Joint Attention in Autism - Essay Example

?Introduction “She had such pretty-hazel eyes with long curly eyelashes, finely tapered eyebrows, flaxen coloured curls and a sweet yet ‘far-away’ expression. I hoped against hope that all would eventually go well, and that she was just a slow starter” (Frith, U, 2003,1). The above extract comes from a mother’s letter; we can see how a child with autism is described by a person who is unfamiliar with the image of people with ASD. Autism is a development disorder that is characterized by a significant disturbance of social development (Mundy, 1995). The expression ‘’far-away’’, with which the child is characterized, describes perfectly the lack of social interaction that people have with autism. This is one of the reasons why children with autism may be referred to as ‘aloof’ or ‘withdrawn’ as they appear disinterested in the world around them (Wall, 2004, 5). Other behavioural aspects that show the existence of autism are avoidance of eye contact, lack of desire to interact or play with other children or adults, lack of desire to establish relationships and friendships, inability to interpret people’s feelings and emotions, lack of verbal and non-verbal social communication as well as some restricted repertoire activities. One of the factors that prove to be problematic while handling social behaviour of children with autism is ‘joint attention’. It can be described as the process by which one alerts another about any observation via nonverbal means such as gazing or pointing (Wikipedia). Impairment in joint attention is common in every person with autism and thus it is considered as a fundamental area that needs to be studied in depth. Joint attention in typical development In the early years of their lives, infants of typical development are capable only of involuntary signals; a thing that is similar to what other animals do that have limited social behaviour themselves. From an evolutionary point of view, behaviour exists for communication purposes as the older, more mature and cognitively developed people are able to interpret them correctly and therefore understand the children’s needs. But unlike other animals, human infants’ communication skills improve very quickly. They tend to develop new cognitive capacities that enable them to extract socially relevant information from the voices, faces and gestures of other people (Slater, Lewis, 2002, 264). After the first year of their lives, the infants develop rapidly in a cognitive level while leaving behind the limited capacities he used to have. He gets one step closer to a fully developed human being who is able to understand the intentions of others through their behaviour. During this period, the infants quickly learn the procedure of understanding other people’s mind through specific procedures. First they look into their mother’s eyes with delight and follow the direction of her gaze for information. Then, it has been observed that the children smile in response to their mother’s voice in order to get her attention. Finally, the infants babble syllables; using words symbolically to get people’s attention and influence their behaviour. Not after the first year will the ability of understanding other’s thoughts develop in the child. The mind reading ability, which distinguishes humans from other animals, develops gradually over the first year. This ability is spotted first within the non-verbal communication (gaze, gesture- in other words joint attention) of the children and then, it is manifested more clearly in the child’s ability to speak and understand language. Joint attention in autism Recent studies have shown that children with autism cannot initiate joint attention skills; a thing that is called ‘joint attention deficit’. It is described as ‘a lack of spontaneous seeking to share enjoyment, interests or achievements with other people’ (American Psychiatric Association, 1995, p.72). Specifically, there are two different functions that joint attention behaviours seem to serve; imperative triadic and declarative triadic exchanges. Imperative triadic exchanges serve as a requesting function and declarative triadic exchanges serve to share awareness or the experience of an object or event. Children with autism are impaired in the development of both imperative and declarative acts but impairments in latter are more severe. However, joint attention is not completely absent in children with autism. Researches indicate that even though some children (particularly those with low verbal mental age) cannot follow the gaze and head direction activities of others but older and verbally high-functioning children with autism are significantly better at this. Regarding this matter, a research was conducted by Ben Robins, Paul Dickerson, Penny Stribling and Kerstin Dautenhahn in 2004. The goal of the research was to examine whether there exists joint attention within a child’s behaviour. The results showed that children’s spontaneous reactions were embedded with joint attention skills but even then they did not initiate joint attention by themselves. During the trials of this study, the researchers used a robot as a salient object which attracted the children’s attention. The children reacted in a spontaneous way, interacting with an adult-experimenter. The reactions of the children were recorded and presented in the form of transcripts and photo stills. After being analyzed by Conversation Analysis (CA), they were characterized as reciprocal. Even though, we cannot be sure if the robot mediated joint attention or whether we would have had the same results using something else as a salient object, the results can be characterized as reliable. However, bigger sample would increase the level of reliability of the research since only 3 participants took part in this qualitative research. Apart from this study, there are other inquiries that aimed to examine whether there exists joint attention within children with autism. Many of those researches resulted in