Deficits In Joint Attention Research Articles

Characteristics of communication profiles of children with autistic spectrum disorder and their parents

This paper represents a review of current studies of communication and affective characteristics in dyads of children with autistic spectrum disorder and their parents. The review is aimed at establishing if specific features of communication exist in this population when there is an interaction with a close partner. In an attempt to describe the basic characteristics of these dyads, advantage is given to the deficit in nonverbal communication shown by children with autistic spectrum disorder, especially the joint attention deficit. Also, the dyads are described from the perspective of coordination of affect. Affective reactions of the child are described within the dyads, including empathy. Numerous study results focusing on emotional reactions of the mother are reviewed. After describing the characteristics, the question is posed concerning the strategies used in the dyads in difficult communication phases or following communication break offs. In an attempt to describe the characteristics of the other partner in communication - the parent, stress and fatigue are especially treated. These factors have a strong influence on everyday interactions of the parent and child. We have accented the importance of careful examination of these factors when making decisions on therapeutic interventions, because they need to be based on parents' strengths.

Increasing responding to others' joint attention directives using circumscribed interests

Children with autism show significant deficits in joint attention (JA), which occurs when 2 people engage in verbalizations, gestures, or eye contact with each other and a common object. Children with autism also exhibit intense interests in specific topics (i.e., circumscribed interests; CI). This study investigated the effectiveness of teaching responding to JA directives (RJA) to 3 children with autism while engaged in CI activities. RJA increased during intervention and generalized from CI to preferred activities.

Joint Attention Responses of Children with Autism Spectrum Disorder to Simple versus Complex Music

Joint attention deficits are viewed as one of the earliest manifestations and most characteristic features of the social deficits in Autism Spectrum Disorder (ASD). The purpose of this study was to examine the effect of simple versus complex music on joint attention of children with ASD. Thirty children with a diagnosis of ASD participated in this study. Fifteen of the participants were diagnosed with severe ASD and 15 were diagnosed with mild/moderate ASD. Each participant took part in six, 10-minute individual music conditions (3 simple & 3 complex) over a 3-week period. Each condition was designed to elicit responses to joint attention. RESULTS indicated a statistically significant interaction between music modality and functioning level. Therefore, the effect of simple versus complex music was dependent on functioning level. Specifically, the Simple Music Condition was more effective in eliciting Responses to Joint Attention (RJA) for children diagnosed with severe ASD, whereas the Complex Music Condition was more effective in eliciting RJA for children diagnosed with mild/moderate ASD. The results of the present study indicate that for children in the severe range of functioning, music that is simple, with clear and predictable pattems, may be most effective in eliciting responses to bids for joint attention. On the contrary, for children in the mild/moderate range of functioning, music that is more complex and variable may be most effective in eliciting responses to bids for joint attention. These results demonstrate that careful manipulation of specific musical elements can help provide the optimal conditions for facilitating joint attention with children with ASD.

Early Joint Attention Deficits in Autism: Evidence from a Retrospective Case Study

Early Joint Attention Deficits in Autism: Evidence from a Retrospective Case Study

Joint attention in autism: Teaching smiling coordinated with gaze to respond to joint attention bids

Children with autism demonstrate early deficits in joint attention and expressions of affect. Interventions to teach joint attention have addressed gaze behavior, gestures, and vocalizations, but have not specifically taught an expression of positive affect such as smiling that tends to occur during joint attention interactions. Intervention was applied to teach smile and gaze shift with eye contact to respond to others’ joint attention instructions. All targeted responses increased during intervention, with generalized performance as well as maintenance of performance during follow-up. Related measures of joint attention and characteristics of autism showed overall improvements from pre- to post-intervention.

Broad Autism Phenotype in Typically Developing Children Predicts Performance on an Eye-Tracking Measure of Joint Attention

We examined visual attention allocation during a set of social videos that are intended to elicit the coordination of attention with another person, compared to a control condition. Deficits in joint attention are a characteristic of young children with autism spectrum disorder (ASD). Participants included a diverse sample of 50 typically developing school-aged children between 3 and 9 years of age (M = 6:3, SD = 1:8). Results demonstrated that gaze allocation differed significantly between the experimental and control condition. Further, individual differences in gaze allocation were significantly predicted by a parent-report measure evaluating features of the broad autism phenotype. This study contributes to a research program that aims to develop and validate an endophenotype measure of ASD.

