Joint Attention Episodes with an Infant - Essay Example

A Review of Joint Attention Episodes with an Infant Observation Ethan is an adorable 11 month old baby. His cherubic face brightens up every time he sees his mother who works as a secretary in an office downtown. On the day I observed Ethan, he was in his mother’s arm, head contently resting on her shoulder. He seemed to be sleepy as I approached him. I smiled at him and he looked at me with a blank face, then he looked away. He turned his head towards his mother’s neck. His mother encouraged him to look at me, and he turned his head back, shyly peeking from his mother’s shoulder. I made faces to try to make him smile, and he just stared at me for a moment. I started making sounds with my mouth and he raised his head, seeming surprised as he looked at my moving mouth. A while later, I saw a small smile curl on his lips. I kept popping my lips and making sounds, and earned a small chuckle from this beautiful baby. His mother kept cooing and encouraging him, as if to tell him that I was safe to interact with. It only took a short time, but I felt good that our interaction was very positive, making me want to see more of Ethan’s awesome smile. What transpired in the interaction between Ethan and me is known as ‘joint attention’. There have been several studies on the topic of joint attention, and several definitions have been formed in relation to the study design. Naoi, Tsuchiya, Yamamoto, Nakamura (2008) broadly define joint attention as the “coordinated and shared attention between two individuals directed at an object or event” (p. 595). Naber, et al (2007) refer to joint attention as a “triadic relation between self, other and object and indicates the earliest behavior of the infant’s awareness of others’ minds” (p. 899). In their view, Naber, et al conclude that manifested early joint attention behaviors are major milestones in child development. Illustrated in simple terms, joint attention does not refer to only one observed behavior but a host of related behaviors such as gaze following; pointing behavior; mutual gazing or joint visual attention; following the direction of the pointing of the speaker; showing an object; giving an appropriate response to a mutually gazed at object; etc. It includes another person joining the individual in attending to an object or event observed. Rocha, Schreibman and Stahmer (2007) categorize joint attention into joint attention initiations or joint attention responses. They claim that joint attention responses develop earlier in the individual than the ability to initiate joint attention bids. As early as 6 months of age, an infant can follow an adult’s direction of eye gaze, and such is evidence of a joint attention response. Later on between 15 to 18 months of age, infants coordinate joint attention by alternating his or her gaze between an object and person while being actively engaged with the object. Naoi, Tsuchiya, Yamamoto, Nakamura (2008) have observed the same classes of joint attention behavior and have aptly termed them as ‘responding to joint attention’ (RJA) and ‘initiating joint attention’ (IJA). They say that IJA behaviors using gaze shift and/or pointing are expected between 9-12 months and refers to this stage as the early phase of joint attention as supported joint attention (SJA). This is so because during this stage, joint attention is mostly facilitated by the child’s caregiver. However, when an infant reaches his or her first birthday, they show gaze shifts that do not need adult support. As the infant develops further, he or she emits various combinations of joint attention behaviors which may include gaze shifting, pointing to an object and eventually, verbalizing. Studies have linked joint attention behaviors to language development. Basic joint attention (BJA) behaviors such as pointing out objects to others and checking others’ gaze direction have been argued to be particularly related to both expressive and receptive language (Naber, et al, 2007). These are pre-linguistic gestures that may later be translated to simple verbalizations. For example, pointing out to an object in infancy may progress to be accompanied by words such as “Want that” when the infant learns how to talk. Behaviors associated with basic joint attention such as following pointing or looking in the point of direction of speaker; showing an object; taking and giving an object; and responding to one’s name develop after the basic attention behaviors are manifested and are referred to as ‘associated joint attention’ (AJA) (Naber et al, 2007). It must be clarified that the alternating of attention between an object and a person is not always considered “joint attention”. Tomasello (1995) contends that it is only considered such when the child is concerned with the adult’s attention to the object. However, in basic joint attention (BJA), understanding the other’s intention is of no importance to the child. On the other hand, checking behavior and follow pointing behavior will not be possible if the other’s intention is not properly understood. Thus, these behaviors indicate awareness and exhibit the ‘shared attention mechanism’ between the child and the adult. With Ethan, the first time he turned his head from me was his voluntary reaction. However, when his mother encouraged him to look at