Joint Attention and Social Reciprocity In Mother-Child Interactions: Efficacy of An Early Intervention Approach for ASD and ‘at –Risk' Groups

Background: Joint attention is considered to be a pivotal skill in elucidating developmental trajectories  of young children(e.g. Bakeman & Adamson 1984; Adamson & Bakeman 1991; Mundy & Gomes, 1998), and is a construct facilitated in interactions with parents, and studied extensively in typically developing children (e.g., Adamson, Bakeman & Deckner, 2004; Moore & Dunham, 1995; Tomasello & Farrar, 1986).  However, little systematic research has focused on mother’s strategies to recruit their children’s joint attention  behaviors during dyadic interactions (Adamson, Bakeman & Deckner, 2004), and even less has been discussed in high-risk populations (Bornstein, Hendricks, Haynes & Painter, 2007).

Objectives: This paper examines an early intervention program focused on joint attention and social reciprocity in very young children in mother-child interactions as a potential mediator of resilience in high-risk mother-child dyads for children with autism and those ‘at risk’ for neurodevelopmental delays.

Methods: Two groups of children and their mothers are the focus of this study: those recently diagnosed with autism and young children considered to be ‘at –risk’ due to compromised social-emotional environments.  The specified intervention included targeted interactions to facilitate joint attention based on evidence-based practices.   The home-based intervention was implemented several times a week , and mother-child interactions were videotaped once a week . Maternal behaviors, child behaviors, and dyadic interactions were coded using the Maternal Child and Behavioral Rating Scale (Mahoney, 1988, 1999) which was implemented to assess maternal directiveness, sensitivity, and responsivity of the mother in dyadic interactions, as well as the Dyadic Interaction Coding System Adaptation (Timmer, Zebell, Culver & Urquiza, 2010) which is designed to assess the quality of parent-child interactions through categorization of maternal verbalizations to the child.   This paper focused on the following questions:  (1) Does a targeted joint attention intervention increase maternal sensitivity and reciprocity? ; and  (2) What factors  appear to mediate maternal strategies used in dyadic interactions?

Results: Results revealed an overall increase in maternal scores of sensitivity and responsivity, and a decrease in maternal directiveness. Additionally, observed maternal responsivity had a significant negative correlation with mothers’ reported stress of their child’s adaptability score.  A Wilcoxon Signed Ranks text showed a significant increase in observed child joint attention (z = -2.23, p=.03), a significant increase in the proportion of maternal praise (z= -1.93, p =.05) to their child from the total verbalizations during the mother-child  joint attention contexts, and a significant decrease in the proportion of maternal commands (z = -.77, p=.05) from the pre-intervention to post-intervention assessment.

Conclusions: These findings suggest that relationship-based interventions targeting children’s joint attention with their mothers provides evidence of both direct and indirect effects of the intervention as well positive effects on children’s developmental outcomes.  Overall, joint attention intervention for autism and at-risk populations appears be constructed as a pivotal skill that mediates resilience in the mother-child dyadic interventions. Further, these interventions demonstrate that change in one or two pivotal behaviors appear to be relate to important collateral changes in developmental outcomes(Koegel & Frea, 1993; Koegel, Koegel & Schreibman; Whalen & Schreibman, 2003).