Intervention Targeting Joint Attention In Children With Autism

Intervention Targeting Joint Attention In Young Children With Autism


A.  Introduction

1. Joint Attention

a. Definition

It is used to the development and gain of certain skills in young children which helps them engage and share attention with others on an object or an event. (Brereton, 2010).  It is identified as one of the earliest indicators of developing communication skills in young children and involves engaging with a social partner, focussing and coordinating the attention on a common goal and recognition that the partner is engaged too in the same activity.

This process thus involves several things including: (Brereton, 2010) (Taylor & Hoch 2008; Schertz& Odom, 2004)

1. ability to engage attention

2. ability to recognise that other person is also interested

3. share these attention states and sustain the joint engagement


Such activities may involve pointing to objects or activities, playing games and so on. The onset is believed to occur in infancy and then mature by the second year or so. (Jones et al, 2006). JA is a very important subject as it is critical to social and cognitive development and impairment in this is associated with autism.


b. Kinds of joint attention

Joint Attention Studies devolve on two things. One is whether the child is initiating the shared attention process or whether it is responding to a gesture or signal initiated by others. RJA (Responding to Joint Attention) refers to the child’s ability to respond to a signal or gesture initiated by others, by following the direction of these signals to the target object or action. IJA, on the other hand, is when the child itself is able to spontaneously initiate a gesture or signal to the other participant or recipient, to engage his or her attention towards a particular direction. The JA process takes place in the following way: the child’s look switches between object and the other person, who notices this and responds by saying or looking at the object. This maybe accompanied by signs, body language, gestures and vocalisations. (Mundy et al., 2007) (Striano et al, 2006)


c. What does it do? Purpose

JA involves the information processing system in the brain which allows the integration of internal information obtained through the child’s own visual mechanisms with the information from external sources (i.e. the visual attention of other people) This information about self and other concept is encoded and processed by the spread out anterior and posterior cortical attention network (Mundy et al) The development of this system is influenced by genetics. Continuous work on the JA behaviours will ensure that it transforms into executive and automatic responses.  The two components of the JA are the proto-declarative and proto-imperative function. (Schertz and Odom, 2004) (Mundy, 2003)


d. Association between Joint Attention and Language Development

Research indicates that there is a close connection between the development of JA and the development of language in children. (Carpenter,1998) and that the successful development of JA behaviours is related to the improved results in communication.


e. JA and Social Cognitive Development

Considerable research also points at the close connection between JA behaviours and Social Cognitive development. The initiation of JA behaviours is associated with subsequent development of cognitive actions.


Development of following is considered to be indications of developing cognitive system:

i. early demonstration of intentional use of eye contact.

ii. pointing to adults is also considered as a sign that cognitive developmental would be faster (Mundy, 2007)


f. Joint Attention in Autism

Studies on Joint Attention are particularly important to the study of autism.  Research has reported that there is a strong association between difficulties in social responsiveness and Joint Attention and Autism and in fact these are used as indicators of autism in toddlers. (Brereton, 2010). Autistic children experience difficulties in both in initiating joint attention and sustaining joint engagement (Brereton, 2010). One of the strongest indicators of an autism diagnosis is the lack of ability to initiate gestures or sharing interest by age two. Most autistic children display a delay in IJA but are able to respond to requests from others (RJA). IJA is needed for development of emotional connectivity is unique to humans  (Tomasello & Carpenter, 2005).


B. Client Profile

The clients for this study would be a mix of children between the age of 2.5 to five years,  who have been diagnosed for autism, for deficiencies in JA behaviours and social  communicative deficiencies. This diagnosis is carried out by the use of various scales such as Diagnostic Interview- Revised (ADI-R) Autism Diagnostic Observation Schedule (ADOS).


C. Rationale

                         The rationale on choosing such children is that young autistic children are identified on the basis of their poor social skills and difficulties in communication. The area of JA impaired in autistic children is the area of initiation of sharing gestures. It has been seen that 90% of children associated with JA initiation deficits have been diagnosed with autism.  Koegel et al in 1999 has hypothesised that developing and working on crucial skills that are required in JA, would lead to improvements in other areas of development include cognition and language development and thus help in improved learning. Some evidence is there to connect JA skills to social-cognitive skills.


D. Materials and Methods

                         The methods we use would be a combination of discrete trial approaches (Whalen Model) and Developmental–responsive approach (based on the relationships). (Whalen et al, 2006). The targeted behaviors would include orientating the child towards its social partner, helping to teach them focus on the faces, imitation of gestures, practicing shifting and transference of gazes from the child to the item as well as to the partner, training of gestures and coordinating all these aspects. The Whalen model emphasizes on teaching the child to direct gaze , shifting and transference with videotaped and practice sessions during interventions. There are different levels in this where the child is trained from focusing to engaging and sharing through eye contact and gestures with the partner. The Developmental Responsive Approaches is based on focusing on the relationship between the child and the caregiver and to strengthen and improve the communication as well as social cognitive skills.  (Prizant et al., 2000) and focuses on improving the initiating and responding parts of JAA In children. Adults help the children by helping them improve their engagement, increase the length if interaction and also help them strengthen their reciprocative responses.


