Improving Reciprocal Social Conversation Through Question Asking In Children and Adolescents with Autism

Background: Impairment in social communication is a defining feature of individuals with autism spectrum disorder (DSM-IV-TR, APA, 2000). Individuals with ASD lack the appropriate use of verbal initiations during conversation, which leads to appearing disinterested and unfriendly to others (Marans, Rubin, & Laurent, 2005). A lack of initiations contributes to social isolation and fewer opportunities to practice conversation and improve (Charlop-Christy & Kelso, 2003). Although scholars have researched the social communicative difficulties that individuals with ASD face, only a few studies have investigated interventions to improve social conversation in high-functioning older children and adolescents with ASD. This study focuses on one initiation, namely question asking, which has been shown to be less frequent in children with ASD, yet is central to appropriate social conversation (Koegel, 2000).

Objectives: The aim was to investigate whether a new technique for monitoring questions would improve the rate of question asking and reciprocity during social conversation in older children and adolescents with ASD. Additional questions included whether the intervention could be successfully faded, if the skills would generalize to new conversational partners and if there would be any socially significant gains.

Methods: The participants were two ethnically diverse males, ages 11 and 15, who had previously been diagnosed with autism. Both participants had conversational language and knew how to ask questions, but were reported to have difficulty integrating questions into their conversations. A non-concurrent multiple baseline across participants design was employed. During the intervention phase, the participants monitored their questions and their conversational partner’s questions by using a self-management based system while talking. The participants were told to give themselves a point for each question they asked and to give their partner a point for each question he/she asked. The child was told that the goal was to ask an approximately equal number of questions as the conversational partner. Every three minutes, the clinician would check-in with the participant about the balance of the conversation and what he could do to make it more even. Following the conversation, the participants received their chosen reinforcer. 

Results: With implementation of the intervention, both participants increased the number of on-topic questions asked. Furthermore, conversation monitoring improved the reciprocal interaction, with both participants displaying appropriate levels of question asking during the majority of the conversation. These gains held once intervention was faded and generalized to new conversational partners, including peers. Social validity data suggest that both participants improved in the expected direction on variables including interest, reciprocity, and normalcy.

Conclusions: Conversation monitoring is a promising technique for improving social conversation in children with ASD. Given the lack of existing research, this study serves as a foundation for how to teach skills necessary for typical social conversation. By increasing initiations that result in the child being more interested and an easier conversational partner, the cycle of social isolation may be broken. Conversation monitoring is a skill that can be used naturally and has important implications for helping older children and adolescents with ASD thrive in friendships and relationships.