RESEARCH

REFLECTIONS Joint Attention and Its Importance in Autism

DO YOU SEE WHAT I SEE?

Joint Attention and Its
Importance in Autism
By Jan Blacher, Ph.D., Columnist, and Stacy Lauderdale, M.A.*
and her mother are
playing in the backyard one summer day when a butterfly
lands on a flower nearby. Logan looks
over at the butterfly, looks at her mother,
and then points to the butterfly as if
silently saying Mom look at this!
Logans mother then looks where she is
pointing and says, That is a beautiful
butterfly, Logan!
Logans desire to share the experience
of the butterfly with her mother constituted an episode of what researchers call
the initiation of joint attention. Joint
attention involves the organization of
attention between oneself, an object or
event, and another person with the purpose of sharing interest. Simply put, joint
attention requires a child to socially
coordinate the attention with other people. This initiating of joint attention (as
opposed to responding to joint attention)
is particularly important in understanding social and affective deficits in autism.
Sharing of interests begins at a very
young age. When typically developing
children are between the ages of six and
nine months their behaviors become
more goal directed. They learn that
another person can be used to achieve
goals, such as getting them the things
that they want like food, toys, and attention. As they continue to grow, typically
developing children begin to expand
their ability to communicate. By eleven

Logan

38 November 2010 EP MAGAZINE/www.eparent.com

months they are alternating their gaze

between an object and a communicative
partner. An example of this would be
when an adult holds up a puppet and
makes it talk. The child will look at the
puppet and then look at the adult to see
what she is looking at and how she is
reacting. The child will then turn his
gaze back to the puppet. This shift in
gaze from the puppet, to the adult holding the puppet, will continue throughout
the interaction. At thirteen months children begin to point at objects to initiate
joint attention and identify objects of
interest, as in the example with Logan
and the butterfly. Finally, at fifteen
months children begin requesting and
communicating with greater frequency.

Joint Attention and Autism

Autism is a disorder characterized by an
impairment in communication and
social interactions, and restricted and
repetitive behaviors with symptoms
beginning before the age of three. One of
the criteria for being diagnosed with

autism, according to the Diagnostic and

Statistical Manual of the American
Psychiatric Association, is a lack of
spontaneous seeking to share enjoyment, interests, or achievements with
other people (e.g., by a lack of showing,
bringing, or pointing out objects of interest) (APA, 2000, p. 75).* These shared
experiences are necessary to acquire
language, and they are also facilitated by
joint attention.
A lack of joint attention can help to
discriminate children with autism from
those with other developmental delays
or from children with typical development. In contrast to typically developing
children, those with autism engage in
less pointing, eye gaze alternation, and
showing of items to another person. Not
all children with autism lack joint attention skills, but in the absence of intervention, many do. Researcher Connie Kasari
and her colleagues at UCLA have conducted a randomized controlled trial in
which joint attention and symbolic play
interventions were compared. In this

When choosing toys to use during

surprise events, you want to consider toys that light
up, play music, and move around. These will help to
gain and keep your childs attention.

study, reported in the Journal of

Consulting and Clinical Psychology, both
interventions were successful in producing expressive language gains and both
were more effective than a control group
that received no intervention. However,
for children with the lowest level of language, joint attention intervention was
more effective than the intervention
involving symbolic play.
In addition to being associated with
the development of language and communication, joint attention can be further understood within an informationprocessing model, where brain mechanisms for encoding information about
the self and others are employed. This
has been nicely explained by researchers
Peter Mundy, Lisa Sullivan, and Ann
Mastergeorge in a recent article in the
journal, Autism Research. Simply put, by
practicing joint attention behaviors in
infancy and early childhood, these
behaviors become automatic. In information-processing terms, joint attention
is part of a childs executive functioning,
which is involved in many types of learning throughout childhood and even the
entire lifespan.

Getting Your Child to Respond

to Your Bids for Attention: What
Can You Do?
Thomas and his mother are sitting
together looking at a new book. They
open the book and look at the first page.
Thomass mother looks and points to
one of the pictures saying, Look, its an
elephant! Thomas responds by looking
at the picture of the elephant, then looking at his mother, and then looking back
at the picture of the elephant.
In this example Thomas is alternating
his eye gaze between his mother and the
picture that she is showing him. This is a
response to her bid for joint attention.
She wants to share something with
Thomas and he is responding by looking
at what she is trying to share with him
and looking at her face to see how she is

