Background Nonverbal communication abilities, including gesture use, are impaired in autism spectrum disorder (ASD). However, little is known about how common gestures may influence or be influenced by other areas of development. Aims This study examined relationships among gesture, fine motor, and language in young children with ASD compared to a comparison group using multiple measures and methods in a structural equation modeling framework. Methods & Procedures Participants included 110 children with ASD and a non-ASD comparison group of 87 children (that included children with DD or TD), from 12 to 48 months of age. A construct of gesture use as measured by the Communication and Symbolic Behavior Scales–Developmental Profile Caregiver Questionnaire (CQ) and the Autism Diagnostic Observation Schedule (ADOS), as well fine motor from the Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales-II (VABS-II) was examined using second-order confirmatory factor analysis (CFA). A series of structural equation models then examined concurrent relationships between the aforementioned latent gesture construct and expressive and receptive language. A series of hierarchical regression analyses was run in a subsample of 36 children with ASD with longitudinal data to determine how gesture factor scores predicted later language outcomes. Outcomes & Results Across study groups, the gesture CFA model with indicators of gesture use from both the CQ (parent-reported) and ADOS (direct observation), and measures of fine motor provided good fit with all indicators significantly and strongly loading onto one gesture factor. This model of gesture use, controlling for age, was found to strongly correlate with concurrent expressive and receptive language. The correlations between gestures and concurrent language were similar in magnitude in both the ASD and the non-ASD group. In the longitudinal subsample of children with ASD, gestures at Time 1 predicted later receptive (but not expressive) language outcomes on the VABS-II, after controlling for nonverbal cognition, ASD severity, age, and Time 1 language. Conclusions & Implications This study extends research on the relationship of nonverbal communication and language by supporting the idea of an underlying construct of gesture use that includes fine motor ability and relates to language in young children with ASD. This further supports theories espousing developmental influences of motor and nonverbal communication strategies as important in early language learning.

Background and aims: Young children with language delays or other factors that heighten risk for autism spectrum disorder often show reduced gesture use. In particular, deictic gestures such as pointing and showing are reported to be deficient in young children with autism spectrum disorder, and their use has been found to predict expressive vocabulary development. The first aim of this study was to examine the production of two types of gestures (deictic and conventional) for two communicative functions (behavior regulation and joint attention) across two observational contexts in a sample of 18-month-old toddlers with significant language delays compared to typical controls. The second aim was to examine if and how gesture use (type and communicative function) at 18 months is associated with later receptive and expressive language. Methods: Toddlers with significant language delays (n ¼ 30) or typical development (n ¼ 62) were drawn from longitudinal studies of early language delay as a risk factor for autism spectrum disorder. Toddlers identified with early language delay were classified based on a diagnosis of autism spectrum disorder (n ¼ 12) or non-autism spectrum disorder (n ¼ 18) after an evaluation at 36 months. Gestures were coded from video recordings of the Communication and Symbolic Behavior Scales Developmental Profile-Behavior Sample and a naturalistic parent-child interaction obtained at 18 months. Language outcomes included receptive and expressive age equivalents from the Mullen Scales of Early Learning and the number of words produced on the MacArthur-Bates Communicative Development Inventories. Results: At 18 months, toddlers with language delay showed reduced deictic and conventional gesture use in both the Communication and Symbolic Behavior Scales Developmental Profile-Behavior Sample and parent-child interaction compared to toddlers with typical development. Within the language delay group, toddlers with an autism spectrum disorder diagnosis at outcome also produced significantly fewer deictic gestures than those without an autism spectrum disorder diagnosis across both communicative functions and observational contexts. While all groups of toddlers gestured more in the Communication and Symbolic Behavior Scales Developmental Profile-Behavior Sample, the mean difference in gesture use between the Communication and Symbolic Behavior Scales Developmental Profile-Behavior Sample and parent-child interaction was significantly larger in toddlers with typical development than language delay for deictic gestures, as compared to the difference between the two contexts for conventional gestures. In the

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