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

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.