Speech delay isn't the only link to autism

My 15-month-old grandson understands everything you say, but hasn't started speaking. He enjoys being read to and everyone knows what he wants without him having to say words. At the last visit to the pediatrician, my daughter was given some material on autism. The doctor didn't say that he had it, but said that some children with delayed speech did, and that we should look for other things. We are very worried and I wonder if we should do anything else now.

Autism is a developmental disorder. It is associated with problems in verbal and nonverbal communication, social interactions and activities involving imagination. Most autistic children demonstrate characteristics of the disorder before age 3.

Infants usually speak their first words around a year of age, but understand the meaning of words like "give me," "bye bye" and "no" much earlier. By 15 months, they can point to appropriate body parts, but may not be able to say the words. At 18 months, a toddler says about 10 words and, by 2 years, their vocabulary expands to more than 100 words, using short, two-word sentences. Hearing is critical for speech development and is evaluated with delayed speech, especially when receptive language (understanding) is affected.

Speech delay is seen with autism, but problems with social interaction are central to the disorder. Infants may not like being held or fail to engage with other children or adults, avoiding eye contact. They may focus intently on objects for long periods of time and develop rituals, becoming disturbed when there are deviations. They may not appreciate the changes in tone and facial expressions when others are speaking. They may be extra-sensitive to touch, sound and light, while having a high threshold for pain. Autistic children may have repetitive behaviors like head banging, rocking or twirling. These behaviors make it difficult to play with other children. Self-absorption and isolation are common.

The diagnosis of autism is made by the presence of behaviors and a comprehensive evaluation involving cognition, speech, neurological and developmental testing. Treatment involves a multi-disciplinary approach. The initiation of therapy at younger ages has produced better outcomes than treatment started on older children.

Your grandson may only have speech delay. I have seen a number of children who have the ability to speak, but haven't been encouraged because family members anticipate their needs. Given the concern, family members should make a concerted effort to encourage his speech -- by asking him to repeat words while being shown picture books or requesting food/drinks.

A developmental pediatrician can perform an evaluation that might be reassuring. If the evaluation raises further concerns, a more comprehensive evaluation will be recommended.

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