An operant approach to teaching joint attention skills to children with autism

A lack of joint attention skills may constitute a core impairment in autism. In the present study, a training protocol was developed, based on the literature on joint attention and on behavioral interventions. The training was organized into a sequence of three main parts respectively aimed at establishing each of the following skills: (1) responding to joint attention bids, (2) engaging in turn‐taking activities based on joint attention skills, and (3) initiating joint attention. Two novel components were incorporated in the training: (a) a discrimination training procedure aimed at establishing the adult's nods as conditioned reinforcers and (b) tasks based on turn‐taking, where joint attention skills were targeted and reinforced. The study was conducted according to a single‐subject experimental design, in which joint attention skills were measured before and after intervention, using the “behavioral assessment of joint attention.” Four 3.5–5.5 year‐old children diagnosed with autism participated in the study. All four children completed the training successfully and made significant progress in engaging in joint attention and in initiating joint attention skills. Following the completion of training and at 1 month follow‐up, parents reported that their children used their skills in different settings. Moreover, at follow‐up, all four children were reported to engage in joint attention behaviors and to enjoy doing so. Copyright © 2009 John Wiley & Sons, Ltd.     

Teaching children with autism to respond to and initiate bids for joint attention

A multiple baseline design across 3 children with autism was used to assess the effects of prompting and social reinforcement to teach participants to respond to an adult's bid for joint attention and to initiate bids for joint attention. Participants were taught to respond to an adult's bid for joint attention by looking in the direction of an object at which the adult pointed, by making a comment about the object, and by looking back at the adult. Additional training and reinforcement were needed to teach the participants to initiate bids for joint attention. Findings are discussed in terms of the social relevance of teaching children with autism to respond to and initiate bids for joint attention.     

Infant responding to joint attention, executive processes, and self-regulation in preschool children

Infant joint attention is related to behavioral and social outcomes, as well as language in childhood. Recent research and theory suggests that the relations between joint attention and social-behavioral outcomes may reflect the role of executive self-regulatory processes in the development of joint attention. To test this hypothesis two studies were conducted. The first, cross-sectional study examined the development of responding to joint attention (RJA) skill in terms of increasing executive efficiency of responding between 9 and 18 months of age. The results indicated that development of RJA was characterized by a decreased latency to shift attention in following another person's gaze and head turn, as well as an increase in the proportion of correct RJA responses exhibited by older infants. The second study examined the longitudinal relations between 12-month measures of responding to joint attention and 36-month attention regulation in a delay of gratification task. The results indicated that responding to joint attention at 12-months was significantly related to children's use of three types of self-regulation behaviors while waiting for a snack reward at 36 months of age. These observations are discussed in light of a developmental theory of attention regulation and joint attention in infancy.     

Development of executive attention in preschool children

The development of self-regulatory systems during the preschool years is accompanied by a dramatic increase in the ability to inhibit actions based on the directions of others. Several tasks have shown evidence of changes in self-regulation during the fourth year of life. The current cross-sectional study used a Simple Simon task, in which 33 3- to 4-year-old children were asked to respond to the command of one large toy animal but not to the command of another. Three important aspects of self-regulation were examined: the ability to inhibit action in the face of conflict, error detection/correction and the use of verbal and physical control strategies. The ability to inhibit a response in this task increased from 22% to 90% between 36 and 48 months of age. Post error slowing of Reaction Time (RT) indicative of error detection emerged at about the same age as successful inhibition. Physical rather than verbal self-regulation strategies were spontaneously employed by children to aid in the process of inhibition.     

Low-level visual attention and its relation to joint attention in autism spectrum disorder

Visual attention is integral to social interaction and is a critical building block for development in other domains (e.g., language). Furthermore, atypical attention (especially joint attention) is one of the earliest markers of autism spectrum disorder (ASD). The current study assesses low-level visual attention and its relation to social attentional processing in youth with ASD and typically developing (TD) youth, aged 7 to 18 years. The findings indicate difficulty overriding incorrect attentional cues in ASD, particularly with non-social (arrow) cues relative to social (face) cues. The findings also show reduced competition in ASD from cues that remain on-screen. Furthermore, social attention, autism severity, and age were all predictors of competing cue processing. The results suggest that individuals with ASD may be biased towards speeded rather than accurate responding, and further, that reduced engagement with visual information may impede responses to visual attentional cues. Once attention is engaged, individuals with ASD appear to interpret directional cues as meaningful. These findings from a controlled, experimental paradigm were mirrored in results from an ecologically valid measure of social attention. Attentional difficulties may be exacerbated during the complex and dynamic experience of actual social interaction. Implications for intervention are discussed.     

