2012. Vol.3, No.9, 681-685
Published Online September 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.39103
Copyright © 2012 SciRes. 681
Imitation Effects on Joint Attention Behaviors of Children
Shauna Ezell1, Tiffany Field1,2, Jacqueline Nadel3, Rae Newton1, Greg Murrey1,
Vijaya Siddalingappa1, Susan Allender1, Ava Grace1
1Fielding Graduate University, Santa Barbara, USA
2University of Miami Medical School, Miami, USA
3Hôpital la Salpêtrière, Paris, France
Email: tfield@ med.miami.edu
Received May 27th, 2012; revised June 28th, 2012; accepted July 26th, 2012
This study examined the effects of adult imitation on three joint attention behaviors of nonverbal pre-
schoolers with autism including referential looking, gaze following and gesturing to the adult. Videotapes
taken from a previous study were recoded for the adult’s imitation behavior and the children’s joint atten-
tion behaviors (Field, Field, Sanders, & Nadel, 2001). In the original study, twenty nonverbal, 4 - 6-year-
old children with autism were randomly assigned to one of two groups, an imitation or a contingent re-
sponsivity group. Both groups of children engaged in an intervention play phase during which the adult
imitated the children or contingently responded to them and a subsequent spontaneous play phase.
ANOVAs revealed that the imitation group children versus the contingent responsivity group children
spent a greater percent time looking at the adult during the intervention phase and looking at the adult and
following the adult’s gaze during the spontaneous play phase. A correlation analysis on the data collapsed
across the 2 groups yielded significant correlations between adult imitation during the intervention phase
and referential looking and gaze following during the spontaneous play phase. Overall, these results re-
vealed that adults imitating preschoolers with autism elicited joint attention behaviors, highlighting the
value of imitation as an intervention.
Keywords: Imitation; Joint Attention; Autism
Children with autism show limited joint attention behavior
such as referential looking, gaze following and gesturing (Char-
man et al., 1997). Joint attention delays and deficits, in turn, can
affect their language development (Meltzoff & Gopnik, 1993;
Williams, Whiten, & Singh, 2004). Some research has noted
moderate relationships between imitation and language devel-
opment (Carpenter, Nagell, Tomasello, Butterworth, & Moore,
1998), while at least one other study reported strong relations
between joint-attention and language development (Boucher,
A growing body of research has demonstrated that training
children with autism can enhance their social interaction skills
(Hwang & Hughes, 2000). For example, our studies showed
that very young children with autism respond to being imitated
by increasing both their distal (attention) and proximal (touch-
ing) social behaviors during and after imitative interactions
(Escalona, Field, Nadel, & Lundy, 2002; Field, Field, Sanders,
& Nadel, 2001; Heimann, Laberg, & Nordoen, 2006). In the
Field et al. (2001) study, the possibility of imitation merely
being a contingently reinforcing response was determined by
randomly assigning half the sample to a contingent responsivity
group. The imitation group showed more social behavior than
the contingent responsivity group.
Several studies have focused on joint attention skills in chil-
dren with autism (Ingersoll & Screibman, 2006; Kasari, Free-
man, & Paparella, 2006; Klinger & Dawson, 1992; McCarthren,
2000; Salt et al., 2002), with one of these studies focusing spe-
cifically on imitation as a significant contributor to the joint
attention effects (Ingersoll & Schreibman, 2006). However,
different types of interventions were combined in these studies,
thus confounding any imitation effects. For example, in one
program (Salt et al., 2001, 2002), the treatment group received
parent training, imitation, intrusion into solitary play, touch,
and verbalization, and in another study, prompts, linguistic
mapping and descriptive talk were used in conjunction with
imitation and modeling (McCarthren, 2000). Nonetheless, se-
veral of these studies suggest that imitation improved children’s
responsivity including their joint attention behaviors. It is still
unclear, however, whether imitation per se or the contingent
responsivity of imitation facilitated the joint attention behaviors.
Thus, in the current study, imitation and contingent responsi-
vity were compared for their effects on joint attention behaviors
including referential looking, gaze-following, and showing and
pointing gestures in children with autism.
Videotapes that were previously coded for proximal and dis-
tal social behaviors (Field et al., 2001) were re-coded to assess
the effects of adult imitation versus contingent responsivity on
joint attention behaviors in preschool children with autism. The
children who were imitated versus those in the contigent re-
sponsivity condition were expected to spend a greater percent
time showing joint attention behaviors including referential
looking, gaze-following, showing and pointing gestures (Car-
penter, Pennington, & Rogers, 2002). Further, adult imitation
was expected to be related to these joint attention behaviors in
the children with autism.
