In press in: Journal of Speech-Language Pathology and Applied Behavior Analysis
Teaching Imitation to Children with Autism: A Focus on Social Reciprocity
Brooke Ingersoll
Abstract
Children with autism are impaired in their use of imitation. This paper reviews evidence suggesting that
imitation deficits may be particularly pronounced when the purpose of imitation is social. It then
provides a description of a novel imitation intervention that is focused on teaching imitation within a
social context and discusses the research supporting its effectiveness.
Key Words: Autism, imitation, social communication, intervention.
Introduction
Children with autism exhibit significant impairment in imitation skills (for a review, see Rogers
& Williams, 2006; Smith & Bryson, 1994; Williams, Whiten, & Singh, 2004). However, the scope of this
deficit is highly debated. Imitation skills do not appear to be uniformly disrupted, but rather limited to
specific types of actions and contexts (e.g., Williams et al., 2004). One possible explanation for these
discrepancies is that children with autism may have difficulty using imitation for certain purposes.
Research on typical development suggests that imitation serves two distinct functions in infancy and early
childhood. One is a learning function, through which infants acquire new skills and knowledge, and the
other is a social function, through which infants engage in social and emotional exchanges with others
(Uzgiris, 1981, 1990). Recently, it has been hypothesized that children with autism may be particularly
impaired in their social use of imitation, while the learning function is less impaired (Ingersoll, in press-a;
Rogers, Cook, & Meryl, 2005). The possibility that the social use of imitation may be especially
disrupted in individuals with autism has significant implications for the treatment of imitation deficits in
young children with autism. This paper will address three issues with respect to the imitation skills of
children with autism. First, it will review evidence for a specific deficit in the social use of imitation.
Second, it will discuss limitations of current methods for teaching imitation which target only the learning
function in highly structured contexts, and third, it will describe a naturalistic imitation intervention
designed to teach the social use of imitation in young children with autism.
Evidence of a Specific Deficit In the Social Use of Imitation
There have been two general approaches to investigating the distinction between the two
functions of imitation in children with autism. The first approach has been to present actions which
represent the different functions in structured or elicitation contexts. The second approach has been to
vary the contexts in which the imitation tasks are presented. Studies utilizing each of these approaches are
summarized below.
Studies Comparing Both Types of Imitation Within Structured Elicitation Tasks
Specifically, a child is seated across from the examiner in a distraction-free environment. The
examiner gains the child’s attention, models an action and instructs the child to imitate (e.g., “Do this”,
“You do it”). Actions that represent the learning function of imitation are typically meaningful actions on
objects, whereas actions that represent the social function of imitation have involved body movements
and non-functional acts on objects (Rogers, Cook, Young, & Giolzetti, 2005). For example, Hobson and
Lee (1999) compared children with autism and developmental delay on an object imitation task in which
the experimenter modeled the action in either a “harsh” or “gentle” style (i.e., body movements). The
children with autism imitated a similar number of goal-directed actions as the developmentally-delayed
children. However, they did not imitate the experimenter’s style. The authors suggested that children
with autism, while capable of imitation as demonstrated in their ability to replicate the goal of the actions
(learning function), do not use imitation as a means to identify with others (social function).
In other study, children with autism were found to be more likely to imitate actions with objects
that produced a sensory effect (flashing lights and sounds) than those that did not (Ingersoll, Schreibman,
and Tran, 2003). Typically developing children matched for mental age did not show this discrepancy
and imitated all actions equally well. The typically developing children also used more social behaviors
during imitation than the children with autism. This suggested that typical children are motivated to
imitate by the social feedback (i.e., eye contact with experimenter, exchange of positive affect) they
receive during the interaction, while the children with autism, who are not motivated by social feedback,
prefer to imitate only when provided with a non-social reward (i.e., sensory feedback).
Recently, Rogers and colleagues examined differences in imitation when the action produced a
functional outcome (e.g., hit maraca on hand) versus when it did not (e.g., hit potato masher on hand;
Rogers, Cook, et al., 2005). Compared to typically developing children and children with developmental
delay, the children with autism imitated significantly worse in the second condition than the first, while
the other groups did not show this difference. The authors suggested that children with autism are most
impaired in their ability to imitate when the act serves an exclusively social function.
