We report the first study on pronoun use by an under-studied research population, children with autism spectrum disorder (ASD) exposed to American Sign Language (ASL) from birth by their deaf parents. Personal pronouns cause difficulties for hearing children with ASD, who sometimes reverse or avoid them. Unlike speech pronouns, sign pronouns are indexical points to self and other. Despite this transparency, we find evidence from an elicitation task and parental report that signing children with ASD avoid sign pronouns in favor of names. An analysis of spontaneous usage showed that all children demonstrated the ability to point, but only children with better-developed sign language produced pronouns. Differences in language abilities and self-representation may explain these phenomena in sign and speech.

Children with autism spectrum disorder (ASD) who have native exposure to a sign language such as American Sign Language (ASL) have received almost no scientific attention. This paper reports the first studies on a sample of five native-signing children (four deaf children of deaf parents and one hearing child of deaf parents; ages 4;6 to 7;5) diagnosed with ASD. A domain-general deficit in the ability of children with ASD to replicate the gestures of others is hypothesized to be a source of palm orientation reversal errors in sign. In Study 1, naturalistic language samples were collected from three native-signing children with ASD and were analyzed for errors in handshape, location, movement and palm orientation. In Study 2, four native-signing children with ASD were compared to 12 typically-developing deaf children (ages 3;7 to 6;9, all born to deaf parents) on a fingerspelling task. In both studies children with ASD showed a tendency to reverse palm orientation on signs specified for inward/outward orientation. Typically-developing deaf children did not produce any such errors in palm orientation. We conclude that this kind of palm reversal has a perceptual rather than a motoric source, and is further evidence of a “self-other mapping” deficit in ASD.

The manual gestures that hearing children produce when explaining their answers to math problems predict whether they will profit from instruction in those problems. We ask here whether gesture plays a similar role in deaf children, whose primary communication system is in the manual modality. Forty ASL-signing deaf children explained their solutions to math problems and were then given instruction in those problems. Children who produced many gestures conveying different information from their signs (gesture-sign mismatches) were more likely to succeed after instruction than children who produced few, suggesting that mismatch can occur within-modality, and paving the way for using gesture-based teaching strategies with deaf learners.

Children with autism spectrum disorder present with a variety of social communication deficits such as atypicalities in social gaze and verbal and non-verbal communication delays as well as perceptuo-motor deficits like motor incoordination and dyspraxia. In this study, we had the unique opportunity to study praxis performance in deaf children with and without autism spectrum disorder in a fingerspelling context using American Sign Language. A total of 11 deaf children with autism spectrum disorder and 11 typically developing deaf children aged between 5 and 14 years completed a fingerspelling task. Children were asked to fingerspell 15 different words shown on an iPad. We coded various praxis errors and fingerspelling time. The deaf children with autism spectrum disorder had greater errors in pace, sequence precision, accuracy, and body part use and also took longer to fingerspell each word. Additionally, the deaf children with autism spectrum disorder had poor receptive language skills and this strongly correlated with their praxis performance and autism severity. These findings extend the evidence for dyspraxia in hearing children with autism spectrum disorder to deaf children with autism spectrum disorder. Poor sign language production in children with autism spectrum disorder may contribute to their poor gestural learning/comprehension and vice versa. Our findings have therapeutic implications for children with autism spectrum disorder when teaching sign language.

Two populations have been found to exhibit delays in theory of mind (ToM): deaf children of hearing parents and children with autism spectrum disorder (ASD). Deaf children exposed to sign from birth by their deaf parents, however, show no such delay, suggesting that early language exposure is key to ToM development. Sign languages also present frequent opportunities with visual perspective-taking (VPT), leading to the question of whether sign exposure could benefit children with ASD. We present the first study of children with ASD exposed to sign from birth by their deaf parents. Seventeen native-signing children with a confirmed ASD diagnosis and a chronological- and mental age-matched control group of 18 typically developing (TD) native-signing deaf children were tested on American Sign Language (ASL) comprehension, two minimally verbal social cognition tasks (ToM and VPT), and one spatial cognition task (mental rotation). The TD children outperformed the children with ASD on ASL comprehension (p < 0.0001), ToM (p = 0.02), and VPT (p < 0.01), but not mental rotation (p = 0.12). Language strongly correlated with ToM (p < 0.01) and VPT (p < 0.001), but not mental rotation (p = ns). Native exposure to sign is thus insufficient to overcome the language and social impairments implicated in ASD. Contrary to the hypothesis that sign could provide a scaffold for ToM skills, we find that signing children with ASD are unable to access language so as to gain any potential benefit sign might confer. Our results support a strong link between the development of social cognition and language, regardless of modality, for TD and ASD children. Autism Res 2016, 9: 1304-1315. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

