Autism services · Speech and language
Pediatric speech-language therapy for autism in Maryland
If your toddler isn’t talking yet, uses few gestures or seems hard to reach in back-and-forth play, you don’t have to wait and see. Pediatric speech-language therapy helps autistic children and children with early communication delays build joint attention, turn-taking and ways to communicate, whether through words, signs, pictures or a device.
Prefer to talk? Call (410) 231-0488
Key takeaways
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Start with connection
Therapy builds joint attention, turn-taking and intentional communication, the foundations later language grows from.
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Know the milestones
Milestone checklists describe what most children do by each age. Missing one is a reason to talk with your child’s doctor, not a diagnosis.
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You can ask before a diagnosis
A communication delay can be evaluated and supported whether or not your child has an autism diagnosis.
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Every way of communicating counts
Words, signs, gestures, pictures and AAC devices all count, and AAC can be introduced early.
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Families are part of the plan
Caregiver coaching turns everyday routines like meals, bath time and play into practice.
Speech and language therapy is listed among Blue Sails autism services. Therapy is provided by a licensed speech-language pathologist (SLP), so ask our intake team about current availability, the treating clinician and their credentials before services begin.
How autism can shape early communication
Autism doesn’t mean a child doesn’t want to connect. It often changes how a child shares attention between a person and an object, a skill called joint attention. A toddler may lead you by the hand instead of pointing, use words to ask for things before using them to share, or respond to their name inconsistently.
The American Speech-Language-Hearing Association (ASHA) describes social communication differences, including joint attention, as a core area SLPs assess and support in autistic children.
Echolalia and scripted language
Many autistic children repeat words or phrases they’ve heard, right away or later. This echolalia can serve a purpose, such as requesting, protesting, joining in or calming down. Rather than correcting the words, clinicians look at the context and respond to the likely message.
You may also hear about gestalt language processing (GLP) and the Natural Language Acquisition (NLA) framework. A 2024 systematic review found no intervention studies evaluating GLP/NLA-based approaches, so ask any clinician how a recommended approach is supported and how progress will be tracked.
Communication milestones and red flags by age
The CDC’s milestone checklists describe what most children (75% or more) can do by a certain age. If your child hasn’t reached one or more milestones, has lost skills they once had, or you have other concerns, talk with your child’s doctor and ask about developmental screening.
- By 9 months: makes a lot of different sounds like “mamamama” and “bababababa,” and lifts arms up to be picked up.
- By 12 months: waves “bye-bye,” calls a parent “mama,” “dada” or another special name, and understands “no.”
- By 18 months: points to show you something interesting, tries to say three or more words besides “mama” or “dada,” and follows one-step directions without gestures.
- By 2 years: says at least two words together, like “More milk,” and uses more gestures than just waving and pointing.
- By 30 months: says about 50 words and puts two or more words together with an action word, like “Doggie run.”
Losing words or social skills at any age is a reason to call your child’s doctor promptly. Because hearing problems can look like a language delay, a hearing check is a common first step. If autism is part of the question, our autism and early intervention guide explains screening and next steps.
Expressive delay, receptive delay or autism?
- Expressive language delay: difficulty sharing messages through words, signs or gestures.
- Receptive language delay: difficulty understanding words, directions and questions.
- Autism: a developmental diagnosis based on a wider pattern of social communication differences and restricted or repetitive behaviors, not on language level alone.
A language delay alone doesn’t confirm or rule out autism. According to the CDC, there is no medical test, such as a blood test, for autism; clinicians look at a child’s developmental history and behavior. If autism is a question, a comprehensive autism evaluation can help clarify next steps. Wondering whether a late talker’s pattern points to autism? Our guide to toddler speech delay vs. autism covers the joint-attention signs clinicians look at and red flags by age.
Apraxia, autism or both?
Childhood apraxia of speech (CAS) affects the planning and programming of the movements needed for speech. ASHA notes features that have gained some consensus among researchers:
- Inconsistent errors on consonants and vowels when the same syllables or words are repeated.
- Lengthened or disrupted transitions between sounds and syllables.
- Unusual stress or rhythm in speech (prosody).
Autism-related differences center on joint attention, back-and-forth interaction and how communication is used socially. A child can have both, and an SLP can look at speech production and social communication together.
What a pediatric speech-language assessment looks at
A speech-language evaluation for a young child is usually play-based. It combines direct observation with what you share about your child at home, and may look at:
- Understanding (receptive language): words, directions, questions and concepts, often using pointing so your child doesn’t have to speak to show what they understand.
- Expressing (expressive language): the words, signs, gestures or AAC your child uses and how they combine them, often through a natural sample during play.
- Gestures and social interaction: pointing, showing, giving, waving and nodding, whether gestures share interest as well as request, and how your child takes turns.
- Speech sounds and movement patterns: including signs that point toward apraxia.
Standardized scores may not capture everything a minimally speaking child understands, so clinicians weigh them alongside observation and caregiver input.
How to start Maryland’s Infants and Toddlers Program
If your child is under 3, you don’t need a diagnosis to ask for an early intervention evaluation. The Maryland Infants and Toddlers Program serves children from birth to age 3 who have at least a 25% delay in one or more areas of development, atypical development, or a diagnosed condition likely to result in a delay.
