Keywords
elaborative reminiscing - episodic memory - parent training - autism - autobiographical
memory
Learning Outcomes: As a result of this activity, the reader will be able to (1) describe episodic memory
and how it is impacted in persons with autism; (2) identify key features of elaborative
reminiscing; (3) explain how to scaffold elaborative reminiscing to support episodic
memory in autistic children.
It is only through sharing our stories with others that we come to own our experiences
as uniquely ours and different from others. Memories may not be true to the world,
but they are true to the self; through language we share our memories with others
and through sharing our memories with others we come to understand that our memories
are our own subjective perspective on our personal past.[1]
Sharing stories with others is a universal but uniquely human activity.[2] Humans share stories for a variety of purposes. We tell stories to inform, teach,
persuade, problem-solve, and entertain others and to establish and maintain social
relationships.[3]
[4] Stories serve a wide variety of purposes and take many shapes, including elaborated
cultural narratives passed down from generation to generation, life stories or autobiographies,
and parables and fairytales. Fictional narratives are made-up stories that include
previously heard or read stories,[5] and mastery of these types of stories appears to be important for literacy development
and overall academic success.[6]
[7] Personal narratives, on the other hand, are stories about one's own experiences
and include personal event narratives as well as integrated life stories which integrate
an accumulation of events and experiences across a person's life.[7] Both types of personal narratives play an important role in social development,
psychological well-being, and academic achievement.[7]
[8] Moreover, sharing past experiences through personal narratives is foundational to
successful social relationships[9] and broader social–emotional development.[7] As such, fostering personal narrative discourse skills from a young age has consequences
for healthy social and cognitive development.[10] As a composite skill, personal narrative production requires mastery of several
subskills. These include the ability to organize and understand one's own and others'
thoughts, feelings, and perspectives; explain causal relationships; identify relevant
information; adapt the content and delivery of the story based on the context and
the audience; and organize this information into a coherent story.[8]
[11] Although these skills are foundational to successful narrative production, the sharing
of past personal experiences also relies on and requires another cognitive ability:
episodic memory (EM).
Episodic Memory
Although personal narrative discourse involves the sharing of past personal experiences, EM is the memory of past personal experiences. During episodic recall, an individual mentally travels
back in time and re-experiences an event from their subjective, first-person perspective.
Information pertaining to the when, where, who, what, and why of the event is typically recalled,[12] as are sensory details (e.g., sights, sounds, smells, tastes) and mental states
(e.g., thoughts and feelings) of oneself and others.[13]
EM and personal narrative discourse are inextricably linked, and it is difficult to
imagine personal narrative discourse skills without EM. In fact, it is well-established
that EM is central to the ability to construct and communicate personal narratives
and to reminisce about past experiences.[14] Moreover, sharing past personal experiences (i.e., personal narrative discourse)
requires one to reflect on and integrate EMs while maintaining narrative coherence.[7] In turn, personal narrative discourse provides an “organizational and evaluative
structure around which EMs can be recalled”[15]: as children become more practiced in recalling past experiences, they become more
skilled at organizing their past experiences, which leads to a better understanding
of their place in the broader societal and cultural context.[16]
EM in autism. Although there is great heterogeneity in the EM abilities of autistic individuals
(see Hutchins et al[17]), it is well documented that the EMs of autistic and neurotypical individuals also
differ in consequential ways.[18]
[19]
[20] Specifically, research suggests that individuals with autism (regardless of language
ability) report fewer EMs, and when they do recall EMs, they tend to be less detailed
and less elaborate.[19]
[20]
[21]
[22]
[23]
[24]
[25] Moreover, the EMs of autistic persons may be fragmented, overly general and lacking
specificity, and contain relatively few subjective details (e.g., reference to thoughts/feelings[26]
[27]
[28]
[29]), and, thus, manifest in “a significantly reduced sense of presence.”[30] Personal narrative development is similarly impacted in autism. Compared with neurotypical
individuals, the personal narratives of autistic persons tend to be shorter[31] and less specific,[24]
[32] reference fewer person and resolution elements, and are less coherent and contain
fewer mental state references.[27]
[31]
[32]
[33]
Elaborative Reminiscing
Reminiscing is a ubiquitous activity that occurs spontaneously in day-to-day life.[34]
[35] In fact, it is estimated that people share their past experiences in the form of
personal narratives “as frequently as every five minutes in everyday conversation.”[36] As noted previously, personal narratives can take a variety of forms. A specific
type of caregiver reminiscing that facilitates children's recall of past personal
experiences is called elaborative reminiscing
[37] (for a review, see Fivush et al[36]). During elaborative reminiscing, caregivers and children talk about past experiences,
and the adult structures the conversation in a way that supports children's ability
to recollect and take meaning from the experience.
