Woman with two boys working with letter and number blocks

Murdoch Children's Dr Amanda Brignell and the Autism Research Team answer some common questions parents ask about language development and ASD.

Q. My 18-month-old child doesn’t say any words. Could this mean they have Autism Spectrum Disorder (ASD)?

A. Children develop their first words at a wide range of ages. First words usually emerge around 12 to 16 months of age and by two years children are typically starting to combine two words together. As many as 20% of young children in Australia have language delays, yet only 2% of children are diagnosed with ASD. While language delays do commonly occur in ASD they are not required to make a diagnosis. Other problems and behaviours (difficulties with social communication skills, repetitive restrictive behaviours and interests) would also have to be present before ASD would be considered.

If you are concerned about your child’s ability to talk, or any other aspect of their development or behaviour is worrying you, your GP or maternal and child health nurse are good people to talk to.

Q. My child was starting to say a few words, then after she was 18 months old she stopped saying them. Does she have ASD?

A. Loss of previously-acquired words, also referred to as ‘regression’, has been reported to occur in a quarter of children with ASD. Children with ASD are more likely to lose words than other children. However, a proportion of children without ASD also lose words. Therefore, losing words does not necessarily mean your child has ASD. If your child has lost words or other skills, a paediatrician should assess your child. In order to make a diagnosis of ASD a detailed diagnostic assessment needs to be conducted and many other areas of development, not just language, will be investigated to assist with diagnosis.

Q. My child has just been diagnosed with ASD and is not yet speaking. Will he ever be able to speak?

A. It has been proposed that several factors may be linked to the development of language; such as a child’s social communication ability, social motivation, intelligence, and understanding of language, and whether they have other conditions, such as epilepsy. While we understand factors that may be important in language development, we are not yet able to reliably predict which children will talk or when they will start to talk.

Older studies used to report around 50% of children with ASD were talking by five years of age. In contrast, recent studies have shown between 70-80% of children with ASD were talking by five years of age, and 80-85% by nine years of age. The increase in number of children who are able to talk in recent studies could be related to an earlier age of diagnosis, better access to intervention, changes in the criteria used to diagnose ASD or children with milder symptoms being diagnosed.

Q. I’ve heard that some toddlers and young children with ASD who are not able to talk suddenly start speaking fluently when they are older. Is this possible?

A. There have been some reports of non-verbal children suddenly starting to talk fluently. More often children who start to talk do so gradually and require time and practice to develop their communication skills. In this way, they progress through similar stages of language development to other children. For example, they may start with words and short phrases and then build up to sentences and narratives.

Q. My child copies back what I and what others say (echolalia). Does this mean she has ASD?

A. The use of echolalia (parroting words used by others) is more common and persistent in children with ASD; however, imitation of other people’s words and phrases also occurs for some children as part of normal language development. Echolalia can also be seen in children who do not have ASD but who have severe language delays and intellectual disabilities. As echolalia can occur in a range of different developmental conditions, a detailed assessment of the child’s communication ability by a speech pathologist is important if your child’s talking appears to be behind other children of the same age and he/she persistently echoes words or uses words or phrases inappropriately.

Q. My two-year-old child uses single words and short phrases but he doesn’t use any gestures like waving goodbye. Is this linked to ASD?

A. Reduced use of gestures can be a feature of ASD however there is a wide variation in the use of gestures within a community and between communities, and gestures are just one part of a child’s social communication development. It is important to look at other areas of social communication to diagnose ASD, such as the ability to engage with others, use eye gaze, respond to other people, and initiate interaction. It is also important to look at other areas of the child’s development. By doing this your child’s use of gestures can be understood within their overall level of development.

Q. My eight-year-old son has an extensive vocabulary and had advanced speech as a toddler. He can talk all day about complex subjects. I’ve been told that he has ASD but how can this be if he can talk so well?

A. While language difficulties are common in children with ASD, many children with ASD are able to speak fluently and in some cases have superior language abilities on formal testing. A child may have good language but not be able to use their language appropriately during social interactions. If a diagnosis of ASD has been made it will have been based on social communication skills (ability to use non-verbal cues, interest in other people and ability to interact socially and form relationships) and the presence of repetitive and restricted interests and behaviours.

Q. My paediatrician has recommended my child sees a speech pathologist – what is their role in working with children with ASD? What can I do to assist my child to talk?

A. A speech pathologist can assess your child’s communication abilities and investigate factors that may be contributing to their difficulties with learning to talk. Following an assessment, the speech pathologist can provide advice about appropriate interventions and strategies you can use to help your child develop their communication skills.

Intervention for children is usually play-based and may take a variety of forms such as parent training, group intervention or individual sessions with the child to demonstrate specific techniques. It may take place in the home, at a clinic or in school or pre-school. The emphasis of intervention with a speech pathologist is on supporting the child to develop effective communication, be it talking or other means.

Speech pathologists work directly on developing the child’s language as well as on key skills that are important for the acquisition of language such as play, social interaction, joint engagement and imitation. The use of augmentative or alternative forms of communication may also be recommended, such as the use of keyword signs, gestures and pictures. Research has found that using pictures and alternative means of communication such as signing does not prevent a child from talking. In fact, these alternative methods of communication have been found to facilitate a child’s ability to talk. A speech pathologist can perform a comprehensive assessment and this will help plan the most appropriate approach for your child.

For more general information on ways to encourage your child’s language development please visit the Raising Children Network website.

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