Does a child with Asperger Syndrome typically have delayed speech?
Approximately 50% of kids with Aspergers (high-functioning autism) have delayed speech. While many "Aspies" grow out of this by age five, others go on to experience other language problems. These generally fall into one or more of the following three areas of linguistics:
Pragmatics refers to language usage and the way that context relates to meaning. Kids with Aspergers often have difficulty in holding a normal conversation where there is give and take and social interaction. While most children learn these skills by observing others, those with Aspergers may need some personal coaching. Problems with pragmatics manifest in the following forms:
- does not allow the other person to talk
- does not use people’s names
- focuses exclusively on topics that interest them
- gives too much detailed information
- interrupting others
- lack of facial expression and eye contact
- lack of greeting
- oblivious to boredom in others
- oblivious to emotional reactions in others
Semantics is defined as the meaning or interpretation of a word, sentence, or other language form. While many children with Aspergers are extremely intelligent and avid readers, they often struggle in this particular area. They may have problems with the following:
- difficulty in understanding jokes
- difficulty in understanding metaphors and figures of speech
- interpreting everything literally
- pedantic speech
- problems with understanding teasing
- sarcasm is not understood
Prosody refers to the tonal and rhythmic aspects of speech. Kids with Aspergers often have a strange manner of speaking. It may come across with words enunciated precisely and formally and the speed, volume and rhythm may be odd. Problem areas to look out for include the following:
- difficulties in coordinating speaking and breathing
- little or no inflection
- monotonous sound
- stilted or formal speech
- strange rhythms of speech
- talking loudly
Help for Linguistic Difficulties—
Aspergers kids and grown-ups with language problems can benefit from one-on-one training with a parent or speech therapist. The problems are often tackled individually and it takes perseverance and repetition to see lasting results. Methods vary but could include the following:
- practicing eye contact and body language
- practicing normal pronunciation and inflection
- teaching how to start a conversation
- training them not to interrupt
- use of pictures to explain figures of speech
Unless they observe other areas of "slowness" during early development, moms and dads may hesitate to seek advice. Some may excuse the lack of talking by reassuring themselves that "he'll outgrow it" or "he's just more interested in physical things." Knowing what's "normal" and what's not in speech and language development can help you figure out if you should be concerned or if your youngster is right on schedule.
It's important to discuss early speech and language development, as well as other developmental concerns, with your physician at every routine well-child visit. It can be difficult to tell whether a youngster is just immature in his ability to communicate, or has a problem that requires professional attention.
These developmental norms may provide clues:
• Before 12 Months: It's important for children this age to be watched for signs that they're using their voices to relate to their environment. Cooing and babbling are early stages of speech development. As babies get older (often around 9 months), they begin to string sounds together, incorporate the different tones of speech, and say words like "mama" and "dada" (without really understanding what those words mean). Before 12 months, kids should also be attentive to sound and begin to recognize names of common objects (for example bottle, binky, etc.). Babies who watch intently but don't react to sound may be showing signs of hearing loss.
• By 12 to 15 Months: Children this age should have a wide range of speech sounds in their babbling (like p, b, m, d, or n), begin to imitate and approximate sounds and words modeled by family members, and typically say one or more words (not including "mama" and "dada") spontaneously. Nouns usually come first, like "baby" and "ball." Your youngster should also be able to understand and follow simple one-step directions ("Please give me the toy," for example).
• From 18 to 24 Months: Though there is a lot of variability, most toddlers are saying about 20 words by 18 months and 50 or more words by the time they turn 2. By age 2, children are starting to combine two words to make simple sentences, such as "baby crying" or "Daddy big." A 2-year-old should also be able to identify common objects, common pictured objects, indicate body parts on self when labeled, and follow two-step commands (such as "Please pick up the toy and give it to me").
• From 2 to 3 Years: Moms and dads often witness an "explosion" in their youngster's speech. Your toddler's vocabulary should increase (to too many words to count) and he or she should routinely combine three or more words into sentences. Comprehension also should increase — by 3 years of age, a youngster should begin to understand what it means to "put it on the table" or "put it under the bed." Your youngster also should begin to identify colors and comprehend descriptive concepts (big versus little, for example).
Language vs. Speech—
Speech and language are often confused, but there is a distinction between the two:
• Language is much broader and refers to the entire system of expressing and receiving information in a way that's meaningful. It is understanding and being understood through communication — verbal, nonverbal, and written.
• Speech is the verbal expression of language and includes articulation, which is the way sounds and words are formed.
Although problems in speech and language differ, they often overlap. A youngster with a language problem may be able to pronounce words well but be unable to put more than two words together. Another youngster's speech may be difficult to understand, but he or she may use words and phrases to express ideas. And another youngster may speak well but have difficulty following directions.
If you're concerned about your youngster's speech and language development, there are some things to watch for.