positive outcomes and there are also many interventions made in order to improve joint attention; the outcomes of which are mentioned later in my paper. Joint attention plays a crucial role in the early development of autism Children with autism display specific types of disturbances in the development of social behaviour and social-cognitive skills. Studies have shown that autism results from a neurological disturbance and the cause of this may involve an ‘integrated system running from the brain stem through the midbrain to anterior portions of the cortex’ ( ). A recent research demonstrates another view of the functional neuropathology of autism; it suggests that there may be a neurological system involving frontal processes in association with midbrain neuroanatomical and neurochemical processes. This specifically exerts execution influence over social stimulus approach behaviours ( ). It is also suggested that children with autism are not able to effectively initiate positive social behaviours and that the early attenuation of this tendency effects the interactions that are necessary for social-cognitive capacities in a negative way. Thus, it can be deduced that there is a connection between deficits in early social-emotional approach behaviours, such as joint attention bids, and with social-cognitive disturbances in children with autism. These deficits within the social behaviour of young children need to be examined closely. The best way of studying a child’s behaviour is through the notes that parents maintain during the growth of their child. With reference to parental reports of early symptoms between 12 and 18 months, some abnormalities have been spotted in sensory, motor, repetitive and stereotyped behaviours. This fact is one of the highly witnessed characteristics of autism. However, most studies state undeniable proofs of autism as the social and communication impairments; in particular, joint attention behaviours such as eye contact, gaze monitoring and response to name. Home videos were examined to observe the children who were diagnosed with autism. The home videos contained the time period before the diagnosis of autism. This endeavour provided valuable observations about their behaviour in their early years of age. Home videos are valuable sources of evidence that show the children’s impairments during social interaction, lack of social smile and facial expression, hypotonia and poor attention. Home videos further show that children with autism tend to ignore people, prefer to stay alone, avoid eye contact and show lack of appropriate gestures. These observations have been noticed in their second year of age. A study was conducted that examined home videos taken on first birthday parties. It was found that children with autism were unwilling to look at others, to show an object or point to objects and to orient to their name. It is also submitted that abnormalities in orientation to visual stimuli, aversion to touch and delayed response to name have been characterized as indications of autism. These indications have been noticed in as early as at the first nine months of the child’s life. Other things that prove the significance of joint attention for the early development of autism are the outcomes of studies that have examined cases using screening instruments. Lack of gaze monitoring as well as lack of pointing interest was found in the subjects. These things were found in combination with an absence of simple pretend games at 18 months of age. These findings are concrete proofs of the existence of autism. Moreover, the matter of discovering an association between joint attention in the pre-school years and language, social development in the later years, is something that has been examined thoroughly in the past. It was found in a study conducted by Mundy et al. study (1990) that joint attention behaviours were associated with language ability 12 months later than usual. This finding was a result of measurement at 45 months. Social interaction, requesting behaviour, IQ and language abilities were not associated with language at follow-up. Sigman and Ruskin (1999) found that response to joint attention bids measured at the initial time period was associated with gain in expressive language at the age of 12. Further, joint attention behaviours that were measured at 4 years of age were also associated with social and peer group behaviours (Sigman and Ruskin 1999). Finally, Stone and Yoder (2001) reported a similar association between early joint attention ability and expressive language ability from 2 to 4 years of age. All these sources of evidence suggest that joint attention plays a critical role in the early development of autism. Impairments in joint attention behaviours are among the earliest abnormalities noticed in autism. It becomes apparent around the end of the first year of the child’s life. Screening instruments, that assess joint attention behaviours, can identify some cases of autism. Individual differences in joint attention ability relate to later language and social outcomes over time-periods as long as 8 years. Joint attention behaviours are what psycho-educational approaches are working on and trying to plan early interventions. This does not mean that joint attention impairments ‘cause’ autism. However, it does suggest that joint attention is a critical ‘downstream’ effect of earlier brain psychopathology. What remains to be understood now, is why the development of joint attention skills is impaired in individuals with autism and the mechanisms by which joint attention behaviours are related to later outcomes. Hopefully, further studies will give answers to these questions. Interventions in joint attention in autism Joint attention is very strongly connected to autism; research has shown that the impairment is unique in autism since children with other disabilities do not show such deficits. The impairment in joint attention is also a characteristic of the majority of children with autism. It is only