Two questions on autism-spectrum diagnosis:

1) What exactly does
"failure to develop peer relationships appropriate to developmental level"
mean?

2) If a child can understand and attempts to use language, does a speech impediment (severe enough to make the child's speech almost completely incomprehensible) count as a delay in language development?

"1) What exactly does "failure to develop peer relationships appropriate to developmental level" mean?"

It usually means that the child does no get along with children his or her age, does not have any friends his or her age and may either play only with much older children (or talk to adults) or much younger children.

"2) If a child can understand and attempts to use language, does a speech impediment (severe enough to make the child's speech almost completely incomprehensible) count as a delay in language development?"

Not usually, speech and language are two distinct things. Has this child had their hearing tested? Failure to develop understandable speech sometimes can be caused by a hearing impairment, and hearing impaired and autistic children can sometimes behave in similar ways when little. (i.e. failure to respond or make eye contact etc.)

There is no problem with the child's hearing.

The speech problem is that the child speaks very quietly and very rapidly without pronouncing certain sounds - 'R' and 'L' sounds are completely omitted; other sounds are sometimes not pronounced, depending on how rapid the speech is at the time.
The only way to make the speech understandable is to get the child to slow down considerably and emphasise every sound in the word - even then it is difficult to understand.

The child is regularly seeing a speech therapist and produces the required sounds during the sessions, but this has made no improvement to the child's speech in general.

Has the child been diagnosed with anything at all? Is he/she showing any actual signs of autism?

And what nature, if any was given, does this speech impediment have according to the speech therapist? Rapid, disorganised speech can be indicative of many things.

The child has not been diagnosed with anything - no professional diagnosis or evaluation has been sought at this time.

There are many signs that could indicate autism - most probably HFA or AS.

The child is very bright and is obsessed with numbers and counting - hours are spent looking at old calendars and counting, sometimes into the thousands. The child will organise or arrange toys in a specific order and make patterns (which must be perfectly symmetric) with blocks or tiles, and will spend considerable amounts of time dragging toy cars along the ground then lifting them to look at the wheels or playing with spinning-tops.

There is extreme sensitivity to touch. The child can detect light touches through heavy clothing or shoes and is difficult to bath due to incessant struggling. Many foods (of different textures or tastes) make the child gag.
The child displays insensitivity to pain - when upset the child will headbutt walls or the floor without any noticable pain reaction and, when given an injection, will not report any pain. Once the child, using a knife, (accidentally) cut deeply across the base of three fingers one one hand without producing a pain or even a fear/panic reaction.

The child has no friends and does not attempt to interact with other children, but this is understandable given the speech problem. When relatives visit the child will often passively avoid them, but generally prefers the company of adults over other children. Eye contact is poor.


According to the speech therapist the speech impediment is not indicative of an underlying problem. The impediment is primarily due to a combination of a lack of oral coordination during speech and trying to speak too quickly.

Hello to both Iovis and Redhead;

I am new to this board. I hope you do not mind my intrusion. Rehead has some very good things to say. Based on your last post, I would urge you to get an evaluation as soon as feasible. Early intervention certainly provides the best prognosis for success.

The child has not been diagnosed with anything - no professional diagnosis or evaluation has been sought at this time.

There are many signs that could indicate autism - most probably HFA or AS.

The child is very bright and is obsessed with numbers and counting - hours are spent looking at old calendars and counting, sometimes into the thousands. The child will organise or arrange toys in a specific order and make patterns (which must be perfectly symmetric) with blocks or tiles, and will spend considerable amounts of time dragging toy cars along the ground then lifting them to look at the wheels or playing with spinning-tops.

There is extreme sensitivity to touch. The child can detect light touches through heavy clothing or shoes and is difficult to bath due to incessant struggling. Many foods (of different textures or tastes) make the child gag.
The child displays insensitivity to pain - when upset the child will headbutt walls or the floor without any noticable pain reaction and, when given an injection, will not report any pain. Once the child, using a knife, (accidentally) cut deeply across the base of three fingers one one hand without producing a pain or even a fear/panic reaction.

The child has no friends and does not attempt to interact with other children, but this is understandable given the speech problem. When relatives visit the child will often passively avoid them, but generally prefers the company of adults over other children. Eye contact is poor.


According to the speech therapist the speech impediment is not indicative of an underlying problem. The impediment is primarily due to a combination of a lack of oral coordination during speech and trying to speak too quickly.

"The impediment is primarily due to a combination of a lack of oral coordination during speech and trying to speak too quickly."

Based on that, I would suggest looking further into the possibility of DYSPRAXIA (developmental co-ordination disorder).

This can occur on its own (and is often accompanied by "autistic" behaviours, like lack of imaginative play and sensory issues) and alongside autism and AS, and one form (verbal dyspraxia I think) specifically refers to the kind of problem you described.

http://www.dyspraxiafoundation.org.uk/dyspraxia-information/PDFfiles/Developmental%20Verbal%20Dyspraxia.pdf

(The dyspraxia foundation website also contains a massive list of symptoms, including sensory issues etc., that usually accompany Dyspraxia)

1) What exactly does
"failure to develop peer relationships appropriate to developmental level"
mean?

