By: Kelli Ellenbaum, MS CCC-SLP
The importance of gesture development in infants and children has been long underestimated. In the field of speech language pathology and communication, there are few formal assessments that provide therapists and developmental specialists with developmental age comparisons. Therefore, much of the work we do as therapists during the evaluation process relies heavily on experience. This article will talk about the importance of gesture as a form of communication and provide a general guideline for gesture development up to 24 months.
Gestures are defined by Iverson and Thal (1998) as “actions produced with the intent to communicate and are typically expressed using fingers, hands, and arms, but can also include facial features (e.g. lip smacking for “eating”) and body motions (e.g. bouncing for “horsie”).“ Gestures appear very early in infancy. The jury is out on exactly when these gestures reliably show themselves. However, one study that was conducted by Meltzoff & Moore, 1983, evaluated infants 0.7 to 71 hours after birth and found that infants were able to imitate facial expressions specific to open/closing mouth, and sticking their tongue out. Researchers hypothesize that this form of imitative gesture means that language will later be built (http://minnesota.publicradio.org/display…1/midday2/). Early developing gestures have themselves deeply rooted into imitative learning. Human children learn communication through example. Communication, by definition, is the process of transferring information from one entity to another. Communication processes are sign-mediated interactions between at least two agents which share a repertoire of signs and semiotic rules (Wikipedia, 2010). Children observe activities around them and process large quantities of information through their senses. They track, gaze, see, and watch their environment and the interactions people have within that environment. Children use visual information to imitate what has been stored in their brains. More reliable communicative gestures are documented around 7-9 months (Carpenter et al., 1998). Some examples include open-handed reaching, reaching up to indicate they want to be held, pushing objects away in protest, and arm flailing.
As I stated earlier, infants and toddlers learn gesture through observational and imitative learning. There is an important social interaction component to this imitative learning that is required. Communication must be developed from human interaction. In other words, radio or TV will not develop communication that can be interpreted and used in natural context. Many children who are diagnosed with an autism spectrum disorder will use scripts derived from TV programs, movies, commercials, etc. While I do consider this a form of language learning, it is not initially functional for 2-way communication. In my clinical experience, I have found that the development of gesture in children with autism spectrum disorders is consistently absent if not significantly delayed. Many children that enter my office initially seek services for a delay in verbal communication (either not talking, or talking very little compared to their peers). During my evaluation process, I often ask parents if their child uses alternative forms of communication to convey messages (i.e. gesture, sign, pointing, hand leading, eye gaze, grunting). If their answer is yes, I derive that they have a good foundation for 2-way communication, and therapy will focus more heavily on increasing verbal communication (words, sounds, and the like). However, if the answer is no, this could indicate deficits possibly related to imitative learning, gesture, eye contact, social interaction, etc. Children who lack understanding and/or use of “gestural” communication often use behavior as a form of communication (represented by screaming, tantrums, crying, etc). If gesture is absent or delayed, I make observational notes and attempt to determine if an evaluation for an autism spectrum disorder, sensory processing disorder, or developmental disability is warranted. It is important to note that gestural communication and body language can taught, and just because gesture is absent or delayed does NOT mean that meaningful communication cannot be developed with the right strategies and treatment plan.
The frequency and variety of gestural use can be used as a factor in identifying deficits. In the presence of responsive adults, 12-month-olds typically communicate intentionally about one time per minute, 18-month-olds about two times per minute, and 24-month-olds about five times per minute (Wetherby, et al., 1988). Specific gestures (especially pointing) have also proven to be a strong indicator of later language skills in children with typical development (Morrissette, et al., 1995), children with Down syndrome (Franco & Butter, 1996), and children with autism (Baron-Cohen, 1989). An analysis of videotapes of 9-12-month-old infants who were later diagnosed with autism revealed that a limited variety of social interaction gestures was what differentiated them from the typically developing infants, not the frequency of social interaction gestures (Colgan, et al., 2006). Thus, a limited variety of communicative gestures may indicate risk for communicative disorders as early as 12 months of age (Crais, et al., 2009).
There are few formal assessments available to assess gestural function. Those tools available have not historically focused primarily on gestural development, but are rather included as a component of overall development. Gestural communication can be difficult to observe in an unfamiliar/new clinic setting, therefore, more informal assessments (such as parent interview and observation of parent/child interaction) are extremely helpful. Informal assessments are subjective and provide the most information when the evaluator is skilled and knowledgeable in the areas of interaction, nonverbal communication/gesture, and play. Documented observation of communicative components will positively contribute to the information obtained by formal tests. A complete communication evaluation helps therapists determine etiology and plans of treatment that specifically address those deficits most impacting a child.
Based on the research that has been conducted, here are some general guidelines for gesture development ages 9-24 months. This information is provided by Crais, E., Douglas, D. & Campbell (2004) in their article titled: The intersection of the development of gestures and intentionality.
