Improving Language Comprehension via Hand Gestures in Children with Autism Spectrum Disorders and/or Language Impairment in Rural Montana

Abstract

Background: Developmental Language Disorder (DLD) and Autism Spectrum Disorder (ASD) are lifelong challenges, dramatically impairing communicative abilities with long term impacts on outcomes. Children with DLD and/or ASD benefit from interventions to improve language skills, but those are hard to reach in rural areas. Caregiver hand gestures can improve comprehension of content words in DLD/ASD via multimodal processing. However, little is known about how gestures affect comprehension of grammatical determiners (e.g., “the” or “an”). Methods: We investigate whether combining determiner phrases (e.g., “the apple” or “another apple”) with specific gestures (signs for [same] or [different] from American Sign Language) can improve language comprehension in hearing children with DLD/ASD, compared to TD controls. Operating Gazepoint or Tobii eye tracking at participants’ homes or a university space, we use a constrained act-out task presented via a custom-made interactive computer game with pre-recorded video prompts, or a toy and paper version, using a pretest-training-test-posttest protocol. Results: After evaluating 35 participants with ASD, DLD, and TD, ages 2-31, we identified three subgroups (across diagnoses) based on their knowledge of determiners at pretest. 51% of participants showed good (adult-like) knowledge across determiners and tests. 26% of participants were unable to complete our interactive game. However, 23% of participants showed initial poor knowledge of “the”, followed by improvements in the comprehension of “the” with gestures in the test, which were mostly retained in the posttest. Eye tracking demonstrated consistency between children’s attention to gestures and answers and their behavioral responses. Conclusion: Hand gestures can improve language comprehension in some children with DLD/ASD and TD. Our findings may lead to designing an inclusive intervention, for both children and their caregivers, to improve communication using multiple modalities – both speech and simple gestures which emphasize the main points of the spoken message, thereby supporting rural & underserved families.