Infant joint attention skill and preschool behavioral outcomes in at-risk children

Early symptoms of autism spectrum disorder (ASD) in 1-8 year old children with sex chromosome trisomies (XXX, XXY, XYY), and the predictive value of joint attention

The objective of the present study is to investigate the impact of Sex Chromosome Trisomy (SCT; XXX, XXY, XYY) on the early appearance of Autism Spectrum Disorder (ASD) symptoms, and the predictive value of Joint Attention for symptoms of ASD. SCTs are specific genetic conditions that may serve as naturalistic 'at risk' models of neurodevelopment, as they are associated with increased risk for neurobehavioral vulnerabilities. A group of 82 children with SCT (aged 1-8 years) was included at baseline of this longitudinal study. Joint Attention was measured at baseline with structured behavior observations according to the Early Social Communication Scales. ASD symptoms were assessed with the Modified Checklist for Autism in Toddlers questionnaire and Autism Diagnostic Interview-Revised in a 1-year follow-up. Recruitment and assessment took place in the Netherlands and in the United States. The results demonstrate that ASD symptoms were substantially higher in children with SCT compared to the general population, with 22% of our cohort at clinical risk for ASD, especially in the domain of social interaction and communication. Second, a predictive value of Joint Attention was found for ASD symptoms at 1-year follow-up. In this cohort, no differences were found between karyotype-subtypes. In conclusion, from a very early age, SCT can be associated with an increased risk for vulnerabilities in adaptive social functioning. These findings show a neurodevelopmental impact of the extra X or Y chromosome on social adaptive development associated with risk for ASD already from early childhood onward. These findings advocate for close monitoring and early (preventive) support, aimed to optimize social development of young children with SCT.

Responding to joint attention as a developmental catalyst: Longitudinal associations with language and social responsiveness

Joint attention (JA), infants' ability to engage in triadic attention with another person and a separate object or event, emerges in infancy. Responding to joint attention (RJA) develops earlier than initiating joint attention (IJA) and may benefit from a reconceptualization from a competence to a skill that varies in performance. Investigating associations between RJA performance and important skills of toddlerhood such as language, social responsiveness, and executive function (EF) in typically developing samples can better elucidate how RJA may serve as a developmental precursor to later dimensional skills, with implications for both typical and atypical development. Here, 210 (82% White) infants completed the Dimensional Joint Attention Assessment (DJAA), a naturalistic play-based assessment of RJA, at 8-15 months. At 16-38 months social responsiveness, verbal ability, and EF were assessed. Multilevel models showed that DJAA scores were associated with later verbal abilities and parent-reported social responsiveness. Exploratory analyses showed trend-level associations between RJA and EF. Results establish the content validity of the DJAA as a measure of RJA, and longitudinal associations with later verbal ability and social responsiveness. Future work should examine EF emergence and consolidation, and RJA and later EF associations.

Exploring development of infant gaze, affect, and object exploration in a primarily Latino sample

Infants demonstrate rapid development across the first years of life, which underlies increased human interactions that promote social-emotional development. In particular, gaze, affect, and object exploration are early indicators of engagement and show rapid changes in the first year of life. However, current understanding on developmental trajectories during infancy often comes from majority white, non-Hispanic/Latino samples. This longitudinal study explored the development of infant gaze, affect, and object exploration across 2-18 months of age in a sample of primarily Latino infants drawn from a pediatric community clinic. Videos of mother-infant play when infants were 2, 6, 9, 12 and 18 months were coded for durations of three types of behaviors: gaze, affect, and object exploration. Additionally, mother-infant play videos when the infant was 24 months of age were coded for joint engagement. Descriptive statistics for the three behavior types were obtained at each timepoint, and repeated measures analysis of covariance investigated the development of behaviors from timepoint to timepoint. Latent growth curve analyses were conducted to analyze developmental trajectories of capacities across 2-18 months, as well as development in relation to joint engagement at 24 months. Results indicate an important development period from 2 to 6 months of infants' life, unique developmental patterns of specific behaviors, and heterogeneity in gaze development in the sample and across ages. Overall, this study provides an important description of development within mother-infant play in a primarily Latino sample.