In the above studies, imitation of certain actions (examiner style, non-meaningful actions on
objects) was assumed to represent imitation for social purposes. However, imitation was presented
exclusively in a highly structured context with explicit instructions to imitate. In general, the social
imitation observed in young children does not occur in these structured contexts; rather it tends to occur
during social interactions with others, such as during play (Eckerman & Stein, 1990). In addition, social
imitation often occurs spontaneously, rather than in response to an instruction (Eckerman & Stein, 1990).
Thus, one potential confound to these studies is that the tasks used to assess the social function of
imitation are not representative of the context in which social imitation typically occurs. A second
potential confound is that the imitative acts used to represent the learning and social functions of imitation
were different (Hobson et al., 1999) or involved different objects (Ingersoll et al., 2003; Rogers, Cook, et
al., 2005). Thus it is possible that the actions in the social condition were fundamentally more difficult to
imitate, regardless of their social properties. For example, we noted that the sensory feedback provided
by the learning tasks may have made the modeled actions more salient and thus easier to represent
(Ingersoll et al., 2003).
Studies Comparing Both Types of Imitation Across Different Elicitation Contexts
Another approach to examining differences in the social and learning function of imitation in
children with autism has been to vary the context in which the imitation tasks are presented. For example,
Whiten and Brown (1998) found that individuals with autism imitated behaviors during an elicited
imitation task. However, they did not imitate as well as young typical and developmentally-delayed
children during a spontaneous imitation task. The authors suggested that individuals with autism are
capable of imitation, as evidenced by their imitation in the elicited condition, but lack the social
motivation to imitate spontaneously. Although the authors manipulated the social context in which the
imitation tasks were presented, the tasks themselves may have tapped the opposite function of imitation.
The elicited condition used manual gestures, which have been proposed to subserve the social aspect of
imitation (Rogers et al., 2005), while the spontaneous condition used meaningful actions on objects
(opening an “artificial fruit” containing a treat), which likely involve the learning aspect of imitation
(Rogers et al., 2005). In addition, the use of such different tasks across conditions makes the results
difficult to interpret.
Stone and colleagues examined immediate imitation skills in young children with autism in three
contexts: A structured-elicited condition, a naturalistic-social condition in which children were alternately
imitated by the examiner and presented with actions to imitate during free play, and a spontaneousinstrumental condition in which children observed an experimenter activate a mechanical device to
produce lights and sound and were given the opportunity to imitate without instructions. They found that
the children with autism imitated significantly better in the structured-elicited and the spontaneousinstrumental condition than in the naturalistic-social condition (Stone, Ulman, Swanson, McMahon, &
Turner, 2004). They also found that imitation on the structured-elicited and spontaneous-instrumental
conditions were associated with attention-following skills, while performance in the naturalistic-social
condition was associated with reciprocal social interaction (McDuffie et al., 2007). Their findings
suggest that children with autism are particularly impaired in their ability to imitate when the function of
imitation is purely social and that use of imitation in different contexts is mediated by different underlying
skills (McDuffie et al., 2007; Rogers, Hepburn, Stackhouse, & Wehner, 2003).
In their study, the modeled actions differed in each condition. The structured task used the Motor
Imitation Scale (Stone, Ousley, & Littleford, 1997), the social task used a standard set of toys with
different actions modeled for each participant based his or her play level, and the observational learning
task used a different set of objects which produced a sensory effect. Thus it is unclear if differences were
due to the social context or actions modeled. For example, it is possible that the actions presented during
the social condition, were simply more complex. In addition, since there was no control group, it is
unclear if lower performance in a social context is unique to autism or is also found in typically
developing children.
To further examine this question, we compared object imitation performance in young children
with autism and typical children matched for non-verbal mental age in a structured and social condition
(Ingersoll, in press-b). In the structured condition, the child was seated at a table and given specific
instructions to imitate. In the social condition, the child was alternately imitated by the adult and
presented with models in a free play setting. To control for possible differences in the complexity of
modeled actions between the two conditions, two set of 10 actions were designed and counterbalanced
across condition. The results indicated that, unlike the typically developing children who imitated equally
well in both conditions, the children with autism imitated significantly more poorly in the social
condition. In addition, the children with autism displayed significantly less coordinated joint attention
during imitation than the typical children, which suggests that even when children with autism do imitate,
their imitation appears less social.
