Speech Delay vs Autism: How the Signs Differ in Toddlers

It's easy to feel worried when your child doesn't reach the same milestones as other children their age. Speech is one of the first things many parents notice. Your two-year-old may use only a handful of words, even though they seem to understand everything you say. Someone around you may even have asked, “Have you had your child evaluated for autism?”

Speech delay and autism can overlap, but not every child with a speech delay is autistic. The clearest clues usually come from how your child connects with you without words, such as pointing, showing you things, and sharing play.

Key Takeaways

• The main difference: A speech delay affects how a child talks and understands words, while autism also involves differences in social communication and behavior.
• What parents can watch: Gestures, shared attention, play, and how your child responds to their name often tell you more than the number of words they say.
• What to do next: Ask your pediatrician about a hearing test and a speech-language evaluation rather than relying on a checklist alone. Alpaca Health's free toddler autism screener can help you decide whether to ask about autism too, and you can start your intake whenever you want support.

What counts as a speech delay?

A child is speech delayed when they say fewer words, or start putting words together later, than most children their age. Doctors also separate two kinds of difficulty: talking less than expected, and having trouble understanding words. A child who understands what you say but doesn't talk much is in a different situation from a child who finds both speaking and understanding hard.

Speech refers to producing sounds and spoken words. Does your child try to repeat words when you talk? Do they use sounds or words to ask for things, or do they communicate through gestures, such as pointing?

Language includes both understanding and using words, gestures, and other forms of communication. A child may have difficulty speaking but still communicate well in other ways, which is why clinicians look at receptive and expressive language separately.

Expressive language is how a child shares their thoughts and needs. This can include spoken words, sounds, and gestures.

Receptive language is what a child understands. For example, if you say, “Go get the blue cup,” does your child understand the instruction and bring you the cup?

The CDC's developmental milestones list the talking skills most children reach by each age.

• 18 months: Tries to say three or more words besides “mama” or “dada.”
• 2 years: Says at least two words together.
• 30 months: Says about 50 words.
• 3 years: Has a conversation with at least two back-and-forth exchanges.

A milestone list is a guide rather than a diagnostic test, and a child can have a speech delay without having any diagnosed disorder.

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Does autism cause speech delay?

Some autistic children do start talking late, but many talk on time, and a speech delay on its own doesn't mean a child is autistic.

Autism is a neurodevelopmental condition. Doctors diagnose it when a child has differences in social communication and interaction, together with restricted or repetitive patterns of interests and behavior.

Some autistic children speak later than expected or have speech patterns that differ from those of other children, such as repeating words or phrases. Other autistic children develop spoken language on time or have large vocabularies. That's why a speech delay alone can't establish an autism diagnosis.

Picture two toddlers who each use ten spoken words. One also points to share interesting things and joins in back-and-forth play. The other shows differences in shared attention or plays the same way over and over. Those differences are why clinicians look beyond word counts, although no one could diagnose either child from a description like this.

Speech delay vs autism: how the signs compare

Clinicians look at more than how many words a child uses. They watch eye contact, how your child responds to their name, gestures, and play, because those show how a child connects with other people.

You may also hear clinicians use terms that are new to many parents, such as echolalia, regression, and joint attention.

Echolalia is when a child repeats words or phrases they've heard, such as a line from a TV show. The repetition can also be a way of communicating.

Regression is the loss of a skill a child used to have. For example, a child who used to point at things but no longer does may be showing regression.

Joint attention is when a child shares attention with another person on an object or event. A child who points to an airplane to share their excitement with you is showing joint attention.

The table below shows how these signs usually differ between the two.

Clinicians may also look for repeated behaviors, such as lining up toys again and again or focusing on spinning wheels. They notice, too, when a child responds to their name in some situations but not others. These observations help them decide whether a child needs a fuller evaluation.

How do you know if a speech delay is not autism?

You can't rule out autism with a checklist at home, but watching your child's everyday communication can help you describe your concerns to a professional. These yes-or-no questions about everyday moments are a good place to start.

• Does your child bring you an interesting object just to share it with you?
• Does your child point toward something exciting and look back at you?
• If you point at something, does your child follow your gesture?
• Does your child use gestures such as waving?
• Does your child seek interaction during playtime?
• Does your child share enjoyment with other people?

Mostly “yes” answers don't rule autism out, and mostly “no” answers don't mean your child has autism. You can bring these observations to your pediatrician when you talk about your concerns.

Does your child understand more than they can say?

There's a difference between understanding language and being able to use it. For example, a toddler may understand “Bring me the blue ball” but not yet be able to say “blue” or “ball.”

A simple way to check at home is to give a one-step direction without pointing or looking at the object, such as “Give me the cup.” The CDC lists following a direction like this, without gestures, as a milestone for 18 months.

Some children who start talking late understand much more than they can express, while others have difficulty in both areas. Good understanding is a hopeful sign for a late talker, but it doesn't rule out autism on its own. Tell your pediatrician how your child responds to directions like these, because it helps them decide which evaluations to order.

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At what age can doctors tell a speech delay from autism?

