Early gesture, early vocabulary, and risk of language impairment in preschoolers

•Children of male sex and from disadvantaged sociodemographic backgrounds were at a higher risk for language impairment.•Children at risk for language impairment had lower early gesture and vocabulary scores than their counterparts.•Early deictic and conventional gestures were related to both early vocabulary production and comprehension.•The effect of early vocabulary production on the risk of language impairment at preschool ages was direct but the effect of gesture was indirect.•Early vocabulary production mediated the contribution of early gesture use to later risk of language impairment. Gesture precedes vocabulary development and may be an early marker of later language impairment. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, this study examined the contribution of children’s (N=1064) early gestures and early vocabularies to their risk of language impairment in preschool years. At age 15 months, maternal reports on children’s use of gestures and vocabulary comprehension and production skills were measured using the MacArthur Communicative Development Inventories. At age 3 and 4.5 years, children’s language skills were assessed using the Reynell Developmental Language Scale and Preschool Language Scale-3, respectively. After controlling for child, maternal, and family sociodemographic factors, children at later risk for language impairment were found to exhibit significantly less early gesture use and vocabulary skills relative to their typically developing peers. Early use of gestures was also significantly correlated with early vocabulary skills. The effect of early gesture on children’s later risk of language impairment was indirect and mediated by early vocabulary production. Early gesture may have the potential to serve as an early diagnostic tool and play a role in early intervention.