The Origins of Theory of Mind in Infant Social Cognition: Investigating Longitudinal Pathways from Intention Understanding and Joint Attention to Preschool Theory of Mind

A growing body of literature has established longitudinal associations between key social cognitive capacities emerging in infancy and children's subsequent theory of mind. However, existing work is limited by modest sample sizes, narrow infant measures, and theory of mind assessments with restricted variability and generalizability. The current study aimed to extend this literature by (a) recruiting a large sample of participants (n = 116; 53 boys; 63 girls; all U.S. residents; 88 White, 8 Hispanic or Latino, 2 Black or African American, 14 two or more races/ethnicities, 4 unknown; median family income: $74-122,000), (b) examining multiple measures of infant social cognition (intentional action understanding, responding to joint attention, initiating joint attention) at Time 1 (8-12 months), and (c) using an ecologically valid theory of mind assessment designed to capture individual differences in preschoolers' mental state understanding (the Children's Social Understanding Scale; Tahiroglu et al., 2014) at Time 2 (37-45 months). Measured variable path analysis revealed a significant longitudinal association between infants' initiating joint attention and later theory of mind: infants who engaged in more attempts to initiate joint attention with experimenters through gaze alternation or gestures went on to show better parent-reported mental state understanding as preschoolers. Notably, the paths from infants' responding to joint attention and intentional action understanding to later theory of mind did not emerge as significant. These findings bolster and clarify existing claims about how mental state reasoning is rooted in foundational social-cognitive capacities emerging in infancy.

RJAfinder: An automated tool for quantification of responding to joint attention behaviors in autism spectrum disorder using eye tracking data

Deficits in responding to joint attention (RJA) are early symptoms of autism spectrum disorder (ASD). Currently, no automated tools exist for identifying and quantifying RJA behaviors. A few eye tracking studies have investigated RJA in ASD children but have produced conflicting results. In addition, little is known about the trajectory of RJA development through developmental age. Here, a new video was designed including 12 clips of an actor pointing to or looking at an object. Eye tracking technology was used to monitor RJA in three groups: 143 ASD children assessed with the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) (4-7 years old), 113 age- and gender-matched typically developing children (TDC), and 43 typically developing adults (TDA) (19-32 years old). RJAfinder was developed in R and MATLAB to quantify RJA events from the eye tracking data. RJA events were compared among the three groups. Spearman correlation coefficients between total number of RJA events in ASD and the Social Responsiveness Scale (SRS) scores were calculated. A logistic regression model was built using the average valid sampling rate and the total number of RJA events as two predictive variables to classify ASD and TDC groups. ASD children displayed statistically significantly less RJA events than the TDC and TDA groups with medium-to-large-sized effects. ASD and TDC children both displayed more RJA events in response to pointing stimuli than to looking stimuli. Our logistic regression model predicted ASD tendency with 0.76 accuracy in the testing set. RJA ability improved more slowly between the ages of 4-7 years old in the ASD group than in the TDC group. In ASD children, RJA ability showed negative correlation with SRS total T-score as well as the scores of five subdomains. Our study provides an automated tool for quantifying RJA and insights for the study of RJA in ASD children, which may help improve ASD screening, subtyping, and behavior interventions.

Infants' object interactions are long and complex during everyday joint engagement