In summary, research is beginning to emerge that suggests that children with autism may be
particularly impaired in their ability to imitate when the function is purely social. Such a deficit would
lead to a behavioral pattern in which children with autism are much more likely to imitate when the
imitative act results in some type of interesting or positive outcome and much less likely to imitate
spontaneously for the purposes of engaging with others.
Possible Explanations for a Specific Deficit in Social Imitation
Why are children with autism more impaired on tasks which tap the social function of imitation?
One explanation is that these children lack the social motivation to share experiences or to be like others.
It is this social motivation that naturally draws typically developing children into imitative interactions
(Carpenter, 2006; Ingersoll et al., 2003). This possibility is supported by the finding that the children
with autism exhibit significantly lower rates of coordinated joint attention during imitation than typically
developing children (Ingersoll, in press b; Ingersoll et al., 2003). This finding suggests that even when
children with autism do imitate, their imitation appears less “social” and may be an indication of a lack of
interest in sharing the imitation experience with the partner.
It is also possible that social imitation deficits in autism result from a failure to visually attend to
others during spontaneous interactions (Rogers, Cook, et al., 2005). A pervasive lack of visual attention
to others during natural interactions may disrupt imitation development, particularly for social tasks.
Alternately, poor imitation skills may lead to a lack of visual attention to others or may parallel imitation
deficits (Rogers et al., 2005).
Another potential explanation involves the intervention strategies used for teaching imitation
skills to young children with autism. Current imitation training programs typically utilize highly
structured, adult-directed procedures originally described in the 1960s (e.g., Maurice, Green, & Luce,
1996). In this approach, which is based on learning theory, imitative behavior is broken into a series of
discrete sub-skills, which are presented in multiple, successive trials. Specific sub-skills, such as
individual non-verbal actions, are selected by the therapist from a variety of actions (meaningful and nonmeaningful) that the child is not yet performing spontaneously. Acquisition is facilitated by the use of
explicit prompting, prompt fading, and contingent reinforcement, usually food or access to a preferred toy
unrelated to the imitative act.
Limitations of Current Methods for Teaching Imitation
By teaching imitation as an isolated skill, traditional behavioral procedures do not incorporate the
social-communicative process that typically occurs during adult-child interactions (Schreibman, Kaneko,
& Koegel, 1991). In addition, the use of heavy structure and artificial reinforcers renders limits the
generalization and spontaneous use of these skills (Lovaas, 1977; Spradlin & Siegel, 1982; Koegel,
O'Dell, & Koegel, 1987). Thus, the current method for teaching imitation to young children with autism
may not adequately address the social function of imitation. Since, it is likely the social use of imitation
is involved in the development of other social-communication skills (Rogers et al., 2003), intervention
programs which promote the social use of imitation may be most effective at promoting the development
of other social-communication skills (McDuffie et al., 2007).
Alternative Methods for Teaching Social Imitation to Children with Autism
The field is just beginning to embrace new methods for targeting imitation skills that are more
likely to address the social use of imitation. There have been several preliminary reports of
developmentally-based procedures that teach imitation skills within a social context (Klinger & Dawson,
1992; Nadel & Peze, 1992). These reports, while promising, are limited by a lack of experimental
control. In a controlled study, Hwang and Hughes (2000) partially replicated Klinger and Dawson’s
(1992) intervention strategy using a multiple-baseline design with three preverbal preschool-aged children
with autism. This study used contingent imitation, naturally occurring reinforcement, expectant looks,
and environmental arrangement. All three children showed an increase in their frequency of eye contact,
joint attention, and motor imitation concurrent with the onset of treatment, suggesting that imitation skills
can be concurrently taught with other social-communication skills, a strong indication that this type of
approach may teach the social use of imitation.
However, Hwang and Hughes (2000) targeted the imitation of only familiar actions that were
already in the children’s repertoire. Therefore, while they were able to increase the spontaneous use of
imitative behavior, they did not demonstrate that their technique could teach imitation of actions outside
of the children’s repertoire. In addition, the authors found minimal generalization and did not measure
maintenance. Further, they reported that increases in targeted behaviors occurred at a slower rate than
anticipated (seven months), suggesting the acquisition of imitation behaviors using this method may be
very time intensive.