S. EZELL ET AL.
The sample videotaped for the original study comprised
twenty preschool non-verbal children with autism (10 boys and
10 girls) who ranged from 4 to 6 years of age (M = 5.4). The
families of the children were middle socioeconomic status
(Hollingshead Index (1975), M = 2.9), and ethnicity was dis-
tributed 52% Caucasian, 40% Hispanic, and 8% African-
American. All children had received a DSM-IV diagnosis of
autism. The children’s PEP-R scores averaged 18.8 (imitation =
17.9, perception = 22.6, cognitive performance = 18.2, cogni-
tive verbal = 16.7). The two groups of children did not differ on
In the original study the interaction sessions were held in a
playroom equipped with two chairs, a table, and two identical
sets of toys to enable imitation of same object actions. Placed in
full view on the table, the two sets of toys included cups, plates,
slinkies, dolls, balls, hats, sunglasses, umbrellas, stuffed ani-
mals, and balloons. The children were randomly assigned to
one group in which an unfamiliar adult was asked to immedi-
ately imitate all of the children’s behaviors with the same object
or to a second group in which the adult was asked to immedi-
ately contingently respond with a nonverbal behavior to the
children’s behaviors (respond immediately but with a non-
imitative behavior) (Field et al., 2001). This was the first
3-minute interaction called the intervention phase. Imitation for
the current study was defined as the adult reproducing the same
behavior observed in the child (vocal, gestural, object-action
with the same object) during the same time sample unit. Field et
al. (2001) noted that even though the unfamiliar adult was in-
structed not to imitate the child’s behaviors during the contin-
gent responsivity (non-imitative) condition, some imitation may
have occurred during this intervention. Likewise, the imitation-
only intervention phase featured occasional non-imitative, yet
contingently responsive behaviors. After the intervention phase,
both groups participated in a 3-minute spontaneous play phase
during which the adult was asked to play spontaneously with
the children rather than imitating or contingently responding to
their behaviors. Although three sessions were videotaped for
the original Field et al. (2001) study, because of limited power
only the first and last sessions were coded for the present study
(yielding 6 minutes of intervention play and 6 minutes of spon-
The joint attention behaviors included the following: 1) refe-
rential looking or looking at the interactive adult and what the
adult was holding and doing (dyadic) and looking from object
to adult and back to object (triadic); 2) gaze-following or fol-
lowing the attentional focus of the adult by shifting gaze; and 3)
pointing and showing gestures with the adult. Three graduate
students were trained to code the videotapes that were ran-
domly assigned to them. The coders were blind to the purpose
of the study and the group assignment. The videotapes of the
adult and child were coded at 10-second time intervals for the
two 3-minute phases, checking these three child behaviors and
adult imitation behavior on a time sample unit coding sheet
whenever they occurred. The total number of time sample units
checked for each behavior was divided by the total number of
time sample units to calculate the percent time each behavior
occurred for each interaction phase (intervention and sponta-
neous play). Percent time was calculated because of the slight
variability in the length of the interaction phases. Inter-coder
reliability was established by Cohen’s Kappa on one-third of
the videotapes as follows: Adult imitation (.89), child referen-
tial looking (.81), child gaze-following (.83), and child gesture-
The two sessions were combined for data analyses because
of limited power and the apparent absence of differences across
the two sessions. ANOVAs were performed to compare the 2
groups on the adult’s imitation behavior and the children’s 3
joint attention behaviors during the intervention play phase and
during the spontaneous play phase. A Pearson correlation
analysis was then conducted on data collapsed across the 2
groups to determine the relations between adult imitation and
the child joint attention behaviors.
As can be seen in Table 1, and as expected, more adult imi-
tation occurred in the imitation group versus the contingent
responsivity group during the intervention phase (F[1, 18] =
14.50, p = .001, partial η2 = .45). Also as expected, the groups
did not differ on the percent time the adult imitated the children
during the spontaneous play phase (F[1, 18] = .63, p = .44, par-
tial η2 = .03).
ANOVAs conducted on the three joint attention behaviors
revealed that the children in the imitation group spent a greater
percent time engaged in referential looking during the interven-
tion phase (F[1, 18] = 12.37, p = .003, partial η2 = .41) as com-
pared to the children in the contingently responsive group. The
size of this observed effect was noteworthy according to
Cohen’s guidelines (1988) indicating that 41% of the variance
in referential looking during the intervention phase could be
explained by the imitation intervention. No group differences
were observed for the child gesturing behavior (F[1, 18] = .86,
p = .37, partial η2 = .05).
