Improving Conversational Fluidity in Adults with Autism Spectrum Disorder

Background: Young adults with ASD often demonstrate significant challenges in their social conversation skills, including difficulty with conversational fluidity (reciprocal, to-and-fro conversation) and social pragmatics. Previous research has demonstrated that with appropriate intervention, these individuals can make significant improvements in this area. In particular, video-based interventions may be useful for this population because of frequently observed strengths in visual perception skills and sustained attention with this medium (Sherer et al., 2001; Bellini & Akullian, 2007). Video-feedback, which involves the viewing and evaluating of a client’s previously filmed performance, has shown promise as an effective means to improve social initiations and general social communication skills in individuals with ASD (Koegel, Ashbaugh, Navab, & Koegel, 2016; Maione & Mirenda, 2006), but it is unclear if this type of intervention can improve conversational fluidity in high-functioning adults, specifically.

Objectives: This study evaluated the merits of using a tailored video-feedback intervention to improve conversational fluidity and overall social conversational desirability in young adults with ASD.

Methods: Three adults ages 19–26 participated in this study. Each adult had a diagnosis of ASD according to current criteria of the DSM-5. Participants demonstrated difficulties with social communication skills and conversational fluidity, as noted by the referring agency, direct observations, and self-report. A multiple baseline design across participants was used to assess the effects of the video-feedback intervention on level of conversational fluidity and social desirability. During baseline sessions, participants engaged in a 10-minute, video-taped conversation, in which the conversational partner purposely created an unnatural (three second) pause at least once per minute. During intervention sessions, participants were shown video clips of opportunities for conversational fluidity. Each participant was instructed to think of filler words or follow-up or novel questions they could have communicated to fill the gap in the conversation. The participant and clinician role played the exchange to ensure the participant could effectively implement the skills. Video-recorded conversation probes with novel peers were collected every session. Dependent measures included (1) level of conversational fluidity, defined as the percentage of minutes in the conversation with no pauses lasting three seconds or more; and (2) rating of social desirability, as rated by age-matched peers who were blind to study aims and time point.

Results: Preliminary results indicate that all participants increased their conversational fluidity and ratings of social desirability in the context of a multiple baseline design. Participants increased from a mean of 15% of conversationally fluid intervals to 90% of intervals (an increase indicative of a large effect size). Participants also increased their rating of social desirability from an average score of 1.5 (“undesirable”) to 4 (“desirable”). These effects generalized one month after completion of the intervention.

Conclusions: Results of this study demonstrate the promise of video-feedback interventions to improve conversational fluidity and other social communication skills among adults with ASD. The results highlight the utility of implementing these interventions in practice and suggest that future research on improving reciprocal conversation in adults with ASD may be highly lucrative.