Joint Attention Skills Research Articles

Diagnostic Stability and Phenotypic Differences Among School-Age Children Diagnosed With ASD Before Age 2.

Given the importance of early detection, it is critical to understand the non-linearity in manifestation of ASD before age 24 months, when ASD symptoms are beginning to consolidate, through the age of 36 months when stability of ASD diagnosis is reportedly high into school-age when increased demands may challenge previously successful compensatory processes and permit first ASD detection. We employed a prospective, longitudinal design focused on children with an older sibling with ASD (n = 210) who received diagnostic evaluations at mean ages of 15.4 months (Time 1), 36.6 months (Time 2), and 5.7 years (Time 3) to examine: (1) diagnostic stability, (2) developmental trajectories associated with different patterns of ASD vs. non-ASD classifications, and (3) predictors of classification group over time. Clinical best estimate (CBE) diagnosis of ASD or non-ASD was made at each time point. Linear mixed-effects models were implemented to examine differences in developmental trajectories of stable and dynamic diagnostic groups. Multinomial logistic regression analyses were used to examine predictors of the likelihood of belonging to each CBE diagnostic classification group. Results revealed that sensitivity and stability of an ASD diagnosis significantly increased from Time 1 (sensitivity: 52%; stability: 63%) to Time 2 (sensitivity: 86%; stability: 68%). Different developmental trajectories of autism symptom severity and non-verbal and verbal IQ were observed across groups, with differences first observed at Time 1 and becoming more pronounced through Time 3. Presence of restricted and repetitive behaviors as well as limitations in initiation of joint attention and expressive language skills differentially predicted the likelihood of belonging to the different CBE diagnostic classification groups. Results suggest that ASD symptoms may emerge or attenuate over time, with some children meeting diagnosis at follow-up, and other children no longer meeting diagnostic criteria. From a systems perspective, diagnostic non-linearity may be viewed as a dynamic developmental process, where emergent properties arising from various biological, genetic, and experiential factors interact, culminating in phenotypic phenomena that change over time. Clinical implications include extending universal ASD and social communication screening into school-age, supporting families' understanding of diagnostic shifts, and ensuring unbiased diagnostic decision-making when following children with ASD.

Enhancing Joint Attention Skills in Children on the Autism Spectrum through an Augmented Reality Technology-Mediated Intervention.

In the present study, the effects of an intervention based on an augmented reality technology called Pictogram Room were examined. The objective of the intervention was to improve the responding to joint attention (RJA) skills of gaze following and pointing in six children on the autism spectrum between 3 and 8 years old. A multiple baseline single-subject experimental design was conducted for 12 weeks in a school setting. Results indicated that all of the participant children improved performance in RJA following the intervention. Improvements were maintained over time and generalised to real-world situations. These findings demonstrate that autistic children can improve their RJA skills with a targeted and engaging intervention based on an accessible augmented reality technology tool.

Teaching joint attention skills to pairs of children with autism

AbstractThe purpose of the current study was to integrate recommendations from the joint attention literature into a set of procedures suited for a clinical setting serving children diagnosed with autism spectrum disorder. In baseline, the two pairs of children did not engage in any form of joint attention with one another during the target play context (i.e., a treasure hunt). A treatment package consisting of script fading, graduated guidance, and echoic prompting was used to teach one child per pair to engage in an initiation of joint attention (IJA) and the other child to engage in a response to joint attention (RJA). Results suggest the intervention was effective as children in all pairs independently engaged in IJA and RJA. During a role reversal probe (i.e., without direct teaching), all participants demonstrated responses taught to their peer. Finally, some increases in responding were observed during generalization activities.

Does Use of Books and Electronic Media Associate to Joint Attention Skills and Temperament during the First Year of Life?