As infants interact with the object world, they generate rich information about object properties and functions. Much of infant learning unfolds in the presence of caregivers, who talk about and act on the objects of infant play. Does mother joint engagement correspond to real-time changes in the complexity and duration of infant object interactions? We observed thirty-eight mothers and their first-born infants (cross-sectional, 13, 18, and 23 months) during 2 hours of everyday activity as infants freely navigated their home environments. Behavioral coding explored thousands of infant object interactions within and outside mother joint engagement. Object interactions involving exclusively simple play were shorter than complex play bouts. Critically, mothers' multimodal input (i.e., touching/gesturing toward and talking about the focal object) corresponded with more complex and longer play bouts than when mothers provided no input. Bouts involving complex play and multimodal input lasted 7.5 times longer than simple play bouts absent mother input. Moreover, "action-orienting talk" (e.g., "Twist it", "Feed dolly"), rather than talk per se, corresponded with longer bout duration and complexity. Notably, the association between joint engagement and play duration was not a function of mothers having more time to join. Analyses that eliminated short infant bouts and considered the timing of mothers' behaviors confirmed that mother input "extended" the duration of play bouts. As infants actively explore their environments, their object interactions change moment to moment in the presence of mothers' multimodal engagement. RESEARCH HIGHLIGHTS Mothers and infants were videorecorded for 2 hours at home; researchers coded infants' object interactions and mothers' behaviors (verbal, manual) toward the focal object. Mothers' multimodal joint engagement (i.e., coordinated manual and verbal input) was associated with long and complex infant object interactions. The pragmatics of mothers' talk-namely action-orienting language-related to the duration and complexity of infant object bouts beyond talk per se. Infants' object interactions change in complexity and duration in line with maternal joint engagement, indicating potential mechanisms of real-time learning. This article is protected by copyright. All rights reserved.

Construction of a tool for assessment of joint attention in Egyptian Cairene children

Background

Joint attention (JA) is a basic social communicative skill important for language development. JA deficits appear prior to language acquisition. Because autism is often not diagnosed until a child is three or four years of age, it is important to look for indicators prior to language acquisition such as JA to provide appropriate treatment at a younger age. Therefore, the aim of this study is to construct an objective tool for assessment of joint attention skills in young Egyptian children to detect the presence of autistic behaviour in high-risk children in order to conduct plans for early intervention. The questionnaire was constructed to assess the five main components of JA and was termed Egyptian Joint Attention Questionnaire. The questions were formulated in the colloquial Egyptian Arabic language and in an ‘easy-to understand’ design that would be comprehensible by mothers. No question was directly translated from another questionnaire. Ten typically developing (TD) children, with an age range of 18–54 months, were included in the pilot study of the test design. It was applied to 90 TD children and 30 autistic children (contrast group) within the same age range. Participant's responses were statistically analysed to assess the validity and reliability of the questionnaire and to compare the responses related to TD children and autistic children.

Results

There was high internal consistency and reliability of the questionnaire (Cronbach’s α = 0.9, Intra-class correlation = .776), with a statistically significant difference between TD and autistic children (P < 0.001).

Conclusions

The questionnaire is a valid and reliable assessment tool that could be used in early detection of autistic Egyptian children.

A longitudinal study of the differential social-cognitive foundations of early prosocial behaviors

A growing body of work has documented the emergence of instrumental helping and sharing in the second year of life; however, less is known about mechanisms that underlie development and production of prosocial behavior. The current study took a longitudinal approach to explore whether the origins of prosocial behaviors can be traced back to foundational social-cognitive capacities emerging in infancy. In a sample of 90 children, longitudinal relations were examined between intention understanding and joint attention measured in infancy (8-12 months) and later instrumental helping and sharing behavior assessed in the toddler years (18-25 months). We expected social-cognitive capacities supporting infants' understanding of others to be positively related to their prosocial behaviors as toddlers. Measured variable path analyses revealed two distinct developmental pathways from infant social cognition to later prosocial behavior: 1) Instrumental helping in the toddler years was positively predicted by intention understanding in infancy; 2) sharing in the toddler years was positively predicted by infants' initiating joint attention. These results lend support to proposals on the multidimensional nature of early prosocial behavior and offer the first longitudinal evidence that the origins of toddlers' prosocial behavior can be traced to social-cognitive capacities emerging in infancy.

Differences in Established Joint Attention in Hearing-Hearing and Hearing-Deaf Mother-Child Dyads: Associations With Social Competence, Settings, and Tasks

The authors examined relations among observed joint attention, maternal report of child's social competence, setting (home vs. laboratory), task (unstructured vs. semi-structured), and dyad type [hearing mother-hearing child (n = 55, M_age  = 25.8 months) vs. hearing mother-deaf child (n = 27, M_age  = 26.9 months)]. Hearing child dyads scored higher on joint attention during unstructured tasks, especially in their home environment. Hearing child dyads displayed similar joint attention to deaf toddler dyads when they engaged in a semi-structured task, but higher on these measures during unstructured free play. Unlike hearing children, joint attention was differentially related to social competence in deaf children, with relatively higher versus lower social competence depending on relatively high versus low observed joint attention, respectively.

