Joint Attention

Is your child not looking when someone says, ‘look at that!’?

Is your child:

  • In his own world?
  • Failing to pay attention to others?
  • Looking away when someone points something out?
  • Seeming to ignore other kids or adults?
  • Not focusing long enough to enjoy playing with or talking to other kids?
  • Looking in a different direction than others?
  • Seeing something exciting but forgetting to invite others to look as well?
  • Not understanding cues in the social environment?

LET'S TALK ABOUT IT

If your child seems to be in his or her own world, there may be an attention problem. Psychologists call the ability to pay attention to other people ‘joint attention.’ Joint attention is the most basic and perhaps the most important social skill of all. A child has to be able to pay attention to other people in order to learn from them or make friends with them.

Essentially, all social learning skills build on one another and joint attention is the cornerstone. Joint attention is the most fundamental and critical social skill of all.

Some children seem to be in their own world and do not invite others to attend to items of interest. Similarly, some children do not respond when others’ behaviors suggest that something interesting is happening.

These children might communicate to ask for what they want but not for pure social enjoyment. Children who are socializing only to meet their own needs are likely to struggle socially and in school. If your child does not share attention with others, this lack of joint attention might indicate concerns about his or her social development.

CLINICAL DESCRIPTION

Clinically, joint attention is the procedure of engaging and changing attention for social interaction.

Joint Attention has two parts, which are 1) initiating and 2) responding.

At the park, a child who references an ice cream truck’s arrival, then looks at mom, smiles and jumps, is initiating joint attention. At a birthday party, a child who turns and pays attention to a princess character because another child began to look at the doorway with enthusiasm is responding to joint attention.

Initiating joint attention has three parts aligned for the purpose of social connection, as follows:

1) noticing an object of interest

2) changing attention to another person

3) changing attention back to the object

For example, a child is initiating joint attention with their parent if they see a bunny in a field, look back at their parent, and then look back to the bunny while pointing.

A child watching a window washer who dropped in front of window without using gesture or gaze to alert his parents is not initiating joint attention. A more typical response would be, ‘Look mom, a window washer is out there!’ This is an attempt at engaging the parent in the child’s point of view. Initiating joint attention is essentially, ‘inviting you to join the child’s world.’

Responding to joint attention has the following two parts:

1) noticing another person’s attention/interest by following the gaze or point of another person, and

2) following their gaze or point to an object of interest

For example, students who follow the direction of a teacher’s point in a museum are responding to joint attention. A child who does not turn to look at the doorway when all her peers excitedly notice a clown entering the room is not responding to joint attention.

A more appropriate response would be “Yeah, I see it,” said with some sort of gleeful expression. Joint attention is the most basic and generally considered the most important social skill. We simply cannot learn how to socialize if we aren’t paying attention.

“Because joint attention is particularly salient to learning language and social skills, deficits in joint attention can have a profound impact” (Linder, 2008, p.317) [3].

Lack of initiation and lack of response to joint attention are common in Autism Spectrum Disorders (ASD) and Attachment Disorders. Challenges with joint attention may also occur in the context of Attention Deficit Hyperactivity Disorder (ADHD). In this case, the child would have trouble paying attention in lots of different settings and situations.

Challenges with joint attention may be secondary to these other aspects of attention. It will be important to consider what can be done to help your child engage socially as well as remain on task within the learning and social environments.

WHAT TO DO IF YOUR CHILD DOES NOT PAY ATTENTION TO YOU

If you are wondering about your child’s ability to initiate or respond to joint attention, it will be important to have your child tested through a pscyhological evaluation. If your child’s struggles are significant, treatment is likely needed.

These skills need to be taught for many children with ASD or with ADHD. An ABA therapist can work with your child to model and teach both initiating and responding to joint attention. A therapist can provide direct support, at the child’s current level, to teach these skills step-by-step. This therapist can work to reinforce social engagement and can thus increase a desired behavior like socially responding or initiating.

Simply stated, a therapist can help your child learn how to get people’s attention and learn how to pay attention to you.

For example, if your child wants a cookie off of the top shelf, an ABA therapist would require your child to appropriately get his or her attention before responding. The therapist may give the child the language to get attention and make requests. For example, “Excuse me, can you help me get that cookie down?”

