1. Joint Attention

2. A definition of Joint Attention (JA)
“Two people actively sharing attention with respect to an object or event and monitoring each other’s attention to that object or event” (Jones & Carr, 2004, p.13)
Example: Kitten runs into the room and 3-year-old girl smiles and then looks at her mother and points at the cat
Other terms for JA:
Joint visual attention
Commenting
Indicating
Social referencing
Gaze following
Monitoring
Protodeclaratives
Protoimperatives
Coordinated joint engagement
NOT the same thing as joint control

3. Holth (2005)
Research on Joint Attention (JA) has been conducted primarly by cognitive/developmental psychologist
Has focused on typically-developing children
Emergence of JA skills
How JA skills are related to development of other skills
Many have thought that JA can’t be taught
Not much attention from behavior analysts (or others working in the field of autism tx)
Strange b/c JA deficit is defining characteristic of autism
Recent calls for BAs to develop interventions!
Outcome studies should report measures of JA skills
JA may be linked to the development of other skills (pivotal? cusp?)

4. Development of JA (Jones & Carr, 2004)
Develops about the end of 1st year – 2 forms:
Responding to another person’s directive attention – develops at end of 1st year
At months, infants begin to “check back” and look at the person after first looking at the object
Initiating attention of another person to the object or event
Gaze shifts between object and familiar person
Adults usually respond by labeling object or event
Later combined with gestures, verbalizations, pointing, reaching, showing
By the middle of the 2nd year, joint attention is well-developed

5. JA and Autism (Jones & Carr, 2004)
Some researchers say that deficits in JA are the earliest indicators of autism
Can be detected before 1 year old
Infant screening measures for autism (e.g., CHAT) include assessments of JA
Compared with children with MR and language delays matched for developmental level, only children with autism show deficits in JA
One of the DSM-IV criteria for autism: “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)”
By comparison, using gestures and eye gaze to request objects is “relatively unimpaired”

6. JA and Autism (Jones & Carr, 2004)
Joint attention may be important to the development of language because…
Language is learned in the context of joint attention interactions
Early in the 2nd year, when children hear a novel word, they look at the adult and then at the object the adult is looking at
If a child with autism doesn’t do this, he may not learn from this interaction at all or may look at the wrong object

7. Operant Analysis of JA Holth (2005)
Gaze Following
Lower-level responding - Orienting head and eyes toward someone else
Higher-level responding – Following someone’s line of regard to the object or event
Adult’s gaze in a direction is an SD for looking in same direction
Interesting/novel/irregular activity or object reinforces following adult’s gaze
SD:
Adult points or touches something
Reinforcer?
Child orients head and eye toward adult’s face or pointing finger
SΔ:
Adult not pointing or touching
No reinforcer

8. Operant Analysis of JA Holth (2005)
Protodeclarative – Tact?
Interesting
object
Child looks at mom
Child points
Child says “cat!”
SR+:
Mom looks and gives attention

9. Holth (2005)
Visual orienting of one person is under discriminative control of pointing/visual orientation of other person
This control may be conditional upon other stimuli
Gaze following may be more likely when someone says, “look” or you have just asked for directions
The direction of the person’s gaze and the interesting object may jointly control looking at the object
Small changes in another person’s gaze may function to reinforce the pointer’s responding; sight of novel stimulus may reinforce continuing to look at object
Pointing to something and looking when someone else points may be conditioned reinforcers because other behavior (e.g., verbal behavior) is likely to be reinforced in that situation
A limited number of exemplars may be sufficient for learning this skill

10. A Model for Assessing JA (MacDonald et al., 2006)
Participants ages 2-4
26 children with autism/PDD-NOS
21 TD children
JA Responding Tests – Measured orientation in direction of examiner’s point
Following a point to pictures in a book
Following a point to items around the room
JA Initiating Tests - Measured gaze shift, gestures, vocalizations
Toy Activation Task: Bear
Book Presentation Task
Toy Activation Task: Elephant

11. Joint Attention Responding Results

12. Joint Attention Initiation Results
About ½ of children didn’t initiate at all

13. Interventions for JA (Jones & Carr, 2004)
JA seems important goal for EI, but there’s relatively little research to guide a program for teaching it to children with autism
Some procedures used in the literature
Introducing silly, out of place events/objects into normal routines to evoke a response
Teacher puts high preference item and face in line of vision to evoke gaze responses
Teaching child to point to/show something to someone else and say, “look”
Limitation: these procedures teach a response, but do not necessarily teach the child that social interactions are interesting (reinforcing)

14. Establishing Nodding and Smiling as Reinforcers (Holth, 2005)

15. Establishing Monitoring (Holth, 2005)

16. Establishing Gaze or Point Following (Holth, 2005)
Recall Weiss and Harris (2001)
Teach by having person hold it and look at it
Then touching it & looking
Then reaching toward & looking
Fade reaching prompt

17. Establishing Mands with JA (Holth, 2005)

18. Establishing Tacts with JA (Holth, 2005)

19. Establishing the presence of adults as generalized reinforcers
Jones and Carr (2004): PRT Model for Teaching JA Could remediating the deficit in JA result in improvements in language and social skills (without specific training in those areas)?
Establishing the presence of adults as generalized reinforcers
Adult presents a variety of highly preferred items repeatedly over time
Once the child seeks proximity to the adult…
Using child choice
When teaching JA, let child choose items to be used in teaching
Use items that are salient (e.g., move, light up)
Use a variety of items and incorporate novel items
Natural consequences
Natural consequence for JA initiation is a social interaction about the object
Deliver idiosyncratic attention (e.g., loud “wow”, funny face, high-amplitude tickles)
Activity interspersal
Interspersing easy tasks with difficult tasks has been shown to increase acquisition of difficult tasks
They recommend using playing with the preferred item as the easy task

20. Jones, Carr, and Feely (2006) Study 1
Participants
5 children ages 2-3 with PDD/NOS, autism, or “likely autism-spectrum disorder”
Purpose – evaluate effectiveness of discrete trial + PRT in teaching JA initiations and responding
Method
Rotated use of a large number of high-preference, activation toys
Design: MB Probe Design across behaviors (initiating & responding)
Conditions…

21. JA Responding Procedures

22. JA Initiating Procedures

31. Social Validity Assessment

32. References
Dube, W.V., MacDonald, R.P.F., Mansfield, R.C., Holcomb, W.L., & Ahearn, W.H. (2004). Toward a behavioral analysis of joint attention. The Behavior Analyst, 27,
Holth, P. (2005). An operant analysis of joint attention skills. Journal of Early and Intensive Behavior Intervention, 2,
Jones, E.A., & Carr, E.G. (2004). Joint attention in children with autism: Theory and intervention. Focus on Autism and Other Developmental Disabilities, 19,
Jones, E.A., Carr, E.G., & Feeley, K.A. (2006). Multiple effects of joint attention intervention for children with autism. Behavior Modification, 30,
MacDonald, R., Anderson, J., Dube, W.V., Geckeler, A., Green, G., Holcomb, W., Mansfield, R., Sanchez, J. (2004). Behavioral assessment of joint attention: A methodological report. Research in Developmental Disabilities, 27,