What is considered a speech delay?

[Suki]

In the context of diagnosing ASD.......

 

My son had no recognisable words at 2 years 3 months so our health visitor referred him for a speech therapy assessment. The speech therapist said he had a mild expressive language delay, although he was actually saying more than we actually realised. She didn't consider any further action was required as she could see that speech was developing normally. He was also found to have mild glue ear. Sure enough, within weeks of that appointment his speech came on in leaps and bounds. All I remember is that by 2 years 9 months when his sibling was born he was speaking well and about normal for his age and went on to become a real chatterbox. He is now 7 and has no speech problems whatsoever.

 

Just curious really. We are embarking on the long road to diagnosis, although I'm struggling to see how he meets the criteria for AS as, as far as I can tell, he doesn't meet the key criteria of issues with communication and social interaction, although he does have a lot of other AS traits, particularly the sensory related ones. However, my mum said "ah, but he did have a speech delay". But, did he??

 

I'm feeling he's more likely to have ADHD and/or SPD but of course I'm no expert and will just have to wait, ho hum.

 

Thanks

[baddad]

Hi Suki -

 

Sounds like your mum is doing a bit of selective retrospective labelling! If the professionals didn't consider it a delay in acquiring speech then it probably wasn't; just him being slightly later in hitting that specific milestone, which, given the added complication of glue ear would sort of even itself out. The biggest consideration (and it is mentioned in DSM IV along with delay in acquisition) would be what happened when he did start speaking. If he was communicating effectively (in an age appropriate way) and there weren't other indications like echolalia/repetitive speech (again, bearing in mind what would be age appropriate -which it 2.5 would include some of this kind of stuff)from then on, then it's likely the delay was just what the speech therapist concluded.

 

My own son followed a similar pattern to yours speech-wise, and it was a similar 'mild delay' in acquiring speech that prompted me to seek medical advice (well, partly that)... Again, like your son, his speech came on in leaps and bounds once he started talking, but the way in which it - and the rest of his communication, i.e. interaction, interactive play, eye-contact etc - developed strongly indicated that his vocabulary far outstripped his wider understanding. Other areas of his behaviour were also significantly 'autistic' - in fact, it was precisely during that period that his autistic tendencies stepped up to 'full power' (following a viral infection my GP believed to be measles but which he 'fought off' in one terrifying night of roaring temperatures where I held him in a bath of cold water for extended periods; make of that what you will MMR campaigners!) and became apparent. By the time we went back for his second visit with the paediatrician - a routine 'check' on his speech delay - three months later there was no doubt about his dx, and the speech delay really didn't come into the equation - it was all the other stuff going on!

 

With hindsight, though, there were mild delays in almost all 'milestones'; he was a 'bit late' in rolling over, a 'bit late' in sitting up, a 'bit late' in crawling and walking etc. It was quite disheartening at Gym Babes that he was the last kid to do any of those things (especially as I was the only dad going - I expect all sorts of wrong assumptions were made by the mums, don't you! ), and it was these kinds of delays that account for the 'well partly that' parenthesis above!

 

Recalling your other post re your son and the number of ways in which he doesn't fit the criteria I'd be very cautious about diagnostic process all round. It would be very easy (and I think it already happens quite often) to 'find' six traits if the paediatrician (or your mum!) went looking for them - I think, in all honesty this could apply to anyone if the dx process is selective enough.

 

It sounds as though you are trying to look at the bigger picture and make a full holistic assessment of your son's difficulties and his strengths, and that's definitely what any professionals involved should be doing too. If they do, and having weighed up all the evidence autism seems an appropriate diagnosis, that clarity of diagnosis will obviously have clear benefits for your son. If, on the other hand, they just seem to be looking for bits that fit the pre-drilled cut-out they have waiting on the sidelines it would be as much of a 'square peg/round hole' equation as one where an autistic child doesn't get the appropriate diagnosis...

 

Hope that's helpful, and that whatever the explanation for your son's current problems you can find some answers.

 

L&P

 

BD

Edited May 25, 2011 by baddad

[Suki]

Thanks Baddad, that makes sense. Incidentally, when he did start talking it was (and still is) totally *normal* for his age. In fact he is a very articulate and expressive little boy. I shall add the information about his speech development to the ongoing Word Document I've started which lists all my concerns, observations and, of course, positives. I shall be printing it off and taking it along to our CDC appointment, whenever we eventually get one! I actually just added some evidence of his understanding of sarcasm; he got his shorts wet (missed the toilet!), he took them off and threw them across floor exclaiming "oh great!" Challenging him, I said "what's so great about that?". He looked at me, rolled his eyes, and said "I was being SARCASTIC!". On days like that I wonder how he can possibly have ASD. Then, on another day, he could be off on his own humming and playing with an imaginary car while his peers are playing football and I start worrying again. However, he's told me himself its because he can't stand the noise and hates games like that (quote: "boys don't have to play football mummy, it's not the law you know").

 

I just wish I could get some answers as all this speculating is driving me crazy, which I guess is what forums like this are for!

 

Thanks.

 

Suki

[baddad]

Then, on another day, he could be off on his own humming and playing with an imaginary car while his peers are playing football and I start worrying again. However, he's told me himself its because he can't stand the noise and hates games like that (quote: "boys don't have to play football mummy, it's not the law you know").

 

 

 

His explanation sounds far more likely than ASD!

