With so much information out there in recent years about autism I thought it would be beneficial to get back to the basics.
Much of the information in today’s news usually relates to causes, treatments, and statistics. I want to talk more about how autism affects speech and language and often eating in individuals who have an autism spectrum disorder.
While many of you reading this article are dealing with autism first hand, many of you are not and only know what you have read.
Autism and Language Skills
First let’s talk about language. Language can be divided into 2 main parts: expressive and receptive.
Expressive language is our ability to convey our thoughts into words with meaning. Basically our ability to talk. Receptive language is our understanding of what is being said to us. Both expressive and receptive language skills are necessary to be an effective communicator. When either is impaired our ability to communicate is impacted. Children on the autism spectrum will always have some sort of a language deficit depending on their actual diagnosis.
Very often expressive language is impacted to a greater degree than receptive language. This is the reason why augmentative communication with these children is so important. Augmentative communication is another means of communication which can involve pictures, picture boards or talking computers (communication devices).
One exception to this is found in children with Aspergers.
These children will usually have advanced language skills both expressive and receptive; however their pragmatic language skills are impacted to a degree which makes understanding the world around them difficult.
Pragmatic Language and Autism
All children on the autistic spectrum will have deficits in pragmatic language to some degree.
Pragmatic language refers to the social use of language. The ability to use the language skills you have to interact with the world around you.
These deficits may be subtle to an outside observer but can be profound to a child experiencing them.
Social skills deficits are very complex and they are usually mistreated and misunderstood. They are also a very emotional issue to all involved.
Imagine spending years watching your child struggle to learn to communicate and once he does you realize he still can’t use these skills to make friends.
Autism and Speech Skills
Another area that is not part of autism but quite often coexists is speech disorders.
Childhood Apraxia of Speech is a severe motor speech disorder that is believed by some to occur in higher percentage of children on the autistic spectrum than in the general population. This speech disorder makes it even more difficult for these children to learn to communicate. Therapy for a severe speech disorder should be intensive and is often not very exciting.
This being said children on the autism spectrum who have other behavioral challenges will have a harder time making progress than a child who does not have an autism spectrum disorder. Minor articulation errors such as lisps will often get overlooked as they are not priorities when looking at the child as a whole.
Autism and Eating
Eating is another area that is very often impacted with a child on the autistic spectrum.
While it is not a speech or language issue it is often treated by a speech language pathologist. It is one of my areas of specialty; so, I thought I would discuss it as well.
Children on the autistic spectrum often fall into the category of resistant or problem eaters.
The most important distinction between a picky eater and a resistant eater is severity. A child who is a resistant eater could put his life at risk by refusing to eat or drink when pushed in the wrong direction by well meaning parents or uninformed therapists.
There is a lot of information out there on picky eating and you will rarely read anything about a child starving himself if not treated properly. This is putting children’s lives at risk. While a typically developing child may not starve himself, a resistant eater might.
The Central Concern of Autism
If you are a parent of a child with autism or a professional working with these children I am sure you realize the importance of getting the right and the best speech language pathologist you can find.
While these children definitely have other significant issues that need to be addressed by other experts, we can all agree that communication is the central concern in autism spectrum disorders.
I have worked with hundreds of children on the autistic spectrum over the years and as a whole they are the most challenging to work with but in turn are the most rewarding.
{ 40 comments… read them below or add one }
Friends and professionals alike have told me to only give my child (picky eater with autism) food options that are healthy and provide variety assuring me that when he is hungry enough he will eat. I have often thought that he would rather starve than eat anything other than a starch. I have pushed him as many as two or three meals and he would never ever even try, no, not even touch any of the other foods offered. So it is good to hear your validation that children may be harmed by such ideas of forcing a change in diet. I have tried lots of things but have given up and I just want him to eat.
Hi Wren,
I am glad you found my blog before following advice that could have harmed your child. To know for sure how to best deal with your son’s feeding issues you should seek professional guidance. It angers me that it is rarely mentioned that some children will starve themselves when preferred foods are withheld.
Good luck, Isa
Is it possible to have autism and never learn to speak? I have an uncle who does not speak and we think it’s autism. He is in his 40s and when he was growing up, no doctors could diagnose his condition b/c the lack of understanding back then of these conditions.
Yes, some individuals with Autism never develop language. Does he have any other special needs other than his lack of speech?
My son was diagnosed as PDD-NOS at age three. He never transitioned to table food as a baby. We went through two different feeding therapy programs, one at age 2 and one at 4, at highly regarded hospitals. He is now 10 and he has not progressed at all. He only eats 3 foods. Should we try another program now that he is older? It has now become a social problem. He is “normal” in every other way. This is the one thing that makes him stand out with his peers.