Using the ADI-R to diagnose autism in preschool children

The use of an investigator-based interview (Autism Diagnostic Interview—Revised; ADI-R) in the diagnosis of 51 autistic and 43 nonautistic mentally handicapped preschool children of equivalent mental and chronological age is described. Significant differences occurred between the groups on every diagnostic subdomain from the DSM-IV/ICD-10 draft criteria, except specific aspects of stereotyped language, still relatively rare in these young children. All but one of the 51 children judged to be autistic by clinical observation and only two of the 30 nonautistic mentally handicapped children with mental ages of 18 months or higher met criteria for autism on an algorithm to DSM-IV/ICD-10 draft criteria. However, discrimination using domain totals between autistic and the 13 nonautistic, nonverbal mentally handicapped children with mental ages under 18 months was poor. Quality of social overtures to adults and peers, play, and unusual sensory behaviors and mannerisms continued to differentiate these two groups. The relevance of these findings to the diagnosis of autism in preschool children is discussed.     

Early social attention impairments in autism: social orienting, joint attention, and attention to distress

This study investigated social attention impairments in autism (social orienting, joint attention, and attention to another's distress) and their relations to language ability. Three- to four-year-old children with autism spectrum disorder (ASD; n = 72), 3- to 4-year-old developmentally delayed children (n = 34), and 12- to 46-month-old typically developing children (n = 39), matched on mental age, were compared on measures of social orienting, joint attention, and attention to another's distress. Children with autism performed significantly worse than the comparison groups in all of these domains. Combined impairments in joint attention and social orienting were found to best distinguish young children with ASD from those without ASD. Structural equation modeling indicated that joint attention was the best predictor of concurrent language ability. Social orienting and attention to distress were indirectly related to language through their relations with joint attention. These results help to clarify the nature of social attention impairments in autism, offer clues to developmental mechanisms, and suggest targets for early intervention.     

学龄前孤独谱系障碍儿童汉语核心语法的习得

学龄前孤独谱系障碍(Autism Spectrum Disorders; ASD)儿童对语言的习得程度是决定ASD儿童早期科学干预效果和最终预后水平的关键。以往ASD儿童语言研究多局限于英语ASD儿童, 较少有研究探讨不同语种ASD儿童语言习得的普遍机制。本研究拟结合汉语独特的语法属性, 通过多通道优先注视范式眼动实验考察2~5岁ASD儿童汉语核心语法的理解程度, 通过共同注意游戏评估ASD儿童的社会交流能力, 同时分析ASD儿童语言环境中相关语法结构的输入频率。研究旨在通过探讨学龄前ASD儿童的语法习得, 进一步探索人类语言习得的深层机制, 包括探索人类特有的语言机能对包括ASD儿童语言习得在内的人类语言习得的作用, 同时考察社会交流障碍与语言环境对人类语言习得过程的影响。     

Initiation of joint attention and related visual attention processes in infants with autism spectrum disorder: Literature review

Autism spectrum disorder (ASD) represents a group of neurodevelopmental disabilities that can be difficult to identify before the age of 2 or 3 years, the age when the full range of behavioral symptoms has emerged in most cases. Initiation of joint attention is an important developmental function in which impairments are already observable before the second birthday and can predict children’s ASD symptomatology. In the first part of this review, we summarize results pertaining to retrospective studies of initiation of joint attention in children with ASD and prospective studies of infants at high risk for ASD during the first 2 years, when this behavior is becoming more complex in terms of frequency, quality, and variety. We will also discuss the implications of impairments in dyadic engagement, a precursor of joint attention behavior, for the early development of joint attention. Finally, the early development of initiation of joint attention has been related to specific visual attention mechanisms such as social orienting and visual disengagement. In the second part of this review, we provide an overview of the relationship between those visual attention mechanisms and subsequent social-communication impairments. Clinical and research implications of these findings for both early detection and early intervention will be discussed.     

