Financial: Texas Tech University Health Sciences Center will reimburse travel.

Transcription

1 Disclosure-Sancibrian Financial: Texas Tech University Health Sciences Center will reimburse travel. Nonfinancial: Member of Specialty Board on Child Language; member of Convention Planning Committee

2 Joint Attention Joint Attention = Consciously focusing your attention on the same event or object as another person Not just looking at the same thing as someone else, but being aware that you re sharing the experience

3 Survival of the Busiest Infants with autism may prefer self-stimulatory behaviors over baby games that involve social interaction, anticipation, joint attention Twachtman-Cullen, 2008

4 RJA and IJA Response to Joint Attention child follows adult s line of regard Initiation of Joint Attention child spontaneously draws adult s attention toward an object or event ( showing ) Expect more deficits in IJA than RJA Mundy, Sigman, & Kasari (1990)

5 Correlates of Joint Attention For children with ASD, early JA correlates with: Language gains in early intervention Language skills 1 to 10 years later Siller & Sigman, 2002

6 What does early JA look like? Should be able to point to an object, then look at adult s eyes to establish JA by months Babies later diagnosed with ASD may use gestures to regulate others behavior (protoimperative) but not to share focus (protodeclarative) Wetherby et al, 2004

7 Communicative Intent and IJA Lack of commenting is hallmark of ASD, not seen in children with language impairment only Mundy P, Sigman M, Kasari, C. (1990)

8 Vocabulary and RJA Early impairment in JA interferes with learning new words in incidental learning contexts; not following the adult s gaze means the child may not attach meaning to the correct referent Baron-Cohen et al. (1997)

9 But can we teach JA?

10 10 Interventions for Attention Patten & Watson (2011) Reviewed 12 studies targeting attention Protocols varied, but 4 consistent strategies emerged: Child choice toys or topics of interest to child Reinforcement both natural and artificial Imitation contingent imitation of facial expressions, actions on objects, gestures (leading to turn-taking) Prompting visual, tactile, and auditory cues

11 Strategies focusing on faces (Schertz and Odom, 2007) turn-taking activities (Girolametto & Weitzman, 2002) using child interests (Vismara & Lyons, 2007) contingent imitation (Whalen & Schriebmann, 2003; Ingersoll & Schreibman, 2006). tactile and visual attention-gaining strategies (Whalen et al 2006); illuminated targets (Leekam, Lopez, & Moore, 2002)

12 Focusing on Faces Be face-to-face Lie on your side or stomach when child is on the floor Hold desired item close to face Mirror play Imitate facial expressions Respond to even the briefest eye contact

13 Turn-taking Begin with face-to-face play, rather than play with toys Turn a chance action into a game Play teasing games (e.g., chase, tickling) Trade toys

14 Turn-taking in People Games Peek-a-boo Hide-and-seek Chase Horsey rides Up and down Tickling Bouncing on big ball Pillow Mountain Tug of War 1, 2, 3 Jump! Swinging Ring around the rosy Hanen - More Than Words

15 Turn-taking with Objects Feathers (to blow) Balloons Pinwheels Wind-up toys Rain sticks Bubbles Books w/sound buttons Books w/ pop-ups Musical instruments Vibrating toys Preserve novelty by having 20+ items! Hanen - More Than Words

16 Follow the child s lead the four I way Include child s interests Interpret Imitate Intrude Hanen - More Than Words

17 Include child s interests Notice what the child is doing and then join in. Bring what the child looks at into your shared space. Notice what the child is looking at and then point to the person, thing, or action accompanied by an exaggerated, Look! Hanen

18 Interpret Respond as if the child deliberately tried to communicate with you Model fun comments with exaggeration uh-oh, whee, yucky, stinky, wow, ouch Hanen

19 Imitate Imitate the child s vocalizations, gestures, body movements (exaggerate!) If inappropriate, shape into something more appropriate (e.g., if excited child is flapping, model clapping). Have identical sets of toys so you can imitate without taking the toy.

20 Intrude Insist on joining in on what the child is doing, even is he doesn t welcome you at first. Keeper strategy join in dropping, lining up toys Find a similar toy and join the play. Model actions with objects, like pushing a car, then move to actions without objects (e.g., clapping) and then sounds (e.g., animal sounds). Get in the way, make mistakes.

