International Meeting for Autism Research: A Novel Measure of Joint Attention for Use with Older Children and Adolescents: Evidence for Clinical Utility and External Validity

A Novel Measure of Joint Attention for Use with Older Children and Adolescents: Evidence for Clinical Utility and External Validity

Thursday, May 20, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
2:00 PM
J. L. Bean , Clinical Psychology, University of Connecticut, Manchester, CT
J. Casares , Psychology, University of Connecticut, Storrs, CT
I. M. Eigsti , Psychology, University of Connecticut, Storrs, CT
Joint attention (JTAT), the ability to share a mutual focus of attention with another person, is an essential developmental milestone; deficits in JTAT are one of the earliest symptoms of autism spectrum disorders (ASD).  JTAT is thought to directly influence language acquisition and social development. It is effectively assessed in young children (e.g., with the ESCS, Mundy, 1982, and Modules 1-2 of the Autism Diagnostic Observation Schedule, ADOS).  However, only limited research examines JTAT at later developmental periods and whether skills continue to distinguish ASD populations; research may be limited in part by lack of assessment measures.
To investigate JTAT skills in older individuals, we designed a measure consisting of six prompts for the initiation of and response to JTAT. The current study tests this measure’s ability to discriminate between individuals with ASD and typically-developing (TD) controls.  We also report reliability and external validity (e.g., correlations with the Social Communication Questionnaire, SCQ; ADOS; Childhood Behavior Checklist, CBCL; and Social Responsiveness Scale, SRS).  
Participants included 18 children with ASD and 24 TD controls, ages 7 to 17. Groups were matched on age, FSIQ, and PPVT (p’s > .29).  The JTAT measure consisted of three verbal and three nonverbal naturalistic prompts, interleaved with a standardized testing situation.  Prompts were designed to elicit initiation of and response to joint attention, and included the experimenter searching for a lost item, calling attention to an interesting object, introducing the participant to another experimenter, etc. Scores were based on response characteristics (making eye contact, making an appropriate verbal response, and providing the socially-appropriate action).
As expected, the ASD group’s JTAT scores were lower than for controls, p < .01. In addition, within the ASD group only, JTAT scores were correlated with the SCQ Communication scale, r = -.61, p = .02; SRS Social Awareness scale, r = -.71, p = .02; and (as a trend) with ADOS scores, r = -.46, p = .05. In contrast, for the TD group, JTAT scores were associated with SRS Social Motivation, r = -.41, p = .04; the SCQ (total), r = -.46 p = .03; and Social Withdrawal scale on the CBCL, r = -.38, p = .05. Twenty percent of JTAT assessments were coded by two raters for reliability; Cohen’s kappa will be reported.
Results indicate that this novel measure of JTAT, which requires no special equipment and is administered during a typical evaluation, is highly reliable and useful in capturing joint attention skills in older individuals with ASD. Further, scores were associated with parent-report and interviewer assessments of social awareness and ASD-specific behaviors, indicating high external validity. Individuals with TD showed a wide range of scores (14 - 22) and associations with social motivation and withdrawal, suggesting this measure captures meaningful variability in joint attention. Given the powerful developmental sequelae of JTAT and the numerous interventions targeting these skills, this measure offers a novel approach to assessing JTAT development longitudinally.
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