Dyadic and Triadic Behaviours in Infancy as Precursors to Later Social Responsiveness in Young Children with Autistic Disorder

Abstract

The relationship between dyadic (eye contact and affect) and triadic (joint attention) behaviours in infancy, and social responsiveness at pre-school age, was investigated in 36 children with Autistic Disorder. Measures of eye contact and affect, and joint attention, including requesting behaviours, were obtained retrospectively via parental interviews and home videos from 0- to- 24-months of age. Concurrent measures (3–5 years) included social responsiveness to another’s distress and need for help. Early dyadic behaviours observed in home videos, but not as reported by parents, were associated with later social responsiveness. Many triadic behaviours (from both parent-reports and home video) were also associated with social responsiveness at follow-up. The results are consistent with the view that early dyadic and triadic behaviours, particularly sharing attention, are important for the development of later social responsiveness.

Appendix

Operational Definitions and Coding Criteria for Video Study 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.

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 sec 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 sec 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.

Note: 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.

Parent Interview Summary

Parents to answer in terms of this scale and interviewer to record answer:

Eye contact (All questions asked for: 0–6; –12; 12–18; and 18–24 months).

1. While in close proximity to your child (e.g. when sitting with your child on your lap facing you, while sitting close together at the table, at bath time) did your child gaze into your eyes?

2. When you try to get your child’s attention, did you ever feel that your child avoids looking directly at you?

3. Was it difficult to get eye contact initially with your child? (i.e. to ‘catch’ your child’s eye).

4. Was your child’s eye contact ever unpredictable?

5. Did your child seem to display abnormal eye contact, that is, the QUALITY seems to be different (e.g. an empty or lifeless expression, fleeting or piercing looks).

Eye contact and affect (All questions asked for: 0–6; 6–12; 12–18; and 18–24 months).

6. Did your child participate in peek-a-boo games? (i.e. a hiding behind a cloth and then being surprised in an anticipatory manner).

7. Did your child combine smiling and eye contact in interactions with you? (e.g. look at you smiling, make eye contact with you and smile at the same time).

Affect (All questions asked for: 0–6; 6–12; 12–18; and 18–24 months unless stated).

8. Does your child smile during interactions with you while playing with another object or sharing an event (e.g. smile at you when a mechanical toy is operating, or when an animal is near)?

(Interviewer Note: not asked for the first 6 months, as this behaviour is not generally shown during this age).

9. While close to your child (i.e. face to face with eye contact) how often did your child INITIATE smiles with you (i.e. smile spontaneously, first)?

10. Did your child smile IN RESPONSE to your smile?

11. Did your child use his/her emotions appropriately? (e.g. cry when sad; smile and laugh when happy; show a fearful face when scared etc.).

Joint attention (All questions asked for: 6–12; 12–18; and 18–24 months unless stated).

12. Did your child look at things you pointed at (follow your point)?

13. Did your child look at things you look at (follow your gaze)?

14. How often did your child use his/her index finger to point to indicate INTEREST in something (or extend his/her arm and hand to indicate like an approximation of a point)?

15. Did your child ever bring objects over to you, to SHOW you something?

(Interviewer Note: not asked for the first 12 months, as this behaviour is not generally shown during this age).

16. Did your child ever bring objects over to you, to GIVE you something?

(Interviewer Note: not asked for the first 12 months, as this behaviour is not generally shown during this age).

17. Did your child try and attract your attention to his/her own activity by looking back and forth between you and the object (and possibly vocalising)? (Demonstrate behaviour).

18. Did your child look at your face to check your reaction when faced with something unfamiliar? (e.g. a new toy, a stranger).

19. Does your child share your affect when faced with something unfamiliar (e.g. if you look uncertain, your child looks uncertain)?

Requesting (All questions asked for: 6–12; 12–18; and 18–24 months).

20. Did your child ever use his/her index finger to point to ASK for something (or extend his/her arm and hand to ASK)?

21. Did your infant ever BRING you something in attempt to request something (e.g. a toy to be activated or a box to be opened, often accompanied with a vocalisation such as a whine)?