Gesture Development, Caregiver Responsiveness, and Language and Diagnostic Outcomes in Infants at High and Low Risk for Autism.
Boin Choi, Priyanka Shah, Meredith L Rowe and 2 others
PMID 30877417WHAT IT FOUND
At 12 months, high-risk infants without autism gestured more than those later diagnosed with autism.
At 18 months, low-risk infants gestured more than both high-risk groups. Higher 12-month gesture use predicted better receptive language and lower chance of autism diagnosis. Caregiver response rates were similar.
Key findings
01Total gesture production differed at 12 and 18 months but not at 24 months; at 12 months, high-risk infants without autism produced more gestures than high-risk infants later diagnosed with autism and low-risk comparison infants, while at 18 months, low-risk comparison infants produced more gestures than both high-risk groups.
02Caregivers did not differ in the proportion of contingent responses to infant gestures at 12, 18, or 24 months, although the raw number of contingent responses differed at 12 and 18 months.
03Gesture use at 12 months predicted receptive language scores at 24 months, and higher 12-month gesture use was associated with a lower probability of an autism diagnosis among high-risk infants.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample was small, with only 21 high-risk infants later diagnosed with autism, so the estimates are imprecise. High-risk infants who later developed autism were deliberately oversampled, and the autism recurrence rate in the larger study was about 30%, higher than expected, so results may not generalize to all high-risk families. Attrition and missed visits changed the number of dyads analysed at each age, and some visits were lost because equipment failed or infants were fussy. Diagnoses were made at different ages, from 18 to 36 months, and infants classified as having other conditions were excluded, which can affect group membership. The study is observational, so it can show that early gesture is associated with later language and diagnosis, but it cannot show that changing gesture would change outcomes. A ten-minute play session may not capture the full range of gesture-speech combinations, and the sample was mostly English-speaking and relatively high socioeconomic. Infant sex and caregiver education differed across groups and were controlled statistically, but the study cannot rule out other family or developmental differences. The authors caution that gesture alone is not likely to be diagnostic because its specificity and sensitivity are low.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not treat low gesture use as a stand-alone autism screening result or as evidence that caregivers are less responsive. The study found group associations in a small high-risk sample, and caregiver response proportions were similar once infant gestures were accounted for.