Recent findings that earlier intervention results in greater gains for infants and toddlers with autism spectrum disorder (ASD; Rogers, et al. 2012) necessitate ascertainment of early, reliable ASD indicators. However, ASD behavioral risk factors in infants under 12 months of age remain difficult to identify (see Zwaigenbaum, 2010). One leading hypothesized risk factor for autism in the first year of life has been social attention during play with objects, i.e. joint attention and joint engagement (Adamson, et al. 2012; Mundy, et al. 2009). Little is known, however, about social attention in young at-risk infants during face-to-face dyadic interactions (i.e. without objects). This type of paradigm allows for analysis of pure social attention in which the focus of the interaction is not an object, but rather the caregiver. Moreover, few studies have investigated a) differentiating characteristics in six-month-old infants already exhibiting concerning social behaviors nor b) early intervention focused on improving social attention.
The current study investigates early patterns of social attention in face-to-face dyadic interactions through repeated measures of infants exhibiting significant concern for ASD (high-concern) and typically developing infants (no-concern). A social intervention treatment is additionally explored as a method of improving social attention in high-concern infants.
Seven six-month-old infants participated in this study. Infants first participated in a social assessment, which determined their assignment to the “high-concern” or “no-concern” participant group. Four infants exhibited high concern for social difficulties and three exhibited no concern for social difficulties based on parent report and clinical assessment. High-concern infants participated in a systematic time-series analysis of baseline followed by an intervention designed to improve social engagement. During assessment and intervention phases, each infant-caregiver dyad participated in multiple measures of face-to-face interaction. These interactions were videotaped and coded for infant behaviors: affect, social interest, gaze to face of caregiver, positive engagement (positive affect and gaze to face), and neutral engagement (neutral affect and gaze to face).
During the initial assessment phase, high-concern infants showed notably less social interest and lower positive affect during play scenarios than the no-concern infants. Additionally, when looking at the face, they exhibited lower levels of positive engagement and higher levels of neutral engagement.
Following a social engagement-based intervention, high-concern infants’ attention patterns showed more overall positive affect and social interest during face-to-face interactions. They additionally slightly increased positive engagement while markedly decreasing neutral engagement during interactions. Attention patterns after intervention paralleled no-concern infants’ social attention patterns.
Despite challenges identifying behavioral markers in six-month-old infants, the present study provides preliminary evidence that an assessment incorporating high-concern and no-concern infants may elucidate differentiating characteristics related to social engagement. The addition of an experimental paradigm in which parent-infant dyads are assessed during face-to-face play may provide new insight in regard to early diagnosis markers. Specifically, this research identifies differences in affect associated with social attention, rather than solely visual scanning. Lastly, this intervention markedly improved social attention of high-concern infants to increasingly mirror the no-concern infants, suggesting feasibility of developing social interventions for high-risk infants.
See more of: Treatment Trials: Behavioral Interventions
See more of: Prevalence, Risk factors & Intervention