Speech & Communication

Is It Autism or Just a Speech Delay?

Medically reviewed by Dr. Emily Torres, PhD, CCC-SLP · Pediatric Speech-Language Pathologist

Content reviewed against published AAP, ASHA, NIH guidelines

Editorial policy

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Speech and communication milestones vary widely, and worries about is it autism or just a speech delay, here is what you need to know.

The short answer

The key difference is in social communication. A child with a speech delay typically has good social skills: they make eye contact, point to share, use gestures, play pretend, and engage socially. They simply have fewer words. A child with autism has differences in social communication itself: reduced eye contact, limited joint attention, absent or reduced gesturing, and difficulty with the social aspects of communication. A comprehensive evaluation can distinguish between the two.

Key takeaways

  • The key difference is in social communication. A child with a speech delay typically has good social skills: they make eye contact, point to share, use gestures, play pretend, and engage socially. They simply have fewer words. A child with autism has differences in social communication itself: reduced eye contact, limited joint attention, absent or reduced gesturing, and difficulty with the social aspects of communication. A comprehensive evaluation can distinguish between the two.
  • Usually normal when: Your child has few words but points, gestures, makes eye contact, and engages socially
  • Call your doctor if: Your child has lost words or social skills they previously had
  • Varies by age — see the age-by-age breakdown below

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to AAP, ASHA, NIH guidelines, the key difference is in social communication. A child with a speech delay typically has good social skills: they make eye contact, point to share, use gestures, play pretend, and engage socially. They simply have fewer words. A child with autism has differences in social communication itself: reduced eye contact, limited joint attention, absent or reduced gesturing, and difficulty with the social aspects of communication. A comprehensive evaluation can distinguish between the two. At 12-18 months, at this young age, it can be difficult to distinguish. Key differences: a late talker typically points, shows objects, responds to their name, and engages socially. A child with early autism signs may not do these things even though both groups may have limited words. It is generally considered normal when your child has few words but points, gestures, makes eye contact, and engages socially. However, you should contact your pediatrician promptly if your child has lost words or social skills they previously had.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Your child has few words but points, gestures, makes eye contact, and engages socially
Your child has lost words or social skills they previously had
Your child understands language well and communicates through gestures
Your child has almost no communication including words, gestures, and eye contact
Your child is a late talker but plays pretend and shows interest in other children
Your child has few words AND limited gestures, reduced eye contact, or no pointing
Your child's only concern is the number of words they use
Your child does not respond to their name alongside a speech delay

By Age

What to expect by age

12-18 months

At this young age, it can be difficult to distinguish. Key differences: a late talker typically points, shows objects, responds to their name, and engages socially. A child with early autism signs may not do these things even though both groups may have limited words.

18-24 months

Differences become clearer. Late talkers usually have strong gesture use, good eye contact, respond to their name, and understand language well. Children with autism may have limited gestures, reduced eye contact, and difficulty with joint attention.

24-36 months

By age 2, distinctions are more apparent. Late talkers with strong social skills often catch up. Children with autism typically show social communication differences beyond just word count. A developmental evaluation can clarify.

3-4 years

Most late talkers have caught up or are catching up. Children with autism continue to show social communication differences even as their language skills may improve.

4-5 years

If speech delay has resolved but social communication challenges persist, a comprehensive evaluation is warranted. Some children may have both a language disorder and autism.

What to Tell Your Pediatrician

  • Describe when you first noticed is it autism or just a speech delay and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child has few words AND limited gestures, reduced eye contact, or no pointing.
  • Mention if your child does not respond to their name alongside a speech delay.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Your child has few words but points, gestures, makes eye contact, and engages socially
  • Your child understands language well and communicates through gestures
  • Your child is a late talker but plays pretend and shows interest in other children
  • Your child's only concern is the number of words they use
Mention at your next visit when...
  • Your child has few words AND limited gestures, reduced eye contact, or no pointing
  • Your child does not respond to their name alongside a speech delay
  • Your child has no pretend play alongside limited words
Act now when...
  • Your child has lost words or social skills they previously had
  • Your child has almost no communication including words, gestures, and eye contact

What You Can Do at Home

  • Keep track of when you notice is it autism or just a speech delay — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your child has few words but points, gestures, makes eye contact, and engages socially — this is generally within the range of normal.
  • At 12-18 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Talk, read, and sing to your baby frequently. Narrate daily activities to build language exposure.
  • While monitoring at home, seek immediate care if your child has lost words or social skills they previously had.