Joint attention abilities in Brazilian preterm and full-term infants

Joint attention abilities of preterm and full-term Brazilian infants were assessed at 12- and 18-months, age corrected for prematurity. Results showed that preterm infants displayed significantly lower levels of correct responses to others' bids for joint attention at both time-points, compared to full-term infants. Both groups improved their responding to joint attention from 12 to 18 months of age. Contrastingly, prematurity did not impact infants' initiating joint attention behaviors, which remained stable over time for both groups. Findings were discussed in terms of the specific mental processes involved in distinct behavioural dimensions of joint attention.

Mother-child behavioral and physiological synchrony

The interactive, give and take "dance" that highlights the synchrony between parents and young infants during social interaction occurs at the behavioral as well as the physiological level. These dyadic processes seen across infancy and early childhood appear to contribute to children's development of self-regulation and general socio-emotional outcomes. The focus of this chapter is on dyadic synchrony, the temporal coordination of social behaviors and the associated physiology. Research on behavioral, brain, and cardiac synchrony is reviewed within a bio-behavioral synchrony model. Tutorials for analyzing these types of complex social interaction data are noted.

Individual differences, social attention, and the history of the social motivation hypotheses of autism

The stereotype of people with autism as unresponsive or uninterested in other people was prominent in the 1980s. However, this view of autism has steadily given way to recognition of important individual differences in the social-emotional development of affected people and a more precise understanding of the possible role social motivation has in their early development.

Developmental changes in infants' and mothers' pathways to achieving joint attention episodes

Combining the joint attention approaches of Mundy and colleagues' (2007) experimental coding of infants' specific initiating and responding acts and of Bakeman and Adamson's (1986) descriptions of both infants' and mothers' behaviors during joint engagement, this study examined 29 infants' and mothers' initiatives and responses leading to success in achieving joint attention (JA) episodes during naturalistic interactions when infants were 13 and 17 months old. Analyses revealed developmental changes in initiative frequencies and in the origins of JA episodes. At 13 months, although infants' less sophisticated object-only initiatives (IObj) were most frequent, JA episodes most often originated in maternal combined initiatives (IJA), which focused on both object and partner. By 17 months, however, infants' combined initiatives were most frequent and led to more JA episodes than any other initiative type. Infants with more combined initiatives achieved more JA episodes at both ages and greater 17-month vocabularies.

Contributions of infant vagal regulation at 1 month to subsequent joint attention abilities

Since birth, humans develop an ability to regulate their inner states and behaviors, when facing demanding situations, in order to restore calmness and engage with other persons and the surrounding environment. The present study analyzed whether 1-month infant vagal regulation to auditory stimuli was associated with later joint attention abilities-responding to and initiating joint attention-in interaction with their mothers. Twenty-three infants were assessed and measures of respiratory sinus arrhythmia-RSA (baseline and vagal tone change during auditory stimulation) were used as index of vagal regulation. At 12-months, joint attention behaviors were assessed in a 10-min toy-play mother-infant interaction. Correlational analyses showed that lower baseline RSA and larger increases in vagal tone during auditory stimulation were related to more instances of joint attention behaviors at 12 months, especially responding to joint attention. Results suggest that distinct profiles of autonomic functioning may contribute to joint attention skills.

