Improving Social Conversation in Children with Autism Spectrum Disorders Through Teaching Multiple Questions

Background: Social conversation is a multifaceted construct that involves a natural and reciprocal exchange of information between two or more people who are engaged in an interpersonal interaction (McTear, 1985). Conversation is a ubiquitous part of our social world, and is necessary for everyday interactions as well as forming and maintaining relationships with others (Brinton & Fujiki, 1985). However, individuals diagnosed with autism spectrum disorder (ASD) have a “marked impairment in the ability to initiate or sustain a conversation,” often leading to social isolation (APA, 2000, p. 75; Marans, Rubin & Laurent, 2005).

Objectives: This study looks at one type of initiation, question-asking, and investigated whether a self-management intervention is effective for teaching simultaneous acquisition and discrimination of three social questions used in conversation: who, what and where. Additionally, the objectives included seeing if the participants’ gains generalized to conversational partners not involved in treatment, and if the gains maintained over time.

Methods: Two female children diagnosed with ASD, ages 7 and 9, participated in this study. A non-concurrent multiple baseline across participants design was employed (Barlow, Nock, & Hersen, 2009). The children were taught when it is appropriate to use the words what, where, and who, when asking questions during social conversation. To increase the child’s motivation for learning the new skill, self-management was used. The child and clinician held a natural conversation, in which the clinician provided leading statements that prompted a question in response. The participants checked off a box each time they asked an appropriate wh-question during these opportunities, and upon completion of checking all boxes, the participants were given a reinforcer.

Results: Both participants dramatically and suddenly increased the appropriate use of all three wh-questions. These gains generalized to conversational partners uninvolved in treatment and gains were maintained at long-term follow-up (6 months or 1 year). Furthermore, the data suggest that lack of question-asking appears to be motivation-based rather than ability-based.

Conclusions: Asking questions may help to reduce negative psychological and psychosocial outcomes by teaching children to use an effective tool that facilitates reciprocal interactions with others. Increased use of basic question-asking has been shown to result in long-term improvements and collateral gains for young children with autism (Koegel et al., 2010) and may decrease their learned helplessness by motivating them to ask questions of others. A major strength of this study is that it used a versatile, easy to implement intervention that can be used by clinicians, teachers, and parents to teach question asking skills. Furthermore, changes in behavior were very fast, resulting in a short duration of intervention. The positive results of this study inspire future research on using self-management procedures to target several simultaneous spontaneous questions (i.e., without a clear leading statement as a prompt), and expanding on the complexity of the question taught to build on the partner’s utterances, in addition to investigating collateral gains from teaching appropriate question-asking.