Mother's Interactions

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Journal of Autism and Developmental Disorders, Vol.28, No. 1, 1998

Following the Child's Lead: Mothers' Interactions withChildren with AutismLinda R. Watson1

This study examined the extent to w hich mothers of preschool children with autism use lan-guage that is related to the child's focus of attention. Fourteen mother-child dyads involvingpreschool children with autism participated in this study, along with 14 matched dyads in-volving typically developing preschool children. Both groups w ere observed durin g 15 minutesof free play. Results revealed that the mothers of children with autism directed verbalizationsto something within the child's focus of attention as frequently as the mothers of typicallydeveloping children. Thus, children with autism had as many opportunities to benefit fromverbal input related to their focus of attention as did typically developing children. However,mothers of c hildren with autism directed verbalizations to something not within the child'sfocus of attention more frequently than mothers of typically developing children. This non-related input may have reflected the mothers' attempts to adapt to their children's difficultiesin attention and interaction.

INTRODUCTIONPast research on interactions between adults andchildren with typically developing skills ha s sup-ported the idea that children's language developmentis enhanced wh en adults follow the child's attentionallead by providing verbal inp ut related to the child'sfocus of attention (see Chapman, 1981; Dunham,Dunham, & Curwin, 1993; Newhoff & West, 1993).Tomasello and Farrar (1986), for example, reportedresults from both observational and experimental re-search demonstrating a positive correlation betweenadult utterances that followed into the child's ongo-ing focus and the child's subsequent lexical develop-ment. According to Tbmasello (1995), this correlation

occurs "because such forma ts provide a referentialframe within which the adult's attention to the out-side world when using a piece of language is discern-ible to the chi ld nonl inguist ical ly" (p. 115).1Division of Speech and Hearing Sciences, CB# 7190 MedicalSchool Wing D, University of North Carolina, Chapel Hill, NorthCarolina 27599-7190.

Advantages inherent in utterances that follow intothe child's attentional focus appear to be inde-pendent of the utterance function. For example, inthe Tbmasello and Farrar (1986) report, the experi-mental procedure involved an adult utterance func-tion of commenting on objects within the chuu'sfocus of attention. Examining adult utterances withdirective functions, Donahue an d Watson (1976)found that the single variable best predicting whetherchildren in the one-word stage of development wouldcomprehend and comply with mothers' directives waswhether the directive followed into the child's focusof attention. This variable was a more powerful pre-dictor than any of the other variables examined, in-cluding length of utterance, use of direct versusindirect directives, intonation contour, and mother'suse of gestures to accompany the directive.Considerable research has now demonstratedthat children with autism have difficulty establishingand maintaining joint attention compared to typicallydeveloping children or children with developmentallanguage delay or mental retardation (Loveland &Landry, 1986; McArthur & Adamson, 1996; Sigman,

510162-3257/98/0200-0051$15.00/0 1998 Plenum Publishing Corporation

KE Y WORDS: Autism; vocalization.


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52 WatsonMundy, Sherman, & Ungerer, 1986). In terms of in-itiating joint attention, children with autism rarelyuse gestures as a means of directing an adult's at-tention to an object of interest (Curcio, 1978; Mundy,Sigman, Ungerer, & Sherman, 1986; Wetherby &Prutting, 1984) and rarely use referential looking(Mundy et al., 1986). The joint attention behaviorsof children with autism are significantly less frequentthan children developing typically or children withmental retardation, even when the children's mentalages and mothers' educational levels are matched(Mundy et al., 1986; Sigman et al., 1986). Childrenwith autism also have difficulty in responding to thejoint attention bids of others (Loveland & Landry,1986; McArthur & Adamson, 1996; Mundy et al.,1986); however, their ability to respond to attentionbids of others seems to increase more readily withdevelopmental advances than their ability to initiatejoint attention (Baron-Cohen, 1989; Mundy, Sigman,& Kasari, 1994).

