By Nayda Torres-Soto, PhD, CCC-SLP and Wilma Benitez-Rivera, PhD, CCC-SLP
Why is my child not communicating? Why are mealtimes such a battle? These are some of the questions that speech-language therapists are asked when first meeting families seeking therapy for a young child. Sometimes, it is not just a lack of “speech” or difficulties eating that are the focus of our evaluation. Sometimes we are the first to tell parents or caregivers that the child has what we call “red flags for autism.”
What are “red flags” for autism as it relates to communication?
The following may be indications that a child has autism (Centers for Disease Control and Prevention, 2019). The child:
- Does not respond to their name by 12 months of age
- Does not point at objects to show interest (point at an airplane flying over) by 14 months
- Does not play “pretend” games (pretend to “feed” a doll) by 18 months
- Avoids eye contact and want to be alone
- Has trouble understanding other people's feelings or talking about their own feelings
- Has delayed speech and language skills
- Repeats words or phrases over and over (echolalia)
- Gives unrelated answers to questions
- Gets upset by minor changes
- Has obsessive interests
- Flaps his or her hands, rock his or her body, or spins in circles
What are some additional “red flags” as it relates to feeding?
The following feeding issues may indicate that a child has autism (Centers for Disease Control and Prevention, 2019). The child:
- Has unusual reactions to the way things sound, smell, taste, look, or feel
- Has unusual eating and sleeping habits
- Limits his or her diet to only a few foods
- Eats nonfood items
- Has issues such as chronic constipation
Some parents or caregivers notice many of these “red flags” as early as their child's first birthday! Maybe you have seen some of these behaviors and have shared your concerns with family or friends, but you've been told to give your child time. Or maybe your family and friends are always asking “what is wrong with your child?” but you don't see anything wrong! And you are right, there is nothing “wrong” with your child. But it might be time to speak to your child's pediatrician or maybe even talk to other specialists, such as a neurologist or neuropsychologist, so they can help you figure out if your child's behaviors are associated with autism or another condition.
While a neurologist or neuropsychologist is an important part of the care team, your child does not need to see a neurologist or neuropsychologist before starting speech and/or feeding therapy. All your child needs is a referral from his/her pediatrician to have a speech-language evaluation and/or feeding-swallowing evaluation to determine if therapy is needed.
However, once therapy starts, if your child is showing “red flags” for autism your therapist will talk to you and will refer your child to see a specialist.
What does speech-language therapy look like?
During the speech-language evaluation, you and the therapist will identify your child's communication strengths and some of the areas where your child needs help, and together will write some therapy goals. Therapy should look like everyone is learning and having fun! You will be an active participant in therapy and you'll contribute ideas of things you can do at home to support therapy! You can expect a lot of play activities, toys, songs, anything that gets your child's attention and teaches him or her to make simple requests, call attention, follow commands, etc. There might also be some crying or refusing to engage in activities, but don't worry; once everyone learns the routine, things should start to flow a bit easier.
What does feeding-swallowing therapy look like?
During your child's feeding-swallowing evaluation, you and the therapist will look for clues or patterns in the way your child eats. The therapist will observe how your child eats, how his/her mouth and tongue moves and how he/she reacts to different foods. You will answer questions about your child's eating preferences. Does he or she like to eat only carbs, crunchy foods, snacks, foods of certain colors, or only eats using a certain cup or plate? Are there problems chewing certain foods, problems accepting “wet” foods or both?
Depending on the observations and answers to these and other questions, therapy might help your child improve his or her chewing skills, accept new foods and/or textures or both! You can expect to participate in the sessions, bring foods you want your child to learn to eat, but also bring foods your child is already eating without difficulty. Your child's therapist will teach you strategies on how to introduce new foods and will help you to create a home mealtime program. And don't worry if at the end of the therapy session there is food everywhere! You and your child will learn how to use strategies that can potentially work for your individual needs.
What can I do after I read this blog?
- Use the list of “red flags” and “other possible symptoms” and observe your child
- Talk to your child's pediatrician about your concerns, ask for referrals for speech-language therapy and/or feeding-swallowing therapy and make an appointment for a speech-language evaluation and/or feeding-swallowing evaluation
- Even if you don't want to use the word “autism” or “red flags” when talking to your pediatrician, come see a speech-language therapist. We'll help you figure things out, we'll talk about who should your child see and next steps.
Important Resources:
Autism (Autism Spectrum Disorder)
Feeding and Swallowing Disorders in Children
About Nayda Torres-Soto, Ph.D., and Wilma Benitez-Rivera, Ph.D.
Dr. Nayda Torres-Soto and Dr. Wilma Benitez-Rivera are certified bilingual speech-language pathologists/clinical specialists within the Department of Rehabilitation Services at Nicklaus Children's Hospital, each with 20 years of experience. They evaluate and treat pediatric patients with a variety of disorders and coach caregivers on how to help their child thrive. Dr. Torres-Soto's clinical interests include the use of tools and technologies to support children's communication skills and Dr. Benitez-Rivera's clinical interest include the use of different approaches to aid children in accepting and managing foods and liquids safely to support their feeding/swallowing skills.