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A Review of Joint Attention Interventions for Children with Autism
What is Autism Spectrum Disorder (ASD)?
A developmental disability characterized by:
• Challenges with social interactions
• Difficulty with language skills
• Display of repetitive behaviors
What is joint attention?
(Murray et al., 2008)
• The ability of two people to coordinate looking at an object
• Initiating Joint Attention (IJA) is when the child attempts to share a gaze or
gesture with another person, such as pointing to an object
• Responding to Joint Attention (RJA) is when the child is able to follow another
person’s gaze or gesture, such as looking at an object after another person
points to it
Why focus on joint attention and autism?
(Pickard et al., 2014)
• Joint attention skills are believed to be a precursor for verbal communication
skills
• Lack of joint attention skills is a characteristic of having autism
• It could be used as a tool to diagnose autism
• Focusing on joint attention skills could be incorporated into intervention
programs that help people with autism develop language skills.
Joint Attention, Symbolic Play, and Engagement Regulation (JASPER)
(e.g., Goods et al., 2012)
PARTICIPANTS: 15 minimally verbal children with autism between the ages of 3
and 5.
GOAL: To increase a child’s social engagement by encouraging
parents/facilitators to follow a child’s lead during play tasks.
APPROACH:
• The therapy setting is frequently changed to encourage the child to initiate
more, engage in new ways, and be creative with the given toys.
• The therapist will only use words at the level of the child. When the therapist
says less, it encourages the child to initiate more.
RESULTS: Children showed greater improvements in variety of play,
demonstrated more forms of joint engagement (gestures), and spent less time
unengaged while in school.
Joint Attention Mediated Learning Intervention (JAML)
(e.g., Schertz et al., 2013)
PARTICIPANTS: Children younger than 30 months old who were diagnosed with
autism and lack joint attention skills.
GOAL: To help infants with autism work on nonverbal communication skills at
their home with their parents and an intervention coordinator.
APPROACH:
• Focusing on faces (FF) phase- used to help the child pay attention to his or
her parent’s face.
• Turn-Taking (TT) phase- the child is involved in back-and-forth play with the
parent.
• Joint Attention (JA) phase- the child both initiates play and responds to his or
her parent by exchanging looks and gestures
RESULTS: Children’s RJA skills and receptive language skills improved, but the
results were not significant for IJA skills and expressive language skills.
Applied Behavior Analysis (ABA)
(e.g., Kasari et al., 2006)
PARTICIPANTS: 58 children with autism between the ages of 3 and 4 years old.
GOAL: To “teach” joint attention behaviors by using a reward system.
APPROACH:
• The therapist works with the child during a structured table activity and a semi-
unstructured floor activity following the child’s lead.
• The child is rewarded if he or she successfully initiates play, follows eye gaze,
etc.
RESULTS: Children showed improvement in RJA skills and were able to
generalize these new skills to situations outside of therapy by engaging more with
their parents.
Relationship Development Intervention (RDI)
(e.g., Gutstein et al., 2007)
PARTICIPANTS: 16 children with autism between the ages of 20 and 96 months.
GOAL: To work on nonverbal forms of communication in a comfortable
environment for the child.
APPROACH:
• Implemented by the child’s parent after the parent receives intense training.
• The intervention takes a cognitive development approach by engaging the
child in challenging situations on a daily basis in the child’s home (or
environment that he or she feels comfortable in.)
RESULTS: Children were more successful in mainstream classrooms and more
likely to engage in social interaction with their peers after completing intervention.
• http://www.therapycenterofbuda.com/uploads/3/9/1/4/39145783/2549270.jpg?252
Adamson, L. B., Bakeman, R., Deckner, D. F., & Romski, M. (2009). Joint Engagement and the Emergence of Language in Children with
Autism and Down Syndrome. Journal of Autism and ‘Developmental Disorders, 39(1), 84–96. http://doi.org/10.1007/s10803-008-0601-7
Goods, K. S., Ishijima, E., Chang, Y., & Kasari, C. (2012). Preschool Based JASPER Intervention in Minimally Verbal Children with Autism:
Pilot RCT. J Autism Dev Disord Journal of Autism and Developmental Disorders, 43(5), 1050-1056. doi:10.1007/s10803-012-1644-3
Gutstein, S. E., Burgess, A. F., & Montfort, K. (2007). Evaluation of the Relationship Development Intervention Program. Autism, 11(5), 397-
411. doi:10.1177/1362361307079603
Kasari, C., Freeman, S. and Paparella, T. (2006), Joint attention and symbolic play in young children with autism: a randomized controlled
intervention study. Journal of Child Psychology and Psychiatry, 47: 611–620. doi: 10.1111/j.1469-7610.2005.01567.x
Murray, D. S., Creaghead, N. A., Manning-Courtney, P., Shear, P. K., Bean, J., & Prendeville, J. (2008). The Relationship Between Joint
Attention and Language in Children With Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 23(1), 5-14.
doi:10.1177/1088357607311443
Pickard, K. E., & Ingersoll, B. R. (2014). Brief Report: High and Low Level Initiations of Joint Attention, and Response to Joint Attention:
Differential Relationships with Language and Imitation. J Autism Dev Disord Journal of Autism and Developmental Disorders, 45(1), 262-
268. doi:10.1007/s10803-014-2193-8
Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of Joint Attention Mediated Learning for toddlers with autism
spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28(2), 249-258.
doi:10.1016/j.ecresq.2012.06.006
Lindsey Jackson, Virginia Salo & Nathan A. Fox
• When creating therapy plans, it is important for therapists to consider that joint
attention skills are a precursor for verbal language skills and therefore these
skills should be included in intervention programs.
• Children with autism do have the ability to learn joint attention skills, but they
learn them later than typically developing children.
• Intervention programs working on joint attention seem to have lasting effects,
both in term of joint attention and language, and are especially successful with
responsive joint attention behaviors (RJA).
• Joint attention intervention programs help set the groundwork for future
therapy in other areas.
• There is a relationship between a child’s joint attention skill level and
expressive language skill level, but does incorporating joint attention behaviors
into intervention actually improve expressive language skills?
• How should joint attention programs be altered depending on where the child
falls on the autism spectrum?
• Can joint attention intervention program be effective at any age, or is there an
age limit to when a person should begin a joint attention based intervention
program?
• If joint attention is a precursor for language development and all children with
autism show deficits in joint attention abilities, then why are some children with
autism able to acquire more spoken language skills than others?
• Do children with autism develop joint attention behaviors (pointing, showing,
following eye gaze, etc.) in a different order than typically developing children
and if so, how would this effect joint attention intervention plans? The literature
has mentioned that children with autism develop joint attention behaviors in a
different order, but more research needs to be done.
TREE =
TREE
To examine studies, through a literature review, of various joint attention based
intervention programs for children with autism, with a specific focus on studies
that have measured potential improvements in language skills.
Language
Production
Word
Mapping
Language
Comprehension
Joint
Attention
Background Intervention Programs Conclusions
Objective
Future Directions/Questions
References