Joint Attention in Young Children with Autism

Background: Joint attention, which occurs when two individuals focus on the same object or event, plays a critical role in social and language development. Impairment in joint attention is an early sign of autism, and seems to play an important role in later social and language development in individuals with autism. However, previous reports of joint attention (JA) have focused primarily on the number of episodes, on children older than 4 years of age, and on interactions between children and experimenters rather than children and their caregivers. The current report is part of a longitudinal study in which we investigate the JA of young children with autism across a 3-year time span, and relate JA behaviors to concurrent and subsequent language. This report includes data from Visit 1. Objectives: We investigate a variety of joint attention (JA) behaviors of 2-year-old children with autism, during interactions with their parents, and relate these behaviors to other aspects of development. Methods: We tested 10 typically developing toddlers (TYP: mean age = 20.45 months, 7 males), and 10 children with autism (ASD: mean age = 32.32 months, 9 males), who were matched on expressive vocabulary. Children engaged in a 30-minute, structured play session with their parents; these sessions were coded for (a) number of JA episodes, (b) total duration of JA episodes, (c) number of JA episodes which were child-initiated, (d) number of JA episodes that were parent-initiated, and (e) type of toy that was the focus of each JA episode (i.e., toys depicting animates (e.g., dog, baby doll), artifacts (e.g., car, ball), and food and real-life items (e.g., snacks, water, bubbles). Joint attention was coded as occurring whenever both child and parent were looking at the same object. Children were also administered the MacArthur Communicative Development Inventories (CDI), ADOS, Vineland Adaptive Behavior Scales (Vineland), and Mullen Scales of Early Learning (Mullen). Results: The ASD and TYP groups did not differ the number and total duration of JA episodes (Ms (ASD) = 28.7 episodes, 16.05 minutes; Ms (TYP) = 35.1 episodes, 17.45 minutes). However, more JA episodes in the ASD group were parent-initiated rather than child-initiated (88.3% vs. 11.6%, p < .01); children in the TYP initiated significantly more joint attention episodes than did children in the ASD group (27.7% vs. 11.6%, p < .01). The ASD group and the TYP group did not differ from each other in the type of toys they played with during JA episodes. For the ASD group, the number of child-initiated JA episodes was significantly and positively correlated with the CDI, Vineland (all subscales), Mullen Fine Motor, Mullen Receptive and Mullen Expressive scores (ps between .002 - .042). No significant correlations emerged for the TYP group. Conclusions: Number and duration of JA episodes did not vary across groups; however, these 2-year-olds with autism initiated fewer joint attention episodes with their parents. Initiation of JA is related to concurrent social, language, and motor abilities very early in development. Future research will investigate how the JA episodes change across development.