Systematic Review of Evidence-Based Interventions for Improving Imitation Ability of Children With Autism Spectrum Disorder

PURPOSE: The aim of this systematic review was to explore interventions to improve imitation ability of children with autism spectrum disorder (ASD) and the role of occupational therapy practitioners in providing such interventions. Imitation is considered a prerequisite skill for children to learn new things. However, children with ASD have significant deficits in imitation skill. The immaturity of imitation negatively affects development in various areas such as language, play, and social interaction throughout childhood.

To improve imitation skill, various intervention methods, including reciprocal imitation training, video modeling techniques, and robot-mediated training, have been introduced. The World Health Organization (2001) stated that full participation in everyday life is the ultimate marker of health function. It is important for children’s healthy and functional life that occupational therapy practitioners provide interventions to improve imitation skill in children with ASD and demonstrate the effectiveness of these interventions.

METHOD: This systematic review included articles published in English and Korean located using the ProQuest, PubMed, MEDLINE, Scopus, RISS, and KISS databases. The literature search focused on Level I–? studies published 2006–2016 using the key words “ASD AND Gesture imitation AND (Intervention OR Training).” A total of 1,835 articles were found; after careful review, 13 articles were included in this analysis. The studies were analyzed using the hierarchy of levels of evidence for evidence-based practice and psychology guidelines for evidence-based treatments. The details of each study were classified and analyzed on the basis of type of intervention, ages of participants, secondary dependent variables and their category, and field in which the research was conducted.

RESULTS: The majority of the 13 studies used a single-subject design. The most commonly applied of seven identified intervention methods was reciprocal imitation training. Interventions were mostly provided with a wide range of ages. Improvement in imitation skills affected language and social skills, behavior problems, motor skills, and activity of daily living (ADL) skills in children. The study field accounting for the highest proportion was psychology.

CONCLUSION: Analysis of the areas influenced by imitation skills revealed improvements in seven categories—language, interaction and social skills, problem behavior, play skills, motor skills, ADL performance, and other. These categories have many similarities to the occupations named in the Occupational Therapy Practice Framework: Domain and Process (American Occupational Therapy Association, 2014): ADLs, IADLs, rest and sleep, education, work, play, leisure, and social participation. However, none of the 13 studies was conducted by occupational therapy professionals. It is necessary for occupational therapy practitioners to apply evidence-based interventions to improve the imitation skill of children with ASD, which will help emphasize the role of occupational therapy practitioners as specialists who promote healthy and functional life for children with ASD.

IMPACT STATEMENT: Many factors related to imitation are closely related to the areas of interest in occupational therapy. This study can be the basis for suggesting the necessity and significance of occupational therapy intervention to improve imitation skill in children with ASD.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Tardif, C., Laine, F., Rodriguez, M., & Gepner, B. (2007). Slowing down presentation of facial movements and vocal sounds enhances facial expression recognition and induces facial–vocal imitation in children with autism. Journal of Autism and Developmental Disorders, 37, 1469–1484. https://doi.org/10.1007/s10803-006-0223-x

Wainer, A. L., & Ingersoll, B. R. (2015). Increasing access to an ASD imitation intervention via a telehealth parent training program. Journal of Autism and Developmental Disorders, 45, 3877–3890. https://doi.org/10.1007/s10803-014-2186-7

Williams, J. H., Whiten, A., & Singh, T. (2004). A systematic review of action imitation in autistic spectrum disorder. Journal of Autism and Developmental Disorders, 34, 285–299. https://doi.org/10.1023/B:JADD.0000029551.56735.3a

World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.