Objectives: The objective of the current study was to improve imitation and joint attention in preschoolers with ASD, with a combination of naturalistic and behavioural techniques.
Methods: Eighteen pairs of children (aged 4 – 7 years) participated in the study. Each pair was matched as precisely as possible on chronological and language age, total IQ, gender and pre-test imitation and joint attention scores. Of each pair, one child was randomly assigned to the treatment condition, the other child received care as usual.
The intervention was developed for use in the Flemish rehabilitation centres, where children with developmental-, learning-, and/or behaviour disorders are treated in a non-residential setting. The program consisted of 24 30-minute sessions, with a pace of two sessions per week. Each session comprised both imitation and joint attention exercises, with gradually increasing difficulty over the sessions. The intervention was delivered by the child’s usual therapist (either a psychologist or a speech-language therapist). The sessions replaced part of the child’s care as usual so both groups of children received a comparable total amount of therapy.
Pre- en post-testing was done by research assistants. This testing included measures of gestural, verbal, procedural and symbolic imitation, and initiating as well as following imperative and declarative joint attention. In addition to these scores, a total imitation- and joint attention score were calculated.
Results: The treatment group’s joint attention skills improved significantly more between pre- and post-testing than those of the control group (F(1,34)=9.341, p<.01). For imitation, both groups together obtained higher scores on the post-test than on the pre-test (F(1,34=16.635, p<.001). The treatment group, however, made a significant gain in imitation scores between pre and post (t(17)=-3.976, p<.001), while this was not the case in the control group (t(17)=-1.860, p=n.s.).
Conclusions: The results of our study suggest that it is possible to improve joint attention as well as imitation skills with a limited number of treatment sessions. While our treatment was clearly more effective in promoting joint attention than standard care, both groups seemed to have improved their imitation skills at post-testing. However, this improvement only reached statistical significance in the treatment group. Upon inquiry it appeared that imitation was also an explicit treatment goal for most children who received care as usual. Although this seemed to be somewhat effective, our results suggest that the current treatment had a stronger effect on these children’s imitation skills. In sum, the current intervention seems to be a promising approach to improve both imitation and joint attention in preschoolers with ASD.