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. Author manuscript; available in PMC: 2025 May 1.
Published in final edited form as: Autism Res. 2024 May 1;17(5):989–1000. doi: 10.1002/aur.3131

Are minimally verbal autistic children’s modality and form of communication associated with parent responsivity?

Chelsea La Valle 1, Lue Shen 1,2, Lindsay K Butler 3,4, Helen Tager-Flusberg 1
PMCID: PMC11247963  NIHMSID: NIHMS1982144  PMID: 38690644

Abstract

Prior work examined how minimally verbal (MV) children with autism used their gestural communication during social interactions. However, interactions are exchanges between social partners. Examining parent-child social interactions is critically important given the influence of parent responsivity on children’s communicative development. Specifically, parent responses that are semantically contingent to the child’s communication plays an important role in further shaping children’s language learning. This study examines whether MV autistic children’s (N=47; 48–95 months; 10 females) modality and form of communication are associated with parent responsivity during an in-home parent-child interaction (PCI). The PCI was collected using natural language sampling methods and coded for child modality and form of communication and parent responses. Findings from Kruskal-Wallis H tests revealed that there was no significant difference in parent semantically contingent responses based on child communication modality (spoken language, gesture, gesture-speech combinations, AAC) and form of communication (precise vs imprecise). Findings highlight the importance of examining multiple modalities and forms of communication in MV children with autism to obtain a more comprehensive understanding of their communication abilities; and underscore the inclusion of interactionist models of communication to examine children’s input on parent responses in further shaping language learning experiences.

Keywords: Minimally verbal, autism, communication skills, modality of communication, form of communication, parent-child interaction, parent responsivity, semantic contingency

Lay Summary

Given the complexity of communication during interactions, we examined how minimally verbal (MV) autistic children’s modality and form of communication may relate to how and in what ways parents respond during an in-home parent-child interaction. We found that parents responded in a semantically relevant way to their child’s communication regardless of the child’s type of modality and form of communication. Parents of MV children with autism are very in-tune with their child’s communication and play an important role in shaping their language learning.

Introduction

Minimally verbal (MV) individuals comprise 30% of diagnosed individuals with autism spectrum disorder (ASD) (Haebig et al., 2021; Plesa-Skwerer et al., 2016; Slušná et al., 2021; Sullivan et al., 2019; Tager-Flusberg & Kasari, 2013). Characterizing children as MV occurs when they are well past the age for important language milestones of combining words into functional sentences (DiStefano & Kasari, 2016). Previous research has examined how MV individuals with autism are using their communication skills during social interactions (La Valle et al., 2021). However, interactions are exchanges between social partners (Bottema-Beutel & Kim, 2021; Warlaumont et al., 2014). Interactionist models consider the interaction as an essential means through which social actions take shape (Goodwin & Cekaite, 2018). Examining parent-child interactions is critically important given the association between parent responsivity and children’s communicative development (Bottema-Beutel et al., 2014, 2018; Bottema-Beutel & Kim, 2021; Siller & Sigman, 2002, 2008; Yoder et al., 2015). To our knowledge, no study has explored multiple modalities and forms of communication expressed by MV autistic children and whether these are associated with parent responsivity during the interaction.

This study investigates whether modalities of communication including spoken language (ASHA, 2023), gesture, gesture-speech combinations, and alternative and augmentative communication (AAC; e.g., manual signs, picture-based communication systems, speech generating devices) and the form of communication (e.g., precise vs imprecise) expressed by MV children with autism are associated with parent responsivity during an in-home parent-child interaction. The current study lends key insights into which aspects of the child’s communication (modality and form) may be associated with how and in what ways the parent responds to enhance language learning and communicative development in MV autistic children.

Natural Language Sampling: In-home Parent-Child Interactions

Parents, by virtue of familiarity, are in-tune with their child’s communication (Kover et al., 2014; Lord, 2010). Barokova et al. (2020) found that parent collected natural language samples (NLSs), or spontaneous recordings of expressive language in the home allowed for a richer and more representative assessment of MV autistic individuals’ expressive language abilities compared to examiners collecting a NLS in the lab. Parent-child interactions in the home provide an ecologically valid assessment (Butler et al., 2022) of children’s communication abilities and parent responses (Goodwin & Cekaite, 2018). Therefore, it is an important avenue to collect NLSs in the home setting during parent-child interactions to capture MV autistic children’s communication abilities and parent responses.

