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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). 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 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. These findings highlight the need for further research into the developmental trajectories and communicative strategies of autistic bimodal bilingual children.

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.

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.

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.

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.

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.

Purpose: We present the first study of echolalia in deaf, signing children with autism spectrum disorder (ASD). We investigate the nature and prevalence of sign echolalia in native-signing children with ASD, the relationship between sign echolalia and receptive language, and potential modality differences between sign and speech. Method: Seventeen deaf children with ASD and 18 typically developing (TD) deaf children were video-recorded in a series of tasks. Data were coded for type of signs produced (spontaneous, elicited, echo, or nonecho repetition). Echoes were coded as pure or partial, and timing and reduplication of echoes were coded. Results: Seven of the 17 deaf children with ASD produced signed echoes, but none of the TD deaf children did. The echoic children had significantly lower receptive language scores than did both the nonechoic children with ASD and the TD children. Modality differences also were found in terms of the directionality, timing, and reduplication of echoes. Conclusions: Deaf children with ASD sometimes echo signs, just as hearing children with ASD sometimes echo words, and TD deaf children and those with ASD do so at similar stages of linguistic development, when comprehension is relatively low. The sign language modality might provide a powerful new framework for analyzing the purpose and function of echolalia in deaf children with ASD.

We report the first study on pronoun use by an under-studied research population, children with autism spectrum disorder (ASD) exposed to American Sign Language from birth by their deaf parents. Personal pronouns cause difficulties for hearing children with ASD, who sometimes reverse or avoid them. Unlike speech pronouns, sign pronouns are indexical points to self and other. Despite this transparency, we find evidence from an elicitation task and parental report that signing children with ASD avoid sign pronouns in favor of names. An analysis of spontaneous usage showed that all children demonstrated the ability to point, but only children with better-developed sign language produced pronouns. Differences in language abilities and self-representation may explain these phenomena in sign and speech.

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.

Autism spectrum disorder (ASD) consists of a set of neurobiological developmental disorders characterized by communicative and social deficits as well as repetitive, stereotyped behaviors.¹ In this chapter, we use the terms ‘ASD’ and ‘autism’ interchangeably; although ‘autism’ is not a clinical term, it is the term popularly used to refer to the range of disorders found in ASD. The language deficits of hearing children with autism are well documented, and can range from the very mild in highly fluent speakers to the very severe in children with a total absence of productive spoken language. For those children who do acquire