Several researchers have found that media exposure through books or electronic media contribute to preschoolers’ development. However, research with behavioral measures and during the first years of life have not been carried out in Latin American contexts. The aim of the following research was to evaluate the relations between media exposure through electronic media and books with joint attention skills and temperament (i.e., effortful control, surgency and negative affect) during the first year of life. A free play session was carried out, where the number of mother-infant interaction behaviors were assessed. Findings state that only the amount and the frequency of the use of books at home between caregivers and infants were positively associated with the behaviors of joint attention and surgency. Conclusion denotes that books would probably be associated with more infant interactions and higher SES, mediating in the promotion of cognitive development from the first months of life.

Effects of a creative yoga intervention on the joint attention and social communication skills, as well as affective states of children with Autism Spectrum Disorder

BackgroundYoga is gaining popularity as a multisystem intervention due to its impact on both the physical and mental well-being of children with typical development. However, there is limited empirical evidence to support the use of this approach in school-aged children with Autism Spectrum Disorder (ASD). The current pilot study evaluated the impact of a creative yoga intervention on the joint attention and social communication skills, as well as affective states of children with ASD. Methods24 school-aged children with ASD received eight weeks of yoga (e.g., breathing, poses, relaxation) or tabletop play/academic intervention (e.g., reading, arts-crafts, building activities). Children were tested before and after the intervention using a standardized measure of responsive joint attention. Additionally, changes in socially directed verbal communication and affective states of children were assessed three times during the intervention period, i.e. during early, mid, and late intervention sessions. ResultsChildren with ASD showed improvements in responsive joint attention in both groups in the posttest vs. the pretest. Furthermore, children in the yoga group showed improvements in socially directed verbal communication skills across the intervention sessions, i.e. greater spontaneous and responsive communication from early/mid to late intervention sessions compared to the academic group. There were no changes in affective states with the intervention, however, the yoga group showed greater interested and less negative affect compared to the academic group. ConclusionsCreative yoga intervention is a promising tool as it led to improvements in intervention-related social communication skills and generalized joint attention skills of children with ASD.

The Impact of Sex Chromosome Trisomies (XXX, XXY, XYY) on Early Social Cognition: Social Orienting, Joint Attention, and Theory of Mind.

ObjectiveAbout 1:650–1,000 children are born with an extra X or Y chromosome (XXX; XXY; XYY), which results in a sex chromosome trisomy (SCT). This study aims to cross-sectionally investigate the impact of SCT on early social cognitive skills. Basic orienting toward social cues, joint attention, and theory of mind (ToM) in young children with SCT were evaluated.MethodAbout 105 children with SCT (range: 1–7 years old) were included in this study, as well as 96 age-matched nonclinical controls. Eyetracking paradigms were used to investigate the eye gaze patterns indicative of joint attention skills and orienting to social interactions. The ToM abilities were measured using the subtest ToM of the Developmental NEuroPSYchological Assessment, second edition, neuropsychological test battery. Recruitment and assessment took place in the Netherlands and in the United States.ResultsEyetracking results revealed difficulties in children with SCT in social orienting. These difficulties were more pronounced in children aged 3 years and older, and in boys with 47,XYY. Difficulties in joint attention were found over all age groups and karyotypes. Children with SCT showed impairments in ToM (26.3% in the [well] below expected level), increasing with age. These impairments did not differ between karyotypes.ConclusionsAn impact of SCT on social cognitive abilities was found already at an early age, indicating the need for early monitoring and support of early social cognition. Future research should explore the longitudinal trajectories of social development in order to evaluate the predictive relationships between social cognition and outcome later in life in terms of social functioning and the risk for psychopathology.

