Relationships Among Joint Attention, Imitation, Play and Language in Young Children with Autism Spectrum Disorders

Background: The long-term outcome of the research in autism spectrum disorders (ASD) was an important issue until now. However, we did not really know what kinds of variables could predict long-term outcome of children with ASD. Previous studies had shown that one of the strongest predictor of long-term outcome for children with ASD was expressive language. And there were some early social communicative abilities (i.e. joint attention, imitation and play) associated with language in children with ASD above the age of three (Toth et al., 2006). However, there was no study to investigate the relationships between joint attention, imitation, play and language in young children with ASD under 36 months.

Objectives: The purpose of the study was to examine the relationships between joint attention, imitation, play and language in young children with ASD less than 36 months. We also further investigated which variable was the unique contribution to language in the ASD population.

Methods: The participants were thirty nine 29-month-old (range = 24-36 months) children with ASD, including 31 cases of typical autism and 8 cases of atypical autism. All of participants were recruited from one local hospital in southern Taiwan and diagnosed by multidisciplinary team with DSM-IV-TR (APA, 2000). A modified form,  T-STAT copy of the STAT (Stone, et al., 2000, 2004), was used to measure the social communicative abilities, including initiating joint attention, responding joint attention, object imitation, manual imitation, and doll-directed play. Besides, the verbal abilities were assessed by Mullen Scales of Early Learning (MSEL, Mullen, 1995) and Macarthur Communicative Development Inventories (CDI, Fensen et al., 1993). Results: First, the correlations of all predictive variables were examined, and the results revealed that responding joint attention, object imitation, and doll-directed play were correlated with language of the young children with ASD. However, the study results could not support the relation between initiating joint attention and language in young ASD children. Next, we used multiple regression analyses to examine the stronger predictor for language. And the results revealed that object imitation could predict expressive language from MSEL and doll-directed play could predict vocabulary ability from CDI.
Conclusions: Results of this current study demonstrated that both object imitation and doll-directed play were the stronger predictors for expressive language in young children with ASD. Both object imitation and doll-directed play were that an agent performs an action involved an object. It provides salience via an action with an object for children with ASD to pay attention. It helped language development in children with ASD when they paid attention. The initiating joint attention could not predict the expressive language ability in young children with ASD. It was a surprising result. We suggested that maybe the performance of initiating joint attention in young ASD children were rarely to be a reason. The development of the language in children with ASD was needed to discuss the spotlight effect of object action.