A central feature of elaborative reminiscing involves the adult's ability to elicit
and expand upon a child's recollections by asking open-ended questions and providing
details about the event that confirm, recast, or draw out the child's recollections
with higher degrees of elaboration or accuracy.[38]
[39]
[40]
[41] Elaborative reminiscing also incorporates a high degree of mental state talk (e.g.,
talk related to thoughts and feelings), which has been found to contribute positively
to children's social cognitive and narrative discourse development.[42]
[43] This style of reminiscing is referred to as “high” elaborative reminiscing, which
can be contrasted with a “low” elaborative reminiscing style in which the caregiver
rarely expands on the child's recollections and instead asks more repetitive (often
redundant or “interview” style) questions.[10]
[Table 1] provides an example of both high and low elaborative reminiscing styles.
Table 1
High Versus Low Elaborative Reminiscing
|
High elaborative reminiscing
|
Low elaborative reminiscing
|
|
Mother: Remember when we went to see grandma and grandpa? And aunt Dani was there? Remember
what she had with her? It was a small animal.
Child: Cat!
Mother: Nooo! She didn't have a cat. Her animal kept barking! (pause) A dog! Remember what
her dog did?
Child: I don't know
Mother: You don't remember?
Child: No
Mother: Remember the dog ran right through the mud puddle?
Child: Yeah
Mother: He got so dirty! You were watching him run through the puddle and were laughing,
huh?
Child: Yeah!
|
Mother: What kind of animal did aunt Dani have?
Child: Candy
Mother: Candy isn't an animal, is it? What kind of animals did she have?
Child: Dog.
Mother: She had a dog. And what did the dog do?
Child: Ruff Ruff!
Mother: No, what did the dog do?
Child: Ruff!
Mother: No. What did the dog run through?
Child: [silence]
Mother: Why was the dog all muddy?
|
During elaborative reminiscing, the child and adult recount a past event with specific,
subjective details so that it can be re-experienced, mutually understood, and socially shared by the discussants. In this way, elaborative reminiscing echoes the experience of joint attention and
the forging of a “common ground”[44] in which two (or more) people have shared contents of mind.[15]
[17] When employed optimally, a family's coordinated storytelling about past personal
experiences “provide[s] a safe and comfortable environment for children to tell their
perspectives, thus creating interconnectedness as a whole family and recognizing the
individual value of the child. Because children's perspectives are validated and integrated,
their self-esteem is [also] high.”[45]
The use of elaborative reminiscing with neurotypical children is associated with positive
changes in children's ability to recall and report their past personal experiences.
Children demonstrate better EMs, such that their memories are more accurate and more
detailed than children whose caregivers do not use a high elaborative reminiscing
style.[14]
[37] Not only do these children demonstrate gains in EM abilities, they demonstrate advanced
social cognitive abilities; they have a better understanding of their own and others'
thoughts and feelings, which is believed to contribute to the development of a stable,
continuous sense of self.[14]
[37] Advances in EM appear to be causal and persistent over long periods of time.[41]
[46] This is important because caregiver reminiscing style is malleable; caregivers can
be taught to adopt a highly elaborative reminiscing style to advance their children's
social and cognitive development.[46]
[47]
Caregiver's talk in autism. Crucially, parents of autistic children appear to be less elaborative and more directive during reminiscence compared with parents of neurotypical children.[48] They tend to ask more yes/no questions, engage in repetitive questioning, and produce
more off-topic utterances.[48]
[49] Questions may frequently call for rote memorized, objective, factual information
that is not central to the memory or the unfolding narrative (e.g., “What month did
we go?”) and discourse may incorporate fewer subjective, mental state references.[42] Although it is likely that parents of autistic children adopt a low style of elaborative
reminiscing and make other adjustments in their language input to support their child's
development in certain ways (e.g., to maintain engagement or repair children's off-topic
turns[48]
[50]), these features of parent conversational discourse do not predict advancement in
autistic children's linguistic or social cognitive development. Indeed, when parents
of autistic children use high elaborative reminiscing, their children initiate and
contribute more to conversation,[51] respond more elaborately themselves,[26] and demonstrate better EM.[49] Clearly, the quality of the language-learning environment influences how both neurotypical
and autistic children develop language and social communication skills.[42]
[52] Similar to their neurotypical counterparts, autistic children's memory and discourse
appear to benefit from a rich language environment as opposed to a simplified or telegraphic
one.[52]
Of importance, a substantial body of research has demonstrated that EM is facilitated
in autism when informational support is provided. Specifically, the Task Support Hypothesis[53]
[54]
[55] postulates that recall is facilitated in autism when more information about the
event is made available (e.g., visual stimuli,[56] question prompts[28]). For example, in autism, questions that rely on cued recall such as “What did the woman say when she dropped the camera” facilitate episodic remembering to a greater extent than do free recall questions
(e.g., “Tell me everything that happened”[28]). This is likely because cued recall questions add information about the event. For example, when asking “What did the woman say when she dropped
the camera,” information is given about the event: a woman dropped the camera and
she said something when she dropped it.