Maternal and infant affect at 4 months predicts performance and verbal IQ at 4 and 7 years in a diverse population

Using existing longitudinal data from 570 infants in the Maternal Lifestyle Study, we explored the predictive value of maternal and infant affect and maternal vocalizations during 2 minutes of face-to-face interactions at 4 months on IQ scores at 4.5 and 7 years. After controlling for demographic factors, maternal depression, and prenatal drug exposure, maternal positive affect and maternal positive vocalizations emerged as predictors of both verbal and performance IQ at 4.5 and 7 years. Although infant positive affect during the interaction with the mother was not predictive of these outcome measures, infant positive affect towards an examiner predicted verbal but not performance IQ at 4.5 years. These results suggest that maternal positive affect may index emotional engagement in interaction that facilitates both verbal and nonverbal cognitive development, while infant social positive affect is specifically related to the acquisition of verbal reasoning abilities. These findings are significant because they are based on a discrete snapshot of observable behavior in infancy (just 2 minutes of interaction), because they extend the range of maternal behaviors and characteristics known to support positive developmental outcomes, and because they are derived from high-risk infants where prevention efforts may be beneficial. Potential mechanisms for these associations are discussed, as are the clinical implications for identifying dyads most in need of targeted interventions.

Infants' early visual attention and social engagement as developmental precursors to joint attention

This study examined infants' early visual attention (at 1 month of age) and social engagement (4 months) as predictors of their later joint attention (12 and 18 months). The sample (n = 325), drawn from the Maternal Lifestyle Study, a longitudinal multicenter project conducted at 4 centers of the National Institute of Child Health and Human Development Neonatal Research Network, included high-risk (cocaine-exposed) and matched noncocaine-exposed infants. Hierarchical regressions revealed that infants' attention orienting at 1 month significantly predicted more frequent initiating joint attention at 12 (but not 18) months of age. Social engagement at 4 months predicted initiating joint attention at 18 months. Results provide the first empirical evidence for the role of visual attention and social engagement behaviors as developmental precursors for later joint attention outcome. (PsycINFO Database Record

IMPACT OF JOINT ATTENTION ON SOCIAL-COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long-term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months' postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow-up session 6 months' postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age-at-adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at-risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.

Cognitive and adaptive correlates of an ADOS-derived joint attention composite

Joint attention skills have been shown to predict language outcomes in children with autism spectrum disorder (ASD). Less is known about the relationship between joint attention (JA) abilities in children with ASD and cognitive and adaptive abilities. In the current study, a subset of items from the Autism Diagnostic Observation Schedule (ADOS), designed to quantify JA abilities, were used to investigate social attention among an unusually large cross-sectional sample of children with ASD (n = 1061). An examination of the association between JA and a range of functional correlates (cognitive and adaptive) revealed JA was significantly related to verbal (VIQ) and non-verbal (NVIQ) cognitive ability as well as all domains of adaptive functioning (socialization, communication, and daily living skills). Additional analyses examined the degree to which the relation between adaptive abilities (socialization, communication, and daily living skills) and JA was maintained after taking into account the potentially mediating role of verbal and nonverbal cognitive ability. Results revealed that VIQ fully mediated the relation between JA and adaptive functioning, whereas the relation between these adaptive variables and JA was only partially mediated by NVIQ. Moderation analyses were also conducted to examine how verbal and non-verbal cognitive ability and gender impacted the relation between JA and adaptive functioning. In line with research showing a relation between language and JA, this indicates that while JA is significantly related to functional outcomes, this appears to be mediated specifically through a verbal cognitive pathway.

Social Preference and Glutamatergic Dysfunction: Underappreciated Prerequisites for Social Dysfunction in Schizophrenia

Impaired social functioning is pervasive in schizophrenia. Unfortunately, existing treatments have limited efficacy, and possible psychological or neurobiological mechanisms underlying social dysfunction in this disorder remain obscure. Here, we evaluate whether social preference, one key aspect of social processing that has been largely overlooked in schizophrenia research, and N-methyl-d-aspartate receptor (NMDAR) dysfunction can provide insights into the mechanism underlying social dysfunction in schizophrenia. Based on evidence from developmental psychology, and behavioral and clinical neuroscience, we propose a heuristic model in which reduced NMDAR function may induce disrupted social preference that can subsequently lead to social cognitive impairment and social disability. We discuss its implications in terms of the pathophysiology of schizophrenia, other disorders with marked social disability, and potential treatments.

