The Implementation of Reciprocal Imitation Training (RIT) with Toddlers in a Community-Based Setting

Background: Numerous studies have indicated that early, ASD-specialized treatment leads to significant improvements in social, language, cognitive, and behavioral functioning for children with ASD. However, very few treatments have been adapted for use in community-based settings, where they may reach a broader segment of the population and remedy limited access. This study examines the implementation of Reciprocal Imitation Training (RIT)--an evidence-based, ASD-specialized treatment–by community Early Intervention (EI; IDEA Part C) providers serving toddlers from birth to 3 years.

Objectives: To examine: (1) the effectiveness of a system-level intervention (i.e., training workshop) for EI providers for increasing their self-efficacy when providing intervention to toddlers with possible ASD; (2) key implementation factors related to providers’ use of RIT (i.e., adoption, acceptability, feasibility); and (3) providers’ perceptions of RIT effectiveness for improving key outcomes.

Methods:

Sample.62 EI providers from 9 agencies in 4 counties across Washington State were enrolled. Providers had a mean age of 42.3 years and mean of 15.2 years in practice. The majority were speech-language pathologists (46.5%) or occupational therapists (23.3%) and female (93.8%).

Procedures. A stepped-wedge design was used to randomly assign counties to the timing of the system-level intervention. Survey data were collected at baseline (T1) and 6-months post-intervention (T2). The system-level intervention comprised a 1-day training workshop conducted for each agency, which focused on imitation impairments in ASD, the RIT cycle steps, parent coaching, and live demonstrations and practice.

RIT. RIT (Ingersoll, 2008) is a manualized ASD-specialized treatment that uses a naturalistic developmental behavioral approach (NDBI; Schreibman et al., 2015) to teach object and gesture imitation within a play-based context. RIT was chosen because of its strong evidence base (Ingersoll, 2010; 2012), ease of administration, flexibility, and focus on a core deficit area for ASD. Given its low intensity and playful nature, RIT is suitable for toddlers with delays in imitation and unlikely to have any negative consequences if used with toddlers who do not have ASD.

Measures. Self-report measures of practices and self-efficacy regarding ASD care were collected at T1 and T2. At T2, providers rated items about RIT feasibility and acceptability from the User Rating Profile (URP; Chafouleas et al., 2011) and about perceived RIT effectiveness.

Results: There were significant increases in providers’ self-efficacy in identifying and discussing treatment goals with families of children with ASD, p<.01. At T2, provider ratings indicated high levels of feasibility and acceptability for RIT (Table 1). 48 providers (81%) reported using RIT with 349 children and coaching 277 parents. The majority of these providers indicated that they perceived RIT to improve key parent-child outcomes (Table 2).

Conclusions: These findings suggest that a relatively brief training workshop can increase EI providers’ use of an evidence-based ASD treatment with their caseload and feel more efficacious in working with families of children with possible ASD. While additional research is needed to directly assess its effectiveness at improving parent-child outcomes, RIT may help families get an early start on accessing specialized treatment within an established infrastructure available across the U.S.