Certainly, this same type of modeling can be done by parents at home. The need for a therapist depends on the intensity of the behavior and how receptive the child is to learning new techniques.

An ABA therapist can teach parents how to work on these skills in between sessions as well. ABA therapy is often covered by insurance if your child is diagnosed with an Autism Spectrum Disorder. Similarly, a number of medication interventions and behavioral interventions can help a child diagnosed with ADHD.

SIMILAR SYMPTOMS

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

  • Selective, Shifting or Sustaining Attention (Focusing): difficulty with attention may occur in a number of different domains of attention
  • Executive Functions (Organizing): difficulties related to planning, sequencing, and organizing information may go hand in hand with attention challenges
  • Processing Speed: difficulties with fluency in cognitive processing. A child may not encode information if he or she is unable to pay attention.
  • Social skills problems (Socializing): difficulty engaging in flexible back and forth communication and building social connections

POTENTIAL DISABILITIES

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

  • ADHD: attention deficits can cause social challenges because the first step of joint attention is noticing someone else. You may be less likely to see kids have trouble with the response to joint attention (paying attention to someone else) and more challenges with initiating instead (taking the time to get someone else’s attention). These children tend to simply run impulsively to the item of interest without thinking about inviting others to join them
  • Autism Spectrum Disorder: deficits in social communication and social reciprocity. Joint attention fosters social interaction and is defined by a child’s engagement in response to an invitation from another person (ability to pay attention to someone else) or a child’s initiation of a social interaction by directing another’s attention to something of interest (ability to get someone else’s attention). Many children with autism lack the skill of joint attention and this can be a hallmark symptom of the disorder
  • PTSD or Attachment: deficits in attention can be related to trauma. Individuals who have experienced something traumatic, including poor or inconsistent care, may appear to avoid social interactions and therefore may not invite others to attend to objects of interest or fearfully not respond to bids for joint attention from others

WHERE TO GO FOR HELP

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

  • CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
  • Psychologist or Neuropsychologist: to consider an evaluation for diagnostic clarification
  • Developmental Pediatrician: This pediatrician specializes in children with developmental concerns and can help guide behavioral and medical treatment.
  • Psychotherapist: CBT/play-based therapy interventions have been shown to be effective in helping children with ASD make gains in recognizing and understanding emotions, improving perspective taking and social skills
  • ABA Therapist: Applied Behavior Analysis uses principals of reinforcement to increase desired behaviors like communication, social interaction and language and to decrease undesired behaviors like ignoring and withdrawal

These professionals may recommend or administer the following tests for this symptom:

  • ADOS-2: for the assessment of social communication and joint attention to be administered to rule in or out the presence of an Autism Spectrum Disorder. Getting this diagnosis early opens doors for funding via insurance or Medicaid waivers. The ADOS gives information that can guide the formation of treatment goals.
  • Play-based Observation: for the assessment of development and social skills [3]
  • TOVA (or other continuous performance test): for the assessment of attention

LEARN MORE

[1] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

[2] Autism Speaks: https://www.autismspeaks.org/science/science-news/do-you-see-what-i-see

[3] Linder Ed.D., Toni & Petersen-Smith Ph.D., Ann (2008) Administration Guide for TPBA2 & TPBI2 (Play-Based Tpba, Tpbi, Tpbc). Paul H. Brookes, Inc. Amazon:

https://www.amazon.com/Administration-Guide-TPBA2-TPBI2-Play-Based/dp/1557668736/ref=sr_1_1?ie=UTF8&qid=1479080269&sr=8-1&keywords=TPBA

[4] Barkley, Russell A. (2013). Taking charge of ADHD, 3rd edition: The complete, authoritative guide for parents.

Amazon: https://www.amazon.com/Taking-Charge-ADHD-Third-Authoritative/dp/1462507891/

[5] Giler, Janet Z. (2011). Socially ADDept: Teaching social skills to children with ADHD, LD, and Asperger’s.

Amazon: https://www.amazon.com/Socially-ADDept-Teaching-Children-Aspergers/dp/047059683X/

Image Credit:
Description Boy and girl during summer time
Stock Photo ID: #49756697 (Dreamstime)
By: Bigandt
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Previously Licensed on: September 25, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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