Drawing on such observations, Shapiro, Frosch,and Arnold (1987) concluded that the unresponsive-ness of the child with autism would have a negativeeffect on the parent's ability to establish synchro-nous, contingent interactions with the child, and wastherefore an area warranting attention in interven-tion. Based on other research, however, the conclu-sion that parents of children with autism are lessresponsive or contingent in interacting with theirchildren appears to be premature. For example,Kasari, Sigman, Mundy, and Yirmiya (1988) foundthat caregivers of young children with autism aresimilar to caregivers of typically developing childrenand children with mental retardation in their respon-siveness to the children's nonverbal communicationbids and in their engagement in mutual play. Further,Kasari et al. (1988) found that it is extremely rarefor caregivers in any of the three groups to fail torespond to a child's nonverbal communicative acts(e.g., showing, giving, and pointing). Examining is-sues of responsivity within subgroups of children withautism, Konstantareas, Zajdeman, Homatidis, andMcCabe (1988) found that the interaction behaviorsof mothers of higher functioning verbal children withautism were different from those of mothers of lowerfunctioning nonverbal children with autism. Themothers of higher functioning children asked morequestions, used more language modeling, gave morereinforcement for language, and answered morechild-initiated questions than mothers of lower func-tioning nonverbal children. The latter group of moth-

ers used more directives, shorter utterances, and re-inforced their children's motoric behavior more thanmothers of higher functioning children. The authorsconcluded that the differences reflect the mothers'appropriate responsiveness to their children's respec-tive abilities.

In an earlier analysis of data from the subjectswho participated in the present investigation,Dawson, Hill, Spencer, Galpert, and Watson (1990)reported that mothers of children with autism dis-played significantly fewer smiles during a snack in-teraction with their children than did mothers ofchildren developing typically. In addition, the moth-ers of children with autism were less likely to smilein response to their children's smiles. These findingswere attributed to the fact that the children withautism were less likely to combine eye contact withan affective expression such as a smile. Thus, it ap-peared that the children with autism were not usingeye contact as a means to communicate emotion tothe same extent as the comparison group.

In summary, the existing literature does not pre-sent strong support for the assumption of Shapiro etal. (1987) that parents of children with autism will beless responsive to their children due to frustrationwith their children's nonresponsiveness. However, thestudy by Dawson et al. (1990) suggests that the spe-cific communication deficits of children with autismmay impact on some aspects of parental responsivityto the child. The present investigation therefore ex-amined the hypothesis drawn from Shapiro et al.(1987) that mothers of children with autism will usefewer utterances related to the child's focus of atten-tion than mothers of typically developing children.

METHODSubjects

Fourteen preschool children with autism and 14typically developing children participated in thisstudy along with the children's mothers. The criteriafor recruiting the mother-child dyads involving chil-dren with autism were that the children be under 6years of age and have received a formal diagnosis ofautism, and that the mothers be native speakers ofEnglish. Eight of these dyads were recruited throughthe Division for Treatment and Education of Autisticand related Communication-handicapped CHildren(TEACCH) at the University of North Carolina at


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Following the Child's Lead 53

Chapel Hill (UNC-CH), and represented consecutivereferrals to the Chapel Hill TEACCH Center thatmet the recruitmen t criteria. Six dyads involving chil-dren with autism were recruited through the Glen-rose Hospital in Edmonton, Alberta, Canada. Thesubjects recruited in Edmonton represented all chil-dren in the Edmonton area who met the recruitmentcriteria and were known to the investigator's col-league assisting in subject recruitment. The psycholo-gists at these two programs confirmed that allchildren met the criteria for a diagnosis of autismbased on the Childhood Autism Rating Scale(CARS; Schopler, Reichler, & Renner, 1988); spe-cific CARS scores were not reported to the re-searcher. All children with the diagnosis of autismexhibited symptoms characteristic of the disorder asdefined by the American Psychiatric Association(1994) during both the testing conducted by this re-searcher and during interactions with their mothers,including difficulties in communication and social in-teraction, and restricted behaviors or interests; in ad-dition, all had demonstrated symptoms prior to 36months of age. Descriptive data for the dyads involv-ing children with autism are given in Table I. In thesample, there were 11 boys and 3 girls, with chrono-logical ages (years; months) ranging from 2;6 to 5;10(M = 4;4). Receptive language age scores rangedfrom < 1;0 to 2;8 (M = 1;8), and expressive languageage (ELA) scores from < 1;0 to 2;10 (M = 1;7). The

