Improving Social Communication through Joint Attention: Interventions to Support Training for Children with Autism Amy Cohen, Ph.D, BCBA; Maigret Fay, M.Ed, BCBA
Dec 26, 2015
Improving Social Communication
through Joint Attention:
Interventions to Support Training for Children with Autism
Amy Cohen, Ph.D, BCBA; Maigret Fay, M.Ed, BCBA
Presentation OverviewWhat is joint attention?
Why is joint attention important?
Considerations/ Decision Making for implementing JA training
Whalen model
Schertz model
Take home messages
What is Joint Attention?Joint Attention (JA) is recognized as one of the
earliest forms of communication in young children and involves coordinated attention between a social partner and an object or event in the environment (Taylor, 2009)
The capacity to use gesture and eye contact to coordination attention with another person to share the experience of an interesting object or event
What is Joint Attention?JA is a child shifting his gaze between you and
an object
It allows a child can communicate with you about his interests (Sussman, 1999)
Usually develops between 9-18 months in typical children (Taylor, 2009).
What is Joint Attention?
A ---> B ---> CA) adult initiates interaction
B) child looks at object/event and looks back to adult
C) child receives social reinforcement from adult
(Taylor, 2009)
Components of Joint Attention
Following adult gaze and point
Eye contact: checking back with adult
Gaze alternation between object and adult
Reciprocal commenting about objects- From Taylor, 2009
Example of Joint Attention
Typical Development of Joint Attention
2-3 months: infants smile in response to parents smile or voice
8 months: follow a parents gaze (e.g., parent looks at the clock, infant will follow)
10-12 months: follow a point, then look back at parent
12-14 months: initiate a point
15-16 months will draw a parents attention to an object of interest with sound, point, looking back and forth
Joint Attention Impairments in ASD
joint attention deficits responding to joint attention bids(RJA) initiating joint attention bids (IJA)difficulty shifting attention from one thing to
anotherfewer displays of positive affect along with joint
attention behaviorsLimited motivation to respond to/engage in social
interactionsreferencing mouth instead of eyes
Typical Peers and ASD illustrations
Autism Speaks Video Glossary:
http://autismspeaks.player.abacast.com/asdvideoglossary-0.1/player/autismspeaks
Joint AttentionLack of joint attention is a core feature of autism
Research has differentiated children with ASD and other developmental disabilities based on joint attention
http://www.youtube.com/watch?v=tif4U3OjT2M&feature=youtube_gdata_player
Why is Joint Attention Important?
JA is a key prerequisites to learning from other (along with receptive language)
ability to focus on people & objects at the same time is a prerequisite for communication
better joint attention skills are associated with better language development (Bono, Daely, Sigman, 2004), *Language => improved prognosis
children with ASD who display more intact joint attention skills exhibit better outcomes w/ respect to development of cognitive, language and symbolic play skills (Sigman & Ruskin, 1999)
identified as a pivotal behavior
Child without Joint Attention
Intervention Planningit is possible to improve joint attention behaviors
in children with ASD
targeting joint attention skill development appears to be an important component for early intervention
Component skills to target:Making eye contactFollowing a pointLooking back to check inCommenting about objectsShowing objects to others/directing others attention
- Taylor, 2009
Group Activity: Follow my Eyes to the Prize
Count off by sevens
Determine who will be the first group “leader”
The group leader should select another group member to be the communicative partner without speaking, just using eye contact
The group leader should then guide the partner’s attention to an object in the environment using only eye contact and eye gaze (no speaking)
Once the partner has accurately guessed what item the leader is looking at, the partner becomes the leader and selects the next person as described above
Continue until all group members have been a leader and partner
Considerations/ Decision Making for Implementing JA
trainingWho will be teaching?
Parent vs. teacher
What setting will the teaching occur in?Home vs. group classroom vs. 1:1 setting
Which approach will be most conducive to child’s learning?Consider learner profile, instructor and setting
Considerations/ Decision Making for Implementing JA
training Two intervention models will be described
today: Whalen and Schertz
Different teaching approaches are based on different theories
Whalen’s model is similar to Discrete Trial: Adult directs. Cue and Prompt attention at person or object and reinforce.
Schertz’s model is similar to Floortime, RDI: More open ended and following child’s lead.
