Measuring Joint Attention in Children with Autism Spectrum Disorder through Structured and Unstructured Play

Background:  Joint attention, or the shared experience of an object or activity, is one of the earliest indicators of social interaction, and an important precursor to language.  Skills used to coordinate joint attention often emerge within the first and second years of life.  Research shows that children with an autism spectrum disorder (ASD) exhibit atypical development of joint attention skills compared to typically developing children.  Considering the important role joint attention plays in language development, the accurate assessment of joint attention skills in children with ASD is critical for identifying deficits and designing early interventions.  The commonly accepted gold standard for joint attention assessment is the Early Social Communication Scales (ESCS).  However, researchers and clinicians may benefit from expanding their methods of joint attention assessment.  Multiple observations across different constructs may improve the accuracy of assessing a child’s development of joint attention, and improve ecological validity. 

Objectives:  The current study aims to explore the validity of measuring joint attention within structured and unstructured play interactions by comparing rates of joint attention in these contexts with rates of joint attention in the ESCS. 

Methods:  Using the same guidelines established by the ESCS, joint attention skills were coded from structured play assessments and unstructured caregiver child interactions administered to 28 young children with ASD, ages 2 to 5 years. 

Results:  Correlation analysis shows strong positive correlations between rates of child initiated joint attention in structured (r(26) = .67, p < .01) and unstructured (r(26) = .61, p < .01) play when compared to the ESCS.  Comparison of correlation coefficient rates in a multitrait-multimethod matrix provides evidence of convergent and discriminant validity for measuring joint attention skills during structured and unstructured play. 

Conclusions:  These findings suggest that structured and unstructured play assessments can be utilized as tools to measure child initiated joint attention in children with ASD.  By gathering information from a variety of assessment contexts, researchers and clinicians can be more confident in their assessment of these skills.  Furthermore, being able to validly assess joint attention in unstructured settings can provide researchers and clinicians more flexibility when working with highly impacted or very young individuals.  Overall, these findings provide evidence for an increase in efforts to include more ecologically valid methods of measurement among individuals with ASD.