Interactive Autism Network at Kennedy Krieger Institute
Date Last Revised: April 29, 2014
Date Published: May 20, 2013
Like many specialists, Ericka L. Wodka, PhD, has met with concerned parents who want to know one thing in particular: when, or if, their child with autism will speak.
She looked to research studies for guidance, but "I wasn't getting my questions answered," she said. So she launched her own study using data from the Simons Simplex Collection (SSC). The SSC includes 2,600 families who each have only one member – a child – with ASD.
In the largest study of the subject to date, her research team found that most young children with ASD and severe language delay developed "phrase or fluent" speech by age 8, with almost half achieving fluent speech. These findings suggest that a greater percentage of children with autism "may be capable of attaining phrase speech than previously reported."1
Phrase speech means a child will use a two-word statement appropriately, such as "want cookie," when he desires a snack, said Dr. Wodka, a pediatric neuropsychologist at the Center for Autism and Related Disorders at Kennedy Krieger Institute.
Her team studied 535 children from the SSC with ASD and a history of severe language delay, which was defined as being nonverbal or "not putting words together into meaningful phrases by age 4." By age 8, 70 percent had phrase speech and 47 percent were fluent speakers.1
The study brings hope to those parents who worry that children who are not talking by age 4 or 5 are unlikely to develop speech at all. Some children with ASD develop meaningful language after age 5. "There is a burst of kids in the 6- to 7- age range who do get language," Dr. Wodka said.
In the study, 16 percent of the children with low-average intelligence or intellectual disability, and 11 percent with average intelligence, attained phrase speech by age 6 or older, said study co-author Luther Kalb, MHS, of Kennedy Krieger Institute.
Dr. Wodka has good news for parents and educators. "The results of our study suggest that if you continue to work on the language development and social goals, and continue to persist with those intensely through the early childhood and early-school age years, the majority of kids who are not using meaningful phrases by age 4 will be by the time they're 8," she said.
The team found that children with higher nonverbal intelligence scores and fewer social deficits were more likely to achieve phrase or fluent speech, and at an earlier age. Social deficits include problems with eye contact, using facial expressions to communicate, and sharing items, thoughts or feelings.
Children with intelligence in the typical range – an intelligence quotient (IQ) score greater than 85 – reached phrase speech about seven months earlier than children with "low-average" intelligence or intellectual disability.
As for fluent speech, the children who achieved fluency were older, and had a higher nonverbal IQ, lower levels of social impairment and more anxiety symptoms, according to the study.1
Unexpectedly, the team did not find a relationship between language development and two other symptoms of autism: repetitive behaviors, such as hand flapping, and unusual sensory interests, such as smelling objects. "That was kind of surprising," Mr. Kalb said. Repetitive behaviors seem like they might interfere with language development, but they did not, he explained.
Implications for Intervention
The findings potentially support the use of autism interventions that focus on "social cognition," such as teaching a child to recognize the feelings and perspectives of others.1
Dr. Wodka explained that ASD "is not a speech or language disorder. It's a social communication disorder. Understanding why it's important to be able to communicate with someone else is not inherent for a child with autism compared to a typically developing child."
Interventions that help motivate children to communicate and share experiences with other people might help improve speech, she said. Her study calls for more research on the topic.
The families in the study have certain characteristics. Only one child has ASD; parents and siblings are unaffected. Also, the child with autism does not have a genetic condition such as Fragile X or Down syndromes, or a family history of psychiatric disorders.2 The study results may not apply to youngsters who have such medical histories or who have other family members with autism.