Because an essential feature of high elaborative reminiscing is that the adult provides
additional information about a past experience to support children's recollections,
it can be thought of as a powerful form of task support.[57] This task support can take various forms, including commenting (to add information,
detail) and cued questioning, but task support can also include certain kinds of closed-ended
questions, which is a device typically associated with a low elaborative reminiscing
style. The following is a sample conversation in which the adult first asks an open-ended
question. When the child does not respond, the adult then asks a closed-ended, forced
choice question. When the child still has difficulty responding, the adult continues
the conversation by offering the information. Asking closed-ended questions (while
not the ultimate goal of elaborative reminiscing) may be necessary in the short run
to provide enough information and task support to help the individual with autism
recall the event and contribute to the conversation.
-
Adult: “Tell me what happened at the racetrack last week.” [open-ended]
-
Child: [no response]
-
Adult: “What did we do?” [open-ended].
-
Adult: “Where did we go?” [open-ended]
-
Child: “I don't know”
-
Adult: “We watched a really exciting horse race.”
-
Child: “The horses raced”
-
Adult: “The horses did race. Who won the race: the brown horse or the gray horse?” [closed-ended]
-
Child: “The gray horse”
-
Adult: “The gray horse did win. Did it win by a lot or a little? [closed-ended]
-
Child: “Like a mile!”
-
Adult: “I'll say! Yes, that's right. It won by a lot.”
-
Adult: “I was very happy because I won $20.00 and used it to buy us all popcorn”
-
Adult: “How were you feeling?” [open-ended]
-
Child: “It was ok. The popcorn stuck in my teeth. I liked the hotdogs better”
Elaborative Reminiscing Parent Training
Elaborative Reminiscing Parent Training
The vast majority of research on elaborative reminiscing has involved parents and
their neurotypical children,[41]
[46] and although theoretically potent and rich with implications, relatively little
is known about whether elaborative reminiscing works as a support for autistic children's
social and cognitive development. To address this gap in the literature, we developed
an elaborative reminiscing caregiver training that was aligned with the research on
EM, autism, and the Task Support Hypothesis while incorporating strategies from the
elaborative reminiscing literature,[41]
[46] existing caregiver training studies,[41]
[58]
[59]
[60]
[61] and well-established, manualized training programs targeting social communication
skills in autistic children.[62] The parent training was piloted on one mother and her neurotypical child to refine
the intervention and data collection procedures. The resulting program was composed
of three sessions, with an additional booster session. The three-session protocol
is provided in the Appendix. The comprehensive training package, including the standard
operating procedure and materials, is available in Hutchins et al.[17]
Training procedures. Our caregiver training in elaborative reminiscing was manualized according to a
standard operating procedure that was developed as part of the first author's doctoral
dissertation. The training consists of three sessions occurring on 3 separate days
over the course of 1 week. Each session ranged from 30 minutes to 2 hours (with the
entire training lasting ∼3 hours). The entire training can be completed remotely via
online video meeting platforms (e.g., Zoom, Microsoft Teams) or in-person. Whether
the training is completed in-person or online, caregivers are provided with the training
materials ahead of time so that they can follow along with the appropriate materials
throughout the training.
During the training, caregivers are taught strategies to support EM (i.e., elaborative
reminiscing and task support) that are paired with best practice principles for supporting
social cognition in children with autism. Best practices include using visual supports
as appropriate, scaffolding the child's memory contributions by providing more information
about the memory, allowing the child to take the lead in the conversation, providing
the child choices, and using supportive repetition. The training can be delivered
to caregivers by professionals (e.g., speech-language pathologist [SLP], special educator,
and psychologist) with a good understanding of EM and elaborative reminiscing, and
who have experience working with children with autism and their families. Before delivering
this training, professionals should study EM and how it is impacted, assessed, and
supported in persons with autism (see Hutchins et al[17]).
