Examination of an Imitation-Based Intervention for Adolescents with ASD and Significant ID

Background:

Individuals with ASD have significant difficulty with social skills across the lifespan. Few social interventions have been developed or evaluated for older individuals with ASD who also have a significant intellectual disability (ID).   A developmental perspective would suggest that techniques that promote social interaction in younger children with ASD would likely also benefit older individuals with significant ID who are functioning at a similar developmental level.  Reciprocal imitation training (RIT) is a naturalistic developmental-behavioral intervention that targets imitation and imitation recognition, key social processes that emerge in infancy and are thought to facilitate the development of more advanced social communication skills in typical development.  Previous research suggests RIT improves imitation and other social-communication skills in young children with autism. 

Objectives:

This set of studies examined whether RIT could be used to improve imitation and social behaviors in adolescents with ASD and significant ID.

Methods:  

Study 1 used a multiple-baseline design to examine the functional relationship between RIT and imitation, joint engagement, and challenging behavior in 4 adolescents with ASD and significant ID living in a residential treatment facility.   Study 2 examined the feasibility of conducting an RCT to evaluate RIT with 20 additional adolescents with ASD and significant ID in a residential facility.  Primary outcomes included metrics of feasibility of the assessment and treatment protocol.  Secondary outcomes included a preliminary analysis of the effect of RIT on imitation, social interaction skills, and challenging behaviors.    

Results:

Results of Study 1 indicated that all 4 adolescents improved their imitation skills.  Improvements were also noted in joint engagement and challenging behavior for a subset of the adolescents.  Results of Study 2 indicated that the assessment protocol was feasible and that RIT was well-tolerated by the adolescents and implemented with fidelity by teaching staff.  Preliminary findings indicate that treatment had moderate to large effects on social interaction and challenging behavior. 

Conclusions:  

Results suggest that RIT is a promising approach for improving social interaction and decreasing challenging behavior in adolescents with ASD and significant ID. A larger RCT of RIT for this population is feasible and warranted.