Hi Lisa,
I would definitely recommend trying another therapist. Especially if it is negatively impacting all of your lives.
Thank you for your question.
Good luck, Isa
Hi Isa,
I have a 9yr old granddaughter who was just diagnosed with aspergers sydrome. I had her eval when she was 31/2 for sensory int disorder, and she did have it. It was affecting all of her senses. She has outgrown/overcome most of her sensory issues except, her eating. This is a big issues. She only eats certain foods. Hot dogs, chicken nuggets, french fries, bacon, waffles, toast, pancakes, dry cereal, pop tarts and popcorn. No fruits or veggies ever. She drinks orange juice, milk, V8 fusion and fruitables, all good juices. She does not eat sweets, only some ice cream. Also she will eat some yogurts. Should we be worried? Should we be taking her to a food therapist? I am so worried about her not getting the proper vitamins. She will not take vitamins.
Looking forward to hearing from you.
It’s great to hear your Granddaughter is doing so well in so many ways. It would be beneficial to see someone who specializes in feeding issues and help her expand her diet. It could be a long road however there is hope for positive change.
Hi. My child is 28 months and is on the spectrum. He only eats dry cereal and drinks milk throughout the day. I hear from many sources that gluten and casein should be eliminated. These are the only sources of his diet. He refuses to eat or even taste anything else aside from the occasional vanilla wafer cookies. Should I try eliminating gluten and casein for the sake of his symptoms improving? Thanks for your help.
There are many different diets out there; so I would not recommend trying the Gluten Free Casein free diet on your child without guidance from a knowledgeable nutritionist. This is especially true given the fact that he has such a limited diet. You want to make sure you are doing what he needs first.
Hi Isa,
Thank you for your response on my granddaughter’s feeding issue. You stated she should be seeing someone who specializes in feeding issues . Can you explain what type of person specilizes in this?
Thank You
Hi June,
You would need to look for a Speech Language Pathologist or an Occupational Therapist with an expertise in feeding. They can often be found in hospital based centers.
Hi Isa
My son is 2 and the doctour said today he may have autism cause he is not puting a bunch of words together can autism just affect his speech?
He is a smart kid he can feed his 2 mouth old brother and holds him when he crys he does all the other normal stuf a 2 year old would do just not putting words together I thank you for all your help
Autism would impact much more than speech and language development. It would impact social skills and behavior as well. Most often doctors use assessment tools to determine if a child should be diagnosed with Autism . I recommend asking your doctor what he sees in your son that would lead him to believe that he has Autism.
Hi Isa,
(From Portugal, I’m sorry if my english is not the best)
I a 4 years old boy (just made) with an ASD (high functioning/ Asperger’s like). He talks to tell us everything he wants and sees, he plays with dolls taking care of them – he feeds them and changes diapers, he dances and sings, and likes to have attention of others. He started to talk about 33 months old; but still has some limitation in use of language. No major motor limitation (he rides bike with little wheel), no visual imparment (he tells almost all colours), no hearing imparment.
He is on ABA (40 h/w) and on DAN diet.
As I know there is no “feeding specialist” in my country.
My biggest concern about him right now is food. I believe he is a resistant eater. My paediatric also said “I’ve never seen a child starving to death, he will eat”.
He eats soap (rice, meat or fish and a sample of vegetables – brocolis, green beans, carrots, peas, but all smashed), smashed fruit, juices (orange, pear, various fruits), and the only solid food he eats is one sort of cookies. I also have some limitation on introduction of food cause he’s diet is no gluten, no caseín, no soja end low on oxalats. He improved a lot on this diet.
When he eats cookies he seems to think how to eat, where he can put the food. He also have trouble while swallowing since he was a baby. He coughs a lot and sometimes even vomits.
I need help to try to help him. Can you help me? Do you know anyone in Portugal / Spain/ Europe that could help us?
Socially we try not to be affected by this. We go out, we encourage him a lot when he eats cookies well.
And we try not to take care about others (even family).
We have already too much to take care of as we also have another boy with 17 months.
Kiss
Rosario
Hi Rosario,
I am sorry to hear about the feeding difficulties you are having with your son. An ABA therapist should be able to help with any behavioral issues around feeding and I would encourage you to speak with the therapist. In regards to the difficulty swallowing I do not have any recommendations for a therapist in your part of the world. It would be beneficial for your son to have a modified barium swallow study which would most likely be conducted in a hospital. I would suggest calling the local hospitals and speaking with them regarding this assessment. They may also know a feeding therapist to refer you to.