Method
Design, participants, and outcomes. The data reported here were collected as part of a larger study designed to evaluate
the newly manualized intervention. An uncontrolled pre-post designed was used to test
proof of concept and the intervention's potential for therapeutic outcomes. Participants
were 27 caregivers and their children (20 males; 7 females; aged 6–15 years; M = 9.93) with a formal diagnosis of autism. Parents received training in elaborative
reminiscing and implemented the intervention techniques for 8 weeks (5 minutes a day/5
times a week). Here, we report intervention outcomes for proximal goals (i.e., caregivers'
degree of conversational elaborateness and their subjective, qualitative impressions
of intervention) and children's EM outcomes. Data for measures tapping distal outcomes
related to children's social cognitive development and personal narrative discourse
abilities are reported elsewhere.[63]
Results
Caregiver's elaborateness. A first step in evaluating the potential of a parent training program to support
children's development typically involves examinations of the proximal intervention
targets and mechanisms—in this case, the degree of caregiver's elaborative reminiscing.
All parent–child dyads participated in the training which is described in the Appendix,
and their reminiscing discourse characteristics were evaluated reliably at pre- and
post-intervention.
To code parental elaborative reminiscing, raters were trained on a random sample of
six transcripts (i.e., 11.1%). Reliability between the primary investigator and her
research team was established on a random sample of 15 of the remaining transcripts
(i.e., 26.3%). Transcripts and measures from both the pre- and post-assessment visits
were used for training and reliability. Cohen's kappa,[64] a chance-correcting measure of agreement, was used as the index of overall reliability
yielding excellent agreement (overall unweighted kappa = 0.89). Due to the large number
of mutually exclusive categories in our coding scheme (i.e., 12 in the larger study
from which this brief report is drawn), kappa was not calculated for individual codes;
rather simple agreement was calculated as an estimate of interrater reliability (see
[Table 2]). Using simple agreement, most coding categories achieved at least 80 or 90% agreement
which is considered good to excellent. Simple agreement for the codes Corrections and Evaluative Statements were lower; however, these were relatively infrequently occurring codes that independent
raters agreed upon 10/13 or 77% and 10/15 or 67% of the time, respectively. Because
estimates of simple agreement for codes with a high number of mutually exclusive categories
(12 in this case) result in low chance agreement (i.e., 8%), and in light of their
theoretical importance, reliability for these codes was deemed adequate and they were
included in subsequent analyses.
Table 2
Caregiver's Elaborateness and Task Support at Pre- and Post-intervention
|
Pre
|
Post
|
|
|
|
|
|
M (SD)
|
M (SD)
|
t(26)
|
p
|
d
|
Simple agreement
|
|
Elaborateness
|
|
|
Open-ended non-rote questions
|
5.67 (4.31)
|
9.41 (5.05)
|
3.43
|
< 0.01[a]
|
0.66
|
91%
|
|
Statement elaborations
|
21.52 (21.77)
|
26.93 (14.48)
|
1.43
|
0.16
|
0.28
|
91%
|
|
Confirmations
|
7.19 (5.43)
|
10.81 (6.26)
|
3.22
|
< 0.01[a]
|
0.62
|
82%
|
|
Follow-ins
|
4.52 (4.30)
|
10.00 (5.36)
|
5.93
|
< 0.01[a]
|
1.14
|
76%
|
|
Evaluative statements
|
0.11 (0.32)
|
4.00 (4.32)
|
4.80
|
< 0.01[a]
|
0.92
|
63%
|
|
Total number of words
|
562.56 (255.98)
|
834.78 (343.40)
|
4.21
|
< 0.01[a]
|
0.81
|
|
|
Task support
|
|
|
Closed-ended questions
|
14.78 (8.30)
|
21.78 (14.63)
|
2.89
|
0.01[a]
|
0.56
|
77%
|
|
Statement elaborations
|
21.52 (21.77)
|
26.93 (14.48)
|
1.43
|
0.16
|
0.28
|
91%
|
a
p < 0.05.
Six of the twelve codes were taken as indicators of parental elaborateness: open-ended
non-rote questions (i.e., questions or statements calling for the child to provide
new memory information about the event; e.g., “tell me about this day”), statement
elaborations (i.e., statements that provide information about the event but do not
require a response; e.g., “Sheldon tried to catch the ducks!”), confirmations (i.e.,
utterances that confirm a child's previous utterance; e.g., “we did eat cake!”), follow-ins
(i.e., a confirmation followed by the adult's own statement or question that elaborates
on and is semantically contingent to the child's utterance; e.g., “Yeah we did give
them cupcakes. They were chocolate cupcakes with sprinkles.”), evaluative statements
(i.e., statement that evaluates or summarizes the memory experience toward the end
of the reminiscing discussion; e.g., “that was so fun. I can't wait to go back again
next year.”), and total number of words. For five out of the six indicators of conversational
elaborateness, caregivers demonstrated more elaborative reminiscing after the training.
