Q&A: My son's language skills are slightly delayed. Could he have autism?
My son is 18 months old and only says about 12 words, although he uses about 20 baby signs. His doctor said he would have his hearing tested if he wasn't speaking better by 2 years old, but not to worry about it if he is only sightly language delayed.
My sister's daughter is autistic and she says that lack of speech is one of the first and prominent signs of autism. I know my son can hear because he follows my directions, and hears and points to airplanes outside and gives his baby sign for airplane. The doctor doesn't feel he shows any signs of autism as he is very social and makes good eye contact, follows directions, etc. My sister said her daughter didn't start showing signs of autism until she was older.
My insurance won't cover an evaluation unless my doctor requests it. Do you think my son's limited vocabulary is something to worry about or is it within a normal range? Even though my sister lives out of state and has never met my son, I worry that she may be right.
First a word about the development of speech. We look for a child’s first specific words at approximately 1 year of age, although many children actually start earlier. By 1 1/2 years old, most children have 12 to 20 words and what follows at appoximately 20 to 24 months of age is a virtual language explosion, with new words coming at a fast clip. When a child’s vocabulary contains about 50 words these begin to be combined into novel two-word phrases, such as “come out,” “mommy, yes.”
By the age of 2, most children are speaking in two word sentences with a quickly expanding vocabulary.
The skills mentioned above are expressive language skills. The other component, receptive language,or the ability to comprehend language,develops sooner. By 9 months, for example, children know their own name.
Like most things involving humans, however, their is a range of skills and different amounts of time needed to acquire those skills. The skills your son is displaying are within the range of normal, although double checking that his hearing is normal is the appropriate first test when language is truly delayed.
Second, a word about the diagnosis of autism. This one diagnosis includes a wide range of behaviors. Autistic behavior runs across a spectrum from quite mild to very severe, so making the diagnosis is easy in some cases and very, very difficult in others. Broadly speaking, autism develops before 30 months of age, though some children appear to develop normally and then regress into an autistic picture at around 15 months. The cause is unknown, but the hallmark behaviors are poor verbal and non-verbal communication skills, unimaginatinve activity, poor social skills often including lack of eye contact, lack of empathy and a strong need for structure and repetition. Speech abnormalities include nonsense rhyming, repeating without understanding what is said by others or memorizing large passages of text, again without comprehending it.
While there is some overlap between the behavior of delayed but otherwise normal children and that of mildly autustic children, time and a developmental evaluation can sort between the two.
Your son’s speech pattern alone does not sound worrisome for autism and if his speech progresses normally in the next six months, you will hopefully be completely reassured.