Exploring the Nature of Joint Attention Difficulties In Young Children with Autism Spectrum Disorder and In Siblings

Background: It is generally accepted that joint attention is impaired in children with autism spectrum disorder (ASD). As joint attention skills have repeatedly been demonstrated to relate to the development of language, cognition, social skills and behavioural competence (e.g., Charman et al., 2003; Kasari et al., 2008; Vaughan Van Hecke et al, 2007), a better understanding of this impairment may not only have positive implications for early detection but also for intervention and long-term outcome.

Objectives: A first aim of the current study is to compare young children with ASD, children at risk for ASD (siblings) and typically developing children (TD) in their joint attention skills. Secondly, we want to examine the relationship between joint attention and possible underlying processes such as social preference, understanding of intention and nonsocial attentional skills.

Methods: Participants. 95 children participated: 23 children with ASD of 3 years old, and 20 siblings and 52 typically developing controls who were seen at both 24 and 36 months of age.
Instruments. Attentional skills (e.g., disengaging, shifting) were measured by a visual orienting task and the orientation towards social stimuli was assessed with a visual preference paradigm with social and nonsocial stimuli. Understanding of intentions was studied by observing the behavioural responses of children towards an adult who was either unwilling or unable to give them a toy. Joint attention tasks were partly based on the Early Social Communication Scale (ESCS; Mundy et al., 2003). The Mullen Scales of Early Learning and the ADOS were also administered.

Results: Quality and quantity of joint attention was significantly better in 24 months old siblings and TD children than in 3-year-olds with ASD. Siblings of children with ASD initiated less joint attention than TD children but both groups did not differ on response to joint attention (RJA).
In the ASD group, RJA was significantly related to initiation of joint attention (IJA) while both forms of joint attention skills were not significantly associated in the two other groups. Different associations were found between the possible underlying processes and joint attention skills in the ASD group, compared to the two other groups.

Conclusions: This is the first study that compares joint attention skills and associated processes in young children with ASD and in siblings. The findings indicate that a slightly delayed pathway is characteristic of the broader autism phenotype while no evidence was found for a deviant pathway. Also in children with ASD, a delayed pathway was found, but only for the development of RJA. Concerning IJA skills however, data indicate that children with ASD are not only following a delayed pathway, but also a deviant one compared to that in typical development. Theoretical and clinical implications will be discussed.