This article provides a consensus perspective based on the authors' expertise and the limited available literature regarding our understanding of children with an autism spectrum disorder (ASD) who are deaf or hard of hearing (D/HH). The challenges in the accurate identification of an ASD in children who are D/HH, including red flags for a potential ASD and screening and assessment for ASD, are described in this article. Additionally, strategies to guide professionals in their communication about a possible ASD with families and to frame the need for expanding aspects of communication important for this group of children are suggested.

Background and aims Praxis, the ability to plan and execute a series of gestures or motor sequences, is impaired in individuals with autism spectrum disorder. In this paper, we present the first study of praxis during a gesture imitation task in a unique population of children with autism spectrum disorder: deaf children who have been exposed to American Sign Language from birth by their Deaf parents. Lifelong exposure to sign language in deaf individuals entails practice with gesture imitation. We ask if deaf, signing children with autism spectrum disorder present with praxis impairments similar to those reported in the literature for hearing children with autism spectrum disorder not exposed to sign. Methods Thirty deaf children of Deaf parents (16 typically developing and 14 with autism spectrum disorder), matched for chronological and mental age, were tested on a simple gesture imitation task. Children were asked to imitate 24 gestures performed by an adult model on a laptop computer that varied along dimensions of movement type (16 trials) and palm orientation direction (eight trials). Data were coded for nine praxis parameters (five formation parameters and four manner parameters) and three timing measures. Results Results showed that the deaf children with autism spectrum disorder produced more errors than the typically developing deaf children on six of the nine praxis dimensions (hand orientation, final orientation, modulation, directness, pace, and overflow) and were more impaired on manner parameters than formation parameters, suggesting underlying deficits in motor control/coordination leading to dyspraxia. Praxis scores were strongly related to severity of autism spectrum disorder symptoms and receptive sign language scores. Conclusions We thus find evidence that praxis is impaired in deaf, signing children with autism spectrum disorder, despite lifelong exposure to a gestural language and extensive practice with gesture imitation. Implications Our findings suggest that interventions targeted toward enhancing praxis and coordination of finger and hand movements could help facilitate language development in children with autism spectrum disorder.

The parts of the body that are used to produce and perceive signed languages (the hands, face, and visual system) differ from those used to produce and perceive spoken languages (the vocal tract and auditory system). In this paper we address two factors that have important consequences for sign language acquisition. First, there are three types of lexical signs: one-handed, two-handed symmetrical, and two-handed asymmetrical. Natural variation in hand dominance in the population leads to varied input to children learning sign. Children must learn that signs are not specified for the right or left hand but for dominant and non-dominant. Second, we posit that children have at least four imitation strategies available for imitating signs: anatomical (Activate the same muscles as the sign model), which could lead learners to inappropriately use their non-dominant hand; mirroring (Produce a mirror image of the modeled sign), which could lead learners to produce lateral movement reversal errors or to use the non-dominant hand; visual matching (Reproduce what you see from your perspective), which could lead learners to produce inward–outward movement and palm orientation reversals; and reversing (Reproduce what the sign model would see from his/her perspective). This last strategy is the only one that always yields correct phonological forms in signed languages. To test our hypotheses, we turn to evidence from typical and atypical hearing and deaf children as well as from typical adults; the data come from studies of both sign acquisition and gesture imitation. Specifically, we posit that all children initially use a visual matching strategy but typical children switch to a mirroring strategy sometime in the second year of life; typical adults tend to use a mirroring strategy in learning signs and imitating gestures. By contrast, children and adults with autism spectrum disorder (ASD) appear to use the visual matching strategy well into childhood or even adulthood. Finally, we present evidence that sign language exposure changes how adults imitate gestures, switching from a mirroring strategy to the correct reversal strategy. These four strategies for imitation do not exist in speech and as such constitute a unique problem for research in language acquisition.