Monday, February 02, 2009

Late-Talking Children Confused with Autism Spectrum

Although one in five children have a language delay, it is surprising how often children are misdiagnosed as having an autism spectrum disorder or low IQ. The reasons are several: greater publicity for and education of professionals about the early signs of autism vs. speech difficulties, the shortage of speech language pathologists in the schools and everywhere, the language-dependence of most social interactions (kids who can't speak well have a harder time making friends) and intelligence testing, school systems and medical professionals who don't diagnose dyslexia, and "assortative mating" in some high tech corridors like Redmond / Microsoft or Silicon Valley where spatial / mathematical / engineering / computer-industry men marry spatial / mathematical / engineering / computer-industry women and have children that are brilliant, creative, and analytical, but also intense, self-sufficient, and content to play for extended times by themselves. Economist Thomas Sowell was driven to write Late-Talking Children and Edison Trait when his son (now an adult) was misdiagnosed as having autism because many of the behavioral traits of late-talking children (reduced socialization, eye contact, sensory seeking) can resemble high functioning autism. These children are often those whose parents say, he's affectionate at home, but has a hard time answering open-ended questions.

This study (figure above) provides insight into some of the whys of speech delay. When late-talking children listened to their mother's voices "recalling relatives, pets, and events; and singing familiar songs", they listened with their right language areas rather than their left (controls). We've blogged on some the characteristics of right-hemispheric language (Searching for the Right Word in the Right Brain); gifted dyslexic storytellers (here) also tend to have a right hemispheric pattern of expression - cinematic (immersive, multisensory, rich in associations), but often non-linear. The fMRI appearance of autistic subjects, on the other hand, is very different from this. Language problems associated with autism showed reduced connectivity with sentence comprehension tasks, but the activity is still on the left hemisphere, not the right. For more on this, look here.

Late-talking children often can be distinguished from autism because of their normal affiliative or social drive and social mirroring ability. Their language strengths and weaknesses are also quite different been non-autistic late talking children and autistic late-talking children. Most mistakes are made when children are diagnosed with behavioral checkslists rather than a detailed professional assessments.

Sensory processing behaviors occur in too many diverse groups (late-talking children, dyslexics, preemie birth, autism) to have any specificity in diagnosis.
Problem school behaviors are also non-specific because children struggling to perceive social cues (visual, auditory, or language-based) won't easily be able to resolve conflicts or other social dilemmas with words alone.

Finally, if you are a parent of a young late-talking child, note this advice from Dr. Rescorla and colleagues: " may be that todderlhood represents a grace period for many children with language delay, inasmuch as they do not also manifest significant psychological maladjustment. However, as they get older, those who are unable to communicate through language may develop behavior symptoms, such as withdrawal, anxiety, or aggression, or their parents may start to become more aware that their behavior is problematic..."

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood
Visuo-spatial processing and executive functions in children with specific language impairment
Speech delay processes language in the right hemisphere
American Academy of Pediatrics: How can I tell if my child has language delay?
Blessings and Burdens of High IQ
Spatially Gifted at a Loss for Words pdf
Language Delay and Behavioral / Emotional Problems
Eide Neurolearning Blog: Spatial Cognition


  1. This is such a useful and needed article. I had a little girl brought to see me about two years ago, who just was not using language at all. Her school, supported by the Educational Psychologist of the education authority had labelled her as autistic. I knew instantly, as did the parents that they had got it wrong, she displayed none of the failures of socialisation and imagination which are so typical of autism. She was merely late developing spoken language and her failure to communicate effectively had made her a little reluctant to try. The knee-jerk reaction to this was to cry 'autism!' How sad!

  2. As the parent of a late talking child, I really appreciate this post. I've been through so many situations where EI and school system representatives have wanted to label her (autism, PDD-NOS, global delay) so she could get more "services", and it's always been my feeling that she'll eventually catch up to her peers (my brother was also a late talker, and my parents were told he'd never live on his own, etc. He's now fine and has a Masters Degree).

    Incidentally, the second Sowell book on late talkers was called "The Einstein Syndrome" - both of Sowell's books have given me great comfort, and my daughter fits their profile very well.

  3. Thank you very much for your very informative discussion. I was searching for such type of blog as yours. Keep it updated. Great Job!

  4. Thanks for you post. My 3 year old has delayed speech. We don't want to go in for a diagnosis as we think he may be wrongly diagnosed as autistic. He has no emotional or social problems and is a loving child who enjoys rough and tumble games but when given the choice will play on his own with a puzzle or blocks. He also does some imaginative play and has a very good memory. My husband is a very bright biomechanical engineer with a doctorate from Oxford. His brother is a computer engineer and their father a very good maths teacher. My husband and his brother also took time to talk. This is why I thought my son was following in his dads footsteps. We do take my son for speech therapy but will not be going in for a diagnosis for some time. Thanks again.

    1. HI, I have a son who seems having delayed speech. As he is completely unlike his 8 years elder brother (my elder son) who is an autistic.

      Does you son speak 2-3 words or no work, asking for comparison only. Thanks

  5. I am blessed. I really needed to see my own diagnose for my two and ten month old son. Not only he's my only child and has no close relatives of his age, he barely started daycare 6 months ago and we also speak two languages at home. My husband is not very patient, neither takes time to research about how can we help my little gifted boy. He is loving, he can seat still and color with me, also pay rough and want to jump around, one second he's sitting and the next he's running or laughing. As much as he loves singing he also reads. Yes, I have used visual stimulating games and not only he reads the entire alphabet in any order, he reads about 30 words and knows how to phonetically pronounce every letter. I discovered this a while ago & I now understand more why is he fuzzy or gets upset or acts a little crazy like we think he gets For what I know, by now he should have been asking lots of questions about everything and anything but the frustration of not being able to speak sentences it's growing more with the time. I'm trying to educate myself and will seek for more advice and search for the best opened minded specialist. I'm a warrior & will do whatever it takes to see him successful always and this is my first challenge. My son is extremely smart and social with adults & older kids, not so much with the same age group.. May throw tantrums and also may look a little out of control sometimes but who wouldn't if they couldn't talk right?. God bless !

  6. I also need to give a lot of credit to his teacher Miss Joy :) she helps him a lot

  7. I have a three year old with speech delay. He only says 10 words. However, he plays, very social, asks my husband and I to play with him, good memory, jumps, catches a ball, etc. But diagnosed him with autism. Totally think the doctor is wrong because the only thing he can't do is talk.

  8. I have a three year old with speech delay. He only says 10 words. However, he plays, very social, asks my husband and I to play with him, good memory, jumps, catches a ball, etc. But diagnosed him with autism. Totally think the doctor is wrong because the only thing he can't do is talk.