Alexis Irazoque, M.S., CCC-SLP
A speech delay and autism can look alike in a young child. Both can involve late talking, small vocabularies, or trouble sharing needs. But speech therapists watch for four key differences: joint attention (does your child follow your gaze and share interest?), eye contact, gestures (pointing, waving, showing), and sensory or repetitive behaviors. A child with a speech delay usually just talks late. Autistic children often show differences in several of these areas. This guide walks through the differences step by step and explains when to ask for an evaluation.
Key takeaways
Children with speech delays still follow typical development, but they may take longer to reach speech milestones. Autistic children usually show a variety of differences related to communication, behavior, and social interaction.
Key signs of autism include trouble with joint attention or eye contact, not making gestures like pointing, and showing repetitive or sensory behaviors.
A child with a speech delay usually gets frustrated when not understood and keeps trying. An autistic child may quietly disengage and go back to a favorite activity.
If you're unsure, ask for two evaluations: a speech-language evaluation and a developmental or autism screening. They answer different questions, and neither one rules out the other.
Early intervention with speech therapy is key to helping any child with a speech delay, and speech therapy also benefits autistic children.
Could your child have a speech delay?
Take our screenerWhat are typical communication milestones for babies and toddlers?
Knowing the key speech and language milestones for young children can help you understand what to expect and when your child might need help.
The first three years of a child's life are a critical time for speech and language development. From the moment a child is born, they begin to communicate. Parents hold their breath until they hear that first scream from their newborn. Within the first three months, babies typically look at their caregivers, respond to voices, smile in response to people, and react to sound. They begin to coo and cry, and we interpret these sounds to anticipate their needs.
Within 6 to 9 months, babies often recognize familiar people, enjoy games like "peek-a-boo," and start imitating sounds and actions. This is also the age when language starts to emerge, through babbling such as “mamama” and “bababa.” Around 12 to 18 months, children start saying their first words and using simple gestures like waving or pointing.
Watch for these milestones in your baby from birth to age 12 months to ensure their communication is on the right track.
By 18 months, a child should have about 50 words that they use consistently. By age 2, their vocabulary rapidly expands to 250–300 words. They should begin combining words to form simple phrases. By age 3, children typically answer questions and follow 2-step directions, such as “First clean up your toys, and then go get your shoes.”
What’s the difference between a speech delay and autism?
A speech delay affects only how or when a child talks. Social skills, eye contact, and shared attention develop on schedule. Autism affects social communication more broadly. That includes joint attention, eye contact, gestures, and how a child responds to people. While research shows that 40% to 70% of autistic children have language delays, late talking is just one possible sign of autism, not the whole picture.
"Both an autistic child and a child with a speech delay may talk very little for their age, or not at all," says Abby Barnes, MS, CCC-SLP, a licensed speech therapist with Expressable. "They may both have trouble expressing their needs and wants, and use behaviors like tantrums to communicate. But there are some key differences between autism and a speech delay."
Children with speech or language delays still follow the same developmental path as their peers, just at their own pace. They may take longer to reach milestones, but they’re often eager to connect with others. These children enjoy hugs, seek out attention, and try to imitate what people around them do. They might get upset or lonely when left alone and show a natural desire for social interaction, even if their words come more slowly.
Autistic children, on the other hand, may show less interest in social engagement. They might prefer exploring objects or focusing on their own activities rather than interacting with people. Imitating others, like clapping or waving, may not come naturally. Understanding or using nonverbal cues, such as eye contact, facial expressions, or gestures, can also be more challenging.
When communication is difficult, autistic children might not seem frustrated in the same way as a child with a speech delay. Instead of trying to keep communicating, they may quietly return to an activity they enjoy. Many autistic children also have self-soothing behaviors, like watching spinning wheels, lining up toys, or mouthing objects. They might not always respond to their name or seek attention the way other children do.
Recognizing these differences between a speech delay and autism can help you know how to meet your child’s unique needs. No matter the cause of a delay, every child can grow and thrive with the right support and encouragement.
Signs of autism vs. signs of a speech delay—side by side
The clearest way to tell the difference is to look at more than just talking. Below are the specific behaviors speech therapists and developmental pediatricians watch for.
Signs more consistent with a speech delay
Makes and maintains eye contact during play and feeding
Follows your gaze when you look at something (joint attention)
Points, waves, and uses gestures to communicate before words come in
Responds to their name consistently by age 12 months
Imitates familiar actions (clapping, blowing kisses, feeding a doll)
Engages in back-and-forth pretend play
Gets frustrated when they're not understood and keeps trying
Sensory responses (to noise, food textures, touch) are typical
Signs more consistent with autism
Limited or fleeting eye contact, especially during social interaction
Does not follow a caregiver's pointing or gaze
Uses few gestures; may pull a caregiver's hand to an object instead of pointing at it
Inconsistent response to their name, even when hearing is normal
Makes repetitive movements (hand flapping, spinning, lining up toys) or fixates on parts of objects (wheels, fans)
Strong reactions to sensory input—for example, covers ears at ordinary sounds, refuses certain food textures, seeks out spinning lights
Uses echolalia (repeating phrases from TV shows or overheard speech) rather than their own language
Quietly disengages instead of getting frustrated when people don't understand them
One or two of these signs on their own does not mean a child is autistic. Many typically developing children hand-flap when excited or go through phases of avoiding eye contact. Speech therapists watch for a pattern: several of these behaviors showing up together, lasting past 18 to 24 months, and paired with the language delay.