The feasibility of Gazefinder under 12\xa0months of age infants

Eye-tracking to evaluate gaze patterns has developed as an assessment tool for children with autism spectrum disorder (ASD). Gazefinder is one of Eye-tracking devices and few studies have investigated whether it can measure the gaze data of infants under 12 months of age. We conducted a prospective cross-sectional study from April 2019 to March 2020 in a periodic health checkup in Ohchi County, Shimane, Japan. Participants included infants between 4 and 11 months of age who were not suspected the presence of developmental problems. Ninety-three participants’ datapoints were analyzed. The mean age was 6.5 months and mean developmental quotient was 88%. The mean fixation time percentage of all sequences was 81.0% (standard deviation; 4.4), and there was no significant difference in each age group. Infants in all groups showed a significantly higher predilection for eyes than for mouths. There was a positive association of age with human gaze and a negative association with geometric gaze. Moreover, we confirmed that joint attention skills were enhanced in accordance with their growth process. The eye-tracking data were almost corresponding to previous studies’ data of infant with typical development and Gazefinder could be applied to infants starting at 4 months of age.

Impacts of using a social robot to teach music to children with low-functioning autism

Abstract This article endeavors to present the impact of conducting robot-assisted music-based intervention sessions for children with low-functioning (LF) autism. To this end, a drum/xylophone playing robot is used to teach basic concepts of how to play the instruments to four participants with LF autism during nine educational sessions. The main findings of this study are compared to similar studies conducted with children with high-functioning autism. Our main findings indicated that the stereotyped behaviors of all the subjects decreased during the course of the program with an approximate large Cohen’s d effect size. Moreover, the children showed some improvement in imitation, joint attention, and social skills from the Pre-Test to Post-Test. In addition, regarding music education, we indicated that while the children could not pass a test on the music notes or reading music phrases items because of their cognitive deficits, they showed acceptable improvements (with a large Cohen’s d effect size) in the Stambak Rhythm Reproduction Test, which means that some rhythm learning occurred for the LF participants. In addition, we indicated that parenting stress levels decreased during the program. This study presents some potential possibilities of performing robot-assisted interventions for children with LF autism.

Social Robots for Joint Attention Development in Autism Spectrum Disorder: A Systematic Review

ABSTRACT With technological developments in the 21st century, robot applications have proven to be beneficial in providing some opportunities to help with teaching numerous skills such as joint attention and social skills to children with Autism Spectrum Disorder (ASD). However, in the studies investigating the effects of robots on joint attention (JA) in children with ASD, contradictory results were reported. On this ground, this study aims to review the recent studies that were conducted with robot applications for the development of JA skills in children with ASD. Thirteen peer-reviewed articles were analysed to gain an understanding of the experimental effect of robot applications. According to the analysis, NAO drew attention as the most frequently used type of robot. It was observed that all JA studies with robots had been conducted in structured settings. Moreover, it was revealed that methodological limitations were making it difficult to draw a definite conclusion about the clinical benefits of robots. It is recommended that further studies should be conducted to increase the use validity of robots and that more studies comparing humans to robot partners, especially in JA interactions, should be conducted to enrich the literature on the subject.

Auditory joint attention skills: Development and diagnostic differences during infancy

To date, joint attention skill assessments have focused on children’s responses to multimodal bids (RJA) and their initiation of bids (IJA) to multimodal spectacles. Here we gain a systematic view of auditory joint attention skills using a novel assessment that measures both auditory and multimodal RJA and IJA. In Study 1, 47 typically developing (TD) children were tested 5 times from 12 to 30 months to document auditory joint attention skill development. In Study 2, 113 toddlers (39 TD, 33 autism spectrum disorder [ASD], and 41 non-ASD developmental disorders [DD]; average age 22.4 months) were tested to discern the effects of ASD. Our findings fit well within the established depiction of joint attention skills with one important caveat: auditory items were far more difficult to execute than multimodal ones. By 24 months, TD children passed multimodal RJA items at the near-ceiling level, an accomplishment not reached even by 30 months for auditory RJA items. Intentional communicative IJA bids also emerged more slowly to auditory spectacles than to multimodal spectacles. Toddlers with DD outperformed toddlers with ASD on multimodal RJA items but toddlers in both groups rarely passed any auditory RJA items. Toddlers with ASD often monitored their partner’s attention during IJA items, albeit less often than toddlers with DD and TD toddlers, but they essentially never produced higher-level IJA bids, regardless of modality. Future studies should investigate further how variations in bids and targets affect auditory joint attention skills and probe the relation between these skills and language development.

