Improving Joint Attention and Reciprocal Language Skills in Children with Autism
Bridget Taylor, Psy.D., BCBA, Alpine Learning Group
“Look Mommy, an airplane!” Hearing that phrase, a mother is likely to look at the airplane, look back at her child, and comment on the airplane (e.g., “Yes honey, that’s a big airplane! It’s flying high in the sky.”). In this example, the mother and child jointly share in the experience of seeing an airplane. The child’s initiation, referred to as a “bid for joint attention,” not only occasions social interaction with his mother, but also creates an opportunity for learning language. Through this social interaction, the child may be introduced to new vocabulary (e.g., “big,” “flying,” “sky”), and may incorporate those new words into his repertoire for future use. Research appears to support this, as studies have demonstrated an association between better joint attention skills and increased vocabulary acquisition (Morales et al., 2000), as well as general language development (Bono, Daley, & Sigman, 2004). For the child with autism, these types of meaningful reciprocal interactions are notably lacking (MacDonald et al., 2006). In fact, deficits in joint attention are among the earliest diagnostic markers in young toddlers with autism (Baron-Cohen, Allen, & Gillberg, 1992). The lack of such responses comes at no small expense: failure to engage in reciprocal exchanges may thwart the development of more complex social interaction and language skills.
Two forms of joint attention are outlined in the literature: (a) responses to another person’s bid for joint attention (e.g., the child looks at the object the adult is pointing to) and (b) initiations for joint attention (e.g., the child points at an object and says “Look!”) (Jones & Carr, 2004; Mundy & Crowson, 1997). In the first nine to eighteen months of a young child’s development, these responses may take the form of gaze shifting between an object and an adult, and may function as a means to gain access to the item (e.g., a baby shifts his gaze between a bottle on the counter and his mother’s eyes) (Bakeman & Adamson, 1984). Later, these responses begin to serve social functions, enabling the child to share in an experience with another person. For example, a child who sees a funny clown points to it, looks up at his father, and they both laugh together. In this case, the child is seeking to attract his father’s attention to meet a social goal: sharing the experience of the clown.
From a behavior analytic perspective, the interesting item or event is discriminative for the child to initiate to his parent about the item (e.g., he points to the item) and his parent’s consequence of social attention (e.g., looking at the object and back the child and smiling) serves as a positive reinforcer for the child’s initiation. Further, the child’s monitoring of the adult’s attention to the interesting item or event is likely maintained by generalized positive social reinforcers (e.g., smiling, approval, positive verbalizations) or negative reinforcers (e.g., in the case of a potentially aversive or anxiety-provoking situation, adult’s response indicating to the child that nothing is wrong) (Dube et al., 2004). Consider, for example, a child who, while walking in the park with his father, who upon seeing a very large dog, experiences a degree of “fear.” He immediately looks up at his father and back at the dog. In order to determine whether the dog is something to be fearful of, the child looks back and forth between his father and the dog; if the father smiles, laughs, and says, “That’s a big furry doggie!,” the child will relax. In this case, the child’s gaze shifting between his father and the dog led to the negative reinforcer of relief: relief from the discomfort and fear he felt upon first seeing the dog.
In recent years, applied research has demonstrated that children with autism can learn a number of responses associated with joint attention (Bruinsma, Koegel, & Koegel, 2004). For example, Whalen and Schreibman (2003) used gestural and physical prompts, along with access to toys, to teach children with autism to follow the point and gaze of an adult to an object in the room. Kasari and colleagues (2005) increased the joint attention skills of 20 young children with autism using a systematic prompt-fading and reinforcement procedure to teach the children to coordinate eye gaze between objects and adults, and then to show objects to the adults. Compared to a control group receiving no intervention, the children with autism showed greater improvement in both initiating and responding to bids for joint attention. MacDuff, Ledo, McClannahan, & Krantz (2007), used a script fading procedure to increase bids for joint attention towards objects in the environment, reinforcing successful bids by giving the child access to the item. Taylor and Hoch (2008) demonstrated that prompt fading procedures and the provision of social reinforcers alone (e.g., adult attention without access to the items) could increase responses to bids for joint attention, comments about the objects, and coordinated gaze shift between the object and the adult. Initiations of joint attention bids, however, increased only when systematic instruction was introduced. This indicated that children who learn to respond to bids for joint attention will not necessarily begin to initiate such bids on their own unless specifically taught to do so.
The prompting and reinforcement procedures used to address joint attention skills are no different than those used to shape other important skills of children with autism. Special emphasis, however, is placed on enticing the interest of the child by placing novel or provocative objects within the child’s view (e.g., a big red balloon tied to the back of the child’s chair, a colorful wig placed on a familiar doll, a scary mask) and providing improved social attention for engaging in the joint attention responses (e.g., exaggeratedly “fun” social interaction, improving the value of the toy or object). The novelty of the objects increases the child’s motivation (Michael, 1993) to notice and talk about what he sees.
To teach the child to respond to the adult’s bid for joint attention, the child is provided gestural and physical guidance to turn in the direction of the adult’s point toward the interesting item. An echoic prompt (a vocal model) of a comment about the object is provided (e.g., “That’s a big balloon!”), and gestures are used to prompt the child to look back at the adult. Exaggerated social praise and interaction are provided to shape the targeted responses. To teach the child to initiate bids for joint attention, rather than simply to respond to others’ bids, the child is brought to the location where the objects are placed and the teacher waits a few seconds to see if the child notices the novel objects. If the child does not take note, the adult provides a model for the child to point toward the object, make a comment, and look back at the adult. The adult may then allow the child to engage with the object, but the adult improves the value of the object (e.g., makes the balloon fly around), to reinforce the child’s initiation. By improving the value of the object, the adult becomes a conditioned reinforcer that the child is more likely to seek out when he sees an interesting item or event.
Joint attention skills serve as a foundation for other topographies of reciprocal social interactions. For example, initiating questions (Taylor & Harris, 1995), commenting about toys (Taylor & Levin, 1998), and initiating requests to peers (Taylor, Hoch, & Potter, 2005) all require the child with autism to visually attend to objects in the environment, or to attend to a topic and coordinate their attention between the object or topic and their communicative partner. By cultivating the skills associated with joint attention (e.g., eye contact, coordinated gaze shifting, commenting, and initiating these interactions with adults and peers), we create the conditions for children with autism to broaden their gestural and verbal vocabularies and to participate in dynamic social interactions. In short, by addressing joint attention we confront the core symptoms of autism at their root, and set the stage for children with autism not just to engage in reciprocal exchanges, but to appreciate and engage the world around them.
References
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