me, there was understanding of his mother’s intent, and so, he followed her and looked back at me. At that point, mother and son were engaged in a shared attention mechanism, with me as the object of their attention. Colombi, et al (2009) suggest that sharing intentions to reach a common goal (in this case, for both mother and Ethan to look at me), is first manifested by infants as early as 9 months. This involves a coordinated visual attention between two people on an object or event (me). This is considered shared intentionality. Engaging Ethan in joint attention might not have been as successful had his mother not been around. Naber et al (2007) theorize that secure infant-parent attachment relationships lead to interactive competence (Thompson, 1999), while insecure and disorganized attachments reflect poor interactive competence. This is explained by the fact that joint attention skills begin developing during the first year of life when infants spend most of their time with their mothers. The study of Naber et al (2007) found that children with secure attachment relationships displayed more BJA and AJA as compared to children without secure attachment relationships. Slaughter, Peterson & Carpenter (2008) identified two types of maternal references used on influencing their infants’ mental states. One is imperatives where in mothers ordered or requested their babies on what to do, like telling him to “Look at that!” or “Please give me some”. Another reference is the declaratives where in mothers labeled, described or commented on their infant’s current mental state. An example would be “You are looking at her, you’re smiling now!”. It was observed that mothers mostly used imperatives, but maternal talk is reasoned to be most effective in explaining to the infant his mental state during the ongoing experience. Declarative statements have a learning advantage for the infant’s language development as maternal talk that responds to rather than directs infants’ focus of attention is more effective in word-learning (Slaughter, Peterson & Carpenter, 2008). Ethan’s mother was observed to be using a soothing voice in nudging her little one to interact with me. She used both imperative and declarative statements which he responded to non-verbally. When I approached them and Ethan was resting his head on his mother’s shoulder and seemed uncooperative at first, his mother asked him without looking at him, “Are you sleepy, baby?” Then, she spoke intermittently, “Someone wants to play with you.”… “Go on.”….. “Look at her.”….. “It’s ok” Slaughter, Peterson & Carpenter (2008) likewise found in their study that mothers used more declarative references when they wanted their infants to focus on something or the mothers’ tendencies to label or comment on their infants’ perceptual states. This declined after the infants engage in the visual attention himself. Observation 2 My next interaction with Ethan was more reflective of joint attention. I brought with me a toy, which when pressed, makes various sounds. Again, his first reaction to me was seeming disinterest, and even a beginning scowl as he tried to place where he saw me last. However, when I brought out the colorful toy, it immediately grabbed his attention. He was hesitant to touch it until his caregiver at the children’s centre said it was alright. Ethan’s chubby fingers tentatively explored the toy, but could not find the button that made a sound since he was not yet familiar with the toy and what it could do. I had to show him where it is by pressing it. He was surprised at the sound it made. Later on, he imitated my action and produced the sound on the toy himself. I was seeing that he was delighted with the toy. He repeatedly tapped on the button which responded to his every touch. I took turns with him and gave him cues as to when his turn goes. Again, I was rewarded by seeing his bedimpled smile. Colombi et al (2009) posit that imitation plays a fundamental role in the child development. It provides mutual connectedness and shared social experiences (Meltzoff, 2005; Trevarthen et al., 1999). Non-verbal imitation involves a child intentionally imitating another’s action which constitutes a shared experience between them. This eventually leads to the acquisition of cooperative coordinated actions in the future. Cooperation needs two or more individuals to share the same intention to reach a common goal, and in our case, Ethan and I both pressed the button to create a sound from the toy. At first, he just observed what I did, he imitated it, and went on to cooperate with me as I encouraged him to take turns with me in our play. Joint Attention and Autism Children with Autism are often compared to infants in terms of their attention, social and communication development. Whalen, Schreibman & Ingersoll (2006) agree that there is considerable evidence that children with autism possess impairments in their symbolic and pretend play which are related to deficits in joint attention abilities. This similarity with infants is one baseline why most research studies on joint attention have infants and autistic children as participants. Children with autism show deficits in imitative abilities. Because imitation is fundamental to the development of more mature socio-emotional skills, it is now studied thoroughly with the aim of understanding its role