Minimally-verbal autism is well described in hearing populations, but little is known about minimally-signing autism in deaf children with early, full access to sign. This case series presents seven deaf autistic children born to Deaf parents and exposed to American Sign Language (ASL) from birth who nonetheless remain minimally expressive signers. Participants were drawn from a nationwide cohort of 23 native-ASL deaf children with autism. Four children completed the Autism Diagnostic Observation Schedule-2 (ADOS-2); all caregivers completed the Social Communication Questionnaire (SCQ). Selected children also received the Test of Nonverbal Intelligence-4 (TONI-4) and the ASL Receptive Skills Test (ASL RST). Six of seven children scored above the SCQ cutoff, and all four ADOS-2 cases met diagnostic criteria. Across cases, hallmark autistic features were evident, including limited reciprocal interaction, reduced joint attention, and restricted/repetitive behaviors. Expressive signing ranged from absent to small repertoires of echolalic or idiosyncratic signs, rarely coordinated with gaze or affect; symbolic play was similarly constrained. Two children completed standardized testing: one showed average nonverbal cognition but ASL comprehension <3 years; the other showed below-average nonverbal cognition and minimal ASL comprehension. These findings demonstrate that minimally expressive autism occurs in Deaf children with full access to a natural signed language, ruling out language deprivation or auditory processing as necessary explanations. Instead, domain-general constraints (limited generativity, social-pragmatic integration, and sensorimotor planning) likely contribute across modalities. Documenting minimally signing autism underscores the need for modality-sensitive diagnostic tools, neurodiversity-affirming supports, and longitudinal research to better understand and serve this underserved group.

PURPOSE:Sign language research has often been framed as supplementary to spoken language studies. In this article, I argue that sign language research is not only equal in value but also essential to understanding the human language faculty and its disorders. METHOD:I present three arguments: that sign language reveals phenomena unobservable in speech, enables the testing of otherwise untestable hypotheses, and helps disentangle speech from language. RESULTS:Drawing on research with deaf children with autism and other language disorders, I demonstrate how signed languages can transform both theoretical models and clinical approaches to language impairment. CONCLUSION:Sign languages provide a unique empirical lens through which to view linguistic and clinical phenomena that would otherwise remain obscured.

Background and aims:Children of Deaf adults (codas) acquire both a spoken language and a signed language from birth, making them bimodal bilinguals. While the language development of typically developing codas has been well studied, little is known about bimodal bilingual development in children with autism spectrum disorder (ASD). Methods:This study presents the first longitudinal case study of expressive spoken and signed language in an autistic bimodal bilingual child, spanning ten years of development. The participant, a hearing child with Deaf parents, was exposed to both English and American Sign Language (ASL) from birth. Expressive language samples were analyzed at ages 4;11, 6;6, 9;11, and 14;11 for syntactic complexity, lexical diversity, modality use, and echolalia. Results:Results revealed a significant expressive language delay in both modalities, with no consistent advantage of one modality over the other. Despite lifelong exposure to ASL, the child exhibited similarly limited language development in both English and ASL, challenging assumptions that signed language may be inherently more accessible for autistic individuals. Although there were global delays in expressive language in both modalities, there was evidence of pragmatic strengths and sensitivity to the linguistic preferences of his conversation partners. Unique features of bimodal bilingualism in autism, including code-blending, whispering, and cross-modal echolalia, are described. Conclusions:These findings highlight the need for further research into the developmental trajectories and communicative strategies of autistic bimodal bilingual children.

Facial expressions and body language play crucial roles in communication by conveying emotional and contextual information. In signed languages, facial expressions also serve linguistic functions. While previous research on autistic individuals’ facial expressions has focused primarily on affective expressions in hearing people, studying deaf autistic individuals offers insight into how autism affects linguistic and affective facial expressions. This case study examines the nonmanual expressions of “Brent,” a Deaf autistic adolescent natively exposed to American Sign Language (ASL). Five video recordings (four monologues and one conversation, totaling 35 m) were coded for nonmanual expressions, including affective facial expressions, question marking, negation, and other functions. Across 590 coded utterances, Brent showed absent or reduced facial expressions for both linguistic and affective purposes. However, he frequently used alternative communicative strategies, including additional manual signs, sign modification, and body enactment. Use of body movement to convey negation, affirmation, or emphasis was observed but inconsistently applied. These findings expand the current understanding of how autistic individuals use facial expressions by including linguistic functions in a signed language and support a broader view of autistic communication that embraces diverse and effective languaging strategies beyond neurotypical norms.

