The Use of Mirroring to Improve Social Engagement in Young Children with ASD

Background: Reduced social engagement in young children with autism spectrum disorder (ASD) can be particularly challenging to treat. If not treated, social deficits could ultimately hinder a child’s development, ability to establish meaningful relationships, and engagement in learning opportunities. Interventions that target social skills and social interaction are key in reducing negative outcomes associated with these deficits, and may ultimately improve the quality of life for individuals with ASD.  Mirroring is a component of dance-movement therapy (DMT) that is somewhat comparable to imitation.  Anecdotal and case study reports suggest the effectiveness of the use of mirroring and DMT to positively engage children with ASD.  However, little to no objective data on outcomes of such interventions are available.  There is empirical support for imitation interventions in improving play, movement, vocalization, and engagement in children with ASD. Thus, we were interested in objectively determining the effectiveness of mirroring to engage minimally-verbal children with ASD. 

Objectives:  We sought to measure the effectiveness of a mirroring intervention on the social engagement skills of young, minimally-verbal children with autism.

Methods:  A multiple baseline across participants design, with replication was used to measure the effects of the intervention. Thus far, four participants (three boys and one girl) with ASD ages 3-4 years have participated in this study. Prior to intervention, children attended baseline sessions in which no mirroring of the child’s behaviors occurred.  During baseline the interventionist engaged in non-contingent movement and vocalization.  During the intervention phase, the interventionist engaged in mirroring and attunement of the child’s movements, vocalizations, and mood throughout the session.  Sessions were videotaped and operationalized definitions of dependent measures (e.g., initiations, gaze toward the interventionist, and positive affect) were coded throughout. Data were analyzed using visual inspection and calculation of change in level, trend, immediacy of effect, stability, variability, and degree of overlap. Inter-observer agreement and treatment integrity data were also calculated.

Results:  Results indicated that this non-intensive intervention increased all participants’ social engagement behaviors almost immediately. A stable and functional relationship between the mirroring intervention and increases in target social engagement skills by all four children was demonstrated. Additionally, results indicate that the intervention was implemented with fidelity.

Conclusions:  Overall, findings support the use of mirroring to improve the social engagement skills of young, minimally-verbal children with ASD. This study is one of very few in the literature to quantify and objectively measure the effects of this technique. Additionally, it addresses a gap in research on minimally verbal, young children with ASD using non-intensive implementation. Establishing empirical support for this technique, when implemented by a clinician trained in mirroring is vital. This study has important implications for theoretical basis of mirroring and DMT, as well as clinical and practical implications. Once further empirical support is established, future studies may expand on this technique by training parents, clinicians, and other professionals to utilize mirroring techniques to engage children with ASD.