Whalen ModelTeaches child to respond to requests to shift their
attention, first between objects and eventually between an object and another person’s face
Very structured, clearly defined criteria for each step, and outlines correct versus incorrect responses (consequences)
Involves videotaping three, 10 minute play sessions per week for each “level” or step
Instructor is encouraged to implement intervention procedure in daily routines beyond the 10 minute taped sessions
Whalen ModelLevel 1: “Hand on”
Level 2: “Tap”
Level 3: “Show”
Level 4: “Eye Contact”
Level 5: “Follow a Point”
Level 6: “Following Eye Gaze”
Level 1: “Hand on” When child is engaged with another activity, an object is
placed under their hand. A correct response is defined as manipulating or looking at the new object for 5 seconds.
All correct responses are rewarded with continued access to the new object or object previously used (approximately 1 minute) and social praise.
Incorrect responses are addressed by re-presenting a desired object following a 5 second inter-trial break and providing a physical prompt. Prompted responses are rewarded by access for approximately 20 seconds.
The criteria for progression for all response levels is 80% accuracy during 2 out of 3 sessions.
Level 2: “Tap”
When child is engaged with another activity, an object is placed in front of them and tapped.
A correct response is defined as manipulating or looking at the new object for 5 seconds. All correct responses are rewarded with access to the new object or object previously used (approximately 1 minute) and social praise.
Incorrect responses are addressed by re-presenting object following a 5 second inter-trial break and providing a physical prompt. Prompted responses are rewarded by access for approximately 20 seconds.
The criteria for progression for all response levels is 80% accuracy during 2 out of 3 sessions.
Level 3: “Show” When child is engaged with another activity, an object is
placed in front of them (shown).
A correct response is defined as manipulating or looking at the new object for 5 seconds. All correct responses are rewarded with continued access to the new object or object previously used (approximately 1 minute) and social praise.
Incorrect responses are addressed by re-presenting the object following a 5 second inter-trial break and providing a physical prompt. Prompted responses are rewarded by access for approximately 20 seconds.
The criteria for progression for all response levels is 80% accuracy during 2 out of 3 sessions.
Level 4: “Eye Contact”
The child is required to make eye contact with partner when a bid for attention is made (“look”).
The reward for a correct response is access to the object for 1 minute and social praise.
Incorrect response is addressed by representing the object after 5 second break and providing a gestural prompt – hold object at eye level.
Level 5: “Following a Point”
Once eye contact is established with the child; turn head and point to object.
A correct response involves the child turning toward the direction of object. The correct response is rewarded with access to the new object or continued access to the object they had been using for 1minute and social praise.
If child makes an incorrect response re-present the instruction (“look” + point) and a physical prompt (move head in direction of the object) is used. Prompted responses are rewarded with access to a new or previously obtained object for 20s and social praise.
Once the child is following the point, the child will be expected to look back to the adult. This closes the joint attention circle.
Level 6: “Eye Gaze”
Eye contact with the child is established; turn head and look toward the object. A correct response involves the child turning toward the direction of object.
The correct response is rewarded with access to the new object or continued access to the object they had been using for 1 minute and social praise.
If child makes an incorrect response re-present the instruction (“look” + point) and a physical prompt (move head in direction of the object) is used. Prompted responses are rewarded with access to new or previously obtained object for 20 seconds and social praise.
Once the child follows the eye gaze, the child will be expected to look back to the adult. This closes the joint attention circle.
Whalen Level 1: Hand on
Whalen Level 2: Tap
Activity with Whalen Model
Pair up, 1 person will be the “child” and the other will be the adult
Practice the prompting in each of the six levels
Take turns as adult and child
Practice the correction procedure as well as the protocol for correct responding
Discuss implementation with a child
Schertz ModelFocuses on 3 areas of social communication:
Focusing on Faces Taking turns in back-and-forth play Sharing attention about things he is interested in
Less structured than Whalen modelDecisions to move on based on viewing videos, not
specific criteria
Uses natural strengths of family/ teacher, “going with the flow” & teaches the adult to follow the child’s lead
Involves planning longer play time sessions (30-60 minutes) and video taping sessions
Schertz ModelThere are 5 principles for mediating the child’s
learning within each of the 3 stages:1. Focusing
2. Organizing and planning
3. Encouraging
4. Giving meaning
5. Expanding
Focusing on FacesWhy it is important:
An early form of social communication which helps children pick up on social signals and form bonds.
Child will see others’ reactions to things that happen.Will lay the ground work for other forms of social
communication.
Child will learn that looking at your face is different than looking at other things in environment.
Taking TurnsWhy it is important:
Helps child to be reciprocal and include you in play.It is a building block for verbal communication in
which we take turns in conversation speaking and listening.
Child will learn to focus on both what he or she is doing and what you are doing.
