Expert: Dr. Sharon A. Mitchell - 9/26/2010

Question
hello, my daughter is a 3 year old toddler. She does not speak in sentences or if she speaks i cannot understand her almost all the time. She is very artistic and can sit and color for hours. She also has a speech problem with her ''S''. I am very concerned because lately she has been very naughty. Outbursts of anger, throwing things, hitting, screaming. She has traces of autism but wanted to know another opinion. Thanks

Answer
From what you describe, I think that her language may be the first issue to think about. There are two parts to this:

1. That she does not use sentences when she speaks.
2. That her speech is not understandable.

When a three year old does not yet use phrases may indicate a language delay. Is your little girl just barely three? It's within the norm for two to three year olds to still communicate in phrases, while four year olds often speak in short sentences.

Take a look at this chart for two - three year olds: http://www.asha.org/public/speech/development/23.htm

And this one for three to four year olds: http://www.asha.org/public/speech/development/34.htm At the bottom of each of these pages are suggestions on how parents may help encourage their child's language development.

On the positive side, you imply that she does speak. It would be of greater concern if she did not try to communicate orally at all.

Think of how life must be for her if when she talks people do not understand what she is trying to convey. Three year olds are not known for their patience. Imagine how frustrated she must be if asked to slow down or repeat over and over what she is trying to say. This is frustrating for you, as her mom, as well, but as an adult, you have better control of your emotions and won't throw a tantrum.

As for her /S/ difficulty, I would put that far down on my list of concerns as lisping is not uncommon in toddlers and this may simply be a developmental problem that will right itself over time. If she is still 6 or 7 and pronouncing /S/ incorrectly, then you may want to pay more attention to this problem. Her /S/ errors are part of speech, while the other difficulties are part of language. If you'd like to read more about these two aspects of communication, you can find explanations here: http://www.asha.org/public/speech/development/language_speech.htm

If after looking at the above links to the developmental charts you feel that your daughter's communication skills are below what you'd expect for her age, then I would suggest that you take her to a speech language therapist for an evaluation. If you are unsure of where to go, this link will help you find one near you if you reside in North America: http://www.asha.org/proserv/

It is not usual for signs of autism to suddenly spring up in a three year old; generally there would have been many signs at earlier ages. First Signs is an organization devoted to helping families and professionals recognize the early signs of autism. This link describes some of the important developmental markers:  http://www.firstsigns.org/healthydev/milestones.htm The website also has a wonderful video library that shows typically developing children and those with autism. You need to sign up to access the videos, but there is no cost nor obligation. http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

If after looking through the First Signs site you still have concerns, consider taking this free, short online checklist about your daughter: http://www.childbrain.com/pddassess.html You could then take all this information to your physician for a referral for assessment.

First though, in your place, I would concentrate on your language concerns. Most speech pathologists also have experience with autism and may offer you an opinion and suggestions on what to do next. They will also be able to help with your little girl's skills at communicating her wants and needs, which may well decrease her behavior outburst and frustrations.

Dr. Sharon A. Mitchell