Suki, what exactly are your concerns for your son? I don't mean that sarcastically and hope it didn't come across that way, but you've not said, and I'm wondering if maybe your projecting your concerns onto him, iyswim... it might just be that he prefers his own company and feels more comfortable being 'him' than being what the other kids are? While that could be quite worrying if taken out of context it's actually a pretty big positive if you think about it, whatever he choses to do in life. If you think about that American cliche of a 'class year book', they have a whole section of 'person most likely to' pages, and it's the people who stand out as individuals who win the best prizes. Sounds to me like you've got one of them, and maybe your concerns are the waste of a good worry!

Of course, if there are things that are genuinely causing him difficulties you need to look into those, but if it's more just a sort of nagging concern that he's not a 'team player' and he's not following the herd in terms of the things he should like/dislike that may not be such a bad thing. Ultimately, the question you need to ask is 'is he happy'? If he is, and that happiness doing different things isn't having a detrimental effect on other aspects of his life there's not really much more a parent could wish for!

 

HTH

 

L&P

 

BD

[Suki]

No offence taken. I can see why you say that as I’ve often thought it myself and until recently had convinced myself he was just a very individual, if rather quirky character! There are also some rather quirky, some may say eccentric, individuals in my family including my late dad so I presumed he had just inherited some of his personality traits. I have often wondered if my dad or his brother were kids today whether they would be diagnosed with something, although not sure what the point would be as they both led happy and productive lives.

 

You asked what I was actually worried about. I know you’ve seen my post on the meet & greet page, but to clarify:

 

Very poor attention span, he can hardly read or write which is the main reason the school are now taking action.

 

Very hyperactive, can’t sit still for a moment, reading to him is a joke and behaviour can be challenging to say the least! Always fiddling, messing about. Until recently, I just thought he was a lively child, but now he’s 7 it’s more obvious he has a problem and the gap is appearing between him and his peers.

 

The above 2 are what makes me think he might have ADHD

 

However, he also has a number of sensory issues, mainly noise and light/dark. The woman who assessed him at school said he had “major issues with sensory integration” and he is on the waiting list to see OT. It is this that makes me think he might have SPD. Obviously, I know that many autistic children have SPD but it’s not a core deficit (as I have recently discovered) and you can have SPD and not have ASD.

 

Aggressive towards his sister, is very fond of her but seems to be unable to stop prodding, pinching and “overhugging” her. I’m actually now wondering if this is a sensory thing too??

 

He has never joined in with team games or at parties which, as you say, may just be that he doesn’t like that sort of thing. He actually says he likes being an individual and gets annoyed when I question him about not joining in and says “oh blah blah” and changes the subject. However, not only does he not join in, he behaves very strangely by humming and playing imaginary games by himself. This really worried me and my first thought was ASD. I was taken aside by one of the leaders at Beavers as they do a lot of that kind of thing there. Once I said he was undergoing assessment for ASD she said another leader had actually asked if he was autistic (that parent also has an ASD child). However, having learnt about his sensory issues, I wonder if that may actually be the cause rather than any problem with social interaction. He joins in totally with gentler activities or ones he is interested in such as arts & crafts and does interact normally one on one.

 

He is very obsessed with cars and anything electrical and mechanical. However, I really don’t know if his interest is “abnormal” and, as you say, that is very subjective.

 

The humming and other silly noises which is causing disruption in class.

 

The school say he often “seeks out a repetitive routine” When pressed, the only examples they can give me is that he insists on placing his water bottle away from the others and sitting on the carpet with all his stuff at the end of the day when they’re supposed to leave them on the table. However, he often forgets his water bottle, leaving it either at home or school so can’t be that fussed about it. Going back a couple of years, he did get upset if I parked the car in a different place on the drive or moved things around his room, but not anymore. These days I can’t say he does anything routine driven or repetitive at home so I do wonder if they’re just trying to make the cap fit with this one?!?

 

Has little in common with the boys in his class and mainly plays with the girls or alone. I believe he is generally liked in class and is not bullied and comes across as sociable & confident. He gets on well with his 6 year old cousin who is also not a typical boy and also prefers playing role play type games with girls. However, there’s no concern about him as he’s doing well at school and doesn’t show any of the other traits my son does.

 

This is not the first time concern has been raised about him. When he was 2 and in private nursery they had him observed due to his lack of speech and the fact he didn’t interact with the other kids, preferring to play alone with cars. Report was inconclusive, his speech and interaction improved and he left the nursery soon after. He went on to preschool, then school nursery and although he was one of the naughtier kids with issues listening and sitting on the carpet, they weren’t unduly concerned (and I did ask). Reception and the behaviour team were called in after he thumped a class mate and was generally very badly behaved and disruptive. They said it could be a “parenting issue” and were reluctant to take it further without more evidence. Year 1 and his behaviour improved at school and he was taken off the SEN list. Year 2 and his new teacher expressed concern and got the ball rolling…..

 

I listed reasons why I think he’s not autistic on my other post and the lady who saw him in school said there was a lot to suggest he isn’t, although stressed that she wasn’t qualified to diagnose and a lot more evaluation would be required.

 

Having said all that, I do think he definitely has significant issues that need addressing so really don’t think I’m worrying over nothing. Initially, the only explanation I could think of was autism but I’ve since discovered that other conditions can produce similar symptoms and I am struggling to see that he fits the diagnostic criteria for ASD. However, only an expert will be able to tell me for sure so for now I’ll have to play the waiting game…………..

Edited May 25, 2011 by Kathryn
to fix quote error