Abstract
Reciprocity is central to many aspects of our lives. The key to reciprocity is the notion of mutual interchange, the ‘give and take’ between two parties. Despite the many controversies over the forthcoming changes to the diagnostic criteria, there is clear consensus that difficulties in social reciprocity remain one of the hallmarks of autism. Such difficulties are usually manifested as problems responding to the communicative acts of others, that is, the ‘give’ in the ‘give-and-take’ of social interactions. Good – or even ‘optimal’ – outcomes in later childhood and adulthood are indicative of significant gains in the ability to regulate the to-and-fro of social exchanges.
More often than not, the onus is on the autistic person 1 to meet the demands of others. Autistic people are expected to be able to read social cues, like eye-gaze direction and gesture, to take the other’s (usually non-autistic) perspective and adjust their interaction accordingly. Rarely, however, are the expectations reversed, where the onus is instead on the non-autistic social partner to engage with the autistic person via his or her unique modes of communication and ways of interacting. Exchanges with autistic people are therefore often largely asymmetric – you could even say unequal – in nature.
Among the excellent articles in this issue of Autism, two articles highlight the need to redress this imbalance. They remind us of the importance of genuine reciprocity among researchers, clinicians and parents. In one of these articles, Freeman and Kasari report on the interactions between parents and their (autistic or non-autistic) children during play. Previous research has reported greater engagement when parents follow their typically developing child’s focus of attention and mimic their child’s actions. Freeman and Kasari therefore examined whether similar devices had positive effects on autistic children’s level of engagement during play. After coding 10-min-worth free play for each parent–child dyad, they found that parents of autistic children had greater difficulty ‘matching’ their level of play with the child’s level. They also often took over, commanding and suggesting rather than responding to the child’s play routines. And, as a result, their interactions were much less sustained. Indeed, those parent–child dyads who engaged in longer play interactions were the ones who were more likely to imitate each other, showing reciprocal copying from both partners – the parent and the autistic child. These findings highlight the importance of teaching parents both to tune in to their children’s level of ability and to engage in such a way so as to respond to their child’s actions and interests, however idiosyncratic they might be.
The second article by Casenhier et al. examined similar strategies in an ongoing parent-mediated early intervention programme. The characteristics of the intervention followed Developmental Social Pragmatic (DSP) principles (Prizant and Wetherby, 1998) in which functional skills are taught within a social context. In Casenhier et al.’s specific intervention, parents were taught about their child’s strengths and challenges, and among other skills, were encouraged to tune in to their child: to join the child’s focus of interest and to respond to his or her communicative attempts, whether or not they seemed purposeful or meaningful. The authors found that the children who received the DSP-based treatment showed more enjoyment during the interaction, were more attentive and involved and showed more bids for interactions with their parents than children receiving regular community-based interventions (‘treatment as usual’).
This trial is ongoing, and it will be extremely interesting to know how the parents in the treatment group feel about this increased engagement with their children, what it feels like to notice what has captured their child’s interest and to follow their lead – to enter their world – and to understand the impact that their increased reciprocity has on their child’s subsequent engagement.
Reflecting on these articles, it struck me that the attentiveness to reciprocity can still go deeper than this. It is not just individual parent–child interactions or family-mediated interventions that can show an improvement when we become more mutually engaged. As Gernsbacher (2006) stresses, if we embody an attitude of reciprocity, not just in our interventions but in our everyday interactions with autistic people, then our research should also profit as a result. We will be more likely to be drawn to the research questions that matter to autistic people themselves. And we will be more likely to approach those questions in a way informed by autistic experience, including both the strengths and the challenges of a life lived as autistic.
From the young people and adults with whom I work, it is clear that the autistic community is more than ready to play its part in deepening its relationship with non-autistic researchers, clinicians and educators. As they do so, autistic people rightly demand to be valued and accepted for their unique expertise – something that is still not afforded to them anything like as often as it should be. Real reciprocity begins with mutual understanding. Such broader engagement should be part and parcel of all of our interactions with autistic people and their families – in the research lab, in the clinic and in the community.