The Early Development of Joint Attention in Infants with Autistic Disorder Using Home Video Observations and Parental Interview

Abstract

The aim in the current study was to investigate the early development of joint attention, eye contact and affect during the first 2 years of life, by using retrospective parental interviews and analyses of home videos of infants who were later diagnosed with Autistic Disorder (AD). The 36 children with AD and the 27 matched control children were all aged between 3 and 5 years at recruitment. Reported anomalies in gaze and affect emerged in the children with AD as early as the first 6 months of life, generally becoming more severe just prior to the second birthday. Video data confirmed these anomalies from as early as the first year. Joint attention impairments were found throughout the second year of life. The results suggest that early dyadic behaviours—eye contact and affect—may play a role in the joint attention impairment in AD.

Appendix: Operational Definitions of Social Behaviours

A detailed coding protocol is available from the authors; N.B. The Early Social Communication Scales, Seibert et al. (1982) and the ADOS-G Module 1/2 (Lord et al. 1999) were used in the development of these operational definitions.

Dependent Variables

1. Eye contact: The infant looks directly into the person’s face/eyes; here it is clear that the infant is looking at a person, and not the camera.

*Coding example for quality ³

• 0 = infant shows age and contextually appropriate level of eye contact with other persons that is clear, flexible, socially modulated and of appropriate duration;

• 1 = infant shows a slight deficiency in eye contact with other persons, but does engage in some eye contact (i.e., eye contact occurs but may be fleeting and of short duration, or may sometimes consist of empty, lifeless or vacant stares;

• 2 = infant shows a moderate deficiency in eye contact with other persons, rarely engaging in eye contact and with extremely short duration, or may often consist of empty, lifeless or vacant stares, or somewhat poorly modulated eye contact;

• 3 = infant never engages in eye contact or continuously stares vacantly and lifelessly, or displays poorly modulated eye contact in interactions.

2. Responds to name call: Infant looks directly at person calling them. If there is repeated calling, code a new look after 3 s has elapsed.

3. Social smile: The infant smiles at a person while looking at them (initiating the smile); the infant responds to the smile of a caregiver by returning a smile immediately after the caregiver initiated that smile (reciprocal).

4. Shared positive affect: The infant demonstrates at least one of the following behaviours (in addition to a social smile): laughs, giggles, shows joy, happiness, facial enthusiasm, elevation, excitement; and combines these with some eye contact all while in close proximity to another person’s face. The infant wants to share enjoyment and excitement with the caregiver and directs toward the caregiver.

5. Joint attention gaze switching (checking/looking behaviour: sharing through eye contact): Infant looks at another person’s face in the presence of something interesting (possibly while holding/activating a toy) and then looks back at that object/event (in a sense ‘checking’ that the person has seen the object/event; Infant looks to caregiver to within 2 s of a toy ceasing and then back to toy.

6. Initiating joint attention (Proto-declarative pointing/showing/giving/pushes toward for sharing, not to obtain or to request the removal of a toy): The infant points at a (proximal or distal) object in order to direct the caregiver’s attention to the object to share interest in the object; brings an object/hands object to a person or extends arm in the direction of the person’s face to show the object (not associated with need for help).

7. Responding joint attention (gaze monitoring and point following): The infant follows the caregiver’s point, gaze or head turn by moving their own head and focus or turning in the same direction in which the caregiver is looking, pointing, or showing interest (attention to a common focus). The caregiver may be vocalising too (e.g., “look”).

8. Social referencing: Infant looks at another person’s face in the presence of something ambiguous/threatening for information (and then may look back at that object/event).

9. Initiate requests (proto-imperatives): The infant points or extends arm and hand toward a desired object which aids the infant in obtaining the object (is part of a request for something out of reach; is often accompanied by vocalisation); infant gives object/pushes object toward caregiver in order to obtain help “do it again” or to “get rid” of something they do not want.

10. Responds to requests: The infant responds to the request of another (verbal or gestural) by, for example, giving an object to another person when they request it with an open palm; coming to ‘sit down’ when signal is given; labelling.

Possible Confounding Variables

• a) What was the predominant context (circle number)?

  • 1. Birthday party

  • 2. Bath

  • 3. Meal time

  • 4. Playing with toys

  • 5. Beach

  • 6. Yard/play ground

  • 7. Other

• b) What was the overall level of caregiver interaction with the infant?

  • 1. Low (few attempts to initiate and respond to interactions with infant)

  • 2. Moderate (moderate level of attempts to initiate and respond to interactions with infant)

  • 3. High (frequent level of attempts to initiate and respond to interactions with infant)

• c) What was the overall level of engagement of infant?

  • 1. Low (largely disengaged, not attending or responding, unaware of social context)

  • 2. Moderate (occasional references to social context)

  • 3. High (interconnected, appropriate to social context, responsive)

• d) Presence of toys

  • 1. Low

  • 2. Moderate

  • 3. High