Also as can be seen in Table 1, regarding the spontaneous
play phase, the imitation group versus the contingent respon-
sivity group spent more time showing: 1) referential looking
(F[1, 18] = 7.45, p = .01, partial η2 = .29); and 2) gaze-follow-
ing (F[1, 18] = 23.19, p < .001, partial η2 = .56). The effect
sizes were large for all three behaviors. The largest effect was
noted for gaze-following behavior, with 56% of the variance
explained by the imitation intervention. Again, no significant
group differences were noted for the child gesturing behavior
(F[1, 18] = .12, p = .74, partial η2 = .01).
As can be seen on line 7 of Table 2, the Pearson correlation
analysis yielded significant correlations between the percent
time the adult imitated the child during the intervention phase
and the percent time the child engaged in referential looking
during both the intervention (r = .62, p = .004) and the sponta-
neous play phases (r = .47, p = .03). According to Cohen’s
guidelines (1988) the power of each was calculated to be appro-
ximately .83 and .40 respectively. Adult imitation during the
intervention phase also correlated with gaze following (r = .69,
p = .001) during the spontaneous play phase. An examination
of Cohen’s guidelines revealed a better than chance probability
falling above .83 and just below .96. No significant association
Copyright © 2012 SciRes.
S. EZELL ET AL.
Copyright © 2012 SciRes. 683
Mean percent time (and standard deviations) behaviors occurred in the imitation and contingent responsivity groups during the intervention and spon-
taneous play phases.
Imitation Contingent Responsivity
M SD M SD F p
Adult Imitates Child 73.70 11.80 33.15 31.54 14.50 .001
Referential Looking 33.20 18.30 10.70 8.72 12.32 .003
Gaze Following 59.70 23.50 38.83 23.63 3.91 .06
Child Gestures to Adult 18.85 18.16 12.90 9.12 .86 .37
Spontaneous Play Phase .63 .44
Adult Imitates Child 8.50 7.34 5.00 11.86 .63 .44
Referential Looking 27.30 17.66 10.65 7.77 7.46 .01
Gaze Following 74.80 15.57 40.40 16.37 23.19 .000
Child Gestures to Adult 28.45 18.36 25.90 14.81 .12 .74
Correlation matrix: adult imitation and joint attention behaviors during intervention (IP) and spontaneous play (SP) phases.
(1) (2) (3) (4) (5) (6) (7) (8)
(1) Referential Looking (IP) 1.0
(2) Referential Looking (SP) .73* 1.0
(3) Following Gaze (IP) .05 .14 1.0
(4) Following Gaze (SP) .51* .50* .18 1.0
(5) Gesturing (IP) .66** .19 –.29 .22 1.0
(6) Gesturing (SP) .11 .03 –.17 .18 .39 1.0
(7) Adult Imitation (IP) .62** .47* .03 .69** .26 –.08 1.0
(8) Adult Imitation (SP) .24 .23 .36 .11 –.07 –.08 .47* 1.0
Note: *p < .05; **p < .01 (2-tailed).
was found between adult imitation during the intervention
phase and gesturing in either phase. Also, not surprisingly,
adult imitation during the spontaneous play phase was not re-
lated to child joint attention behaviors during the previous in-
The present study investigated the effects of adult imitation
on joint attention behaviors of preschoolers with autism.
ANOVAs yielded differences between the imitation and con-
tingent responsivity groups on the adult imitation and child
joint attention behaviors during both the intervention and spon-
taneous play phases. During the intervention play phase, the
children in the imitation group showed more referential looking.
During the spontaneous play phase, the imitation group showed
not only more referential looking, but also more gaze-following.
The correlation analysis revealed robust relations between adult
imitation and these two joint attention behaviors of the children.
Significant correlation coefficients were noted for the percent
time the adult imitated the children’s behaviors during the in-
tervention phase and the percent time the children engaged in
referential looking during the intervention phase as well as
referential looking, and gaze-following by the children during
the spontaneous play phase.
