How Are Minimally Verbal Children and Adolescents with Autism Spectrum Disorder Using Pragmatic Communication in a Different Medium?

Background: Minimally verbal (MV) individuals with ASD demonstrate difficulties in pragmatic communication, both in the use of speech and communicative gestures, when engaging with a conversational partner (La Valle et al., in prep). Motor difficulties may contribute to reduced communicative gestures (Dewey, Cantell, & Crawford, 2007); however, no studies have assessed gestural forms in MV individuals with ASD. Further, how MV individuals are using pragmatic communication in a different medium, sign language, and how this may differ between children and adolescents, has not been studied, yet a full understanding of pragmatic communication should include both more categorical (sign) and imagistic (gestural) components (Kendon, 2014). The inclusion of sign and gesture can lend key insights into how other modalities collaborate to accomplish communicative goals (Goldin-Meadow & Brentari, 2017). This study will assess how MV children and adolescents are using sign and gesture to display communicative intent during a social interaction.

Objectives: To compare the pragmatic communication profiles of MV children and adolescents with ASD by investigating gestural form and sign language use when engaging with a conversational partner.

Methods: Twenty-five MV children with ASD (19 males; Mage: 8.92 years) and 25 MV adolescents with ASD (19 males; Mage: 15.89 years) were administered the ADOS (n = 50 Module 1). Within this sample, five children (4 males; Mage: 9.91 years) and 8 adolescents (6 males; Mage: 15.35 years) used sign language. Of the 13 participants who used sign language, 12 used sign language and communicative gestures. Transcripts of the first 30 minutes of the ADOS sessions were coded for gestural form: reach, point, reach approximation, point approximation, nodding, and head shaking and sign language use, including the form of the sign (clear sign vs sign approximation). Sign function was assessed in terms of communicative intent: responding to a question, request, repetition, label, comment, and to acknowledge/agree/disagree with the conversational partner.

Results: Both participant age groups, on average, produced fewer than two gestures. The primary gestural form for both groups was a reach approximation (M = 3.36). Adolescents nodded more (Mean rank = 30) during the conversational interaction compared to children (Mean rank = 21; U = 200, p = .001, r = .46). The groups did not differ in reaching, pointing, reach approximations, point approximations, and head shaking. Both participant age groups of signers, on average, produced 2.38 signs. Adolescents used more clear signs (Mean rank = 28.5) compared to children (Mean rank = 22.5; U = 237.5, p = .037, r = .58). The primary sign function for both groups was to request (M = 1.5). The groups did not differ in any of the sign functions (see Figure 1).

Conclusions: Findings highlight potential motor difficulties as evident by the use of poorly formed gestures. However, both groups showed similar patterns in the use of communicative functions when using sign language (e.g., request). Overall, use of gestures and signs were very low, suggesting that MV individuals with ASD are not compensating for decreased verbal output via other modalities when engaging with a conversational partner.