Improvement in expressive language can be achieved by

• Playing with the child on a regular basis and talking about what they are doing

• Talk to the child continuously through the day, about what you are doing, where you are going to go to, what you are going to do there, and repeat what you have just done

• Increase the interaction by turning off background noises and distractions.

• Talk face-to-face with the child who should mirror your facial expressions and process of language creation

• Expand the language that they use, ie add words to what they are saying hence "Dog" becomes "Big dog" or Big black dog", etc.

• Read lots of books together with the child, particularly on subjects that they are interested in. Ask them which books that they want to read, and talk about the story or the pictures in the book.

• Repeat back to the child words or phrases that they have said incorrectly, but correct the sentence.

Understanding the process of development of Speech.

Analogies to the development of speech. The first would be when a person is outside, particularly at sun-rise. The person hears all these noises. Now to the untrained ear, you can't tell what bird is what, but you can select out a kookaburra, Channel-billed cuckoo, rainbow lorikeet, and an Indian Minor plus you can tell a car going by, and you can selectively listen to a conversation in the street. Your mind has been able to sort all of those noises and identify them. You could also think of those puzzles that have all the jumbled letters in them and you have to find words in amongst the jumbled words. This is of course easier if you are given the words that you have to find. I "liken" the two examples to a child trying to understand speech. Hence to develop receptive language, the child has to be able to "selectively" pull out language from all the noises around him/her/ At first the child has to be able to follow one voice - probably the mother - who the child would be most familiar with. Then the child has to try to separate all the sounds coming from the mother into individual words, phrases and sentences. This requires lots of processing. Imagine trying to build a machine to do it. In this case the machine is the child's brain. Once the child has "recognized" that there is something special in the "language" it has to be able to Comprehend the different words, Understand how small changes in the words can change the meaning. Distinguish between the different speech sounds. Understand how important the order of the words are in a sentence.

Encouraging the Development

Firstly one needs to work out where in the analogy is the problem, and then fix that. Simplistically one could start by drawing attention to one particular sound, so that the child is able to focus on a sound. One could say, "where is that sound coming from?". E could also follow a sound, so that the child sort of tracks it. By tracking the sound the child has to focus on the one sound. E can do it with pictures of animals in books as well. "What sound does a duck make - Qvack, Qvack, Qvack". The mother duck said Qvack, Qvack, Qvack and all of the little ducks came back. The get the child to make the sound of the duck. So the child has some receptive language - ie what or where is the sound, and some expressive language in that the child has to mimic the sound.

Nutritional Deficiencies and Delayed Development of Speech in Autism

Myelination is essential for the development of speech, and delays in myelination are associated with neurodevelopmental retardation (Webb 2017). Myelination is in turn controlled by the action of melatonin and functional vitamin D (1,25dihydroxyvitamin D) on neuronal stem cells and the differentiation into myelin-producing oligodendrocytes.

Production of Melatonin is critically dependent upon functional B12 sufficiency, and lack of melatonin is associated with poor sleep, poor gut health and food intolerance, and lack of myelination, thereby causing delays in ability to sit, crawl, stand, walk and delays in potty training. Myelination is essential for the development of speech, and delays in myelination are associated with neurodevelopmental retardation. Brain myelination at 7 months predicts later language development (Corrigan et al, 2022). Language exposure in children contributes to myelination, with the increases in myelination being associated with increased exposure to language (Fabia et al, 2022; Huber et al, 2023); Pujol et al, 2006)

Production of melatonin is essential for stimulating the differentiation of neuronal stem cells into myelin-producing oligodendrocytes. Production of melatonin, requires active B12. Hence if active B12 levels are low during this early period, myelination will be delayed and so too will the development of speech.

Production of the intracellular energy transfer molecule, creatine is also dependent upon functional B12 sufficiency and lack of creatine alone causes many of the symptoms of autism and will contribute to hypotonia (floppy baby syndrome), and neurodevelopmental delays (Incecik et al, 2010).

An essential part of speech production is the development of memory, and deficiency in the gaseous neurotransmitter, hydrogen sulphide has been associated with loss of memory in conditions such as Alzheimer's disease. (He et al, 2019). Production of hydrogen sulphide is dependent upon functional methyl B12 sufficiency, and lack of functional methyl B12 would in turn result in reduced producion of hydrogen sulphide and further delay in the development of speech.

Education and Speech Delay

One of the mainstays of successful teaching is achievement and reward. Thus, it is the reward that the person gets from learning that drives learning, not the actual process of learning. Normally these "rewards" entail increased transient production of dopamine and serotonin. When a rewarding event occurs, dopamine levels increase, which enhances motivation to repeat the behavior leading to that reward. This is a problem in functional  vitamin B12 deficiency, particularly in Autism as the children have extremely high levels of dopamine (often higher than any drug addict), and serotonin (levels 200 times normal are not uncommon). This then can mean that it is very hard to motivate the children to learn, particularly to learn reading and writing (Russell-Jones 2022). Thus, neurotypical children often learn early speech and language skills through close contact with their parents, and repeated social interaction, however, children with autism have problems with social contact and are not as comfortable to even be in the position to learn. This is re-enforced by the perceived difficulty in doing so. One of the problems with using external rewards to motivate the child is that they may rely on external validation of their worth, rather than develop their own sense of self-worth.

Comparison of the dopamine break-down products, HVA and VMA between neurotypical children (NT) and those with ASD.

Accompanying the increase in the levels of dopamine, one would expect a reduction in the expression of the dopamine receptors, meaning that even if the children do get a reward from their behaviour the absence of the receptor will greatly diminish their response. A similar phenomenon is found in obese people where the level of dopamine receptors is reduced, and so they get less reward from eating, and hence would eat more (Wang et al, 2001). In addition, several studies have shown a correlation between obesity and elevated homocysteine, indicative of functional B12 deficiency (Al Fatly et al, 2024; Wang etal, 2023; 2021). Reduction in brain stimulation to decrease the reward seeking brain stimulation can be achieved by over-production of dopamine or by using  dopamine-antagonizing drugs, which blocked the effects of dopamine, or through destroying the reward pathways.

Overcoming Speech Delay in children with autism

It would appear that in order to do this effectively there are two essential and complementary strategies that need to be employed

1. The functional vitamin B12 deficiency needs to be resolved, This would then lead to increased myelination, increased production of creatine for energy, increased production of hydrogen sulphide, and hence greater memory retention. The increased methyl B12 then would decrease the production of dopamine, and so increase the learning-reward stimulus

2. Increased use of techniques that stimulate the child to learn to speak, including increased involvement of the parents and teachers with the child, increased excitement/stimulus/reward by the parents and children as they perform the task with the child, and increased emphasis on the rewards aspect of learning.

Examples can be found at Speech Sounds by Age (and How to Teach Them)

There are lots of memorable examples in kids books, such as Fee, Fi, Fo, Fum in Jack and the Beanstalk.

The Great, Grey, Green, Greasy Limpopo River of Rudyard Kipling fame

Around the ragged rocks the rugged rascal ran.

The silver snake slithered on the sunny hillside

Shrek, the sheep who escaped shearing for seven years

Larry, the lounge lizard, lay along the ledge

Make it fun.

Other Ongoing problems for Children with Autism

Vitamin B12 deficiency is strongly associated with the ongoing mental problems observed in many children with autism, including anxiety (20%), sleep-wake disorders (13%), depressive disorders (11%), obsessive-compulsive disorder (9%), bipolar disorders (5%) and schizophrenia spectrum disorders (4%)