Speech Delay and Its Connection to Autism

What is a speech delay?

If your child is having a difficult time communicating with you, it may be due to a speech and language delay. All children learn how to communicate at various times; however, there are general milestones for early speech and language development that can help guide you to know what to expect and when.

Speech refers to actual spoken words and the ability to produce sounds, syllables, and words. Difficulty with sounds, syllables or spoken words may be the result of a speech delay. A young child may have spoken words, but their speech is hard to understand because they cannot produce a certain sound or sounds correctly. They may exhibit difficulty planning the motor movements that are necessary to combine sounds and syllables to form words, and/or they may present with muscular weakness that can lead to mumbled or slurred speech.

Language refers to a system of words and symbols that are used to share ideas, information, and feelings with others. When we talk about language, we are referring to both receptive (what your child understands) and expressive (how your child communicates with the world around them) language.

Receptive language

Receptive language refers to the understanding of language.

Here are a few ways to support receptive language with your child:

• Reduce distractions and background noise.
• Gain your child’s attention before talking to him or her (e.g., get down on his or her level and let your child see how your lips, tongue and jaw are moving while you talk). 
• Pair simple gestures with familiar words. 
• Label/Tact items throughout your everyday activities and routines.
• Talk about what you are doing as you do it (self-talk).
• Talk about what the child is doing, seeing, and/or hearing (parallel talk).
• Simplify-Simplify-Simplify (use less words so your child can focus on each sound and syllable being said). 

Expressive language

Expressive language is the way basic wants, needs, feelings, and ideas are communicated through spoken words, written words, and gestures with others.

Prior to developing spoken words, young children often begin to use a variety of gestures (e.g., pointing, reaching, hand leading, waving, shaking head to indicate “yes” or no”, simple sign language, etc.) to communicate with those around them. 

Here are a few ways to support expressive language development in your child (these should be practiced every day):

• Limit screen time.
• Read and/or look at books (picture, interactive, predictable, etc.).
• Sing songs and fingerplays (Itsy Bitsy Spider, Twinkle Twinkle Little Star) with repetitive text.
• Play on the floor.
• Limit test-like questions (tell your child rather than ask). 
• Talk to your child using words that help promote meaningful communication.
• Become your child’s voice in the absence of his or her words. Increased pressure to talk may reduce your child’s attempts to talk so do not ask them to “say” words. 

It is important to teach words or signs that will help your child develop functional communication, thus reducing the potential for increased frustration. Words that communicate basic wants, needs, and feelings (e.g., milk, bubbles, eat, etc.), words that encourage interaction with others (e.g., hi/bye, mama/dada), and words that are used to seek and share information (e.g., ask/answer questions, tact/label) are more important than concept words (e.g., letters, numbers, colors, and shapes) taught out of context in the form of flashcards, etc. Concept words can easily be embedded within the context of your child’s daily routines (e.g., green shirt) rather than the sole purpose of your interaction with them. Your first goal is to help your child develop the ability to effectively communicate his or her basic wants and needs, thus reducing frustration and the potential for challenging behaviors.

Signs that your child could have a speech and language delay may include:

• Lack of gestures for communicative purposes by 12 months of age.
• Use of gestures over vocalizations when communicating by 18 months of age.
• Difficulty imitating sounds by 18 months of age.
• Trouble understanding simple verbal requests by 18 months of age.
• Imitation of speech sounds without the presence of words or simple phrases to communicate basic wants and needs by 2 years of age.
• Not following simple directions by 2 years of age.

Your child’s words should be 50% intelligible to you or a familiar listener by 2 years of age and approximately 75% intelligible to you or a familiar listener by 3 years of age. At 4 years of age, your child should be 100% intelligible to you and others.

Are there different kinds of speech delays?

