ASA's 36th National Conference on Autism Spectrum Disorders (July 13-16, 2005)

    ASA Homepage
Thursday, July 14, 2005: 1:30 PM-3:00 PM
#1546- The Critical Role of Joint Attention in the Treatment of Children with Autism Spectrum Disorders
Participants will be provided with information about the typical emergence of joint attention and its important role in the development of social, communication and play skills. Joint attention skills impairments in children with autism spectrum disorders (ASD’s) will be described and approaches for intervention will be discussed.

Presenter:Jennifer S. Durocher, University of Miami Center for Autism and Related Disabilities, Coordinator of Research & Clinical Services - Dr. Jennifer Durocher holds a Ph.D. in Clinical Psychology and is currently the Coordinator of Research & Clinical Services at UM CARD. She has 10 years of experience in autism spectrum disorders and has presented nationally and internationally on assessment and diagnosis, joint attention, executive functions, and Asperger’s Disorder.
Great advances have been made in understanding the nature of autistic spectrum disorders within the past two decades. Current diagnostic systems (DSM-IV; APA, 1994) now recognize the social impairments of autism as a primary diagnostic feature, reflecting the core, or central, disturbance of this disorder. Joint attention is one of the earliest syndrome-specific manifestations of the social deficits in autism. As such, joint attention abilities are critically important to consider for assessment and intervention with children affected by ASD's.

Joint attention refers to the propensity of a child to engage another's attention to share enjoyment of objects or events. Children display joint attention skills by initiating bids to others to pay attention to what they are attending to and by following the line of visual regard and point gestures of a social partner (Mundy & Thorp, in press. Thus, children both initiate and respond to joint attention bids.

Joint attention behaviors represent a critical area in typical development, emerging between the ages of 9 and 15 months. Joint attention skills have been found to be concurrently related to receptive and expressive language skills among typically-developing children. In addition, research indicates that joint attention is important for the development of a host of other, later-emerging, skills, such as more complex expressive language, symbolic play, and theory of mind.

Impairments in the development of joint attention skills are a hallmark of children with autism spectrum disorders (ASD's). While children with ASD's do not differ from typically-developing children or children with global developmental delays (but not autism) in the amount of requesting behaviors, they exhibit far fewer joint attention behaviors (Mundy et al. 1994; Mundy et al. 1996). Other studies have also found that while children with autism consistently used gestural communication to request objects or actions, they rarely attempted to direct adults' attention through the use of gestures (Wetherby & Prizant, 1984). Kasari, Sigman, Mundy, and Yirmiya (1990) have further noted that, even when joint attention is shown, children with autism are much less likely than either typically developing or other developmentally delayed children to display positive affect along with joint attention behaviors. Finally, joint attention deficits have been observed for responding (RJA), as well as initiating (IJA) and skills (e.g., Mundy et al. 1994).

Despite the salience of joint attention deficits in autism, research also suggests that there are individual differences among children with autism in their joint attention development. In other words, some children with ASD's tend to display better developed joint attention abilities than others. Research suggests that children with autism who display more intact joint attention skills exhibit better outcomes with respect to the development of cognitive, language, and symbolic play skills (Sigman & Ruskin, 1999).

This body of research implies that joint attention skills may play a pivotal role in the early development of young children with autism. ABA research literature defines pivotal skills as those which, “once strengthened, result in positive changes in other areas of functioning and improvements in subsequent learning” (Jones & Carr, 2004). Evidence for joint attention's role as a pivotal skill is provided by research indicating that there may be a significant interaction between individual differences in joint attention development and later outcome (Charman, 2003; Sigman & Ruskin, 1999). Therefore, it appears especially important to develop interventions to improve joint attention skills in children with ASD's.

Several research groups around the country are currently attempting to develop effective interventions for this critical domain of impairment in autism (see Jones & Carr, 2004 for a review). For the most part, these studies have focused on improving the capacity of young children to initiate bids for joint attention (IJA). Research in this area has suggested that one effective strategy may be the contingent imitation of children's actions by adults (Dawson & Galpert, 1990; Klinger & Dawson, 1992; Field et al., 2001). Preliminary findings from these studies have indicated that children with ASD's exhibited some improvement in IJA skills when adults imitate their actions.

However, it is also important to develop intervention methods that target the tendency of children to respond to the joint attention bids of others (RJA). This is because responding to joint attention has been found to be related to the development of receptive and expressive language. Ability to engage in RJA may be critically important for the ability to learn from the environment (naturalistic learning), as opposed to being taught discrete skills in isolation. With respect to intervention of RJA skills in children with autism, some preliminary studies have indicated that a number of children with autism improved in RJA skills when illuminated targets were activated after correctly following the adult's gaze (Leekam, Lopez & Moore, 2001).

Taken together, research suggests that joint attention skills are markedly impaired in children with ASD's and that joint attention plays a critical role in the typical development of language and play skills. Children with autism who have better joint attention skills tend to exhibit better outcomes in a number of areas of development. Further, preliminary studies suggest that it is possible to improve joint attention behaviors in children with ASD's. Therefore, targeting joint attention skill development appears to be an important component for early intervention among children with autism.

This presentation will explain the role that joint attention plays in typical development, as well as the type of impairments in joint attention exhibited by children with autism. The ramifications of joint attention disturbances for subsequent development in children with autism will be discussed, with an emphasis on the importance of developing intervention to target this critical skill. Assessment techniques and instruments which incorporate measures of joint attention skills will be addressed, with an emphasis on how this information may be used for diagnosis, as well as evaluation of intervention efforts. Finally, a variety of instructional techniques (e.g., ABA, pivotal response training, incidental learning, “floor time,” etc.) which may have utility for increasing joint attention behaviors in children with autism will be discussed.

Learner objectives:

1. Participants will be able to describe joint attention and the importance of this skill for typical development

2. Participants will describe the features of joint attention impairments in children with ASD's

3. Participants will list assessment batteries that contain joint attention measures

4. Participants will identify intervention techniques that may help increase joint attention skills

5. Participants will describe how they can incorporate activities and instructional approaches into their intervention plans to target joint attention skills

See more of The ASA's 36th National Conference on Autism Spectrum Disorders (July 13-16, 2005)