Overall, these results demonstrate the effectiveness of imi-
tating preschoolers with autism specifically in terms of their
referential looking and gaze following behaviors. Imitation as
compared to contingent responsivity by an unfamiliar adult
elicited at least these two joint attention behaviors of the four to
six-year-old preschoolers. These results, in conjunction with the
findings of Field et al. (2001) using the same sample, highlight
the effectiveness of adult imitation for eliciting more proximal
and distal social behaviors and more joint attention behaviors in
young children with autism. The joint attention behaviors ob-
served during this study are similar to those demonstrated by
younger, typically-developing children during imitative games
(Meltzoff, 1990; Trevarthen, 1977). The significant correlations
between imitating the children’s behaviors during the interven-
tion phase and the time the children spent looking at the adult
and following the imitating adult’s gaze, during the subsequent
spontaneous play phase were noteworthy. Imitation may have
captured the children’s attention reflected by their greater ref-
erential looking during the intervention play phase (more ref-
erential looking) leading to the children’s increased referential
looking and gaze following in the subsequent spontaneous play
S. EZELL ET AL.
Gesturing appeared to increase from both intervention condi-
tions (imitation and contingent responsivity) to the spontaneous
play phases The considerable intragroup heterogeneity (high
standard deviations) may have masked potential group diffe-
rences, especially given the combining of the referential look-
ing and gaze-following behaviors. A larger sample would en-
able further examination of the specific gesturing behaviors and
whether any differences exist between communicative and in-
strumental gestures (Loveland & Landry, 1986). Some have
referred to these as initiating joint attention behaviors and initi-
ating regulating/requesting behaviors. Also, with a larger sam-
ple, comparisons could be made between those children who
used gestures and those who did not. Alternatively, this result
may be consistent with the finding that children with autism are
less inpaired in gesturing than other joint attention behaviors
(Mundy & Sigman, 2006).
Research supports the perspective that imitation serves two
functions (Nadel, Revel, Andry, & Gaussier, 2004; Uzgiris,
1981). Nadel et al. (2004) refer to these as communication and
learning. The present study supports this position by expanding
on previous studies that showed increased distal (attention) and
proximal (touching) social behaviors during and after imitative
interactions (Escalona et al. 2002; Field et al., 2001). The pre-
sent study demonstrates that imitating preschoolers with autism
elicits more joint attention behaviors.
Although there is ample evidence that children with autism
have joint attention deficits, these deficits are not universal and
are more evident in the imitation of joint attention than in re-
sponse to the joint attention of others. (Charman et al., 1997).
Some have argued that an imitation deficit disrupts the deve-
lopment of joint attention behavior (Rogers & Pennington,
1991). However, Nadel (2006) suggests that the lack of imita-
tion may be the result of how this capacity has been researched
in children with autism.
Caution must be taken regarding the interpretation and gene-
ralization of these results beyond this age group or to apply
them to children with other developmental disabilities or lan-
guage impairments. Also, joint attention was assessed by only
three behaviors thereby limiting the generalization of these
findings to this definition of joint attention. Future studies
might include additional joint attention behaviors. Further re-
search is also needed to determine the effects that imitating
nonverbal children with autism may have on language devel-
opment. Other suggestions for future research include further
examination of joint attention behaviors and other behaviors
related to the development of language including the child’s
recognition of being imitated and the child’s initiation of novel
behaviors. Another possible investigation might be the exami-
nation of the relations between imitation, practice effects, and
the child’s development of joint attention behaviors. Nonethe-
less, the results of this study suggest an association between
social-affective and communicative behavior. They also indi-
cate that imitating preschoolers with autism may be an effective
intervention for at least increasing two of the joint attention
behaviors observed in this study including gaze following and
gesturing to the adult.
We would like to thank the researchers who conducted the
original play sessions with the children (Tory Field and Brenda
Lundy) and the children who participated in the play sessions.
Additional gratitude is also extended to Lissette Medina who
assisted with the manuscript. This paper was completed in par-
tial fulfillment of the Ph.D. in clinical psychology by the first
Boucher, S. M. (2008). Joint attention, imitation, and repetitive behav-
iors as predictors of autism and expressive language ability in early
childhood. Doctoral Dissertation, Chapel Hill, NC: University of
North Carolina at Chapel Hill.
Carpenter, M., Nagell, K., Tomasello, M., Butterworth, G., & Moore, C.
(1998). Social cognition, joint attention, and communicative compe-
tence from 9 to 15 months of age. Monographs of the Society for Re-
search in Child Devel opment, 63, i-174. doi:10.2307/1166214
Carpenter, M., Pennington, B. F., & Rogers, S. J. (2002). Interrelations
among social-cognitive skills in young children with autism. Journal
of Autism and Developmental Disor ders, 32, 91-106.
Charman, T., Swettenham, J., Baron-Cohen, S., Cox, A., Baird, G., &
Drew, A. (1997). Infants with autism: An investigation of empathy,
pretend play, joint attention, and imitation. Developmental Psychol-
ogy, 33, 781-789. doi:10.1037/0012-16188.8.131.521
Cohen, J. (1988). Statistical power analysis for the behavioral sciences
(2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Escalona, A., Field, T., Nadel, J., & Lundy, B. (2002). Brief report:
Imitation effects on children with autism. Journal of Autism and De-
velopmental Disorders , 32, 141. doi:10.1023/A:1014896707002
Field, T., Field, T., Sanders, C., & Nadel, J. (2001). Children with
autism display more social behaviors after repeated imitation ses-
sions. Child Development, 5, 317-323.
