Associations Among Child Gestures and Measures of Social Communication and Autism Symptoms in Toddlers with and without ASD during a Home Observation

Background: Results of recent research suggest that there is a relationship between early gestures and developmental outcomes in children with and without autism spectrum disorder (ASD). Unique gesture inventories and the rate that young children use gestures can provide important indicators of ASD and developmental delay (DD).

Objectives: 1) To describe and compare mean rates of child gestures and communicative functions expressed during a home observation, and 2) to examine concurrent relationships among these variables and measures of social communication and autism symptoms.

Methods: Participants were 211 toddlers diagnosed with ASD (n = 121), DD (n = 46), and typical development (TD; n = 44) recruited through screening in primary care from the archival database of the FIRST WORDS Project. Children completed a video-recorded 1) home observation scored using the Systematic Observation of Red Flags for ASD (SORF; M_length=56:04, SD=6:19) at a M_age of 20.01 months (SD=1.70), and 2) Communication and Symbolic Behavior Scales Behavior Sample (CSBS), A detailed coding scheme was developed and the first author and one research assistant, blind to child diagnoses, coded child gestures using Noldus Pro^© Observer XT.

Results: CSBS: Children with TD scored significantly higher than other groups on all composites (Social, Speech, and Symbolic). Children with ASD scored significantly lower than children with DD on the Social composite. SORF: Children with ASD scored significantly higher than other groups on social communication, red flags, and total sum scores. ASD differed from TD, but not DD, on the RRB sum score. Gestures: A total of 40,738 communicative acts was coded. Toddlers with ASD used a median of 9 unique gestures (DD=9; TD=11). Rate of gesture use significantly differed among all groups (M_rate ASD=2.7 per minute; DD=3.50; TD=5.21). The ASD group used a significantly lower rate of deictic gestures than DD and TD but did not differ from DD on rate of conventional and iconic gestures used. Rates of gestures used for behavior regulation differed among all groups; however, rate of acts for joint attention were not significantly different among DD and ASD groups, and for for social interaction, did not differ among groups.

Moderate correlations were observed between the CSBS Social and Symbolic composites and rate of deictic and conventional gestures (range r=.34-.46), as well as rate of gestures for behavior regulation and joint attention (r=.25-.57). Moderate to strong correlations were observed between the use of deictic gestures for joint attention and CSBS Social, Speech, and Symbolic composites (r=.53, .41, and .47, respectively). Moderate to large negative correlations among SORF total scores and rate of gestures for behavior regulation, social interaction, and joint attention were observed (r =.29-.55).

Conclusions: Previous investigations have studied child gestures in a structured clinical setting. Gathering information within the home environment is important since 88% of families receive early intervention services at home, and may help teams build consensus on early red flags of ASD. Results suggest that there may be great potential for incorporating gestures into early developmental screening for toddlers who are at risk for ASD.