Brief Report: Pilot Randomized Controlled Trial of Reciprocal Imitation Training for Teaching Elicited and Spontaneous Imitation to Children with Autism

Children with autism exhibit significant deficits in imitation skills. Reciprocal Imitation Training (RIT), a naturalistic imitation intervention, was developed to teach young children with autism to imitate during play. This study used a randomized controlled trial to evaluate the efficacy of RIT on elicited and spontaneous imitation skills in 21 young children with autism. Results found that children in the treatment group made significantly more gains in elicited and spontaneous imitation, replicating previous single-subject design studies. Number of spontaneous play acts at pre-treatment was related to improvements in imitation during the intervention, suggesting that children with a greater play repertoire make greater gains during RIT.     

The Collateral Effects of Joint Attention Training on Social Initiations, Positive Affect, Imitation, and Spontaneous Speech for Young Children with Autism

Joint attention may be a core deficit in autism which underlies the abnormal development of later emerging social-communication behaviors. Given this theory, researchers have suggested that teaching young children with autism to engage in joint attention may lead to collateral increases in other non-targeted social-communication behaviors. In this study, children with autism participated in a 10-week joint attention training program and collateral changes in non-targeted behaviors were assessed. Following participation in the intervention, positive collateral changes were observed in social initiations, positive affect, imitation, play, and spontaneous speech. Results support the hypothesis that teaching joint attention skills leads to improvement in a variety of related skills and have implications for the treatment of young children with autism.     

Teaching play skills to young children with autism

Abstract

Background Play is critical for the development of young children and is an important part of their daily routine. However, children with autism often exhibit deficits in play skills and engage in stereotypic behaviour. We reviewed studies to identify effective instructional strategies for teaching play skills to young children with autism.

Method Empirical studies on teaching play skills to young children with autism published from 1990 to 2011 were located. These studies included single subject and group designs.

Results Twenty-six studies were reviewed. The majority of studies on teaching play skills used combined interventions. Children with autism improved their play skills, with direct intervention embedding their interests during play. Improvements in play skills increased positive social interactions and decreased inappropriate behaviour as collateral effects.

Conclusions Further research is needed to develop more effective play skill interventions that assess the functional use of play and are implemented in the natural environment.     

Autism severity and motor abilities correlates of imitation situations in children with autism spectrum disorders

Impaired performance in a range of imitation tasks has been described in children with autism spectrum disorders (ASD) and several underlying mechanism have been suggested. This study examined whether imitation abilities are related to autism severity and to motor skills. Furthermore, the performance of children with ASD in four imitation situations (body movements and ‘action on objects’, using meaningful and non-meaningful tasks) was compared. Twenty-five children aged 32–51 months diagnosed with autism (23) and ASD (2) were evaluated for autism severity using the Autism Diagnosis Observation Schedule and for gross and fine motor skills using the Peabody Developmental Motor Scales. Controlling for cognitive level, imitation abilities in all four situations correlated significantly only with autism severity measures and mostly with socio-communication deficits. Motor abilities were below average and did not correlate with imitation abilities nor with autism severity. Comparison of the four imitation situations revealed that performances of meaningful actions were better than non-meaningful actions and imitation of ‘action on objects’ was better than imitation of body movements. The current research supports the fact that socio-communication deficits and not motor abilities are linked to imitation abilities in young children with autism.     

Sibling self-management: Programming for generalization to improve interactions between typically developing siblings and children with autism spectrum disorders

The present study taught typically developing (TD) siblings of children with autism spectrum disorders (ASD) social-communicative and self-management skills. The authors’ hypothesized that the acquisition of self-management skills would support generalization of targeted social-communicative responses. A multiple baseline probe design across sibling dyads was used to decrease exposure to unnecessary sessions in the absence of intervention. Four TD siblings were taught self-management of a social skills curriculum using behavioral skills training, which consisted of instructions, modeling, practice, and subsequent feedback. Results indicated that TD siblings learned to self-manage the social skills curriculum with some generalization across novel settings and over time. Comparisons of social-communicative responses to their typical peers provided some support for the social validity of the intervention outcomes. These results support the use of self-management, when explicitly programming for generalization, which continues to be a key consideration when including TD siblings in interventions with their siblings with ASD.     

