Severe language delays early in the life of a child with autism can be overcome, especially if a child exhibits nonverbal intelligence.
A recent study that looked at speech delays in children with autism spectrum disorders found that 70% of children who were not stringing words together into even the simplest of phrases by age four went on to do so by age eight, and in some cases, even achieved fluent speech.
"Autism spectrum disorders" is an umbrella term for neurodevelopmental conditions ranging from Asperger's syndrome to severe autism. Hallmarks of these conditions include problems with social interaction and repetitive behaviors.
The findings, published in the journal Pediatrics, offer hope, said lead author Ericka Wodka, MD, a neuropsychologist and assistant professor of psychiatry at the Kennedy Krieger Institute's Center for Autism and Related Disorders, in Baltimore.
"The study gives doctors and parents a sense that when these delays persist—when a child presents at age six or seven without phrase speech--they still have growth opportunity," Dr. Wodka said. "There's still a lot of hope that these children can go on to gain meaningful language."
The scientists evaluated data on more than 500 children with an autism spectrum disorder who were part of a national multisite study that involved complete evaluations on every child.
"Our data are based on actual measurements of current functioning and parent interviews, not chart review," Dr. Wodka said.
As toddlers, none of the children in the study had achieved "phrase speech," the ability to put together more than two or three words to communicate-to say basic sentences such as, "I want juice," for example.
Demographics-including parent income and education level, and child psychiatric characteristics—were not associated with whether a child with language delay attained phrase speech, Dr. Wodka said. Repetitive behaviors, such as hand-flapping, were not linked with delayed speech either.
Strong predictors of a child's ability to go on to develop phrase or fluent speech skills included his or her non-verbal IQ and being less impaired socially, Dr. Wodka said.
The size of the study lends the findings weight, said Sarah Paterson, PhD, a scientist in the Developmental Neuroimaging Laboratory at the Children's Hospital of Philadelphia. Dr. Paterson conducts brain imaging and cognitive studies of infants at risk for autism.
"There is a large number of children involved," Dr. Paterson said. "It's hard to get a sample that big in an autism study and I think it gives us some insight into what's happening with language."
Dr. Paterson said the results are not surprising, "I think the take-home message is that, as we've thought for a long time, social skills and nonverbal communication skills really are building blocks for language. Those who do have those skills generally have better language than those who don't."
Parents need to keep the results in perspective, though, said another autism expert.
"Parents should be cautious about applying statistics from studies like these to their individual child's outcome," said Andrew Adesman, MD, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park.
Dr. Adesman said it's also important to note that although autism has to be considered whenever evaluating a child with language delay, the majority of children with language delay at age two or three don't have an autism spectrum disorder. "That's an important point," he said. "This study wasn't looking at severe language delay without diagnosis of autism."
Dr. Adesman said if children have good nonverbal communication skills-if they use gestures to communicate even though they don't use words, for example, and if they engage with people appropriately and are socially responsive—that would suggest something other than autism spectrum disorder is the likely cause of language delay.
What Parents Can Do
Parents with concerns about their toddler's lack of language development can ask their pediatrician about autism screening, or look for a community resource. "Every child can get a free evaluation when language delay is suspected," he said.
Dr. Wodka said she hopes the study findings will help guide parents and health professionals who work with children with autism to set both language and behavioral goals.
"What complicates issues for children with autism is that it's not purely a language disorder," she said. "It's a communication disorder, and it's important to consider the child's intellectual level as well as the social issues."