Other communication-related signs of autism
Keep in mind that autism is a complex developmental condition that affects every child differently. "There’s a common saying: 'If you’ve met one child with autism, you’ve met one child with autism,'" Barnes says. Here are a few other communication differences and challenges that autistic children may experience:
Slow to respond to attempts to gain their attention
Compulsively labels objects rather than commenting or requesting
Uses a "robotic" speaking voice that lacks inflection or intonation
Has challenges with reading and writing. Some autistic children may be able to read, but have a hard time understanding words on the page (called hyperlexia)
Appears to look through people; doesn't seem aware of others
Has difficulty taking turns and shows no interest in playing with family or other children
Want a deeper look? See our full guide on how autism affects a child's communication, social skills, and behavior. For early red flags, see our guide on early signs of autism in toddlers. And if your child has been diagnosed, our guide to speech therapy for autism explains what to expect.
What is echolalia? Learn whether echolalia is ADHD or autism, see examples, and discover how children use repetition to communicate.
Other causes of speech delay in children
Not every late-talking child is autistic. The most common non-autism causes of speech delay are hearing loss (often from ear infections), oral-motor issues, developmental language disorder, and limited talk time at home. For a full breakdown of each cause and what to do, see our guide on the common causes of speech delay in children.
What’s the difference between speech and language delays?
Let's also discuss the difference between speech and language delays. While they are similar in some ways, there are key distinctions every parent should know.
"Speech" refers to how children say sounds and words to express their needs, wants, and desires. Children who have a speech delay still follow typical developmental patterns, but often at a slower rate than children of similar age.
For example, they may continue to struggle with hard-to-pronounce sounds that other children have mastered, such as the /r/, /s/, or /z/ sounds. This makes them harder to understand, and their speech sounds less mature.
"Language" is different from the physical way we produce sounds. It refers to the words we use and how we use them to share our thoughts, wants, and needs. Children with a language delay can often correctly pronounce sounds and words, but they can’t use these words to form intelligible phrases or sentences. Or, they may have trouble understanding what others are saying. They may struggle to process information, follow directions, or learn the meaning of new words.
Check out this informative guide to learn more about language delays.
What to do if you think your child has a speech or language delay
If you're concerned, the first step is to discuss your child’s behaviors with your pediatrician. They may recommend seeing a developmental pediatrician or pediatric neurologist. In many cases, you may receive a referral to a speech-language pathologist, who can perform an evaluation and play a key role in your child’s treatment.
Early intervention with speech therapy is key to helping any child with a speech or language delay. Research has consistently shown that early intervention is crucial to helping a child catch up and better express themselves.
If your child is diagnosed with autism, your pediatrician may also recommend speech therapy. Speech therapy can help autistic people improve both their verbal and nonverbal communication skills, understand body language, ask and answer questions, and develop conversational skills. "The goal of speech therapy for autism is to help children better function in day-to-day life and learn to communicate in a way that feels authentic and fulfilling to them," Barnes says.
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Get startedShould I request an autism evaluation or a speech evaluation?
You can ask for both. They answer different questions, and neither one rules out the other. A speech-language evaluation is done by a licensed speech therapist. It shows whether your child's language skills are on track. A developmental or autism evaluation is done by a developmental pediatrician, psychologist, or team of specialists. It looks at social communication, play, sensory response, and behavior across settings.
Both evaluations are free through your state's Early Intervention program for children under 3, and both can happen at the same time. Keep in mind that if your pediatrician tells you to "wait and see," it's fair to ask for an evaluation anyway. An evaluation is used to diagnose your child, not treat them, and it doesn't commit you to anything.
No matter where your child is on their communication journey, your support, love, and patience can make all the difference. With the right help, every child has the potential to find their voice and share it with the world.
If you’re concerned about your child’s speech development, don’t hesitate to reach out. We’ll answer your questions and help you determine the next best steps. Find a speech therapist for your child today--we’re here to support your family every step of the way!
An important note: We believe that when speaking about any community as a whole, the best approach is to prioritize that community’s voices, needs, and preferences. Within the larger autism community, the current language preference is identity-first, which is why we use that language in our content. Expressable is committed to listening to and learning from the populations we serve. If and when their preferences change, we’ll adjust our approach accordingly.
Frequently asked questions (FAQs)
A speech delay is a delay in spoken language. Autism is a broader condition. It can affect social skills like joint attention, eye contact, gestures, and play, as well as sensory responses and other behaviors. Late talking is just one possible sign of autism, but having a speech delay does not mean a child is autistic.
Yes. The two can occur together. Up to 30% of autistic children may never develop functional spoken language, and some autistic children also have a speech delay. However, having a speech delay does not mean a child is autistic. A speech delay can have other causes, such as hearing loss, problems moving the mouth for speech, or a learning disability. That's why it's so important to schedule a speech evaluation if your child seems to be behind. Your speech therapist can also recommend an autism screening if they notice potential signs of autism.
It can help to start with your pediatrician. Ask for two referrals: a speech-language pathologist for a speech evaluation, and a developmental pediatrician or your state's Early Intervention program for an autism screening. If you're told to "wait and see," ask for the referral anyway. It never hurts to have your child evaluated sooner rather than later. Also, keep in mind that kids younger than 3 qualify for free evaluations through Early Intervention in every state, with no referral needed.
How Expressable Can Help
Concerned your child isn't reaching age-expected milestones? Looking for communication support from a professional? Expressable is a national online speech and occupational therapy practice serving children and adults. We treat all major areas of communication, feeding, and developmental skills, offer flexible hours including evenings and weekends, and accept most major health insurance plans. We’re proud to have earned more than 4,500 5-star reviews from our clients (4.83/5 average).
Our therapy model is centered on parent and caregiver involvement. Research proves that empowering caregivers to participate in their loved one’s therapy leads to better outcomes. That’s why we combine live, 1-on-1 speech and occupational therapy with personalized education and home practice activities for faster progress.
