GirlsGoneChild has written a fair amount over at her blog here about her son Archer, who's had some speech therapy, etc., because of delayed talking. You might find her comments helpful...

One of the mom's I hang with said that her doctor told her at their 18 month check up that her son should have 5 words that he says regularly. How much actual talking can be done with 5 words he did't clarify, but I am thinking not much. Cooper is not even a month behind Hugo, and says 5 or 6 words regularly, but really relies on gestures to communicate. As for early intervention, because Coop was 2 months early, they recommended we get him evaluated at 1 month and again at 6 months, in case any delay or developmental issues were apparent. In both cases he was fine. I was happy to get him evaluated, if for no other reason than to have someone tell me "he doesn't qualify for services, he is just fine". And finally, boys are just slower at talking. Period. At some point in the future Hugo will just begin talking in full sentences "Mommy may I have the keys to the car", that kind of thing. I would NOT worry about the end result, I would go ahead and get him evaluated, what can you lose. If he needs services, then you find out and address the problem. If he doesn't you get the objective affirmation that he is doing great. But I am betting he is just fine.

Years ago my friend felt the same way about her son -- that he wasn't developing verbally in an appropriate way. She worked with developmentally disabled kids and I'm sure that colored her thinking.  She went all around with whether or not to test, but decided not to, if only to spare any results becoming part of his Permanent Record. Anyway -- one of the things she did was gently hold his head or his arm while she was talking to him, getting him to focus.  

Well, the boy has always had an astounding vocabulary.  (When he was in first grade - "I thought I'd be a little intimidated...") The poetry he's written in high school is breathtaking in its use of language and images.  He heads off to college next year.  

And to pull this all together -- last year on NPR there was an interview with an author (whose name and book escape me now).  He suggested that to develop a boy's verbal skills, you should make physical contact with him while speaking, either by cupping his chin or later, holding his arm.  JUST what my friend had done with her son!  Too bad she was so busy being a mom she didn't have time to write a book.  

I am quite sure Hugo has no issues. And that is a big difference between doctor's recommendations. Mine didn't seem to have any concerns about how many words Cooper had or didn't have as long as he was chugging along gaining one here and there. I like the suggestion Dee made - what guy doesn't focus better when a woman touches his arm? HA. Anyway, the good news is if you do get him evaluated, you will have the opportunity to see them in action and get a lovely report that says he is totally normal. They often have recommendations on things you can do to improve skills too, even though there are no official issues to work on. I try not to stress about most of this, I know it all works out in the end barring any major problems. And you have NO major problems. He may also not feel the need to talk if you and dad respond to his physical gestures, or fill in the blanks for him yourselves. I can hold a conversation with a spoon, so sometimes I make up Cooper's part of the conversation for him. I have to dial that back and let him try telling me what is on his mind. He might not feel the need to talk if I do it for him! M

Your doctor is quite right in pointing out that the lack of speech is a red flag, but it may or may not mean anything (Einstein didn't talk until he was 4). A speech delay does not necessarily indicate autism, certainly. It could be nothing; it could be a mild garden-variety language processing issue (learning disability). An evaluation from a private speech therapist (one specializing in children) at some point would probably be a good idea, if only to put your mind at rest. With a private evaluation (paid for by you) there is no public Permanent Record unless you choose to make his evaluation public, such as in eventual school, to get state early intervention funding for speech therapy, etc.

I just feel compelled to add (as the parent of two brilliant and creative children with learning disabilities and since you mentioned the intelligence of your husband) that learning disabilities/processing issues (not that your son has them) do not mean that a child is less intelligent.

Your son is gorgeous, by the way!