A Systematic Review of Augmented Input Interventions and Exploratory Analysis of Moderators.

Purpose Augmented input is the act of concurrently modeling language verbally and on a communication device, and is one strategy for teaching individuals to effectively use aided modes of communication. The purpose of this literature review is to assess the efficacy of augmented input for increasing communication and to identify intervention components, participant characteristics, and instructional contexts related to therapeutic outcomes. Method We double screened all potential sources and double coded all included sources. Database, forward, and backward searches yielded 99 single case designs in 26 sources. We coded characteristics of participants, instructional contexts, independent variables, and dependent variables. We also coded quality/rigor and primary outcomes for each design or comparison. Results Across high-quality studies, two thirds of designs indicated that augmented input was effective compared to baseline conditions and alternative interventions, and exploratory analyses indicated that receptive language skills, age, and diagnoses may moderate intervention efficacy. Most augmented input interventions included additional components that may serve as "active ingredients" (e.g., systematic prompting, contextual reinforcement). Most studies also did not report participant characteristics hypothesized to moderate intervention efficacy (e.g., joint attention skills, imitation repertoire). Results also indicated high risk of publication bias, with peer-reviewed sources twice as likely to include positive effects than dissertations and theses. Conclusions Across high-quality studies, augmented input was inconsistently effective as a stand-alone intervention. Packaged interventions that included augmented input were typically more effective than augmented input in isolation, particularly for individuals who were young, had strong receptive language skills, or had no comorbid diagnoses.

Visual disengagement in young infants in relation to age, sex, SES, developmental level and adaptive functioning

Visual attention plays a key role in infants’ interaction with the environment, and shapes their behavioral and brain development. As such, early problems with flexibly switching gaze from one stimulus to another (visual disengagement) have been hypothesized to lead to developmental difficulties (e.g. joint attention and social skills) over time. This study aimed to identify cross-sectional associations between performance in the Gap task (gaze shift latencies and visual attention disengagement) and measures of development and adaptive behavior in conjunction to any sex or socioeconomic status effects in infancy. We measured visual attention disengagement in 436 5-month-old infants and calculated its association with cognitive developmental level, adaptive behaviours, socioeconomic status (SES) and biological sex. In the Gap task, participants must redirect their gaze from a central stimulus to an appearing peripheral stimulus. The three experimental conditions of the task (Gap, Baseline and Overlap) differ on the timepoint when the central stimuli disappears in relation to the appearance of the peripheral stimulus: 200 ms before the peripheral stimulus appears (Gap), simultaneously to its appearance (Baseline), or with peripheral stimulus offset (Overlap). The data from the experimental conditions showed the expected pattern, with average latencies being the shortest in the Gap and longest in the Overlap condition. Females were faster (p = .004) than males in the Gap condition, which could indicate that arousal-related effects differ as a function of biological sex. Infants from higher SES were slower (p = .031) in the Overlap condition compared to lower SES infants. This suggests that basic visual attention may differ by socio-cultural background, and should be considered when studying visual attention and its developmental correlates. We observed no significant association to concurrent developmental level or adaptive function. Given its large sample size, this study provides a useful reference for future studies of visual disengagement in early infancy.

Joint engagement is a potential mechanism leading to increased initiations of joint attention and downstream effects on language: JASPER early intervention for children with ASD.

Social communication interventions benefit children with ASD in early childhood. However, the mechanisms behind such interventions have not been rigorously explored. This study examines the mechanism underlying a naturalistic developmental behavioral intervention, JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation), delivered by educators in the community. Specifically, the analyses focus on the mediating effect of joint engagement on children's initiations of joint attention (IJA) skills and whether IJA postintervention are associated with later gains in children's receptive and expressive language. One hundred seventy-nine children, age 2-5years, were randomized to immediate JASPER treatment or waitlist (treatment as usual) control. Independent assessors blinded to time and treatment coded children's time jointly engaged and IJA during a 10-min teacher-child interaction at baseline, exit, and follow-up. Age-equivalent receptive and expressive language scores from the Mullen Scales of Early Learning were collected at baseline and follow-up. Mediation analyses with linear mixed models were used to explore the potential mediating effect of joint engagement on IJA. Joint engagement significantly mediated 69% of the intervention effect on young children's IJA and IJA predicted improvements in standardized language scores. Small but sustained changes in child-initiated joint engagement improved IJA, a core challenge in children with ASD, which in turn led to improvements in language.

