The relationship between joint attention and language in children with autism spectrum disorders.(Report)

The relationship between initiation of and response to joint attention and components of receptive and expressive language in 20 children with autism between the ages of 3 and 5 years were examined. Receptive language skills were assessed using the Mullen Scales of Early Learning (MSEL). Expressive language skills were evaluated by examining Mean Length of Utterance and Type Token Ratio. These variables, along with data on responses to joint attention bids and initiation of joint attention were analyzed using Spearman calculations. The ability to respond to the joint attention bids of others was positively correlated with receptive language scores on the MSEL and mean length of utterance in children with autism. There was no relationship between the ability to initiate joint attention and the selected components of language examined.

Keywords: joint attention; communication; autism spectrum disorders; language

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Research reveals that children with autism spectrum disorders (ASD) demonstrate significant deficits in both initiation of and response to joint attention (Charman et al., 1997; Leekam, Hunnisett, & Moore, 1998; Lewy & Dawson, 1992; Mundy, 1995; Mundy & Gomes, 1998; Mundy, Sigman, & Kasari, 1994; Pennington et al., 1997). Joint attention is defined as the simultaneous engagement of two or more individuals in mental focus on the same external thing (Baldwin, 1995). Tomasello (1995) states that joint attention is more complex than two people looking at the same object. There is synchronization between both participants to coordinate attention between the object and the other person. In joint attention episodes, there is an understanding that the other participant has a focus of attention on the same entity. Joint attention has been further subdivided into initiation and responding components. Initiation of joint attention is defined as the initiation of a communicative act that is used to direct another's attention to an object, event, or a topic of a communicative act (Wetherby & Prizant, 1993). These joint attention acts may include the use of eye contact, declarative pointing, or showing gestures to share an object or event with another. Response to joint attention is defined as the act of responding to a joint attention bid of another (Mundy, 1995).

Development of Joint Attention

Most researchers agree that joint attention emerges between 6 and 12 months in typically developing infants and is well established by 18 months of age (Butterworth & Jarrett, 1991; Leekam et al., 1998; Mundy & Gomes, 1998; Povinelli & Eddy, 1997). Some researchers report that emerging joint attention skills, such as tracking, appear before 6 months of age (Scaife & Bruner, 1975). This tracking skill develops into actual shared attention to an object or event and eventually becomes more interactive and social. Initiation of joint attention develops closely following response to joint attention. A child initiates joint attention bids and protodeclarative pointing behavior emerges. As the child gets older and develops verbal skills, nonverbal forms of joint attention are replaced by more verbal means of establishing joint attention with others (Adamson & Bakeman, 1985; Schaffer, 1984).

The ability to follow the head and eye direction of another individual is one of the earliest elements of joint attention development. The ability to "gaze follow" requires that the child be able to attend both to objects in the environment and to human cues (Leekam et al., 1998). Butterworth and Jarrett (1991) described gaze following as the simple act of looking where another individual is looking. This early joint attention act often is described as "joint visual attention" or "visual coordination." Visual attention has been demonstrated in children as young as 2 to 4 months of age (Bruner, 1977; Nadel & Tremblay-Leveau, 1999; Scaife & Bruner, 1975) and is reliably established by the end of the 1st year. This skill signals a shift from dyadic interactional structures (infant-other) to triadic interactional structures (infant-object-other; Butterworth & Jarrett, 1991; Collis, 1977; Corkum & Moore, 1995). Very young children respond to head turns, and children as young as 9 months are found to comprehend a pointing gesture to objects in close proximity (Schaffer, 1984). These early eye gaze, head turn orientations do not signify that there is an understanding of shared focus but signals a move from primary intersubjectivity (an appreciation for the mutual engagement that occurs between infant and caregiver) to the development of secondary intersubjectivity (the ability to recognize shared attention on an object external to the participants in the interaction). By 18 months, typically developing children respond to subtle cues of eye direction alone.