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Not Talking: A Sign of Autism?

By Robert Needlman, M.D. Provided by: DrSpock.com

Every month I see a few toddlers who are not talking. Most are boys; all are worrying their parents. Some have autism, and others don't.

There are so many children with autism now, that almost everybody knows somebody who knows somebody who has an autistic child. Parents, daycare providers and teachers are all on the lookout. Ten years ago children with autism were often diagnosed as late as age 4 or 5. These days, it seems that most are diagnosed by 3, if not before.

People are also more aware of related diagnoses on the autism spectrum, including Asperger syndrome and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). As the "not otherwise specified" part of its name implies, PDD-NOS does not have a very clear cut definition. Children often qualify for PDD-NOS, even though they don't meet the full definition for autism itself.

All of this awareness -- which is a good thing -- and the open-ended nature of the PDD diagnosis makes more parents feel even more insecure. If something is not quite right with their child developmentally, the possibility of autism looms large.

Fear of autism worried the parents of two little boys I saw recently. I'll call them Jack and Tom. They were both around two years old.

Jack did not speak or use sign language, and did not turn to me when I called his name. When I offered him crayons, he took one, but he wasn't interested in scribbling or in playing give-and-take. He opened and closed the door of my toy car, and spun the wheels again and again, but did not "zoom" it across the floor. Jack's mother said she had a hard time getting him to play with her. "He does sometimes," she said, "when he wants to."

Tom looked very different. "I can ask him to get something from another room," his dad explained, "and he goes right there and gets it." He also could point to lots of pictures in books when his parents asked him to. He only said a very few words. But he did make a sound that seemed to mean "What's that?", and he would point at things with his index finger -- a sign that he expected his parents to look where he was looking. We played catch back and forth with a rolled up paper towel, and Tom could have played all day, giggling.

I think that Jack probably has a condition on the autism spectrum. It will be important for him to have a thorough assessment. He is already in speech therapy, but he will need additional therapies to help him with social interactions, attention and play.

Tom probably has a condition that is sometimes called Specific Expressive Language Delay. In other words, he is a late-talker. In general, late talkers do well. Some of them have difficulty learning to read when they're older, and it's not clear that speech therapy helps late talkers much. On the other hand, it can't hurt. I also encouraged his parents to teach him some sign language, and was pleased to learn that he already knew some signs.

Two toddlers who are not talking. Two very different problems.

P.S. My 4-year old isn't talking properly yet and the doctor found out that she has hearing problem. So, if your child isn't talking properly at after 2 years old, consult the doctor. Don't IGNORE.