One Size Doesn't Fit All - A Randomized Comparison of Intensive Imitation Versus Treatment As Usual

Background: Although imitation is viewed as a core deficit in autism by many researchers and clinicians, a contrasting view holds that it is not imitation in itself that is the problem. Rather, a primary social motivation deficit explains the low levels of imitation usually observed among children with autism. According to this latter view, Intensive Imitation (that is, the adult imitates everything the child does; see Nadel et al, 2000) can create an awareness of the other person, a social interest. Several studies have explored this idea and the findings tend to confirm the hypothesis (e.g.: Escalona et a., 2002; Heimann et al., 2006): Intensive Imitation increases the social awareness in young children with autism, especially in children with no or very low language levels. Based on these findings it has been proposed that repeated sessions of imitation might be an additional intervention strategy for young children with autism.

Objectives: To investigate how young children with autism respond to Intensive Imitation (II) compared to treatment as usual when given as the first intervention after receiving an autism diagnosis. It is well known that the treatment as usual method, Intensive Behavior Therapy (IBT), is effective. Thus, the main goal of the study was not to see which one of the method that is better, but to gain information that can help us tailor treatment to the individual child. Children with autism are a heterogeneous group that to a high degree responds differently to various intervention methods.

Methods: Forty families with children that have been newly diagnosed with autism were invited to the study. The children were randomized to one of two 12-week long interventions: Intensive imitation (II) or Intensive Behavior Therapy (IBT). To date, 36 children have completed the intervention (29 boys, 7 girls), 19 have received II and 17 IBT. The intervention started on average two months after receiving the diagnosis when the children were around 3:6 years old. Based on the Bayley the two groups did not differ in mental age. The children were evaluated with an extensive battery (e.g.: PEP, ESCS, Bayley, imitation, memory, video observations of social interaction) at start, end, and at a follow-up one year later.

Results: Although children in both groups show progress, the children in the II group tend to change their communicative style to a higher degree. They also became more positive towards physical closeness and increased their eye contact. There is also some indication that II promotes language development and joint attention albeit this is not finally analyzed yet. In addition, the preschool teachers being involved in the project describes II as an attractive method that is relatively easy to learn.  

Conclusions: As expected, both methods promote development. II has the advantage of being relatively easy to learn and that it does not involve the parents to the same degree as IBT. Thus, II might be an important complement to the more ‘traditional’ behaviorally based methods that we know are effective but are also very time costly.