IntroductionIt is often assumed that sign language may be a more accessible alternative to speech for autistic children who have minimally expressive spoken language. However, this hypothesis remains largely untested in children exposed to both modalities from birth. This case series describes the developmental, cognitive, and language profiles of seven hearing autistic children of Deaf parents (CODAs) with native exposure to American Sign Language (ASL) and English.MethodsStandardized assessments of receptive language, nonverbal cognition, and autism characteristics were collected alongside observational and parent-report data.ResultsResults revealed substantial individual variation: some children showed delays in both ASL and English; others showed slightly better ASL comprehension; and still others were clearly dominant in English, despite early access to ASL. Notably, no child demonstrated a consistent sign-language advantage.DiscussionThese findings challenge the assumption that sign is inherently more accessible to autistic children and highlight the need for individualized, modality-sensitive assessment. This study provides the first in-depth look at bimodal bilingualism in autism, offering a novel perspective on bilingual language acquisition in autism.

The American Sign Language (ASL) fingerspelled alphabet is often a starting point for novice sign learners. The twenty-six handshapes of the alphabet are typically compiled into visual pedagogical materials designed to help learners master this cornerstone of sign learning. Second-language sign learners often make mistakes in their signing that are related to the fact that signs are visual symbols which thus appear differently depending on one’s perspective. In this study, we analyzed fifty-two commonly available representations of the ASL alphabet to determine the degree of variability exhibited among these materials for general characteristics, such as the medium employed (photographs, digital illustrations, or hand drawings), inclusion of alphabet graphemes and/or object images, and representations of diversity, as well as five parameters related to perspective-taking: perspective on the sign (signer/addressee), angle of hand (0, 45, or 90 degrees), directionality of hand (facing left, right, or front), hand selection (left or right hand), and depiction of movement. We discovered a high degree of variability in the way that ASL handshapes are represented pictorially, with most of the letters of the alphabet exhibiting either moderate or high variability in the perspectives, angles, and directionalities of the hand portrayed. We conclude that there is a great deal of heterogeneity in the way that the ASL finger-spelling alphabet is represented in didactic materials, and we suggest ways that educators and publishers can improve their teaching materials by incorporating multiple visual perspectives.

Children with autism often struggle with the establishment of joint attention, a skill strongly linked to language outcomes for both typically-developing and autistic children. Increasing the amount of time spent in episodes of joint attention between parents and their autistic children is a worthy goal that could improve eventual language outcomes. This paper investigates a novel research population: Deaf parents of deaf autistic children. We look to Deaf parents because of previous work documenting numerous advantages that Deaf parents have over hearing parents in their ability to gain and maintain their children's visual attention. Using a semi-structured play-based protocol, we developed an exploratory coding scheme for defining an inventory of attention-getting strategies deployed by Deaf parents while interacting with their autistic children. We describe these strategies, including several that may be unique to Deaf parents. While much remains unknown, including the key question of which strategies are most effective in leading to increases in joint attention, this study represents a first step towards that important goal.

Research on the acquisition of American Sign Language (ASL) by deaf autistic children has documented similarities to the linguistic profile of hearing children on the autism spectrum and has identified sign-specific phenomena that could serve as clinical markers of autism in the deaf population. However, the acquisition of a signed language by deaf autistic individuals whose language use appears to be at age-level is not well documented. Here we present a case study of ASL use by a Deaf autistic adolescent exposed to ASL since birth. Data include two video recordings (collected at age 16;11 and 17;4 years) of his spontaneous ASL. Utterances were coded for repetitions, phonological form, fingerspelling, metalinguistic awareness, and facial expressions having grammatical functions. Other data include a writing sample (17;6) and background information obtained from parental interviews and formal psycho-educational evaluations (between ages 14 and 17). Results revealed this adolescent has strong ASL skills including sophisticated vocabulary and semantic content, advanced fingerspelling, and evidence of metalinguistic awareness. His distinctive signing patterns include abundant repetition of phrases, intrusion of non-ASL handshapes, articulation disfluency, reduced facial expressiveness, and a dissociation between fingerspelling and writing skills. The results of this study diversify and broaden discussions of the ways that autism may interact with language development, especially in the visual-gestural modality. Understanding language patterns in autistic signers more fully will improve identification of autism in the deaf population, promote acceptance of diverse signing patterns in the Deaf community, and lead to better support for this population.

In this paper we highlight some of the difficulties that deaf and hard-of-hearing (DHH) children with autism spectrum disorder (ASD) are likely to exhibit in the classroom, such as echolalia and insistence on sameness, deficits in perspective-taking and theory of mind, difficulty producing and comprehending facial expressions and pronouns, articulation difficulties, and challenges with social interaction. For each challenging area we propose educational strategies that teachers may find useful, including video modeling, visual schedules, Social Stories, Power Cards, and peer support groups. We encourage educators to be flexible and creative in their use of multiple teaching strategies with these children, so that we can meet our ultimate goal of serving students' diverse educational needs more effectively.

