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The Social Role of Imitation in Autism Implications for the Treatment of Imitation Deficits

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The Social Role of Imitation in Autism Implications for the Treatment of Imitation Deficits Infants & Young Children Vol. 21, No. 2, pp. 107–119 Copyright c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins The Social Role of Imitation in Autism Implications for the Treatment of Imitation Deficits Brooke Ingersoll, PhD Individuals with autism exhibit significant deficits in imitation skills. This article reviews the impor- tance of imitation in typical development, focusing on the social function of imitation and its role in the development of social communication skills. Second, it reviews evidence suggesting an asso- ciation between imitation deficits and social communication impairments in children with autism. Third, it discusses limitations of the current method for teaching imitation that targets only the learning function of imitation. Finally, it describes a new imitation intervention designed to teach the social use of imitation in young children with autism. Key words: autism, early intervention, imitation, social communication HILDREN WITH AUTISM exhibit signifi- found effect on learning and development Ccant impairment in imitation skills. These in children with autism (Meltzoff & Gopnik, deficits have been reported on a variety of 1994; Rogers & Pennington, 1991), making it tasks including symbolic and nonsymbolic an important focus of intervention. body movements, symbolic and functional This article reviews the importance of imi- object use, vocalizations, and facial expres- tation in development. In particular, it focuses sions (for review, see Smith & Bryson, 1994; on the social function of imitation and its role Williams, Whiten, & Singh, 2004). In typi- in the development of social communication cal infants, imitation emerges early in devel- skills. Second, it reviews evidence suggesting opment (Meltzoff & Moore, 1977) and plays an association between imitation deficits and a crucial role in the development of cog- social communication impairments in chil- nitive and social communication behaviors, dren with autism. Third, it discusses limita- such as language, play, and joint attention tions of the current method for teaching im- (Rogers & Pennington, 1991). This associa- itation that targets only the learning function tion, as well as evidence for the specificity of of imitation. Finally, it describes an imitation the imitation deficit in autism (eg, Charman intervention designed to teach the social use et al., 1997; Rogers, Hepburn, Stackhouse, of imitation in young children with autism. & Wehner, 2003; Stone, Ousley, & Littleford, 1997), has led some researchers to propose ROLE OF IMITATION IN DEVELOPMENT imitation as a primary deficit that has a pro- In typical infants, imitation emerges early in development (Meltzoff & Moore, 1977) and serves 2 distinct functions: a learning Author Affiliation: Lewis & Clark College, Portland, Oregon. function, through which infants acquire new skills and knowledge, and a social function, This study was supported by grants from the Organiza- tion for Autism Research and Cure Autism Now. through which infants engage in social and emotional exchanges with others (Uzgiris, Corresponding Author: Brooke Ingersoll, PhD, 105B Psychology Bldg, Michigan State University, East 1981). It is through this social use of imita- Lansing, MI 48824 ([email protected]). tion that typically developing infants acquire 107 108 INFANTS &YOUNG CHILDREN/APRIL–JUNE 2008 the social communication skills that are found more sophisticated play skills (Morrison & to be deficient in children with autism. Kuhn, 1983). Imitation of peers serves to in- For example, in typical infants, early face- crease and refine peer interactions during to-face interactions with caregivers are often early childhood and remains a strong elicitor characterized by mutual or reciprocal imita- of social interest throughout childhood. tion in which both the caregiver and the in- In sum, the social use of imitation in in- fant engage in imitation of the others’ vocal- fancy and early childhood is associated with izations and facial expressions. It is through the development of more sophisticated social these reciprocal imitation games that infants communication skills. This research would communicate social interest in their partner suggest that a disruption in the early social (Nadel, Guerini, Peze, & Rivet, 1999; Uzgiris, use of imitation might have a significant im- 1981, 1999), develop a sense of shared affec- pact on the development of other social com- tive experience (Malatesta & Izard, 1984), and munication skills, a hypothesis proposed by engage in conversational turn-taking eventu- others (Meltzoff & Gopnik, 1994; Rogers & ally necessary during spoken communication