Children diagnosed with autism have deficits in social skills, and specifically that of joint attention. Joint attention refers to the shared focus of two individuals on an object (Wikipedia), and the synchronizing of attention between two or more persons (Per Holth, 2006). Some other definitions in the literature are:
- Joint attention means the simultaneous engagement of two or more individuals in mental focus on one and the same external thing (Baldwin, 1995)
- Joint attention is looking where someone else is looking (Sigman and Kasari, 1995)
- Joint attention involves knowing that another person is looking at and experiencing something in the visual word (Bruner, 1995)
For example – Billy is with his dad and sees an airplane in the sky. He looks at his dad, points to the airplane, his dad then looks at the airplane too, and Billy and his dad make eye contact and smile at each other. People engage in joint attention for the sole purpose of sharing an event or object with another person (i.e., the reinforcer is social!)
Joint attention is a crucial skill for children to develop. Research has linked joint attention to future development of skills, including symbolic abilities, language abilities, and general social-cognitive processes. Joint attention is an essential foundation skill and holds the potential of a significant breakthrough in interventions for children with autism (Per Holth, 2006).
To begin teaching joint attention, we must start with eye contact. Our children need to look at us not only in order to get something they want, but because eye contact with us and attention from us is a reinforcer in and of itself. Some of our children learn this naturally; however sometimes we need to use specific joint attention procedures to condition eye contact and social attention as reinforcers.
In his 2006 article An Operant Analysis of Joint Attention Skills, Per Holth describes different teaching procedures to establish joint attention skills. The Social Referencing protocol is described below and is an excellent first step in conditioning our eye contact as a reinforcer.
Adult and child should be sitting across from each other at a table or on the floor. A preferred edible should be placed in between the adult and child. The correct response is for the child to sit with his/her hands down and make eye contact with the adult. The adult should wait up to 10 seconds (during which the child and adult are continuing to make eye contact) and then smile and nod. Immediately following the smile and nod, the child should take the preferred item.
If the child reaches for the item before establishing eye contact or before the adult nods and smiles, the adult should physically block the child from taking the item. In addition, if the child does not immediately take the item following the nod and smile, the adult should physically prompt the child to get the item.
Other variations and ways to generalize this protocol include: putting up to 10 different edibles out at once; generalizing to play areas with other toys (e.g., there are a bunch of cars in front of you for the race track and the child needs to look at you and wait for your nod and smile before he can pick which one to play with); and to introduce a head shake as no before you nod so the child starts to discriminate the non-vocal gestures for no versus yes.
By using this protocol, you are conditioning eye contact, as well as the non-vocal cues of smiling and nodding, as conditioned transitive motivating operations (CMO-T’s) in accessing a primary reinforcer. Simply put, the child wants the edible; he/she cannot get the edible until he/she looks at you; you are not looking at him/her; he/she needs to get you to look at him/her = making eye contact with you becomes a reinforcer!
Have a question about this protocol or have a success story about using joint attention procedures? Please comment below, and stay tuned for future blogs on more ways to teach joint attention!