What is the best course of treatment for a child with autism spectrum disorder (ASD), an Intelligence Quotient (IQ) of 77, and delayed speech development?

Treatment for Your Child with Autism, Speech Delay, and IQ of 77

Begin immediately with 20-30 hours per week of intensive Applied Behavior Analysis (ABA) therapy combined with speech-language therapy, without waiting for any additional evaluations, as early intervention before age 3 produces significantly better outcomes than starting after age 5. 1, 2

Immediate Action Steps

Start Intensive Behavioral Intervention Now

• Enroll your child in 20-30 hours per week of direct ABA therapy as the foundation of treatment, which represents the evidence-based standard for children with autism and communication delays 1, 3
• This intensive schedule should begin immediately—do not delay waiting for additional testing or formal diagnosis completion, as every week matters at this age 1, 2
• The therapy should specifically target joint attention skills (looking where you point, sharing interests with you) and functional communication training to replace frustration behaviors with appropriate ways to communicate needs 2, 3

Add Parent Training Component

• Participate in 5 hours per week of parent training where you learn to be a co-therapist, implementing ABA techniques during daily routines at home 1, 2
• Learn alternative communication methods including Picture Exchange Communication System (PECS), sign language, or voice output devices if your child is not yet using words effectively 2
• This parent involvement is not optional—it's essential for your child to generalize skills from therapy sessions to real-world settings 1, 2

Specific Treatment Targets for Speech Delay

Communication-Focused Interventions

• The ABA program should prioritize expressive and receptive language development, as children with autism and speech delay show the strongest responses when communication is the primary target 4
• Speech-language therapy should be embedded within or coordinated alongside the behavioral programming, not delivered in isolation 3
• Focus on pragmatic/social language use—how to use language for social interaction, not just vocabulary building 1

Evidence-Based Programs to Request

• Ask specifically for Early Start Denver Model (ESDM) or Early Intensive Behavioral Intervention (EIBI), which have demonstrated large effect sizes for joint attention and moderate effect sizes for expressive language after just 6-8 weeks 1, 2
• These programs combine behavioral analysis techniques with developmentally-informed curricula specifically designed for your child's profile 1

Addressing the IQ of 77

Cognitive Assessment Integration

• Your child's IQ of 77 (borderline range) means the intervention must include adaptive functioning goals—teaching real-world skills like self-care, following routines, and functional communication 1
• Request cognitive assessment using standardized tools (like Mullen Scales of Early Learning) to identify specific cognitive strengths and weaknesses that should guide the intervention plan 1
• The therapy intensity should remain 20-30 hours weekly regardless of IQ, as children with co-occurring intellectual challenges benefit from the same intensive approach 1, 3

What NOT to Do (Critical Pitfalls)

Do Not Wait or Delay

• Do not wait for more evaluations before starting treatment—the median time from concern to diagnosis is already too long, and starting before age 3 has superior outcomes compared to after age 5 1
• Do not reduce therapy hours thinking less is sufficient—the 20-30 hour weekly minimum is based on what actually produces measurable improvements 1, 3

Do Not Use Medication First

• Do not request medication for core autism or speech symptoms—behavioral interventions are primary treatment, and medication is only considered for severe aggression or self-injury that doesn't respond to behavioral approaches 1, 2

Do Not Accept Fragmented Services

• Do not accept separate, uncoordinated therapies (one hour speech here, one hour OT there)—your child needs a comprehensive, integrated program with all therapists communicating and working toward unified goals 3

Monitoring Progress

Reassessment Timeline

• Expect reassessment within 4-8 weeks of starting intensive intervention to determine which specific deficits are improving and which require modified approaches 2
• The program should adjust intensity, focus, and strategies based on your child's response, with particular attention to communication gains 2

Realistic Expectations

Prognosis Factors

• Children with autism who receive intensive intervention before age 3 show significantly better language outcomes than those starting later, though individual responses vary 1, 2
• Some children with language impairments at 14 months function well by 54 months with appropriate intervention, though some language delays may persist 4
• Your child's borderline IQ means realistic goals should focus on functional communication (making needs known, basic social interaction) rather than age-typical language complexity 1