Nonverbal Communication Skills in Young Children with Autism

Objective The study was to examine nonverbal communication in young children with autism. Methods The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18–20-month-old, and 22 13–15-month-old typically developing toddlers and infants. The abbreviated Early Social Communication Scales [Mundy et al. 1996, Early social communication scales (ESCS)] were used to test three types of nonverbal communicative skills, i.e., joint attention, requesting, and social interaction. Both frequency and proportion analyses were done in group comparisons. Results (1) Two- to three-year-old children with autism displayed deficits in joint attention ability, especially high-level skills. (2) The deficit in terms of frequency of communication was marked even compared with typically developing infants with younger mental age. (3) Young children with autism had different nonverbal communication profile compared with all three comparison groups. Conclusion Early social-communicative difficulties in autism involve early triadic communications involving joint attention and possibly dyadic turn-taking skills, which has implications for both early screening and early intervention.     

The effect of context on imitation skills in children with autism

Children with autism exhibit deficits in imitation skills. Previous authors have suggested that they may have particular difficulty imitating in natural social interactions, but properly controlled experiments investigating this possibility have not been conducted. To investigate this possibility, children with autism and typically developing children were compared on a series of imitation tasks presented either in a structured-elicited or naturalistic-spontaneous condition. Modeled actions were counterbalanced across conditions. Results suggest children with autism imitated less than typically developing children overall; however, this difference was mainly evident when the imitation task was presented in a spontaneous context. In addition, they exhibited less coordinated joint attention during imitation than the typically developing children. These findings support the hypothesis that children with autism are particularly impaired in their ability to imitate spontaneously.     

The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism

This study assessed the relation between pre-intervention variables (cognition, socialization and communication) to outcome in young children with autism. METHOD: Twenty five children with autism (20-32 months) were enrolled in intensive behavior intervention. The children were divided into groups based on their IQ scores and on the severity of their social interaction and communication deficits [per autism diagnostic observation schedule (ADOS) scores]. Six developmental-behavioral domains including, imitation, receptive language, expressive language, nonverbal communication skills, play skills and stereotyped behaviors were assessed at pre- and post-1 year of intervention times. RESULTS: Significant progress was noted in all the six developmental-behavioral domains after 1 year of intervention. Children with higher initial cognitive levels and children with fewer measured early social interaction deficits showed better acquisition of skills in three developmental areas, receptive language, expressive language and play skills. Both groups showed better progress in Receptive language skills. Better progress in expressive language was associated with the child's social abilities, while more significant progress in play skills was related to pre-intervention cognitive level. CONCLUSIONS: These findings emphasize the importance of early intensive intervention in autism and the value of pre-intervention cognitive and social interaction levels for predicting outcome.     

Disseminating ASD Interventions: A Pilot Study of a Distance Learning Program for Parents and Professionals

There is a need for the adaptation of training in evidence-based interventions to non-traditional methods, particularly for individuals working with children with autism spectrum disorders (ASD). An internet-based self-directed distance learning program was created to teach reciprocal imitation training, a naturalistic behavioral intervention aimed at increasing imitation in children with ASD. A single-subject multiple-baseline design study evaluated the effect of the program on changes in therapist (sample 1) and parent (sample 2) knowledge and behavior, and changes in child behavior. Adult participants improved their knowledge and use of the intervention techniques, and child participants improved their rates of imitation. Results suggest that a self-directed distance learning program may be effective for disseminating evidence-based practices to individuals working with children with ASD.     

Multiple effects of joint attention intervention for children with autism

Joint attention refers to an early developing set of behaviors that plays a critical role in both social and language development and is specifically impaired in children with autism. In a series of three studies, preschool teachers demonstrated the effectiveness of discrete trial instruction and pivotal response training strategies to teach joint attention to 5 children with autism (Study 1). Parents of 2 of the 5 children also taught joint attention at home and in the community (Study 2). Several additional dependent measures demonstrated collateral improvements in expressive language and social-communicative characteristics that were socially validated by parent raters (Study 3). Results are discussed with respect to the importance of addressing different forms of joint attention, the necessity to extend intervention to naturalistic contexts and joint attention partners, the pivotal nature of joint attention, and whether intervention adequately addresses both the form and social function of joint attention.     

