Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes.
Toddlers who gesture a lot but only sometimes are the ones most likely to pass parent screens yet still be autistic—always run the ADOS-2 before you rule it out.
01Research in Context
What this study did
The team watched ADOS-2 videos of toddlers who do not yet talk.
They looked for every nonverbal move: eye contact, pointing, waving, showing toys.
A computer sorted the kids into five clear styles of nonverbal use.
Then they asked: which style is most often missed by parent questionnaires?
What they found
One profile stood out: kids who use lots of gestures, but only sometimes.
These children passed parent screens yet were quickly flagged by trained clinicians.
In short, spotty but frequent nonverbal use is the biggest red flag for slipping through parent checklists.
How this fits with other research
Christensen et al. (2024) saw the same toddler tapes and found that clinicians need only five minutes to spot autism when social reciprocity, eye contact, and nonverbal use are all off.
The two studies line up: the kids with the mixed, inconsistent profile are the very ones experts notice first.
Narzisi et al. (2013) showed that CBCL 1½-5 Withdrawn and PDP scales catch many toddlers that parent reports miss.
Together the papers say: if the parent score looks clean but nonverbal signs are uneven, trust the ADOS-2 and double-check with CBCL sub-scales.
Why it matters
You can’t rely on parent forms alone for toddlers who gesture in fits and starts.
Add a brief, structured ADOS-2 play session to every intake.
If the child shows mixed nonverbal use, move straight to full evaluation even when parents say “we don’t see problems.”
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →During intake, if the parent checklist is clean but the child’s pointing or eye contact comes and goes, schedule an ADOS-2 right away.
02At a glance
03Original abstract
Autistic individuals exhibit differences in their use and understanding of nonverbal communication; however, individual patterns of nonverbal strengths and challenges vary significantly. This heterogeneity can complicate the diagnostic and screening processes and can result in delayed or missed diagnoses. In this study, we characterize various profiles of nonverbal communication skills among 215 pre-verbal children with autism (Mage = 36.27 months, range = 18-70) and explore how these profiles are related to screening outcomes, diagnostic certainty, and developmental and behavioral features. We conducted a latent class analysis of nine items assessing nonverbal communication skills from the Toddler Module and Module 1 of the Autism Diagnostic Observation Schedule, 2nd Edition. Five nonverbal profiles were identified that differentiated children based on the form, function, and frequency of their nonverbal communication skills. Furthermore, screening outcomes and clinician certainty in autism diagnosis varied by nonverbal profile. False negative screening outcomes based on parent report were highest for children who used a range of nonverbal skills but with limited frequency or consistency. Clinicians, on the other hand, tended to have high certainty in an autism diagnosis for children with this profile, and instead rated their lowest certainty in diagnosing children who demonstrated consistent integration of eye contact with their nonverbal communication. The profiles identified in this study could be clinically useful in helping to identify children at highest likelihood of being overlooked during the screening or diagnostic processes, providing an opportunity to improve early identification and intervention for autism.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.1002/aur.3229