Specifically, parents talked more to their children, asked more open-ended non-rote
questions, confirmed their children's memory contributions, offered utterances that
were semantically contingent to the child's responses, and concluded the discussions
by offering an evaluation of the experience or commenting on what they would do in
a similar experience in the future.[63]
Additionally, because autistic children show better EM recall when more information
about the event is provided, caregivers were taught when to provide task support (i.e.,
when children experienced memory failures or difficulty responding). Two codes were
taken as indicators of task support: closed-ended questions (i.e., including yes/no,
forced choice, clarifying, and fill in the blank questions; e.g., “did you feel happy?”
and “was this at the beginning of our trip or the end of our trip?”) and statement
elaborations. Statement elaborations were considered as an index of both elaborateness
and task support because their function is inherently elaborative and supportive. In alignment with training, caregivers increased their use of task-support
by asking more closed-ended questions from pre- to post-intervention. Caregivers did
not increase in their use of statement elaborations at post-intervention; however,
the means for statement elaborations for pre- and post-intervention did move in the
expected directions, and this effect would likely be significant with greater statistical
power. In addition to indices of elaborateness and task support, other codes were
developed and coded as “other” and are not applicable to these data. Therefore, these
data are not analyzed here. Finally, caregivers used more mental state terms in their
talk with their children after training (see [Table 2] for caregiver data pre- and post-training).
Data for caregiver elaborateness and task support were analyzed inferentially to explore
pre-post effects using a series of paired samples t-tests. Bonferroni tests to correct for family-wise error were not conducted to protect
against the likelihood of multiple Type II errors (due to the large number of comparisons[65]
[66]). All inferential statistics were accompanied by effect size analyses (i.e., Cohen's
d).
Children's EM. Children's EM was formally assessed using two methodologies. One popular EM assessment
paradigm (i.e., the Remember/Know Task) employed with adults (but that we attempted
to modify for young children) did not prove useful and was dropped from analysis (i.e.,
it evidenced floor effects and we concluded that the instructions were too complex
and not understood by the majority of young autistic children in our sample). However,
another popular procedure known as the cueing procedure that has been used successfully
with children and adolescents did yield interpretable results. The cueing task is
intended as a measure of EM specificity. Degree of recall specificity involves the
question of whether memory is general or specific. General memories refer to memories
for routine or habitual past events (e.g., “We used to always play ‘eye-spy’ on road
trips to Utah”), whereas specific memories are located at a particular (specific)
point in time (e.g., “One time we played ‘eye-spy’ and the answer was the white lines
in the middle of the road”). In this task the examiner presents the child with a series
of positive and negative cue words and asks the child to recall a specific memory
that is associated with that cue word (e.g., “tell me a specific memory you have that
goes with the word ‘happy’”). Results of this assessment revealed that children's
EM specificity increased from pre- to post-intervention (p = 0.01). Said another way, children included more information about when an event happened, which is a characteristic feature of EM.[12]
Parent's perceptions of intervention. To gather information on the quality and therapeutic potential of the training processes
and procedures, we conducted an interview at posttreatment to ask parents about the
intervention. Qualitative data were collected through the administration of a carefully
constructed semistructured interview.[63] Responses were transcribed and examined for shared patterns, but we were also interested
in the heterogeneity and range of experience in response to questions about the elaborative
reminiscing parent training. The general conclusions resulting from this process are
described below.
In response to a question about their general impressions of the elaborative reminiscing
intervention, one mother shared the following sentiment: “[elaborative reminiscing]
doesn't take a lot of time. There are lots of emotional rewards and I am motivated
to do it. The level of enjoyment for me is high because this is our lives. For the
amount of time it takes, the bang for your buck is worth gold.” Another parent noted
that after engaging in elaborative reminiscing with her son for several weeks, he
independently started sharing memories of events that happened at school. This mother
noted, “this was the first time he was able to provide me with this kind of information
about an event that I had not experienced with him. It's a great example of how he
is starting to generalize the strategies from elaborative reminiscing with me to telling
me about events I wasn't present for in a logical way.”
