Worried About Autism in My Twins

Twins have a little less incentive to talk than singles because they communicate with each other in ways that other people don't understand - you've heard of twins having their own language. So, while they are not communicating with you in the way you want them to, I bet they are communicating with each other just fine and really don't yet feel the need/desire to talk to others.

Call for the early intervention, but please try to relax. I bet they are just fine. If they make good eye contact, that's a real good sign that it is not autism.

You sound very concerned, although by the sound of it, it doesn't sound like autism. Autism usually has a social interaction aspect to it -- lack of eye contact, lack of affection, etc.

If I were you, I would call early intervention NOW. What's the point of waiting? The sooner they're evaluated, the sooner you will get answers and/or the help you need.

What does their pediatrician say? Does she or he have concerns about their development? There is a long distance between speech delay and Autism - I wouldn't go there quite yet.

FWIW my sons had very different speech/learning patterns. My oldest said his first words at 10 months old and could say and understand a lot. My 2nd was being watched for speech delay and would have been referred for EI if he didn't know 10 words by his 2nd birthday. He knew 12. I had his hearing checked, etc. because his receptive language seemed delayed as well and he had had a lot of ear infections but his hearing was normal. He didn't really start speaking coherently until he was 3.5. My youngest son was like the middle one - just didn't have much to say until he was well past his 3rd birthday.

So...oldest is 18. Has ADHD and learning disabilities but has always had very strong verbal skills. Middle son started talking up a storm at age 3.5 and hasn't stopped since (he's 12). People ask him to stop talking (or just come right out and plead with him to just shut up for 5 seconds) all day long. He too has ADHD but no LDs and his verbal intelligence is 95th percentile. Youngest son is neurotypical and a happily average learner.

Younger siblings often speak later because they have older siblings to speak for them. And I've heard that twins speak later because they have their own language (babbling, facial expressions and movements) between themselves so they have less of a need to communicate with other people because they've already got someone their size and age who understands them. Just something to think about.

Okay, well first off I would agree that you should call early intervention now. Realistically it could take 4 months to get an appointment. I would definitely bring it up at their 2 year visit and hear what the ped has to say. I do think that mother's intuition should account for something...however... you also have to remember...

All kids are different and although we naturally do compare one child to the next, we really shouldn't because they are all different and being raised in at least a little bit of a different environment with the addition of siblings, etc.

I also think that approaching this in more a language delay attitude is more appropriate. I'm not sure that I would go Autism for the symptoms you described.

Also, they are twins. Twins break the rules of everything. They may not need to communicate verbally because they are getting what they need from their twin. They understand each other.

My son was the second born and his sister was speaking in full sentences by 18 months. At almost 2 he barely said anything ever. I did get help and he did qualify for a speech aide. It was great and wonderful and literally 5 weeks later he had graduated from the program and hasn't stopped talking since! (he's now 6) I think they are probably ok, but it's okay to be worried. Go through the proper channels and figure it out. Take action to help ease your stress, but based on this info, I think you'll find it to be a manageable issue.

Why are you waiting? Call now if you are worried. It will probably take a few weeks for them to get you on their schedule anyway.

As for advice - even if they do need help with receptive language, it does not mean that they are on the spectrum. Autism is much more than language. Please don't borrow trouble.

Positive stories - one of mine qualified for services under Early Intervention for speech at 19 months. He worked with a speech/developmental therapist once a week for a year. After one year, he was reassessed, and was all caught up. No long term issues at all. So, while a language delay can be part of a bigger developmental problem, most of the time, it's just a language delay. The sooner you get the ball rolling with EI, the better, IMO.

ETA: You don't usually need a ped referral to get an EI evaluation. My ped wasn't concerned with my child's speech, but my momma intuition said to get the eval, so I did it on my own and he qualified for services. So again, while it's good to get your ped's opinion at the 2 year appt, no need to wait. Just call EI and get on their schedule.