mothers' educational levels ranged from high schooleducation to masters degree, with a mean of 14.4years of education.The dyads involving typically developing chil-dren were recruited from the use of birth recordsfrom two Piedmont North Carolina counties. Thesedyads were matched case-by-case to those dyads in-cluding children with autism on the basis of thechild's receptive language age (RLA) as measured bythe Reynell Developmental Language Scales (RDLS;Reynell, 1977). In each case, the matched childrenhad RLAs within 2 months of each other, or, for chil-dren whose RLAs fell below 1 year, the matchedchildren had raw scores within 1 point of each other.Receptive language age was used to match the chil-dren due to evidence that several indices of mate rnallanguage input are more closely correlated with chil-dren's receptive language abilities than expressiveabilities (Clarke-Stewart, VanderStoep, & Killian,1979; Cross, 1977). In addition to the children'sRLA, the dyads were matched on the basis of thechild's gender and race, and as closely as possible onthe mother's educational level. Thirty-eight familieswere contacted initially; 20 of these agreed to par-ticipate. Of these, 14 dyads were found to adequatelymatch the dyads involving children with autism. De-scriptive data for the dyads with typically developingchildren are given in Table II. The chronological ages

Table I. Descriptive Data for Autistic Group DyadsID

AlA2A3A4ASA6A7A8A9A10AllA12A13A14

CA2;62;114;13;84;85;93;75;104;94;05;04;114;113; 10

SexMMMMMMMFMMFMFM

RaceaWWWWWWWAAWWWWWAA

RLAb


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54 Watsonof these children ranged from 0;9 to 2;11 (M = 1;6);RLAs from < 1;0 to 2;9 (M = 1;7) and ELAs from< 1;0 to 3;3 (M = 1;8). The mothers' educationallevels ranged from a high school education to mas-ters degree with a mean of 15.1 years of education.

ProceduresData Collection

Data collection procedures varied slightly be-tween children developing typically and those withautism, and between the geographic subgroups ofchildren with autism. The children with autism seenin North Carolina were brought by their mothers toa child research laboratory at UNC-CH. The chil-dren were first tested on a test of imitation skills aspart of another study. The dyads then were escortedto a playroom approximately 16 meters in size. Astandard set of toys was placed in the room, alongwith a low table, a high chair, a chair for the mother,and a toy box. The toys in the room included woodenblocks, large wooden beads on a string, a "shapebox" (geometric shapes puzzle box), assorted toy ve-hicles, a ball, a stuffed animal, and a toy telephone.The room also contained two remote control videocameras.

Each mother was told that the session would lastapproximately 30 minutes. For the first 15 minutesthe mothers were asked to play with their child asthey would at home, to the extent this was possiblein the playroom setting. The latter 15 minutes of thesession involved a clean-up activity and snack, butwere not analyzed for the purposes of the presentinvestigation. After explaining the format of the ses-sion, the investigator left the room. The video cam-eras were operated from an adjacent control room.

A second session was scheduled within 3 weeksof the videotaped interaction. Each mother returnedto UNC-CH with her child, and the RDLS were ad-ministered. The mother was present in the room dur-ing the test administration, which took approximately15 to 45 min, depending on the child's level of skilland cooperation.

The children with autism recruited in Canadawere brought by their mothers to a classroom atGlenrose Hospital. The investigator first adminis-tered the RDLS to the child with the mother presentin the room. Following the testing, the mother andchild were escorted to the play area. A section of

the room comparable in size to the playroom atUNC-CH was partitioned off from the remainder ofthe room. This area contained a comparable set oftoys and furniture to that in the room at UNC-CH.The mother was given instructions identical to thosegiven to the mothers in North Carolina. After givinginstructions to the mother, the investigator left andvideotaped the session through a one-way mirror.

