Language delays are the biggest sign in a child’s early development that the child may have autism. It’s not always the leading factor, as some children with language delays may have something else going on, but it is one of the key criteria. Children who do not speak before the age of two to two and a half should be evaluated for early intervention services.
When they are evaluated, children who may have autism are evaluated for both expressive and receptive language delays. There is quite a difference between the two, and parents should be able to relay what they have noticed as part of the evaluation. The evaluator will probably see what the parents are seeing when he or she interacts with the child.
Expressive language delays are much more obvious. This is typical of children with autism; they can’t speak or aren’t trying to speak or aren’t interested in speaking because they have their needs met. When all physical problems are ruled out, such as a hearing problem or a vocal chord issue, and the children still don’t or won’t speak, it’s an expressive language delay. It is treatable with several hours of speech therapy every week and there are services in every state and community to help.
Receptive language delays are much more serious. A child who doesn’t speak but who obviously has excellent nonverbal skills doesn’t speak because he understands what is being said but doesn’t add anything verbal to the “conversation”. His receptive skills are there; he hears everyone and everything around him, but just doesn’t use his own voice or doesn’t grasp how to use his own voice to interact. With receptive language delays, none of that exists. The child with autism and receptive language delays will stare at someone who is talking with a blank look as though he or she has no idea what you just said.
It’s not that the child doesn’t hear you, it’s that the processors in their brains aren’t catching on and moving fast enough to get it. In extreme cases, autistic children with receptive language delays may never “get it” because the part of their brain that processes what it hears doesn’t process anything. Neurologists can be consulted to examine this part of the brain, known as Broca’s area, to see if it is damaged in some way. (Patients who have suffered brain injuries in this area are diagnosed with Broca’s aphasia, the inability to process speech and understand it.) If this area of the brain looks fairly normal, it’s likely that intense speech therapy combined with adaptive devices may help the child communicate.
Unfortunately, for an autistic child that has both expressive and receptive language delays, the prognosis is very grim. It doesn’t mean a speech pathologist won’t try and won’t work with a child who has this much of a challenge gaining a way to speak to others; it just means that they will probably never speak in full sentences or understand anything their parents say to them.