高功能孤独症幼儿空间工作记忆的组块加工缺陷

孤独症谱系障碍者存在空间工作记忆加工缺陷,其具体受损环节尚不明确。组块是一种有效的策略性信息编码方式,是空间工作记忆的关键环节。高度结构化的刺激容易形成高水平组块,因此,刺激结构化程度对记忆效果的影响能够反映个体的组块加工能力。研究采用Sternberg空间工作记忆任务、Corsi空间广度任务,加入刺激结构化因素,考察高功能孤独症幼儿是否存在组块加工缺陷,并探讨组块加工是否直接影响到空间工作记忆容量。实验1采用Sternberg空间工作记忆任务,结果表明,ASD幼儿存在明显的组块加工缺陷。在易于组块的高结构化条件下,健康幼儿的记忆成绩明显较高,而ASD幼儿在高、低结构化条件下的记忆成绩并无显著差异。实验2采用Corsi空间广度任务,结果显示,不论高、低结构化条件,ASD幼儿的空间工作记忆容量均显著低于健康幼儿。但ASD幼儿由于存在组块加工缺陷,在高、低结构化条件下的记忆成绩差异较健康幼儿小。因此,ASD幼儿的组块能力一定程度上影响了空间工作记忆容量。此外,记忆存储器的异常可能也是ASD幼儿空间工作记忆容量不足的重要原因。研究表明,ASD幼儿的空间组块缺陷主要由于弱中央统合的认知风格,他们缺乏自上而下的组块加工动机,难以主动对刺激形成高水平组块编码,从而影响记忆效果。     

Perceptuomotor functioning in preschool children with symptoms of attention deficit hyperactivity disorder

Given limited research on perceptual-motor functioning of preschool children with symptoms of ADHD, the purpose of this study was to compare the fine motor, gross motor, visuomotor, and oral-motor functioning of 49 4- to 6-yr.-old children with symptoms of Attention Deficit Hyperactivity Disorder and 48 typically developing children. Analysis showed scores of the ADHD group were significantly lower than those of the control group on all perceptuomotor measures. In addition, scores on all measures yielded significant correlations with scores on the Hyperactive-Inattentive scale of the Preschool Behavior Questionnaire. Regression analyses indicated that the scores of gross motor and visuomotor functioning were significant predictors of group classification (with and without ADHD). These findings extend the well documented findings of perceptuomotor deficits among school-age children with ADHD into the preschool period and emphasize the importance of early assessment and treatment of these deficits in young children with symptoms of ADHD.     

Joint attention and children with autism: a review of the literature

Preverbal communication and joint attention have long been of interest to researchers and practitioners. Both attending to social partners and sharing attentional focus between objects or events and others precede the onset of a child's first lexicon. In addition, these prelinguistic acts also appear to have important implications with regard to learning to socialize. The construct of joint attention has been noted as an early developing area prior to the transition to symbolic communication. Thus, the importance of joint attention in typically developing children, and the lack thereof in children with autism, has interested researchers for use in diagnosis and intervention for autism. That is, joint attention has been gaining momentum as an area that not only helps characterize children with autism, but also as a prognostic indicator and a potential intervention goal. In this paper, the status of the literature about initiation of joint attention by young typically developing children and young children with autism was examined. Empirical studies regarding joint attention behaviors, including eye gaze alternation, the use of protodeclaratives and protoimperatives, and studies that investigated joint attention as a predictor of language acquisition were reviewed. Possible areas for future research for children with autism are discussed.     

Social stimulation and joint attention in young autistic children

The present study was designed to examine the effects of social stimulation on the joint attention behavior of 20 autistic children under 6 years of age, 20 receptive language-matched Down syndrome children, and 20 receptive language matched-normally-developing infants. Children's social and non-social engagement states were measured during two experimental play sessions and during free play with parent. For all groups, joint attention was increased when adult play behavior closely followed and was contingent on the behavior of the children; however, the autistic children were significantly less responsive to the experimental manipulation than control subjects. In contrast, the autistic children were no less responsive in terms of other forms of social engagement. Results are interpreted as supporting a model of joint attention deficits in autism that involves factors inherent to the disorder in transaction with social context.     

