Identifying Relationships Between Parental Stress and Joint Attention Development in Infants at Risk for Autism

Background: Infant siblings of children with autism, themselves at risk for developing the disorder (Zwaigenbaum et al., 2005, High Risk; HR), often experience delays in both initiating and responding to joint attention (e.g., Cassel et al., 2009). In children with ASD, joint attention improvements have been linked to better quality parent-child interaction (e.g., Siller et al., 2002). In typically developing samples, elevated parent-reported stress levels have been related to lower quality parent-child interaction (e.g., Fiore 2009). However, the relationship between parent stress, parent-child interaction, and joint attention development has yet to be examined in a HR sample.
Objectives: (1) to describe the development of joint attention (JA) behaviors in HR infants from 12 to 18 months; (2) to explore the relationship between parental stress and parent-infant interaction; and (3) to identify links between parental stress and infant joint attention.
Methods: The Early Social Communication Scales (ESCS; Mundy et al., 2003) was administered to 19 HR infants (11 male) at 12-, 14-, and 18-months to assess high levels of responding to JA (HRJA) and initiating JA bids (HIJA). At 12-months, caregiver verbal utterances were coded during caregiver-infant toy play. These were classified as Redirecting (changing the object of infant attention) or Responding (addressing the object of infant attention) and according to success of caregiver’s bid (e.g., whether the infant responded to bid). Caregivers completed the Parenting Stress Index (PSI; Abidin, 1983) at 12-months to assess stress from the caregiver/infant relationship on two subscales: Reinforce Parent (RE) and Attachment (AT). Infants were then classified according to caregiver stress: (a) low in both subscales (LS); (b) high in both subscales (HS); (c) mixed (high in one subscale; MXS); or (d) moderate (mid-range for both subscales; MOS).   
Results: Although HIJA bids were infrequent in any group at 12 months, at 14 and 18 months the proportion of infants who produced HIJA bids was highest in the HS group (100% at 14 mo, 67% at 18 mo), followed by the MOS group (50% at 14 mo, 50% at 18 mo). The proportion of MXS and LS infants who exhibited HIJA bids was below 35% at all ages. Similar patterns were observed for HRJA; HS infants consistently scored 40% higher than any group; all other groups exhibited low HRJA scores (below 30%) at all age points. During toy play, caregivers of HS and MOS infants were slightly more successful than caregivers of MXS or LS infants when producing a Responding bid (H (3) = 6.949, p = .074).  Additionally, caregivers of HS infants maintained their infants’ attention longer than the other groups when responding to the infant’s object of focus (H (3) = 10.309, p = .016).
Conclusions: The presence of higher or moderate stress levels in both subscales was positively associated with infant joint attention development. Caregivers who experienced greater stress tended to engage in more successful attention bids with their infants during toy play. Higher levels of stress may motivate parents to engage infants more frequently and more successfully, thus scaffolding joint attention development.