21 Illuminated Targets

22 Tactile Strategies While child is playing with one toy, place the child s hand on a different toy. While child is playing with a toy, tap or bang on another toy. Tap or touch the child on the arm or leg.

23 Following Gaze/Point Stare at the object you want the child to look at. Turn your body in the direction of the object. Point to the object, putting your arm close to the side of child s head, so he can look along your arm and along your pointing finger.

24 RJA-Following a Point Engage the child in play and hide some desirable items (e.g., puzzle pieces). Initially, the objects should be at least partially visible. Start playing, and when the child realizes the item is missing, shrug your shoulders and say, Hmm, where is it? Then point to the object and say, Look, there it is! Adapted from

25 RJA-Shifting Gaze When surprising events occur (e.g., a jack-in-the-box popping up, a block tower falling over), look at the child, make an exaggerated surprised face and say, Wow! or Uh-oh! If the child looks at you, provide a playful response (maybe a brief tickle). Adapted from

26 Shifting Gaze Obtain the child s attention Look in direction of a target event (e.g., remote control car or fan) Activate the target event Gradually increase the time interval between the gaze shift and activation of the event. (creates opportunities for child to anticipate and look in direction that adult is looking)

27 Success!

28 Resources

29 References Adamson, L., Bakeman, R., Deckner, D. & Romski, M. (2008). Joint engagement and the emergence of language in children with autism and Down Syndrome. Journal of Autism and Developmental Disorders, 39, Baron-Cohen S., Baldwin, D., & Crowson M. (1997). Do children with autism use the speaker s direction of gaze strategy to crack the code of language? Child Development, 68(1), Bono, M. A., Daley, T., & Sigman, M. (2004). Relations among joint attention, amount of intervention, and language gain in autism. Journal of Autism and Developmental Disorders, 34, Charman, T., McArthur, D., & Adamson, L. B. (1996). Joint attention in preverbal children: Autism and developmental language disorder. Journal of Autism and Developmental Disorders, 26, Girolametto, L. & Weitzman, E. (2002). Responsiveness of child care providers in interactions with toddlers and preschoolers. Language, Speech, and Hearing Services in the Schools, 33, Ingersoll, B. & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36 [4], Jones, E. A., & Carr, E. G. (2004). Joint attention and autism: Theory and intervention. Focus on Autism and Developmental Disabilities, 19, Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008). Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76, Leekam, S.R., Lopez, B. & Moore, C. (2000). Attention and joint attention in preschool children with autism. Developmental Psychology 36(2): Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism & Developmental Disorders, 20(1),

30 References Mundy, P., & Stella, J. (2000). Joint attention, social orienting, and nonverbal communication in autism. In A. M. Wetherby & B. M. Prizant (Eds.), Autism spectrum disorders (pp ). Baltimore: Brookes. Paparella, T. & Kasari, C. (2004). Joint attention skills and language development in special needs populations: Translating research to practice. Infants and Young Children, 17, Patten, E. & Watson, L. (2011). Interventions targeting attention in young children with autism. American Journal of Speech-Language Pathology, 20, Schertz, H. & Odom, S. (2007). Promoting joint attention in toddlers with autism: A parentmediated developmental model. Journal of Autism and Developmental Disorders, 37, Siller, M. & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children s communication skills. Journal of Autism and Developmental Disorders, 32 (2), Tomasello, M. & Farra, M. (1986). Joint attention and early language. Child Development, 57, Vismara, L.A. & Lyons, G.L. (2007). Using perseverative interests to elicit joint attention behaviors in young children with autism: Theoretical and clinical implications for understanding motivation. Journal of Positive Behavior Interventions, 9 [7], Wetherby, A., Woods, J., Allen, L., Cleary, J. Dickinson, H., & Lord, C. (2004). Early indicators of autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 34, Whalen, C., & Schreibman, L. (2003). Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry, 44, Whalen, C., Schreibman, L., & Ingersoll, B. (2006). The collateral effect of joint attention training on social interaction, positive affect, initiation, and spontaneous speech. Journal of Autism and Developmental Disorders, 36,