Speech and Language Development

Language development is one of the areas that shows the widest variety across the autism spectrum. While some children don't speak at all or develop very limited spoken language, others have fluent, even advanced, language; but difficulty with the social use of language (pragmatic language) is commonly seen.

• The Different Paths of Spoken Language Development
• In children with autism, language development may follow one of these patterns:

• Delayed but progressing language — first words and sentences appear late, but show steady progress over time.
• Language after regression — some children lose previously gained words between 12 and 24 months (see Chapter 1, developmental regression); this situation always requires prompt evaluation.
• Nonverbal or minimal spoken language — some children develop very limited spoken language up to school age or for life; this doesn't necessarily mean that intellectual capacity is limited too (see Chapter 2).
• Advanced structural language — in some children, vocabulary and grammar may be ahead of their peers, but a clear difficulty is seen in the social/pragmatic use of language.

Echolalia: Aimless Repetition or a Communication Strategy?

Echolalia, the repetition of heard phrases either immediately (immediate echolalia) or after some time (delayed echolalia), was long seen as a "meaningless" behavior. Current research shows that echolalia is most often a functional communication strategy: a child may use a sentence they heard from a cartoon to express a similar emotional state ("delayed echolalia"), or, when they don't understand a question, may repeat the last words they heard to buy time ("immediate echolalia"). Rather than suppressing this behavior, speech therapists aim to support the child's move from this strategy toward more flexible and spontaneous language.

Pragmatic Language: Knowing "How to Talk"

Pragmatic language refers to the use of language in a social context: starting and keeping up a conversation, waiting your turn to speak, explaining things according to the listener's level of knowledge, understanding humor, irony, and idioms, and adjusting your tone of voice to the situation. Many children with autism who speak fluently and with correct grammar struggle precisely in this pragmatic dimension; this makes up the answer to the question "why can he talk but not connect?"

Tip / Practical Suggestion

Even if your child is nonverbal or has limited spoken language, always accept and respond to their attempts to communicate (reaching for an object, making a sound, touching a picture) as an attempt at communication. This strengthens the "responsiveness loop" and supports language development. You'll find detailed information about alternative and augmentative communication methods (picture exchange systems, speech-generating devices) in Chapter 22.

Caution / When to Seek Advice

Not using a single word at 18 months, not putting together a two-word sentence at 24 months, or the loss of previously gained language skills at any age, are signs that require evaluation without delay.