Joint Attention refers to the process of joint engagement with another person in relation to another object or event.1Joint attention behaviors include alerting another person to a stimulus through nonverbal cues such as finger pointing or gazing2. It is one of the first signs of the development of a theory of mind in babies and serves as an important step to later language and social development.1,2,6
Initiating Joint Attention behaviors and Responding Joint Attention behaviors have both been useful in diagnosing those with autism. Initiating Joint Attention behaviors such as pointing or alternating gaze between objects or events and other people involves processes in goal directed behavior while Responding Joint Attention behaviors emphasize information processing facilities. Deficits in Initiating Joint Attention behaviors have been shown to persist in children with autism throughout adolescence while Responding Joint Attention deficits are present less robustly.11
- Joint Attention and Autism Spectrum Disorder
Joint Attention is considered one of the early core deficits in children with ASD. It is a significant predictor of language development in children with autism.2,6 Joint Attention behaviors that have frequently been investigated in children with ASD are pointing. follow pointing, checking, gaze-following, response to name, showing and joint visual attention.
- Joint Attention trajectory
Joint Attention behaviors have been differentiated recently in literature. Behaviors like pointing and gaze following develop during the first year of life, and can be thought of as basic joint attention behaviors. They have been found to be directly related to language development. In contrast, joint attention behaviors like checking and follow pointing develop later in life and may be more socially related than basic joint attention behaviors. These behaviors are called Associated Joint Attention behaviors.
Various studies have together led to the belief that these different joint attention behaviors may elicit participation from different groups of neurons in the brain. By lumping all the joint attention behaviors together, we may have diverging findings across studies on joint behavior, depending on what type of joint behavior is studied. For example, Basic Joint Attention behaviors only require a child to be concerned with the adult's attention on an object. In these behaviors, it is not necessary for the child to understand the adult's intentions. In contrast, 'checking behavior' and 'follow pointing behavior' cannot be done without understanding the others' intentions. Thus, these behaviors more clearly show the mechanisms of shared intentions. One study found that children with ASD showed less Joint Attention behaviors than typically developing students at 24 months, but by 42 months, they reached similar developmental trajectories and endpoints except for in Joint Visual Attention. Thus, children with ASD showed deficiencies in Joint Attention behavior only early on in life. Joint Visual Attention behaviors will increase over time while Basic Joint Attention behaviors and Associated Joint Attention behaviors will decrease. These changes in Joint Attention Behaviors may be because of the development of language.1
It could be that Basic Joint Attention behaviors are primarily important for development of language, and are more needed during the typical period for language acquisition, thus explaining the decrease in Basic Joint Behavior by both autistic and typically developing samples to the same end point.
Studies have found that initiating Joint Attention behaviors is associated with activity in the left frontal lobe.9, 10 Many fmri studies have established altered facial and emotional processing in the amygdala among those with autism12, 13 Some hypothesize that amygdala abnormalities may be the cause of the deficit in Joint Attention behaviors seen in autistic children because orientation to the eyes is crucial to Joint Attention. According to one study, growth trajectories in the amygdala are similar between children with autism and typically developing children, although amygdala volume remains enlarged between 2-4 years of age. Amygdala volumes were positively associated with both Initiating Joint Attention Behaviors and Response Joint Attention Behaviors15 This is consistent with other studies which show an association between decreased amygdala volumes and reduced eye contact in children and adults with autism.13 These results suggest a nonlinear growth pattern15. The subsequent decreased amygdala volumes in those with autism have been hypothesized to result from an allostatic overload model13, 14.
Tests to Measure Joint Attention
Treatments have been developed to improve Joint Attention in children with a variable amount of success. Many studies2,7,8 have shown that child joint attention initiations and joint engagement with mothers significantly predict the child's language abilities many years later. One study was done which compared the effectiveness of explicitly targeting Joint Attention deficits in improving language abilities. In this study, 30 minute treatments targeting Joint Attention, Symbolic Play, or a control treatment not specific for either of these deficits were added onto a typical ABA style intervention program. It was found that those children who received either the Joint attention or Symbolic Play treatments had significantly improved language development over the control group. Furthermore, Joint Attention treatment was most effective in improving language acquisition for children who were initially nonverbal (speaking less than five spoken words). Participants who were randomized to a symbolic play treatment also showed improvement in language development over a control group that received an intervention that did not specifically target either Joint Attention or Symbolic Play. Another important finding from this longitudinal study was that improvements in language abilities were maintained even a year after the end of the treatment. Additionally, the significance of the improvement in language development experienced by the groups receiving Joint Attention or Symbolic Play treatments had increased when participants were evaluated 6 and 12 months post treatment.4,5
Other potential factors that could affect the success of a treatment could be ethnic and economic conditions. However, research incorporating subjects of various economic and ethnic backgrounds have been few and more needs to be done in order to see if these factors are actual moderators of treatment success.
Intervention Effects on Emotional Regulation One study on the co-regulation of emotions between mothers and children with autism has shown that an intervention targeting joint engagement can also have a positive effect on emotional regulation for both the child and the mother. Results from the study suggest that mother-child interactions may be an ideal place for children to learn how to regulate their emotions.16 In addition, one study has seen that an intervention which targets joint attention can be taught and facilitated by mothers to their autistic toddlers with significant gains in joint attention skills.17
- Tasks or Tests to Measure Joint Attention
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