The Importance of Including Mesures of Joint Attention Abilities In the Clinical Assessment of Very Young Children with ASDs

Background:  One of the core social symptoms of Autism Spectrum Disorders (ASDs) involves a marked reduction in the ability to engage in Joint Attention (JA) episodes, in order to share a common perceptual experience of objects and events (Mundy & Newell, 2007). This ability seems to be central for language and social development (Baldwin, 1995; Charman, Baron-Cohen, Sweettenham, Baird, Cox and Drew, 2000). Moreover, individual differences in JA skills are related to the responsiveness to intervention and to long-term social outcomes in children with ASDs (Mundy et al., 2007). However, despite the centrality of these abilities, individual differences in early JA are rarely assessed in very young children with autism and they are almost never considered in relation to the developmental and cognitive measures necessary to define personalized and effective interventions.

Objectives:  This study aimed to investigate the relationship between JA abilities and developmental measures of language and cognitive abilities in very young children with ASDs.

Methods:  30 participants with ASDs (17 M), including 4 PDD-NOS, aged between 1.10yrs and 5.7yrs (mean age=3.6yrs), were evaluated for the following early social communication behaviors with the Early Social Communication Scales – ESCS (Mundy et al., 2003): Initiating Joint Attention (IJA) , Responding to Joint Attention (RJA), Initiating Behavioural Requests (IBR), Responding to Behavioural Requests (RBR), Initiating Social Interaction (ISI) and Responding to Social Interaction (RSI). Developmental functioning was tested with the Bayley Scales for Infant Development Third Edition (Bayley, 1999). The measures of the two scales were correlated and the JA abilities were analyzed as possible predictors of both language and cognitive scores of the Bayley Scales.

Results:  The results showed positive and significant correlation between Bayley scores of language development and IJA (r=0.53; p=0.04), RJA (r=0.019; p=0.019), IBR (r=0.63; p=0.001) and RBR (r=0.55; p=0.01), confirming the pivotal role of these abilities in early linguistic and social development. IBR correlated also with the Bayley scores of cognitive development (r=0.40; p=0.03), confirming the important role of cognition in planning and structuring social reciprocal interactions and goal-directed actions. However, while all the socio-communicative behaviors measured by the ESCS predicted the Bayley Language scores (r squared=0.41; F(4;20), p=0.05), none of each single ability was a significant predictor per se.

Conclusions:  These results indicate that measures of joint attention abilities may provide an early behavioral indicator of atypical development in very young children with ASDs, due to their high correlation with standardized measures of language and cognitive development. Moreover, the assessment of individual differences in JA abilities in very young children with ASDs may be particularly interesting, if we consider that early intervention on JA seems to have important effects on long-terms outcomes in social-learning and socio-communicative development (Charman, 2004; Kasari et al., 2008; Mundy and Crowson, 1997).