In short, yes, there are different kinds of speech delays. A speech and language delay occurs when a young child does not develop speech and language skills by an expected age according to general developmental milestone standards. If your child is   having difficulty communicating with others, it is important to figure out the why. Is it related to speech, language, or a combination of the two? The cause of speech delay may be unknown, or it may be the result of underlying developmental or physical difficulties.

What Causes Speech Delays?

The most common cause of speech and language delays stems from oral-motor problems, autism spectrum disorder (ASD), hearing loss or auditory processing difficulties, and/or an intellectual disability.

Oral-motor problems- occur when a child has difficulty controlling his or her mouth (lips, tongue, jaw, teeth, and palate) to make sounds, talk, blow, chew, and/or eat. There are two main oral-motor disorders that impact speech: apraxia and dysarthria. When a child has apraxia, they have trouble planning the motor movements necessary to combine sounds and syllables to form words. Dysarthria is caused by weakness in the muscles; therefore, often resulting in speech that comes across slurred or mumbled. 

Autism Spectrum Disorder (ASD)- The Diagnostic and Statistical Manual, 5th edition (DSM-5), states that the primary characteristics of autism spectrum disorder includes social communication and interaction impairments and the presence of restricted and repetitive behaviors or interests that occur in the early developmental stages of life. While the DSM-5 no longer lists language deficits as a primary characteristic of ASD, language delays is generally one of the earliest concerns parents describe their child as having. It is important to note that oral language development in children diagnosed with ASD varies greatly. Some children who have not yet learned how to talk are considered pre-verbal, some children who say a few words are considered minimally verbal, and some children use spoken words but have a difficult time learning grammar and social rules. 

Hearing loss or auditory processing difficulties- a crucial part of speech and language development is a child’s ability to hear his or her environment. Some children may inherit a hearing loss; however, if a child has experienced frequent ear infections (acute otitis media) or fluid in the middle of his or her ear (otitis media with fluid) they may have suffered from temporary hearing loss which could have impacted overall speech and language development. Both ear infections and fluid in the middle ear have been compared to a child trying to hear and learn how to talk while submerged under water. Auditory processing difficulties can directly impact a child’s ability to process what they hear because his or her brain interprets sounds differently than others. Approximately 3-5% of kids present with auditory processing challenges. 

Intellectual disability- children with an intellectual disability often have a hard time with speech sound production, semantics, syntax, and the pragmatic aspects of language. It can be difficult for children with an intellectual disability to string sounds into words, put words together into sentences and/or use language to communicate effectively with others. This difficulty communicating may lead to poor social interactions, challenging behaviors and/or isolation.

How can a speech delay affect / impact a child diagnosed with autism?

Autism is often defined as a condition that is marked by difficulties with communication and social skills as well as the presence of restricted or repetitive behaviors. A speech and/or language delay can affect a child diagnosed with autism in a variety of ways. It may affect a child’s ability to communicate his or her basic wants and needs, effectively engage with their environment and those around them as well as impact their overall academic growth trajectory.

Why is it important to address speech delays?

Addressing a child’s suspected speech and/or language delay as early as possible can make a huge impact as early childhood is often considered a critical period for language development. When a child can effectively communicate their basic wants and needs and interact with people and his or her environment, the less likely they are to get frustrated and engage in challenging behaviors. Untreated speech and/or language delays can have a cascade effect from early childhood into adulthood and negatively impact several areas of one’s life, limiting a person’s ability to engage and succeed across various activities of daily living. 

How does ABA therapy address speech delays?

Applied Behavioral Analysis, also known as ABA, addresses speech and language delays in a variety of ways. While ABA is primarily associated with autism spectrum disorders, it can be used across different populations such as those with intellectual disabilities, attention deficit hyperactive disorders, and stuttering, etc. 

ABA is a science that involves the application of research-based strategies and techniques that are based upon the principles of learning to make a change in socially significant behaviors. It involves identifying the skills that are missing in a child’s repertoire as well as socially inappropriate behaviors, and then turns around and teaches those skills and/or replacement behaviors that are deemed more socially acceptable. ABA is also used to address maladaptive behaviors (self-injurious, aggression, tantrums) that impede a child’s development of skills by identifying the functions of the behavior, reducing the occurrence of the behavior, and replacing such behaviors with more socially acceptable ones. 