Child Modality of Communication

The type of communication modality expressed by the child may be associated with responding by the social partner. Previous studies in children with autism found that adults were more likely to respond to spoken language compared to non-spoken language vocalizations (Warlaumont et al., 2014). Researchers suggest that spoken language is a particularly salient modality for eliciting responsivity (McDuffie & Yoder, 2010; Siller & Sigman, 2002, 2008). In contrast, noticing gestural communication requires an additional visual focus of attention for the parent to recognize and respond to the child’s gestural communication (McDuffie, Yoder, & Stone, 2005; Yoder & McDuffie, 2006). If the parent is not within the visual field of the child, this influences whether they notice and respond to the child’s communication cue(s). However, when children combine gesture and speech (Sweller et al., 2021) this provides additional clarity of the intended message through the incorporation of two modalities (Guarino & Wakefield, 2020). This can result in increased parent responsivity compared to using one modality alone. MV autistic individuals may also use AAC modalities to replace or supplement spoken language (Lorah et al., 2022). AAC includes, but is not limited to manual signs (American Sign Language; Gevarter et al., 2013), printed picture symbols (Picture Exchange Communication Systems; PECS) (Bondy & Frost, 1994), and computer technology with voice output (speech-generating devices; SGDs) (Gevarter et al., 2018). Responding is influenced by the parent’s familiarity and training in knowing how to respond to communication that is produced via AAC by the child and in the proximity of the AAC device (e.g., SGD) in relation to the social partner (Aydin & Diken, 2020; Calculator & Black, 2010; Clarke & Williams, 2020; Ferm et al., 2011; Iacono et al., 2016; Lima Antão et al., 2018; Sigafoos et al., 2014).

Alternatively, given that parents are very in-tune and familiar with their child’s communication, parents may display high levels of responsivity regardless of the child’s type of communication modality (spoken language, gesture, gesture-speech combinations, AAC) expressed during the interaction (Barokova et al., 2020; Kover et al., 2014; Lord, 2010). In the current study, spoken language, gesture, gesture-speech combinations, and AAC refer to MV autistic children’s expressive communication. To our knowledge, no studies have examined whether multiple modalities of communication expressed by MV children with autism are associated with parent responsivity during an in-home parent-child interaction. Such work can provide key insights into MV autistic children’s complexity of communication (multi-modal communication) during the interaction.

Child Form of Communication

In addition to exploring communication modalities, considering the precision of communication forms in MV autistic children can 1) offer implications for understanding communication abilities (Gernsbacher et al., 2008; West, 2019) and 2) determine whether the precision of communication forms should be targeted to enhance responding by the social partner to increase opportunities for language learning. In our prior study (La Valle et al., 2021), we explored communicative gestures in MV children and adolescents with ASD and investigated how gestures may complement spoken language abilities in this population. We included gestural form (point/reach gestures). Point gestures included well-formed point gestures (the index finger is extended, and adjacent fingers are noticeably inclined downward, or away from the index finger and toward the palm) as well as point approximations (index finger is not well-formed), which were collapsed into point gestures. As part of the current study, we will further disentangle point/reach gestures that were approximated versus non-approximated to determine if communication form is associated with parent-responsivity, building upon our prior work (La Valle et al., 2021).

Gestures approximated in form impact opportunities for parents to notice and respond to these gestures which can have cascading effects on word learning (e.g., Karasik et al., 2014). However, the production of gesture and speech (gesture-speech combinations), in particular, supplementary combinations, in which the gesture adds semantic information to the speech (Choi et al., 2020) can result in more responsivity, as the speech contributes additional information to the gesture when conveying a message. Prior work suggests that supplementary combinations enhance the social partners understanding of the speakers spoken language (e.g., Hostetter, 2011), therefore increasing responsivity. Additionally, some MV individuals with autism may also produce spoken language that is unintelligible or partially intelligible (Akhtar et al., 2016; Robledo et al., 2012; Tager-Flusberg & Kasari, 2013). The form of spoken language can play a role in determining the likelihood of responding (Warlaumont et al., 2014). Spoken language that is only partially intelligible can influence the clarity of the message. Alternatively, parents, given their familiarity to their child (e.g., Barokova et al., 2020), may be particularly in-tune to their child’s spoken language regardless of the level of intelligibility produced. To our knowledge, no studies have examined whether the form of communication expressed by MV autistic children may be associated with parent responsivity. Taken together, examining the child’s form of communication can provide insights into what influence this has on the parent-child interaction.

