Parent Report of Social Communication Milestones in Very Young Children with Autism Spectrum Disorders

Background:  Young children with autism spectrum disorders (ASD) have core social communication deficits that impact gesture use. There is limited research on the specific gestures that may distinguish young children with ASD compared to matched control groups of both developmentally delayed and typically developing children, which would have important implications for earlier detection.

Objectives: The purpose of this study was to examine social communication profiles and use of gestures based on parent report for children diagnosed with autism (AUT), autism spectrum disorder (ASD), developmental delay (DD) in which autism was ruled out, and typical development (TD) from 18 to 36 months of age.

Methods: CSBS DP Caregiver Questionnaires (CSBS CQ; Wetherby & Prizant, 2002) were completed by parents of 176 children: 60 AUT (mean age=26.3 months), 23 ASD (mean age=25.3), 33 DD (mean age=24.9 months), and 60 TD (mean age=24.3 months). Participants were recruited from two sites, the NIMH and the FSU FIRST WORDS Project. The AUT, ASD, and DD groups were matched on nonverbal and verbal developmental level (developmental quotients) on the Mullen Scales of Early Learning (Mullen, 1995), and all groups were matched on chronological age.  Scores were computed for the Social (emotion and eye gaze, communication, gestures), Speech (sounds, words), and Symbolic (understanding, play) composites.

Results: Children with AUT, ASD, and DD scored significantly lower than TD on all composites of the CSBS CQ using weighted raw scores. No significant differences were found between the AUT and ASD groups on the composite scores. In comparison to children with DD, AUT and ASD groups scored significantly lower on the Social composite only. Within the Social composite, children with AUT scored significantly lower than DD on all clusters:  emotion and eye gaze, communication, and gestures. Children with ASD were significantly different from DD on gestures, but not emotion and eye gaze or communication. No differences were observed between AUT, ASD, and DD on the Speech or Symbolic composites.  

Preliminary analyses on the 10 individual gestures measured on the CSBS CQ were conducted on a subset of the sample of children with AUT (n=29), DD (n=14), and TD (n=22). Compared to TD, significantly fewer children in the AUT group were reported to use all 10 gestures [all X²’s ≥ 4.4. All p values < .05]. Compared to children with DD, significantly fewer children in the AUT group were reported to use the following 5 gestures: showing, raising arms, waving, distal pointing, and nodding head [all X²’s ≥ 5.7. All p values < .05].

Conclusions: This study contributes to understanding the ontogeny of social communication milestones in children with ASD. The findings demonstrate distinct patterns of gesture use in young children with AUT compared to children with DD and TD. Preliminary analyses indicate that young children with autism have particular difficulty with certain gestures, particularly those often used for social initiation (showing, pointing, waving).  These findings support the use of parent report of early gestures along with other social communication milestones for improving early detection of ASD .