A randomized controlled trial of preschool‐based joint attention intervention for children with autism

Deficits in joint attention (JA) and joint engagement (JE) represent a core problem in young children with autism as these affect language and social development. Studies of parent-mediated and specialist-mediated JA-intervention suggest that such intervention may be effective. However, there is little knowledge about the success of the intervention when done in preschools. Assess the effects of a preschool-based JA-intervention. 61 children (48 males) with autistic disorder (29-60 months) were randomized to either 8 weeks of JA-intervention, in addition to their preschool programs (n = 34), or to preschool programs only (n = 27). The intervention was done by preschool teachers with weekly supervision by trained counselors from Child and Adolescent Mental Health Clinics (CAMHC). Changes in JA and JE were measured by blinded independent testers using Early Social Communication Scale (ESCS) and video taped preschool teacher-child and mother-child play at baseline and post-intervention. Clinicaltrials.gov: NCT00378157. Intention-to-treat analysis showed significant difference between the intervention and the control group, with the intervention group yielding more JA initiation during interaction with the preschool teachers. The effect generalized to significantly longer duration of JE with the mothers. This is the first randomized study to show positive and generalized effects of preschool-based JA-intervention.

Assessing Joint Attention Responding and Initiation in Children with Angelman Syndrome

Background Angelman syndrome (AS) is a rare neurogenetic disorder that overlaps with autism and is associated with severe cognitive, speech and motor impairments. Communication and social deficits are found among children with AS, both of which may be linked to impairments in joint attention. Methods The participants in this study were four children with a genetically confirmed diagnosis of AS, aged 5–10. Children’s joint attention responding and initiation were measured using a modified version of a structured assessment protocol from MacDonald et al. (2006). Results Children’s ability to respond to joint attention bids was less impaired than their ability to initiate joint attention. Conclusions Differences in children’s response patterns are discussed in relation to their characteristics on measures of cognitive, adaptive and language functioning as well as on a measure of autistic symptomatology. A better understanding of the nature of joint attention deficits in children with AS may assist with developing remedial approaches to improve their communication and social skills.

Survey of Paediatric Occupational Therapists' Understanding of Developmental Coordination Disorder, Joint Hypermobility Syndrome and Attention Deficit Hyperactivity Disorder

Evidence suggests that developmental coordination disorder (DCD) co-occurs with attention deficit hyperactivity disorder (ADHD) and joint hypermobility syndrome (JHS). Paediatric occupational therapists working with children with DCD need to consider the impact of co-occurring conditions on the children they assess and treat. A survey investigating the knowledge base and understanding relating to these conditions was conducted. The results showed that therapists (n = 225, response rate 23%) have an understanding of DCD; however, a more detailed knowledge of ADHD and JHS would allow them to consider the impact of the overlapping nature of these conditions. This highlights a training need to ensure understanding of these conditions and appropriate management.

Communicative Acts of Children With Autism Spectrum Disorders in the Second Year of Life

To examine the communicative profiles of children with autism spectrum disorders (ASD) in the second year of life. Communicative acts were examined in 125 children 18 to 24 months of age: 50 later diagnosed with ASD; 25 with developmental delays (DD); and 50 with typical development (TD). Precise measures of rate, functions, and means of communication were obtained through systematic observation of videotaped behavior samples from the Communication and Symbolic Behavior Scales Developmental Profile (A. Wetherby & B. Prizant, 2002). Children with ASD communicated at a significantly lower rate than children with DD and TD. The ASD group used a significantly lower proportion of acts for joint attention and a significantly lower proportion of deictic gestures with a reliance on more primitive gestures compared with the DD and TD groups. Children with ASD who did communicate for joint attention were as likely as other children to coordinate vocalizations, eye gaze, and gestures. Rate of communicative acts and joint attention were the strongest predictors of verbal outcome at age 3. By 18 to 24 months of age, children later diagnosed with ASD showed a unique profile of communication, with core deficits in communication rate, joint attention, and communicative gestures.

Teaching discrimination of adult gaze direction to children with autism

Three young children diagnosed with autism did not reliably locate objects in the environment on the basis of an adult's gaze shifts. A training program designed to teach gaze following used the activation of remote controlled mechanical toys as both prompts and consequences. Over several training sessions, toy activation was progressively delayed following the adult's gaze-shift cues. All of the children eventually came to anticipate the toy activation and locate the target object on the basis of the adult's gaze-shift cue alone. Discrimination of another person's gaze direction is discussed in relation to joint attention deficits in children with autism.

Using Perseverative Interests to Elicit Joint Attention Behaviors in Young Children With Autism

Various explanations have been offered in the literature on the underlying cause of joint attention deficits in autism. One possible explanation is that children with autism are capable of producing joint attention but lack the social motivation to share their interests with others. The current study used a single-subject reversal design with alternating treatments to examine whether joint attention initiations for social sharing would occur as a collateral effect of utilizing the motivational techniques of Pivotal Response Treatment (PRT) in conjunction with perseverative interest stimuli for three young nonverbal children with autism. Results indicated an immediate increase in joint attention initiations when perseverative, or highly preferred, interests were incorporated within the motivational techniques of PRT. Additional findings included collateral increases in joint attention initiations toward less preferred interests, as well as improvements in the quality of interaction between the children and caregivers. Findings are discussed in terms of theoretical and clinical implications for understanding the role of motivation in the development of joint attention in autism.