Sharing AttentionWhy it is important:
Helps child to broaden interests and pay attention to what others are interested in.
This makes it easier to learn new concepts and words and builds communication skills.
It is a form of nonverbal commenting, such that the child can have a conversation before learning to talk.
Child will learn to experience pleasure when others are excited and showing him or her something.
Focusing on Faces: Examples of how to support each principle
1. Focusingholding your head so child can see easilyincorporate looking at your face into a gameexaggerating expressionsmanipulate toys near your face
Focusing on Faces: Examples of how to support each principle
2. Organizing and planningHave rituals before transitions to new
activitiesarrange toys in environment that encourage
facial referencing and hide toys that encourage solitary play
engage in songs with lots of repetition and predictability
Focusing on Faces: Examples of how to support each principle
3. EncouragingBe sensitive to difficulty of looking at facesif child resists, make expressions more
predictableinclude soothing singing in language with
childpair looking at face with things child likes
Focusing on Faces: Examples of how to support each principle
4. Giving meaningPause unexpectedly while walking or
playingbe more unpredictable, put shoe on your
head, or eat with a toyHave child search for your voice by hiding
behind a screen and responding playfully when he looks behind screen
Focusing on Faces: Examples of how to support each principle
5. ExpandingCollect close up photos of your face and sort
from faces of strangersmake a book of faces and discuss
expressions simplisticallyhave others wait for child to look before
interacting
Activity with Schertz Model
Come up with one example of how to work on each principal for either “Taking Turns,” or “Sharing Attention.”1.Focusing 2. Organizing and planning 3. Encouraging 4. Giving meaning 5. Expanding
Data Collection for both models
Data Sheet (JA) Intervention format__________________
Teacher name_______________________ Child name________________________
Date Phase Trial # + / - / (P) COMMENTS
_____ _____ _____ _____
_____ _____ _____ _____
_____ _____ _____ _____
_____ _____ _____ _____
_____ _____ _____ _____
_____ _____ _____ _____
_____ _____ _____ _____
Number correct _____ = _____ (100) =______%
Total trials
ActivityThink of your target students
Discuss where each child may be starting with joint attention skills (ex: some eye contact in response to gestures, no response at all to bids for attention, etc).
Discuss which intervention would be most appropriate for each child and why.
Determine how you might integrate the intervention into the child’s day including collecting data.
Activities to Incorporate into Classrooms to Address JA
Freeze game
I lost my voice
Follow my eyes to the prize
Look at my face to find the prize
Imitation games
Try it together: Red light green light with faces
Video ExampleFollow my eyes
http://www.youtube.com/watch?v=k1s4wNH4KcU&playnext=1&list=PLA15F94F7622527FE
Take Home Messages
Joint Attention is a pivotal, prerequisite skill for communication
Joint Attention does not come naturally to most children with autism therefore it must be targeted in intervention
Can be implemented across child’s routines and care providers; therefore, increasing the amount of teaching the child is exposed to
References
Bono, M, M., Daley, T., & Sigman, M. (2004). Relations among joint attention, amount of intervention, and language gains in Autism. JADD, 34, 495-505.
Delaney, E.M.,& Kaiser, A.P. (2001). The effects of teaching parents blended communication and behavior support strategies. Behavioral Disorders, 26, 93-116.
Moes, D.R., & Frea, W.D. (2002). Contextualized behavior support in early intervention for children with Autism and their families. JADD, 32, 519-533.
Rocha, M., Schreibman, L. & Stahmer, A. 2009. Effectiveness of training parents to teach joint attention in children with Autism. Journal of Early Intervention. Sage Publications.
Schertz, H.H. (2005). Joint Attention Mediated Learning manual. Unpublished manuscript.
References
Schreibman, L., & Koegel, R.L. (1996). Fostering self management: Parent-delivered pivotal response training for children with autistic disorders. In E.D. Hibbs & P.S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders (pp. 525-552) Washington, DC: American Psychological Association.
Sussman, F. (2007). Hanen More than Words Training Manual. A Hanen Center Publication, Toronto, Ontario (pp. 96-97, slide #10).
Sussman, F. (1999) More Than Words; Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorder. A Hanen Center Publication, Toronto, Ontario. (pp. 20, 388).
Taylor, B.A. (2009). Improving Joint Attention and Reciprocal Language Skills in Children with Autism (PowerPoint slides).
Whalen, C. & Schreibman, L. 2003. Joint attention training for children with Autism using behavior modification procedures. Association for Child Psychology and Psychiatry, 44, 456-468.