Pennington, 1991). (Trevarthen, Kokkinaki, & Fiamenghi, 1999). Toward the end of the first year, play be- RELATIONSHIP BETWEEN IMITATION tween the infant and caregiver becomes more AND SOCIAL COMMUNICATION object focused and the infant begins to imitate BEHAVIOR IN AUTISM the caregiver’s actions with toys (eg, Uzgiris, 1990). In the second year, imitation games Indeed, the research on autism suggests a often involve affective gestures (Kuczynski, relationship between imitative performance Zahn-Waxler, & Redke-Yarrow, 1987). Among and other social communication skills, includ- mother-child dyads, imitation remains one of ing language, play, and joint attention. There the most common, stable patterns of interac- is considerable support for an association be- tion throughout early childhood (Halliday & tween imitation and language abilities in chil- Leslie, 1986). Reciprocal imitation serves to dren with autism. Dawson and Adams (1984) express interest and engagement between the found that children with autism categorized as child and caregiver (Waxler & Yarrow, 1975) high imitators verbalized to the experimenter and is a strategy through which the child significantly more than children categorized learns conventional actions with toys (Uzgiris, as low imitators. Sigman and Ungerer (1984) 1990) and affective gestures (Kuczynski et al., found that children with autism exhibited spe- 1987). cific deficits in vocal and gestural imitation Reciprocal imitation also plays a key role compared with typical children and children in early peer interactions. Performance of with developmental delay. These skills were the same act on the same object initiates correlated with receptive language for all 3 interactions between toddlers (Mueller & groups, and vocal imitation was correlated Lucas, 1975) and often results in maintained with expressive language in typical children or increased social interaction including coun- and children with autism. terimitation (Eckerman & Stein, 1990; Grusec A longitudinal study of imitation and lan- & Abramovitch, 1982). Sustained reciprocal guage in children with autism found an asso- imitation is the predominant mode of so- ciation between gestural imitation and the de- cial interaction and preverbal communication velopment of expressive language 6 months between same-aged toddlers (Baudonniere, later in young children with autism (Stone 1988; Eckerman, 1993). These imitative ex- et al., 1997). In another longitudinal study, changes appear to foster continued social in- Stone and Yoder (2001) found that motor im- teraction by communicating a common un- itation ability at age 2 significantly predicted derstanding of ongoing activities (Eckerman, language outcomes at age 4, suggesting the 1993) and play a role in the acquisition of strong correlation between motor imitation Imitation and Autism 109 and language development in children with relationship between the ability to imitate ac- autism. In contrast, after controlling for devel- tions with objects and the development of opmental age, Rogers et al. (2003) did not find higher level play behaviors; however, the re- a relationship between imitation skills (oral, lationship may be mediated by developmental object, or body) and concurrent language age age. in young children with autism. This finding Imitation deficits may further disrupt the may be due to the use of different imitation development of peer play, as early peer in- tasks (oral-motor vs verbal) or may suggest teractions are heavily based on reciprocal that the relationship between imitation and imitation with toys (Eckerman & Didow, language is mediated by other factors. 1996; Eckerman & Stein, 1990). Indeed, Stone The research also supports a relationship and Lemanek (1990) found that parents of between imitation and play skills in autism. A preschool-aged children with autism reported variety of studies have indicated that young that their child displayed significantly less children with autism are impaired on the imitation of another child at play compared imitation of functional and arbitrary actions with parents of children with developmental with play materials (eg, Charman et al., 1997; delays. 1998; DeMyer et al., 1972; Stone et al., Several studies have found a correlation be- 1997). Hammes and Langdell (1981) found tween imitation and joint attention in autism. that children with autism performed signifi- In nonverbal children with autism, Curcio cantly worse than children with learning dif- (1978) found that higher gesture imitation ficulties on imitation tasks involving 1 real performance predicted more sophisticated object and 1 imaginary object or pantomime communicative gestures. In another study, of an action with 2 imaginary objects. Libby, Abrahamsen and Mitchell (1990) found that Powell, Messer, and Jordan (1997) found that vocal imitation was highly correlated with the children
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