Doctors can sometimes detect autism at 18 months or younger, according to the CDC. By age 2, a diagnosis by an experienced professional can be considered reliable. Many children aren't diagnosed until much later, so it helps to know the early signs of autism to watch for.

The American Academy of Pediatrics recommends general developmental screening at 9, 18, and 30 months, and autism screening at 18 and 24 months. The autism screening at those visits is often a short questionnaire that parents fill out, such as the M-CHAT-R.

A screening can't diagnose autism, but it shows which children need a closer look. If you're worried about your child's development, you don't need to wait for a particular checkup to talk with your pediatrician.

Should you wait and see if your child starts talking?

Parents who raise a concern about speech are often told to wait and see. Some children do start talking later and catch up with their peers. Still, it's hard to know in advance which children will catch up and which need extra support. That's why the CDC encourages families to act early on a concern.

An early evaluation can find hearing difficulties, speech and language problems, or other developmental differences. Understanding these challenges early helps you and your child's care team decide what kind of support your child needs.

You don't need an autism diagnosis to get an evaluation started, and in the US you can begin in one of these places.

• Under age 3: Contact your state's Early Intervention program, which evaluates babies and toddlers for developmental delays.
• Age 3 and older: Contact your local public school district to request an evaluation.
• At any age: Ask your child's pediatrician about referrals to an audiologist or a speech-language pathologist.

Which evaluation does your child need?

Most late talkers start with a hearing test and a speech-language evaluation. An autism evaluation is added when there are also signs in social communication or behavior. Each one answers a different question, and together they show what kind of support your child needs.

A hearing test

Hearing difficulties can affect a child's speech and language development. A child may hear some sounds and still miss others, and an audiologist, a specialist in hearing, can test for that.

A hearing test shows whether hearing is part of the reason for the delay. A child can also have hearing difficulties alongside other developmental conditions, including autism.

A speech-language evaluation

A speech-language evaluation is done by a speech-language pathologist (SLP), who looks at how your child understands and uses language. It may include speech sounds, vocabulary, gestures, play, and social communication.

If the SLP recommends therapy, check whether your plan covers speech therapy before you start. For autistic children, speech therapy and ABA are often used together.

An autism evaluation

An autism evaluation looks at your child's developmental history, including social communication, interaction, behavior, and interests. It may involve standardized tools, such as the ADOS-2 (a play-based observation), and more than one professional.

A screening isn't the same as a diagnostic evaluation. A screener flags a possible concern, while the evaluation determines whether your child meets the criteria for autism. An autism diagnosis checklist can help you get ready for the appointment, and the cost of an autism diagnosis depends mostly on your insurance.

How Alpaca Health helps when a speech delay might be autism

Finding the right evaluation can be confusing, especially when you're not sure where to begin. Worrying about your child's development can also be stressful. Alpaca Health helps families with each step. For toddlers 16 to 30 months, that starts with the free M-CHAT-R screener, which can help you decide whether to ask about autism. When a screener or your pediatrician points that way, the next step is an insurance-covered autism evaluation.

If your child is diagnosed, the same team connects your family with ABA therapy for toddlers that builds communication through play. The team also checks your insurance coverage before therapy starts. If you're not sure whether your child needs ABA, that's a good question to bring to the evaluation. If you're ready to get your child started with ABA therapy, you can start your intake here.

You don't have to figure this out alone.

Alpaca Health matches your family with a vetted, in-network BCBA, often within days and with no waitlist. We handle the insurance paperwork so you can focus on your child.

Get matched with a BCBA →

Frequently Asked Questions About Speech Delay vs Autism

Can a child have a speech delay and not be autistic?

Yes, a child can have a speech delay without being autistic. Delayed speech has several possible causes, including hearing problems or simply learning to talk later than other children. A speech delay alone doesn't mean a child has autism. If you're concerned, talk to your pediatrician. If your child is between 16 and 30 months old, Alpaca Health's free M-CHAT-R screener can also help you decide whether to ask about an autism evaluation.

Does a speech delay count as a disability?

A speech delay can count as a disability when it affects how your child learns and communicates. Under the Individuals with Disabilities Education Act (IDEA), a speech or language impairment can qualify a child for special education and an IEP. Babies and toddlers with a significant delay can qualify for early intervention. A speech delay can also be part of a broader condition, such as global developmental delay. Whether your child qualifies depends on an evaluation and your state's rules, and none of these services requires an autism diagnosis.

How long does speech delay last?

There's no single timeline: some children catch up with their peers, while others keep having language difficulties. The American Speech-Language-Hearing Association reports that about 50% to 70% of late talkers catch up to their peers and develop typical language by late preschool or school age. Understanding of words and vocabulary size are among the best predictors of how a late talker's language develops. Even so, it's hard to predict the outcome for any one child, so an early evaluation helps you find the right support sooner.

What should I do if my 3-year-old has a speech delay?

Start by talking to your pediatrician and asking for a hearing test and a referral to a speech-language pathologist (SLP). At age 3, you can also ask your local public school district for an evaluation. You don't need to wait for an autism diagnosis to get help with your child's speech. If autism is a concern too, Alpaca Health offers insurance-covered autism evaluations for children of all ages. When you're ready, you can get started with Alpaca Health.