Teaching Individuals Diagnosed with Autism to Recruit Social Interaction: Initiating Joint Attention

Background: Individuals diagnosed with autism and other pervasive developmental disorders often lack appropriate skills for initiating social interaction. Specifically, such individuals may not spontaneously initiate sharing enjoyment, interests, or achievements with other people and display marked impairments in gestures used to regulate social interaction (Diagnostic and Statistical Manual of Mental Disorders, 4^th Ed. Revised, APA, 2003). These types of skills are often referred to as initiating joint attention skills.  Previous research has examined treatment packages that have resulted in increases in joint attention following years of intensive intervention.  Other research has specifically examined procedures to improve components of joint attention with individuals displaying low levels of initiating joint attention and responding to bids for joint attention.  Less research is available examining specific procedures to teach joint attention initiation skills in children with autism who do not exhibit the skill.

Objectives: The current study sought to examine treatment procedures aimed at increasing verbal and gestural joint attention initiation skills in children with autism.

Methods: Three boys and one girl diagnosed with autism between the ages of 3 and 9 years participated in the current study.  All four participants were included in the present study because they were never observed to initiate joint attention in the form of recruiting attention or sharing interests with others.  A pre-assessment was conducted in which 10 opportunities to initiate joint attention were embedded in a naturalistic language instruction session.  Following the pre-assessment, treatment was initiated in which each participant was taught to show a completed project to a therapist or family member by vocally requesting “look” or “look what I did” and showing the item to the other person.  Each trial consisted of having the child complete a leisure activity such as drawing a picture, completing a maze, or completing a puzzle.  Once completed, vocal and physical prompts were provided to teach the response.  Once independent responding was observed the distance between the therapist and the child was lengthened requiring the child to seek out social interaction from further distances.  Additionally, a post-assessment of joint attention initiations during naturalistic teaching was conducted. 

Results: None of the four participants engaged in correct responding during the pre-assessment or baseline. Following treatment, all four participants began recruiting social attention from others vocally and by showing the completed project.  All four participants continued to initiate joint attention in a more naturalistic setting and when tangible reinforcement was removed.

Conclusions: This study provides a simple treatment procedure that can used to teach social interaction and social initiation skills to children with autism.