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Studies in Joint Attention for Children with Autism

3399 words (14 pages) Essay in Psychology

08/02/20 Psychology Reference this

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Joint attention is defined as the ability to coordinate attention between an object and a person in a social context (Adamson & McArthur, 1995). There are two forms of joint attention identified by researchers: (a) response to another person’s bid for joint attention which is defined as “follow the direction of the gaze and gestures of others in order to share a common point of reference”(Mundy, & Newell, 2007, page 269)  and (b)initiations for joint attention,defined as use of gestures and eye contact to direct others’ attention to objects, to events, and to themselves”(Mundy, & Newell, 2007, page 269) .

Joint attention is an early emerging form of social communication for typical development children. Bakeman and Adamson (1984) demonstrated that children typically develop joint attention between 9 and 19 months of age. A deficit in joint attention is one of the earliest symptoms of autism and it can be identified before they are diagnosed (Baron-Cohen, Allen, & Gillberg, 1992; Charman et al., 1998; Osterling & Dawson, 1994). Researchers differentiated two functions of joint attention: imperative triadic exchanges serve an instrumental or requesting function, whereas declarative triadic exchanges serve to share awareness, or the experience, of an object or event (Go´mez et al. 1993; Mundy et al. 1993). Individuals with autism show deficits in both acts, and impairments in the latter are more severe. On the other hand, some researchers pointed that the degree to which a child is monitoring and regulating the attention of the other person in relation to objects and events determines the severity of the deficit in autism, rather than the distinction of imperative and declarative level(Mundy et al. 1994; Phillips et al. 1995; Charman 1998).

Joint attention is considered related to two core areas of disturbance in autism: language and social development (Bakeman & Adamson, 1984; Bruner, 1975; Moore & Dunham, 1995; Mundy, 1995; Mundy & Willoughby, 1996, 1998). joint attention is both concurrently and predictively related to language ability in both typical developmenting children and those with autism(Loveland & Landry, 1986; Markus, Mundy, Morales, Delgado, & Yale, 2000; McCathren, Warren, & Yoder, 1996; Mundy & Gomes, 1998; Mundy, Sigman, & Kasari, 1990, 1994). The ability to shift gaze between an adult and an object predicts receptive language 20 months later (Charman et al., 2003). Travis et al. (2001) found that for individuals with autism, initiating joint attention was related to measures of social competence and prosocial behaviors. The emergence of joint attention in early age is described as a pivotal skill because it is believed to provide a foundation for language development and social competence (Bakeman & Adamson, 1984; Bruner, 1975; Vaughan et al., 2003). Effectively teaching joint attention skills may have collateral effects on social interaction and language development in children with autism. For these reasons, many researchers suggested that joint attention behaviors should be targeted directly in early intervention studies(e.g.,Mundy, 1995) An overview of researches which described interventions that taught joint attention as a direct target demonstrates that 12 out of 18 articles reported solely positive effects(White, O’Reilly, Streusand, Levine, Sigafoos, Lancioni, & Aguilar, 2011).

A child will learn to follow an adult’s point before learning to follow an adult’s gaze toward to an object (Carpenter, Nagell, Tomasello, Butterworth, & Moore, 1998), and responding to joint attention emerges prior to initiating joint attentions (Dunham & Moore, 1995). MacDonald et al., 2006 indicated that some children with autism engage in some of the components of joint attention (e.g., looking in the direction of joint attention) without specific instruction. However, initiation of joint attention and coordinating gaze shift between an object and a person are difficult to engage without direct instruction.Taylor et al.(2008) concluded that learning to respond to bids for joint attention did not result in the skill of initiating bids and the participants required specific instruction in the skill of initiating bids for joint attention. Interventions of joint attention for children with autism could follow the same pattern of development by first teaching child follow the adult’s pointing, and then shift gaze between object and adult, followed by joint attention initiation training.

Many researchers employed intervention strategies relied on a combined discrete trial training and naturalistic teaching. For example, Kaale, Smith & Sponheim, E. (2012) implemented two daily sessions which includes 5 min of table training priming for the targeted joint attention skill by teacher-driven trials and 15 min of floor play focusing on generalization of the skill within an optimized engagement setting which is child-driven in each session. Wong, Kasari, Freeman,& Paparella. (2007) set up two teaching settings that included similar prompt hierarchies, natural rewards, and corrective feedback. But one setting is discrete trial training oriented, in which the child and interventionist were seated at the table for targeted teaching trials. And in another setting which was following the first setting, the child and the interventionist played on the floor, with more child choice, the development of play routines, imitation of the child, greater wait time for spontaneous production of targeted behavior and greater language scaffolding of child behaviors. In this setting, the researcher’s purpose was to provide opportunity to generalize the skills taught at the table and also instruct the child to carry out the skill using developmental and behavioral strategies. Whalen & Schreibman, (2003) implemented a naturalistic behavior modification technique using components from discrete trial training and pivotal response training. These components includes: interspersing maintenance tasks with acquisition tasks,allowing the child choose the activity; taking turns with the child and so on.

