News and Knowledge

The OAR Funded Research Report provides updates on the status of OAR funded research through the publication of the different studies’ interim and final reports. This month’s report was submitted by Dr. Brooke Ingersoll and examines the effectiveness of imitation intervention in helping children with autism improve their social skills.

This project was conducted by the Principal Investigator (P.I.), Brooke Ingersoll, PhD, with the assistance of five undergraduate research assistants from Lewis and Clark College. This study was designed to determine whether an experimental naturalistic imitation intervention could be used to teach imitation of descriptive gestures to young children with autism during play. It also examined whether the intervention resulted in increases in the children’s spontaneous use of descriptive gestures. Further, the question of whether the intervention led to socially valid changes in the children’s use of social-communication skills that could be identified by naïve observers was examined.

This study used a multiple-baseline design across five boys with autism ranging in age from 34 to 49 months. Baseline ranged from 2 to 6 weeks, followed by 10 weeks of treatment. Once a week towards the end of treatment, generalization probes, which were identical to baseline and included novel toys, therapist, and setting, were conducted. Participants returned for a one-month follow-up and received three generalization sessions. The first 10 minutes of each day of baseline, treatment, follow-up and all generalization probes were videotaped and scored for total gesture imitation, combined gesture imitation, total spontaneous gesture use, and combined spontaneous gesture use. In addition, the Motor Imitation Scale (Stone et al., 1997) and (2) Structured Laboratory Observation (SLO) with the parent were administered at pre and post. Lastly, the social validity of the intervention was assessed through subjective ratings by naïve viewers of the children’s behavior before and during treatment (Schreibman, Koegel, Mills & Burke, 1981). Two groups of 18 college students viewed one of two tapes containing a videotaped sample of all the participants during a randomly selected baseline session and randomly selected generalization session taken during treatment. One tape consisted of three of the children at during baseline and two children during treatment and the other tape consisted of the same children in opposite points of treatment. The participants completed a brief questionnaire about the children’s imitation, language, play, and social behavior using a 5-point rating scale after viewing each 2-minute segment.

All participants increased their imitation of total descriptive gestures and combined descriptive gestures in the treatment setting and on a structured imitation assessment. Gains generalized to novel materials, a therapist, and a setting. One-month follow-up data indicated that all children maintained their gains in gesture imitation and combined imitations. In addition, all participants exhibited increases in their spontaneous use of total descriptive gestures which generalized to some untrained contexts. For two children the gains were small, while for three children the gains were robust and included combined spontaneous gesture use. All children increased their gesture imitation from pre to post on the structured imitation assessment. Gains in gesture imitation and spontaneous use did not, however, generalize to use with the parents during the SLO. Finally, naïve observers rated the children significantly better during treatment than baseline in all categories (imitates gestures, uses gestures appropriately, shows interest in adult, imitates actions with objects, plays with toys appropriately, and uses language appropriately). These results provide support for the effectiveness of a naturalistic intervention for teaching gesture imitation and offer a new and potentially important treatment option for young children who are not yet imitating or using descriptive gestures.

This study advances the state of knowledge regarding autism intervention in that it demonstrates that imitation of descriptive gestures can be targeted using a naturalistic approach. Previous research has used a structured behavioral approach; thus our findings suggest that imitation can be taught within ongoing interactions. In addition, our findings suggest that teaching children with autism to imitate gestures within natural interactions results in increases in spontaneous gesture use. Further, the findings suggest that this intervention also leads to more global gains in social-communication skills including language and thus increasing gesture imitation in young children with autism may improve communicative competence.

Despite the promising results, evidence for generalization to interactions with the parents has been much more limited, particularly for gesture imitation. One potential explanation for this failure to generalize is that parents may not be aware of their own gesture use. Further, their gestures may be too subtle for initial acquisition by the child, a possibility that we observed during our parent-child interaction observation in which the parents did not model many gestures and those they modeled were very subtle. We believe that an important modification would be to include a brief parent training component on the importance of gesture use, appropriate gestures to model, how to encourage children to imitate, and how to reinforce gesture use. Therefore, an important next step in this research is to assess the effect of teaching parents to implement the intervention with their children with autism. We conducted a small study examining the effectiveness of teaching parents to use the experimental intervention to teach their children to imitate with objects. We included one parent-child dyad in which the mother was taught to target object and gesture imitation. Our findings suggest that this is an effective intervention and that teaching parents to target gesture imitation resulted in generalization to the family’s home. This study has been accepted for publication in Research in Developmental Disabilities.

The results of this study are relevant for individuals with autism to the extent that they provide support for a novel intervention that is successful for teaching the imitation and spontaneous use of descriptive gestures, an important skill that has received little attention in intervention literature. The intervention resulted both in improvements in the targeted behavior (gesture imitation) but also resulted in spontaneous use of gesture, which generalized to a novel setting, therapist, and materials. In addition, the children were rated as exhibiting more appropriate gesture, social, play, and language skills during treatment, suggesting that the intervention resulted in global changes in social-communication skills that were evident to naïve observers in a brief observation. These findings suggest that the experimental intervention offers a simple, yet highly effective approach for targeting needed skills in young children with autism.

For parents, the results are relevant because they provide support for an effective intervention that targets skills that parents consider to be very important: social-communication. Our findings showed that the gains were limited with parents motivated us to conduct a follow-up study using parent training. These results suggest that parents can learn to use the intervention and that it results in positive gains in imitation skills in their children with autism. Parents in the follow-up study rated the intervention as easy and enjoyable to use as well as effective for increasing a variety of social-communication skills in their children. This finding suggests that the intervention would be highly appropriate for parent training. For teachers, the findings are relevant because they offer a new and potentially promising intervention option for targeting gesture imitation skills in young children with autism. Based on these and previous findings, it is recommended that early intervention programs use Reciprocal Imitation Training (RIT) to target both gesture and object imitation skills in their young students with autism. This recommendation would provide a better treatment option for early intervention programs for children with autism.

The findings of this study suggest two future directions for research. First, the need to conduct a larger study of the experimental intervention targeting both object and gesture imitation, which uses standardized assessments and randomized control trials. Along these lines, determining whether certain behavioral characteristics can predict which children respond best to the intervention and whether changes in imitation as a result of the intervention lead to gains in other social-communication skills, including language, play, and social interaction. Second, interest in comparing the effectiveness of this intervention to Discrete Trial Training (DTT), a traditional structured imitation training procedure that is commonly used in early intervention programs to determine whether one intervention leads to greater gains in imitation skills and/or more improvement overall in social communication than the other.