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Parents often worry when their child doesn’t meet developmental milestones, which can lead to significant concerns.

Understanding the importance of early identification and intervention is crucial for effectively addressing these developmental delays.

This guide aims to help parents understand the differences between speech delay and Autism Spectrum Disorder (ASD), so they can seek the right support for their child.

Typical Developmental Milestones for Speech and Language

First things first, let’s establish the average speech developmental milestones to help you get a better gauge of your child’s condition.

By age two, most children are able to:

Use at least 50 words
Combine phrases to form simple sentences
Follow simple instructions
Show interest in communication

What Is Speech Delay and How Do You Recognise It?

A speech delay refers to a condition where a child’s speech development is slower than that of their peers. Speech delays can vary in severity and cause.

Common Causes of Speech Delay

Speech delay can be caused by various factors, including:

Hearing loss
Oral-motor problems
Developmental disorders
Autism Spectrum Disorder
Environmental factors, such as lack of stimulation

Signs and Symptoms of Speech Delays

A speech-language pathologist (SLP) uses a combination of standardised assessments, observations, and parent reports to evaluate speech delay and determine the appropriate interventions.

These criteria typically involve assessing a child’s speech and language development against age-appropriate milestones as outlined in the previous section. Some common indicators and criteria for speech delay include:

Limited Vocabulary: Using fewer words than expected for their age.
Sentence Formation: Difficulty forming sentences that are age-appropriate in length and complexity.
Pronunciation: Challenges with clear pronunciation of words.
Speech Intelligibility: Difficulty being understood by others.
Articulation or Phonological Processes: Persistent errors in speech sounds beyond what is typical for their age.
Social Communication: Difficulty with using language in social interactions, such as maintaining conversation or understanding social cues.
Comprehensive Language Skills: Challenges with understanding or using language in a variety of contexts (e.g., home, school, social settings).
Parental Concerns: Recognition by parents or caregivers that their child’s speech and language skills are not developing as expected.

However, each child is unique, so the criteria may vary slightly depending on individual circumstances and developmental factors.

What Is ASD and How Do You Recognise It?

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by difficulties in social interaction, communication and language development, repetitive behaviors, and delays in gross motor skills and fine motor skills.

Children with ASD may show delays or differences in:

Social interactions
Communication skills
Play and imagination

Signs and Symptoms of ASD

ASD varies widely in severity and symptoms. Some children may have significant challenges, while others may have mild symptoms and function independently.

Furthermore, symptoms need to be present in the early developmental period, but may not fully manifest until social demands exceed limited capacities, or may be masked by learned strategies later in life.

Diagnosing Autism Spectrum Disorder (ASD) involves assessing a range of behaviours and developmental patterns.

While there is no single definitive test, clinicians, typically psychiatrists or developmental paediatricians, use specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include:

Persistent Deficits in Social Communication and Social Interaction

Difficulty in social-emotional reciprocity (e.g., abnormal social approach, failure of normal back-and-forth conversation).
Difficulty in nonverbal communicative behaviours (e.g., poorly integrated verbal and nonverbal communication, abnormalities in eye contact and body language, deficits in understanding and using gestures).
Difficulty in developing, maintaining, and understanding relationships (e.g., difficulties adjusting behaviour to suit various social contexts, difficulties sharing imaginative play or making friends).

Restricted, Repetitive Patterns of Behaviour, Interests, or Activities

Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects).
Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal or nonverbal behaviour (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects).

Significant Impairments in Functioning

These disturbances in functioning must not be better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Parents should also note that intellectual disability and ASD frequently co-occur. In order to make co-diagnoses of ASD and intellectual disability, social communication should be below that expected for the general developmental level.

Examples of children with Autism Spectrum Disorder

Gladys, 19 months old

Glady’s mother reported that Gladys had not called parents “mama, or papa”, but was able to name items when mum pointed to them. She was mostly quiet at home. She responded to her name and smiled at family members.

Glady’s often pulled her parents to items she wanted but did not use words or say the name of the item even though she knew the name (e.g. ball). Additionally, when they pointed at things, she sometimes did not seem to know where they are pointing towards. Gladys had specific routines, and would only sleep if she was put to bed by her mother.