All of the typically developing children and theirmothers were seen at UNC-CH in the same laboratoryplayroom used for the children with autism recruitedin North Carolina. The investigator administered theRDLS these children prior to the videotaped mother-child interaction. The mother was present in the roomduring the testing, which took approximately 15 to 45min, again depending on the child's level of skill andcooperation. The videotaped interaction was con-ducted following a format identical to that used withthe dyads involving children with autism (i.e., 15 minof play followed by 15 min of cleanup and a snack).A time code was recorded on each videotape for bothsubject groups to facilitate later transcription andanalysis of the data.

Data Transcription and CodingThe vocal/verbal interactions between each dyad

during the free play portion of the session were tran-scribed by research assistants who were graduate stu-dents in speech-language pathology or linguistics.Each videotape was initially transcribed orthographi-cally by one research assistant. In instances in whicheither partner uttered speech-like sounds that werenot conventional words (usually, but not always, pro-duced by the children), the research assistant indi-cated that the utterance consisted of a "vocalization."Utterances that were judged to be conventional wordsbut that could not be understood were marked as"unintelligible" in the transcript. A second researchassistant then reviewed the transcript while lookingat/listening to the videotape, and marked disagree-ments with the original transcript. Subsequently thetwo assistants jointly viewed the portions of videotapein which there were disagreements, and either re-solved the disagreements or marked the questionedwords of the transcript as "unintelligible." The tran-scribers used conventions specified in the SystematicAnalysis of Language Transcripts (SALT) software(Miller & Chapman, 1985) and entered data intoSALT files.


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Following the Child's Lead 55Following the preparation of transcripts, a re-

search assistant reviewed each videotape and codedthe transcript based on both the verbal/vocal inter-action and the nonverbal information available onthe videotape. Each maternal utterance was codedas:

(a) Child-focused, or related to the child's focusof attention at the onset of the maternal utterance,based on the child's verbalization, gaze and/or ma-nipulation of objects. For example, the child is tryingto put a block in the shape sorter, and the mothersays, '"Him it around in your hand."

(b) Out-of-focus, or related to the immediatecontext but not to the child's focus of attention. Forexample, the child is feeling the sound-proofing ma-terial on the walls of the room and the mother picksup two cars of a toy train and begins to hook themtogether, saying to the child, "Come and help me dothis, okay?"(c) Other, including utterances that interpretedthe child's state, described the mother's feelings, orpertained to topics outside of the immediate context.For example, the child is running around in theroom, and the mother says, "You're really wound uptoday, aren't you?"

Maternal utterances that occurred when thechild was not visible on the video were not coded;also, unintelligible maternal utterances were notcoded.

ReliabilityTranscripts for two dyads in the autistic group

and two dyads in the normal group (14% of the totaldata set) were randomly selected and coded inde-

pendently by a second coder for reliability in judgingthe relation of maternal utterances to the child's fo-cus of attention (i.e., Child-focused, Out-of-focus, orOther). A coefficient of interjudge agreement whichcorrected for chance agreement was calculated (Co-hen, 1960), with a resulting value of K= .7, indicatinga high level of interjudge agreement on the coding(80% raw interjudge agreement).

RESULTSAn analysis of covariance (ANCOVA) was used

to examine the differences between the two groupsin frequencies of (a) maternal utterances, (b) childutterances, (c) child-focused maternal utterances,and (d) out-of-focus maternal utterances. The vari-able of child's comprehension age, as shown in TablesI and II, was used as a covariate in each analysis toexamine possible effects of language level on the de-pendent variables. Entering comprehension age as acontinuous covariate allowed for a more sensitiveanalysis of language level effects than would havebeen the case if the subjects had been dichotomizedinto only two comprehension age groups. In analysesin which the covariate was significant, the correlationbetween the dependent variable and the covariatewas calculated to examine the direction of effects.Table III presents summary statistics on the be-haviors compared in these analyses. Total utterancesincluded all intelligible productions of speech as wellas unintelligible productions and nonspeech vocali-zations. No differences were found between the twogroups for the total number of utterances used byeither the mothers or the children, although themothers of children with autism tended to have more

Table III. Summary Statistics on Verbal Interaction BehaviorsAutistic

UtterancesChild totalVocalizations

UnintelligibleIntelligibleMother totalChild-focusedaOut-of-focusa

Othera

M87511323

303202924

SD46.731.215.729.382.890.549.54.2

Range0-1680-1080-590-87

179-42085-36519-2100-13

NormalM85331438

271217492

SD54.619.216.743.280.560.440.77.7

Range10-17010-650-560-147

123-45269-2795-1720-29

aSum of these coded categories does not add up to total mothers' utterances becausemothers' utterances when action was off-video were no t coded for focus.


