Apraxia and Autism in Toddlers

October 27, 2022 / Laura
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Today let’s look at apraxia and autism in toddlers.

 

According to research from 2015, Tierney and her colleagues found that 63 percent of children with autism also have apraxia. Because of that staggering statistic, as pediatric SLPs, when a child has autism, we should rule out apraxia, and when he has apraxia, we should screen for autism. This is consistent with our earlier statement about identifying the root cause of a child’s communication problem so that we can provide the right treatment strategies.

 

When I suspect apraxia, I begin with screening for autism using these seven reliable screening indicators for autism in very young children. These characteristics below separate kids who will go on to be diagnosed with autism from kids with other types of language delays. Even though there are similarities between autism and language delay—chiefly late talking—the following signs point to autism and are not typically seen in language delay. This is a common issue in early intervention…how can I tell if this is a language delay or if I’m seeing something more serious like autism? For comparison, I’ve also added the age when typically developing children master each skill.

 

To reiterate, if a child is struggling with any of the seven issues listed here, a child should be referred for an autism evaluation:

 

Characteristics that Differentiate ASD from other Developmental Language Delays/Disorders (ASHA, 2015)

 

Eye Contact and Eye Gaze – Kids with autism have difficulty paying attention to faces and following when you point at something. In typically developing kids, both skills are mastered before 12 months.

 

Orienting to One’s Name – Kids with autism respond inconsistently to their own names. Babies begin to alert to their names between 4 to 6 months and consistently respond by looking when someone calls their names by 12 months.

 

Pointing to or Showing Objects of Interest – Kids with autism may have difficulty pointing or showing objects to others, which is typically mastered by 15 months.

 

Pretend Play – Toddlers with autism have difficulty pretending in play or using one object to represent another object. Most typically developing children are able to demonstrate how familiar objects are used by 15 months, and they show true “pretending” in play, such as feeding a baby doll or substituting objects during play, by 24 months.

 

Imitation – Toddlers with autism have difficulty learning to imitate actions, sounds, and words. Typically developing children imitate well by 16 months.

 

Nonverbal Communication – Toddlers with autism have difficulty understanding and using gestures and may display a “flat” affect or limited facial expressions or body language. As noted previously, toddlers should be using many gestures by 16 months.

 

Language Development – Children with autism exhibit delays and differences in both language comprehension and expression as compared to their same-age peers; they may talk but not communicate with others. Expressive language test results for a toddler with autism may be at a higher developmental level than receptive skills, meaning that a child with autism may say more than they understand. This is an atypical pattern of development, since most toddlers understand much more than they can say.

 

When we observe a constellation of these issues in toddlers with speech-language delays, we should begin to suspect autism and adjust our treatment protocols as well as our conversations with parents. It is unwise to ignore these issues.

 

For more information about apraxia and autism, please check out my newest therapy manual, The Apraxia Workbook 1.  This post is an excerpt from Chapter 1: Understanding Early Signs of Apraxia.

 

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