The Role of Social Awareness and Motivation in Interpersonal Behavior and Imitation in Children with Autism

Background: Imitation is one of several important social matching behaviors (Moody & McIntosh, 2006) implicated in numerous outcomes (e.g., Bavelas, Beavin-Black, Lemery, & Mullett, 1987). Imitation deficits are associated with autism (Rogers & Williams, 2006); although, there is variability in the consistency of this finding (Charman & Baron-Cohen, 1994). Deficits in social motivation have been proposed as a possible explanation for imitation deficits in autism (Rogers & Williams, 2006).

Objectives: This study investigates the relationship between social factors (i.e., motivation, social cognition, social communication and social awareness), and social and imitative ability in children with autism. This will provide a better understanding of the mechanisms underlying imitation deficits and social behavior and will guide future research on improving social abilities in individuals with autism.

Methods: Data for this analysis came from the Study to Explore Early Development (SEED; n = 628), a multi-site case-control study on risk factors for autism. Participants were included if they received a final classification of autism, and completed the following measures: 1) Social Responsiveness Scales (SRS), 2) Vineland Adaptive Behavior Scales-II (Vineland), 3) Autism Diagnostic Observation Schedule (ADOS) and 4) demographics. Separate models were computed for the Vineland Interpersonal Relationships subdomain and for a subset of Vineland items from the same subscale that relate to imitation (items 8, 12, 16, 18, and 21). Linear regression was used for all analyses; p-values less than 0.05 were considered significant. The primary exposures for these analyses were the social constructs from the SRS: social motivation, social cognition, social awareness, and social communication subscales. All analyses were adjusted for age, sex, maternal race, maternal ethnicity, and income. Autism severity (Calibrated Severity Score (CSS) from the ADOS) was tested as an effect modifier. However, no effect modification was found, therefore, CSS was included as a covariate. Due to the non-normal distribution of the Imitation score, a bootstrapped regression was conducted. All analysis was performed in R version 3.1.2 (2014-10-31). The car package v(2.0.25) was used for the bootstrap regression.

Results: Social awareness is significantly associated with the Vineland Interpersonal Relationships v-score (p = 0.0043). For every 10 point increase in Social Awareness there was a 0.36 decrease in the mean Interpersonal Relationship score after adjusting for Social Motivation, Communication, Cognition, autism severity, age, race, sex, ethnicity, income, and maternal education. Social Motivation was significantly associated with Imitation (p = <0.05). For every 1 point increase in Social Motivation there was a 0.038 (95% CI: 0.067-0.011) decrease in the mean Imitation score after adjusting for Social Awareness, Communication, Cognition, autism severity, age, race, sex, ethnicity, income, and maternal education.

Conclusions: There is a significant association between Social Motivation and Imitation, and between Social Awareness and Interpersonal Relationship skills after adjusting for other social domains, autism severity, and socioeconomic status. This suggests that separate social constructs relate to social and imitative abilities in children with autism. This may help guide targets of intervention in the future; however, additional research is needed to better understand this association.