ABA therapy helps increase a child’s independence and engagement with other people as well as his or her environment by teaching a variety of skills across different developmental domains (adaptive, personal-social, communication, motor, and cognitive). Once a child acquires a targeted skill, the focus of ABA moves to maintaining and generalizing those skills across people (parent/caregiver, siblings/family, therapists, community), environments (home/school/community) and materials (different examples of the same toy or material). 

ABA programs are highly individual; therefore, to best fit a child and family’s needs, an individualized program is created for each child by the Board-Certified Behavior Analyst (BCBA) assigned to the child’s team. The BCBA trains and shares information with all members of the child’s team to implement programs and monitor progress across targeted goals. The BCBA works with the other service providers to ensure consistency and collaboration. A team approach is what leads to the best prognosis and/or intervention results for a child. It ensures all team members and service providers are teaching needed skills in a manner that ensures consistent and positive learning without conflicts or contradictions. A team approach helps a child generalize and maintain learned skills across people and environments. 

Finally, there is a huge emphasis on parent training in ABA therapy. Parents learn how to create learning opportunities within their child’s daily activities, routines, and natural environment to consistently teach specific skills. Parent training is the best way to ensure a child’s learned skills are generalized and maintained across people and environments. Parents are the gateway to collaboration across all service providers involved in their child’s intervention program. A child’s best advocate is his or her parent as they are the experts on their child. Effective parent training helps maximize the impact of intervention for a child, 

How are speech delays related to an Autism Diagnosis?

Speech and language delays are related to an autism diagnosis when a child’s communication and social interactions are impacted in early life. A child’s inability to communicate his or her basic wants and needs with gestures, words or other modes of communication can lead to increased frustration and behavioral challenges. Speech and language delays are very common with the autism population; however, it is important to note that there are speech and language delays that are not related to an autism diagnosis. Speech and language delays can stand alone and have no known cause, and/or they can be secondary to other disorders such as oral-motor, hearing/auditory processing, and/or intellectual impairment. 

How common is it for an individual diagnosed with autism to have a speech delay?

Given that the Diagnostic and Statistical Manual, 5th edition (DSM-5) notes the primary diagnostic traits of ASD include impairments in social communication and social interaction as well as the presence of restricted, repetitive behaviors or interests in the early developmental period of life it is highly likely an individual diagnosed with autism will have some level of a speech and/or language delay. The development of speech and language in children diagnosed with autism may vary greatly as follows:

Preverbal– when a child has complex communication needs and is non-speaking (preverbal) but learns how to express themselves in other ways.

Minimally verbal – when a child presents with limited output of spoken words. They may use a few words or word approximations but not at a rate one would expect for his or her age.

Verbal with structural and pragmatic language deficits– at least half of children diagnosed with autism have a lot of spoken words but present with structural and pragmatic language difficulties. A child may have a lot of words and speak fluently but displays structural deficits related to phonological processing, vocabulary, and grammar in addition to pragmatic deficits related to social-emotional reciprocity, nonverbal communication, and the ability to develop and maintain relationships with others. 

Verbal with pragmatic language deficits- refers to a child who speaks fluently and with an intact language structure (phonological processing, vocabulary, and grammar) but tends to have difficulty with pragmatic language skills related to social-emotional reciprocity, nonverbal communicative behaviors, and the ability to develop and maintain social relationships.

It is important to note that to meet the criteria for an autism diagnosis, a child must also display restricted, repetitive patterns of behavior or interests. Per the DSM-5, an older child who has marked deficits in social communication without the presence of restricted and repetitive patterns of behavior or interests may meet the criteria for a social communication disorder (SCD) and should be evaluated specifically for a social communication disorder.