John, 2.5 years old

John’s parents reported that he started speaking at 15 months. At 2.5 years of age, he was still at single word level, and only spoke when he was asked to name things, or when he was extremely frustrated. He did not always respond to his name, which parents attributed to “selective hearing”.

He knew names of animals, all the letters of the alphabet and also could recite numbers from 1-20. He would imitate or echo what his parents said, or imitate phrases he heard on YouTube, sometimes “out of the blue”.

He was unable to say what he wanted or how he felt. His communication skills were not growing and his frustrations were evident.

Julie, 2.5 years old

Julie was referred because her speech output was limited and unclear, except when she imitated after her parents.

She was described as “quiet”, “girl with very few words”, “prefers to play by herself”. Julie’s parents also found it unusual that she did not seek their attention or ask them to play with her.

Her parents reported that Julie’s mood swing were a concern; she would “fly into a rage” without warning, and could not say why she was “angry”.

Julie also had no interest in anything except for a t-shirt, which she would insist on wearing daily. Although she had toys, Julie did not know how to play with them. She was usually seen holding a toy in one hand but not playing with it.

Spotting the Differences: Speech Delay vs. Autism Spectrum Disorder

Communication: Verbal and Non-verbal Cues

Speech Delay

Children with speech delay primarily face challenges with verbal communication. They may struggle with vocabulary, sentence formation, and pronunciation. They are keen to engage and communicate with others in their environment.

However, their non-verbal communication, such as gestures and facial expressions, is often typical for their age. They can use these cues appropriately to express themselves and interact with others.

ASD

Children with Autism Spectrum Disorder (ASD) typically have difficulties with both verbal and non-verbal communication.

They may find it hard to develop speech, understand and use gestures, maintain eye contact, and interpret facial expressions. For example, they are often seen leading adults to the item they want but not point or use words to say what they want. Additionally, they may not have the desire to communicate with others (such as share information, or joy) but may only communicate when they need or want something. These challenges can significantly affect their ability to communicate effectively.

Social Interaction

Speech Delay

Despite limited verbal skills, children with speech delay usually engage in typical social interactions that are generally in line with developmental norms. They often enjoy playing and interacting with others and show interest in social activities.

ASD

Children with ASD often struggle with social interactions. They may have difficulty forming relationships, understanding social norms, and participating in typical social activities. They might prefer solitary play and have trouble engaging with peers in a conventional manner.

Behaviour and Interests

Speech Delay

Children with speech delay generally do not exhibit repetitive behaviours or restricted interests. Their play and interests are typically varied and appropriate for their developmental stage.

ASD

Children with ASD often display repetitive behaviours for self-stimulation (also known as “stimming”, such as hand-flapping, rocking) and have restricted interests.

They may focus intensely on specific topics or activities (hyperfixation) and may show resistance to change in routines or environments. Changes in routine may increase their anxiety. For example, children with ASD may insist on parents taking the same route to school, taking the same lift, or even putting on the left sock and shoes first.

Response to Intervention

Speech Delay

Children with speech delay often respond positively to speech therapy. With targeted interventions, they can make significant improvements in their speech and language skills, catching up to their peers over time.

ASD

Children with ASD generally require a multi-faceted approach to intervention. In addition to speech therapy, they often benefit from behavioural therapy, occupational therapy, and social skills training.

There are a number of approaches that are used that facilitate speech and language development such as Hanen.

These comprehensive interventions are necessary to address the wide range of developmental challenges associated with ASD.

Early Intervention Matters: Schedule a Professional Evaluation with Speech Matters Today!

While this guide provides valuable information, diagnosing conditions like speech delay or Autism Spectrum Disorder (ASD) requires a professional evaluation.

Early detection and tailored intervention are crucial in helping children reach their full potential. If you have concerns about your child’s development, seeking prompt professional advice is essential.

Speech pathologists are instrumental in diagnosing and treating speech delay and ASD, offering specialised therapies and strategies to enhance communication skills and social interactions and treat voice, fluency (stuttering), swallowing, speech, and language disorders.

At Speech Matters, you are in the expert hands of our speech-language pathologists with extensive experience in helping children with speech delays and ASD.