I have sailed in your boat with my twins, my older son was ahead for everything and I thought, the twins will mimic him and lear early. But no, they had a mind of their own and did not talk until 2.5 years old. I tried EI and had them tested multiple times, but they never qualified. Also, as far as receptive language, my girls only understood what they wanted and ignored the rest, so there was no way of knowing if they understood it at all.
They are now 5 and will start Kindergarten in a few weeks. I now have to plead with them to slow down and take turns.
I would encourage you to get them evaluated as soon as possible, just so you know that you have done everything in your power.
Hang in there mama, you are their best advocate.

My older son is the one with neurological differences and he spoke as soon as he could form a word. My younger son declined to say much until he was 2.5 years old, but he did not have a true delay.

A speech delay alone does not indicate being on the autism spectrum. It is a common phenomenon for twins to be less vocal at early ages when it comes to proper language and interacting with people who are not their twin.

Certainly do work towards getting the answers you need, but you may be worried about nothing at all. :-)

What you are describing here does sound problematic. My son, who had severe speech problems, had 60 words at 24 months, and the early invention team told me that if I waited until he was 3 to start working with him, he may not learn normal speech. The best thing I did was get him evaluated at 24 months, and then start him getting speech and language therapy. I also had him evaluated later for sensory integration problems through an occupational therapist. OT therapy made a big difference for him.

You say that you want to "be sure". What do you mean by that? You're not an expert. That's what you have evaluations for - from experts who know what they are doing.

Your pediatrician can help you here. Ask for evaluations from speech therapists and the right people who can evaluate for autism.

I know it's very hard to realize that you have your work cut out for you. But you do, and you need to be proactive in getting evals done, and a plan put in place to help your children.

My son is 21 years old now. He is in university and communicates well. He didn't learn his ABC's until he was over 4 years old. If I had not gotten him lots of help early on, and I mean LOTS of help, he would not be where he is today.

You can do this. But you must have a plan, be organized about it, have a daily schedule and keep to it religiously. You will feel like you are a speech therapist yourself. And that's okay. It will be your new job. And it's an important one.

M., take a deep breath. It's always disconcerting when our own kids don't seem to be doing what their peers are doing-- this often sets parents off on red alert. First of all, it's highly likely they are 'just fine'.... but lets say "what if...." because you seem to be concerned about the unknown.

It's hard to diagnose autism in a child as young as yours are. That said, you are right, there are specialists and this may be either a short or long path for you. You could wait another 6 months and see a lot of development, but lets say you don't want to, or that you wait for months and your fears feel more and more confirmed. An evaluation and information are the best ways to deal with that worry.

My first word of advice is "be okay with this path". Results sometimes take a while to receive. Appointments-- sometimes you have to wait a while to be seen. So, please, don't let your sense of urgency keep you from being present and enjoying your boys.

Second piece of advice: when you decide you want the evals done, don't wait, talk to your pediatrician and get the ball rolling. You may likely need a referral from your pediatrician for insurance coverage purposes. When you get a referral, call the facility and talk to the intake coordinator. They want to help families and these conversations have saved us a lot of out of pocket expenses.

Ask when you are unclear about something: a cost, a procedure, an evaluation, an aspect of the evaluation, a technical term. The staff want to help parents understand what's going on, both financially and with their child. Don't feel afraid to ask questions, and do a LOT of active listening. It may be wise to have your husband or partner there to help with the kids after evaluations/when receiving information so that one of you can focus on the information while the other tends the kids.

Again-- be okay with this. I have a child for whom this journey started when he was 4. (He has ADHD-inattentive and some significant processing delays.) I'll admit, it's a different world entirely. Parents of special needs kids deal with a society which largely has a tendency to blame parents or not understand certain issues. (for example, our school district has a panel on autism and lots of education in that regard but nothing for ADHD other than "have you considered medication".) Early on, our preschool teachers told us they suspected a non-verbal communications disorder which was 'often found in families with only children'. There are non-professionals and professionals both who may insinuate that if you parented your child differently they might not be as impacted as they are. There are people out there who confuse abilities with idea that the child actively chooses a certain behavior which that person finds problematic. So, if you do get a diagnosis for your boys, understand that there is a sea of misinformed/under-informed people out there who need to be educated on your child's diagnosis and educate yourself to be your child's best advocate.

