Promoting Joint Attention in Toddlers with Autism: A Parent-Mediated Developmental Model

Abstract

Joint attention, a foundational nonverbal social-communicative milestone that fails to develop naturally in autism, was promoted for three toddlers with early-identified autism through a parent-mediated, developmentally grounded, researcher-guided intervention model. A multiple baseline design compared child performance across four phases of intervention: focusing on faces, turn-taking, responding to joint attention, and initiating joint attention. All toddlers improved performance and two showed repeated engagement in joint attention, supporting the effectiveness of developmentally appropriate methods that build on the parent–child relationship. A complementary qualitative analysis explored family challenges, parent resilience, and variables that may have influenced outcomes. Intervention models appropriate for toddlers with autism are needed as improved early identification efforts bring younger children into early intervention services.

Appendix A

Joint Attention Mediated Learning (JAML) Parent Manual (excerpt)

The following pages have ideas for helping your child make progress in focusing on faces, turn-taking, and joint attention––all important to help your child communicate and interact socially with others. Each idea or learning strategy is just that––an idea. Working with the researcher, you will have other ideas that can help reach similar goals. Each strategy is connected with one or more learning principles, identified in bold after each strategy.

These learning principles show five ways to help children learn. The five learning principles are:

• 1. Focusing: Helping your child to focus helps her look at or listen to something that can help her learn, to share attention with you by looking at what you want her to see, or by showing you what she wants you to see.

• 2. Giving meaning: You can help your child understand the meaning of things by expressing your feelings (such as excitement) when you are sharing attention with him about an object or a happening. Giving meaning helps him to understand what parts are important to pay attention to because they are special in some way.

• 3. Expanding: When you and your child are paying attention to something, you can help your child to expand his understanding of an object or event. You do this by providing labels, by helping him see something about an object that he had not noticed before, or by seeing how something relates to other things he knows about.

• 4. Encouraging: Toddlers learn best when they feel successful. You can help your child experience success by making activities challenging enough but not too hard, by pointing out what he did that caused his success, by expressing affection when he is successful, and by showing him that you are confident that he can succeed.

• 5. Organizing and planning: Helping your child experience order can boost his learning by helping him see how what he is doing relates to the larger world. If activities are structured, he can better predict what comes next. He may be more willing to do something that he does not like (but that is important for his learning) if he knows a preferred activity will come later. Also, if activities happen in a logical sequence, your child can better see the connections between things. Structure is especially helpful to promote learning for toddlers with social and communication difficulties. You can help to structure activities by

• a. showing your child only the part he needs to know for what you want him to learn,

• b. helping him to keep his attention on one thing at a time,

• c. reducing sights and sounds that may draw his attention away from the activity,

• d. helping him to understand “first ___, then ____” (to know what comes next),

• e. moving gradually from simple tasks to ones that are more complicated,

• f. helping him to see how things are organized––the relationships between things

• g. keeping objects in the same location; putting toys in order at the end of play

• h. helping him to understand the value of rules.

During play sessions, all of the time is not spent working on new and more difficult learning strategies. It is important that your child enjoy interacting with you and experience success most of the time. The targeted strategies will help him to learn new things, and these new activities should be mixed in with comfortable activities he already knows, enjoys, and is successful with. However, the purpose of the parent–child play sessions is for him to interact, so you should expect your child to interact with you during all play activities––he can be left to play with toys on his own at other times.

Children learn best when they choose their activities. You can help this to happen by following your child’s lead. You do this by joining into his play rather than asking him to switch from something he is doing to an activity you want to do. However, you can guide him toward new activities when he loses interest with an activity. The most important thing to remember is to keep him engaged in interaction with you as long as possible.

Suggested strategies for developing your child’s social-communication skills are divided into four areas: (1) focusing-on-faces, (2) turn-taking, (3) responding to joint attention, and (4) initiating joint attention. Each of these four areas is divided into two levels. With the first level, you are doing most of the work by showing your child how to do things. In the second level of each area, your child is expected to do more of the work by practicing the skills you have taught him.