Attention development in infants and preschool children born preterm: a review

A potential mechanism that can explain preterm children's heightened risk for the development of later cognitive and behavioral problems is attention. Attention is the ability of an infant or child to orient to, to shift between and to maintain focus on events, objects, tasks, and problems in the external world, processes which are all dependent on the functioning of attentional networks in the brain. The aim of this paper is to provide a review of the literature on attention development in children born preterm during the first 4 years of life. First, research examining the differences between preterm and full-term children indicates that early attention development in infants born preterm is less optimal and that these differences increase when infants grow into toddlers. Second, studies investigating individual differences within preterm populations reveal the influence of both biological factors and environmental factors. Third, individual differences in early orienting and sustained attention have been shown to be predictive of later attentional, cognitive and behavioral functioning in children born preterm. The importance of long-term follow-up studies, with a focus on individual developmental trajectories in orienting, sustained and executive attention, is emphasized.     

Attention of preschool children: electrodermal activity during auditory stimulation

Electrodermal activity during passive and active listening tasks of 43 healthy preschool children (aged 4 yr., 8 mo. to 6 yr., 5 mo.) was studied. The procedure included the following phases: baseline recording (3 min.), a passive listening task, instructions, and an active listening task. An increase in mean amplitude of skin conductance response (SCR) was found during the active listening task over the level for the passive listening task over 10 trials. On the passive listening task from Trial 1 to Trial 10, habituation of mean SCR amplitude occurred. The younger children, moreover, exhibited significantly greater habituation than the older children. Habituation of mean SCR amplitude did not occur during the active listening task. No significant difference was found in mean SCR amplitude during the active listening task for the two age groups. The children seemed to pay more attention during the active listening task than during the passive listening task. The younger children, moreover, are believed to have shorter attention spans.     

Visual exogenous and endogenous attention and visual memory in preschool children who stutter

PurposeAttention develops gradually from infancy to the preschool years and beyond. Exogenous attention, consisting of automatic responses to salient stimuli, develops in infancy, whereas endogenous attention, or voluntary attention, begins to develop later, in the preschool years. The purpose of this study was to examine (a) exogenous and endogenous attention in young children who stutter (CWS) and children who do not stutter (CWNS) through two conditions of a visual sustained selective attention task, and (b) visual short-term memory (STM) between groups within the context of this task.Method42 CWS and 42 CWNS, ages 3;0–5;5 (years;months), were pair-matched in age, gender (31 males, 11 females per group), and socioeconomic status. Children completed a visual tracking task (Track-It Task; Fisher et al., 2013) requiring sustained selective attention and engaging exogenous and endogenous processes. Following each item, children were asked to recall the item they had tracked, as a memory check.ResultsThe CWS group demonstrated significantly less accuracy in overall tracking and visual memory for the tracked stimuli, compared to the CWNS group. Across groups, the children performed better in sustained selective attention when the target stimuli were more salient (the condition tapping both exogenous and endogenous attention) than when stimuli were less so (the condition tapping primarily endogenous processes).ConclusionsRelative to peers, preschool-age CWS, as a group, display weaknesses in visual sustained selective attention and visual STM.     

A continuous performance task in preschool children: Relations between attention and performance

The continuous performance task is currently used to detect attention disorders in school-age children. However, its use with younger children is problematical, because indices measuring attention indirectly (omissions, commissions, reaction time) may be distorted by difficulties in following instructions: the ability to maintain and manipulate instructions in working memory, and to inhibit inappropriate actions increases with age. In the present research, we adapted such a task for children between 2 years 6months and 5 years 6 months, and recorded visual activity in order to measure directly visual attention and to relate it to performance. Even very young children spend most of the time looking at the screen, but they display poor performances and are unable to re-engage in the task after a gap (2 consecutive omissions). At a medium level (age 3 years 6 months to 4 years) endogenous control of attention increases, children come back to the task, off-task looks shorten and reach the short values observed in older children. After 4 years 6 months no more gaps are observed, the consistency of reaction times shows that a controlled strategy, including shifts from and to the screen, is now adopted. The discussion suggests that only at this upper level do indirect performance indices evaluate attention.