found in joint attention behaviour; it is not found in other aspects like object requesting or social interactions. All of these findings indicate the immense need of practicing interventions in joint attention and early intervention. Early intervention is given more importance since research indicates that early intervention becomes more and more important and needs to be implemented as soon as possible to have maximum effect on each child. To ensure successful results, intervention needs to be able to a) predict which child will need what type and intensity of treatment for any particular developmental behaviours and b) intervene as early as possible, particularly with respect to salient areas of development. Unfortunately, neither of these key intervention elements has been adequately addressed so far. Few studies have been conducted on interventions that have aimed at ameliorating joint attention. The probable reason for this is the abstract nature of the skills that have to be taught or the uncertain capability of children to learn skills concerned with joint attention. There are four areas on which the effectiveness of the interventions is depended. The first aspect is about the ability to teach joint attention which concerns the content of interventions for young children with autism. The second aspect concerns the way one should go about teaching this skill. In other words, the most effective approach should be found to teach children to engage them in joint attention. Once this has been taught to the child, it remains to be seen if the skill will be generalized into the child’s repertoire so that it becomes apparent when the child interacts with different partners and objects in a variety of settings (e.g. home, school). The third aspect is concerned with the child/family characteristics that affect the outcomes of the intervention, in other words, the child and environmental characteristics that are usually overlooked. The final aspect centers on how we know when an intervention has been successful. According to Casari, Freeman and Paparella, who did research on intervention in joint attention as well as in symbolic play; there are two types of interventions that have generally been conducted. The first aims to change the environment of a child and the second type of intervention targets the specific skills of the child, for example, improvements in pointing. Two studies have been carried out in order to improve joint attention in children with autism and both aimed to change the child’s environment. In both studies, joint attention skills were improved. However, in the second one, language was improved as well. As for the conclusions of the intervention, it has been shown that a) joint attention as well as symbolic play skills can be improved in children with autism, b) other, non-targeted joint attention and symbolic play skills do not change and c) both joint attention and symbolic play interventions are associated with improved language skills. These findings provide us with great help for the direct teaching of joint attention and symbolic play skills to young children with autism. Future studies should be conducted to examine several other issues, such as examine a bigger number of children. Secondly, we need to be able to chart change more effectively. Yet, it is not clear to us as to which point indicates the success of an intervention and which one marks the loss of the effect of the intervention. Finally, the outcome measures should be carefully linked to the treatment goals that have been set. If, for example, the intervention is focused on social skills, then our outcome measures should relate to social development in some way. All in all, our knowledge and practice of intervention with young children with autism will benefit from future studies that examine the process more closely and investigate the outcome of intervention efforts with individual children. These endeavours will enable us to help children with autism more effectively. Moreover, another intervention study was conducted by Kassari, Freeman and Paparella that is concerned with joint attention and symbolic play in young children with autism. 58 diagnosed children were invited to participate from the age bracket of 3 and 4 years. They were randomly put in a joint attention intervention, a symbolic play intervention and a control group. As a result, the children from both intervention groups showed greater improvement as compared to the control group. The children that took part in the joint attention intervention initiated more ‘showing and responsiveness to joint attention on the structured joint attention assessment and more children initiated joint attention in the mother-child interaction.’ (Casari, Freeman ,Paparella). On the other hand, the children that participated in the play group showed more diverse types of symbolic play during the interaction with their mothers. What is worth mentioning from this study, are the three main findings: - In the question whether joint attention and play skills can be taught to children with autism, the answer is ‘yes’, since there was significant improvement in the behaviour of children that participated in the intervention groups compared to the children of the control group. Children in the joint attention group showed more eagerness to interact and showed greater improvement in responding to joint attention. However, children in the play group showed greater diversity of playing skills (Casari, Freeman, Paparella). Moreover, effect sizes were large; a fact that confirms the efficacy of the treatments. - The second finding was that children were able to generalize the learned skills when playing with their mothers who were not the ones that provided the treatment. During the playing with their mothers, children in the joint attention intervention showed more child-initiated joint attention. Whereas, children in the play intervention showed more novel types of symbolic play and increased play levels. Both treatment groups