Pointing and Anticipatory Responding to Joint Attention In Children with Autism

Background: Joint Attention is trainable for children with ASD (Drew et al., 2002; Whalen & Schreibman, 2003; Siller, 2006; Kasari et al., 2006; Yoder & Stone, 2006), and showed collateral effect such as expressive language gain (Kasari et al., 2006, 2008). Children with Autism whose Language-Social Developmental Age (L-S DA, in Kyoto Scale of Psychological Development) is above twelve months respond to Joint Attention (Beppu, 1996). There are few study on sequential effect within Joint Attention skills.

Objectives: Study 1 aimed to assess anticipatory Responding to Joint Attention (RJA) and pointing for young children with autism and Down syndrome in ESCS. Study 2 aimed to see whether a child with autism learns anticipatory RJA through intervention for pointing.

 Methods: In Study 1, six children with ASD and one child with Down syndrome (ages 2 to 6 years, Developmental Age 9 months to 6 years, 2 female) were assessed in Early Social Communication Scale (ESCS; Mundy, Hogan, & Doehring, 2003). In Study 2, a participant was a five-year-old boy with autism; L-S DA was twelve months. During intervention, he was trained to request out of two choices (edible/ non-edible) by approximation from reaching to pointing, once a week at university clinic session. ESCS was applied before intervention and after intervention.

Results: In Study 1, 3 children with ASD, one child with Down syndrome anticipated RJA in ESCS. All of them had pointing skill in daily life or in ESCS, and DA was above thirteen months. In Study2, the participant learned proximal pointing during intervention. In RJA task at pre-ESCS, he responded to the tester’s pointing in hundred percent; and in post-ESCS, he anticipated the tester’s pointing in fifty percent as well as followed the tester’s head-turn in thirty-eight percent. He also showed reaching toward the poster, and gaze shift from the poster to the tester.

Conclusions: Children with ASD and Down Syndrome who had pointing skill showed anticipatory RJA in ESCS; and a child with autism who learned pointing also showed anticipatory RJA and respond to the tester’s head-turn. This study suggests the possibility of sequential effect of teaching one skill in Joint Attention toward another JA skill. The limitation of the study is small number of the participants and other factor possibly underlies anticipatory RJA.