The Effect of Teaching Attending to a Face on the Emergence of Joint Attention Behavior in Young Children with Autism Spectrum Disorders

Background: A failure to attend to the faces of others is the single best discriminator between 1-year-old children later diagnosed with an autism spectrum disorder (ASD) and those with typical development. A more advanced form of attending is referred to as joint attention, which is defined as behavior used in a social context to direct attention to an object or event, thus establishing a common focus of attention between a child, another individual, and an object of interest. A deficit in the development of joint attention skills is a defining feature of children diagnosed with an ASD and is clearly unique to the disorder
Objectives: The purpose of the study was to teach children with an ASD to attend to a face by training the participants to look at the face of the examiner with a stimulus that has been established as a reinforcer and increase the response by delivering the reinforcer contingent upon attending to the face of the examiner. Upon meeting mastery criteria, the participants were then required to follow the eyes and head turn of the examiner to the stimulus/reinforcer. Given the evidence that techniques for teaching attending to a face may have implications for joint attention behavior in individuals with an ASD, the present study is important if this behavior deficit is to be targeted in early intervention programs.
Methods: A single-subject, multiple-baseline-across-subjects experimental design was implemented to demonstrate experimental control for attending to face behavior. Three subjects between the ages of two to three years and diagnosed with an ASD using the ADOS-G participated. Single-subject research design demonstrates experimental control by introducing intervention progressively for each subject while continuous assessment or observation of performance over time is measured.

Results: All three participants demonstrated an increase in the attending-to-a-face response and the following examiner gaze behavior as compared to baseline levels. An increase was also demonstrated during generalization trials, which took place with two additional adults. The attending-to-a-face responses were maintained during post-training sessions for all three participants. In addition, anecdotal reports from parents indicated an increase in responses to joint attention bids outside of the training setting compared to pre-treatment levels.
Conclusions: Attending to the face of another provides the opportunity for episodes of attention sharing, which is crucial for the development of social behavior. If problems with these social behaviors are found in children diagnosed with an ASD, then there may be a deprivation of the necessary experience for the development of social behavior in autism beginning early in life because of a failure to attend to the faces of others. Should the face of another become a signal that certain responses will be reinforced following specific consequences, and because faces provide information related to social communication, further complex social behavior is more likely to occur as a result of the increased opportunities for reinforcement when attending to the face of another. Therefore, providing the environment that will significantly increase opportunities of positive experiences with faces for children with an ASD should be considered.