Parent Responsivity

Parents offer an important source of linguistic input during interactions with their children (Rowe, 2012; Tamis-LeMonda et al., 2001) by providing responses that are conceptually related to the child’s communication and actions (semantically contingent; Rowe & Snow, 2020). Parent responses that are semantically contingent can further support language and vocabulary development (Choi et al., 2020; Goldin-Meadow et al., 2007; Tamis-LeMonda et al., 2014). Examining semantically contingent parent responses is grounded in the social interactionist theory of language development. This theory suggests that language development occurs through a complex and dynamic interactive process where interaction facilitates language learning and communicative development (Bohannon & Bonvillian, 2001; Goldstein et al., 2003; Goldstein & Schwade, 2008; Warlaumont et al., 2010). Parents model language that interprets and relates to the child’s experience and focus of attention. A child who points to a truck and the parent responds by saying, “truck”, results in a semantically contingent response by labeling the item in the child’s immediate environment to enhance language learning and word-meaning connections (Choi et al., 2020).

Firstly, being responsive to the attentional focus of the child increases the child’s ability to connect the parent’s communication to the current activity and language learning environment (Baker et al., 2010) and better accommodates difficulties in shifting attention (Bottema-Beutel et al., 2018). Secondly, it increases the child’s motivation to incorporate and efficiently encode the parent’s communication into their own communication repertoire as it is within their foci of interest (Schreibman et al., 2015). Semantically contingent parent responses support advances in children’s language by providing labels for objects and events under joint attention, reducing the cognitive load of children matching linguistic symbols to their referents (Bottema-Beutel et al., 2014; Edmunds et al., 2019; Golinkoff et al., 2019; Tamis-LeMonda et al., 2019; Yoder et al., 2015). This is particularly important for MV children with autism. Haebig et al. (2013) found that autistic children with minimal language skills had larger gains from responsive parent communication when compared to autistic children with fluent language skills. Given the bidirectional nature of parent-child interactions and the importance of semantically contingent responses on children’s communicative development, the proposed study will classify the parent’s type of response (e.g., semantically contingent) immediately following the child’s communication.

Current Study

To address the gap in the literature on whether MV autistic children’s modality and form of communication are associated with parent responsivity during an in-home parent-child interaction, this study seeks to answer the following questions:

  1. Is the child’s modality of communication associated with parent semantically contingent responses? Given that parents are very in-tune and familiar with their child’s communication (Barokova et al., 2020; Kover et al., 2014; Lord, 2010), we predict there will be no difference in parent semantically contingent responses based on the child’s modality of communication. Alternatively, given that spoken language is a salient modality for displaying responsivity (McDuffie & Yoder, 2010; Siller & Sigman, 2002, 2008; Warlaumont et al., 2014), this modality may result in a higher proportion of parent semantically contingent responses compared to other communication modalities.

  2. Is the child’s form of communication associated with parent semantically contingent responses? We predict that forms that are precise will result in a higher proportion of parent semantically contingent responses compared to forms that are imprecise (Akhtar et al., 2016; Dewey et al., 2007; Warlaumont et al., 2014).