An infant who isn't responding to sound or who isn't vocalizing is of particular concern. Between 12 and 24 months, reasons for concern include a youngster who:
- has difficulty understanding simple verbal requests
- has trouble imitating sounds by 18 months
- isn't using gestures, such as pointing or waving bye-bye by 12 months
- prefers gestures over vocalizations to communicate by 18 months
Seek an evaluation if a youngster over 2 years old:
- can only imitate speech or actions and doesn't produce words or phrases spontaneously
- can't follow simple directions
- has an unusual tone of voice (such as raspy or nasal sounding)
- is more difficult to understand than expected for his or her age. Moms and dads and regular caregivers should understand about half of a youngster's speech at 2 years and about three quarters at 3 years. By 4 years old, a youngster should be mostly understood, even by people who don't know the youngster.
- says only certain sounds or words repeatedly and can't use oral language to communicate more than his or her immediate needs
Many things can cause delays in speech and language development:
• Ear infections, especially chronic infections, can affect hearing ability. Simple ear infections that have been adequately treated, though, should have no effect on speech.
• Hearing problems are also commonly related to delayed speech, which is why a youngster's hearing should be tested by an audiologist whenever there's a speech concern. A youngster who has trouble hearing may have trouble articulating as well as understanding, imitating, and using language.
• Many children with speech delays have oral-motor problems, meaning there's inefficient communication in the areas of the brain responsible for speech production. The youngster encounters difficulty using and coordinating the lips, tongue, and jaw to produce speech sounds. Speech may be the only problem or may be accompanied by other oral-motor problems such as feeding difficulties. A speech delay may also be a part of (instead of indicate) a more "global" (or general) developmental delay.
• Speech delays in an otherwise normally developing youngster can sometimes be caused by oral impairments, like problems with the tongue or palate (the roof of the mouth). A short frenulum (the fold beneath the tongue) can limit tongue movement for speech production.
What Can A Speech-Language Pathologist Do?
If you or your physician suspect that your youngster has a problem, early evaluation by a speech-language pathologist is crucial. Of course, if there turns out to be no problem after all, an evaluation can ease your fears. Although you can seek out a speech-language pathologist on your own, your primary care physician can refer you to one.
In conducting an evaluation, a speech-language pathologist will look at a youngster's speech and language skills within the context of total development. Besides observing your youngster, the speech-language pathologist will conduct standardized tests and scales, and look for milestones in speech and language development.
The speech-language pathologist will also assess:
- if your youngster is attempting to communicate in other ways, such as pointing, head shaking, gesturing, etc.
- sound development and clarity of speech
- what your youngster can say (called expressive language)
- what your youngster understands (called receptive language)
- your youngster's oral-motor status (how a youngster's mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)
If the speech-language pathologist finds that your youngster needs speech therapy, your involvement will be very important. You can observe therapy sessions and learn to participate in the process. The speech therapist will show you how you can work with your youngster at home to improve speech and language skills.
Evaluation by a speech-language pathologist may find that your expectations are simply too high. Educational materials that outline developmental stages and milestones may help you look at your youngster more realistically.
What Can Parents Do?
Like so many other things, speech development is a mixture of nature and nurture. Genetic makeup will, in part, determine intelligence and speech and language development. However, a lot of it depends on environment. Is a youngster adequately stimulated at home or at childcare? Are there opportunities for communication exchange and participation? What kind of feedback does the youngster get?
When speech, language, hearing, or developmental problems do exist, early intervention can provide the help a youngster needs. And when you have a better understanding of why your youngster isn't talking, you can learn ways to encourage speech development.
Here are a few general tips to use at home:
• Read to your youngster, starting as early as 6 months. You don't have to finish a whole book, but look for age-appropriate soft or board books or picture books that encourage children to look while you name the pictures. Try starting with a classic book (such as Pat the Bunny) in which the youngster imitates the patting motion, or books with textures that children can touch. Later, let your youngster point to recognizable pictures and try to name them. Then move on to nursery rhymes, which have rhythmic appeal. Progress to predictable books (such as Eric Carle's Brown Bear, Brown Bear) that let children anticipate what happens. Your little one may even start to memorize favorite stories.
• Spend a lot of time communicating with your youngster, even during infancy — talk, sing, and encourage imitation of sounds and gestures.
• Use everyday situations to reinforce your youngster's speech and language. In other words, talk your way through the day. For example, name foods at the grocery store, explain what you're doing as you cook a meal or clean a room, point out objects around the house, and as you drive, point out sounds you hear. Ask questions and acknowledge your youngster's responses (even when they're hard to understand). Keep things simple, but never use "baby talk."
It is never too late to seek help for speech difficulties. While a child may never sound completely normal or be able to hold a perfect conversation, there are definitely ways to work towards a great improvement. The key to success is often a commitment from a parent or family member to work with the youngster for extended periods of time.
Whatever your Aspergers youngster's age, recognizing and treating problems early on is the best approach to help with speech and language delays. With proper therapy and time, your youngster will likely be better able to communicate with you and the rest of the world.