Reciprocal Imitation Training (RIT)
The developmental approach is child-centered and conducted in the natural environment;
therefore it theoretically addresses the problems with generalization and spontaneity found in the
traditional behavioral method (Tsakiris, 2000). In addition, it targets multiple, co-occurring social-
communicative behaviors concurrently. However, outcomes from these studies suggest that a purely
developmental approach may be insufficient for producing robust gains in imitation skills.
Thus, we developed Reciprocal Imitation Training (RIT), a naturalistic imitation intervention that
emphasizes the social role of imitation over the cognitive role typically emphasized in traditional
behavioral imitation training protocols (Ingersoll & Gergans, 2007; Ingersoll, Lewis, & Kroman, in press;
Ingersoll & Schreibman, 2006). This intervention incorporates strategies from the developmental
literature that have been shown to increase reciprocity (i.e., following the child’s lead, contingent
imitation, linguistic mapping) with naturalistic behavioral strategies that have been shown to promote
acquisition and maintenance (i.e., explicit prompting, contingent reinforcement, direct response-reinforcer
relationship).
In RIT, imitation is taught within on-going play interactions with the therapist or parent. The
adult begins by engaging the child in free play with around five sets of identical play materials. Toys are
chosen based on the child’s interest and are rotated every 20 minutes or so to keep the child’s motivation
high. During this play, the adult imitates all of the child’s actions with toys, gestures, and vocalizations
(contingent imitation) to encourage responsivity to being imitated (Klinger & Dawson, 1992). At the
same time, the adult provides a running commentary of the child’s actions using simplified language
(linguistic mapping; Warren, Yoder, Gazdag, & Kim, 1993) to enhance the correspondence between the
child and the therapist's actions and to provide appropriate language models. For example, if the child is
rolling a car back and forth, the adult would role another car back and forth in the child’s line of sight.
While doing so, the adult might say, “Roll, roll car; car is rolling.”
To teach object imitation, the adult models an action with the duplicate of the toy the child is
manipulating once a minute, on average. Actions are varied across trials with the same play materials and
may involve familiar actions (actions the child already performs spontaneously) and novel actions. The
modeled action is presented up to three times and is paired with a descriptive verbal marker that is varied
across toys and actions. For example, if the child is rolling a car, the adult might model placing a figure
in the car and say “Man in.” The adult presents the action and the verbal marker up to three times,
leaving a brief time in between models for the child to respond. Once the child imitates, the adult praises
the child, and allows the child to engage with toys as he or she prefers (contingent reinforcement) and
returns to imitating the child. If the child does not imitate after the third model, the adult physically
guides the child to complete the action (explicit prompting) and then provides praise and continued access
to toys. As the treatment progresses, actions are modeled with toys the child is not engaged with to
encourage more flexible responding.
Gesture imitation is taught within context, such that the gestures presented are directly related to
the child’s play. For example, if the child is playing with cars, the adult might model a gesture related to
driving, such as pantomiming steering or beeping, pointing to where the car will drive, or clapping hands
to represent “crashing.” The goal is to model descriptive and affective gestures that are meaningful.
Again, the adult uses the same prompting procedure for encouraging imitation if the child does not imitate
spontaneously.
Unlike structured imitation training in which pre-selected actions are presented until the child
reaches criterion, actions in RIT are modeled based on the child’s interest and are varied across the
session. Thus, the goal is to increase the overall percentage of modeled actions imitated, rather than
teaching specific actions to mastery. Typically, actions with objects are taught before gestures because
object imitation is less abstract and easier for children with autism to perform (DeMyer et al., 1972).
Although both object and gesture imitation can be taught within a session (Ingersoll & Gergans,
2007), we have found that it is easier for the adult to remember what to model if he or she focuses on only
one type at a time. Thus, in our current study in which the children receive three, 20-minute sessions per
day, three days per week, we alternate object and gesture imitation every session.
