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Promoting Reciprocal Social Interaction through Comprehensive Imitation Training for Nonverbal and Minimally Verbal Children with Autism in Japan
Imitation skills are one of the most pivotal behaviors emphasized within teaching programs for children with autism. In particular, previous studies have shown effects of imitation training on social communication abilities such as language, joint attention and play skills (Ingersoll, 2012; Ingersoll & Schreibman, 2006). However, few studies have examined the effect of low intensity imitation training for children with autism and shown effects on imitation skills (Warreyn and Roeyers, 2014). In addition, more studies are needed to understand the effects of imitation training on reciprocal social interaction. Finally, little is known about how visual fixation patterns may change during imitation tasks following imitation training.
Objectives:
The purpose of this study is to examine whether a low intensity comprehensive imitation training program promotes reciprocal social interaction and changes socially relevant eye gaze behavior in children with autism.
Methods:
Six children with autism participated in this study, in a multiple baseline design. The range of chronological ages was 4 years to 6 years, and developmental age ranged from 1 year to 3 years. Children came to the laboratory once or twice per week and received 60-minute imitation training sessions, for approximately 12 weeks. During the training, children were taught motor imitation, object imitation, and vocal imitation skills and were trained to imitate actions sequentially for as long as they could. Imitation training was conducted primarily in a structured setting. To demonstrate the process of acquiring imitation skills, we utilized a multiple baseline across target behaviors experimental design. We also utilized six dependent variables in pre and post assessments to evaluate the effect of imitation training, as follows: (1) Imitation skills: Motor Imitation Scale (MIS); (2) Reciprocal social interaction: Proportion of social engaged imitation, frequency of spontaneous language, and the duration of chained mutual imitation through 5-minute video observations between child and mother and child and therapist; (3) Gaze behavior: Change of visual fixation pattern during imitation tasks using eye tracker Tobii; (4) Motor development : Scores on the Developmental Voluntary Movement Test. Pre to Post assessment changes were evaluated using Wilcoxon signed-rank tests.
Results:
All children improved in their imitation skills sequentially through multiple baseline design. Preliminary results suggest that low intensity comprehensive imitation training produced significant increases in imitation skills which were not used in the training in pre and post assessment (Wilcoxon signed-rank test: Z =-2.14, p=0.032, two-sided). The results also showed that imitation training increased the proportion of socially engaged imitation and spontaneous language production in the post assessment. Children also changed their visual fixation patterns during imitation tasks after training, looking at an adult’s face more than during the pre-training assessment. Finally, motor development also improved from the pre to post assessment.
Conclusions:
The current findings suggest that a low intensity comprehensive imitation training program promoted reciprocal social interaction between mother and child. The finding of increased looking time at the adult’s face following imitation training provides further information and support for the observed behavioral effects on reciprocal social interaction.