I should add, one of the kindest things I have ever heard toward my son was from his second grade teacher, who thrived on his own education regarding brain function and learning. "We often believe it is okay for a student to have a challenging teacher; it's also okay for a teacher to have a challenging student. There's nothing wrong with that. It's a challenge and that's how we grow." That message of grace and the understanding that education/interaction is a dance between the child and the adult is a philosophy I've come to live by. It gives me permission to feel challenged and to recognize that it's okay I'm not a perfect parent. I'm just working on being the best mom I can be for my own kiddo. It's also created a standard in my own mind as to what 'quality' is as I continue to grow this child up. So often we are told to see the child as the primary problem and that neurotypical people are the 'norm', so that any problematic incidents are the fault of the child. There has to be receptivity on both sides and the adults are far better able to make small adaptations initially than the child is able to analyze and try to cognitively puzzle through how to change their behavior (without the benefit of mind-reading) so that the adult is pleased with them. For the most part, all of our kids respond to positive feedback and want to please adults, so for many adults, they are in a much better position to influence positive behaviors than to expect a child to change what we would consider a 'negative' behavior.

Don't shy away from an diagnosis or 'label'. I've seen children suffer incredibly because parents weren't open about the child's challenges or were afraid that the label would influence how people treated the child. It's just a word, it's information. You can be sensitive about who you share information with, but if there is a dx, the child needs their parent to advocate for them *before* there's a social or behavioral hiccup with other children, teachers or caregivers. One parent I've known refused to accept her child's ADHD and to get help for it when he was younger. He suffered as a learner (because educators did not have strategies for a kid who appeared 'lazy' and whose parent did not inform them otherwise); he suffered in feeling poorly about himself as a learner. Only in his teens did his grandparents take over parenting and found successful therapies for the child. One wonders what sort of potential might have been open to this child if only he'd learned early-on about himself that he just *learns* differently? If you were going to drive a new car, you'd want to know if it was a stick or an automatic, right? Educators and caregivers will want that same info about your child, not to be nosy or judgmental, but so they can best help your child. One child we know is very physical-- even violent-- toward other children. The parents will not discuss their child's autism, which leads to other parents being very angry with the child for the harm to their own kids and the impulse-control issues which they witness. (In that case, when the student's parents didn't actively advocate for their child, a number of us parents DID insist the school provide a para-educator. Too many of our children were getting hurt AND it wasn't fair to the boy in question, either, not to have help.)

Lastly-- your kids are amazing. Every single child comes with strengths and challenges. I used to teach preschool and can tell you, that was my experience. Each child is their own person, full of their own beauty, quirks, knowledge, kid-wisdom, funny moments, so full of life! In my journey thus far I've learned to let go of my hope that my son would be typical and 'on par' with his peers.... I now celebrate the unique facets of his personality. I've worked over time to adapt to parenting styles which work for my kid. (some of it flies in the face of what we consider 'good parenting', by the way-- but it's good for MY kid and he's positive in his responses). I won't say it isn't hard or that there won't be hurtful moments-- there have been some and there will be more---- but choosing to appreciate my sweet, glorious kiddo for who he is *right now* is the best vote of confidence I can give him. And that is more valuable than anything else I have to offer: my faith that he will be just fine as he grows up and matures into the person he will become. That he will find ways to adapt and learn to manage himself in our world. So be present, enjoy them for who they are in *this* moment, learn to understand that the label doesn't change who they truly are. Wonderful human beings who need a lot of support and guidance, just like any kid, anywhere.

I know this is a lot to take in. Please know it's just another journey in life, you've got to walk the path to know it. There's no other way to get this sort of education-- I'd worked in early childhood ed for nearly 20 years or so before I started down this path, and it's changed so much of my thinking as I learn. I don't parent at all in the way I would have expected I might, but I still do so with love and appreciation for who my kiddo *is*. Best wishes.

These are questions and concerns you should be discussing with your pediatrician, at your well child visits. He/she will refer you to testing/services if there's a need.
What DOES your pediatrician think?