Social skills interventions for the autism spectrum: essential ingredients and a model curriculum

This article outlines the ingredients the authors feel are critical to making social skills interventions successful for children with autism spectrum disorders. The authors described basic principles for teaching social skills that capitalize on the strengths of such children, while specifically addressing their deficits. The authors applied these widely used principles to group social skills intervention. In particular, social skills groups for children with ASD need to break down complex social behaviors into concrete steps and rules that can be memorized and practiced in a variety of settings. Abstract concepts must be made concrete through a variety of visual, tangible, "hands-on" activities that make socialization fun. Visual structure and predictable routines are essential. Also critical to the success of social skills intervention are instruction and activities that provide necessary support for the language abilities of the participants. A variety of learning opportunities must be used to teach the goals and skills most relevant to children with ASD. These skills must be integrated as intervention progresses. Furthermore, interactions that require the children to focus on peers create a positive social group culture. Within this culture and environment, self-awareness and positive self-esteem can be fostered. A behavior plan that specifies individual goals for group members and a specific system for delivering rewards should be included. Other important ingredients include generalization, which is encouraged through community outings, skill practice in more naturalistic settings, and collaboration with parents and teachers to work on skills outside the group intervention. Weekly therapy does little to change basic deficits of ASD unless there is daily practice and reinforcement of the skills being learned in more natural situations. The authors hope that outlining these principles and specific techniques will encourage more clinicians to offer social skills groups and thus increase their availability around the nation and world. Continued research and treatment for social skills is necessary to provide much needed empiric evidence to determine effectiveness of such interventions.     

Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism

Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. Although several studies have identified behaviors that are possible indicators of best outcome, changes in performance are typically measured using norm-referenced standardized scores referencing overall functioning level rather than via repeated observational measures of autism-specific deficits (i.e., social behavior). In the current study, 83 children with autism (CWA), aged 1, 2 and 3 years, and 58 same-aged typically developing children (TDC) were directly observed in the areas of cognitive skills, joint attention (JA), play, and stereotypic behavior using a measure called the Early Skills Assessment Tool (ESAT; MacDonald et al., 2006). CWA were assessed at entry into an EIBI program and again after 1 year of treatment. Changes in performance were compared pre- and post-treatment as well as to the normative data by age. Results indicate significant gains on the ESAT across all age groups with the greatest gains seen in the children who entered treatment prior to their second birthday. Increases were seen on direct measures of JA, play, imitation and language while decreases were seen in stereotypy regardless of level of performance at entry into EIBI. The ESAT, a direct measurement tool, served as a sensitive tool to measure changes in autism symptomatology following EIBI treatment.     

Teaching caregivers to implement video modeling imitation training via iPad for their children with autism

Children with autism fail to imitate from an early age and this lack of imitation is a salient diagnostic marker for the disorder. For children with Autism Spectrum Disorder (ASD), increased imitation skills appear to be related to increased skill development in a variety of areas. Video modeling was recently validated as a technique to support imitation acquisition in young children with autism. The purpose of this research was to determine if there is a functional relation between caregiver implemented Video Modeling Imitation Training (VMIT) via iPad and increased imitation skills in young children with autism. In addition, a secondary analysis of language development after exposure to VMIT was also conducted. A multiple baseline design across four caregivers and their children with autism was implemented. Results indicated that all four caregivers were able to successfully create video models on an iPad when provided with minimal training and implement VMIT with fidelity for their children. All four children made substantial gains in their imitation skills during caregiver implemented treatment. Imitation skills maintained post treatment and, to varying degrees, generalized to imitation of live models. Expressive language skills increased to varying degrees for all participants.     

