talking. Parents should also seek out a Speech-Language Pathologist who has special training on how young children learn to talk.
If a referral is made for an autism test, it is important to ensure that the assessment provides a diagnosis rather than simply determining whether a toddler displays some symptoms of autism. Because many toddlers, including those who do not have autism, sometimes throw tantrums, ignore parents and/or refuse to respond to questions, late talking can sometimes be mistaken for ASD. No child should ever be diagnosed as ASD simply because they began speaking late.
If your child is diagnosed with autism or ASD, be sure to ask questions about why the diagnosis was made and have a thorough understanding of the diagnosis and the recommended treatment. Moreover, all clinicians should welcome questions from anxious parents and be forthright and supportive while answering these questions. Parents should always be offered the opportunity to be part of the treatment plan because home-based treatment can often be very effective. On the other hand, if a late talking child does not have ASD, treatments for autism may actually hinder development.
Sadly, there are many questionable treatments being pushed on parents of late talking children, especially those with ASD. These include “detox” programs such as “chelation,” special diets, special vitamins, and unusual therapies such as tongue and mouth exercises, listening to metronomes, receiving auditory bombardment, wearing weighted vests, being brushed or put on “sensory diets” or other controversial and unproven “remedies.” No child should ever be strapped into a chair and forced to talk. Rather, treatment should be play based (because toddlers learn best while playing), positive and nurturing.
The truth is that the scientific evidence is overwhelming that late talking toddlers with ASD or with other developmental problems such as speech and language disorders that require treatment learn best when taught to talk in play based interventions. It may seem like common sense that late talking children should be taught how to talk, but all too often alternative ineffective (and expensive) “treatments” are recommended.
The good news is that there are many knowledgeable and highly skilled clinicians ready to help. They will teach your late talking child that communicating is positive and fun. Work with your pediatrician or family physician to get the right answers. And, as always, trust your intuition.
[1] Whitehurst,G.; Fischel,J.; Arnold, D.; Lonigan,-C. (1992). Evaluating outcomes with children with expressive language delay. Warren, Steven and Reichle, Joe Ernest (Eds). Causes and effects in communication and language intervention. Communication and language intervention series, Vol. 1. (pp. 277-313). Baltimore: Brookes.
[2] Paul, R (1993). Patterns of development in late talkers: Preschool years. Journal-of-Childhood-Communication-Disorders, 15: 7-14.
