Addressing Late Talker and Autism Concerns

Addressing Late Talker and Autism Concerns Probably the biggest concern that parents have of all of the developmental milestones is that related to speech. The late talker causes tremendous concerns. Why? 15 to 25% of all late talkers have a significant medical disease. They have hearing loss. They may have fragile X chromosome, Down syndrome or other syndromes. They can have mental retardation. There can be many factors but the one that really produces the greatest concern in today’s world is the four time incidents over normal of autism that’s associated with the late talker. Now I refer to you first to a chart that I am now -- we’re going to put up that will go over the normal milestones in development of language and speech. I want to point out that normal milestones fall in two groups, receptive skills and also expressive skills. Expressive skills are obvious, they’re the actual formation of speech and the ability to talk. Receptive skills though are following directions and learning what’s said to them and interpreting what speech they take in. If you look at the normal milestones basically I refer to the following things to the table, on the left you have receptive skills. By six month most children respond to their names. They respond to re-verbal commands by 12 months. By two years they ask questions, they follow two step commands. By 15 months they point to body parts. These are receptive skills they're very important, expressive skills which is what most parents key in on obviously start off with crying at birth, cooing at two to four months, babbling by six month, pointing by nine months, saying “dada” and “mama” by nine months they then use jargon around 12 months of age, their first words are between 12 and 15 months. The average 18 month to two-year of age child is beginning to use words quite effectively. By two years to three years of age, is when their phrases and short sentences become major factors. Obviously these milestones are ones that we follow. Alright, there are two things one -- two things to differentiate. One is the late talker who will eventually catch up and the other is the child who has a disorder associated with delayed speech. How do we tell the difference, what are hints of this? One would be a limited sound play or babbling as an infant. Beware of the infant who doesn’t babble much. This often puts it in more in the disorder category than in the late category. A limited number of consonant sounds, vowel distortions, these all are of concern. Poor verbal imitation skills are another concern. Associated very immature play, interact with adults but can never interact with peers. Few communicative gestures, not pointing for example, impaired social skills, has very small vocabulary for age and a comprehension delay of at least six months or greater. This all hints to us that this is a greater problem than is simply speech delay. So when do we refer to kids? Basically our role is to screen and to refer. We would refer an 18 to 20-month-old to have less than 10 words. We refer a 21-month-old to 30-month-old who had less than 50 words and no two words. We will refer all late talkers by two years of age for early intervention to make sure there’s no associated problem. We will refer immediately if there were no babbling, no pointing or gesturing by 12 months, no single words at all by 16 months, no two-word phrases by 24 months and a regression of speech, language and social skills is an immediate referral. We refer less than three years if developmental delay or other conditions of high probability of developmental delay are associated with speech delay. Now, finally the most important thing that we’re asked because it is a literal epidemic speech delay and especially autistic spectrum disease, we are asked what, how can I differentiate or reassure myself that my child is not autistic, who has speech delay? The criteria for autistic disorder, these are the criteria that we use in the office and then question you. One, social interaction limitations you’ll notice. They are marked impairment of non-verbal behaviors. The kid, they make poor eye contact. Their gestures to regulate social interaction are absent. Their facial expression is absent. The next thing is they fail to establish developmentally appropriate peer relationships. They have no spontaneous sharing. They lack social and emotional reciprocity. These are all clues to autism. Also impairment in communication which we’ve already referred to and the third thing on this chart if you notice is at least one of the following signs of restricted behavior and interests may be present. And this are something that parents often come to use concerned about. They have rigid adherence to non-functional routines and rituals. They're very ritualistic. That is that like to put on the same clothes all the time and in the same pattern. They have stereotypic movement, you see rocking, inappropriate activities that the child is engaged in. They are preoccupied with objects or parts of objects like the wheels of cars. And they have very restricted interest. So these are things that we pay attention to, we ask, we look at because they are very important and autistic spectrum is something we try to screen early, be on top of early, make early referrals and get early treatment. And this is something that gives as a comprehensive physical exam should yield good insight into these problems.