Speech delay or autism? Questions to ask your child’s paediatrician

By The Jay Way team

Published 24 October 2026 · Checked against official sources 24 October 2026

A delay in speech or language can have many different causes, and autism is only one of the things a health professional may consider. Working out the cause is the job of a GP, paediatrician, speech pathologist or team after assessing your child, not something to decide from a checklist at home. This article explains who assesses speech and language delay and gives you questions to take to the appointment.

The short version: Raising Children Network says language delay is sometimes associated with autism, epilepsy, deafness or hearing loss and genetic conditions, but many delays have no known cause. healthdirect says that if you’re worried about your child’s speech, you can ask your doctor for a referral to a speech pathologist and for a hearing check. Write down what you’ve noticed, with dates, and bring any reports. Then use the questions below to ask what the assessment will look at, what it might show and what happens next.

What is speech and language delay?

People often say “speech delay” to cover a few different things. Raising Children Network separates them:

Language delay is when a child has difficulties understanding or using spoken language that are unusual for their age. That can include responding to language, understanding and using words, saying first words, understanding sentences and putting words together.
A speech disorder is when a child has difficulty pronouncing the sounds in words, which can make their speech hard to understand.
Developmental language disorder is when children have language difficulties after the age of 3 to 3½ years that affect everyday life and don’t go away.

A child might have one of these, or more than one. It’s useful to tell the clinician which of these sounds most like what you see, for example “she understands us but doesn’t say many words” or “he talks a lot but we can’t understand him”.

Raising Children Network also notes that children raised in bilingual or multilingual families might seem to learn language more slowly, and that this isn’t considered language delay. healthdirect says hearing more than one language at home does not cause speech or language delays.

What can cause a speech or language delay?

Raising Children Network says language delay is sometimes associated with autism, epilepsy, deafness or hearing loss, genetic conditions and other conditions. It also says many language delays have no known cause, and that language delay tends to run in families. It lists these as more likely to be linked with language delay:

boys
children with a close family member who has a history of language delay or a communication disorder
children with a developmental or genetic condition
children with ongoing hearing problems and ear infections.

healthdirect adds that hearing loss in babies and toddlers can delay speech development, and that common causes of hearing problems in young children include repeated middle ear infections and “glue ear”. That’s why a hearing check is a common part of the conversation.

The Autism CRC guideline for assessing autism in Australia says a proper assessment doesn’t focus on autism alone. It should consider all possible explanations for the parts of a child’s development that appear delayed or different. So a clinician may ask about hearing, general development and family history as well as communication.

What do health sources say about speech delay at 2 years?

Children develop language at different rates, even within the same family, according to healthdirect. It describes children aged 18 months to 2 years as using about 50 words and starting to link 2 words together.

Both healthdirect and Raising Children Network give 2 years as a point to take notice of:

healthdirect says to see your doctor or child health nurse if, by 2 years, your child is not saying about 50 words or hasn’t started putting words together into short sentences.
Raising Children Network lists, among the signs by 2 years, not saying about 50 different words, not putting 2 or more words together and not responding to everyday instructions and questions.

Raising Children Network also says language delay is quite common at this age: about 1 child in 3 shows signs and is considered a “late talker”, and by 4 years most late talkers have caught up to other children the same age. It also says that if you’re concerned and a professional isn’t, it’s a good idea to seek another opinion. Whether your own child’s pattern needs a closer look is a question for a health professional.

Who assesses speech and language delay?

Several professionals can be involved:

GP or child and family health nurse: a good first step. Raising Children Network lists them, along with teachers or educators and speech pathologists, as people to talk to if you think your child is having trouble with language.
Speech pathologist: a university-trained health professional who works with communication difficulties. They can use language tests to assess how your child uses words and responds to requests, instructions or questions.
Paediatrician: a medical doctor with special training in the health, growth and development of children. Raising Children Network says a GP might refer a child to a paediatrician for further assessment of a range of concerns.
Audiologist: if you think your child might be hard of hearing, Raising Children Network says it’s best to have their hearing checked by an audiologist.
A team: Raising Children Network says autism in young children is usually diagnosed by multidisciplinary teams that might include doctors and allied health professionals, and sometimes by a single doctor or health professional.

How do I get a referral?

The pathway depends on who you want to see:

Paediatrician: Raising Children Network says you’ll need a referral from your GP. If you’re referred to a private paediatrician, Medicare might not cover the whole cost.
Speech pathologist: healthdirect and Raising Children Network both say you don’t usually need a referral from a doctor. healthdirect adds that if your doctor refers you, Medicare might cover some costs, and that Medicare may help with costs if your doctor refers you through a special program. Ask your GP whether any Medicare option applies to your child.
Costs and waiting: healthdirect says public speech pathology services are usually free, though there may be a small fee, and private services set their own fees. Ask about the waiting time when you book, and ask whether there is anything you can do while you wait.

What should I bring to the appointment?

Raising Children Network suggests writing down your questions or concerns and your observations before an assessment. Useful notes include:

what you’ve noticed about your child, with specific examples
how old your child was when you noticed it
how long you’ve noticed it
anything the early learning service, preschool or school has raised.

For a paediatrician visit, Raising Children Network says to ask what to bring, such as test results or your child’s child health and development book. If you have reports from a hearing test, speech pathologist or child health nurse, bring those too. You could also ask the clinic whether short phone videos of your child communicating at home would help.

What questions should I ask the paediatrician?

These are questions to ask, not answers to look for yourself. Pick the ones that matter most to you and write the answers down.

About what the assessment will look at

What do you think might be contributing to my child’s speech or language? What are you ruling in or out?
Will you check my child’s hearing, or should we see an audiologist first?
Is my child’s main difficulty with understanding, using words or pronouncing sounds?
Are you looking at other areas of development as well, like play, movement and social skills?

About who else should be involved

Should my child see a speech pathologist, and can you refer us?
Would a team assessment suit my child, and how long is the wait?
Can any Medicare items or programs help with the cost? What will we pay?

About what happens next

What are the next steps, and who contacts whom?
Is there anything we can do at home while we wait?
When should we come back or review, and what changes should prompt us to call sooner?
Will I get a written report? Who else can it be shared with, such as my child’s preschool or school?
If I still have concerns after this visit, how do I ask for a second opinion?

Free tools to help

Appointment questions: build a question list for your child’s next paediatrician or therapy appointment.

Official sources

This article is general information. It isn’t medical, legal, financial or NDIS eligibility advice. Every child’s circumstances are different, and government programs and requirements can change. Check the official sources above before you apply.