Methods

Participants

Participants included 47 minimally verbal (MV) children with autism (10 females; average age = 74.77 months) who were drawn from a larger study of autistic children (Butler et al., 2022). MV was defined as producing 20 or fewer different spontaneous words in a 15-minute natural language sample (M=5.17 words, SD=6.23) (Butler et al., 2022). NLS-based definitions of MV which include 20 or fewer different spontaneous words has been used in other studies (e.g., Almirall et al., 2016; Kasari et al., 2014; Rose et al., 2016; Shire et al., 2018). MV children are typically age > 5 years old and showcase difficulties in the production of flexible and spontaneous spoken language (DiStefano & Kasari, 2016; Haebig et al., 2021). See Table 1 for a description of participant characteristics and assessment scores. Study participants completed the study between December of 2020 and November of 2021. The study was remote and carried out during the coronavirus pandemic (Mathieu et al., 2020). Families were recruited through social media advertising and the Simons Foundation Powering Autism Research for Knowledge (SPARK) match registry (Feliciano et al., 2018). SPARK is a national ASD genotypic project that recruits families from 31 U.S. academic medical centers. Inclusionary criteria for SPARK included any individual residing in the U.S. with a professional diagnosis by a physician, psychologist, or therapist of ASD (Feliciano et al., 2018). SPARK has been shown to have high validity for autism diagnosis. Based on two different methods of confirming ASD diagnosis using electronic medical records, Fombonne et al. (2021) found 98.8% agreement with SPARK cohort data. ASD status was reported by their parents based on a community clinical diagnosis and confirmed with the Social Communication Questionnaire (SCQ; Rutter et al., 2003). The cut-off for the SCQ is 15, but 12 was used to adjust for the participant’s age (Corsello et al., 2007). Written informed consent was obtained from all parents prior to enrollment. This study was reviewed and approved by the Boston University Institutional Review Board.

Table 1.

Participant demographics and assessment scores.

Characteristic N (%)
Gender, male 37 (78.7%)
Child Ethnicity
Hispanic or Latino 6 (12.8%)
Non-Hispanic 39 (83.0%)
Prefer not to respond/missing 2 (4.2%)
Child Race
Asian 3 (6.4%)
Black or African American 5 (10.6%)
White 33 (70.2%)
More than one race 3 (6.4%)
Other 1 (2.1%)
Prefer not to respond/missing 2 (4.3%)
Caregiver Highest Education Level
Graduate/professional degree 16 (34.0%)
College graduate 17 (36.2%)
Some college 7 (14.9%)
Vocational or trade degree 3 (6.4%)
High school graduate or GED 3 (6.4%)
Missing 1 (2.1%)
Family Annual Income
Over $200,000 3 (6.4%)
$150,000 – $200,000 1 (2.1%)
$125,000 – $150,000 2 (4.3%)
$100,000 – $125,000 8 (17.0%)
$80,000 – $100,000 7 (14.9%)
$50,000 – $60,000 3 (6.4%)
$40,000 – $50,000 3 (6.4%)
$30,000 – $40,000 4 (8.5%)
$15,000 – $30,000 7 (14.9%)
Prefer not to respond/missing 9 (19.1%)
VABS-3 Adaptive Behavior Composite Standard Score 50.57 (12.22)
VABS-3 Expressive Language AE 15.81 (6.70)
SCQ Total Score 20.85 (5.62)
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Note: VABS-3 and SCQ scores include means and standard deviations.

Measures

Social Communication Questionnaire (SCQ; Rutter et al., 2003): a parent-completed screening instrument based on the Autism Diagnostic Interview-R that contains 40 yes-no questions pertaining to their child’s ASD symptoms. Item-level scores correspond to “0” or “1” determined by the parent’s report of “no” or “yes” responses. Total scores range from 0 to 39 with higher scores representing more social communication difficulties.

Vineland Adaptive Behavioral Scales-Third Edition (VABS-3; Sparrow et al., 2016): the VABS-3 was administered remotely via Zoom by research-reliable technicians. The VABS-3 is a parent interview assessing their child’s daily living skills, communication, and socialization skills and provides a measure of adaptive functioning used in the diagnosis of intellectual and developmental disabilities. The VABS-3 Standard Score is a composite of Communication, Socialization, and Daily Living Domain scores and represents each child’s overall adaptive behavioral functioning (Adaptive Behavioral Composite Standard Score; M = 100; SD = 15). Age equivalents from the Expressive Language subdomain provide an estimate of parent-reported expressive language skills.

Natural Language Sample (NLS)

Parent-Child Interaction (PCI): a 15-minute in-home interaction between the child and parent. This interaction was recorded by an examiner over Zoom. Parents were instructed to prepare activities at home that they thought would hold their child’s attention for this duration of the interaction and elicit communication (see Butler et al., 2022 for a description of the types of activities parents selected). Parents positioned themselves so that both they and their child were visible on the screen. Parents were provided with detailed instructions for recording high quality audio in .wav format using the Lexis audio editor app on their home devices and then were instructed to upload the files to a secure shared folder. Once the parent uploaded the .wav audio file, a research technician moved it to a secure password protected lab server and deleted the file from the shared folder. Recording via the Lexis app on an in-home local device, in addition to Zoom, ensured audio that did not rely on variable internet connectivity.

