Mary Gavin on gestures, and how her research into gesture development has influenced her understanding and practice when working with non-speaking autistic children.
In early 2020, I wanted to explore ideas for supporting autistic children, particularly children who were non-speaking (non-verbal), and I set out to investigate their gestures more thoroughly. This was influenced by the fact that 25–30% of autistic children never acquire language, so observing their non-speaking interactions might be the only window to their communication attempts.
I quickly came to realise I had a lot to learn in this area. As a speech and language therapist, I understood the importance of certain gestures (point, wave) but little of other gestures. I realised this was crucial to my work, especially after I discovered the link to language development. To deepen my knowledge, I embarked on reading articles on gestures that explored neurotypical development, atypical gestures, indicators of autism, links to language, assessments, and support strategies. However, I was often left confused. The scholarly literature surrounding gestures, and in particular gestures in autism, is scarce and can be contradictory.
Functions of gestures
In neurotypical development, gestures have a communication function which refers to a child’s communication goal or purpose, so when observing gestures, it is important we understand why they are used.
Bruner, back in 1981, helpfully proposed three functions of gesture:
- Behaviour Regulation (BR): A gesture is used to regulate someone’s behaviour, so they do something for them, related to their wants, support or to protest.
- Social interaction (SI): A gesture is used to get someone to look and notice them, which maintains the interaction.
- Joint Attention (JA): A gesture directs someone’s attention towards a reference to share interest or to prompt them to comment.
Types of gestures
In neurotypical children, gestures are naturally occurring, and they follow a predictable sequence of development. Autistic children do use gestures, and these appear to follow a sequence similar to that seen in neurotypical children, but some alternative atypical gestures are exclusively used by non-speaking autistic children.
The gestures are frequently mentioned in the literature are:
Deictic gestures
These include reach, give, point (far) and show. These gestures are used to direct someone to a reference, and they make up 88% of all gestures.
Conventional Gestures
These culturally specific gestures, that are used to send a message to someone to help maintain an interaction. I found it useful to divide these into four sub-groups in my proposed classification, for example reactions to an event (hands to ears), an activity (clap), a person (wave) or a question (nod).
Representational (descriptive) gestures.
These gestures describe a symbolic reference and are often used alongside language (for example hands shaped into a circle to represent a ball.
Hand contact gestures
More recently articles have provided further information on hand contact gestures, often seen in non-speaking autistic children. These have now been usefully divided into either instrumental or ritualised. An instrumental gesture is when a child takes a partner’s hand (like a tool) to ‘do’ an action for them. These are usually only observed with autistic children. A ritualised gesture is when a child takes their partner’s hand to ‘go’ to a place to request a want or need. It’s rarely seen beyond 12 months in neurotypical children, but continues when the point gesture does not emerge.
Additional gesture types
Further gestures are included or adapted in my proposed classification. These are:
- Protest (towards an object or person)
- Close point
- Reach (towards a person)
Intentional gestures
For an action to be considered a gesture, an intentional, meaningful message needs to be sent to someone, often accompanied by a directed gaze. It is often documented that autistic children rarely direct their gaze, so do autistic children send intentional gesture messages, and if so, how? The gestures reportedly used by non-speaking autistic children, such as hand contact, give, and tap, do not require a child to direct their gaze or shift their attention.
From clinical experience, I agree that the gestures used by autistic children do not typically require them to shift their focus. Instead, they tend to approach someone and then use certain gestures (give or hand contact) which allows them to signify their intent while maintaining their focus on the reference.
If gestures are linked to sending an intentional message to someone, then not all actions are gestures. Therefore, to imitate is not classified as a gesture as these are copied actions and no message is sent, for example as in nursery rhymes. We can also exclude emotional display—these are behaviours directed at themselves (such as biting self) and observed without a sent message.
Further actions that are not gestures are when a child reaches or uses a point to activate or set something in motion. In this instance, a child is acting on an object, and not acting to indicate. This, too, applies to nominal gestures which are action-based gestures seen in play events (such as when a child brushes a doll’s hair).
Gestures and language
The literature suggests that gesture comprehension and production are in place before the acquisition of spoken language for neurotypical children. A child’s ability to gesture at 12 months is a significant predictor of their spoken language skills at 2–3 years old.
Importantly, not all gestures are significant but there is a strong correlation between the ability to far point and spoken language. Typically developing children follow a reliable sequence in which they acquire the far point, and then single words emerge, which leads them to combine gestures with words before combining words in speech. However, the far-point gesture to establish joint attention is suggested to be significantly reduced in autistic children. Does this explain why some autistic children have difficulty with the acquisition of spoken language? In my clinical experience, it is when the close point emerges in autistic children that words might then begin (for example in books, the alphabet, trains, and numbers).
Changing my practice
Since I’ve embarked on this gesture discovery, I can truly say it has significantly changed my practice. I’ve deepened my knowledge, especially about non-speaking autistic children. I propose that these children can follow a neurotypical gesture sequence, but their onset age differs. They often use gestures that don’t require them to shift their focus or direct their gaze. Instead, they approach others and use specific behaviour-regulated gestures. I realised early on that there was no ‘classification of gestures’, so I set out to create a system to explain neurotypical and atypical gestures, linking these to their communication function and intentionality.
An example of a change to my practice is that, where I would previously have set targets to develop representational gestures (like signs), I now understand the importance of establishing other gestures first, such as reach, give, close point, and focusing on the child’s strengths (hand contact). In my role I have shared the importance of gestures, and this has influenced a change in others.
My proposed classification of gestures has not yet been clinically evaluated. While research is required to take forward my clinical idea, this classification will hopefully help others to assess, diagnose, and set support strategies.