Teaching Young Nonverbal Children with Autism Useful Speech: A Pilot Study of the Denver Model and PROMPT Interventions

This single subject design study examined two models of intervention: Denver Model (which merges behavioral, developmental, and relationship-oriented intervention), and PROMPT (a neuro-developmental approach for speech production disorders). Ten young, nonverbal children with autism were matched in pairs and randomized to treatment. They received 12 1-h weekly sessions of therapy and daily 1-h home intervention delivered by parents. Fidelity criteria were maintained throughout. Eight of the ten children used five or more novel, functional words spontaneously and spoke multiple times per hour by the conclusion of treatment. There were no differences in acquired language skills by intervention group. Initial characteristics of the best responders were mild to moderate symptoms of autism, better motor imitation skills, and emerging joint attention skills. This research was supported by an award from the National Institute of Deafness and Communication Disorders #R21 DC05574, and by the Coleman Institute of University of Colorado. Dr. Rogers and Dr. Hepburn are also partially supported by the National Institute of Child Health and Human Development HD35468.     

Treatment approach,autism severity and intervention outcomes in young children

The current study examined the relation between autism severity at baseline, type of intervention employed and outcomes in young children with autism spectrum disorder (ASD). Seventy-eight children with ASD, aged 15–35 months (M = 25.4, SD = 4.2), received either applied behavioral analysis (ABA) or integration of several intervention approaches (Eclectic) in community center-based programs. Outcome was measured after 1 year of intervention using standardized autism diagnostic tests, and cognitive and adaptive skills evaluations. ASD diagnosis was highly stable (99%). Both intervention groups improved significantly in verbal cognitive abilities and in socialization and communication adaptive skills, but no significant difference between the intervention groups was documented. Less severe autism symptoms at baseline were associated with better progress in adaptive skills and in cognitive abilities. Within the group with less severe autism symptoms, those who received Eclectic intervention had a better outcome than those who received ABA in communication and socialization adaptive skills as reported by the parents, but not in the standardized cognitive test results. The child's baseline social abilities and deficits appear to be crucial variables for intervention outcomes and should be considered in treatment approach decision-making.     

A Comparison of Two Group-Delivered Social Skills Programs for Young Children with Autism

A social skills group intervention was developed and evaluated for young children with autism. Twenty-five 4- to 6-year-old (diagnosed) children were assigned to one of two kinds of social skills groups: the direct teaching group or the play activities group. The direct teaching group used a video-modeling format to teach play and social skills over the course of the intervention, while the play activities group engaged in unstructured play during the sessions. Groups met for 5 weeks, three times per week, 1 h each time. Data were derived and coded from videotapes of pre- and post-treatment unstructured play sessions. Findings indicated that while members of both groups increased prosocial behaviors, the direct teaching group made more gains in social skills.     

Symbolic Play in School-Aged Minimally Verbal Children with Autism Spectrum Disorder

Few interventions exist for school-aged minimally verbal children with autism spectrum disorder (ASD). Even though play skills are associated with children’s production of language, few studies have focused on play for minimally verbal children. Fifty-eight minimally verbal children with ASD received a naturalistic developmental behavioral intervention. Children were randomized to receive a speech generating device in the context of the intervention or not. Children in both conditions improved in play skills at exit. Children demonstrated an increase in play skills in proximal (sessions) and distal (during blind assessment) contexts. Minimally verbal children with ASD can improve their play skills within a targeted intervention. Increases in symbolic play were associated with increases in expressive language skills.     

Play skills taught via behavioral intervention generalize,maintain, and persist in the absence of socially mediated reinforcement in children with autism

We measured generalization, maintenance and parent reports of child happiness in the context of a behavioral intervention to teach toy-play skills to three young children with autism. Lag schedules of reinforcement were implemented for two participants whose play did not initially generalize. The play skills intervention was conducted within the participants’ early childhood classroom and the utility of teaching play as a means to reduce stereotypy within this setting was also evaluated. A multiple baseline design across participants demonstrated that play taught via behavioral intervention may be maintained after programmed reinforcement is discontinued, generalize across settings and toys (i.e., response and stimulus generalization), and occasion a decrease in stereotypy. Further, the occurrence of play in the absence of socially mediated reinforcement suggested that play taught via behavioral interventions may come to be automatically reinforced. Finally, parent responses on rating scales suggested that two of the participants were happier, in a better mood, and were more interested in appropriate toy-play following behavioral intervention.