Coding scheme

The PCI was transcribed using Systematic Analysis for Language Transcripts (SALT; Miller & Iglesias, 2012) as part of a previous project (Butler et al., 2022). The coding for child communication (modality and form) and parent responsivity (response type) was carried out in SALT, while viewing the PCI video. The coding scheme (see Table 2 for definitions and examples of each coding category) built upon our prior work examining communication skills in MV autistic individuals (La Valle et al., 2020, 2021) and the pre-existing literature on children’s modalities (Aydin & Diken, 2020; Clarke & Williams, 2020; Iacono et al., 2016; Lima Antão et al., 2018; Özçalışkan et al., 2016; Sigafoos et al., 2014; followed ASHA, 2023 guidelines using the term spoken “language” instead of “speech” for the modality of spoken language variable) and forms of communication (Arendsen et al., 2007; Choi et al., 2020), and parent responsivity (Choi et al., 2020). For gestures, reach/point and reach/point approximation gestures were coded, as these types of gestures were found to commonly occur in our prior study investigating communicative gestures in MV autistic participants (e.g., La Valle et al., 2021). Event coding was used for child modality and form of communication, and parent responsivity. Parent response was coded within the first two utterances immediately following the child’s communication. Gaze behaviors (Ajodan et al., 2019) and communicative functions (e.g., joint attention vs requests; see La Valle et al., 2021) were not coded in the present study.

Table 2.

Definitions and examples of each coding category.

Category Operational Definition Example
Child communication modality
Gesture Spontaneous and intentional movements that are directed to the conversational partner and interpreted as communicating meaning. C: {reach towards blocks}.
Spoken language In accordance with SALT procedures, utterances were segmented into communication units defined as an independent clause with its modifiers. A word was defined as a set of characters bound by spaces. Words were transcribed using standard orthography. Utterances were separated when there were different thoughts or when it appeared to be the same thought but was separated by a pause of greater than 3 seconds. Common phrases with co-occurring words that were spoken without pauses between them (e.g., “alldone,” “nothankyou,” “allgone,” “cleanup,”) were transcribed as one word following transcription standards for children with ASD. C: Red {coloring}.
Gesture-speech combinations Communicative gestures that are accompanied by speech. C: Open {+ point gesture}.
Alternative and augmentative communication (AAC) Modalities (SGDs, PECS, manual signs) that replace or supplement speech and other communication skills. C: {presses “chips” on iPad}.
Child AAC types
Speech generating devices (SGDs) Tablets or iPads that allow one to communicate thoughts by electronic voice generation. C: {presses “green” on SGD when coloring}.
Picture-based communication systems (PECS) Consist of photos of preferred items for the child. C: {selects photo of banana on PECS}.
Manual signs Includes common signs (e.g., “want”, “eat”, “help”, “all done”, “no”) derived from American Sign Language. C: {signing “yes” (“s” handshape moving up and down)}.
Child communication form: precise
Reach/point gesture The index finger is extended, and adjacent fingers are noticeably inclined downward, or away from the index finger and toward the palm (point), or fingers are noticeably extended (reach). The start of a point gesture includes when the hands depart from a rest position, including the extension of the index finger towards an object or person. The end of the gesture comprises a return to a rest position. C: {point gesture with index finger extended towards a puzzle piece}.
Intelligible spoken language Speech that is fully discerned by the transcriber. C: Bubble {playing with bubble wands}.
Supplementary gesture-speech combinations Speech that adds information to what the gesture indicates. C: More {point gesture to juice}.
Child communication form: imprecise
Point/reach approximations Index finger is not well-formed (point approximation), or handshape does not include all fingers well extended (reach approximation). C:{point approximation to Connect 4 piece}.
Partially intelligible spoken language Only part of the utterance can be fully discerned by the transcriber. This is denoted in the SALT transcript as “X” for a word that is not fully intelligible and “XX” for a segment of an unspecified length that is not fully intelligible. C: More X.
Other gesture-speech combinations Speech that is transcribed as unintelligible (“XXX”) but accompanied by a gesture. C: XXX {reach gesture to toy figures}.
Parent response type
Contingent Parent verbal or nonverbal response is semantically related to the child’s communication. C: {point gesture to a car}.
P: Car.
Non-contingent Parent verbal or nonverbal response that is unrelated to the child’s communication. C: {point gesture to a car}.
P: Let’s do a puzzle.
No response Parent missed the child’s communication. C: {point gesture to a car}.
P: {no response}.
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Reliability

