A scoping review of deictic gesture use in toddlers with or at-risk for autism spectrum disorder

Abstract

Background and aims Young children use deictic gestures, such as pointing, to indicate referents in their immediate environment. Early deictic gesture use is important in facilitating the development of language. In toddlers with or at-risk for autism spectrum disorder, the emergence and use of gestures may be delayed, and deficits in deictic gesture may inform clinical practice regarding early identification, differential diagnosis, and early intervention. The aim of this scoping review was to investigate the extent to which deictic gesture use has been examined in young children with or at-risk for autism spectrum disorder ≤ 36 months of age. Methods Four databases (PubMed, PsycINFO, CINAHL, and ERIC) were comprehensively searched for relevant articles. Articles were reviewed in two phases: titles and abstracts followed by full text. Key variables related to participant/study characteristics and group differences on deictic gesture use were extracted. A narrative review was used to synthesize findings across studies. Main contribution Nineteen studies met inclusion criteria – 12 studies of toddlers with autism spectrum disorder and 7 studies of high-risk infant siblings of children diagnosed with autism spectrum disorder. Overall, toddlers with autism spectrum disorder were found to demonstrate reduced gesture use across deictic gesture types and ages compared to those with typical development. Findings were more variable when comparing toddlers with autism spectrum disorder to those with other developmental delays and in high-risk infant sibling studies. Although only measured in a limited number of studies, results suggest differences in gesture use in toddlers with autism spectrum disorder based on communicative function. Conclusions This review provides insight into the gesture use of toddlers with or at-risk for autism spectrum disorder. Results indicate the particular types of deictic gestures that may be delayed and the age ranges we might expect to observe these deficits in toddlers with autism spectrum disorder compared to those with typical development and other developmental delay groups. Results also reveal variability across studies in the measurement of gestures, and highlight where gaps remain in understanding deictic gesture use in young children with autism spectrum disorder. Implications Findings have research and clinical implications related to profiling and targeting gesture use as part of the assessment and treatment process, including identifying patterns of strength and weakness in deictic gesture use of young children with or at-risk for autism spectrum disorder.

Gesture and Language Trajectories in Early Development: An Overview From the Autism Spectrum Disorder Perspective

“…This is quite surprising considering that research on gesture-speech combinations has the potential to shed light on the disruptions in the verbal and non-verbal communication trajectory and add up to the knowledge of word learning in ASD. In their recent review, Manwaring et al. (2018) pointed out that only a single study investigating the gesture-language combinations in HR infants (Winder et al., 2013) has been carried out.…”

The Developmental Sequence and Relations Between Gesture and Spoken Language in Toddlers With Autism Spectrum Disorder

“…Some researchers report children with ASD have difficulties with structural aspects of language such as grammar or phonological processing, though others have argued these difficulties disappear when controlling for overall language level (Gernsbacher, Morson, & Grace, ; Kjelgaard & Tager‐Flusberg, ; Tager‐Flusberg, ). The evidence regarding relations between gesture and language in ASD is somewhat mixed (see Manwaring, Stevens, Mowdood, & Lackey, for a review). On the one hand, strong correlations between overall gesture production and concurrent and subsequent language are frequently reported (Luyster, Kadlec, Carter, & Tager‐Flusberg, ; Mitchell et al., ; Talbott, Nelson, & Tager‐Flusberg, ).…”

Gesture Development, Caregiver Responsiveness, and Language and Diagnostic Outcomes in Infants at High and Low Risk for Autism

“…Furthermore, a number of prospective studies have examined gesture as a potential early sign in infants with an older sibling with ASD, who are at high familial risk for the disorder (hereafter, "highrisk"; Ozonoff et al 2011). Significant group differences between high-risk infants and infants with no family history of ASD (hereafter, "low-risk") have been found in previous studies, with high-risk infants producing fewer gestures, compared to their low-risk peers (Cassel et al 2007;Goldberg et al 2005;Leezenbaum et al 2014;Manwaring et al 2018;Mitchell et al 2006;Toth et al 2007;Yirmiya et al 2006;Zwaigenbaum et al 2005).…”

“…Another limitation of prior research is that there has been a predominant emphasis on the amount and types of gestures that high-risk infants produce. Relatively little is known about gestures produced in conjunction with or without speech (Manwaring et al 2018;Özçalışkan et al 2017). A comprehensive review by Manwaring et al (2018) reported that only one of the 19 studies on deictic gestures, which indicate objects, people, or locations in the immediate environment, in toddlers with or at risk for ASD examined gesture paired with speech (hereafter, "gesture-speech combinations").…”

“…Relatively little is known about gestures produced in conjunction with or without speech (Manwaring et al 2018;Özçalışkan et al 2017). A comprehensive review by Manwaring et al (2018) reported that only one of the 19 studies on deictic gestures, which indicate objects, people, or locations in the immediate environment, in toddlers with or at risk for ASD examined gesture paired with speech (hereafter, "gesture-speech combinations"). In particular, Winder et al (2013) found that high-risk infants integrated deictic gestures with communicative non-word vocalizations at a significantly lower rate, compared to low-risk infants, at 13 and 18 months.…”