Good luck, Isa
Hello, my 3 yr old son has diagnosis of autism. He was recently re-evaluated in speach and the therapist commented that his receptive language is quite a bit lower than his expressive. I see a lot of info for the other way around but not much on this scenario. Is it that uncommon?
Hi Jill,
This is not uncommon especially with the diagnosis of Autism. Usually it is difficult to figure out what these children truly understand because of the inconsistency in responding. Because of this they often will not test well especially when it comes to receptive language.
My grandson is a 6 year old and was diagnosed with mild autism. His social skills are quite well that is he has eye contact and practically understands everything in the sense that his receptive is much higher than his expressive and except for a few garbled words he power of speech is next to none. We tried all sorts of tests and examination with psychologists, nutritionist, speech therapists and even psychiatrists. I she destined to remain in such a state?
Charles,
Unfortunately, without meeting your grandson it is not possible for me to give my opinion on his prognosis.In general, most children with high functioning Autism do speak. Does he receive intensive speech therapy?
my 41/2 years old son was diagnosed with autism at 3 years old,he has speech impairment, his receptive communication is at 25 month while his expressive is at 35 month in the most recent test, adult interaction was 67 month and peer interaction 24 month ,his cognitive is at 37 month to my surprise because he use the computer and knows the ABC , read and spell sight word since age 2 but it seems he stop there, he keep doing it but not improve, he wont eat, only starch, never veggie or fruits , he have a lot bowel movement per day,I offer every thing but he only eat white rice ,white pasta , bread, french fries ,chicken nuggets, ,chocolate and cookies, no milk, he is happy and very active,he weight 35 pound doctor say he is not concern with his weight ,but my main worry is if he ever will able to express other than his needs ..he is going to speech therapist and he his repeating more but he do not make his own sentences like he is stuck in only 2 words combination with little progress…is any age limit to start talking ? I mean if he past certain age most likely wont happen?..I know if he could talk he will do much better in every other aspect, social , cognitive and adaptive .. …. thank you
Hi Iris,
Thanks for all the information. It is great to hear that your son is able to talk in short phrases. It is likely that he will keep making progress! You have so many concerns that are difficult to address without meeting him.
Have you ever gone to a Developmental Pediatrician?
Hi Iris,
My 26 month old son just has his speech evaluation this morning. The ST said that he scored at a 17 month old level for cognitive… and his receptive speech was way lower than his expressive speech.
This concerned me, I started looking online and all flags point to autism. Does it mean that he has autism because his he is saying more than he’s understanding?
Thanks,
Tia
Hi Tia,
No it does not mean he has autism. Autism also impacts social skills and behavior. I would recommend seeing a Developmental Pediatrician if you have concerns regarding the diagnosis of Autism.
Good luck, Isa
Is it possible for a child to outgrow autism without the necessary treatment?Thanks
Hello Isa, My 4yr old has just been diagnosed as being very high on the spectrum of autism, She is a very different child when she is at home then when she is out in public, at home, she knows her colors, shapes & her numbers (up to 20) and her speech isn’t great but she learns a new word everyday . She is hard to understand if you are an outsider but her father and I know what she is saying most of the time…she sings songs from her favorite shows and has a surprisingly good memory but when she is out in public especially in a small room like a doc’s office or something like that she is a different child, she can’t calm down and just screams, kicks and puts her fingers in her ears (she also does this at home when the vacumm is turned on and with water from the faucet in the tub)..she is not a great eater at all, she drinks milk, juice and water, but will only eat some dry cereal, goldfish, crackers, bananas and loves dry or cooked pasta…she has been eating like this for the past 3 years, she screams and will have a fit if you offer her anything else..my question here is can autistic children be different at home then they are out in public..it makes me question what she really does have, even though 1 doctor has said Autism. She also likes to scream, kick her feet on the floor, slam her fists together and also her knees on the floor..Could it be something else besides Autism?
My 14 year old nephew has autism. I’m not well informed of his health other than what I observe when he visits his grandmother (my sister) during long school breaks. My nephew is also type 1 diabetic. This makes it extra difficult for him and for her to help him control his diet. Even with the medication he is now taking to help control his sugars he tends to find some sugary substance to eat and puts his health in jeopardy. Just today he found his prescribed medicine and drank from the bottle because the substance was sweet. He’s always trying to hide things to eat from his grandmother even though he is given a healthy diet regularly. There have been several times where he has been taken to the hospital due to seizures. Throughout his life he has struggled with his problem and us with him because we can’t and don’t know how to help him, please suggest.