reacting. This responding to joint attention initiated by someone else needs to

be taught to children with autism. Listed
below are two ways to teach your child to
respond to your bids for joint attention.
When choosing toys to use during surprise events, you want to consider toys
that light up, play music, and move
around. These will help to gain and keep
your childs attention. Please know that
these suggestions are provided in the
context of fun activities for you to do with
your child; they are not the equivalent of
an experimental intervention intended to
produce specific language gains.
#1: Teaching your child to look
back and forth between you and an
object:
When turning on a toy (such as a dancing bear, singing Elmo, or light up piano)
you are going to exaggerate verbal and
facial responses to these surprise
events. This can also be done throughout
the day when unexpected or surprising
events occur such as the doorbell ringing, a jack-in-the box popping up, a
music box stopping, a block tower falling
over, or a toy car falling off of the table.
Your tone should be positive. Watch for
your childs response. If your child looks
at you, you can reward him by saying,
Good looking! or by giving him a brief
tickle, hug, or kiss. If your child doesnt
look at you, keep trying this during different parts of the day. You can set up
play activities so that a surprise event
occurs periodically and turn this activity
into a game.
#2: Teaching your child to follow
your point or eye gaze:
Hide objects your child wants and
teach him to follow your point, head
turn, and eye gaze to find them. Gather
some of your childs favorite toys or
objects (these can be the same toys that
you are using to teach your child to look
back and forth) and place them in differcontinued on page 40

www.eparent.com/EP MAGAZINE November 2010 39

RESEARCH
REFLECTIONS Joint Attention and Its Importance in Autism

Although this might seem overwhelming

at first, researchers have shown evidence of increased
joint attention in children after parents and teachers
implemented strategies just like those listed above. Sharing
in these moments with your child will be worth the hard
work that you put into teaching these skills to them.
continued from page 39

ent parts of the room. When starting this

activity, the objects should be fairly close
to the child and at least partially visible.
Start playing a game with him so that he
needs the objects youve hidden. When
the need becomes apparent, shrug your
shoulders and say, Hmm, where is it?
Then point to the object and say, There
it is! When your child is able to find the
objects consistently, try turning your
head in the direction of the object
instead of pointing to it. Eventually you
can try just shifting your eyes to indicate
the general direction of the object. Be
sure to use objects that are highly motivating for your child.

Getting Your Child to Try and Gain

Your Attention: What Can You Do?
While Thomas and his mother are
looking at the same new book together
his sister Jenny comes in to join them.
She sits down and sees that there is a
zebra on the page. Without any outside cue Jenny looks up at her mother
and then points to and looks back at
the picture of the zebra as a way to tell
her that she wants her to look at the
picture too.
In this example, Jenny is initiating
joint attention with her mother. She
sees something that she wants to share
with her mother and points to it while
looking at her mother to make sure that

40 November 2010 EP MAGAZINE/www.eparent.com

she sees her. This ability to initiate joint

attention typically comes after a child is
already able to respond to bids for joint
attention. After working on responding
to bids for joint attention, you can work
on teaching your child to initiate joint
attention:
Put an interesting toy, or stage an
interesting event, within 3 feet of your
child so that it will evoke her attention
for at least 2 seconds.
The child should then respond by
pointing and alternating her gaze
between you and the toy or event.
If this does not happen:
The first few times you introduce this
initiating procedure you need to immediately: Call the childs name so that she
looks at you (this is alternating gaze),
model the point with your arm outstretched and your finger pointing
towards the object, and say Do this. If
the child does not answer to her name
take the toy that you want her to look at
and trace a line from where the toy was
back to your eyes and then put the toy
back down. This will force an alternate
gaze. If she does not imitate what you
are doing, physically form her hand into
a point directed towards that toy or
event after finishing the alternating
gaze activity.
After the child consistently responds
to this prompt, begin to give her two

seconds to respond, by pointing when

seeing the interesting toy or event. If
she does not respond within the two
seconds, then say the beginning of her
name. For instance, if the childs name
is Ashley you would say Ash. This is
beginning to provide a partial prompt
so that she can begin to initiate joint
attention independently. If saying the
beginning of her name does not
prompt the beginning of initiating joint
attention, then continue to follow the
steps above.
The ultimate goal of this activity is to
have adults meet the childs gaze, provide a reinforcing smile or comment
about what the child is pointing to, and
then have them both look back at the
object or event.
Although this might seem overwhelming at first, researchers have shown evidence of increased joint attention in
children after parents and teachers
implemented strategies just like those
listed above. Sharing in these moments
with your child will be worth the hard
work that you put into teaching these
skills to them.
Stacy Lauderdale is a SEARCH Associate and a
Special Education Leadership Fellow (Ph.D. candidate) in the Graduate School of Education at the
University of California, Riverside. Her research currently focuses on families and autism, as well as student-teacher-relationships in autism. Prior to entering graduate school, Ms. Lauderdale was a teacher
of children with autism and Asperger syndrome.
The authors wish to acknowledge the Doug Flutie,
Jr. Foundation for Autism, Inc., and other support
provided to the SEARCH family autism resource center at UC Riverside.

** AMERICAN PSYCHOLGOICAL ASSOCIATION.

(2000). DIAGNOSTIC AND STATISTICAL MANUAL
OF MENTAL DISORDERS (4TH ED., TEXT REVISION). WASHINGTON, DC: AUTHOR.
For a complete list of references used
in this article please write to lapel@eparent.com.

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