Nonverbal Communication and Social Imitation Skills in Children with Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is a developmental disorder characterized by communication problems and repetitive movements (American Psychiatric Association, 2013). People with ASD demonstrate stress (Miller & Seligman, 1975) and fear (Maier & Watkins, 1998) in uncontrollable social situations. In these situations, people with ASD typically withdraw themselves, allowing learned helplessness and peer rejection to intensify communication problems (Seligman, 1975). Training in nonverbal communication skills, such as joint attention, will strengthen communicative imitation. Imitation is a major component of social interaction. Building imitation skills in children with ASD will ultimately contribute to their ability to interact with other people and form relationships. By identifying which skill is most predictive of communication gains during treatment, clinicians would have adequate evidence as to which treatment may be the best fit for children with varying severities of ASD.

Objectives: The primary aim of this study was to determine whether pre-existing nonverbal communication skills provided a strong foundation for social imitation skills. Specifically, researchers examined whether better response to joint attention at baseline was associated with greater improvement on imitation assessments following ten weeks of play-based treatment focused on building social imitation skills.

Methods: Young children with ASD (N=10) participated in videotaped recordings of the Early Social Communication Scales (ESCS), as well as two imitation assessments—the Motor Imitation Scale (MIS) and both the object and gestural forms of the Unstructured Imitation Assessment (UIA). Children also received ten weeks of twice weekly Reciprocal Imitation Training, a naturalistic developmental behavior intervention focused on building social imitation skills. Responses to proximal and distal pointing were coded from videotaped ESCS assessments. Percentage of models correctly imitated were scored from the MIS and the UIA. The ESCS data was utilized to predict change in imitation using regression analysis of the MIS and UIA before and after therapy.

Results: Regression analyses indicated that child responses to proximal bids for joint attention (examiner pointing to a picture in a book) were related to change both in MIS scores and UIA object imitation scores, after controlling for imitation score at intake. Interestingly, responses to distal bids for joint attention (examiner pointing to a poster on the wall) were not predictive of change in imitation over time. In proximal responses, the object is closer to the child’s line of sight and is noticed more often by children with ASD than a gesture referencing an object in the distance.

Conclusions: The results of this study develop better understanding of the relationship between reciprocal joint attention and social imitation. Having a stronger foundation of joint attention skills, particularly responses to joint attention, was associated with more improvement in imitation during a short-term, play-based intervention. Future work should examine this relationship in a larger sample of children to better understand which children may benefit most from imitation-based therapies such as Reciprocal Imitation Training.