When a child is silent: causes and red flags

One thing right away. If a child is silent or speaks little, there can be many causes. It is not always autism. And it is not always a reason for panic.

But there are situations when it is better not to wait. This text is about how to understand whether an assessment is needed now.

Why a child may not speak

There really are many causes.

• Speech development delay. The child develops more slowly, without accompanying problems. Often with support everything evens out.
• Autism. A characteristic disruption of communication and social interaction.
• Hearing impairment. Even mild hearing loss greatly slows speech. Hearing is always checked with a speech delay.
• Disorder of language comprehension. The child hears but does not understand words.
• Childhood apraxia of speech. A motor-speech feature when the child cannot coordinate the muscles for pronunciation.
• Intellectual disabilities, global developmental delay. General slowing, including speech.
• ADHD or attention difficulties. It is hard for the child to focus on communication.
• Anxiety, sensory overload. If the world is too loud, the child "shuts down."
• A bilingual environment. It may slightly delay speech, but by itself does not cause delay or autism.
• Speech regression. The child already spoke and lost words. This is a signal for a quick consultation.

Red flags by age

• By 12 months. Does not babble, does not react to the parents' voice, few gestures, does not make eye contact.
• By 16-18 months. No words at all, more than exclamations.
• By 2 years. Simple phrases of 2-3 words do not appear.
• At any age. Loss of previously acquired words or social skills, you need to see a doctor quickly.

If at least one of these points describes your child, do not wait for them to "grow out of it." It is time to show a specialist.

Signs that communication is worth assessing

Not only about words. If you notice.

• Does not react to their name.
• Does not use gestures (waving, clapping).
• Does not point with a finger.
• Does not show or give objects to share.
• Does not imitate an adult (sounds, movements).
• Does not understand simple requests ("give the ball," "come here").
• Pulls the adult by the hand instead of asking with words.
• Cannot report "no," "it hurts," "more," "enough," "help."
• Echolalia, repeats phrases from cartoons without understanding.

Not one separate sign. Look at whether several of them coincide in time.

What to check first

First of all, hearing. This is mandatory with any speech delay. Not because hearing "explains autism," but because hearing loss seriously affects speech and it needs to be ruled out.

How it is done. A pediatrician or family doctor will refer to an audiologist. This is a painless procedure, available in Ukraine free of charge with a referral.

Where to go for an assessment

• Pediatrician or family doctor. The first contact. You describe specific concerns.
• Audiologist. Hearing check.
• Speech therapist. Assessment of speech, language comprehension, communication.
• Child psychiatrist. If there is a suspicion of autism or other conditions. In Ukraine, possible without a referral.
• Child neurologist. As indicated (regression, seizures, motor difficulties).

Do not try to make appointments with everyone at once. The route has a logic, first primary care, then by referral.

What is not worth doing

• Waiting "until 3 years." If there are pronounced delays, waiting takes away precious months.
• "Treating" speech on your own. Pressuring the child to repeat words is useless and harmful.
• Listening to "she did not come from the war, she will start talking." Bilingualism does not explain the absence of communication.
• "Growing out of it" through a bunch of cartoons. Content does not teach communication. The child learns through live exchange.

If autism is confirmed

This is not a verdict. In the "Understanding autism and ABA" category there are detailed materials about how supportive approaches work.

One thing is important here. The earlier you understood, the earlier you can start support. And that really matters.

What is next

There are four more materials in this category.

• How communication differs from speech, why these are not the same thing.
• Basic prerequisites for language development, what should be "under the hood" for words to appear.
• Gestures, pictures, AAC, how alternative communication actually works and why it does not "take away" speech.
• How to develop communication at home, specific strategies in daily life.