`

Printing:

A Review of Joint Attention Interventions for Children with Autism

What is Autism Spectrum Disorder (ASD)?

A developmental disability characterized by:

• Challenges with social interactions

• Difficulty with language skills

• Display of repetitive behaviors

What is joint attention? (Murray et al., 2008)

• The ability of two people to coordinate looking at an object

• Initiating Joint Attention (IJA) is when the child attempts to share a gaze or

gesture with another person, such as pointing to an object

• Responding to Joint Attention (RJA) is when the child is able to follow another

person’s gaze or gesture, such as looking at an object after another person

points to it

Why focus on joint attention and autism?(Pickard et al., 2014)

• Joint attention skills are believed to be a precursor for verbal communication

skills

• Lack of joint attention skills is a characteristic of having autism

• It could be used as a tool to diagnose autism

• Focusing on joint attention skills could be incorporated into intervention

programs that help people with autism develop language skills.

Joint Attention, Symbolic Play, and Engagement Regulation (JASPER)(e.g., Goods et al., 2012)

PARTICIPANTS: 15 minimally verbal children with autism between the ages of 3 and 5.

GOAL: To increase a child’s social engagement by encouraging parents/facilitators to follow a child’s lead during play tasks.

APPROACH:

• The therapy setting is frequently changed to encourage the child to initiate more, engage in new ways, and be creative with the given toys.

• The therapist will only use words at the level of the child. When the therapist says less, it encourages the child to initiate more.

RESULTS: Children showed greater improvements in variety of play, demonstrated more forms of joint engagement (gestures), and spent less time unengaged while in school.

Joint Attention Mediated Learning Intervention (JAML)(e.g., Schertz et al., 2013)

PARTICIPANTS: Children younger than 30 months old who were diagnosed with autism and lack joint attention skills.

GOAL: To help infants with autism work on nonverbal communication skills at their home with their parents and an intervention coordinator.

APPROACH:

• Focusing on faces (FF) phase- used to help the child pay attention to his or her parent’s face.

• Turn-Taking (TT) phase- the child is involved in back-and-forth play with the parent.

• Joint Attention (JA) phase- the child both initiates play and responds to his or her parent by exchanging looks and gestures

RESULTS: Children’s RJA skills and receptive language skills improved, but the results were not significant for IJA skills and expressive language skills.

Applied Behavior Analysis (ABA)(e.g., Kasari et al., 2006)

PARTICIPANTS: 58 children with autism between the ages of 3 and 4 years old.

GOAL: To “teach” joint attention behaviors by using a reward system.

APPROACH:

• The therapist works with the child during a structured table activity and a semi-unstructured floor activity following the child’s lead.

• The child is rewarded if he or she successfully initiates play, follows eye gaze, etc.

RESULTS: Children showed improvement in RJA skills and were able to generalize these new skills to situations outside of therapy by engaging more with their parents.

Relationship Development Intervention (RDI)(e.g., Gutstein et al., 2007)

PARTICIPANTS: 16 children with autism between the ages of 20 and 96 months.

GOAL: To work on nonverbal forms of communication in a comfortable environment for the child.

APPROACH:

• Implemented by the child’s parent after the parent receives intense training.

• The intervention takes a cognitive development approach by engaging the child in challenging situations on a daily basis in the child’s home (or environment that he or she feels comfortable in.)

RESULTS: Children were more successful in mainstream classrooms and more likely to engage in social interaction with their peers after completing intervention.

• http://www.therapycenterofbuda.com/uploads/3/9/1/4/39145783/2549270.jpg?252

Adamson, L. B., Bakeman, R., Deckner, D. F., & Romski, M. (2009). Joint Engagement and the Emergence of Language in Children with Autism and Down Syndrome. Journal of Autism and ‘Developmental Disorders, 39(1), 84–96. http://doi.org/10.1007/s10803-008-0601-7

Goods, K. S., Ishijima, E., Chang, Y., & Kasari, C. (2012). Preschool Based JASPER Intervention in Minimally Verbal Children with Autism: Pilot RCT. J Autism Dev Disord Journal of Autism and Developmental Disorders, 43(5), 1050-1056. doi:10.1007/s10803-012-1644-3

Gutstein, S. E., Burgess, A. F., & Montfort, K. (2007). Evaluation of the Relationship Development Intervention Program. Autism, 11(5), 397-411. doi:10.1177/1362361307079603

Kasari, C., Freeman, S. and Paparella, T. (2006), Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47: 611–620. doi: 10.1111/j.1469-7610.2005.01567.x

Murray, D. S., Creaghead, N. A., Manning-Courtney, P., Shear, P. K., Bean, J., & Prendeville, J. (2008). The Relationship Between Joint Attention and Language in Children With Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 23(1), 5-14. doi:10.1177/1088357607311443

Pickard, K. E., & Ingersoll, B. R. (2014). Brief Report: High and Low Level Initiations of Joint Attention, and Response to Joint Attention: Differential Relationships with Language and Imitation. J Autism Dev Disord Journal of Autism and Developmental Disorders, 45(1), 262-268. doi:10.1007/s10803-014-2193-8

Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of Joint Attention Mediated Learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28(2), 249-258. doi:10.1016/j.ecresq.2012.06.006

Lindsey Jackson, Virginia Salo & Nathan A. Fox

• When creating therapy plans, it is important for therapists to consider that joint

attention skills are a precursor for verbal language skills and therefore these

skills should be included in intervention programs.

• Children with autism do have the ability to learn joint attention skills, but they

learn them later than typically developing children.

• Intervention programs working on joint attention seem to have lasting effects,

both in term of joint attention and language, and are especially successful with

responsive joint attention behaviors (RJA).

• Joint attention intervention programs help set the groundwork for future

therapy in other areas.

• There is a relationship between a child’s joint attention skill level and expressive language skill level, but does incorporating joint attention behaviors into intervention actually improve expressive language skills?

• How should joint attention programs be altered depending on where the child falls on the autism spectrum?

• Can joint attention intervention program be effective at any age, or is there an age limit to when a person should begin a joint attention based intervention program?

• If joint attention is a precursor for language development and all children with autism show deficits in joint attention abilities, then why are some children with autism able to acquire more spoken language skills than others?

• Do children with autism develop joint attention behaviors (pointing, showing, following eye gaze, etc.) in a different order than typically developing children and if so, how would this effect joint attention intervention plans? The literature has mentioned that children with autism develop joint attention behaviors in a different order, but more research needs to be done.

TREE =

TREE

To examine studies, through a literature review, of various joint attention based

intervention programs for children with autism, with a specific focus on studies

that have measured potential improvements in language skills.

Language

Production

Word

Mapping

Language

Comprehension

Joint

Attention

Background Intervention Programs Conclusions

Objective

Future Directions/Questions

References