Validation of the Pictorial Infant Communication Scale for preschool-aged children with autism spectrum disorder

Joint attention, or the shared focus of attention between objects or events and a social partner, is a crucial milestone in the development of social communication and a notable area of deficit in children with autism spectrum disorder. While valid parent-report screening measures of social communication are available, the majority of these measures are designed to assess a wide range of behaviors. Targeted assessment of joint attention and related skills is primarily limited to semi-structured, examiner-led interactions, which are time-consuming and laborious to score. The Pictorial Infant Communication Scale is an efficient parent-report measure of joint attention that can be used as a complement to structured assessments in fully characterizing early social communication development. This study examined the psychometric properties of the Pictorial Infant Communication Scale. Results revealed a high degree of internal consistency and strong intercorrelations between subscales. Additionally, confirmatory factor analysis supported a three-factor model of joint attention. Furthermore, significant correlations between the Pictorial Infant Communication Scale and direct clinical measures of child joint attention, language skills, and autism spectrum disorder symptom severity were suggestive of concurrent validity. Findings suggest that the Pictorial Infant Communication Scale is a promising tool for measuring joint attention skills in preschool-aged children with autism spectrum disorder.

Attention to the mouth and gaze following in infancy predict language development

We investigated longitudinal relations among gaze following and face scanning in infancy and later language development. At 12 months, infants watched videos of a woman describing an object while their passive viewing was measured with an eye-tracker. We examined the relation between infants' face scanning behavior and their tendency to follow the speaker's attentional shift to the object she was describing. We also collected language outcome measures on the same infants at 18 and 24 months. Attention to the mouth and gaze following at 12 months both predicted later productive vocabulary. The results are discussed in terms of social engagement, which may account for both attentional distribution and language onset. We argue that an infant's inherent interest in engaging with others (in addition to creating more opportunities for communication) leads infants to attend to the most relevant information in a social scene and that this information facilitates language learning.

Assessing and Improving Early Social Engagement in Infants

Empirical studies have documented a variety of social abnormalities in infancy that indicate risk for later social and behavioral difficulties. There is very little research illustrating the presence of such behavioral vulnerabilities with frequent repeated measures, and the feasibility of designing interventions for improving social engagement in infants under one year of age. In the context of a multiple baseline research design, three young infants, ages 4, 7, and 9 months referred for concerns about social engagement were assessed for affect, social interest, eye contact avoidance, and response to name. Additionally, the feasibility of implementing an intervention to target social behaviors was examined. Results demonstrated that: (1) consistently low or erratic levels of social behavior were evident throughout the baseline assessment period; (2) these patterns could be improved with a brief intervention (a modified Pivotal Response Treatment) showing an immediate increase and stability of social engagement; and (3) social engagement remained at a stable and high level at follow-up. The results are discussed in terms of implications of early assessment and intervention for clinical populations, including infants with Autism Spectrum Disorder.

How joint attention relates to cooperation in 1- and 2-year-olds

Joint attention has been suggested to contribute to children’s development of cooperation; however, few empirical studies have directly tested this hypothesis. Children aged 1 and 2 years participated in two joint action activities to assess their cooperation with an adult partner, who stopped participating at a specific moment during the tasks. Children’s joint attention skills were measured by the Early Social Communication Scales (ESCS). Results showed that children’s responding to joint attention ability contributed to their successful cooperation in an activity that required parallel roles, whereas initiating joint attention ability contributed to their successful cooperation in an activity that required complementary roles. These results suggest a complex relationship between joint attention and cooperative abilities when considering RJA and IJA separately.

Prediction of 7-year psychopathology from mother-infant joint attention behaviours: a nested case-control study

BACKGROUND

To investigate whether later diagnosis of psychiatric disorder can be predicted from analysis of mother-infant joint attention (JA) behaviours in social-communicative interaction at 12 months.

METHOD

Using data from a large contemporary birth cohort, we examined 159 videos of a mother-infant interaction for joint attention behaviour when children were aged one year, sampled from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Fifty-three of the videos involved infants who were later considered to have a psychiatric disorder at seven years and 106 were same aged controls. Psychopathologies included in the case group were disruptive behaviour disorders, oppositional-conduct disorder, attention-deficit/hyperactivity disorder, pervasive development disorder, anxiety and depressive disorders. Psychiatric diagnoses were obtained using the Development and Wellbeing Assessment when the children were seven years old.