Three coders (a doctoral student and two undergraduate research interns) were trained and completed practice videos until inter-rater agreement measured by obtaining a Cohen’s kappa coefficient of .80 or above was achieved and then coders went on to code files for analysis. Reliability was assessed regularly between two coders. Approximately 20% of the transcripts were randomly selected and double-coded to calculate interrater agreement using Cohen’s kappa for each category (e.g., Choi et al., 2020): child communication modality, child communication form, and parent response type (Cohen’s kappa’s were above .90 for each category).

Statistical Analyses

Of the 47 participants, all PCI videos were 15-minutes in duration. If the examiner had to intervene or if the child and/or parent had to leave the room, the video was paused and then it was resumed once the child and/or parent returned. First, descriptives are reported on child modality of communication, child form of communication, and parent response type (Table 3) during the 15-minute PCI. Child chronological age, gender, race, ethnicity, caregiver highest education level, and annual family income were not related to our outcome variables. To answer each research question, variables were converted to proportions as the total number of child-initiated communicative acts varied by type (gesture vs gesture-speech combinations) which influenced parents’ total number of responses. Next, Kruskal-Wallis H tests (rank based non-parametric test) were conducted for each aim. Kruskal-Wallis H tests were selected given continuous dependent variables, categorical groups for independent variables, and due to non-normal data distributions. If results of the Kruskal-Wallis H test were significant, additional post hoc testing (pairwise Wilcoxon test) correcting for multiple comparisons was performed to determine which specific categories differed.

Table 3.

Descriptives of child modality, child form, and parent response types.

Sum Mean Range Mean Proportion
Child Modality
Gesture 284 6.04 0–51 .30
Spoken Language 610 12.98 0–64 .41
Gesture-Speech Combinations 90 1.92 0–10 .08
AAC 293 6.23 0–55 .21
Child Form
Precise/Non-approximated 755 16.06 0–62 .69
Imprecise/Approximated 178 3.79 0–12 .31
Child Precise Forms
Reach/Point 129 2.75 0–44 .27
Intelligible Spoken Language 578 12.30 0–64 .62
Supplementary Gesture-Speech 52 1.12 0–10 .07
Child Imprecise Forms
Reach/Point Approx. 102 2.17 0–11 .55
Partially Intelligible Spoken Language 36 0.77 0–8 .14
Other Gesture-Speech 36 0.77 0–5 .16
Child AAC Forms
SGD 216 4.60 0–55 .21
Manual Signs 77 1.64 0–24 .17
PECS 0 0 0 0
Parent Response Type
Contingent 875 18.62 0–47 .68
Non-contingent 345 7.34 0–42 .27
No Response 69 1.47 0–9 .05
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Note: the child modality, child form, and parent response type categories are expressed as counts for each category.

To test for 1) whether the child’s modality of communication is associated with parent semantically contingent responses, child modality of communication was entered as the independent variable (IV) with four levels: spoken language, gesture, gesture-speech combinations, and AAC. Parent semantically contingent response was entered as the continuous dependent variable (DV) to determine if parent semantically contingent responses differed based on child’s modality of communication. To test for 2) whether the child’s form of communication is associated with parent semantically contingent responses, child form of communication was entered as the IV with two levels: precise (reach/point gesture, intelligible spoken language, and supplementary gesture-speech combinations) and imprecise (reach/point approximation, partially intelligible spoken language, and other gesture-speech combinations). Parent semantically contingent response was entered as the continuous DV to determine if parent semantically contingent responses differed based on child’s form of communication. AAC forms were not examined; rather, descriptives on the different types of AAC are reported in the current study.

