Ingersoll, B. (2012). Brief report: Effect of a focused imitation intervention on social functioning in children with autism. Journal of Autism and Developmental Disorders, 42(8), 1768-1773.
Reviewed by: Sarah Luem, Rutgers University
Why research this topic?
Imitation is a skill that emerges early in life and plays a critical role in typical social development. Because children with autism exhibit deficits in both early imitation and subsequent social behavior, teaching imitation to children with autism may ultimately improve social functioning. Reciprocal Imitation Training (RIT) is a child-led, play-based imitation intervention for children with autism. Research has shown RIT is effective for increasing spontaneous gesture and object imitation in this population, and one study found secondary improvements in coordinated joint attention (looking back and forth between an activity and an adult) for most of the study’s participants. However, it was unclear whether gains in imitation were responsible for these improvements in joint attention.
The purpose of the present study was to investigate whether RIT leads to improvements in social functioning in children with autism. The researchers examined two indicators of social functioning: Initiation of joint attention and parent reports of their child’s social-emotional skills. Additionally, the researchers examined whether improvements in social functioning were the result of RIT’s effect on participants’ imitation skills.
What did the researchers do?
Twenty-seven children diagnosed with autism between 27- and 47- months participated in the present study. Participants were randomly assigned to the treatment group or a control group. Children in the treatment group received three hours of RIT per week for 10 weeks. Children in the control group received treatment as usual in the community. Children in both groups continued to receive their existing educational services throughout the study, which included special education, speech therapy, occupational therapy, and in-home applied behavior analysis. All children received the same type and amount of these services.
Treatment took place in a small room with pairs of identical play materials. To promote reciprocity, the therapist contingently imitated the child’s verbal and nonverbal behaviors and expanded the length of the child’s utterances. The therapist also used simplified language to describe the child’s behavior. To teach imitation, the therapist modeled an action approximately once per minute while also verbally describing the action. The therapist modeled the action a maximum of three times; if the child did not imitate the action within 10 seconds of the third model, the therapist physically prompted the child to imitate the behavior. After imitation, the therapist praised the child and returned to promoting reciprocity through contingent imitation and describing the child’s actions.
The researchers measured participants’ initiation of joint attention using the Early Social Communication Scales (ESCS). The measure was administered at pre-treatment, post-treatment, and 2-to 3- month follow-up. The Social-Emotional Scale of the Bayley Scales of Infant Development, 3rd Edition was used to measure participants’ social and emotional development (e.g., self-regulation, communicating needs, establishing relationships, etc.) according to parent reports. This measure was administered at pre-treatment and at follow-up. Lastly, the researchers used the Motor Imitation Scale and the Unstructured Imitation Assessment to measure each child’s motor and gesture imitation skills at pre- and post- treatment. Results from these last two scales were used in the mediation analysis.
What did the researchers find?
The researchers found that children who received RIT made significantly greater gains in their initiation of joint attention than children who did not receive RIT. These gains were maintained at two- to three-month follow-up. Additionally, children in the treatment group made significantly greater improvements in social-emotional functioning than the control group, as measured by parent reports at follow-up. The mediation analysis revealed that improvements in imitation were not responsible for the treatment’s beneficial effect on social functioning. As a result, the researchers argue that RIT’s effects on imitation recognition, rather than imitation production, may partially account for gains in social functioning. Future research is needed to dismantle RIT and determine which treatment components affect social functioning.
What are the strengths and limitations of the study?
Several limitations to the present study are noted. First, parents, therapists, and examiners were not blind to the children’s treatment conditions, which may have affected their expectations. Next, although all children received the same type and amount of services outside of their group assignments (i.e., speech, occupational therapy, special education, and ABA), the two groups may have differed in the types of skills that were targeted during these services, as well as treatment strategies. Also, the study enrolled a fairly small sample size, and results may not be generalizable to other groups of children with autism. Finally, although treatment gains were observed at 2-to-3 month follow-up, longer-term gains were not measured in this study. Despite these limitations, the findings suggest that RIT—a focused, low-intensity, and brief imitation intervention—can significantly improve social deficits in children with autism.
Citation for this article:
Luem, S. (2014). Research Synopsis of Ingersoll (2012), Brief report: Effect of a focused imitation intervention on social functioning in children with autism. Science in Autism Treatment, 11(4), 23-25.
