By Tahirih Bushey M.A.C.C.C.
Speech & Language Pathologist
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Joint attention is:
- when two or more people are paying attention to the same thing at the same time and they are aware that they are sharing attention.
- when two or more people are feeling the same emotions at the same time and they are aware that they are sharing the same emotional state.
- when two or more people are trying to accomplish the same thing and they know they are doing it together.
Joint attention requires:
- that a child be able to look at another person's eyes, follow his or her eye-gaze to then look at the same object. See this picture to better understand this aspect of joint attention.
- that the brain be able to both pay attention to one's own behavior and feelings and also pay attention to another person's behavior and feelings. Social play is one of nature's systems for helping children learn to shift attention back and forth between one's self and another person.
- emotional regulation. Even after learning to engage in joint attention in some situations, many internal and external factors may interfere with successfully using this skill. For many children with ASD the problem is that they become emotionally dis-regulated when engaged in joint attention tasks. For all of us, being really angry, scared, nervous, worried, overwhelmed, or sad makes it nearly impossible for us to pay attention to the behavior and feelings of others. Children with ASD find it much harder to regulated their own emotional state. Play is one of nature's systems for helping children learn to regulate their emotional state.
- language and symbolic thinking. But not at first. Early on, joint attention skills are all nonverbal and mostly related to shared emotional states. As children get older and involved in more complex social situations, joint attention is increasingly hard to establish without the tool of language. Social play is one of nature's systems for helping a child learn to share emotions with others and social play is also one of natures systems for learning language skills and symbolic thinking skills.
So, just to be explicit here, social play is a very reasonable system to use if you want to help your child learn to shift attention, share attention, regulate emotions, share emotions, acquire language and develop symbolic thinking. Social play is not the only way your child can learn these skills, but it is hard to find a more pleasurable way for any child to learn these skills.
Establishing reciprocity
Reciprocity is where two people intentionally interact in a back and forth manner, for example, when you call your child and your child; when your child requests a teddy and you provide that toy; when you give your child something to eat and your child refuses that food; when your child comes in crying and you say, AW, HONEY, WHAT HAPPENED?
Initially, it is that hard to establish any form of joint attention with a child with ASD. Sometimes, in the early days of working with a youngster who has a form of autism, I think that all the stars in heaven need to be aligned just right to make joint attention possible. But there are well established strategies that make this possible.
But then the moment happens when child looks straight at me. Or I just feel that our emotions are aligned. The child knows I am there. He or she either likes or does not like what I am doing and then finds a way to communicate that sentiment intentionally and clearly. At that point, we are not only sharing attention, we are in a reciprocal interaction, because I have been waiting for this moment and I am not going to miss that moment and I respond. The reason that you, as a parent want to understand what joint attention and reciprocity are is so that you can be ready and responsive when your child makes that connection.
In a reciprocal interaction...
one person makes a bid for social interaction with some social intent such as greeting, asking, calling, refusing, complaining, commenting. The other person responds in a way that indicates that he or she understands the social intent. This can happen verbally or non-verbaly. And this continues, back and forth so that a conversation is created between two people.
Dr. Stanley Greenspan calls these back and forth interactions circles of communication. In the intervention method associated with Dr. Greenspan, Floortime, the goal is to increase the number of these circles of communication for longer and longer "conversations". Often Speech Pathologist will talk about increasing the number or reasons for communication. If a child only communicated in order to request food and protest in transitions, it is exciting when a child will communicate in order to express emotions, or ask for comfort. While children can often be taught to respond to adult bids for interaction in a pre-determined manner (e.g. Adult says, What color is this? and child responds, correctly, blue) this is not quite social reciprocity, even if it goes on for several turns. Unless your child has a serious interest in discussing the color of things with you, this exchange is not a sharing of social intents. When your child genuinely, intentionally shares information with you, in any manner, you know it. It feels reciprocal. Parents always come to me excited about an unexpected "next level" of reciprocal social interaction. The vocabulary can be all wrong, but if the intent is there, parents are thrilled--and should be!
Reciprocity is not easy to establish with children who have ASD. It is made harder if a child has not yet developed speech and/or language skills. But it is possible to have a conversation without any language at all. It is also possible to talk without being reciprocal. Many of my young friends talk but do not use language well enough to sustain a social interaction so then the problem is in the area of language. In this case, it does help to teach the child more vocabulary and more about how to use language to express ideas. It is a good idea, though, to keep the goal of reciprocity in mind. Teaching a child to use language in some way that has no genuine usefulness to the child (from the child's perspective) is not very good communication therapy. We know that new language is useful to the child if he or she starts spontaneously using the language.
Video Clip Examples
I found video clips of a little sweetie named Henry on You Tube. His parents have posted clips of their games and activities using an RDI approach to intervention. In the first video Henry is having breakfast with his dad. Henry is enjoying the game that he and dad are playing as they eat. No doubt, this game is helping Henry to develop some of the important skills of Joint Attention and Reciprocity.
It is easy to see what Joint Attention and Reciprocity mean watching this clip. Henry seems quite willing but not quite able to sustain joint attention and maintain reciprocity in the game.
I chose the clip to demonstrate what it looks like when children are unable to sustain joint attention well. In this clip we see how Henry’s attention wanders. He does not stay in the interaction because he apparently loses track of the game and the person that he is with even though I am sure Henry loves his dad.
In the second clip, Henry is playing Row, Row, Row Your Boat with his mom.
Henry appears much more able to sustain Joint Attention with mom in this second clip. I think there are many possible reasons for this. However, one reason I feel quite confident suggesting is that the motion of moving in the way Henry was moving during the Rowing game helps him sustain joint attention. Rocking and Swinging are movement patterns that seem to help most children focus and attend.
Furthermore, most children seem more able to sustain attention when singing is involved. A familiar tune seems to help children maintain focus and attention to any task, including a task that involves joint attention.
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