To examine the efficacy of RIT, we have conducted a series of single-subject, multiple-baseline
designs with 2- to 4-year-old children with autism. Our first study evaluated the intervention's ability to
teach object imitation during play and its effect on the development of more advanced socialcommunication skills in five children with autism (Ingersoll & Schreibman, 2006). Session data
indicated that RIT led to increases in the children’s object imitation skills, which generalized to novel
environments and maintained over time. In addition, the children increased their use of language, play,
and joint attention. Naïve observers viewed videos of the children in naturalistic interactions with a
therapist at pre- or post-treatment. Observers saw each child only once and were kept blind to the child’s
point in treatment. Between subjects t-tests confirmed that the observers rated the children as
significantly more appropriate in their imitation, language, play, and social behavior at post-treatment
than pre-treatment. This finding indicates that RIT led to socially valid changes for the participants.
These results suggest that this method of training produces spontaneous, generalized object imitation and
that increases in imitative behavior precipitated changes in other social-communicative behaviors. The
latter finding provides support for the theory that the early social-communication skill of imitation is
foundational to learning more advanced skills.
Given the effectiveness of RIT for teaching object imitation, in a second study, we adapted it to
teach the imitation of descriptive gestures in five additional children with autism (Ingersoll et al., in
press). Gestures are thought to be learned via imitation and serve as a precursor to language. Thus, this
study also examined whether changes in gesture imitation were associated with gains in spontaneous
gesture and language use. The results indicated that RIT led to increases in the children’s gesture
imitation, which generalized to novel environments and maintained over time. In addition, most children
had substantial gains in their spontaneous use of gestures and began combining verbal utterances with the
gestures. Again, naïve observers rated the children as more appropriate in their social communication. In
a third study, we examined the effectiveness of teaching parents to use this intervention approach with
their children with autism with three parent-child dyads (Ingersoll & Gergans, 2007). The results of this
study replicated previous results, indicating that parents can be taught to use this intervention to enhance
their children’s spontaneous imitation skills. In addition, parents reported that the intervention was
simple and easy to use and expressed high levels of satisfaction with the outcomes of the intervention and
the training procedure itself.
Research on RIT suggests that it is effective for teaching spontaneous imitation skills. In
addition, it leads to good generalization and maintenance of skills. Perhaps more importantly, RIT also
increases other social-communication skills, including joint attention, pretend play, language, and gesture
use. This finding suggests that the approach is able to teach imitation skills within a social context and
that the social use of imitation may lead to improvement in other social-communication behaviors
(Ingersoll et al., in press; Ingersoll & Schreibman, 2006).
Our previous work is limited by the small samples inherent in single-subject designs. In addition,
although our results suggest that the children made gains in other social-communication skills, they did
not indicate whether these changes were due to changes in imitation per se rather than some other aspect
of the intervention. Thus, we are currently using a randomized design to further examine several aspects
of the efficacy of RIT. This study will compare young children with autism who receive 10 weeks of RIT
to a community-based control group. Using this sample, we will also be able to more directly test
whether improvements in language, play, and social interaction are mediated by gains in imitation. In
addition, we will examine whether specific child characteristics can predict which children respond best
to RIT. In future research, we also plan to compare the effectiveness of RIT to the traditional approach
for teaching imitation to determine whether imitation taught via RIT truly appears more social than
imitation taught in a structured context.
Summary
In summary, children with autism have substantial difficulty imitating others. This difficulty
appears to be more pronounced when the function is to engage with others for social purposes. Newer
imitation training methods, such as RIT, are focused on teaching imitation skills to young children with
autism in a social context and thus may be more effective for encouraging spontaneous, generalized
imitation. In addition, teaching imitation via these newer methods may be more likely to promote the
development of other social-communication skills and social reciprocity. Additional research is needed to
determine whether these newer methods of imitation training do indeed teach different forms of imitation
than the traditional methods, whether changes in social communication are mediated specifically by gains
in imitation skills, and which children most likely to benefit.
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Author’s Note
This manuscript was supported by a grant from Cure Autism Now.
Author’s Contact Information
Brooke Ingersoll, Ph.D., BCBA
105B Psychology Building
Michigan State University
East Lansing, MI 48824
Phone: 517-432-8412
Email: ingers19@msu.edu.