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In the current study, children with ASD and language delay had lower IQ scores, and lower age of first words, compared to children with ASD without language delay. In the literature, many studies have reported that children with ASD and language delay have lower IQ and are less verbal than children with ASD without language delay (El-Khamisy et al. 2015; Roux et al. 2008; Zelazo et al. 2001). However, other studies have reported comparable IQ scores between children with ASD and language delay and those without language delay (Goddard et al. 2004; Malek et al. 2014; Ozonoff et al. 2012). These studies have emphasized that children with ASD and language delay are often missing from studies or are under-represented in samples because their language impairments hinder assessments (Baird and Norbury 2016).
Language delay in children with ASD has been well documented (El-Khamisy et al. 2015). However, the under-representation of language delay in children with ASD in research is a serious issue and reflects pervasive biases in the literature. About 50% of all children with ASD have language delay, and language delay is associated with other developmental disabilities (Wing and Grove 2013), increased impairment (Ching and Volkmar 2018), poorer adaptive functioning (El-Khamisy et al. 2015; Zelazo et al. 2001), and reduced quality of life (Goddard et al. 2004). Nonetheless, children with ASD and language delay are either excluded or under-represented in the literature despite the high prevalence of language delay in this subgroup. In the present sample, children with ASD and language delay had the highest rate of regression. This is consistent with the view that regression is unlikely in children with ASD without language delay (Grynszpan et al. 2012). Recently, the American Psychiatric Association (2013) and the World Health Organization (2018) removed language delay and impaired speech/language from the list of core features of ASD, suggesting that ASD symptoms such as social communication impairments may be more relevant than language in understanding the heterogeneity of ASD.
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