Attachment and joint attention in infants: The role of expectation.

Previous research highlighted the correlation between parent-infant's attachment quality and joint attention skills. However, the underlying mechanisms of this relationship are still unclear. The aim of this study was to assess whether it is by mediating the expectation component in Internal Working Models that the quality of attachment style can affect joint attention. At first, 12- to 20-month-old infants were classified into secure and insecure groups using the Strange Situation Procedure. On a following day, using a violation-of-expectation paradigm, infants were habituated to two joint attention videos. Finally, the mean looking time duration of secure and insecure infants were compared with each other between two "divergent attention" and "joint attention" videos. Infants looked longer for divergent attention videos suggesting they did have expectation regarding the appropriate response in triadic interactions. In line with our main hypothesis, secure infants, but not insecure ones, looked longer in the divergent attention situation when an attachment-related context was present, revealing the possible mediating role of "expectations" in the correlation between attachment and joint attention.

Helping Optimize Language Acquisition (HOLA) Online Parent Training Modules for Latinx Parents of Toddlers at Risk for ASD: Protocol for a Pilot Funded by the Organization for Autism Research.

BackgroundCulturally competent parent training in evidence-based intervention for autism spectrum disorder (ASD) can provide young Latinx children from underserved communities with early interventional support while they wait for professional services, thus reducing the impact of intervention delays. Providing parents with brief bilingual training in Pivotal Response Treatment (PRT) is a strategy that can overcome these barriers and is inexpensive to disseminate. Brief PRT training has been shown to significantly improve joint attention, expressive language, responsivity, and adaptive skills in young children with ASD. However, it is unknown whether an interactive, culturally competent online parent training in PRT is effective in a Latinx population.ObjectiveTo this end, we will recruit 24 children (16-36 months old) at risk for ASD and their parent(s) from East and South Los Angeles and provide them with a series of 6 online learning modules in their choice of Spanish or English.MethodsThis pilot study will utilize a single-group, pilot, pre-post design with follow-up assessments 6 weeks later. Linear mixed-effects model analysis will be used to explore most parent-reported and coded outcomes.ResultsBrief online parent training in evidence-based treatments has the capacity to increase access to culturally competent early communication interventions for young children at risk for ASD.ConclusionsThe results of this trial may have particular salience in additional underresourced communities where children have limited access to interventions prior to entering school.International Registered Report Identifier (IRRID)PRR1-10.2196/18004

Increasing joint attention and social play through peer‐mediated intervention: A single case design

AbstractThis study evaluated the effectiveness of a peer‐mediated intervention on joint attention (JA) and social play skills for students with autism spectrum disorder (ASD) using a multiple baseline design. Peer‐mediated interventions are an evidence‐based practice, but there is limited research on using peers outside of the target student's classroom and using them with severely impacted students. In this study, the research team trained third‐grade peers to work with preschoolers with ASD in one‐on‐one play sessions. JA, parallel play, and common focus play were increased during intervention, while solitary and unoccupied play were decreased. Social validity was high as reported by participants. This study provides promising data for increased inclusion of severely impacted students, with benefits for all students involved.

