Characteristics of Joint Attention Episodes In Autism: Initiation, Duration and Termination

Background:  Joint attention in young children is important to later developmental outcomes. Differences in engagement in joint attention are reported for young children with autism, with less joint attention initiating and response behaviours found in staged research situations. Greater understanding of entry into joint attention, and duration and termination characteristics of joint attention in young children with autism in naturalistic situations could inform early intervention and support for individuals on the autism spectrum.

Objectives:  This study analysed early joint attention characteristics in two monozygotic twins, one of whom has a diagnosis of autism, in videoed family situations in the first two years of the children's life. By comparing the joint attention episodes of the two twins in naturalistic situations, the study aimed to reveal possible differences in successful initiation characteristics as well as duration and termination patterns for the twins.

Methods:  Home videotapes of first and second birthday events for the two siblings were analysed retrospectively using specialised software for recording, coding and analysing sequences, frequencies and durations of observed events. Characteristics of initiation, duration and termination of joint attention episodes between the mother and each child were coded and examined.

Results:  A greater number of joint attention bids per minute were made by the mother to the twin with autism in the first year events, although a higher proportion of initiation bids were successful with the child without autism. The most successful types of initiation with the twin with autism were tapping and showing, however, the most successful types of initiation with the twin without autism were verbalization and giving. Overall, a greater number of joint attention episodes were established between the mother and the twin with autism, however, these were of markedly shorter duration than the episodes between the mother and child without autism, with the duration of joint attention episodes for the mother and child with autism being half of that found for the mother and twin without autism. Noticeably, in the first year events, joint attention was always terminated by the child with autism and not the mother, whereas both the mother and the child without autism terminated their joint attention episodes. By the second birthday the mother terminated joint attention with both twins and both twins also terminated their  joint attention episodes.

Conclusions:  The frequency, duration, and termination of joint attention episodes were found to be different for the two twins in this small study, one of whom has a diagnosis of autism. This develops the findings of previous studies, by highlighting that joint attention in natural situations can be frequently engaged in by a child with autism, but that the characteristics of these joint attention episodes differ from those with a child without autism, being initiated differently, considerably shorter and terminated by the child. It is argued that understanding of the differences in characteristics of the successful initiation, duration and termination patterns of joint attention episodes for these infants will help in informing supportive approaches to engaging and sustaining joint attention with young children with autism.