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56 Watsontotal utterances (a mean of 303 compared to 271 forthe mothers of typically developing children). Thecovariate of the child's comprehension age was sig-nificant for the total child utterances, F(l, 25) =16.2, p < .001, but not for the total maternal utter-ances. The correlation between the child's compre-hension age and the child's total utterances was r =.63, indicating that children with higher comprehen-sion ages generally produced more utterances duringthese free play interactions. When correlations forthe two groups were calculated separately, the cor-relation between the child's comprehension age andchild's total utterances was r = .46 for the childrenwith autism, and r = .78 for the children developingtypically. Thus the relationship was considerablystronger in the group of children developing typi-cally.In addition, the two groups of children werecompared for differences in the frequencies of thethree types of utterances (vocalizations, unintelligibleand intelligible). Although the typically developingchildren tended to use fewer vocalizations and moreintelligible utterances (see Table III), the two groupsdid not differ significantly with respect to frequenciesof these utterance types.The next analyses examined the difference infrequency of the mothers' child-focused and out-of-focus utterances. These analyses were conducted onthe frequencies of behavior rather than the propor-tions due to an assumption that the frequency of op-portunity to map language onto the focus of one'sattention is more critical to the child than the relativeproportion of these opportunities. The ANCOVA re-vealed no significant differences between the twogroups in the frequency with which mothers usedchild-focused utterances. The covariate of child'scomprehension age was significant in this analysis aswell, F(l, 25) = 4.9, p = .039. The correlation be-tween child-focused utterances and child's compre-hension age of r = .40 indicated that mothers ofchildren with higher comprehension ages tended touse more child-focused utterances. Examining corre-lations separately in the two groups, the correlationbetween child-focused utterances and child's compre-hension age was r = .41 in the group of children withautism, and r = .41 in the group of children devel-oping typically as well.

In contrast, the two groups were significantlydifferent in the frequency of maternal out-of-focusutterances, or those utterances related to the imme-diate context but not to the child's focus of attention.

The mothers of children with autism used more out-of-focus utterances than did mothers of typically de-veloping children, F(l, 25) = 8.3, p = .008. As notedabove, mothers of children with autism tended to usemore total utterances (a mean difference of 32 ut-terances), although the difference in total utteranceswas not significant between the two groups. This dif-ference in mean number of total utterances is ac-counted for by the greater number of out-of-focusutterances by the mothers of children with autism (amean difference of 43 utterances).

The covariate of child's comprehension age wasalso significant for the out-of-focus utterances, F(1,25) = 9.6, p = .005. The correlation of r = -.48 be-tween out-of-focus utterances and child's compre-hension age indicated that mothers generally usedfewer out-of-focus utterances with children who hadhigher language comprehension skills. For the groupof children with autism, the correlation between childcomprehension age and out-of-focus utterances wasr = -.41. For the group of children developing typi-cally, the correlation was r = -.60.

The data were also examined for possible dif-ferences in variance between the mothers of childrenwith autism and the mothers of typically developingchildren in the use of child-focused and out-of-focusutterances. The two groups did not differ signifi-cantly in the variance for use of either of these typesof utterances.

Due to the low mean occurrence of utterancesin the "other" category, no statistical comparisonswere made between the two groups for this variable.

DISCUSSIONThe hypothesis that mothers of children with

autism would use fewer child-focused utterances thanmothers of typically developing children matched forlanguage comprehension skills is not supported bythe results of this investigation. Mothers of childrenwith autism did not differ significantly from mothersof typically developing children in the frequency ofchild-focused utterances, suggesting that the interac-tion difficulties of children with autism generally donot lead to parents being less responsive to their chil-dren's interests.

