Speech Delay vs Autism

Even for experienced clinicians, it may be difficult to distinguish symptoms of standalone speech delay vs autism, and this is especially true in the case of high-functioning autism speech delay. 

When questions emerge about whether a child has a speech delay vs autism, speech-language pathologists (SLPs) play a critical role in supporting late talkers and their families. SLPs can coach parents, model strategies to help clients elicit speech, and provide valuable insight about childhood language development. 

A speech delay may be a characteristic of an underlying condition like autism spectrum disorder (ASD), or it may exist in isolation. 

SLPs can be part of a collaborative team—including psychologists and pediatricians—that make autism diagnoses. They can share valuable data about a client’s communication development to bring a diagnosis into sharper focus. Likewise, SLPs can provide evidence of a speech delay in the absence of autism. 

This is why it’s crucial for SLPs to recognize the signs of a speech and language delay and identify co-occurring characteristics or behaviors that may point towards autism. 

What is speech delay?

Some people call it a speech delay, others call it late language emergence, and some colloquially refer to children with delayed speech as “late bloomers.” 

The mix of terminology can create confusion when supporting parents who are wondering whether their toddler has a speech delay vs autism. 

It’s important to recognize that a speech and language delay can exist on its own—or it can be a precursor to an autism diagnosis. 

A speech and language delay may look like:

• Expressive vocabulary of only a few words at 18 months
• Preference for gestures over vocalizations
• Difficulty imitating sounds 
• Speaking fewer than 50 words by two years old, with no two-word combinations
• Producing words that contain incorrect consonants, less mature syllable structures, and a smaller inventory of vowels and consonants
• Difficulty with comprehension (receptive language)
• Shorter utterances with less grammatical complexity (in toddlers) 

Children with typically developing speech reach milestones on a fairly predictable timeline. 

Babbling begins around six to eight months, and children usually utter their first words around the one-year mark. From there, it’s a steady progression of increasing utterances and corresponding receptive language skills (following directions, answering questions, etc.). 

Parents may seek out a speech-language pathologist for early intervention when they notice their child isn’t hitting expected developmental milestones. But, at such an early stage, it may be challenging to separate late language emergence from a high-functioning autism speech delay. 

In other words, SLPs must pay careful attention to identify characteristics that indicate an isolated speech delay—vs autism with a delay in speech and language. 

Speech delay vs autism (similarities and differences)

Children with late language emergence, or “late bloomer” talkers, often reach other developmental milestones on time. By school age, many of these children catch up to their peers in terms of communication development too. 

Autism spectrum disorder follows a different path. In young children, speech and language delay is often part of a cluster of behavioral differences that support an ASD diagnosis. 

For infants and toddlers, some characteristics that distinguish autism from a speech or language delay include:

• Reduced or atypical eye contact
• Lack of “social smiling” in infants (smiling in response to others’ smiles)
• Limited response when called by name
• Limited facial expressions 
• Minimal joint attention behaviors and gestures
• Differences in sensory-motor behavior
• Increased distress vocalizations (and corresponding difficulty with emotional regulation)
• Echolalia (repetition of words or phrases)

Speech language assessment tools are helpful in documenting and diagnosing these signs and symptoms. If you’re using an electronic health record (EHR) for SLPs, assessments may be available as built-in documentation templates—to easily fill out and store electronically. 

Recognizing the signs at different ages

Identifying a speech delay vs autism can be tricky in infants and toddlers. 

This is especially the case with a high-functioning autism speech delay, where children may meet some expected developmental milestones and a diagnosis isn’t immediately clear. 

While a speech and language delay is sometimes present in infants and toddlers who later receive an autism diagnosis, it’s only one part of the picture. When paired with other delays or differences in behavior, autism may be the underlying cause. 

To help SLPs identify the differences between speech delay vs autism, we’ve broken down what each diagnosis looks like at various stages of development:

Speech delay vs autism 18 month old

At 18 months old, typically developing children are building their vocabularies and speaking in single-word or even two-word utterances. 

In the case of a speech delay, an 18 month old may communicate in strings of syllables rather than words, or they may only have a few words in their vocabulary. They may also have difficulty with articulation of early developing phonemes like /p/ and /b/. 

Autism, however, encompasses more than a speech and language delay. At 18 months, autistic infants may exhibit reduced facial expression and social interaction compared to typically developing peers. They may have a tendency to fixate on objects and display fewer joint attention behaviors and gestures. 

Speech delay vs autism 2 year old 

By age two, toddlers with typically developing speech possess a vocabulary of at least 50 words. They begin experimenting with two-word combinations and follow two-step directions. 

A two year old with speech delay may have a vocabulary of just a few words, or no words at all. The child may also struggle to articulate some phonemes. 

SLPs can distinguish speech delay vs autism at this stage by looking closely at other behaviors—and asking questions like: Does the toddler seek out interaction and mirror others’ behavior? Or, is there consistent eye contact and use of gestures? 

If the answer to these questions is “no,” autism may be at the root of the speech delay. 

Speech delay vs autism 3 year old

Children with a speech and language delay at age three may possess a smaller phonemic inventory and vocabulary than their typically developing peers. They may struggle to consistently produce sounds like /h/, /w/, and /d/ in words. People unfamiliar with the child may have difficulty understanding their words. 

When autism is present, other differences or delays exist alongside the speech delay. These may include echolalia (persistent repetition of words or phrases), a preference for solitary play, or sensory-motor behaviors like hand flapping. 

How SLPs can help treat speech delays and autism

Speech-language pathologists are the go-to professionals when a delay in speech and language emerges. If a child has also been diagnosed with autism spectrum disorder, the SLP is often a collaborative member of a team of professionals—including occupational therapists, psychologists, or physical therapists—who support the young client and their family. 

A family-centered coaching model is considered best practice, whether treating a speech delay in isolation or within the context of autism. Working directly with the child’s caregivers allows SLPs to model strategies and incorporate family preferences into therapy, ideally within the framework of the child’s natural routines. 

Intervention may be direct or indirect, clinician-directed, or child-centered. The SLP can incorporate shared book-reading, play-based activities, and use of multiple modes of communication (e.g. sign language or augmentative and alternative communication tools, in addition to spoken language). 

All children—including those with a high-functioning autism speech delay—can benefit from therapy that reinforces communication attempts while modeling expansion of utterances. This may be easier to achieve when the child is engaged in their preferred activities—which might mean delivering treatment while playing with cars or stuffed animals.

No matter the cause of speech and language delay, SLPs can support growth and development through a variety of therapeutic interventions, in addition to modeling clear sounds, words, and phrases. They can also coach caregivers to do the same, creating opportunities that foster interaction and expanded communication. 

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