February 2018 Topic Training

National Therapy CenterSpeech Therapy • Occupational Therapy • ABA Therapy

Write it down: How would you define joint attention?

An early emerging social communication skill involving sharing interest in an object, event, or person with a social partner (Mundy, Delgado, Block, Venezia, Hogan, Seibert, 2003).

There are two main types of JA: ◦ Responding Joint Attention

◦ Initiating Joint Attention

Responding Joint Attention Initiating Joint Attention

Visually track objects or people Pointing at something amusing

Look at somebody making a noise Making a silly face or sound at a caregiver

Attends to a toy with caregiver

What happens when children do not demonstrate these skills? Or when they demonstrate these skills and then lose them?

Check for medical causes (parsimonious approach): hearing or vision?Assess for developmental delays or disorders (i.e., autism)

Why is lack of Joint Attention a concern?

Adapted from Critical Issues in Joint Attention Rhonda Davin, Ph.D., BCBA-D

Deficits in JA have been associated with issues in communication development

Associated with issues in social skills development, particularly to take another’s perspective

Imitation ◦ Humans acquire most skills through imitation

◦ Imitation requires that we learn from someone else

Adapted from Critical Issues in Joint Attention Rhonda Davin, Ph.D., BCBA-D

Does the child respond to an interesting stimulus in their direct line of sight?

Does the child respond to an interesting stimulus somewhat removed from their location?

Does the child respond to their name at all?

Does the child respond to their name while engaged in another activity?

Does this child ever attempt to show, point, or lead another person to something interesting at all?

Adapted from Critical Issues in Joint Attention Rhonda Davin, Ph.D., BCBA-D

Current Level of JA Treatment

Has responding and initiating joint attention

Great, move them along in a verbal behavior program!

Has responding and some or no initiating JA

Great, focus on getting the child to make eye contact, give objects, pointing

Has some fleeting responding and/or initiating JA

Work on fluent responding through imitation tasks and fluent responding to the tasks listed above

Has no responding or no initiating JA

Start with “put in” tasks, very simple motor imitation tasks, and give tasks

Adapted from Critical Issues in Joint Attention Rhonda Davin, Ph.D., BCBA-D

3 Primary Tasks of Joint Attention

◦ Eye Gaze

◦ Imitation

◦ Pointing

The strategies we use to teach joint attention are primarily focused on motivation and reinforcement.

Reminder: motivation (and reinforcers) change!

Establishing & Abolishing Operations

Establish adults as generalized reinforcers

Vary stimuli

Provide choice

Child-centered play

◦ Follow Child’s Lead & Comment

◦ Imitation

◦ Animation

◦ Communicative Temptations

◦ Playful Obstruction

Part of building social motivation for JA necessitates establishing the value, for the child, of interacting with the joint attention partner

Establishing an adult as a generalized reinforcer involves repeatedly pairing the presence of the adult with a wide variety of highly preferred reinforcers

Procedurally, this involves having the adult partner dispense a variety of the child’s most preferred reinforcers, such as foods and activities, intermittently over time, and on a regular basis

Ultimately, the adult becomes the SD for reinforcement

Vary preferred/interesting, novel, and salient materials and events

Rotate toys (this is a good tip to tell the caregivers of your kiddos!)

Use child-chosen and/or child-preferred materials for instruction of joint attention

In this strategy, you allow the child to choose the toy or activity. You follow their motivation. Research shows that children engage in more appropriate social and play behaviors are less disruptive when they choose the activity than when the adult does. This is true even when the adult selects an activity the child enjoys!

Let the Child Choose the Activity

Stay Face to Face with the Child

Join in Child’s Play

Comment on Play, but Don’t Ask Questions or Give Commands◦ Why do we limit demands?

Wait for Your Child to Engage or Communicate with You

Be Sensitive, but Persistent

Control the Situation ◦ You are still responsible for monitoring challenging

behaviors!

Do what the child does: Imitating a child’s vocalizations helps develop spontaneous language and vocalizations, as well as develop play skills

Imitate Play with Toys

Imitate Gestures and Body Movements

Imitate Vocalizations

Only Imitate Appropriate Behavior

By being highly animated, you can make interactions more fun and motivating for the child. Animation can increase the child’s engagement and increase interest in the activity.

Be Excited About the Activity Exaggerate Gestures Exaggerate Facial Expressions Exaggerate Vocal Quality Use Attention-Getting Devices Wait with Anticipation

Set up situations in which the child wants something that involves you

In Sight & Out of Reach

Control Access

Assistance

Inadequate Portions

Sabotage

Protest

Silly Situations

Interrupt the child’s play in a playful manner

Four steps: 1) Always use the same brief phrase in advance to warn the child something is going to happen 2) Present a Playful Obstruction 3) Wait for Your Child to Engage or Communicate 4) Respond to Your Child’s Communication

Anticipatory phrases ◦ “Here I come” ◦ “Stop….anddd…goo!!”◦ “Ready….set…”

Comfy laps do not typically support JA due to lack of access to adult eye contact, facial cues, gestures, etc.

Problem Solve: What about children with physical development needs? How can you physically support them AND create opportunities for access to joint attention opportunities?

Joint attention is the foundation for all learning

Joint attention skills are often deficient or non-existent in children with autism

Joint attention can be taught and reinforced

The failure to address joint attention needs sets the stage for communication related behavior issues and slow learning of other skills

What JA strategies will you incorporate in your sessions?