Robot dramas may improve joint attention of Chinese-speaking low-functioning children with autism: stepped wedge trials

Introduction Children with autism spectrum disorder (ASD), especially those with low cognitive functioning, have deficits in joint attention. Previous research has found that these children are interested in engaging with social robots. Purpose In the present study, we designed a robot drama intervention for promoting responses to joint attention abilities (RJA) of children with low-functioning autism (IQs < 70). Materials and methods Using a stepped wedge design, Chinese-speaking children aged six to eight were randomly assigned to three tiers (N = 18). Children of all three tiers had comparable autism severity, language and cognitive function, and joint attention abilities. Tier 1 first received intervention, followed by Tiers 2 and 3. They watched six dramas in which social robots demonstrated RJA behaviours. Results The RJA of children of all tiers improved after intervention and such improvement was maintained over time. Despite initiation of joint attention (IJA) not being explicitly taught, IJA of all children was found to improve after intervention. Conclusions It was, therefore, concluded that a robot drama could enhance the joint attention of children with low-functioning ASD. Implications for rehabilitation In comparison to typically developing children, children with autism spectrum disorder (ASD), especially those with low cognitive functioning, have deficits in joint attention. Robot-based drama intervention program was developed to promote responses to joint attention (RJA) abilities of children with low-functioning autism (IQs < 70). Modelling RJA in robot dramas can promote RJA abilities in these children. An improvement in RJA also yielded an increase in the initiation of joint attention (IJA) abilities. Children with low-functioning autism might be able to extract the initiation of joint attention skills from the drama, even though these behaviours were not explicitly taught.

Joint Attention and Sensory-Regulatory Features at 13 and 22 Months as Predictors of Preschool Language and Social-Communication Outcomes.

Purpose The purpose of this study was to understand how joint attention and sensory-regulatory features are related in early childhood and predict language and social-communication outcomes in preschool in order to build mechanistic theories that can inform early intervention directed at improving these outcomes. Method Cross-lagged panel analysis models were used to examine the association between joint attention and sensory-regulatory features at 13 and 22 months of age in children (n = 87) who were identified via community screening at 12 months as having a higher likelihood than the general population for being diagnosed with autism spectrum disorder. Results Significant concurrent correlations and predictive correlations were found between these constructs at 13 and 22 months. Joint attention skills at 13 months predicted both joint attention and sensory-regulatory features at 22 months. Distal language and social-communication outcomes at preschool age (n = 48) were best predicted by sensory-regulatory features at 22 months. Conclusions Both joint attention and sensory regulation are important factors in the first and second years of life for impacting later preschool language and social-communication outcomes in this sample. These findings may have implications for future early childhood intervention research for children at a higher likelihood for autism spectrum disorder.

Children with ASD use joint attention and linguistic skill in pronoun development

ABSTRACT Producing pronouns involves linguistic and social-cognitive knowledge because children must learn words and understand pronouns’ changing referents. This study examined pronoun production longitudinally in young children with autism spectrum disorder (ASD; n = 15), whose social-cognition might impair pronoun use, and in typically developing (TD; n = 18) children. Modeling the effect of joint attention (JA; a social-cognitive factor) and a name bias (NB; a linguistic factor) revealed a positive relation between NB and second- and third-person pronouns for all children and a positive relation between JA and those pronouns in just the ASD group. Social-cognitive and linguistic processes affected the ability of children with ASD to use pronouns; TD children’s pronouns were related to linguistic skill and unaffected by JA.

Multi-component communication intervention for children with autism: A randomized controlled trial.

This study reports the results of a randomized trial for preverbal preschoolers with autism that demonstrates the effects of multiple intervention strategies including caregiver training. About 50% of children with autism are not talking by age 3 and up to 30% of children with autism will remain minimally verbal past age 5. Interventions delivered by clinicians and caregivers have the greatest effects on spoken language and may reduce the rate of those who remain minimally verbal. Sixty-eight children ages 3-5 with autism and their caregivers participated in this randomized trial comparing the communication intervention to a comparison group. A brief, multi-component, communication intervention (including a speech-generating device) for children with autism that addresses core deficits may be effective in improving joint attention skills immediately following intervention and social communication skills 4 months following intervention. Future research is needed to understand for whom and under what conditions this intervention is most effective.