EDITORIAL article Front. Psychol., 04 December 2023Sec. Psychology of Language Volume 14 - 2023 | https://doi.org/10.3389/fpsyg.2023.1334171

Acquisition of pronominal forms by children with autism spectrum disorder (ASD) continues to garner significant attention due to the unusual ways that such children produce and comprehend them. In particular, pronoun reversal errors (e.g., using the 2nd-person pronoun "you" to refer to oneself) have been noted in the speech of children with ASD since the very first report of the disorder. In more recent years, investigations of the signing of deaf children with ASD have documented a different phenomenon: palm orientation reversals, such that signs typically produced with an outward-facing palm are produced with the palm towards the signer, or vice versa. At the same time, true pronoun reversals have yet to be documented in the signing of deaf children on the autism spectrum. These two curious facts have led us to ask if there is evidence that palm orientation reversals in signed languages and pronoun reversals in spoken languages could be surface manifestations of the same underlying differences present in ASD. In this paper we seek to establish whether there is evidence for such an analogy, by comparing the ages at which the two phenomena appear in both typically-developing (TD) children and those with ASD, the frequency and consistency with which they appear, and their relationships with other linguistic and cognitive skills. Data are presented from a fingerspelling task given to a sample of 17 native-signing children with ASD and 24 native-signing TD children. We conclude that there are provocative parallels between pronoun reversals in spoken languages and palm reversals in signed languages, though more research is needed to definitively answer these questions.

This chapter is a joint discussion of key items presented in Chapters 4.1 and 4.2 related to the assessment of deaf and hearing children on the autism spectrum . From these chapters it becomes apparent that a number of aspects associated with signed language assessment are relevant to spoken language assessment. For example, there are several precautions to bear in mind about language assessments obtained via an interpreter. Some of these precautions apply solely to D/HH children, while others are applicable to assessments with hearing children in multilingual contexts. Equally, there are some aspects of spoken language assessment that can be applied to signed language assessment. These include the importance of assessing pragmatic language skills, assessing multiple areas of language development, differentiating between ASD and other developmental disorders, and completing the language evaluation within a developmental framework. The authors conclude with suggestions for both spoken and signed language assessment.

PURPOSE:Manual sign is a common alternative mode of communication taught to children with childhood apraxia of speech (CAS). Gesture use is positively related to later increases in vocabulary and syntactic complexity in typical development, but there is little evidence supporting the use of manual sign for children with CAS. We sought to identify the communicative functions of signs and gestures produced by children with CAS and to identify concurrent factors suggesting which children are more likely to benefit from sign-supported speech intervention. METHOD:Measures of receptive and expressive language were gathered from 19 children (ages 3.8-11.1 years) with CAS in a school-based sign-supported speech program. Fourteen of the children produced a total of 145 manual signs, which included both gestures and signs from American Sign Language (M = 10.4 per child, SD = 11.6). Manual signs were coded according to whether they conveyed information that was semantically redundant with (complemented) or added information to (supplemented) their speech. RESULTS:Children produced 107 complementary manual signs (75.4%) and 38 supplemental (24.6%) manual signs. Of the 38 supplemental signs, 24 (63.2%) provided additional information in the presence of unintelligible or no speech and 14 (36.8%) provided additional information in the presence of intelligible speech. Children's expressive language scores significantly predicted and accounted for 38.4% of the variance in the number of supplemental signs that children used. CONCLUSION:Children with CAS whose oral expressive language was relatively more impaired produced the most supplementary signs, suggesting that children with oral expressive language challenges are more likely to rely on them for communicating words they cannot yet speak. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.21217814.

Purpose: The purpose of this study was to investigate the association between perceived single-word speech severity and intelligibility in children with childhood apraxia of speech (CAS), with and without comorbid language impairment (LI), and to investigate the contribution of different CAS signs to perceived single-word speech severity and single-word intelligibility. Method: Thirty children with CAS, 18 with comorbid LI, completed the Goldman-Fristoe Test of Articulation–Second Edition (GFTA-2). Trained judges coded children's responses for signs of CAS and percent phonemes correct. Nine listeners, blind to diagnoses, rated speech severity using a visual analog scale. Intelligibility was assessed by comparing listeners' orthographic transcriptions of children's responses to target responses. Results: Measures of speech severity (GFTA-2 standard score, number of unique CAS signs, total CAS signs, and mean severity rating) were significantly correlated with measures of intelligibility (GFTA-2 raw score, percent phonemes correct, and mean intelligibility score). Speech severity and intelligibility did not differ significantly between children with and without LI. Only consonant errors contributed significant variability to speech severity. Consonant errors and stress errors contributed significant variability to intelligibility. Conclusions: Findings suggest that visual analog scale ratings are a valid and convenient measure of single-word speech severity and that GFTA-2 raw score is an equally convenient measure of single-word intelligibility. The result that consonant errors were by far the major contributor to single-word speech severity and intelligibility in children with CAS, with stress errors also making a small contribution to intelligibility, suggests that consonant accuracy and appropriate lexical stress should be prime therapeutic targets for these children in the context of treatment addressing motor planning/programming, self-monitoring, and self-correcting. Supplemental Material: https://doi.org/10.23641/asha.19119350

