Parenting 101: Joint Attention and children with Autism

¨     Joint Attention is parenting 101, a basic skill for parents to develop with children with Autism as well as typically developing children.

¨     Engage with children. 

¨     Show interest in what they are interested in (within appropriate boundaries, i.e. don’t let your kids have pot parties let alone go with them).

¨     Important for all infants, toddlers, and even teens (spouses too).   (Works much better with teens if you’ve been doing it all along.)

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Effectiveness of Training Parents to Teach Joint Attention in Children with Autism

¨     Parents were trained to increase their joint attention bids using behavior analytic techniques to facilitate appropriate responding.

¨     Parents effectively employed joint attention intervention techniques.

¨     As parent joint attention bids increased, children's responses increased.

¨     Children's joint attention initiations also increased, even though they were not direct targets of intervention.

¨     Findings suggest that parent behaviors during and after intervention impact generalization and maintenance of behavior changes.

¨     http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ767169&ERICExtSearch_SearchType_0=no&accno=EJ767169

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How to Teach/Develop Joint Attention (for children with autism)

The P.L.A.Y. Project and DIR/Floortime provide great instruction and opportunities for developing joint attention.

¨     There are many ways to teach and help a child develop joint attention.

Joint attention training for children with autism using behavior modification procedures

¨     The following target behaviors were included in the intervention:

¨     1) Responding to showing, pointing, and gaze shifting of adult;

¨     2) Coordinated gaze shifting (i.e., coordinated joint

¨     attention); and

¨     3) Pointing (with the purpose of sharing, not requesting).

http://www.thelearninglane.com/documents/jointattention4.pdf

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Something a little different in looking at Joint Attention

¨     Imagine a great magician. 

¨     How do they do it???

¨     One of the keys to a great magician is the ability to Share Attention; however, part of the trick is to get you to Share Attention where they determine.

¨     This is a form of Joint Attention

Whithout shared, directed, joint attention it would be very difficult for many magicians to perform their magic.

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Joint Attention is NOT!

¨     Hand leading (taking  someone by the hand to lead them to an desired object or action i.e. to obtain juice or opening a door).  (There is no communicative intent or shared attention, you are no more than a tool to accomplish the goal.)

¨     Pointing to label (pointing and saying what something is).

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What is Joint Attention?

“Joint Attention is the process of sharing one’s experience of observing an object (person, animal) or event, by following gaze or pointing gestures.
It is critical for social development, language acquisition, cognitive development…”

http://eigsti.psy.uconn.edu/jt_attn.html

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The P.L.A.Y. Project®

While Denver is considered Evidence Based Practice, P.L.A.Y. is considered Emerging Practice, with some good preliminary data showing significant improvements.

P.L.A.Y. is a variation on an Evidence Based Practice DIR®/Floortime™ http://www.icdl.com/dirFloortime/overview/index.shtml

“Parents were encouraged to deliver 15 hours per week of 1:1 interaction.  Pre/post ratings of videotapes by blind raters using the Functional Emotional Assessment Scale (FEAS) showed significant increases … in child subscale scores.  Translated clinically, 45.5 percent of children made good to very good functional developmental progress.  There were no significant differences between parents in the FEAS subscale scores at either pre-or post-intervention and all parents scored at levels suggesting they would be effective in working with their children.  Overall satisfaction with PPHC was 90 percent.  Average cost of intervention was $2500/ year.  Despite important limitations, this pilot study of The PLAY Project Home Consulting model suggests that the model has potential to be a cost-effective intervention for young children with autism.

An in-depth research program of this model is currently in progress and going very well.

http://www.playproject.org/

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The Even Start Denver Model (ESDM) can be considered the best or one of the best researched models, with the best outcomes for young children with autism, to date.

This model is not for every child or every parent

Significant parental involvement is required

The lowest beginning IQ score for any of the children in the model was 35

“Children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis.  Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD:15 points.) Compared with 7.0 points in the comparison group relative to baseline scores.  The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children.  In contrast, over the 2 year span, the comparison group showed greater delays in adaptive behavior.  Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, then the comparison group.”

“ESDM intervention hours were systematically recorded.  Although 20 therapist-delivered intervention hour per week were made available, the actual mean was 15.2 hours(SD: 1.4) because of illnesses, vacations, and so on.  Parents reported spending an average of 16.3 hours/week (SD: 6.2) using the ESDM strategies.  The ESDM group reported an average of 5.2 hours/week (SD: 2.1) in other therapies (e.g. speech therapy, developmental preschool) over the study enrollment period. “

http://pediatrics.aappublications.org/cgi/content/full/125/1/e17

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