in autism. Colombi et al (2009) identify another area of impairment in autism, and that is in joint attention. During joint attention the child’s attention becomes divided and alternated between the communicative partner and an object. Such alternation involves a characteristic that most children with autism lack: eye contact (Bruinsma, Koegel and Koegel, 2004). Mundy et al (1986) conducted a study which suggested that behaviors of children with autism were most atypical in the category of initiation of joint attention behaviors because they engaged significantly less in eye contact with the examiner to share enjoyment of a toy, compared to both typical children and the children with mental retardation. Interestingly, there was no difference between the three groups in terms of eye contact after physical social play such as tickling. This suggests that these activities engage children with autism with higher levels of eye contact and social engagement. Bruinsma, Koegel and Koegel (2004) also note that pointing, one of the joint attention behaviors, is something children with autism engage in, although not with the same level seen in typically developing children. Children with autism do referential pointing, as in pointing to something in a book. It is not of the social nature of pointing. They can produce and understand photoimperative (to request for an object) pointing to some extent, but photodeclarative (to comment on an object) pointing is severely impaired, if not absent. There have been several behavioral interventions for children with autism designed to improve language, play, imitation and social behaviors. However, only a few have attempted to teach joint attention behaviors. Whalen, Schreibman & Ingersoll ( 2006) conducted a study to test the hypothesis that teaching joint attention may lead to collateral gains in other skills. They used long baselines (2-10 weeks) to show that significant changes were unlikely to be attributed to developmental maturation alone, but if joint attention intervention strategies were implemented, collateral changes in language, play and social behaviors are likely to be produced. Their study provides support to the theory that joint attention is linked to the development of other behaviors. In relation to this, Rocha, Schreibman and Stahmer (2007) proposed that parents are key factors in targeting the social communication skills of joint attention of their children with autism. They suggest that a parent-implemented model of intervention will support families in facilitating their child’s development. These intervention models create an enriched, responsive environment that provide cost-effective, intensive intervention options for families of children with autism. Because they can be done at home, it decreases the number of services that remove the child from the home to avail of it elsewhere. Thus, it increases the time of the child in his natural environment. Naoi, Tsuchiya, Yamamoto, Nakamura (2008) agree that joint attention behaviors such as gaze shifting between the social partner and the object and pointing toward the object can be learned effectively. These targeted behaviors may likewise be generalized to unstructured settings and are likely to be encouraged by reinforcers such as verbal praise. Hence, parents of children with autism may effectively be trained in helping them develop such skill since the children are more likely to initiate joint attention with them. For example, when a child’s gaze shifts between an event of interest (i.e. an airplane flying in the sky) and a familiar adult (his mother), the child may be immediately reinforced by the presence of the adult. She may mediate events to maintain initiated joint attention of the child, like comment on the airplane or simply smile at the interesting sight. To relate cooperative behavior of typically developing children and children with autism, Tomasello et al (2005) proposed that the ability to cooperate develops during the first two years of the typically-developing child’s life. The complementary process of understanding other person’s intentions intertwines with the sharing of intentions and experiences with others. This happens naturally in usual interactions between the toddlers and their parents. However, in the case of children with autism, Tomasello et al (2005) hypothesize that there are impairments in cooperation skills due to their inability to share intentions and experiences with others despite their ability to understand intentions. This characterizes the communication deficits often observed in children with autism. Sally and Hill (2006) go on to suggest that the cooperative deficit in autism is the result of a lack of understanding the mental states of others, including their intentions. Reflection It is interesting to note that my observations with an eleven-month old infant could be similar to a child with autism far older than Ethan is. Even then, Ethan’s typical development may easily be more rewarding in terms of his responses. A child with autism may be a challenge to engage joint attention with due to his impairment in imitation, attention, cooperation and communication skills. However, getting through that seemingly impenetrable wall would be worth it. Children with autism are known to exist in their own worlds, and only letting some chosen