Two to Ten Years: Developmental Trajectories of Joint Attention in Children With ASD Who Received Targeted Social Communication Interventions

Abstract

Lay Abstract This study follows 40 children who were participants in a randomized controlled early intervention trial (Kasari et al., 2006, 2008, 2012) from early childhood (2–5 years of age) to elementary school age (8–10 years). The growth trajectories of social-communication and language outcomes in these children were estimated based on 5 time points during that period. The children were grouped by diagnosis at the last follow-up (Autism, ASD, No Diagnosis) and by their original treatment group assignment (Joint attention, Symbolic Play, Control), and differences between these groups evaluated. Results showed that joint attention skills of coordinated joint looking and showing increased over time and pointing to share interest increased over the first year measured and decreased thereafter. These trajectories were influenced by both original treatment assignment and diagnostic status at the follow-up. In addition, a cross-lagged panel analysis suggests a causal relationship between early pointing and later language development. This study highlights the longitudinal and developmental importance of measures of early core deficits in autism and suggests that both treatment and ASD symptomatology may influence growth in these skills over time. Scientific Abstract This study follows 40 children who were participants in a randomized controlled early intervention trial (Kasari et al., 2006, 2008, 2012) from early childhood (2–5 years of age) to elementary school age (8–10 years). To fully utilize the available longitudinal data, the general linear mixed model (GLMM) was the primary analytical approach. The growth trajectories of joint attention skills (pointing, coordinated joint looking and showing) and expressive language outcomes in these children were estimated based on 5 time points during the measurement period. The children were grouped by diagnosis at the last follow-up (Autism, ASD, No Diagnosis) and by their original treatment group assignment (Joint Attention, Symbolic Play, Control), and differences between these groups evaluated. Results showed that joint attention skills of coordinated joint looking and showing increased over time and pointing to share interest increased over the first year measured and decreased thereafter. These trajectories were influenced by both original treatment assignment and diagnostic status at the follow-up. In addition, a cross-lagged panel analysis revealed a causal relationship between early pointing and later language development. This study highlights the longitudinal and developmental importance of measures of early core deficits in autism and suggests that both treatment and ASD symptomatology may influence growth in these skills over time.

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

“…Treatment effects included more frequent IJA in children aged 21–60 months with teachers and joint engagement with parents (Kaale et al, 2012). The importance of targeting joint attention in EI is highlighted by Gulsrud, Hellemann, Freeman, and Kasari’s (2014) 6-year follow-up of a sub-sample of preschoolers who had received EIBI only or EIBI supplemented with a brief intervention targeting either joint-attention or play (Kasari et al, 2006). The most rapid growth in frequency of triadic gaze and showing behaviour, and most significant expressive language gains, were observed in children who had received the intervention targeting joint attention.…”

Can Computer-Assisted Training of Prerequisite Motor Skills Help Enable Communication in People with Autism?

“…Technological interventions targeting more low-level skills, such as attentional gaze [77], have shown some suggestive results. A recent study [70] investigating the effect of training joint attention skills also yielded promising results. These data suggest that in children with ASC, early pointing could have a causal effect on expressive language development, and illustrate the importance of therapeutic interventions targeting specific gestural and attentional skills early in development.…”

“…Easy-to-use tablet-based technologies have advantage for users with motor impairments, and can also allow interventions targeted at younger children. Early interventions heighten impact on intelligence and communicative skills in later life [70]. However, few technology-based teaching methods have yet managed to generalise 'in-game' skills to real-life situations.…”

Life Course Health Development in Autism Spectrum Disorders

“…Gillespie-Lynch and colleagues also suggested examining the relationship with responsiveness to joint attention and early executive functioning in childhood on later outcomes given that executive functioning is related to adaptive functioning in children with autism (Gilotty et al 2012). Gulsrud et al (2014) examined the developmental trajectories of specific joint attention gestures (i.e., pointing, showing, coordinated joint looking) and expressive language over a 6-year period and found that coordinated joint looking and showing increased over time and pointing to share interest increased over the preschool years (3-5 years of age) and then decreased. They also reported a causal relationship between early pointing and later language development; that is, those children with high rates of pointing in the preschool years had better expressive language skills later.…”

“…Participation in the joint attention treatment placed these children on a different developmental trajectory. This highlights that "what" you target and "when" you intervene are important (Gulsrud et al 2014). …”