Heimann, M., Laberg, K. E., & Nordøen, B. (2006). Imitative interac-
tion increases social interest and elicited imitation in non-verbal chil-
dren with autism. Infant and Child Development, 15, 297-309.
Hollingshead, A. (1975). Four-factor index of so c ia l s t atus. New Haven,
CT: Yale University.
Hwang, B., & Hughes, C. (2000). The effects of social interactive
training on early social communicative skills of children with autism.
Journal of Autism and Developmental Disorders, 30, 331-343.
Ingersoll, B., & Screibman, L. (2006). Teaching reciprocal imitation
skills to young children with autism using naturalistic behavioral ap-
proach: Effects on language, pretend play, and joint attention. Jour-
nal of Autism and Developmental Disorders, 36, 487-505.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and
symbolic play in young children with autism: A randomized con-
trolled intervention study. Journal of Child Psychology and Psychia-
try, 47, 611-620. doi:10.1111/j.1469-7610.2005.01567.x
Klinger, L., & Dawson., G. (1992). Facilitating early social and com-
municative development in children with autism. In S. F. Warren, &
J. Reichle (Eds.), Causes and effects in communication and language
intervention, Vol. 5. Baltimore, MD: Brookes.
Loveland & Landry (1986). Joint attention and language in autism and
developmental language delay. Journal of Autism and Developmen-
tal Disorders, 16, 335-349. doi:10.1007/BF01531663
McCarthren, R. B. (2000). Teacher-implemented prelinguistic commu-
nication intervention. Focus on Autism and Other Developmental
Disabilities, 15, 21-29. doi:10.1177/108835760001500103
Meltzoff, A. N. (1990). Foundation for developing a concept of self:
The role of imitation in relating self to other and the value of social
mirroring, social modeling, and self practice in infancy. In C. Cic-
chetti, & M. Beeghly (Eds.), The self in transition: Infancy to child-
hood (pp. 139-164). Chicago, IL: University of Chicago press.
Meltzoff, A., & Gopnik, A. (1993). The role of imitation in under-
standing persons and developing a theory of mind. In S. Baron-
Cohen, H. Tager-Flusberg, & D. J. Cohen (Eds.), Understanding
other minds (pp. 335-366). New York: Oxford University Press.
Mundy, P., & Sigman, M. (2006). Joint attention, social competence
Copyright © 2012 SciRes.
S. EZELL ET AL.
Copyright © 2012 SciRes. 685
and developmental psychopathology. In D. Cicchetti, & D. J. Cohen
(Eds.), Developmental psychopathology (2nd ed., Vol. 1, pp. 293-
332). Hoboken, NJ: John Wiley & Sons, Inc.
Nadel, J. (2006). Does imitation matter to children with autism? In S. J.
Rogers, & J. H. G. Williams (Eds.), Imitation and the Social Mind:
Autism and typical development (pp. 118-137). New York: Guilford
Nadel, J., Revel, A., Andry, P., & Gaussier, P. (2004). Toward commu-
nication: First imitations in infants, low-functioning children with
autism and robots. Interaction Stud ie s, 5, 45-74.
Rogers, S. J., & Pennington, B. F. (1991). A theoretical approach to the
deficits in infantile autism. Development and Psychopathology, 35,
Salt, J., Shemilt, J., Sellars, V., Boyd, S., Coulson, T., & McCool, S.
(2001). The scottish centre for autism preschool treatment pro-
gramme: I. A developmental approach to early intervention. Autism:
The International Journal of Research and Practice, 5, 362-373.
Salt, J., Shemilt, J., Sellars, V., Boyd, S., Coulson, T., & McCool, S.
(2002). The scottish centre for autism preschool treatment program-
me: II. The results of a controlled treatment outcome study. Autism:
The International Journal of Research and Practice, 6, 33-46.
Trevarthen, C. (1977). Descriptive analyses of infant communicative
behavior. In H. R. Schaffer (Ed.), Studies in mother-infant interac-
tion (pp. 227-270). London: Academic Press.
Uzgiris, I. C. (1981). Two functions of imitation during infancy. Inter-
national Journal of Behavioral Development, 4, 1-12.
Williams, J. H. G., Whiten, A., & Singh, T. (2004). A systematic re-
view of action imitation in autistic spectrum disorder. Journal of Au-
tism and Developmental Disorders, 34, 285-299.