When asked whether or not the intervention helped support the child's memory or communication,
some parents were uncertain and felt more time was needed to observe the child, but
most responded affirmatively and offered specific examples to justify their positive
evaluations. For example, one parent shared that after she began using elaborative
reminiscing with her son, her son's school said that “he was being more expressive
with feelings and why he was upset.” Another mother shared, “I see definite positive
changes in [my son]. I feel very fortunate to participate in [this training]. I know
the new way of having conversations with my son will make a difference. Thank you
for giving us this chance and thorough training.” This same mother reported that prior
to the training, her son rarely used the word “remember” in his conversational exchanges.
After the training, he began initiating reminiscing discussions by saying “Do you
remember when …?,” at which point an elaborative discussion could unfold. Several
parents echoed this sentiment that their children were verbally expressing more and
initiating discussions with others. For example, one parent said, “[elaborative reminiscing]
provides a framework that makes the anxiety of interacting with others decrease. [My
daughter] started approaching others and asking questions.” One child in particular
started asking his mother to take photos of events they were doing so that they could
reminisce about them later. Parents described that engaging in elaborative reminiscing
was “very effective as a way to explore communication and memories.”
When asked about the most important things learned from the training, many caregivers
reported insights involving the quality of parent–child communication. For instance,
one parent replied: “I saw some strengths that he had that he wasn't showing before.”
Another cited improvement in conversation, stating that her son can talk about past
events and that he can also now remember some details. Still another parent reflected:
“I was never truly talking to my daughter. Elaborative reminiscing created a closer
relationship for us.”
We also asked parents whether anything proved difficult and if they had any suggestions
for improving the intervention. In response, a few parents told us that they found
it difficult to reminisce for 5 minutes for 5 days/week (which was our minimum recommended
“dosage”) and that shorter reminiscing durations would feel more feasible and natural.
Some parents also communicated that they sometimes had a hard time identifying a reminiscing
topic for each day during the intervention period (which was our recommended treatment
intensity). In such cases, caregivers also reported that in the future they planned
to continue their use of elaborative reminiscing with their child but would do so
in more spontaneous ways, an outcome of training that we indeed hoped would occur
and that provides preliminary evidence for the social validity of the implemented
treatment procedures.
In summary, and in general, caregivers' testimonials were positive and encouraging
for training parents of autistic children to use elaborative reminiscing to support
autistic children's EM. The training provided families with a way to talk about the
past in ways that were meaningful and enjoyable and that were frequently incorporated
into family routines in easy and natural settings.
Cultural considerations. Although elaborative reminiscing has been shown to causally impact EM and personal
narrative development,[14]
[41]
[46]
[67] most research on this topic has been performed in Western societies. This notion
gains importance in light of cultural differences in language socialization, including
those that unfold during reminiscing. For example, many Western cultures place high
value on independence and personal achievement.[68] Ross and Wang[2] noted that “by helping individuals to distinguish themselves from others, memories
of personal experiences contribute to an autonomous self-construal.” By contrast,
more collectivist cultures may increasingly value interconnectedness and social cooperation,[68] and therefore the self is featured more peripherally in people's memories and discourse
surrounding past personal experiences.
These cultural differences can be observed in other aspects of reminiscing. People
raised in collective cultures often report differences with respect to the goals and
content of elaborative reminiscing.[68]
[69] For instance, although persons from individualistic cultures tend to focus on descriptive
details about experiences where the self is the center of the reminiscing, caregivers
from collectivist cultures tend to be less elaborative and focus less on the child
and more on others who shared in the experience.[15]
[68] Because of the impacts that culture has on what and how people remember,[2] clinicians must adopt a family-centered practice and consider the family's culture,
values, and goals when determining the appropriateness of any intervention or training.
Adaptations to the elaborative reminiscing training detailed below may be necessary
depending on the family and their cultural beliefs, values, and discourse practices.[70]
Elaborative Reminiscing through the Neurodiversity Framework
Elaborative Reminiscing through the Neurodiversity Framework
Sharing stories with others through reminiscence is a pervasive human activity that
positively impacts children's social cognitive development and the development of
one's sense of self. Elaborative reminiscing provides a structured platform around
which caregivers and children can recount their shared experiences in a natural and
family-centered way. At the same time, recalling and sharing past personal stories
are challenges for autistic individuals.
Elaborative reminiscing has been shown to support the development of EM in neurotypical
and neurodivergent populations, which has strong implications for one's self-concept
and identity. Who we are is shaped by our experiences and our subsequent recollections of those experiences. Elaborative reminiscing, as a means to lay down a record of one's experiences, structure
events into coherent narratives that can be shared with others, and shape one's life
story, is a powerful tool that fits naturally into a family-centered approach, while
drawing on the autistic person's strengths and supporting their recollections for
meaningful events.
