Behavioural Speech Therapy

Early Speech and Language Red Flags in Autism Spectrum Disorders

A curious, observant, active typically developing child is keen on accessing all the information around them. They are developing a multitude of skills from when they are born and especially during their toddler period (12 to 36 months of age). As parents, you are excited of all the learning that is taking place!

Before knowing about red flags of autism speech delay let us first understand the typical development of children. According to the American Speech and Hearing Association, the typical development of a child from birth to 3 years of age is seen below!

Take a look!

Hearing and Understanding Speaking
Birth–3 Months

  • Startles to loud sounds
  • Quietens or smiles when spoken to
  • Seems to recognize your voice and quietens if crying
  • Increases or decreases sucking behaviour in response to sound
Birth–3 Months

  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs
  • Smiles when sees you
4–6 Months

  • Moves eyes in direction of sounds
  • Responds to changes in tone of your voice
  • Notices toys that make sounds
  • Pays attention to music
4–6 Months

  • Babbling sounds more speech-like with many different sounds, including p, b and m
  • Chuckles and laughs
  • Vocalizes excitement and displeasure
  • Makes gurgling sounds when left alone and when playing with you
7 Months–1 Year

  • Enjoys games like peek-a-boo and pat-a-cake
  • Turns and looks in direction of sounds
  • Listens when spoken to
  • Recognizes words for common items like “cup”, “shoe”, “book”, or “juice”
  • Begins to respond to requests (e.g. “Come here” or “Want more?”)
7 Months–1 Year

  • Babbling has both long and short utterances such as “tata upup bibibibi”
  • Uses speech or non-crying sounds to get and keep attention
  • Uses gestures to communicate (waving, holding arms to be picked up)
  • Imitates different speech sounds
  • Has one or two words (hi, dog, dada, mama) around 1st birthday,
1-2 years

  • Points to a few body parts when asked.
  • Follows simple commands and understands simple questions (“Roll the ball,” “Kiss the baby,” “Where’s your shoe?”).
  • Listens to simple stories, songs, and rhymes.
  • Points to pictures in a book when named.
1-2 years

  • Says more words every month.
  • Uses some one- or two- word questions (“Where kitty?” “Go bye-bye?” “What’s that?”).
  • Puts two words together (“more cookie,” “no juice,” “mommy book”).
  • Uses many different consonant sounds at the beginning of words.
2-3 Years

  • Understands differences in meaning (“go-stop,” “in-on,” “big-little,” “up-down”).
  • Follows two requests (“Get the book and put it on the table”).
  • Listens to and enjoys hearing stories for longer periods of time.
2-3 Years

  • Has a word for almost everything.
  • Uses two- or three- words to talk about and ask for things.
  • Uses k, g, f, t, d, and n sounds.
  • Speech is understood by familiar listeners most of the time.
  • Often asks for or directs attention to objects by naming them.
  • Asks why?
  • May stutter on words or sounds.


However, not all of them would fall into the typically developing child category. Sometimes there may be difficulties in social development, comprehending instructions, and expressing needs and wants. Therefore, as a parent, you may be wanting to find out if some of the speech and language milestones of your child are being missed.

In literature published by Mitelman in 2018, some of the early biological signs of Autism in children are the following few:

  • Having differently wired brains with varying connections
  • Having larger brain volumes and increased rate of brain growth at an abnormally rapid rate
  • A neural network dysfunction or dysconnectivity

To narrow down the early signs of speech and language deficits in Autism Spectrum Disorders, you as a parent may consciously interact with your child and look for any developmental deficits. For example: attempt to play with your child, take them to the park to look for social interaction skills or put your child with another age-matched peer.

Here are a few Autism Speech Delay red flags at 12 months of age or even earlier!

  • Cooing and babbling in the first year of life which then stops suddenly
  • Lack of response to his/her name
  • Affected joint attention
  • No pointing uses other’s body to express needs
  • Affected pretend play and imitation
  • Problems with non-verbal communication
  • Speech delay
  • Problems with following directions
  • Repetition of words (echolalia)
  • Odd usage of words (non-meaningful communication)
  • The robotic or singsong voice
  • Tantrums due to lack of verbal language
  • Attention to objects rather than people
  • Solo play rather than interactive play
  • Poor greeting skills

Around the age of 12-18 months, there may be a regression in the development of the child. It could be due to behavioral issues, but researchers are still unclear as to why it happens and to which children it may occur in.

Around 18-24 months of age, look out for:

  • A loss of words, skills or social connection
  • Inappropriate play with toys
  • Blank face, lack of expression
  • Ignorance of people
  • Continued lack of eye contact

A case example of speech deficits in Autism:

Johnny isn’t talking at all at age two. But while he isn’t using words yet, he’s using babbling sounds and body language to communicate with the people around him. He’s pointing, pulling people toward things he wants, and engaging with other people. He actively enjoys playing with his parents and siblings and is frustrated when left alone to take a nap.

A case example of a normal speech delay:

  • Eg: Bobby is the same age as Johnny. Bobby does have a few words, but he doesn’t use them to communicate. Instead, he repeats them over and over to himself. Bobby has not yet figured out how to use gestures, sounds, or words to ask for something he wants. His parents find it almost impossible to hold his attention for more than a few seconds.

According to research done by Bodison (2015), dyspraxia in the early toddlerhood may be present, where coordination skills are likely to be affected in children with Autism because of which they are unable to imitate. They also show lower empathy because as a secondary deficit. Therefore, their social and communication abilities are affected.  Toddlers with dyspraxia will exhibit poor play skills, peer relationships, imitating each other in daycare or at the playground. Not only is it limited to play skills, but also their ability to participate in leisure activities.

Being a parent, you may observe carefully, but more than just observing, trusting your gut instinct would be the best!

When in doubt, get your child assessed by a Speech and Language Pathologist!

-Pranathi Kavi – Jonnalagadda (M.A.S.L.P, Manipal University)



Mitelman, S. A., Buchsbaum, M. S., Young, D. S., Haznedar, M. M., Hollander, E., Shihabuddin, L., … & Bralet, M. C. (2018). Increased white matter metabolic rates in autism spectrum disorder and schizophrenia. Brain imaging and behavior12(5), 1290-1305.

Bodison, S. C. (2015). Developmental dyspraxia and the play skills of children with autism. American Journal of Occupational Therapy69(5), 6905185060p1-6905185060p6.

Charman, T & Baird, G. (2002). Practitioner Review: Diagnosis of autism spectrum disorder in 2- and 3- year old children. J. Psychology and Psychiatry43, 289-305.

Gray, K & Tonge, B. (2001). Review article. Are there early features of autism in infants and preschool children? J. Paediatr. Child Health37, 221-226.

Zwaigenbaum, L. (2001). Autistic spectrum disorders in preschool children. Canadian Family Physician47, 2037-2042.



  1. It was nice of you listing that difficulties with non-verbal communication and speech delay with in the first year are a red flag. My sister noticed her son has been cooing and babbling. I will help her find a pathologist for her baby.

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