RESULTS

None of the three JA behaviours (shared look rate, shared attention rate and shared attention intensity) showed a significant association with the primary outcome of case-control status. Only shared look rate predicted any of the exploratory sub-diagnosis outcomes and was found to be positively associated with later oppositional-conduct disorders (OR [95% CI]: 1.5 [1.0, 2.3]; p = 0.041).

CONCLUSIONS

JA behaviours did not, in general, predict later psychopathology. However, shared look was positively associated with later oppositional-conduct disorders. This suggests that some features of JA may be early markers of later psychopathology. Further investigation will be required to determine whether any JA behaviours can be used to screen for families in need of intervention.

Social interaction in young children with inflicted and accidental traumatic brain injury: relations with family resources and social outcomes

Core social interaction behaviors were examined in young children 0-36 months of age who were hospitalized for accidental (n = 61) or inflicted (n = 64) traumatic brain injury (TBI) in comparison to typically developing children (n = 60). Responding to and initiating gaze and joint attention (JA) were evaluated during a semi-structured sequence of social interactions between the child and an examiner at 2 and 12 months after injury. The accidental TBI group established gaze less often and had an initial deficit initiating JA that resolved by the follow-up. Contrary to expectation, children with inflicted TBI did not have lower rates of social engagement than other groups. Responding to JA was more strongly related than initiating JA to measures of injury severity and to later cognitive and social outcomes. Compared to complicated-mild/moderate TBI, severe TBI in young children was associated with less responsiveness in social interactions and less favorable caregiver ratings of communication and social behavior. JA response, family resources, and group interacted to predict outcomes. Children with inflicted TBI who were less socially responsive and had lower levels of family resources had the least favorable outcomes. Low social responsiveness after TBI may be an early marker for later cognitive and adaptive behavior difficulties.

Joint attention in toddlerhood predicts internalizing problems at early school age

The authors examined the longitudinal relation between joint attention and socioemotional functioning in a low-risk, typically developing sample of children when the children were toddlers and again during the early school-age years. Fifty-eight mothers and their children were observed in the home or laboratory engaging in 1 unstructured and 4 semistructured tasks designed to assess joint attention episodes when the children were toddlers. Approximately 4 years later, the mother-child dyads were contacted again and mothers completed the Child Behavior Checklist as a measure of their children's socioemotional outcome at the early school years. The authors found that lower frequencies of joint attention episodes at toddlerhood predicted higher internalizing behaviors at early school age. Preliminary findings are discussed in terms of their theoretical implications for work on early mother-child interactions and children's typical and atypical sociemotional development.

Predicting language and social outcomes at age 5 for later-born siblings of children with autism spectrum disorders

The relation between early joint attention (in which a child coordinates attention between another person and an object or event) and later language and social outcomes was examined in younger siblings of children with autism spectrum disorder (Sibs-ASD) and younger siblings of children with typical development (Sibs-TD). Initial levels of joint attention (at a mean age of 15 months) as well as growth in levels of joint attention (between 15 months and 34 months) were used as potential predictors of outcomes at age 5. The results revealed that initial levels of initiating joint attention (IJA) were associated with language skills at outcome. In addition, growth of responding to joint attention (RJA) was associated with social skills at age 5. These patterns of associations were not significantly different between the Sibs-TD and Sibs-ASD groups. Although the Sibs-ASD group had lower joint attention scores than the Sibs-TD group at younger ages, significant group differences were not found for most measures at age 5.

The Affect in Play Scale: confirmatory factor analysis in elementary school children

The aim of this paper was to study the construct validity of the Affect in Play Scale, an empirically based measure of pretend play, in a group of 519 Italian children ages 6 to 10 years. In confirmatory factor analysis, a correlated two-factor structure with a cognitive and an affective factor was identified. Possible differences in factor scores by sex and age were investigated but no significant differences were found.

