Issues Establishing Joint Attention/Interaction with Others

Overview

Joint attention is the social ability to share a common focus with another individual to share experiences and interact through non-verbal behaviors (i.e., toys, events). Joint attention is achieved when the two individuals are aware that they are both interested in what they are focusing on. For example, the parent might say, "Look at that car!" and the child responds by gazing toward the car or pointing, and then checking back in with the parent by meeting their eye gaze.

There are two components of joint attention which include initiating joint attention or responding to it. When a child initiates joint attention, they are attempting to bring the caregiver's attention to something. When they are responding to joint attention, they are focusing their attention and interacting with the caregiver who initiated them.

Issues with joint attention commonly present as difficulty with eye contact, following eye gaze, sharing common emotions, gesturing, or engaging with vocalizations.

Assessments

Early Social Communication Scales (ESCS)

The Early Social Communication Scales is a structured assessment designed to provide measures of individual differences in nonverbal communication skills in children with mental ages between 8 and 30 months of age

• Pro: Can provide measures of individual differences in nonverbal communication skills wether or not the child has developmental delays. The stimuli used in this assessment is engaging (wind up toys, balls, etc.) and encourages playful interaction. Additonally the administration time is very brief (15-30 minutes).

• Con: Only assess up to 30 months of age.

Communication and Symbolic Behavior Scales (CSBS)

Norm-referenced screening tool for infants and toddlers whose functional age is between 6 and 24 months. This assessment measures 7 language predictors (eye-gaze, communication, gestures, words, sounds, understanding, and play (object use).

• Pro: Utilizes parent interviews as well as observation to determine strengths and weaknesses

• Con: A possible limitation is the ambiguity of scaling and scoring the checklist times. Another weakness is the checklist scores may be skewed as a result of setting in which the checklist is completed (i.e. therapy room versus naturalistic setting like the home/school).

Intervention

1) Functional Play

Research has found functional play to be effective in increasing joint attention, specifically in children with Autism Spectrum Disorder (ASD). Functional play is a term that describes playing with toys and using them to do their appropriate function (i.e., bouncing a ball, driving a car). Some methods to help establish functional play are:

• Hold toys at eye level

• Modeling functional use of the toy

• Asking questions and prompting the child ("Can you make the car drive?")

• Reinforce the child with rewards/praise

2) Reciprocal Imitation Training (RIT)

RIT is an intervention approach that teaches spontaneous imitation to aid improve different areas of social-communication, including joint attention. To enact RIT, the caregiver imitates what the child does (gestures, vocalizations, etc.) with toys to encourage their joint attention. The steps of RIT are:

• Clinician/caregiver imitates the child

• Clinician/caregiver models familiar actions with a toy or object

• Clinician/caregiver models unfamiliar actions with a toy or object

• Clinician/caregiver picks a new toy than the child and models familiar actions

• Clinician/caregiver then uses the new toy to model unfamiliar actions

Alternative Approach

There are many ways parents and communication partners can support the development of joint attention in order to help children successfully interact with other people and their environment. Some of these methods include:

• Making eye contact; look at the child and request that they look at you when engaging in conversation. To reiterate, children learn through modeling so if they are shown it is appropriate to look at someone when they are being spoken to their behaviors may soon follow.

• Orient yourself at eye level and in front of your communication partner in order to make eye contact more accessible.

• Use an animated tone of voice to increase the child's interest in what you are saying

• Use items of interest when playing with the child to encourage attention to the object

• Encourage the child to shift their focus between two objects

• Practice joint attention during daily routines such as brushing your teeth or snack time by using phrases such as "look at those teeth" while looking in a mirror together.