Look at This, Mommy! Profiles of Spontaneous Social Communication In Toddlers with ASD, DD, and TD During Solitary Object Exploration

Background: Both eye contact and joint attention are key elements of social communication.  Deficits in these areas in toddlers with ASD have been studied primarily in a context of parent-child interaction or adult-mediated tasks. Solitary object exploration tasks, however, can potentially probe for spontaneous rather than elicited social communication behaviors.  A recent study of object exploration, (Ozonoff, Macari, et al., 2008), has suggested that infants with ASD explore toys differently than their typically developing (TD) and developmentally delayed (DD) counterparts, but this study did not examine social communication behaviors exhibited during these tasks.  

Objectives:  To examine spontaneous social communication behaviors in the context of a solitary object exploration session in toddlers with ASD, TD, and DD.

Methods:  Participants included 15 toddlers with ASD, 16 with TD, and 11 with DD. All groups were matched on age (M=19.9 months) and gender. The ASD and DD groups were matched on non-verbal mental age (M=15.1 months, SD=3.5) and expressive language level (M=9.3 months, SD=4.4).  The toddlers were given an opportunity to play with a standard set of objects during a 9-minute object exploration session. Videos were coded offline for episodes of joint attention, looking at an adult’s face, showing objects, and giving objects. Joint attention consisted of either 3-point coordinated or 2-point gaze shifts.

Results:  ANOVA followed by Bonferroni post-hoc comparisons showed that toddlers with ASD spent less time looking at an adult’s face (F(2,39)=12.2, p<.001) and less 2-point gaze shifts (F(2,39)=7.6, p<.005) than both TD and DD toddlers. Toddlers with ASD also engaged in fewer coordinated joint attention bids (F(2,39)=10.9, p<.001), less showing (F(2,39)=4.9, p<.01) and less giving (F(2,39)=5.0, p<.01) than TD children, but this performance was comparable to that of the DD group. Furthermore, toddlers with DD engaged in similar amounts of 2-point gaze shifts as TD toddlers alongside less coordinated joint attention, suggesting they lag behind their typical peers in their use of 3-point gaze, but not in 2-point gaze or looking at an adult’s face.

Conclusions: In the second year of life, social communication impairments differentiate toddlers with ASD from toddlers with global developmental delays and typically developing toddlers. Deficits in elementary social behaviors, such as looking at an adult’s face and 2-point gaze were more likely in toddlers with ASD, despite being matched developmentally to the DD group. Other more advanced behaviors such as coordinated joint attention, giving, and showing, were equally impoverished in both the ASD and DD groups. These results suggest that, while toddlers with ASD and DD were similarly impaired on coordinated joint attention and social communicative behaviors, the toddlers with ASD were much less likely to check in with, or reference, an adult during their solitary play than toddlers with DD or TD. The context of a solitary exploration task with adults present provides an opportunity to observe children’s intrinsically motivated spontaneous social communication skills along with their atypical exploration patterns, offering complementary measures which may provide increased specificity in understanding the behavioral phenotypes of children with ASD early in development.