Difference between revisions of "Joint Attention"

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=== Basic Characteristics ===
 
=== Basic Characteristics ===
 
* Description
 
* Description
Joint Attention refers to the process of joint engagement with another person in relation to another object or event.<sup>1</sup>Joint attention behaviors include alerting another person to a stimulus through nonverbal cues such as finger pointing or gazing<sup>2</sup>. It is one of the first signs of the development of a [[Theory of Mind| theory of mind]] in babies and serves as an important step to later language and social development.<sup>1,2,6</sup>  
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Joint Attention refers to the process of joint engagement with another person in relation to another object or event.<sup>1</sup>Joint attention behaviors include alerting another person to a stimulus through nonverbal cues such as finger pointing or gazing<sup>[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=2324051 2]</sup>. It is one of the first signs of the development of a [[Theory of Mind| theory of mind]] in babies and serves as an important step to later language and social development.<sup>1,[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=2324051 2],[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=12851079 6]</sup>  
  
 
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.<sup>11</sup>
 
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.<sup>11</sup>
 
   
 
   
 
*'''Joint Attention and Autism Spectrum Disorder'''
 
*'''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.<sup>2,6</sup> 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.   
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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.<sup>[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=2324051 2],[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=12851079 6]</sup> 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 trajectory'''
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===Interventions===
 
===Interventions===
Treatments have been developed to improve Joint Attention in children with a variable amount of success.  Many studies<sup>2,7,8</sup> 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| 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.<sup>4,5</sup>     
+
Treatments have been developed to improve Joint Attention in children with a variable amount of success.  Many studies<sup>2,7,8</sup> 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| 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.<sup>[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=16712638 4],[http://www.npistat.org/phenowiki/Search_Result.asp?PMID=18229990 5]</sup>     
  
 
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.     
 
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.     
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'''Intervention Effects on Emotional Regulation'''
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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.<sup>16</sup> 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.<sup>17</sup>
  
 
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==== References====
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====References====
1. Naber, F.B.A. et. al. Joint Attention Development in Toddlers with Autism. Eur Child Adolesc Psychiatry. 2008 Apr;17(3):143-52 PMID 17849078
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See [[Citations_Joint_Attention]]
 
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2. Mundy, P. et al. A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20, 115–128n PMID 2324051
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[http://npistat.org/phenowiki/Search.asp| Phenowiki Database]
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3. Kasari C et al. Randomized Controlled Caregiver Mediated Joint Engagement Intervention for Toddlers with Autism.J Autism Dev Disord. 2010 Feb 10 PMID 20145986
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[http://npistat.org/phenowiki/Search.asp| Phenowiki Database]
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4. Kasari C et al. Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. J Child Psychol Psychiatry. 2006 Jun;47(6):611-20. PMID 16712638
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[http://npistat.org/phenowiki/Search.asp| Phenowiki Database]
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5. Kasari C et al. Language outcome in autism: randomized comparison of joint attention and play interventions. J Consult Clin Psychol. 2008 Feb;76(1):125-37.PMID 18229990
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[http://npistat.org/phenowiki/Search.asp| Phenowiki Database]
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6. Charman T et al. Predicting language outcome in infants with autism and pervasive developmental disorder.Int J Lang Commun Disord. 2003 Jul-Sep;38(3):265-85. PMID 12851079
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[http://npistat.org/phenowiki/Search.asp| Phenowiki Database]
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7. Charman T. et. al.Outcome at 7 years of children diagnosed with autism at age 2: predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time.J Child Psychol Psychiatry. 2005 May;46(5):500-13. PMID 15845130
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8. Sigman M et. al. Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays.Monogr Soc Res Child Dev. 1999;64(1):1-114. PMID 10412222
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9. Mundy P. et. al. EEG correlates of the development of infant joint attention skills.Dev Psychobiol. 2000 May;36(4):325-38. PMID 10797253
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10. Caplan R et. al. Hemispherectomy for intractable seizures: presurgical cerebral glucose metabolism and post-surgical non-verbal communication.Dev Med Child Neurol. 1993 Jul;35(7):582-92. PMID 9435774
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11. Mundy P et. al. A parallel and distributed-processing model of joint attention, social cognition and autism.Autism Res. 2009 Feb;2(1):2-21. PMID 19358304
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12. Bookheimer, S.Y. et. al. Frontal contributions to face processing differences in autism: Eviedence from fMRI of inverted face processing. "Journal of the International Neuropsychological Society". Cambridge University Press:14:922-32;2008 PMID 18954473
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13. Nacewicz BM et. al. Amygdala volume and nonverbal social impairment in adolescent and adult males with autism.Arch Gen Psychiatry. 2006 Dec;63(12):1417-28. PMID 17146016
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14. Schumann CM et. al. Stereological analysis of amygdala neuron number in autism. J Neurosci. 2006 Jul 19;26(29):7674-9. PMID 16855095
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15. Mosconi MW et. al. Longitudinal study of amygdala volume and joint attention in 2- to 4-year-old children with autism. Arch Gen Psychiatry. 2009 May;66(5):509-16. PMID 19414710
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==== Other Details ====
 
==== Other Details ====
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[[Category:Treatments]]

Latest revision as of 13:32, 16 July 2010

Joint Attention

Basic Characteristics

  • Description

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.


Neuroimaging

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

Concerns

Interventions

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





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References

See Citations_Joint_Attention


Related Information

  • Tasks or Tests to Measure Joint Attention
  • Indicators (dependent variables, conditions, or contrasts; measurement variables used for analysis) associated with this construct (vote or nominate by editing this page):

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External Resources

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