Other researches focus solely on discrete trials, prompting procedures, reinforcement contingencies to teach children with autism to engage in joint attention behaviors(Dube et al., 2004, Taylor & Hoch, 2008). In taylor et al.,(2008) study, they provided social reinforcement (appropriate social interaction in an enthusiastic manner and physical social interaction e.g., tackle) to joint attention behaviors.

Although researches have shown that intervention that targets joint attention combined with behavioral and developmental approach is effective on increasing joint attention, the participants in these studies were preschool age. Few of them focus on younger children(under 3 years old). As mentioned above, deficits in joint attention in children with autism can be identified very early. Targeting joint attention in early intervention may produce optimal outcome.

The purpose of the current study is to assess the effects of a systematic intervention procedures combined with discrete trial training for priming and naturalistic training for generalization in the same session in responding to bids of joint attention,shifting gaze between object and adult and initiation of joint attention for young children(under 3 years old) with autism.


One young child will participate in the research. Ethan is a 2-year 5 month-old child, diagnosed with autism. He just started behavioral intervention a month ago. He has deficits in using communication, including requesting desired items, and initiating, responding to, and sustaining social interaction. He is able to gaze at the showing item, if the adult holds the item in front of him within one foot and says “look!”. He can follow 1 and 2-step directions. He is active in exploring toys and items around the environment and he has strong close-ended play skills(inset puzzles, shape sorters, ring stacker toys).  He can imitate some movements and sounds.


Ethan accept ABA service in clinic setting for 5 morning sessions a week. He is in a classroom where young children(under 4 year old) who also get individual behavior intervention service are around. Sessions will be conducted in the clinic classroom equipped with table and chairs, toy shelves and carpet.


Toys will be chosen by periodic informal preference assessment to ensure that the participant is motivated to play with the toy. These preferred toys will be used in the sessions by periodic variation.

Response Definitions and Measurement

Responding to bids of experimenter’s joint attention will be coded if the participant turns his face and gaze at the direction of the experimenter’s pointing when the experimenter says “look” and point to the item. Gaze shifting between the showing item and the experimenter will be coded if the participant look back to the experimenter’s face from the showing item. Initiation of joint attention will be coded when the participant show the item to the experimenter by pointing, holding the item with eye contacts with the experimenter.

Data will be collected during all baseline,probe and follow-up sessions. Percentage of correct response will be calculated.

Reliability of data recording

One third of baseline, probe and follow-up sessions will be scored by two observers to calculate interobserver agreement.

Experimental Design

Multiple baseline across the three behaviors design will be used to evaluate the effects of the intervention on responses to and initiations of bids for joint attention.



Baseline, probe and follow-up session


The protocols of baseline,probe and follow-up session is adapted from research of Whalen & Schreibman, (2003).  It will take 30 minutes each day before and during treatment phase. Before treatment, the session functioned as baseline and during treatment, the session will be conducted before the training session as a probe. The experimenter and the participant sit on the floor in a natural setting with some new toys and ordinary toys on the shelves. The experimenter waits for the participant to initiate bid of joint attention in the first 1 minute. If the participant initiates the bid of joint attention to any toy, the experimenter will deliver the toy or make a comment,”yes, this is a cool race car!” Otherwise, the experimenter will get the participant’s attention(call his name or tap his shoulder) and point a  new toy(placed at the distance of one foot from the participant ), saying “look!”. At this time the initiation of joint behavior will be coded as incorrect and the second behavior(looking at the direction or grabbing the toy) will be respected and measured. If the participant does not have a correct response, the experimenter will engage the participant current activity for one minute to expect gaze shifting. If the participant responds correctly, the experimenter will interact with him with the showing toy for one minute. During the interaction, the behavior shifting gaze between toys and the experimenter will be expected and measured. The participant’s response will be recorded in vivo but  no contingencies will be administered by the experimenter. Interobserver reliability data will be collected by a second experimenter in the observation room for all the baseline and probe sessions. During the whole session, the experimenter will provide 5 opportunities for the child to perform these three behaviors. Percentage of independent response will be calculated by dividing the number of correct response by 5 and multiple 100. If the participant perform more than one independent response within one opportunity, only one will be counted.

After all the training session finished, follow-up 30 minutes sessions will be conducted 1 month later.


