Joint Attention

A definition of Joint Attention (JA)

“Two people actively sharing attention with respect to an object or event and monitoring each other’s attention to that object or event” (Jones & Carr, 2004, p.13)

Example: Kitten runs into the room and 3-year-old girl smiles and then looks at her mother and points at the cat

Other terms for JA: Joint visual attention Commenting Indicating Social referencing Gaze following Monitoring Protodeclaratives Protoimperatives Coordinated joint engagement NOT the same thing as joint control

Holth (2005)

Research on Joint Attention (JA) has been conducted primarly by cognitive/developmental psychologist Has focused on typically-developing children Emergence of JA skills How JA skills are related to development of other skills Many have thought that JA can’t be taught

Not much attention from behavior analysts (or others working in the field of autism tx) Strange b/c JA deficit is defining characteristic of autism Recent calls for BAs to develop interventions!

Outcome studies should report measures of JA skillsJA may be linked to the development of other skills (pivotal?

cusp?)

Development of JA(Jones & Carr, 2004)

Develops about the end of 1st year – 2 forms: Responding to another person’s directive attention –

develops at end of 1st yearAt 12-14 months, infants begin to “check back” and look

at the person after first looking at the object Initiating attention of another person to the object or

eventGaze shifts between object and familiar personAdults usually respond by labeling object or eventLater combined with gestures, verbalizations, pointing,

reaching, showingBy the middle of the 2nd year, joint attention is well-

developed

JA and Autism (Jones & Carr, 2004)

Some researchers say that deficits in JA are the earliest indicators of autism Can be detected before 1 year old Infant screening measures for autism (e.g., CHAT) include

assessments of JACompared with children with MR and language delays

matched for developmental level, only children with autism show deficits in JA

One of the DSM-IV criteria for autism: “a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)”

By comparison, using gestures and eye gaze to request objects is “relatively unimpaired”

JA and Autism (Jones & Carr, 2004)

Joint attention may be important to the development of language because…Language is learned in the context of joint

attention interactionsEarly in the 2nd year, when children hear a novel

word, they look at the adult and then at the object the adult is looking at

If a child with autism doesn’t do this, he may not learn from this interaction at all or may look at the wrong object

Operant Analysis of JAHolth (2005)

Gaze Following Lower-level responding - Orienting head and eyes toward someone else

Higher-level responding – Following someone’s line of regard to the object or event

Adult’s gaze in a direction is an SD for looking in same direction Interesting/novel/irregular activity or object reinforces following adult’s gaze

SD:

Adult points or touches something Child orients head

and eye toward adult’s face or pointing finger

Reinforcer?

SΔ:

Adult not pointing or touching

No reinforcer

Operant Analysis of JAHolth (2005)

Protodeclarative – Tact?

Interesting

object

Child looks at mom

Child points

Child says “cat!”

SR+:

Mom looks and gives attention

Holth (2005) Visual orienting of one person is under discriminative control of

pointing/visual orientation of other person This control may be conditional upon other stimuli

Gaze following may be more likely when someone says, “look” or you have just asked for directions

The direction of the person’s gaze and the interesting object may jointly control looking at the object

Small changes in another person’s gaze may function to reinforce the pointer’s responding; sight of novel stimulus may reinforce continuing to look at object

Pointing to something and looking when someone else points may be conditioned reinforcers because other behavior (e.g., verbal behavior) is likely to be reinforced in that situation

A limited number of exemplars may be sufficient for learning this skill

A Model for Assessing JA (MacDonald et al., 2006)

Participants ages 2-4 26 children with autism/PDD-NOS 21 TD children

JA Responding Tests – Measured orientation in direction of examiner’s point

Following a point to pictures in a book Following a point to items around the room

JA Initiating Tests - Measured gaze shift, gestures, vocalizations

Toy Activation Task: Bear Book Presentation Task Toy Activation Task: Elephant

Joint Attention Responding Results

Joint Attention Initiation Results

About ½ of children didn’t initiate at all

Interventions for JA (Jones & Carr, 2004)

JA seems important goal for EI, but there’s relatively little research to guide a program for teaching it to children with autism

Some procedures used in the literature Introducing silly, out of place events/objects into normal

routines to evoke a responseTeacher puts high preference item and face in line of

vision to evoke gaze responsesTeaching child to point to/show something to someone

else and say, “look” Limitation: these procedures teach a response,

but do not necessarily teach the child that social interactions are interesting (reinforcing)

Establishing Nodding and Smiling as Reinforcers (Holth, 2005)

Establishing Monitoring (Holth, 2005)

Establishing Gaze or Point Following (Holth, 2005)

Recall Weiss and Harris (2001)Teach by having person hold it and look at itThen touching it & lookingThen reaching toward & lookingFade reaching prompt

Establishing Mands with JA (Holth, 2005)

Establishing Tacts with JA (Holth, 2005)

Jones and Carr (2004): PRT Model for Teaching JACould remediating the deficit in JA result in improvements in language

and social skills (without specific training in those areas)?

1. Establishing the presence of adults as generalized reinforcers Adult presents a variety of highly preferred items repeatedly over time Once the child seeks proximity to the adult…

2. Using child choice When teaching JA, let child choose items to be used in teaching Use items that are salient (e.g., move, light up) Use a variety of items and incorporate novel items

3. Natural consequences Natural consequence for JA initiation is a social interaction about the

object Deliver idiosyncratic attention (e.g., loud “wow”, funny face, high-

amplitude tickles)4. Activity interspersal

Interspersing easy tasks with difficult tasks has been shown to increase acquisition of difficult tasks

They recommend using playing with the preferred item as the easy task

Jones, Carr, and Feely (2006)Study 1

Participants 5 children ages 2-3 with PDD/NOS, autism, or “likely

autism-spectrum disorder” Purpose – evaluate effectiveness of discrete trial + PRT

in teaching JA initiations and responding Method

Rotated use of a large number of high-preference, activation toys

Design: MB Probe Design across behaviors (initiating & responding)

Conditions…

JA Responding Procedures

JA Initiating Procedures

Social Validity Assessment

References

Dube, W.V., MacDonald, R.P.F., Mansfield, R.C., Holcomb, W.L., & Ahearn, W.H. (2004). Toward a behavioral analysis of joint attention. The Behavior Analyst, 27, 197-207.

Holth, P. (2005). An operant analysis of joint attention skills. Journal of Early and Intensive Behavior Intervention, 2, 160-175.

Jones, E.A., & Carr, E.G. (2004). Joint attention in children with autism: Theory and intervention. Focus on Autism and Other Developmental Disabilities, 19, 13-26.

Jones, E.A., Carr, E.G., & Feeley, K.A. (2006). Multiple effects of joint attention intervention for children with autism. Behavior Modification, 30, 782-834.

MacDonald, R., Anderson, J., Dube, W.V., Geckeler, A., Green, G., Holcomb, W., Mansfield, R., Sanchez, J. (2004). Behavioral assessment of joint attention: A methodological report. Research in Developmental Disabilities, 27, 138-150.