Many parents whose children exhibit speech and language delays are immediately concerned that their child may have autism. In early intervention, we cannot diagnose a child with Autism Spectrum Disorder (ASD), we can only tell a parent if their child is showing developmental delays and if we see certain red flags that may indicate a child needs further evaluation to rule out ASD.
As an independent evaluator, I have seen many children for “speech only” evaluations (where speech is the only area of concern for the family) who exhibited red flags for autism. Many of the red flags were not related to speech. Conversely, I have seen many children whose parents ask me if their child may have autism (due to delayed speech) and it’s pretty clear to me that they don’t, they simply have a developmental delay in speech.
As a therapist, it’s again important to distinguish that I cannot make a diagnosis of autism. This needs to be done by a licensed professional, such as a child psychologist, psychiatrist or developmental pediatrician. So what are the red flags that I am seeing that some parents miss? Many times it’s their social skills and play skills! Or lack of these skills.
Because parents continually hear about autism in the news, many associate the simple lack of speech or delayed speech with having autism. While this can be one feature associated with ASD, there are many other signs that parents can be aware of in order to determine if their child is simply speech delayed or if it indeed may be something more.
Speech Delay or Autism? The Signs of Autism
This is not an exhaustive list, and remember all children diagnosed with autism do not exhibit all characteristics.
Verbal Communication Skills
-Your child may have no true words and only babble or make noises or odd sounds
-Your child may have some words, but repeat the same words or phrases over and over (echolalia) and not imitate new words or not use the words he has spontaneously in order to request or get wants/needs met
-Your child may say a word once and you never hear it again, or your child may have used a few words for a bit and then lost the words and does not use them anymore
-Your child may use unusual voice tones, such as a sing-song voice, robot-like voice or growling voice
Receptive Language Skills
–Your child may not follow simple commands or directions such as “give me the ball” or “go get your shoes”
-Your child may not respond to his name or seem like he can’t hear you or is ignoring you
Nonverbal Communication Skills
-Your child does not point to objects, pictures or people
-Your child does not use gestures or eye gaze to get wants/needs met
-Your child may use you as a “Means to and End,” such as pulling you towards an object he/she wants in order to get the object
-Your child may not be able to recognize facial expressions or imitate gestures or facial expressions
-Your child may not have shared joint attention. For example, he sees an airplane and without saying a word, he looks to the sky and then looks to you and then back at the airplane as if to say “hey, did you see that?”
-Your child may not understand body language, gestures or facial expressions
-Your child may not make eye contact or have very limited eye contact
-Your child may always be looking at what he is doing instead of you when you speak to him
-Your child may have narrowly focused interests or obsessive interests
-Your child may play with toys in odd ways (lining up cars or blocks instead of driving or stacking, spinning toys or repeatedly dropping/throwing toys)
-Your child may engage in repetitive movements, such as tip toe walking, hand flapping/waving, rocking, spinning in circles
-Your child does not engage in turn taking or play in a back and forth manner with you
-Your child may have an unusual attachment to certain objects (needing to carry a toy in each hand at all times, preoccupation with one certain item such as a hair clip or rubber band)
-Your child may be very rigid in play and routines (a need for “sameness,” getting upset if a toy is moved out of line or if the daily schedule or routine changes)
-Your child may prefer to play alone or play alone for long time periods for his age (for example an 18 month old who plays alone for an hour without engaging an adult in his play)
-Your child may not engage in pretend play with toys (pretending to feed a baby doll or fighting with action figures)
-Your child may be interested in only the parts of a toy instead of the whole toy as it was meant to be played with (such as the wheels on the car, or the underside of the pop-up-box, or the valve where the air goes into the ball)
-Your child may line toys up instead of playing with them
–Your child may be undersensitive or oversensitive to touch, sight, sound, movement, smell, etc.
–Your child may become overwhelmed or have a melt-down in noisy and/or crowded environments
–Your child may cover his ears in response to some sounds
–Your child may be described as a “picky” eater
–Your child has a very limited diet or a few select foods
–Your child is unwilling to try new foods
–Your child has difficulty with textures of foods
–Your child needs foods presented the same way (on the same color plate or in the same box the cookies were in the first time he had them)
–Your child may be oblivious when new people visit the house
–Your child may have difficulty regulating his emotions and laugh, cry or yell at inappropriate times
–Your child may be unaware of common dangers inside and outside the home
–Your child does not participate in or seem to show understanding of social games such as Peek-a-boo, So-Big or Pat-a-cake.
–Your child may not know how to engage you or another child in his play and prefer to play alone
–Your child may seem to shun social interaction and not call attention to himself or anything he is doing (such as showing you a tower of blocks he built or a picture he colored)
–Your child may be difficult to comfort when he gets upset or seem to get upset for “no reason
–Your child may have difficulty interpreting your facial expressions, feelings and body language
–Your child may be clumsy or appear uncoordinated
–Your child may toe walk
–Your child may have an atypical gait pattern
If you suspect your child may have autism, speak to your pediatrician. Some pediatricians will complete an autism screening tool called the M-CHAT (Modified Checklist for Autism in Toddlers), but keep in mind this is only a screening tool and does not pinpoint an actual diagnosis, but will tell you if your child will benefit from more testing. You can also contact your local early intervention provider for a developmental evaluation and a referral to a doctor or clinic where an autism diagnosis can be determined.
Link to the printable Autism Spectrum Fact Sheet from the CDC: http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/autismfactsheet.pdf
Autism Speaks website and M-Chat home screening link: http://www.autismspeaks.org/what-autism/diagnosis/screen-your-child