people in. The close bond I have observed between Ethan and his mother, and her ability to encourage him to interact with me was very inspirational. Coming in as a stranger and engaging the infant in joint attention may be intimidating for him. The presence of a significant person in his life provided him with the security to come out of his shell and give me attention. My second visit was very different from the first one since his mother was not around and I brought with me an object which I expected we could share. True enough, joint attention was elicited by the toy, but more than that, the interaction progressed into imitation and cooperation, capping it off with his sweet, happy smile. All this happened within a few minutes. I wonder how long it would take with a child with autism, or if it is even possible to go through the same process I have gone with Ethan. From the literature, I think establishing eye contact with a child with autism, even for just a moment, would already be a breakthrough. Joint attention involves a host of behaviors and factors for it to happen. Externally, a number of behaviors manifest joint attention such as gazing at the same object, pointing, giving and taking and talking about it, etc. Internally, it entails an understanding of each other’s perspective, intention and experience. I believe that the concept of joint attention is similar to Vygotsky’s concept of intersubjectivity. Vygotsky (1978) posited that children’s intellectual development is influenced more by social context than by individual experiences. His theory places a great deal of emphasis on effective social interaction. Interactions are likely to go through a process called intersubjectivity. This is when two people begin from different understandings but with interaction, comes to an agreed, shared understanding. Joint attention is a human process that ensures connectedness among people. It can become a gateway to communication, understanding and unlimited learning. It is worthwhile to develop the skill in joint attention engagement as early as in infancy and most especially with children with attention deficiencies. References Bruinsma, Y., Koegel, R., & Koegel, L. (2004). ‘Joint attention and children with autism: A review of the literature’. Mental Retardation & Developmental Disabilities Research Reviews, 10(3), 169-175. Retrieved September 9, 2009, doi:10.1002/mrdd.20036 Colombi C., Liebal K., Tomasello M., Young G., Warneken F. & Rogers S. J. (2009) ‘Examining correlates of cooperation in autism: Imitation, joint attention and understanding intentions’. Autism, 13(2), 143-163. Retrieved September 6, 2009, doi: 10.1177/1362361308098514 Meltzoff, A.N. (2005) ‘Imitation and Other Minds: The ‘“Like Me” Hypothesis’, in S . Hurley & N. Chater (eds) Perspectives on Imitation: From Cognitive Neuroscience to Social Science, pp. 55–77. Cambridge, MA: MIT Press. Mundy P, Sigman M, Ungerer J, et al. 1986. Defining the social deficits of autism: The contribution of non-verbal communication measures. Journal of Child Psychology Psychiatry 27:657– 669. Naber F., Swinkels S., Buitelaar J., Deitz C., Daalen E., Bakermans-Kranenbburg M., IJzendoorn M. & Engeland H. (2007). ‘Joint attention and attachment in toddlers with autism’. Journal of Abnormal Child Psychology, 35(6), 899-911. Retreived September 5, 2009, doi: 10.1007/s10802-007-9142-3 Naoi N., Tsuchiya R., Yamamoto J. & Nakamura K. (2008). ‘Functional training for initiating joint attention in children with autism’. Research in Developmental Disabilities, 29(6), pp. 595-609. Rocha M. L., Schreibman L. &Stahmer A. C. (2007). ‘Effectiveness of training parents to teach joint attention in children with autism’. Journal of Early Intervention, 29(2), 154-172. Retrieved September 7, 2009, doi: 10.1177/105381510702900207 Sally, D. & Hill, E . (2006) ‘The Development of Interpersonal Strategy: Autism, Theory-of-Mind, Cooperation and Fairness’, Journal of Economic Psychology 27 (1): 73–97. Slaughter V., Peterson C. C. & Carpenter M. (2008). ‘Maternal talk about mental states and the emergence of joint visual attention’. Infancy, 30(6), 640- 659. Retrieved on September 9, 2009. doi: 10.1080/15250000802458807 Thompson, R. A. (1999). Early attachment and later development. In J. Cassidy&P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (pp. 265–286). New York: Guilford. Tomasello, M. (1995). Joint attention as social cognition. In C. Moore & P. J. Dunham (Eds.), Joint attention; its origins and role in development (pp. 103–130). Hillsdale, NJ: Erlbaum. Tomasello, M. , Carpenter, M. , Behne, T. & Moll, H. (2005) ‘Understanding and Sharing Intentions: The Ontogeny and Phylogeny of Cultural Cognition’, Behavioral and Brain Sciences 28: 675–735. Trevarthen, C. , Kokkinaki , T. & Fiamenghi, G.O. (1999) ‘What Infants’ Imitations Communicate: With Mothers, with Fathers and with Peers’, in J. Nade L. & G. But T Erworth (eds) Imitation in Infancy, pp. 127–85. Cambridge: Cambridge University Press. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press. Whalen, C., & Schreibman, L. (2003). ‘Joint attention training for children with autism using behavior modification procedures’. Journal of Child Psychology & Psychiatry & Allied Disciplines, 44(3), 456-468. Retrieved September 9, 2009, from Psychology and Behavioral Sciences Collection database. Read More