One treatment session will be conducted each day. Treatment protocol is adapted from the research of Kaale, A., Smith, L., & Sponheim, E. (2012). Instruction will be delivered through two parts in treatment session.The first part takes place on the tabletop in which the experimenter structures the environment and delivers discrete trials for the purpose of priming. The second part takes place on the floor following the tabletop setting, where there is a shelf of toys. In this setting, the student can choose the activity and the instruction is delivered loosely, naturally for the purpose of generalization.

Training on responding to bids

During the tabletop time, the experimenter and the student sit at the table side by side. A toy is placed on the table in front of the experimenter,1 foot from the participant. The experimenter will say”look at me” to get the participant’s eye contact firstly.  Physical prompt (e.g. Turn the head towards the experimenter’s face) can be used if necessary. And then the experimenter looks at the toy and points to it and says”look”.  If the participant looks the toy or tries to grab it. The experimenter will praise him, e.g.”good job, look at what I am pointing!” and deliver an edible as reinforcer. If the response is not correct, the experimenter will use most-to-least prompts(e.g. Physical prompt by turning his head towards the toy, holding the toy closer to the participant). Prompt response will be reinforced as the same with independent response. 5 trials with different toys will be delivered during tabletop time and then they move to the floor.  During the floor time, the participant can make a choice of what toys he wants to play with. The instructional opportunities will be delivered loosely. The setting and the procedure of showing toys will be the same with baseline. The prompt procedure and verbal praise is the same with the tabletop. But the reinforcer during floor time is more nature:the experimenter will interact with the participant with the toy for 30 seconds.

Training on shifting gaze

After the first target behavior responding to the bid of joint attention shows a stable state, the training on shifting gaze will be introduced. In this phase, the participant will be required a more response— looking back to the experimenter —after responding to the bids of the experimenter. During the tabletop time, the same procedure of prompting will be used to produce responding to the bid of joint attention . But after the participant look at or engage in the toy, he will be prompted to look back to the experimenter by most-to-least prompting(turn his head toward the experimenter, tap his shoulder to turn back), and at the same time the experimenter will say:”what do you see?, it is a car!”. Prompt and unprompt response will be verbal praised and the participant will get an edible. Then they move to floor activity, the same prompt procedure as in tabletop will be used. But the reinforcer during floor time is more nature:the experimenter will interact with the participant with the toy for 30 seconds. Each parts will have 5 opportunities(trials) for the participant to response.

Training on initiating bids

After the second target behavior shifting gaze shows a stable state, the training on initiating bids of joint attention will be introduced. In this phase, the new preferred toys will be presented and the experimenter wait 10 seconds for the participant to initiate bid of joint attention. During tabletop part, the position and the toy will be placed the same with the two prior training phases, and the experimenter will wait 10 seconds. If the participant initiate bids of joint attention within 10 seconds: eye contact with the experimenter and pointing to the toy, or eye contact with the experimenter and grabbing the toy(eye contact with the experimenter is necessary), the experimenter will praise his behavior with great enthusiasm,e.g.”awesome! Showing me the toy!” and deliver an edible. If there is no initiation of joint attention within 10 seconds, the experimenter will use most-to-least prompt procedure to shape pointing(shape pointing by physical prompt, model pointing, taping the toy) and eye contact(turn his head towards the experimenter, verbal prompt”look at me!”). After 5 trials on the tabletop, they move to floor. The new preferred toy will be placed on the shelf and out reach of the child. The experimenter will wait until for 10 seconds. The same prompting procedure with the tabletop will be used. But the reinforcer during floor time is more nature:the experimenter will interact with the participant with the toy for 30 seconds. 5 opportunities will be provided for the response.


Procedural Fidelity

Fidelity checklist


Intervention strategy











  1. Delivery of SD

Show the toy at the right position, get the participant’s attention, point to the toy and say”look”

2. Use Most-to-least prompt

Full physical prompt:turning head towards the toy

Partial physical prompt: touch his head

Taping the toy

3. Consequence

Verbal praise: behavior specifically

Deliver edible during tabletop time

Interact with the participant with the toy during floor time

4. Components during floor play time

(1)   Let the participant make a choice

(2)   Make a comment on participant’s play

Data Analytic Plan

IOA will be calculated on each selected session. The number of agreement of teaching opportunity is divided the total number of  teaching opportunity and then multiply 100 to get a percentage. 80% and up of IOA will be acceptable. If the IOA is poor, training of definition of correct response, coding rule will be implemented.


This is a draft of the false data. It misses lots of elements, such as label of x,y axis and label of phase. It just provided a rudimentary data graph.


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  • White, P. J., O’Reilly, M., Streusand, W., Levine, A., Sigafoos, J., Lancioni, G., … & Aguilar, J. (2011). Best practices for teaching joint attention: A systematic review of the intervention literature. Research in Autism Spectrum Disorders, 5(4), 1283-1295.
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