were significantly different from the control group of children, and again effect sizes were large. - The last finding concerns the specificity of the interventions. Most studies in autism research have not compared one treatment to another or one approach to another. It is recommended that this should be researched in the future. From the two interventions described, we can see that the results converge; this proves high level of reliability of the studies. It is also clear that intervention has only positive effects that should be considered seriously. An important observation has been that many pre-school children with autism who undergo intensive behavioural treatment for a substantial period of time, exhibit significant IQ gains. This shows how important early intervention is and how essential it is for teachers whose work is the inclusion of children with autism in a classroom of children with typical development. It is important for them to use intervention techniques in their own classroom. In other words, the importance of the application of the techniques in the schools cannot be stressed more. Educational implications During the inclusion of a child with autism in a classroom of typical development children, a teacher should follow different types of teaching techniques depending on the severity of the autism. It should be understood that ASD is a spectrum and every child is an individual case. Every child with autism might have to be treated differently. Thus, low-functioning children should be taught with specific teaching approaches that provide the children with clear stimuli and direct enhancement during their inclusion; the clearer the stimuli for the child, the better he/she will perform the task. On the other hand high-functioning children should be taught with incidental teaching approaches, which is closer to the teaching of children of typical development. I shall use a hypothetical task to make this clear. If, for example, there is a task of teaching the colour ‘red’ to a young child with autism, then the teacher should provide the child with many stimuli- i.e. red toys and should ask him/her: ‘’Show me red’’. If the child doesn’t respond in a correct way the teacher should help the child perform the task and ask the same thing again and again until the child responds correctly. This is the case of discrete trial. If, on the other hand, the child seems to respond quite well to the task at the first time, then incidental way of teaching should be used. For example, if the child brings a red bowl with his/her food in it and the teacher asks the child to ‘’show red’’, then the child should get the food only when the child responds correctly to the assigned task. In other words, the food will be used as a reward for doing the task correctly. Generally, during the inclusion of children with autism in classrooms of typical development children, the first step should be to encourage them to participate in activities that include joint attention efficacy. This will help them to gradually improve at doing the task. I will give random examples that happen during a class, for example, a) the child should be encouraged to look at the board when the teacher asks for everyone’s attention, b) he/she should look at a classmate’s drawing when a group of people do so, c) he/she should also be encouraged to look at the classmate who is reading something aloud in the class d) draw the other’s attention on something that he/she has made. The way and intensity of intervention depends on the severity of the case. Usually, in the first sessions the teacher should help the child to a great extent such they would actually do the task together. Another approach can be to provide the child with the social backup that he might need. Gradually, the teacher should reduce the help while giving even greater reinforcement until the help stops and the child performs the task on his/her own. These teaching approaches should be used by teachers who work with applied behaviour analysis, which is a technique based on the principles of behaviourism. The above mentioned scenarios are examples that give ways of how joint attention can be ameliorated in a school context, and of course other techniques could and should be used, based on the severity, case, time and space given. Conclusion From the conducted research, we can deduce that joint attention is a very important function of human behaviour; the deficit of which is closely connected to autism. Since the deficit is found in a young child with autism, during the first years of his life, early intervention is not only desirable but also indispensable. It is also considered to be amongst the urgent actions that are advised to be performed. It can dramatically alter the quality of the child’s life. After the diagnosis has been made, parents and families need advice and guidance from experts in order to proceed as soon as possible to early intervention. Immediate action is necessary because as time goes by the difficulties get worse and become harder to address. What has been characteristically mentioned by a parent of a child with autism is: ‘’Early intervention is the single most important concept in treating autism’’, which underlies the importance of this task. It is therefore clear that parents and teachers need access to information that will give them a range of approaches available for their child. It will enable them to begin constructive strategies that could be based, for example, on playtime which is without a doubt a very effective way of learning. These strategies should be planned as early as possible and should contain interests on which the child is more successful to concentrate. Even though results may not be immediate, however, the gradual progress will reward not only the children but also the teachers and parents who will see the child being ‘’transformed’’ into a new person. With their correct actions, he/she shall be able to do many new things that they could have never imagined. Read More