Gestural communication 9-12 months
A child between 9-12 months is able to protest by using a body signal (e.g. back arching) and push objects away with their hand. They are able to request objects by pointing with their hand, reaching, making physical contact with an adult to get attention. Children at this age are able to request actions by reaching to be picked up and performing an action indicating they want something to reoccur. Socially, a child 9-12 months can seek attention by banging objects together, use consistent body movement to get attention (e.g. hand flapping, kicking legs), and grab an adult’s hand. Interest in social games emerges at this age. A child can demonstrate anticipation of social games (such as peek-a-boo, and song/finger plays). Examples of anticipation include moving their bodies or holding hands up for the adult to manipulate. Children also initiate social games by covering their face with a blanket indicating they want to play “peek-a-boo.” Representational gestures such as waving goodbye and imitating clapping emerge between 9-12 months. Children demonstrate shared attention by showing and giving objects.

Gesture communication 12-15 months
A child between 12-15 months is able to request by looking at the object, then the adult, and then the object. They are able to request actions by giving an object to an adult for help (e.g. to have something opened or fixed). Social interaction gestures at this age include demonstrating the functions of objects such as brushing hair with a brush, putting on a hat, or stirring with a spoon. At this age, children begin to hug stuffed animals, clap in excitement/accomplishment, and dance to music. Children ages 12-15 months point to objects or events.

Gesture communication 15-18 months
A child between 15-18 months protests by shaking their head for “no.” Requesting gestures include reaching while opening and closing their hands to obtain an object, pointing to get someone to do something (e.g. open a door, carry them to another room), and taking the hand of an adult and guiding a hand or body to do something (e.g. take adult hand and putting it on their stomach to get tickled). Socially, children begin demonstrating actions such as smacking their lips to indicate they want something to eat. Children ages 15-18 months share attention by pointing to objects upon request (e.g. “show me the ball” or “Where’s the doggie?”). They request information by pointing at pictures or objects with the expectation that an adult will name it for them.
Gesture communication 18-24 months
A child between 18-24 months seeks attention through “showing off” (e.g. sticking out tongue, making funny faces, making sounds to get a laugh, and performing fingerplays such as patty cake). Representational gestures include shrugging shoulders or putting hands up to indicate “all done” or “where did it go?” A child of this age blows kisses, signals “shhh” with fingers to lips, nod with a “yes,” pretends to sleep, and uses conventional gestures of excitement (e.g. high five). Children 18-24 months will share attention by clarifying verbal messages with gesture (e.g. point to an object they have attempted to verbally label).
Children who have not developed gestural communication on time should be evaluated by a speech language pathologist. While some children develop verbal language without gesture, it is important to consider the importance of gestural development for the further comprehension and use of nonverbal communication.
References
Baron-Cohen, S. (1989). Perceptual role-taking and protodeclarative pointing in autism. British Journal of Developmental Psychology, 7, 113-127.
Carpenter M., Nagell, K., & Tomasello, M. (1998). Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monographs of the Society of Research in Child Development, 63,(4 Serial No. 255).
Colgan, S., Lanter, E., McComish, C., Watson, L., Craise, E., & Baranek, G. (2006). Analysis of social interaction gestures in infants with autism. Child Neuropsychology, 12, 307-319.
Crais, E., Douglas, D. & Campbell, C. (2004). The intersection of the development of gesture and intentionality. Journal of Speech, Language, and Hearing Research, 47, 678-694.
Crais, E., & Robert, J. (2004). Assessing communication skills. In M. McLean, M. Wolery, & D. Bailey (Eds.), Assessing infants and preschoolers with special needs (3rd ed., pp. 345-411). Upper Saddle River, NJ: Pearson/Merrill/Prentice Hall.
Crais, E., Watson, L., Baranek, G. (2009). Use of Gesture Development in Profiling Children’s Prelinguistic Communication Skills. American Journal of Speech-Language Pathology, 18, 95-108.
Franco, F., & Butterworth, G. (1996). Pointing and social awareness: Declaring and requesting in the second year of life. Journal of Nonverbal Behavior, 24, 81-103.
Iverson, J. & Thal, D. (1998). Communicative transitions: There’s more to the hand than meets the eye. In A. Wetherby, S. Warren, & J. Reichle (Eds.), Transitions in prelinguistic communication. (pp. 59-86). Baltimore: Brookes.
Meltzoff, A., & Moore, K. (1983). Newborn Infants Imitate Adult Facial Gestures. Child Development, 1983, 54, 702-709.
Morissette , P., Ricard, M. & Decarie, T. (1995). Joint visual attention and pointing in infancy: A longitudinal study of comprehension. British Journal of Developmental Psychology, 13, 163-175.
Wetherby A., Cain, D. H., Yonclas, D.G., & Walker, V.G. ( 1988). Analysis of intentional communication of normal children from the prelinguistic to mulitiword stage. Journal of Speech and Hearing Research, 31, 240-252.
http://minnesota.publicradio.org/display…1/midday2/
http://en.wikipedia.org/wiki/Communication
Featured Author: Kelli Ellenbaum, MS CCC-SLP
We thank Kelli Ellenbaum for providing us with this article for our newsletter.
Kelli Ellenbaum is an ASHA certified Speech Language Pathologist who completed her master’s degree at the University of North Dakota in 2001. She is licensed in the state of North Dakota where she has owned Red Door Pediatric Therapy since 2006. Kelli received her Autism Certification in 2005. Kelli specializes in treating children and the autism spectrum. She serves as an executive board member for the Social Key Non-profit organization in North Dakota