In this chapter, the authors discuss assessment of signed language development in deaf/hard of hearing (D/HH) signing children with autism spectrum disorder (ASD). The development of sign in D/HH children with ASD is an area of growing research, with recent papers describing how the language profile of such children is both similar to and different from hearing/speaking children with ASD. The authors highlight the difficulties of assessing signed language in this population, focusing on a lack of tests designed specifically for D/HH children. Furthermore, they describe how variations in degree of exposure to sign at home and different behavioral norms in the Deaf community complicate identification and assessment. Finally, the authors suggest some directions for possible future research.

The language of children with autism spectrum disorder (ASD) is often characterized by difficulties with pronouns. The underlying reasons for such difficulties are still unclear. This study is the first to test the abilities of children with ASD who speak Italian, a language in which overt subject pronouns are optional but verbs obligatorily feature person-referencing morphology. We found that Italian children with ASD were less accurate than typically-developing (TD) Italian children in the production of first-, second-, and third-person singular pronouns, avoiding pronouns in favor of nouns or names more often than controls. Moreover, children with ASD produced more overt pronouns than null pronouns in marked contexts, compared to TD children. These phenomena can be accounted for by difficulties with pragmatics.

Autism spectrum disorder (ASD) is characterized by deficits in social communication, and even children with ASD with preserved language are often perceived as socially awkward. We ask if linguistic patterns are associated with social perceptions of speakers. Twenty-one adolescents with ASD participated in conversations with an adult; each conversation was then rated for the social dimensions of likability, outgoingness, social skilfulness, responsiveness, and fluency. Conversations were analysed for responses to questions, pauses, and acoustic variables. Wide intonation ranges and more pauses within children's own conversational turn were predictors of more positive social ratings while failure to respond to one's conversational partner, faster syllable rate, and smaller quantity of speech were negative predictors of social perceptions.

Purpose: To investigate the latent factors underlying signs of childhood apraxia of speech (CAS) in a group of 57 children with CAS. Method: The speech of 57 children with CAS (aged 3;5-17;0) was coded for signs of CAS. All participants showed at least five signs of CAS and were judged to have CAS by speech pathologists experienced in pediatric speech disorders. Participants were selected to represent a range of severity of CAS: 30 children were verbal and 27 were minimally verbal with comorbid autism. Participants' scores for each sign (the number of times that sign appeared during a child's speech sample) were converted to z-scores, then entered as variables into an exploratory factor analysis. Models were compared using the Akaike Information Criterion (AIC). Results: The three-factor model had the lowest AIC and best fit the data. After oblique rotation, syllable segmentation, slow rate, and stress errors loaded most highly on Factor 1. Groping, addition of phonemes other than schwa, and difficulty with coarticulation loaded most highly on Factor 2. Variable errors loaded most highly on Factor 3. Thus, factors were interpreted as being associated with (1) prosody, (2) coarticulation, and (3) inconsistency. Conclusions: Results are consistent with the three consensus criteria for CAS from the American Speech-Language-Hearing Association: Inappropriate prosody, disrupted coarticulatory transitions, and inconsistent errors on repeated tokens. High loading of the syllable segmentation sign on the inappropriate prosody factor also supports the use of a pause-related biomarker for CAS.

Palm orientation reversal errors (e.g., producing the 'bye-bye' gesture with palm facing inward rather than outward as is customary in American culture) have been documented in the signing of deaf and hearing children with autism spectrum disorder (ASD) and in the imitation of gestures by signing and non-signing children with ASD. However the source of these unusual errors remains opaque. Given that children with ASD have documented difficulties with both imitation and motor skills, it is important to clarify the nature of these errors. Here we present a longitudinal case study of a single child with ASD, a hearing, signing child of Deaf parents. Samples of the child's signing were analyzed at ages 4;11, 6;2, 10;2, and 14;11. Lexical signs and fingerspelled letters were coded for the four parameters of sign articulation (handshape, location, movement, and palm orientation). Errors decreased for handshape, location, and movement after age 4;11, but increased on palm orientation from 4;11 and remained high, exceeding 55% of signs by 14;11. Fingerspelled letters contained a large proportion of 180-degree reversals, which suggest an origin in imitation differences, as well as midline-facing errors, suggestive of a motor origin. These longitudinal data suggest that palm orientation errors could be rooted in both imitation differences and motoric difficulties.