Hi A.! Yes, this issue has been on here many times, which just reinforces my sense of how widespread it's becoming. I think you should be concerned, and I think the parents should see a birth-to-three team. They won't diagnose anything (like autism), but they will tell you if he qualifies for help (which can really help) and if there are other things going on. Very often there are other but subtle things that most parents don't see w/o experience.
Many factors go into evaluating a child's speech development. For example, the child who babbles on time, strings together sounds, spontaneously labels things in baby jibberish, uses non-verbal gestures (like pointing, signing, etc.), and imitates other sounds (like animals) but who isn't using real words yet is less of a concern (though certainly not saying "mama/dada" is still something to note). I would just watch this child for a bit longer b/c everything else is there.
A child who isn't doing these things--who didn't babble on time (like before 8 mos.), who doesn't have a wide range of sounds (consonants and vowels), who doesn't string sounds together (bababidoga), who doesn't imitate sounds spontaneously, who doesn't use gestures to communicate (just sits and cries but doesn't get up, take you by the hand, and lead you to the toy/food he wants), etc., or some combo of these behaviors IS a major concern and needs to be seen. This is NOT a range.
What about receptive language? Does the child respond to his name? Can he follow simple (1 or 2 step) commands? Does he seem to understand most of what you say? Receptive language matters too (an evaluator will ask).
It sounds like your godson grunts but does not actually babble--he's not making progressively more sounds, stringing them together to make more "word-like" sounds, isn't labeling things w/his own words, etc. I don't know about the other things, but this is enough to warrant being seen.
It could be an oral-motor thing (how is his eating? does he drool unusually? etc.?), and a speech therapist can actually work in his mouth. It could be something more.
Birth-to-three does not give a diagnosis (like autism). It will just tell you whether there's a delay, how much, what else might be going on, and what they can do for the child. Early intervention does help, and if there's more going on, the team will see that as time passes.
My son did not babble. He grunted until he was 18 mos. He didn't even sign, and I could tell that he knew he wasn't able to do what we wanted and felt bad about it, so I didn't push him. He did have good receptive language skills and didn't seem delayed in any other area (though he was highly sensitive and fussy). Then suddenly at ~18 mos. he started talking and by 2 years was speaking in complex sentences w/multi-syllabic words.
This does NOT mean he was normal--far from it. He's high-functioning autistic. But he's awesome. Not that we don't have trouble or that our lives are not strongly impacted by his issues, but he's a very cool kid w/a lot of strengths who is one of the top kids in his kindergarten (and he's the youngest one in the room). And we see progress every year and are learning more and more how to work as a family (which is good b/c I suspect my 21 mo. old daughter--who is very different and much more mellow--of being on the spectrum. She is also speech delayed, though not to the same extent as he was). But then I've been working w/him since he was 18 mos. old.
This, of course, is the elephant in the room--no one wants to think about speech delays b/c they're concerned about autism. Late babbling is an early warning sign. Significant speech delays are a criteria (one of 6). W/1 in every 150 kids being diagnosed on the spectrum and it being 4x more likely in boys means we can't take the laissez-faire attitude of our parents' generation.
What about autism? I've finally said "the word!" Because I know it's at the back of people's minds, b/c it feels like the "worst-case" scenario, and b/c there's still so much ignorance about it, I'm going to talk at length here to try to ameliorate some of these problems.
Autism is usually talked about in 2 types: regressive and early onset. Regressive is the most familiar (and scariest) type. The child starts out normally and then by age 2 loses those milestones he seems to have gained. He often withdraws and seems to be unresponsive, in his own world, etc. Parents talk about "losing" their child, and this type has a more "rain man" stereotype.
Even this form has a less pessimistic prognosis than formerly. Many regressive individuals have shown dramatic progress on the "diet" we hear so much about. And recent highly publicized stories of kids finding a way to communicate from the abyss have shown that there's more going on than appears.
The early onset form seems to be the one most on the rise. To my knowledge, it involves signs from the beginning and is seen as the high-functioning/asperger syndrom variety. These kids have challenges--no doubt. Families struggle w/them--no doubt. There may be co-morbid conditions--absolutely.
But they're not "rain man" and they are very workable. A family may deal w/sensory issues, inflexibility, meltdowns, social awkwardness, etc., all of which make "normal" family behaviors more of a challenge and which complicate school and professional careers as well as relationships. BUT YOU CAN DEAL W/THEM--you can help them and make them successful.
In the end, spectrum kids just don't interface w/the world the way we do. This is not to diminish the struggles of these kids and their families, but it is to say that they don't perceive or respond to the world the way we expect. They may have REAL differences in the way their senses take in data. Their brains process info a bit differently (esp. visual info). They don't respond to people the way they're expected. They're much more rigid in the way the world works or should work for them. These things create problems, but they can be overcome, and early intervention is a big part of it.
I see my job w/my kids as helping them w/that interface. To help their nervous systems be more effective at processing sensory input, to help them understand the world, to help them see how they can successfully interface w/it, and to help the world recognize their value.
In other words, autism is not the end of the world! There's a lot you can do, and a lot of people in the same boat. To any family out there avoiding an evaluation b/c of this fear, you should know the problems won't go away b/c you don't address them. But w/help, you can do a lot to help your child now, and most importantly, in the future--esp. in their self-concept..
Btw, the Waisman center in Madison is conducting a study for families w/children 24-36 mos. who have been diagnosed w/or are suspected of being on the spectrum. They're collecting data for help in future early diagnosis, but they can give a (free) diagnosis if needed. They also pay the family for their trouble. Otherwise, a psychologist or developmental pedicatrician can diagnosis autism.
Again, I think your godson needs a speech evaluation esp. if he's not even babbling--only grunting--and is resistant to imitating sounds. These are red flags. Yes, autism is something people suspect w/speech delays, but it's not something to fear or avoid. Maybe speech therapy will help, and nothing more is going on, and the child will hit preschool just like every other child. I hope so! But why take chances and just "wait and see" if things improve. If he's this behind, chances are he won't improve on his own. Being active, taking charge is always less scary than letting life just happen to you.
I hope you find some answers and can help this family take important steps even though they may be emotionally difficult at this time. Best, J.