Results

Child Communication Modality on Parent Responsivity

For gesture, spoken language, gesture-speech combinations, and AAC modalities, of the 47 participants, 17.0% used four modalities, 42.6% used three modalities, 29.8% used two modalities, and only 10.6% used one modality of communication. A Kruskal-Wallis H test showed that there was no significant difference in parent semantically contingent responses based on child communication modality (spoken language, gesture, gesture-speech combinations, AAC), χ2(3) = 7.567, p = 0.06 (see Figure 2 for each child modality of communication and parent responses). When examining the different types of AAC used, out of the 47 participants, approximately 21% used SGDs and 17% used manual signs (9% used both SGDs and manual signs). None of the participants used PECS during the parent-child interaction.

Figure 2.

Figure 2.

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Proportion of parent response type by child communication modality.

Child Communication Form on Parent Responsivity

Precise forms included reach/point gesture, intelligible spoken language, and supplementary gesture-speech combinations and imprecise forms included reach/point approximation, partially intelligible spoken language, and other gesture-speech combinations. A Kruskal-Wallis H test showed that there was no significant difference in parent semantically contingent responses based on child form of communication (precise vs imprecise), χ2(1) = 0.004, p = 0.948 (see Figure 3 for child form of communication and parent responses).

Figure 3.

Figure 3.

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Proportion of parent response type by child form.

Discussion

This study investigated how MV children with autism are using different modalities and forms of communication and in what ways these are associated with how parents respond during a 15-minute PCI at home. The study aims examined 1) children’s modality and 2) form of communication on parent semantically contingent responses. Findings revealed 1) that parents did not differ in their proportion of semantically contingent responses across the modalities of communication expressed by MV autistic children. 2) There was no difference in the proportion of parent semantically contingent responses based on the child’s form of communication (precise or imprecise).

Child Modality of Communication on Parent Responsivity

There was no difference in the proportion of parent semantically contingent responses based on the child’s modality of communication, supporting the proposed hypothesis. Prior work suggests that parents, in particular, are very in-tune and familiar with their child’s communication (Barokova et al., 2020). Parent-child interactions may facilitate an understanding of the child’s communication under conditions of a familiar interlocutor (Kover et al., 2014). Indeed, Choi et al. (2020) study found high proportions of semantically contingent responding from parents of infants with high likelihood of acquiring an autism diagnosis in response to their child’s communication. Taken together, our findings indicate that parents are very in-tune with the communication modalities expressed by their child. Parents are providing similar proportions of semantically contingent responses across their child’s spoken language, gesture-speech combinations, gesture, and AAC, further supporting their language and vocabulary development (Choi et al., 2020; Goldin-Meadow et al., 2007; Tamis-LeMonda et al., 2014). This is particularly important for MV children, who have difficulties with spoken language production (e.g., Haebig et al., 2013). Providing semantically contingent responses that are within the attentional focus of the child increases the child’s ability to connect the parent’s communication to the present language learning environment (Baker et al., 2010). However, our study finding deviates from other research suggesting that child spoken language is a more salient modality for displaying parent responsivity (McDuffie & Yoder, 2010; Siller & Sigman, 2002, 2008). Warlaumont et al. (2014) found that adults responded more contingently to vocalizations produced by autistic children when the vocalizations were speech-related compared to non-speech vocalizations. Multiple modalities of communication were not included in their study, the population was not specific to MV children, the context varied (i.e., home, school), and only speech-related (e.g., speech, nonword babble) and non-speech vocalizations (e.g., coughing, crying, laughing) were considered.

Our findings reiterate the complexity of communication in MV autistic children, who are often characterized by their spoken language production (e.g., Cosden et al., 2006). Out of the 47 participants, over 42% used three different modalities of communication during a brief 15-minute PCI. This finding underscores the importance of examining multi-modal communication (spoken language, gesture, gesture-speech combinations, manual signs, speech generating devices, and other types of AAC) in MV children with autism.