Joint attention development in toddlers with autism

Deficits in Joint Attention (JA) may be one of the earliest signs of Autism Spectrum Disorders (ASD). In this longitudinal study we investigated several types of JA behaviors at the age of 24 and 42 months, and their development over time. Eleven children with ASD, 10 children with other developmental disorders, and eight children without a developmental disorder participated. It was found that children with ASD showed significantly less JA at the age of 24 months. At this age, the various types of JA (Basic Joint Attention, Associated Joint Attention, Joint Visual Attention) were correlated with developmental level and number of autistic characteristics. However, at the age of 42 months, these associations were absent. Although children with ASD may show less JA at the age of 24 months compared to other groups of children, by the age of 42 months they reach about the same level of JA, except for joint visual attention. In fact, at both ages, children with ASD differed consistently only on JVA from the other groups. JVA may be a core component of an early screening device for ASD.

Parent implemented joint attention intervention for preschoolers with autism.

Introduction The absence of joint attention is one of the earliest symptoms of autism, reflecting the hallmark social disturbance that characterizes the disorder (Mundy & Crowson, 1997). Joint attention, first seen in infants between 9 and 12 months of age, involves two people sharing attentional focus on interesting objects and events (Bakeman & Adamson, 1984). Early joint attention behaviors involve children's use of eye gaze and conventional gestures. For example, a child might initiate joint attention, directing his mother's attention to a toy on the floor, by looking from the toy to his mother and back to the toy (i.e., gaze alternating) while simultaneously pointing at the toy. Alternatively, a mother might direct her child's attention by pointing and looking at an object while commenting on the object (e.g., What a fun toy!) to which the child responds by looking from the object to his mother and back to the object (i.e., gaze alternating). These joint attention interactions are considered uniquely social in that they result in an interaction between adult and child about the object/event. Joint attention is also related to social and language skill development, playing a significant role in typical development (Mundy & Gomes, 1998; Mundy, Sigman, & Kasari, 1990; Travis, Sigman, & Ruskin, 2001). Deficits in joint attention are evident in children with autism from very early in development (Baron-Cohen, Allen, & Gillberg, 1992; Charman et al., 1998; Osterling & Dawson, 1994). Infant screening and diagnostic instruments for autism, such as the Checklist for Autism in Toddlers (CHAT) (Baron-Cohen et al., 1992) and the Autism Diagnostic Observation Schedule (ADOS) (Lord, Rutter, DiLavore, & Risi, 1999), include assessment of deficits in joint attention as a marker for autism. In comparison to children with mental retardation or specific language delay (matched for developmental level), preschool children with autism show significant deficits in both responding to others' joint attention directives and initiating joint attention (Charman et al., 1998; Mundy, Sigman, Ungerer, & Sherman, 1986; Sigman, Mundy, Sherman, & Ungerer, 1986; Stone, Ousley, Yoder, Hogan, & Hepburn, 1997). This impairment in joint attention discriminates 80% to 90% of children with autism from those with other developmental disabilities (Lewy & Dawson, 1992; Mundy et al., 1986). Because of the social nature of joint attention, its absence reflects the core social disturbance that characterizes autism (Mundy & Crowson, 1997). Joint attention is also related to two of the areas, social and communication development (Mundy & Gomes, 1998; Mundy et al., 1990; Travis et al., 2001), that are significantly impaired in individuals with autism (American Psychiatric Association, 2000). Thus, the development of effective intervention procedures to address joint attention deficits in young children with autism is of utmost importance. A handful of studies have examined intervention procedures to address joint attention deficits in children with autism with at least some improvement in targeted joint attention skills (e.g., Hwang & Hughes, 2000; Kasari, Freeman, & Paparella, 2001, 2006). Using a behaviorally based intervention, Whalen and Schreibman (2003) examined pivotal response training strategies (Koegel, Koegel, Harrower, & Carter, 1999; Pierce & Schreibman, 1995) with an emphasis on the use of child preferred materials, interspersing difficult tasks among easier ones, and using natural reinforcers as consequences for appropriate behavior to teach joint attention skills to 5 participants with autism (all 4 years of age). All participants acquired responding to others' joint attention directives and 4 of the participants acquired skills to initiate joint attention. More recently, we (Jones, Carr, & Feeley, 2006) also examined the use of a behavioral intervention consisting of discrete trial instruction and pivotal response training strategies to teach five 2-3 year old children with autism to both respond to others' joint attention directives and initiate joint attention. …