My Child Is a Late Talker

Late talkers are children who have fewer than 50 words or aren't combining words by age 2, but are developing normally in other areas. About half of late talkers catch up on their own by age 3, but the other half go on to have lasting language delays. Early evaluation and speech therapy can make a big difference, so it's worth acting even if you're told to "wait and see."

Early Signs of Autism in Babies and Toddlers

Autism spectrum disorder (ASD) can sometimes be identified as early as 12-18 months, though most children are not diagnosed until age 2-3. Early signs include limited eye contact, not responding to their name, lack of pointing or showing, limited social smiling, and absence of pretend play. Having one or two of these signs does not mean your child has autism - many typically developing children share individual traits. However, a pattern of multiple social communication differences warrants evaluation. Early intervention, regardless of eventual diagnosis, consistently leads to the best outcomes.

Worried About Autism - When and How to Screen

The AAP recommends autism screening at 18 and 24 months for all children, using the M-CHAT-R/F questionnaire. If you have concerns before these ages, you can request screening earlier. Early signs of autism may include limited eye contact, no pointing by 12 months, no words by 16 months, no pretend play by 18 months, or loss of any previously acquired skills. Trust your instincts as a parent and raise concerns with your pediatrician.

Milestone

Milestone Checklists by Age

Track your baby's developmental milestones from birth to 5 years with age-specific checklists.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is is it autism or just a speech delay normal?
The key difference is in social communication. A child with a speech delay typically has good social skills: they make eye contact, point to share, use gestures, play pretend, and engage socially. They simply have fewer words. A child with autism has differences in social communication itself: reduced eye contact, limited joint attention, absent or reduced gesturing, and difficulty with the social aspects of communication. A comprehensive evaluation can distinguish between the two.
When should I call the doctor about is it autism or just a speech delay?
Your child has lost words or social skills they previously had Your child has almost no communication including words, gestures, and eye contact
When is is it autism or just a speech delay normal?
Your child has few words but points, gestures, makes eye contact, and engages socially Your child understands language well and communicates through gestures Your child is a late talker but plays pretend and shows interest in other children
What causes is it autism or just a speech delay?
The key difference is in social communication. A child with a speech delay typically has good social skills: they make eye contact, point to share, use gestures, play pretend, and engage socially. They simply have fewer words. A child with autism has differences in social communication itself: reduced eye contact, limited joint attention, absent or reduced gesturing, and difficulty with the social aspects of communication. A comprehensive evaluation can distinguish between the two. Common explanations include: Your child has few words but points, gestures, makes eye contact, and engages socially. Your child understands language well and communicates through gestures.
What should I mention to my pediatrician about is it autism or just a speech delay?
You should mention is it autism or just a speech delay at your next visit if: Your child has few words AND limited gestures, reduced eye contact, or no pointing. Your child does not respond to their name alongside a speech delay. Your child has no pretend play alongside limited words.
Is is it autism or just a speech delay normal at 12-18 months?
At this young age, it can be difficult to distinguish. Key differences: a late talker typically points, shows objects, responds to their name, and engages socially. A child with early autism signs may not do these things even though both groups may have limited words.
Is is it autism or just a speech delay normal at 18-24 months?
Differences become clearer. Late talkers usually have strong gesture use, good eye contact, respond to their name, and understand language well. Children with autism may have limited gestures, reduced eye contact, and difficulty with joint attention.
Should I go to the ER for is it autism or just a speech delay?
Seek emergency care if your child has lost words or social skills they previously had, or if your child has almost no communication including words, gestures, and eye contact. When in doubt, call your pediatrician's after-hours line for guidance.
Does is it autism or just a speech delay go away on its own?
In many cases, is it autism or just a speech delay resolves on its own, especially when your child has few words but points, gestures, makes eye contact, and engages socially. By 4-5 years, if speech delay has resolved but social communication challenges persist, a comprehensive evaluation is warranted. Some children may have both a language disorder and autism.
AAPASHANIH