i am in the middle of trying to get my 4yr old son diagnosed he has been referred to Pediatricians speech therapists dietitians and sees a school psychologist once a month as i believe he is high end of the spectrum he has speech and language issues social issues and eating issues.On the subject of food he is a picky or as you describe resistant eater he would and at 1 point has starved himself if he doesn’t get the foods he wants, his diet consists of weetabix with warm milk stirred to make porridge for breakfast a nutella spread sandwich 50/50 bread and butter and a heinz 1-3 yr old toddler tray meal that do contain veg and a fraction of meat he will not eat real dinners, yogurts (fromage frais) for dessert he will only snack on kit kats milky ways and foxes triples bread rolls burger/hotdog buns muffins and biscuits so absolutely nothing healthy when offered something different it causes a meltdown. I was told to just put the food in front of him eventually he would eat, he stopped eating i was told to persist he still wouldn’t eat i gave in as i could see my son had chosen starvation and gave him back his regular food i would rather he ate crap than not eat at all .
Hi Melissa,
Without seeing your daughter it is not possible for me to give my opinion on her diagnosis. The behaviors that you described seem sensory based and I would definitely recommend an evaluation with an OT. Many children with and without special needs will behave differently outside of their homes than they do in their own homes which is their comfort zone. I would also recommend speech and language therapy if you are not already receiving it.
Good luck! Isa
Hi Isa,
I wrote to you back on Jan 21, 2011 about my Granddaughter, who has Aspergers Syndrome, regarding her eating issues. Well miracles do happen. It is now January 2013 and she has expanded her diet considerbly. She eats so many different types of meat now, and also eats pasta & cheese. Since last month she has tried a new food every week and has liked every thing that she ate. I think the tactile sensory issue she has is may be out growing or the issue is getting better. In addition for a 11 yr old girl with Asperger Syndrome she is the most social child you would ever want to meet. She has changed so much in the last 2 yrs that it is amazing. Her teachers in school are also amazed. She still has some mild issues, but if you did not know her, one would never guess that she had Aspergers. She loves to dance, sing, and most of all be on the stage in front of people. Give her a microphone and she is the happiest kid. This is so anti Aspergers. Praise the Lord
Thanks for listesting.
Hi June,
Thank you for the awesome update! Eating issues can improve with time and patience!
Hi Helen,
Autism is not something anyone outgrows even with therapy. It looks different at different ages however. Just like any child children with Autism will develop and change as they get older. If a child has grown out of Autism it is most likely that they never had Autism to begin with.
Hi Carley,
I agree with you that he needs to eat something. There are strategies to help him increase the variety of foods he will accept. I have a list of feeding clinics around the country. Where do you live?
Hi Alva,
Where do you live? I may be able to refer you to someone in your area.
Hi Isa,
My 26 mths son has ASD and already enrolled on 1-2-1 therapy program (22hrs ABA, 6hrs OT), he is doing well academically and his motor skills improving but he has serious speech delays, we are going to add speech therapy to his program and my question is how many hours monthly will be reasonable for his age? From your experience for a mild autistic child what is the average hours should be introduced and what is the rate of development you normally see?
Thank you very much,
Raf
He
My daughter has a son that will be a year old in 16 days. She is worried that because he was very verbal literally from birth with baby sounds and now much quieter. He says dada but nothing else not bye bye or Moma. Could this be a sign of autism? He plays with his toys but would much rather play with thing like draws in kitchen or stairs remote controlls. I fell this is normal but she is concerned because her girls talked really early.
Sandy,
What you are describing does not describe Autism; however, without seeing him I could not give you my opinion. Many 16 month olds like to play with “things” rather than their toys. With that being said, he should be making more sounds at 16 months. Given your daughter’s concerns I would recommend that she have him evaluated by a Speech Language Pathologist or a Developmental Pediatrician.
Raf,
I would recommend at least 3 weekly speech sessions (30-45 minutes). It is not possible to predict how quickly he will progress without working with him. Every child progresses differently and there are many factors that come in to play. If you do not see any progress in 1 month I would evaluate what you are doing and make any necessary changes such as an increase in therapy, or maybe even a change in therapist
My 3 yr old was recently diagnosed with autism. He has about 10 unclear words in his vocab. He’s getting 30 minutes of speech and OT through cps however it isn’t enough, I feel, as well as his teacher. He’s on a 10 month waiting list for services with Illinois masonic. Is there anywhere I can take him in the meantime? Another huge concern is his eating; all he’ll eat pretty much is bread and fries. I’ve tried not feeding him all day for him to try something new, but it doesn’t work. He eats bread every single day, about 5+ slices of wheat. What can I do?
Shari,
I agree that more therapy would be extremely beneficial. I am not familiar with the providers in your area. If possible I would look for a private therapist or possibly a local hospital. Often hospitals will have speech clinics for out patient treatment.