Our son had adenoids and tonsils so enlarged he couldn't form words. We only learned this when we insisted upon taking him to an ENT, despite our pediatrician's assurances that everything was in order. This may or may not be the underlying issue with your boys, but it might be worth checking out. I'm not a pediatrician, but from what I recall reading about autism, it isn't speech delay so much as signs e.g., not looking at the parent and being withdrawn.

In my personal experience, I seem to have been born talking and have never stopped. My brother didn't talk fluently till he was 5. However, he was a published poet, did presentations and had absolutely perfect S.A.T scores. Everyone has their own path on the journey.

For now, I would try not to think about Autism. Your boys might have a speech delay, and that is absolutely worth investigating. Sometimes speech delays are just that, delays. Sometimes there is a hearing concern. Sometimes there is more to it. No matter what, it's worth looking into.

By focusing on Autism, you begin to look for other symptoms and might even begin to see things that aren't there. Doctors, speech therapists and other professionals will be looking for the right things and really know what they are looking for. They will even be able to focus on symptoms related to other diagnosis that might be more applicable. They might even be able to confirm that it's just a speech delay. And wouldn't that be great!

Relax. Lots of kids have a speech delay, go to speech therapy for a time and turn into perfectly functioning older kids who you would never know had a speech issue at a younger age.

ETA - Speech delays in younger siblings is very common. Could it be that you are anticipating their needs and/or that big brother is talking for them?

nothing you describe would say autism to me. in need of speech therapy maybe. talk it over with their pedi. there is a huge range of normal that your boys may fall into a normal category.
i have a nephew who only grunted and screehed and made noises till he turned 3 then he was talking in sentences and the grunting was gone.

at not quite 2 i wouldn't expect them to follow many simple commands. since they do follow several i wouldn't worry. but like i said i would bring it up with the pedi. young children learn so fast that by reading to talking to and interacting with them they will start talking and listening and responding better

Hi M.! It feels so scary to think there might be something wrong with our children! A few thoughts: First, trust your gut- if you have an intuition or sense something could be wrong, it's best to explore it. Second, Autism is not the only diagnosis. Many children have speech delays that can be remedied and managed! Finally, and this is extremely important, do not wait to get an early intervention assessment. The function of EI is to intervene early enough as to try to get the child's development back on track. The longer you wait, the further behind your children could fall. The sooner you get services, the better the outcome for your kiddos. Don't miss out on the window to intervene, you may very much regret waiting too long! (And, hey, even if they don't qualify for services, the therapists can still give you some tips and pointers to help the twins during the assessment meetings!)

There's a wide range for what passes for normal.
Our sons talking really took off after his 2nd birthday and then it was constant chatter.
Read to them, sing songs, keep talking to them.
They absorb it and eventually they will be talking up a storm.

My son did not talk or attempt to talk until he was 2. He didn't even say dad until after he turned 2. After that it clicked and he just started talking up a storm. He is actually very smart and social. I did worry that something was wrong but my pediatrician told me not to worry that just wait. If you are worried have it checked out but try not to stress.

Why wait until two? All states have Early Intervention services for children ages birth-3. They evaluate in several areas (fine/gross motor skills, cognitive, speech, self help, etc). Evaluations and services are free of charge--regardless of income!

My son has Asperger's Syndrome(high functioning autism) and had no issues talking except for the fact that he was born tongue tied and needed surgery to get clipped. I on the other hand didn't really start walking or talking until the age of 2. I would communicate with my sister who was 1 1/2 years older but it was not typical words or language. My mom took me to the dr at age 2 and the dr asked me what the problem was. I told him to "shut up and leave me alone". My mom was told that I was fine and I would start talking when I was ready. She didn't listen and would force me to. I was not given food, drink, a toy, anything unless I spoke. I'm 49 and I am still upset with her. I do recommend you get testing done because you never know what is going on. The earlier the better.

There's really no reason to wait. If you are concerned get help now. They are too young to be diagnosed with autism (most reputable doctors won't diagnoses this early), but they can certainly receive services to help with speech and communication.