Both groups of mothers used many more utter-ances that were child-focused than utterances thatwere not child-focused. Although there were individ-ual differences among the mothers in both groups


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Following the Child's Lead 57with respect to their relative use of child-focused ver-sus out-of-focus utterances, as a whole these motherswere very responsive to their children's interests asdetermined by the children's nonverbal and/or verbalbehavior. In addition, these mothers used very fewutterances unrelated to the immediate context, re-gardless of the child's diagnosis. This finding is con-sistent with previous research on characteristics ofmothers' language to young typically developing chil-dren whose language skills were in the same devel-opmental age range (e.g., Messer, 1983; Moerk, 1975;Sachs, 1983) and provides evidence that mothers ofyoung children with autism rely on the same contex-tually based language interaction strategies.

The present study does not directly address theissue of how children with autism may benefit fromthe interaction strategies of their caregivers. An in-tervention study by Koegel, O'Dell, and Koegel(1987) supports the potential positive benefits ofchild-focused interactions with children with autism.These researchers employed a single-subject designto compare the effects of a "natural language teach-ing paradigm" (a child-focused approach) with anadult-directed discrete trial teaching condition fortwo children with autism. Both children showed bet-ter performance in the natural language teachingparadigm than in the discrete trial training.

A study by Lewy and Dawson (1992) supportsthe idea that child-centered interactions are benefi-cial for children with autism, but suggests that chil-dren with autism may not benefit as much from suchinteractions as do children developing typically orchildren with Down syndrome, even when languagelevel is controlled. In this study, highly contingent in-teractions involving adult imitation and/or elabora-tion of the child's actions and vocalizations(child-centered play) resulted in increases in joint at-tention for all three groups as compared to interac-tion that was more adult-centered. However, theincreases in joint attention for children with autismduring child-centered play were much smaller thanthe increases for children in either of the other twogroups.

The greater frequency of out-of-focus utterancesby the mothers of children with autism in the presentstudy may reflect the mothers' adaptation to the so-cial interaction an d communication difficulties oftheir children, including the children's problems withestablishing and maintaining joint attention. The in-put of mothers of children with autism may also re-

flect the mothers' adaptation to their children's pat-terns of object interaction.In support of this line of reasoning, we observedthat the children with autism in this study displayedhighly variable behavior during the free play interac-tions. Some children were extremely active and ranor wandered about the playroom, climbed on the ta-ble, and rarely focused their attention on a specifictoy in the room, or did so for extremely brief periods.In such cases, the mothers often made repeated ef-forts to get their child to focus on a toy. In contrast,other children with autism focused primarily on onetoy and repeated the same type of activity with thetoy over and over. The shape sorter box, for instance,was a favorite of many of the children with autism.The mothers of these children usually talked aboutthe child's object of interest for a while, but at somepoint most of them tried to shift their child's atten-tion to a new object.In both types of situations described above, thedifficulty of the children with autism in establishinga joint focus of attention was apparent. A commonfocus of attention was usually a product of themother's adaptation to the child's interest. Tbmasello(1995) suggests that this type of interaction involvingadult "onlooking" does not meet the criterion forjointness as it has been conceptualized by most re-searchers, because there is no evidence that both par-ticipants are monitoring the others' attention to anoutside entity. The mothers of typically developingchildren also carried much of the interaction load, inthat they followed their children's attentional leadmost of the time as well. The sense we had in com-paring the videotapes of the two groups, however,was that the mothers of typically developing childrendid not have to work as hard to get their children toengage in activities with the objects in the room, tosustain interactions with their children around thechild's object of interest, or to shift the child's atten-tion to some new object of interest. This investigatortherefore attributes the greater frequency of out-of-focus utterances by mothers of children with autismto the mothers' efforts to direct, redirect, or maintaintheir children's attention.A recent study by McArthur and Adamson(1996) is directly relevant to these findings. Theauthors looked at verbal and nonverbal bids for jointattention by unfamiliar adults interacting with youngchildren with autism and with developmental lan-guage disorder. These bids were specifically definedas calling a child's attention to an object on which


