• Demonstrating Typical and Partial Imitation

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    Dr. Smith distinguishes between "partial" imitation during a specific situation and "typical" imitation that results in the aquisition and creative incorporation of a new skill into the child's play, a learning process often lacking in children with autism.

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  • Twins Playing with Mom

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    Dr. Smith narrates a video comparison of twins during a routine play session with mom. One twin, Nathan, is on the autism spectrum, while the other, Benjamin, is typically developing. Compared to Benjamin's enjoyment and easy engagement in the session, Nathan's enjoyment in the interaction is dubious, characterized by minimal sustained eye contact, smiling or social reciprocity.

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  • Peek a Boo

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    Dr. Smith discusses how a typical child is engaged in the game of peekaboo, sharing her enjoyment in the game by making a clear effort to play both parts (hiding and finding) and keep the interaction going. By comparison, a child on the spectrum, when presented with the game of peekaboo, shows no interest in continuing the interaction, though he may respond reflexively to some aspects of the game.

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  • Lack of Spontaneous Imitation

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    Dr. Smith explains that a lack of spontaneous imitation can be a key early indicator of autism spectrum risk, though it is sometimes very difficult for parents to identify as a symptom. Given this difficulty, spontaneous imitation is an important area of inquiry for pediatricians when interviewing parents regarding their child's development.

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  • The Duck Song

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    The following clip shows how some children with autism lack the ability to appropriately respond to the emotions of others. In contrast to his classmates who comfort their teacher who is pretending to cry after reading a story, Christian remains seated. He does not exhibit concern or attempt to comfort his teacher; rather, he is nonresponsive to her emotion.

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  • Nathan Plays Cars with Mom

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    It is difficult for Nathan, a young boy on the autism spectrum, to engage in a reciprocal game of stop and go with his mother. He does not attempt to keep the game going, but instead often turns away from his mother, removing the train and himself from the table to look at the train wheels. Both Nathan's unusual interest in parts of the toy (i.e. train wheels) and his difficulty with reciprocal social interaction are risk alerts for ASD.

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  • Nathan On Exercise Ball with Mom

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    Whereas Benjamin, a toddler with developmental delays but not autism, actively engages with his therapist while playing on the exercise ball, Nathan, a child on the autism spectum, does not engage with his mother at the same level. While he seems to enjoy the sensation of the ball, his eye contact is not consistent, nor clearly directed at his mother. As soon as he is given the opportunity, Nathan walks away from the interaction.

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  • Nathan On Exercise Ball with Therapist

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    Unlike his typically developing brother Benjamin, Nathan, who is on the autism spectrum, does not seem to enjoy playing with his therapist on the exercise ball. He quickly disengages from this social interaction; he prefers to stare out the window at the falling snow.

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  • Benjamin and Nathan Playing with Shaving Cream

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    While Nathan is initially interested in the shaving cream his mother shows him, he quickly loses interest and cries when his mother tries to keep him involved. In contrast, Benjamin asks for more of the cream and shows good mastery motivation when he picks up the shaving cream can and imitates his mother's actions in an attempt to make the shaving cream come out of the can all by himself.

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  • Some Interest in Peek A Boo

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    Peek a Boo is a social game that is often enjoyed by children. Connor Puleo, an evaluator, causes Evan to giggle in amusement as she plays Peek a Boo behind a white towel. Although Evan is initially entertained, he does not reciprocate. That is, he never tries to participate or keep the game going by pulling down the towel, hiding himself or asking for the activity to continue. Instead, he quickly loses interest.

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  • Little Interest in Toy Frog

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    Children with autism may demonstrate a lack of interest in toys, even when asked to imitate interactions with the objects. After several demonstrations from both the evaluator, Connor, and his mother, Raquel, Evan shows little concern for the toy frog and fails to imitate Connor and Raquel's actions and vocalizations. Although Evan starts to smile and laugh when his mother makes the frog hop, he backs away from the toy when his mother offers him a turn.

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  • Nathan Likes Peek A Boo; Doesn't Initiate the Game

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    Though Nathan appears to enjoy a game of peek a boo, he lacks the flexibility and reciprocity expected in a typical developing child his age. Specifically, he makes no effort to keep the game going or to play both parts of the game (i.e. both hiding and finding). Such limited ability to play a social imitative game, like peek a boo, is a risk alert for autism.

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  • Risk Alert Imitation

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    Dr. Deborah Fein explains that imitation is an essential part of development and has many forms from imiation of gestures, or sounds, or words.

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Social Communication and Social Interaction

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history

Social Emotional Reciprocity

Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

Non-verbal Communicative Behaviors

Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

Understanding & Maintaining Relationships

Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Restricted and Repetitive Patterns of Behavior

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history

Stereotyped Motor Movements and Speech

Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

Routines, Sameness, Rituals

Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).

Preoccupations -Interests or Objects

Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).

Sensitivity to Sensory Input

Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

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