Q: Good day dr..is it normal for a 21 months old boy have a speech delay?is this something related to autism?..been told that this is normal in boys but it still worry me..thank you ( Liza )
A: Hi Puan Liza, speech delay does not always indicate autism. The language problem can also indicate other health conditions such as the following:
- Hearing impairment: The inability to hear can result in speech delay because babies begin early speech by imitating sounds. Hearing loss can also occur from chronic ear infections.
- Oral impairment: An unusual oral structure such as a tongue tie can limit the free movement of the tongue for speech.
- Intellectual disability: Intellectual disability is one of the most common causes of speech delay.
- Expressive language disorder: A child with expressive language disorder has normal development in areas such as social skills and intellectual ability but has trouble expressing ideas in speech without appropriate intervention.
It is also important to realize that some children with speech delay are simply late talkers and go on to develop an age-appropriate vocabulary and speech skills. In these cases, the children may not have any underlying medical condition.
The features of autism
1. Social interaction
- Poor social interaction
- Lack of interest in other children
- Lack of seeking to share own enjoyment
- Failure to develop peer relations
- Failure to join in activities of others
- Failure to direct adult’s attention to own activity
- Does not show affection
- Does not seek or offer comfort
- Dislikes social touch and being held
- Lack of social responsiveness
- Ignores people
- Lack of social play
- Being in own world
- Prefers being alone
- Indifferent to others
- Lack of attention to voices
- No social smile
- Lack of eye contact
- Lack of gesture
- Lack of facial expression
- No greeting behaviours
- Lack of verbal communication
- No social chat
- Lack/limited range of facial expression
- No/abnormal eye contact
- No or “empty” smiling
- Loss of previously acquired words
- Problems with language comprehension
- Does not express emotion
- Poor imitation
- Lack of infant babble
- Echolalia (repeating or “echoing” whatever words he hears)
- No gaze monitoring
- No pointing to express interest
- No use or understanding of gestures
3. Stereotyped and repetitive routines, behaviours and interests
- Verbal rituals
- Hand and finger mannerisms
- Whole body mannerisms
- Unusual/repetitive preoccupations
- Unusual/repetitive attachment to objects
4. Play and sensory
- Lack of spontaneous play
- Lack of imitative play
- No pretend play
- Sensitivity to noise
- Unusual sensory interests
- Mouthing of objects
- Unusual looking at objects/patterns/movements
Differentiating between speech delay, developmental delay and autism in young children.
Parents of young children with autism often report delayed speech as their first concern, but speech delay is not specific to autism. Delayed speech is also present in young children with global developmental delay caused by intellectual disability and those with severe to profound hearing loss.
Children with speech delays or hearing loss are usually able to compensate for their limited or lack of speech by the use of non verbal communication skills such as using gestures (e.g. pointing), eye contact and facial expression to get their message across. These children also respond to praise, imitate and engage in make believe play. Children with developmental delay will also usually attain these skills when their developmental level passes about 12 months of age.
However, the child with autism continues to have ongoing problems with delayed and disordered language, social communication skills, empathy and pretend play skills regardless of developmental level .
What to look for in the first year of life (for autistic features)
- Lack of social smile
- Lack of appropriate facial expression
- Poor attention
- Not responsive to name
- Unusual looking at objects/patterns/movements
What additional things to look for in the two year old:
- Ignoring people
- Preference for being alone
- Lack of or impaired eye contact
- Lack of gestures (e.g. pointing to objects)
- Lack of emotional expression
- Lack of age appropriate play with toys
Once hearing loss is ruled out, he need to be referred to speech and language therapist. There is hope for a child with autism and speech delay to expand his vocabulary and speech ability through therapy. Even in cases where a child with autism remains nonverbal, there are effective methods of nonverbal communication that allow the child to express himself and communicate. Early intervention is essential to treating autism and speech delay for the best possible outcome.
So I would suggest that you bring your child to see his doctor for proper assessment in order to get appropriate therapy as early as possible.
( answered by Dr Soong Eileen , paediatrician in Taman Desa Medical Centre )