When a child loses words or skills: understanding regression in children

Regression vs developmental delay: what is the difference?

Regression means that a child has lost a skill they had learned and were using regularly. It might be words, play, movement, or looking after themselves. The loss can be total or partial, and it can happen overnight or slowly over months. It can happen at any age in childhood, not only in toddlers.

It is not the same as a delay, where a skill arrives later than expected. But the two can go together. A child who was slow to talk can also lose words later, and an earlier delay can make a loss easy to miss, because everyone has already been telling you that it is nothing.

What it can look like at home

Every child is different, but parents often describe things like these. A child who used to say "mama" and "water" goes quiet. A child who followed "give me the ball" stops responding. A child who loved peek-a-boo looks away, or stops answering to their name. A child who played with their cousins now plays alone, or only lines up toys. A child who walked or used a spoon starts struggling. An older child who was reading or dressing without help can no longer manage.

Losing speech, sometimes called speech regression, is one form of regression, but it is not the only one. If your child has lost something like this, make a note of what it was, and roughly when you first noticed.

What is not regression

Not every change means something is wrong. A baby who stops crawling because they have learned to walk has not lost anything. And after a frightening or upsetting event, such as the death of someone close, a young child may act younger for a while, talk like a baby, and then recover.

If you are not sure which of these you are seeing, treat it as worth checking. A short step back after an obvious upset is one thing. Losing speech or social interest with no clear reason, or not getting it back within a short time, is another.

Regression and autism: at what age does it happen?

Regression is one of the ways autism can first be noticed. In a large study of medical and school records, about one in five autistic children had lost skills. This happened at around two years old on average, but it was recorded anywhere from 6 months to 7 years, and about one in ten children lost abilities after the age of three. Most often it was language, social skills or play.

That does not mean every child who regresses is autistic, and most autistic children do not regress. But when a child loses language or social skills, autism is one of the things a clinician will think about.

Why a doctor should see your child first

Autism is not the only reason a child may lose skills. Hearing loss, conditions affecting the brain and nervous system, genetic or metabolic conditions, and low mood can all do it. Some of these need treatment promptly, which is why a medical check should come early. A doctor may refer your child to a neurologist, a geneticist or a hearing specialist, depending on what they find.

Two rare examples show why. In Landau-Kleffner syndrome, which usually starts between ages 5 and 7, a child who has been developing normally loses their language, sometimes with seizures. It is often mistaken for autism, hearing loss, a learning disability or ADHD, and it is found with an EEG, a test of the brain's electrical activity. In childhood disintegrative disorder, a child develops normally for three or four years and then loses language and movement skills over weeks or months. Both are uncommon, and neither can be told apart from autism just by watching the child. That is the reason any loss of skills is worth a doctor's time.

If there was a delay first

Many families look back and realise that there was a delay in speech or play long before the loss, but that it was explained away. Boys talk late. He will speak when he is ready. He hears two languages at home. These things are said kindly, and they are sometimes true. But they can also mean that the right check happens later than it should.

If this sounds familiar, please do not blame yourself. Almost everyone around a child says the same things. What matters is what you do from here. If your child has a delay and you have now seen a loss, take both to the doctor together. And if your child has a delay that has never been looked at, you don't need to wait for a loss before asking for an assessment.

What to do now

Here is a simple plan for the next few days.

• Book an appointment with your paediatrician soon. Don't wait to see if it passes. You know your child best, so trust what you are seeing.
• Write down what was lost, when you first noticed it, how fast it happened, and what your child could do before. Include anything that happened around then: an illness or fever, a fall, a change at home or school, or any unusual episodes or seizures.
• Look for photos and videos from before the loss. They show the doctor what your child used to do.
• Ask about a hearing test, and about seeing a paediatric neurologist if your child has lost language, movement or attention, or has had any seizures or odd spells.
• Mention any change in mood, sleep, appetite or interest in things. Low mood can also make skills slip.
• Ask for a developmental assessment too, so that your child's strengths and support needs are understood alongside the medical check.

What the doctor is likely to do

The doctor will ask which skill was lost, for how long, and what your child could do before. They will examine your child. They may arrange tests, such as blood, urine or saliva tests, an EEG or a brain scan, and may send you for a hearing or eye test. What happens next depends on the cause and on the skills lost, and may include medicines and therapies such as speech, occupational or psychological support. When the cause is found early, help can start early.

Where a developmental assessment fits

A developmental assessment does not replace the medical check. It adds to it. It describes what your child can do now, in communication, daily living and socialisation, and, where relevant, whether autism or ADHD is indicated. That helps you, your child's school and their therapists decide on the right support.

At Brighters, our psychologist will tell you if they think a medical step, such as a hearing test or a neurological opinion, should come first or go alongside.

Frequently asked questions

Sources

• Raising Children Network (Australia): Developmental regression
• Spectrum (The Transmitter): Regression marks one in five autism cases, large study finds
• BrainFacts.org (from NINDS): Landau-Kleffner syndrome
• Spectrum (The Transmitter, 2017): A rare form of regression distinct from autism
• CDC: Milestones by 2 years (talk to your child's doctor if your child has lost skills)

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