E. Instructions and Intervention Materials

                            The intervention materials would include toys, random items, surprises, familiar objects and packages and the placement of these materials in such a way that it would force the child to enter into joint engagement. It helps increases the chance of joint engagement to occur.  It is also ensured that the environment has minimal distractions and attempts to get the child to make eye contact would be done. Imitation of the child behaviour would be carried out in order to build relationship and time would be given for child to respond. At all times, the child’s behaviours are treated respectfully and with attention. All the activities are carried out in a way to ensure that (Schertz & Odom, 2007; Yoder & Warren, 1999) and appropriate behaviours would be modeled for the child to respond. Schertz & Odom, 200Yoder & Warren, 1999) (Martins & Harris, 2006) (White et al 2011)


F. Outcomes Measurements

                       The measurement of the outcomes following interventions would be carried out using ESCS (Early Social Communication Scales) for JA assessment, Reynell Developmental Language Scales for the assessment of language development and ADOS for assessing the level of social communications. (Kasari, 2008). The interactions between the mother and the child would be videotaped for assessments, both before and at the end of intervention.


G. Implications

                        It is believed that the proposed activities would lead to improvement in JA, language skills,   social and cognitive skills as well as lead to improved initiation of sharing gestures in autistic  children. It is believed that through the above practice children can focus on the behaviours which are most vital to their language and cognitive development such as JA behaviours and languages.


H.  Conclusions

                    The challenges with these approaches are the fact the autistic children tend to display RJA behaviours more easily as compared to JA behaviours. It is more difficult to initiate IJA behaviours, which are unfortunately important to language learning and development. Another issue is the focus on skills rather than the state of the child per se. While these and other issues need to be addressed, Joint Attention behaviours are extremely important to child development and especially for autistic children, and hence interventions based on this would certainly improve their learning and development.





List of References:

Carpenter, M., Nagell, K., Tomasello, M., Butterworth, G., & Moore, C. (1998). Social cognition, joint attention, and communicative competence from9 to 15 months of age. Monographs of the Society for Research in Child Development, 63.

Jones, E. A., Carr, E. G., & Feeley, K. M. (2006). Multiple effects of joint attention intervention for children with autism. Behavior Modification, 30, 782–834.

Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008). Language outcome in autism: randomized comparison of joint attention and play interventions. Journal of consulting and clinical psychology76(1), 125.

             Martins, M. P., & Harris, S. L. (2006). Teaching children with autism to respond to joint     

             attention initiations. Child & Family Behavior Therapy, 28, 51–68

Mundy P, Block J, Vaughan Van Hecke A, Delgado C, Parlade M, Pomeras Y. Individual differences in the development of joint attention in infancy( 2007) Child Development.  78:938–954. [PubMed: 17517014]

Mundy P (2003) The neural basis of social impairments in autism: The role of the dorsal medial-frontal cortex and anterior cingulate system. Journal of Child Psychology & Psychiatry.  44:793–809. [PubMed: 12959489]

Prizant, B.M. , Wetherby, A.M. & Rydell, P. J. (2000) ‘Communication

Intervention Issues for Children with Autism’, in A.M. Wetherby & B.M.

Prizant (eds) Autism: A Transactional Developmental Perspective, pp. 193–224. Baltimore:


Rodger, S . , Braithwaite, M. & Keen, D. (2004) ‘Early Intervention for Children with Autism: Parental Priorities’, Australian Journal of Early Childhood 29 (3): 34–41.

Schertz, H. H., & Odom, S. L. (2004). Joint attention and early intervention with autism: A conceptual framework and promising approaches. Journal of Early Intervention27(1), 42-54.

Striano T, Chen X, Cleveland A, Bradshaw S.(2006) Joint attention social cues influence infant learning. European Journal of Developmental Psychology.  3:289–299.

 Taylor, B. A., & Hoch, H. (2008). Teaching children with autism to respond to and initiate bids for joint attention. Journal of Applied Behavior Analysis, 41(3), 377-391.

Tomasello M, Carpenter M. (2005) The emergence of social cognition in three young chimpanzees. Monographs of the Society for Research in Child Development.  70(1):vii–132. [PubMed: 16156847]


Whalen, C. & Schreibman, L. (2003)Joint attention training for children with Autism using behavior modification procedures.  Association for Child Psychology and Psychiatry, 44, 456-468.

White, P., O’Reilly, M., Streus, Levine, A., Sigafoos, J., Lancioni, G., Fragale, C., Pierce, N. and Aguilar, J. (2011). Best practices for teaching joint attention: A systematic review of the intervention literature. Research in Autism Spectrum Disorders, 5(4), pp.1283–1295.

Yoder, P. J., & Warren, S. F. (2002). Effects of prelinguistic milieu teaching and parent responsive education on dyads involving children with intellectual disabilities. Journal of Speech, Language, & Hearing Research, 45, 1158–1174.






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