Training caregivers to use elaborative reminiscing with their autistic children is
not intended to “normalize behavior or … disassemble autistic habits of cognition
but to support communication by improving access to socially relevant information
and increasing the flexibility of representations of experience.”[17] As such, our training is aligned with the neurodiversity movement[71] insofar as the neurodiversity movement is in favor of interventions to support functional
skills, including language and flexibility.[71] As Carol Greenburg, an autistic self-advocate, and Shannon Des Roches Rosa,[72] a parent of an autistic child, argued, “everyone should have stable, level ground
from which we can launch authentic discussions about what we owe and what we deserve.”
By supporting memories for past personal experiences in neurodivergent children, parents
empower children to take ownership of their experiences, which can lead to meaningful
integration of their experiences in the world.
Clinical Implications
Sharing past personal experiences is a pervasive, human-specific activity that is
associated with the development of one's sense of self and overall psychological well-being
and is often impacted in individuals with autism. Our uncontrolled pre-post intervention
pilot study suggests that caregivers of children with autism can be explicitly taught
to support their children's EM by talking about past personal experiences through
the use of elaborative reminiscing and task support. We believe that the integration
of task support into elaborative reminiscing is key to fostering autistic children's
memories for past personal experiences, but future research is needed to disentangle
effects and elucidate active ingredients of treatment.
SLPs have considerable experience supporting children's narrative discourse skills
and are also skilled at integrating families into their intervention services. SLPs
are well situated to teach caregivers about elaborative reminiscing and how to incorporate
it into their daily lives. Including elaborative reminiscing in treatment plans for
children with autism is promising for facilitating the development of EM, which is,
in turn, theoretically potent for supporting children's personal narrative skills,
self-concept, identity, and sense of belonging in the broader sociocultural context.
While elaborative reminiscing is not the only way to support EM, it is a potentially
powerful way for clinicians and caregivers to strengthen EM in children. Clinicians
are encouraged to incorporate elaborative reminiscing into their interactions with
their clients through engaging in elaborative reminiscing discussions or by selecting
intervention strategies that inherently include features of elaborative reminiscing.
A variety of resources have recently become available[17] to elevate the importance of reminiscing and enhance its quality and frequency in
ways that are responsive to the strengths and interests of the individuals and that
can be employed in a variety of settings (e.g., home, school, community). The resources
differ in format in that some are more child-centered and some are more clinician-directed.
What they have in common is that all are intended to support EM by integrating the
principles of elaborative reminiscing, task support, and best practices for supporting
social learning in autistic persons.
Appendix: Elaborative Reminiscing Training
Training Guidelines and Format
This caregiver training consists of three sessions which occur on three separate days
over the course of a week. Each session ranges from 30 minutes to 2 hours, resulting
in the entire training lasting ∼3 hours. An important and exciting feature of this
training is that it can be completed entirely remotely via online video meeting platforms
(e.g., Zoom, Microsoft Teams) or in-person. Whether the training is completed in-person
or online, caregivers are provided with the training materials ahead of time[17] so that they can follow along with the appropriate materials throughout the training.
Session 1: Introduction to EM and Elaborative Reminiscing
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Clinician and child interaction. Prior to beginning the training with the parent(s), the clinician completes an interactive
activity with the child (adapted from McCrory et al[28]). For this activity, the clinician constructs something with the child that is sensory-rich
and can engage a variety of senses, thoughts, and feelings (e.g., building a science
experiment volcano).[a] Throughout the activity, it is important that the clinician and the child talk about
the event as it is happening, including talk of each of their thoughts and feelings.
Talk of the event while it is happening is associated with increased episodic memory
(EM) in children.[73] During the interaction, the clinician should take multiple photos of the activity
so that they can be used as visual supports for facilitating recall in Session 2.
Caregivers are asked to observe the clinician–child activity, as it will serve as
the basis for an elaborative reminiscing discussion between the clinician and the
child in Session 2 of the training that will be modeled for the parent.
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Episodic memory: what it is and why it's important. Once the clinician–child activity is completed, the child can leave the training,
and the caregiver portion of the training begins. To start, the clinician and caregiver
review the child's memory strengths and challenges (as indicated by the parent), so
that this specific child's memory abilities can be referred to throughout the training.
Then, the foundational concepts of EM are discussed. The clinician teaches parents
about EM: what it is, why it is important, how it is associated with other developmental
constructs (e.g., personal narrative skills, self-concept), and how it is disrupted
in children with autism. To apply this information to their own lives, caregivers
are then asked to think about their own EMs and practice recalling and sharing a few
examples of their own memorable past experiences.
