Moment-by-Moment Sequential Analysis of a Social Engagement Intervention for Young Children with Autism and Their Parents

Background:

Early social development is a transactional process in which parents and children mutually influence one another’s social behavior through an ongoing series of initiated interactions and responses.  In the case of parents with children with autism, however, these transactions understandably occur on a much more limited basis, as their children are less attuned to social bids and are less inclined to reciprocate these types of interaction.  There is abundant evidence that these social vulnerabilities contribute to unfavorable long-term outcomes and negatively impact the emotional wellbeing of parents.  However, emerging research suggests that incorporating social interactions derived from a child’s pre-existing interests can significantly increase social behavior when implemented within the context of a naturalistic autism intervention model.  Parents utilizing such methods for eliciting social behavior may be successful at establishing a positive social interaction feedback-loop with their children, which would have important implications for long-term social development.

Objectives:

This objective of this study was to evaluate the transactional social effects of teaching parents to embed a social interaction component into a Pivotal Response Treatment (PRT) intervention model.  Specifically, this research examined the reciprocal relationship that governs the moment-by-moment emergence of social behavior in both young children with autism and their parents.

Methods:

This study used a multiple-baseline design across three young children with autism (ages 2:4, 2:11, and 4:3), with one parent per child participating in the research.  In the baseline condition, parents were initially taught to use standard PRT procedures for increasing communication skills, with emphasis on using preferred toys and other objects to reinforce their children’s language attempts.  Across the 16 sessions of the experimental intervention phase, parents were taught to use this same intervention model while replacing the preferred non-social materials with socially analogous stimuli. Videos were coded on a moment-by-moment basis using behavioral coding software for child and parent social behavior. Lag sequential analyses were then performed to examine how the onset of specific parent social behaviors immediately evoked a corresponding child social response and vice versa.

Results:

During the social intervention phase, the onset of parent social behaviors (reinforcement delivery, positive affect) significantly predicted the subsequent occurrence of child social behaviors (eye contact, positive affect).  The converse was also observed, with the onset of child behaviors (verbal initiations, eye contact, positive affect) predicting the occurrence of parent social behavior (positive affect).  These behavioral sequences were not observed in the baseline phase, even when the same parent or child social behaviors occurred.

Conclusions:

Evidence of reciprocal social exchanges was noted in the intervention phase, suggesting that social stimuli with adequate salience and motivational qualities can induce parent-child interactions that resemble those occurring in families with typically developing children.  Using this methodology, it was possible to gain a better understanding of specific transactions that elicit desired social responding in children with autism. These findings may suggest a potential method for altering the social developmental trajectory of children with autism.