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58 Watson

the child was not already focused, or a new aspectof an object with which the child was engaged.McArthur and Adamson did not find the number ofjoint attention bids to differ between the two groupsalthough variability was higher when adults were in-teracting with children with autism. However, therewere qualitative differences in the strategies adultsused for joint attention bids, with more frequent useof "literal" strategies (tapping or shaking an objector moving it close to the child's face) with childrenwith autism and more frequent use of "conventionalstrategies" (pointing to objects or using words to re-fer to them) with children with developmental lan-guage disorders. Consistent with the subjectiveimpressions of this researcher, McArthur and Adam-son further found that children with autism were lesslikely to shift their attention following a bid by anadult than the children with developmental languagedisorder. This included allocating attention to the ob-ject or to the adult, or coordinating attention to both(joint attention).Kasari et al. (1988) reported significant negativecorrelations between the caregivers' use of behaviorregulation acts and the use of nonverbal indicatingbehaviors by children with autism. The same trendwas also apparent in negative correlations betweenbehavior regulation acts and children's comprehen-sion scores, although these did not reach significance.These results are similar to the findings of the pre-sent study in that the children's comprehension ageswere negatively correlated with maternal out-of-focusutterances. Although in-focus and out-of-focus utter-ances were defined independently of utterance func-tion in the current study, it was noted that manyout-of-focus utterances served a behavior regulatingfunction. Not surprisingly, it appears that as childrenbecome more competent in their understandingand/or use of communication and language, adultsfind it easier to maintain more synchronous interac-tions with the children.The results of this study indicate that mothersof children with autism provide their children withas much verbal input that is related to the child's fo-cus of attention as do mothers of typically developingchildren. These results imply that children withautism have the same opportunities (but not neces-sarily the same capacity) to benefit from language in-p u t t ha t pa ra l l e l s t he i r ongo i ng nonve rba lexperiences. The findings also indicate, however, thatmothers of children with autism use more utterancesthat are directed at things outside the child's focus

of attention than mothers of typically developingchildren. Although the existing literature on the spe-cific social and communicative deficits of childrenwith autism suggests that these differences in mater-nal input may be attributable to the unique chal-lenges that adults face in trying to establish andmaintain interactions with these children, further in-vestigation is needed to determine the specific func-tions of these out-of-focus utterances. As has beenthe case with most of the previous research on par-ent-child interactions involving children with autism,the present investigation found m ore similarities thandifferences in the interaction styles and strategies ofmothers of children with autism and mothers of typi-cally developing children. Based on the accumulatedevidence, intervention aimed at teaching parents ofchildren with autism to interact more "normally"with their children does not seem warranted for thegeneral population of these parents, although theremay be individual parents wh o could benefit fromsuch intervention.On the other hand, the research to date on in-teractions with children with autism has not resolvedthe question of what type of interaction is optimalfor these children. Future investigations should con-tinue the work of Koegel et al. (1987) and Lewy andDawson (1992) to explore whether the language de-velopment of children with autism is enhanced by thesame style of interaction that appears to enhance the.development of typical ly developing chi ldren,whether children with autism would be nefit from in-tensified input related to their focus of attention, orwhether a style of interaction that varies considerablyfrom normal would be better adapted to the needsof these children. The effect of the child's languagelevel should also be investigated in future interven-tion studies. Given that the natural interaction be-haviors of children with autism an d their parentshave been demonstrated to correlate with the child'slanguage comprehension level, the optimal interven-tion strategy may be different for children at differ-ent language levels.

ACKNOWLEDGMENTSThis research was supported in part by a PublicHealth Service National Research Service Award,F32 MH08708. The author expresses appreciation tothe staff of TEACCH Division and to CatherineLord for assisting in the recruitment of subjects for


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Following the Child's Lead 59this study, and to Geraldine Dawson, Mary Evers,and Larry Galpert for their collaboration in the datacollection.

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Mother's Interactions