Is it a speech delay, or is my child autistic?

Does late talking mean my child is autistic?

No. Late talking has many possible explanations, and autism is only one of them.¹ A late talker is usually described as a toddler with fewer words than you'd expect, whose understanding is still on track.² In a large Australian study that followed children from the age of two, the late talkers as a group were in the typical range for language by seven, although a bigger share of them (20%, against 11% of the other children) scored below what's expected on a general language measure.³

That study wasn't about autism, so it can't tell you whether your own child is autistic. What it shows is that a small vocabulary at two doesn't settle anything by itself. Clinicians look at the picture around the words, and that's what the rest of this guide is about.

What else do clinicians look at?

They look at how a child communicates and plays with other people, as well as how many words they use. NICE, which sets out how autism is recognised in children in England, describes differences across several areas, and the NHS page for parents lists much the same ones.¹⁴ A team may notice how a child shares attention, for instance whether they point to show you something or follow where you point, which professionals call joint attention. They may look at gestures and facial expressions, and at play: pretend play, joining other children, or preferring to play alone. They may ask whether a child responds when their name is called. NICE says this is judged when hearing is normal, which is why a hearing check is a sensible early step.¹ Sensory differences, such as strong reactions to lights, sounds or textures, and repetitive movements or very strong interests (the NHS uses the word stimming for the movements) also come into it.⁴

No child has all of these, and a child can have a few and still not be autistic. The NHS says every autistic person is different and many won't show all of them.⁴ NICE goes further and tells professionals not to rule autism out because a child has pretend play or reached language milestones on time.¹ So please don't use this list to score your child at home.

These are differences in how a child communicates and experiences the world, and I wouldn't call any of them faults. I describe them because they help a team decide whether to look more closely, and because knowing what a professional will be watching for can make the first appointment feel less strange.

What if my child repeats words and phrases?

Repeating words and phrases is something clinicians notice, and it's also communication.⁴ A child who says a line from a favourite cartoon when they're excited may be telling you exactly how they feel. On its own it settles nothing, since NICE reminds professionals that there may be other explanations for individual signs.¹ My page on gestalt language processing explains what that can look like.

Can a speech and language therapist say if my child is autistic?

Not on their own, no. In England a diagnosis comes from a team. NICE says the core of that autism team should include a paediatrician and/or child and adolescent psychiatrist, a speech and language therapist and a psychologist.¹ The Royal College of Speech and Language Therapists (RCSLT) describes the therapist's part as contributing a view of the child's language and social communication to the wider assessment.⁵

I don't diagnose autism on my own. What I can do is look closely at how your child communicates, tell you what I see, and write it up if you'd like it for a diagnostic team or a school. I can also explain how referrals work, which is the next question.

How do I ask for an autism assessment?

Start by talking to your GP. The NHS says to speak to a GP if you think your child might be autistic, and that the GP may be able to refer them for an assessment.⁶ You can also speak to the special educational needs coordinator (SENCo) at your child's school or nursery.⁴ For children, the school may need to make the referral, and if your child isn't school age yet, a health visitor may need to make it.⁶

It helps to write down what you've noticed, with examples, and to say where you see it: at home, at nursery, with other children. NICE tells professionals to look at whether differences show up in more than one setting, and to take a parent's concerns seriously even when other people don't share them.¹ If you can't get a referral, the NHS says you can ask to speak to someone else, such as another GP, for a second opinion.⁶

Does my child's support have to wait for a diagnosis?

No. The National Autistic Society says a formal diagnosis is often not required to get support, though it depends on the kind of support, and that the GP or professional who made the referral should offer as much support as possible while you wait.⁷ It adds that nobody needs a diagnosis for a child's needs to be assessed at school.⁷

Help with communication, play and sensory comfort can start now, at home and in the setting. The aim is for your child to be understood and to understand other people, and nobody has to be made to seem less autistic for that to happen. If you'd like to know how I work with autistic children, my about page sets out what I will and won't do.

When should I ask for help sooner?

If your child has lost words or social skills they used to have, ask for an urgent GP appointment or call NHS 111. NICE tells professionals to refer a child under three with a loss of language or social skills straight to the autism team, and a child over three to a paediatrician first.¹ A doctor should look at this quickly, because there can be other reasons for it.

It's also worth asking if you're unsure your child hears you, if they have few words and aren't trying to communicate in other ways, or if you have a feeling something's different. Your GP, your health visitor and the nursery or school SENCo are all free routes in, and a hearing check is worth asking about too.

What happens if I get in touch?

You can book the free 15-minute call and tell me what you've noticed, and I'll say whether a session looks worthwhile and how the referral route usually works. No GP referral is needed, and seeing me doesn't take your child off an NHS waiting list. The first step after that is an assessment (£270), which is mostly play. There's more on the autism and social communication page, and the fees page lists the costs, including the £95 written report some diagnostic teams like to receive.

My guide to the assessment explains the session.