At about age 2 a child will start to seek out other children to play and interact with, if the child is not doing this and is acting like a baby (happily playing on own, not initiating contact with other children, playing beside but not with other children) this is what failure to blah blah blah means. If you watch a couple of 'normal' say 4 year olds playing, pretending, interacting with each other, then watch your child around other children his or her own age, you will notice these differnces.

It is doubtful (although not impossible) that the child is dyspraxic - if the child is dyspraxic, it is very mild and is exclusively causing speech problems. There is no general problem with the child's mouth control and no history of feeding problems, and there is consistency in speech errors and learned sounds and words are retained. Additionally there are no 'associated' dyspraxic features, such as poor fine/gross motor coordination or late coordinative development.

Many of the child's attributes are explained better/only by an autistic spectrum disorder.

"It is doubtful (although not impossible) that the child is dyspraxic - if the child is dyspraxic, it is very mild and is exclusively causing speech problems."

If a child has verbal dyspraxia, then he or she has just that, usually - i.e. difficulties with articulation and modification of speech.

While speech problems can obviously occur alongside autism, the communicative difficulties in autism are centered around comprehension and functional use of LANGUAGE. I.e. echolalic speech (repeating words or sentences), lack of comprehension, very literal understanding of speech, inability to hold a two-way conversation, initiate or end conversations appropriately and so on - that is IF the autistic child is verbal at all.


In verbal dyspraxia on the other hand, SPEECH and the formation of sounds are impaired, which is what you have described.

The child displays some autism-consistent language problems - specifically an inability to initiate/hold/end conversation and speaking pedantically, literally and with unusual prosody.
The child's language comprehension is usually good. Phrases with different literal/implied meanings ("hop into bed" and the like), while initially misunderstood, are memorised along with their meanings after a few repititions.

It is unclear if the child's autism-consistent language problems are caused by autism (and thus would be present in the absence of the speech impediment) or arise due to the speech impediment (that is, the child finds it so difficult/frustrating to converse that no/little effort is made to do so, and chooses to be literal and pedantic in an attempt to clarify meaning).

"It is unclear if the child's autism-consistent language problems are caused by autism (and thus would be present in the absence of the speech impediment) or arise due to the speech impediment (that is, the child finds it so difficult/frustrating to converse that no/little effort is made to do so, and chooses to be literal and pedantic in an attempt to clarify meaning)."

Interesting point...

If you are having trouble identifying clear autistic traits* (i.e. the social and imagination components of the triad) aside from the language difficulties, there are language disabilities like semantic-pragmatic language disorder which are the same language problems as in autism, but with a much less pronounced "autistic" presentation. (There sometimes are apparent autistic behaviours like flapping or lining up toys but these tend to disappear as language skills are improved)

You are right however insofar as children with speech and language impediments often show anomalies in behaviour caused by their daily frustration.

* your first questions sounded like you could not find these things in this child, or had trouble identifying them

Good morning (in the Eastern US) Iovis and Redhead23,

Iovis, I'm wondering if there is a reason the child has not been seen by a Pediatric Neurologist? Unless I'm reading the posts incorrectly, it seems that the child is regularly seeing a speech therapist, but has not been involved with a PN? I think that an evaluation by a PN may help to clarify your concerns, and point you in the right direction for appropriate therapy to help your child with the other issues you are facing.

As a newcomer to Autism, I thought that my son simply had a speech delay, but I am now learning that it is one of the characteristics of a bigger problem. I didn't put all the characteristics together. I would explain them to my son's regular Ped, but it was only the PN who considered them all relative to one-another. Speech delay, personality changes in the past year, "selective" hearing (as my mother refers to it...), TERRIFIED of bath, haircut, etc, repetitive behaviors, acting out dance scenarios from favorite television shows.

They say the earlier you get the DX, the better for the child.

kitswan, the child has not been seen by a paediatric neurologist because there are no paediatric neurologists to be seen by in this region of the world. Speech therapists, while rare, are accessible.

Redhead23, the diagnosis problem lies in determining which of the autism-spectrum disorders the child most probably has (L/HFA or AS), so a diagnosis of an ASD can be confirmed or eliminated as a possibility.
The diagnostic criteria for autism are essentially identical to those for Asperger's syndrome, except for those related to speech/language.

Autism:
1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

>As has been discussed, the child has a significant speech delay, and (perhaps consequently) almost never converses.

Asperger's Syndrome:
There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

>However, the child seems to have a very good understanding of language, and so seems to meet the criteria for both (classic) autism and AS.

"However, the child seems to have a very good understanding of language, and so seems to meet the criteria for both (classic) autism and AS."

A good udnerstanding of language?

How do you figure that that meets the criteria of autism?

Autism:
1. delay in, or total lack of, the development of spoken language

With emphasis on the difference between 'speech' and 'language' -

(unless misinterpreted) the criterion requires a child to be delayed in 'spoken language' (the ability to use language through speech) but does not prohibit the child from understanding language ('language comprehension').

So a child that cannot speak (and therefore cannot use language by speaking) but can understand language (when spoken to or reading, for example) meets the criterion.