Speech delay/autism advice

[user1464818700]

My son aged 3 and 3 months has delayed speech. We saw SALT when he was about 2 and a half and they referred him to community paeds. Since then he’s come on well, now talking in sentences sometimes (turn on the light, tommy wants ice cream, milk please mummy). When the appointment came through I thought she was just gonna day some speech delay and is catching up. She didn’t. And it has floored
me. She says she’s pretty sure he will be diagnosed as on spectrum. His eye contact not good and was in his own world
A lot of the time (playing with the toys, messing with the tissue on exam couch). He wouldn’t take shoes off to be weighed and she said that never happened. To me he is just my lovely boy who is playful and a pain in the bum and speech delayed but this has taken me by surprise. I’ve been worrying sick. I don’t know what to expect. If he has got autism then so far life has been ok even if he is a handful. Can I expect life to get much harder? When do these things start to
Cause real Problems? Some advice and support would be great. My partner has made me promise not to tell anyone until he is reviewed (he does not think there is a think wrong and does not want him to be treated differently). I broke down in nursery today and they said they had noticed issues with eye contact and boundaries as well as the speech.

He does seem a little speech delayed, as for example those three/four word sentences that you mentioned would be expected at around 24-30M, also around this age pronouns emerge, so they would start using "I" instead of their name. However, speech delays do not necessarily mean autism, speech delays are very common in young children.

Autism is a social communication disorder, so above all, deficits need to be present in that area. Diagnosis at 3YR old tends to be reliable meaning that many clear signs will be present if you know what to look for. I wouldn't read too much into the example of him not taking his shoes off, it could be an example of rigid behavior (depending how he reacts if you force them off, i.e. does he go into a full blown long tantrum or would he recover from his tantrum and accept it after a minute or two?) which tends to be linked to autism but again it could just be stubbornness which is expected in 3YR old. While eye contact is important it is hard to measure, for example, a child making eye contact with you (across the room) for a split second with communicative intent would be much more positive than a child staring at your eyes for a whole minute for no purpose. Reliable indicators include things like pointing to request, and pointing to share by 2 YRS old - there is a strong correlation between a child not pointing to share (i.e. a plane in the sky) by 2YRS old and then being diagnosed with autism. This is because a child which is speech delayed increases its use of gesture to compensate - if a child is speech delayed yet has weak gesturing then that would be concerning. Other reliable indicators include 3-point-gaze, or social referencing (a child glancing at you for a split second to gage your reaction when entering new environments or when something unexpected happens).

AladdinMum - please can I ask you to clarify the age at which the strong correlation & not pointing occurs because I’ve read a lot of your posts & I think you vary it sometimes by a few months. Just curious really. My son is autistic & was late to point but did do it before 2 years. He has speech delay too but used pointing to compensate once he knew how to do it. I didn’t realise the importance of pointing until he was 17 months so never really demonstrated it to him either. He caught on when I showed him.

OP - my son (diagnosed) sounds similar to your in terms of speech. He can also be in his own world although plays alongside other children & will copy them. I don’t know yet what autism means for him because it currently doesn’t seem to cause many problems yet. I’m expecting things to clarify when he starts school or before if he gets an EHCP.

My main advice for you would be to see the assessment through as you will always wonder otherwise. Also, nursery should be involving someone from Early Years/ inclusion (don’t know the right name) who can advise them on strategies to help your DS.

It’s tough when you realise your child may have extra challenges but, personally, I felt much more settled once the diagnosis was given although still have wobbly days.

Sorry I also wanted to say please get your son’s hearing checked. DS also suffers from glue ear & has grommets. It definitely lead to improvements in his speech. Before his hearing was assessed I wouldn’t have said there were problems with his hearing because he would look when I called him but there clearly was.

If he has got autism then so far life has been ok even if he is a handful. Can I expect life to get much harder? When do these things start to Cause real Problems?

If he has autism then the fact that it's been picked up early will make his life a lot easier. Autism causes real problems when children are put into situations they can't cope with. So with this heads-up your DS's life may continue very happily! Children with autism often have problems at transition times, such as starting nursery or moving to school. So they need extra support and understanding to transition comfortably into the new setting. But with that support life can be "ok" and often much better than just "ok".

So do get the assessment when it's offered, then if he needs support things will probably go a lot better for him.

@Confusedaboutvouchers - Officially it is 18M, a child not pointing by 18M would automatically fail the MCHAT screener which normally means automatic referral to a development pediatrician (in the US). However I have seen children point as late as 20M and develop normally, so while 20M would be very late, 22-24M is the absolute maximum in my opinion. In addition, the pointing that is important here is declarative pointing, so pointing to share interests, like a plane in the sky (ideally with a look back). Pointing to request is also important but pointing to share is crucial (as it is a pure social interaction and not just to meet their needs, they are pointing to a plane to share the enjoyment - remember that autism above all is a social communication disorder). I have seen children point to request, and point at books way before 18M but are still diagnosed with autism as pointing to share developed late. Also, in typical development pointing (all forms) develop organically, there is no need to show them, it is not a learned skill like waving or clapping are.