- Refer: parents, health providers, child care providers and others can make a referral to your local Infants and Toddlers Program.
- Evaluate: with your consent, the program evaluates your child to determine eligibility.
- Plan: if your child is eligible, you and the team develop an Individualized Family Service Plan (IFSP).
- Receive services: early intervention services through the program are provided at no cost to families.
Private speech-language therapy can sit alongside early intervention. Ask your service coordinator and our intake team how the two can work together, and see the early-intervention autism program for how Blue Sails supports young children.
What autism speech therapy can include
Therapy aims at more than pronunciation: helping your child communicate needs, ideas and feelings in daily life. UK NICE guidance recommends considering a social-communication intervention that uses play-based strategies with parents, carers and teachers to increase joint attention, engagement and reciprocal communication.
- Play-based social communication: following your child’s lead in play to build shared attention, turn-taking and intentional communication.
- Spoken-language strategies: modeling, expanding your child’s words, shared book reading and practice during everyday activities.
- Augmentative and alternative communication (AAC): signs, pictures, visual supports and speech-generating devices that add to or stand in for speech.
- Caregiver coaching: practical strategies you can use between sessions.
Goals are individualized, and progress looks different for every child. Your clinician should explain how goals are chosen and how progress will be reviewed with you.
Building joint attention before first words
Joint attention is the moment you and your child look at the same thing and both know you’re sharing it. Speech-language clinicians often work on it through play your child already enjoys:
- Getting face to face and following your child’s interest instead of redirecting it.
- Using predictable games like peekaboo, bubbles or “ready, set, go” so your child can anticipate and take a turn.
- Pausing and waiting so your child has a reason and time to communicate.
- Responding to every attempt, whether it’s a look, a reach, a sound or a sign.
Sharing attention this way gives later words something to attach to, and it’s something caregivers can practice anywhere.
AAC: will it delay spoken words?
Augmentative and alternative communication ranges from signs and picture cards to tablets with speech-generating apps. According to ASHA, there are no prerequisites for AAC intervention, and AAC should be considered as early as possible.
It’s a common worry, but ASHA notes that AAC may help improve natural speech when used in a multimodal approach, and that early AAC use can help develop speech and language. Clinicians pair AAC with spoken-word modeling, so your child sees and hears language together.
Modeling on the device
Communication partners point to symbols on the device while they talk during real routines, sometimes called aided language modeling. Your child learns the system by seeing it used, without being required to imitate first.
How parents turn daily routines into speech practice
Short, natural moments repeated across the day often matter more than drills. Caregiver coaching helps you use routines your child already knows:
- Meals and snacks: offer choices, pause before handing over the next bite and model the word or sign.
- Bath and dressing: name body parts and actions and leave space for your child to fill in the routine.
- Play and outings: take turns, comment on what your child is doing and point out things you see together.
- Books and songs: pause before a familiar word so your child can join in any way they can.
Count every attempt. A look, a gesture, a sound or a symbol on a device is your child communicating, and responding warmly encourages the next try.
Who’s on your child’s autism care team?
- Pediatrician: monitors development, screens and makes referrals.
- Speech-language pathologist: supports understanding, expression, social communication and AAC.
- Board Certified Behavior Analyst (BCBA): leads ABA therapy planning when it’s part of your child’s care.
- Evaluation team: clarifies diagnosis through an autism evaluation when autism is a question.
- You: the person who knows your child best and carries strategies into daily life.
When several providers are involved, aligning goals helps your child practice the same skills in different places. Our page on support for toddlers and preschoolers covers other options for young children. For sensory, play and self-care needs, see our guide to pediatric occupational therapy and sensory integration.
Frequently asked questions
Ask intake about your child’s needs, coverage and current availability.
How much does pediatric speech therapy cost, and is it covered?
Cost depends on your plan and the services your child needs. Blue Sails autism services accept Maryland Medicaid and TRICARE. Coverage varies by plan and service, so the team confirms benefits. Services through the Maryland Infants and Toddlers Program are provided at no cost to families. See insurance and billing.
Can my child start speech therapy before an autism diagnosis?
Yes. A speech-language evaluation looks at your child’s communication needs, and therapy can address a delay with or without an autism diagnosis. The Maryland Infants and Toddlers Program also doesn’t require a diagnosis; eligibility can be based on a developmental delay. Some insurance plans have their own requirements, so ask intake to check yours.
What happens to Infants and Toddlers services when my child turns 3?
Transition planning happens before your child’s third birthday. If your child is eligible for preschool special education, Maryland families can choose an IEP or the Extended IFSP Option, which can continue early intervention services until the start of the school year after your child’s fourth birthday.
How long is the wait for a speech-language evaluation?
Availability changes, so we don’t publish a fixed wait time. Call our intake team at (410) 231-0488 for current openings.
Are telehealth speech sessions an option?
Blue Sails offers telehealth across Maryland for many services, but remote sessions aren’t the right fit for every young child, and a caregiver usually needs to be nearby to help. Ask intake whether telehealth is available for speech-language therapy and whether it suits your child.
Talk through the next step
Share what you’re noticing about your child’s communication and ask about speech-language therapy, autism evaluations and coverage. Blue Sails has offices in Bethesda and Lusby, with telehealth across Maryland.
If you or your child are in crisis, contact 911, the nearest ER, or call or text 988.