Retrospective video analyses indicate that disruptions in gesture use occur as early as 9-12 months of age in infants later diagnosed with autism spectrum disorders (ASD). We report a prospective study of gesture use in 42 children identified as at-risk for ASD using a general population screening. At age 13-15 months, gestures were more disrupted in infants who, at 20-24 months, met cutoffs for "autism" on the ADOS [Autism Diagnostic Observation Schedule] than for those who met cutoffs for "autism spectrum" or those who did not meet cutoffs for either, whereas these latter two groups displayed similar patterns of gesture use. Total gestures predicted later receptive and expressive language outcomes; therefore, gesture use may help identify infants who can benefit from early communication interventions.