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J Commun Disord. 2017 Sep;69:27-43. doi: 10.1016/j.jcomdis.2017.06.002. Epub 2017 Jul 1.

Joint attention and oromotor abilities in young children with and without autism spectrum disorder.

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Department of Communication Sciences and Disorders, Appalachian State University, 730 Rivers Street, 124 Edwin Duncan Hall, Boone, NC 28608, United States. Electronic address:
Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill, CB 7190, 3126 Bondurant Hall, Chapel Hill, NC 27599-7190, United States. Electronic address:
Department of Communication Sciences and Disorders, The University of Vermont, Pomeroy Hall, 489 Main St., Burlington, VT 05405, United States. Electronic address:



This study examined the relationship between joint attention ability and oromotor imitation skill in three groups of young children with and without Autism Spectrum Disorder using both nonverbal oral and verbal motor imitation tasks. Research questions addressed a) differences among joint attention and oromotor imitation abilities; b) the relationship between independently measured joint attention and oromotor imitation, both nonverbal oral and verbal motor; c) the relationships between joint attention and verbal motor imitation during interpersonal interaction; and d) the relationship between the sensory input demands (auditory, visual, and tactile) and oromotor imitation, both nonverbal oral and verbal motor.


A descriptive, nonexperimental design was used to compare joint attention and oromotor skills of 10 preschool-aged children with ASD, with those of two control groups: 6 typically developing children (TD), and 6 children with suspected Childhood Apraxia of Speech (sCAS) or apraxic-like symptoms. All children had at least a 3.0 mean length utterance.


Children with ASD had poorer joint attention skills overall than children with sCAS or typically developing children. Typically developing children demonstrated higher verbal motor imitation skills overall compared to children with sCAS. Correlational analyses revealed that nonverbal oral imitation and verbal motor imitation were positively related to joint attention abilities only in the children with ASD. Strong positive relationships between joint attention in a naturalistic context (e.g., shared story experience) and oromotor imitation skills, both nonverbal oral and verbal motor, were found only for children with ASD. These data suggest there is a strong positive relationship between joint attention skills and the ability to sequence nonverbal oral and verbal motor movements in children with ASD. The combined sensory input approach involving auditory, visual, and tactile modalities contributed to significantly higher nonverbal oral and verbal motor imitation performance for all groups of children.


Verbal children with ASD in this study had difficulties with both the social and cognitive demands of oromotor imitation within a natural environment that demanded cross-modal processing of incoming stimuli within an interpersonal interaction. Further, joint attention and oral praxis may serve as components of an important coupling mechanism in the development of spoken communication and later developing socialcognitive skills.


Autism spectrum disorder; Childhood apraxia of speech; Joint attention; Language development; Oromotor imitation

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