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study

. Kasari C., Freeman S. & Paparella T. ( 2006 ) , 47 , 611 – 620 . Background Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism. These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts (see Kasari, Freeman & Paparella 2001). In this study, we examine the efficacy of targeted interventions of joint attention and symbolic play.Methods Participants were 58 children with autism aged 3 and 4 years old (46 boys). Children were randomized to a joint attention intervention, a symbolic play intervention, or control group. Interventions were conducted 30 min daily for 5–6 weeks. Both structured assessments of joint attention and play skills and mother–child interactions were collected pre and post intervention by independent assessors.Results Results indicate that both intervention groups improved significantly over the control group on certain behaviours. Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child‐initiated joint attention in the mother–child interaction. The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels both on the play assessment and in interaction with their mothers.Conclusions This randomized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism. Future studies need to examine the long‐term effects of these early interventions on children’s development.

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study

Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism. These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts (see Kasari, Freeman, & Paparella, 2001). In this study, we examine the efficacy of targeted interventions of joint attention and symbolic play. Participants were 58 children with autism aged 3 and 4 years (46 boys). Children were randomized to a joint attention intervention, a symbolic play intervention, or control group. Interventions were conducted 30 minutes daily for 5-6 weeks. Both structured assessments of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors. Results indicate that both intervention groups improved significantly over the control group on certain behaviors. Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction. The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers. This randomized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism. Future studies need to examine the long-term effects of these early interventions on children's development.

As relações entre deficiência visual congênita, condutas do espectro do autismo e estilo materno de interação

Este trabalho examina a possível ocorrência das condutas do espectro do autismo em crianças portadoras de deficiência visual congênita e focaliza os comprometimentos da habilidade de atenção compartilhada, da capacidade simbólica e de estereotipias motoras, além de investigar o estilo diretivo de interação das mães ao tentar engajar os seus filhos em brincadeiras. Participaram do estudo oito díades mãe-criança distribuídas em dois grupos: quatro com deficiência visual congênita e quatro com desenvolvimento típico. Realizou-se uma entrevista sociodemográfica e de desenvolvimento da criança com as mães e uma sessão de vídeo da interação mãe-criança em laboratório. Os resultados mostraram que duas das crianças com deficiência visual congênita apresentaram uma freqüência maior de comprometimentos de habilidade de atenção compartilhada comparadas às crianças com desenvolvimento típico, e duas crianças com deficiência visual congênita apresentaram estereotipias motoras, porém com baixa freqüência. Apenas uma das mães das crianças com deficiência visual congênita apresentou maior freqüência de diretividade materna comparada à mãe da criança com desenvolvimento típico, contrariando a expectativa inicial. Observou-se a ocorrência de brinquedo simbólico no grupo das crianças com deficiência visual congênita. Esses resultados contrariam algumas das expectativas da literatura. Conclui-se que as crianças com deficiência visual congênita não estão necessariamente em risco para desenvolver condutas do espectro do autismo.

Children on the borderlands of autism: differential characteristics in social, imaginative, communicative and repetitive behaviour domains.

A sample of 37 children aged 4-7 years who all showed some autistic features was investigated. Children with a primary diagnosis of autism were compared with those diagnosed with a language disorder, on behaviours within four domains; social behaviour, imaginative activities, repetitive behaviour and communication. The aim was to identify potentially differentiating features of the two groups using observational ratings and questionnaire measures provided by parents and teachers. Information on participants' intelligence and language skills was also collected. The children with autism showed greater deficits in joint attention, functional play and pragmatic language, and engaged in more repetitive behaviours, than the language disordered children. However, the groups did not differ significantly on formally assessed language skills. A cluster analysis produced three groups of children varying in level of functioning and parent-rated behaviours. The results are informative for clinicians dealing with the challenge of differential diagnosis.

Editorial

Editorial

Unusual Sensory Sensitivities in Autism: A possible crossroads

Although there is ample clinical evidence supporting sensory hyper- and hypo-sensitivities in children with autism, empirical evidence is scant. Review of the available evidence indicated that there was a need for further systematic data on unusual sensory-perceptual sensitivities. A questionnaire was developed to investigate this phenomenon in 30 young children with autism and their controls across auditory, tactile, visual, gustatory, and vestibular domains. Significant differences were found between the two groups across all domains, although the limitations of this preliminary investigation need to be taken into account. The findings are interpreted within the framework of theory of mind and joint attention deficit, as well as psychodynamic hypotheses for autism. A brief argument is given as to how an ongoing experience of sensory aberrations may have an inhibitory effect on the prerequisite processes through which social interactivity, attachment, and communication skills develop. The applied implications of the findings are also discussed.