References

  1. [1]American Academy of Pediatrics. Autism vs Language Delay. HealthyChildren.org. AAP
  2. [2]American Speech-Language-Hearing Association. Late Blooming or Language Problem? ASHA
  3. [3]National Institute of Mental Health. Autism Spectrum Disorder. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Is It Autism or Just a Speech Delay?.

Things to mention

  • Describe when you first noticed is it autism or just a speech delay and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child has few words AND limited gestures, reduced eye contact, or no pointing.
  • Mention if your child does not respond to their name alongside a speech delay.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your child has few words AND limited gestures, reduced eye contact, or no pointing
  • Your child does not respond to their name alongside a speech delay
  • Your child has no pretend play alongside limited words

Urgent signs to report immediately

  • Your child has lost words or social skills they previously had
  • Your child has almost no communication including words, gestures, and eye contact

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Milestone ChecklistsEarly Intervention DirectoryDevelopmental ActivitiesBaby Sign Language GuideBaby Tracker

Bottom line

Most cases of is it autism or just a speech delay are normal. Talk to your pediatrician if your child has lost words or social skills they previously had.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Related Speech Concerns

My Child Is a Late Talker

Late talkers are children who have fewer than 50 words or aren't combining words by age 2, but are developing normally in other areas. About half of late talkers catch up on their own by age 3, but the other half go on to have lasting language delays. Early evaluation and speech therapy can make a big difference, so it's worth acting even if you're told to "wait and see."

Early Signs of Autism in Babies and Toddlers

Autism spectrum disorder (ASD) can sometimes be identified as early as 12-18 months, though most children are not diagnosed until age 2-3. Early signs include limited eye contact, not responding to their name, lack of pointing or showing, limited social smiling, and absence of pretend play. Having one or two of these signs does not mean your child has autism - many typically developing children share individual traits. However, a pattern of multiple social communication differences warrants evaluation. Early intervention, regardless of eventual diagnosis, consistently leads to the best outcomes.

Worried About Autism - When and How to Screen

The AAP recommends autism screening at 18 and 24 months for all children, using the M-CHAT-R/F questionnaire. If you have concerns before these ages, you can request screening earlier. Early signs of autism may include limited eye contact, no pointing by 12 months, no words by 16 months, no pretend play by 18 months, or loss of any previously acquired skills. Trust your instincts as a parent and raise concerns with your pediatrician.

Accent vs Speech Disorder in Bilingual Toddlers

When toddlers grow up hearing more than one language, they naturally blend sounds, patterns, and accents from both languages. This is normal and healthy, not a speech disorder. A bilingual child may pronounce some sounds differently than monolingual peers because they are learning the sound systems of two languages simultaneously. True speech disorders affect both languages equally, while accent influence appears only in specific sounds borrowed from one language to another.

Ear Fluid Affecting Baby's Speech Development

Chronic or recurrent middle ear fluid (otitis media with effusion) can temporarily reduce hearing by 15 to 40 decibels, which is like hearing through water. During critical periods of language learning, this muffled hearing can impact speech and language development. If your baby has frequent ear infections or persistent fluid, discuss the potential speech impact with your pediatrician.

Will Ear Tubes Help My Child's Speech?

Ear tubes (tympanostomy tubes) can restore normal hearing by draining persistent fluid from the middle ear. Many children show speech and language improvement within weeks to months after tube placement, particularly if hearing loss from fluid was contributing to their speech delay. However, ear tubes alone may not resolve all speech delays, and some children benefit from speech therapy alongside tube placement.