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Elaborative reminiscing: what it is and how to do it. After learning about EM, caregivers are taught about elaborative reminiscing and
how they can use it to support EM in their child. Caregivers watch and listen to video
and audio clips of low and high elaborative reminiscing parent–child interactions.
They discuss their impressions of the two different types of interaction styles, highlighting
the features that make the high-elaborative conversation more successful. It is here
that the clinician teaches caregivers about the features present in elaborative reminiscing,
including steps and tips for this type of conversational exchange (adapted from McCabe
et al[60]). Elaborative reminiscing steps and tips are provided in [Figs. 1] and [2]. Included in the review of elaborative reminiscing tips is a discussion of mental
state terms. Mental state terms are a key feature in elaborative reminiscing, and
so parents are taught how to scaffold the use of mental state terms depending on the
child's development. Using visual supports with elaborative reminiscing is also discussed,
and parents are introduced to the Remember Web ([Fig. 3]) and provided with examples of how to use it to support their child's memory for
past experiences. As can be seen from the figure, the Remember Web is used to first
locate the memory in time (by drawing a general timestamp in the When box) and space
(by drawing the location in the Where box). From there, the images in the Remember
Web are used to guide the conversation to include details about physiological (e.g.,
sights, sounds, smells) and psychological (i.e., thoughts and feelings) aspects of
the memory. The Remember Web is a versatile tool as it can be used as a visual support
for both the children and the adult interlocutors.
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Elaborative reminiscing: what to talk about. Although there is no limit to what we can reminisce about (and in fact the overarching
goal of elaborative reminiscing is to talk about the child's past experiences for
which the caregiver was not present [e.g., “Hey honey, what happened at school today?”]),
a few considerations about early reminiscing are provided. To begin elaborative reminiscing
discussions with their child, conversations should consist of events for which both
the child and the adult were present, so that the adult can be sure to provide appropriate
details to the recollection. We also encourage caregivers to talk about events that
are unique, novel, and/or memorable to the child, so that the child is more motivated
to participate in the conversation. During this part of the training, we encourage
caregivers to avoid discussing certain topics, including traumatic events, events
for which the caregiver was not present, general events (e.g., events happening every
summer), scripted events (e.g., birthday parties), and topics involving the child's
restricted interests. Each of these topics presents a challenge for reminiscing, especially
when caregivers and children are first learning to engage in this style of communication.
Figure 1 Elaborative reminiscing steps.
Figure 2 Elaborative reminiscing tips.
Figure 3 Remember Web.
Session 2: Elaborative Reminiscing Modeled
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Clinician and child interaction. During the second training session, the clinician engages in an elaborative reminiscing
discussion with the child about the interactive activity from Session 1 while the
caregiver observes. The clinician follows the steps and tips for elaborative reminiscing
and uses the appropriate techniques to scaffold the child's recollection. It is important
to note that each child may require different supports; clinicians must be skilled
in adapting their reminiscing style based on the specific child's memory responses.
Here, the clinician can also use the photographs that were taken in Session 1 as a
visual support for the recollection. It is important that the caregiver observe this
clinician–child elaborative reminiscing discussion so that they can better understand
how to reminisce with their specific child (as opposed to the example child in the videos in Session 1). Once
the clinician–child elaborative reminiscing is completed, the child is no longer needed
for the remainder of the training.
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Parent practice. After the clinician–child elaborative reminiscing discussion, the caregiver and the
clinician complete a reflection activity that includes what went well during the reminiscing
discussion, what challenges occurred, and what the caregiver could do if these challenges
occur in the future (reflection activity adapted from Sussman[62]). At this point, the caregiver begins to think about elaborative reminiscing discussions
with their child. [Fig. 4] provides a way for caregivers to map out a future elaborative reminiscing discussion
with their child.
Figure 4 Practicing elaborative reminiscing.
Finally, caregivers are asked to complete a home activity to practice what they have
learned in Session 2. For this activity, they are encouraged to use the outline that
they completed during the session and engage in an elaborative reminiscing discussion
with their child. They are asked to video record this discussion with their child
and bring the video recording to Session 3.
Session 3: Practicing Elaborative Reminiscing
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Parent practice. For the final training session, the caregiver and clinician review the video of the
caregiver–child elaborative reminiscing discussion (home activity from Session 2).
The clinician then guides the caregiver in completing a reflection form similar to
the one used in Session 2, indicating what went well during the interaction, what
challenges occurred, and what the caregiver can do if these challenges occur in the
future. For example, parents can reflect on their use of elaborative reminiscing in
real time and how their child responded to the conversation, and they can troubleshoot
any unforeseen challenges that occurred (e.g., if the child kept changing the topic).
