Socialization and nonverbal communication in atypically developing infants and toddlers.
Stacked diagnoses mean stacked social delays—screen for ASD in every child with CP.
01Research in Context
What this study did
The team watched babies and toddlers with three diagnoses: cerebral palsy (CP), Down syndrome (DS), and autism (ASD).
They scored how well each child used eye gaze, gestures, and shared play—skills that come before words.
What they found
Kids with CP plus ASD had the hardest time. Kids with CP alone did better, and kids with DS did best, though every group showed some delays.
In plain words, the more diagnoses stacked up, the bigger the social-communication gap.
How this fits with other research
Mastrogiuseppe et al. (2015) saw the same ranking: toddlers with ASD made fewer gestures than DS peers during play with mom.
Paul et al. (2014) extended the idea downward, showing that even before age two, ASD toddlers trail matched DD peers on daily living and receptive language.
van der Miesen et al. (2024) went deeper, mapping five nonverbal profiles on the ADOS-2 and found that spotty, inconsistent skills are the ones most often missed by parent screens—explaining why some CP+ASD toddlers may pass early checklists yet still need help.
Why it matters
If you serve infants or toddlers with CP, do not assume their motor diagnosis tells the whole story. Add a brief social-communication probe—watch for eye contact, shared smiles, and consistent gestures. When these look uneven, flag for fuller ASD evaluation even if parents say "everything’s fine." Early dual diagnosis means earlier ABA, speech, and play-based services that close the gap before kindergarten.
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02At a glance
03Original abstract
Emphasis on early identification of atypical development has increased as evidence supporting the efficacy of intervention has grown. These increases have also directly affected the availability of funding and providers of early intervention services. A majority of research has focused on interventions specific to an individual's primary diagnoses. For example, interventions for those with cerebral palsy (CP) have traditionally focused on physiological symptoms, while intervention for individuals with Autism Spectrum Disorder (ASD) focus on socialization, communication, and restricted interests and repetitive behaviors. However deficits in areas other than those related to their primary diagnoses (e.g., communication, adaptive behaviors, and social skills) are prevalent in atypically developing populations and are significant predictors of quality of life. Therefore, the purpose of the current study was to examine impairments in socialization and nonverbal communication in individuals with Down's syndrome (DS), CP, and those with CP and comorbid ASD. Individuals with comorbid CP and ASD exhibited significantly greater impairments than any diagnostic group alone. However, individuals with CP also exhibited significantly greater impairments than those with DS. The implications of these results are discussed.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.08.024