Teaching Adults with Autism Spectrum Disorder Responses to Non-Verbal Pragmatic Behavior

Background: One common challenge discussed in the literature for individuals with autism spectrum disorder (ASD) is in area of recognizing and responding to non-verbal pragmatic cues during social interactions. The use of intervention strategies such as self-management and the incorporation of visual prompts have been empirically supported as effective strategies for improving an array of social skills for adults with ASD.

Objectives: The purpose of the present study was to use self-management and question-asking intervention strategies and to assess the efficacy of the intervention with respect to teaching adults with ASD to recognize and respond appropriately to specific pragmatic behaviors, with the goal of enhancing their social interactions.

Methods: A multiple baseline across participants design was used to assess the efficacy of an intervention for adults who demonstrated a lack of responding to their communicative partners’ nonverbal pragmatic behaviors. Participants were taught to ask specific, relevant questions in response to their conversation partner’s nonverbal expressions of boredom and confusion. The intervention included clinician modeling of the expression, creation of a question bank for each expression, and practice with self-management for responding to each pragmatic expression. Conversations were video recorded during baseline, intervention, and follow up sessions, and responses to each pragmatic cue was coded as appropriate or inappropriate, yielding a percent of appropriate responses for each pragmatic expression in each session.

Results: Participants showed substantial gains in responding appropriately to targeted pragmatic behaviors during social conversation after beginning the intervention. Moreover, this skill generalized to novel conversation partners and maintained after terminating the intervention. Additionally, the Empathy Quotient (Baron-Cohen & Wheelwright, 2004) scores improved from pre- to post-intervention, lending support to the social validity of this intervention.

Conclusions: An intervention which utilizes modeling, question banks, and self-management can be effective in teaching recognition of, and appropriate responses to, pragmatic social cues for adults with ASD. Improved performance in this skill likely contributes to benefits in their social communication overall.