Does Early Response to Joint Attention Predict Executive Functioning Among Infant Siblings at School-Age?

Background: Response to joint attention (RJA) (Mundy et al., 1986) and executive functioning (EF) (Dawson et al., 1998) are impaired in children with ASD. Difficulty regulating attention may contribute to JA and EF challenges in ASD (Dawson et al., 2002; Van Hecke et al., 2011).  RJA deficits among children with ASD are evident by 12 months (Osterling and Dawson, 1994) while impairments in EF are not apparent until approximately school age (Dawson et al., 1998; 2002). Concurrent relations between RJA and EF have been found in young children with ASD (Dawson et al., 2002). Among typically-developing children, early RJA has been associated with EF at preschool age (Van Hecke et al., 2011; Morales et al., 2005).  Longitudinal relations between RJA in toddlerhood and later EF have not been evaluated in ASD.

Objectives: The current study examines associations between RJA at 18 months and EF at school age among children with and without ASD.

Methods: Participants were at high- (n=48) and low-risk (n=17) for ASD. High-risk participants had an older sibling diagnosed with ASD. Diagnostic assessments at or after 36 months yielded three “outcome” groups:  ASD (n=11), non-ASD developmental concerns (Concerns; n=10), and typically developing (TD; n=44). RJA, evaluated at 18 months using the Early Social and Communication Scales (Seibert et al., 1982), was calculated as the percentage of trials on which participants followed the examiner's points to pictures in a book (RJA proximal) and posters on the wall (RJA distal). Parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF; Gioia et al., 2000) when participants reached school age (5-9 years old). Higher BRIEF scores correspond to poorer EF.

Results: MANOVAs indicated no differences in EF subscales between risk groups, but ASD > TD and Concerns groups on inhibitory control, attention shifting, working memory, planning, and the ability to monitor effect on others; ASD > TD only on emotional control, p’s < .05. Kendall's tau correlation analyses with the full sample indicated negative associations between RJA proximal and inhibitory control, attention shifting, working memory, and planning, and associations between RJA distal and inhibitory control (tau’s ranged -.25 to -.32, p’s ≤ .05). When correlations were tested separately in ASD and non-ASD groups, associations between RJA and EF were specific to the ASD group: inhibitory control was associated with both RJA proximal (tau = -.741, p=.014) and RJA distal (tau = -.684, p=.042).

Conclusions: Findings extend upon prior research demonstrating that RJA is a core difficulty in ASD (e.g., Sigman & Ruskin, 1999) by documenting longitudinal associations between RJA and EF in ASD. Early difficulties regulating shared attention (RJA) may contribute to later difficulties inhibiting ineffective behaviors. Although associations between RJA and EF were not observed in the non-ASD group, both RJA proximal and RJA distal were negatively correlated with inhibitory control in the ASD group. Inhibitory control is positively associated with math and literacy skills (Blair & Razza, 2007). Thus, early intervention targeting RJA among infants at risk for ASD may support the development of self-regulation and academic achievement.