Do Two-Year Olds with ASD Orient to Sounds They Do Not Share

Background: There have been several demonstrations of impaired orientation to brief auditory stimuli in children with autism spectrum disorder (ASD), particularly to speech and social stimuli, and of impaired initiation of joint attention.  However, we are not aware of studies that detail the relation between alerting and orientating to a sound and initiating joint attention to the sound.  Initiating joint attention to a sound is one part of the process of auditory joint engagement—a child’s active sharing of sounds during parent-child interactions—that we anticipate is impaired in young children with ASD in ways that may have significant implications for communication and language development. 

Objectives: The current study sought to test the hypothesis that young children with ASD are less apt than other children to issue bids to share sounds even when they clearly alert and attend to them. 

Methods: The Screening Tool for Autism in Toddlers and Young Children (STAT; Stone & Ousley, 1997; Stone et al., 2004) was used to observe 30 24-month-olds who were subsequently diagnosed with ASD, 30 diagnosed with a non-ASD developmental disorder (DD), and 30 who were typically developing (TD).  One item (the noisemaker task) assessed whether the child initiated joint attention with an experimenter when she briefly activated a clicker hidden beneath the table (a sound that Orekhova et al., 2012, recently reported has atypical neurofunctional correlates in ASD).  Videorecords of the child’s alerting, orienting, and bids to initiate joint attention were reliably coded.   

Results: Most children (29 of the 30 with DD, 29 of the 30 TD, and 24 of the 30 diagnosed with ASD) both alerted and oriented to the sound.  Of those, children in the DD and TD groups were 4 times more likely to initiate joint attention to the sound than children in the ASD group (20, 23, and 10 initiated; odds ratio = 4.01, 95% CIs = 1.47–10.9, p = .007). 

Conclusions: These findings demonstrate that although young children with ASD are almost as likely to alert and orient to a sound as other children, they are significantly less likely to attempt to spontaneously share that sound with an adult.  These results underscore the importance of investigating variations in responses to sounds and their integration into joint engagement.  Moreover, they help motivate research efforts that systematically expand the study of auditory joint engagement to include a variety of sounds, including speech, and a broader range of child reactions, including how they respond to adult bids for auditory joint engagement.