Child Form of Communication on Parent Responsivity

There was no difference in the proportion of parent semantically contingent responses based on the child’s form of communication. These findings deviated from the proposed hypothesis that forms which are precise would be related to a higher proportion of parent semantically contingent responses compared to imprecise forms (Akhtar et al., 2016; Dewey et al., 2007; Warlaumont et al., 2014). For example, prior research suggests that the form of spoken language (intelligibility) plays a role in determining the likelihood of parent contingent responses (e.g., Warlaumont et al., 2014). In contrast, our findings suggest no difference in parent semantically contingent responses based on whether the child’s spoken language was partially intelligible or fully intelligible or if the gesture (point/reach) was approximated or non-approximated. This finding suggests that precision of form does not need to be targeted as an avenue to enhance parent semantically contingent responding. Parents, given their familiarity with their child’s communication (e.g., Barokova et al., 2020), may be particularly in-tune to their child’s spoken language, regardless of the level of intelligibility produced. Future work should explore this research question with different types of social partners who vary in their level of familiarity with the child. Additional gestural forms (e.g., head nodding/shaking) and types of gestures (e.g., representational, conventional) should be examined when exploring child communication on parent responsivity.

Study Implications

Our findings indicate that MV children with autism are using a variety of communication modalities and forms of communication during the parent-child interaction. Parents responded in a semantically contingent manner across their child’s different modalities and forms of communication. It is important for clinicians to examine communication acts across modalities. Information concerning the modalities and forms of communication each child uses can be provided to professionals working directly with the child to offer a comprehensive understanding of each child’s communication profile.

Limitations and Future Directions

Although this study has enhanced our understanding of how MV autistic children are using multiple modalities and forms of communication during an in-home parent-child interaction and how these are associated with parent responsivity, the interpretation of the findings should be viewed with caution. The parent-child interaction did not include standardized toys and occurred at only one timepoint. Additional timepoints are needed to provide a reliable index of children’s communication skills and parent responses (e.g., Bottema-Beutel et al., 2014; Yoder & Symons, 2010). Given the wide age range in the current study, future longitudinal studies are needed to describe each child’s communication trajectory of spoken language, gesture, gesture-speech combinations, and AAC overtime. Although prior work by Butler et al. (2022) found that different activities did not influence the quantity or quality of language elicited from the child using these same parent-child interactions, future work is needed to explore how different materials may impact child communicative behaviors and parent responses.

The definition of MV in the current study was less stringent than other studies (e.g., Bal et al., 2016; Yoder et al., 2015) and descriptive information is needed to further characterize the study sample. Additional qualitative and quantitative work across a range of interactional contexts can offer further insights into the mutual influence between children and parents (Goodwin & Cekaite, 2018; Tamis-LeMonda et al., 2019). Gaze behaviors of the child and parent (e.g., Ajodan et al., 2019) and communicative functions (e.g., La Valle et al., 2021) exchanged between children and their parents across different forms of communication were not examined during the parent-child interaction. Subsequent studies should explore receptive language skills, in addition to spoken language, gesture, gesture-speech combinations, and AAC. Lastly, future work should employ longitudinal designs, transactional models of communication, and explore moment-to-moment changes in children’s modalities of communication and parent responses.

Conclusion

This study focused on understanding how MV children with autism are expressing multiple modalities and forms of communication during an in-home parent-child interaction and whether these are associated with parent responsivity. Our findings suggest no difference in parent semantically contingent responses (responses related to the child’s communication) based on the modality (e.g., gesture, gesture-speech combinations, spoken language, AAC) and form (e.g., precise vs imprecise) of communication expressed by MV autistic children. Parents employed communication strategies through semantically contingent responding to further support their child’s language learning and communicative development. Findings underscore the importance of examining multiple modalities and forms of communication in MV autistic children and emphasize the inclusion of interactionist models of communication in research designs to examine the influence of children’s input on parent responses in further shaping language learning experiences.

Figure 1.

Figure 1.

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Coding schematic of child modality and form of communication on parent responses.

Acknowledgements:

The authors would like to Sophie Schwartz, Joseph Palana, Judith Licht, Hazel Harvey-Barker, Cerelia Liu, and Natalie Peterman for their contributions to data collection and language transcription. Thank you to the undergraduate research interns for assistance with data coding: Samantha Duggan and Nicole Berliavsky. This research project was funded by NIH NIDCD P50DC18006 (MPI: Tager-Flusberg/Kasari).

Footnotes

Conflicts of Interest: The authors have no conflicts of interest related to this publication to report.

Data availability statement:

Data generated or analyzed during this study is included in the published article.

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Data Availability Statement

Data generated or analyzed during this study is included in the published article.

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