Infant responding to joint attention, executive processes, and self-regulation in preschool children

Infant joint attention is related to behavioral and social outcomes, as well as language in childhood. Recent research and theory suggests that the relations between joint attention and social-behavioral outcomes may reflect the role of executive self-regulatory processes in the development of joint attention. To test this hypothesis two studies were conducted. The first, cross-sectional study examined the development of responding to joint attention (RJA) skill in terms of increasing executive efficiency of responding between 9 and 18 months of age. The results indicated that development of RJA was characterized by a decreased latency to shift attention in following another person's gaze and head turn, as well as an increase in the proportion of correct RJA responses exhibited by older infants. The second study examined the longitudinal relations between 12-month measures of responding to joint attention and 36-month attention regulation in a delay of gratification task. The results indicated that responding to joint attention at 12-months was significantly related to children's use of three types of self-regulation behaviors while waiting for a snack reward at 36 months of age. These observations are discussed in light of a developmental theory of attention regulation and joint attention in infancy.

Joint attention in parent-child dyads involving children with selective mutism: a comparison between anxious and typically developing children

Although joint attention processes are known to play an important role in adaptive social behavior in typical development, we know little about these processes in clinical child populations. We compared early school age children with selective mutism (SM; n = 19) versus mixed anxiety (MA; n = 18) and community controls (CC; n = 26) on joint attention measures coded from direct observations with their parent during an unstructured free play task and two structured tasks. As predicted, the SM dyads established significantly fewer episodes of joint attention through parental initiation acts than the MA and CC dyads during the structured tasks. Findings suggest that children with SM may withdraw from their parents during stressful situations, thus missing out on opportunities for learning other coping skills. We discuss the implications of the present findings for understanding the maintenance and treatment of SM.

Infant joint attention, neural networks and social cognition

Neural network models of attention can provide a unifying approach to the study of human cognitive and emotional development (Posner & Rothbart, 2007). In this paper we argue that a neural network approach to the infant development of joint attention can inform our understanding of the nature of human social learning, symbolic thought process and social cognition. At its most basic, joint attention involves the capacity to coordinate one's own visual attention with that of another person. We propose that joint attention development involves increments in the capacity to engage in simultaneous or parallel processing of information about one's own attention and the attention of other people. Infant practice with joint attention is both a consequence and an organizer of the development of a distributed and integrated brain network involving frontal and parietal cortical systems. This executive distributed network first serves to regulate the capacity of infants to respond to and direct the overt behavior of other people in order to share experience with others through the social coordination of visual attention. In this paper we describe this parallel and distributed neural network model of joint attention development and discuss two hypotheses that stem from this model. One is that activation of this distributed network during coordinated attention enhances the depth of information processing and encoding beginning in the first year of life. We also propose that with development, joint attention becomes internalized as the capacity to socially coordinate mental attention to internal representations. As this occurs the executive joint attention network makes vital contributions to the development of human symbolic thinking and social cognition.

Self-referenced processing, neurodevelopment and joint attention in autism

This article describes a parallel and distributed processing model (PDPM) of joint attention, self-referenced processing and autism. According to this model, autism involves early impairments in the capacity for rapid, integrated processing of self-referenced (proprioceptive and interoceptive) and other-referenced (exteroceptive) information. Measures of joint attention have proven useful in research on autism because they are sensitive to the early development of the 'parallel' and integrated processing of self- and other-referenced stimuli. Moreover, joint attention behaviors are a consequence, but also an organizer of the functional development of a distal distributed cortical system involving anterior networks including the prefrontal and insula cortices, as well as posterior neural networks including the temporal and parietal cortices. Measures of joint attention provide early behavioral indicators of atypical development in this parallel and distributed processing system in autism. In addition it is proposed that an early, chronic disturbance in the capacity for integrating self- and other-referenced information may have cascading effects on the development of self awareness in autism. The assumptions, empirical support and future research implications of this model are discussed.

Predicting social impairment and ASD diagnosis in younger siblings of children with autism spectrum disorder

Later-born siblings of children with autism spectrum disorder (Sibs-ASD) are at elevated risk for social impairments. Two putative predictors of later social impairment-measures of responding to joint attention and weighted triadic communication-were examined in a sample of 43 Sibs-ASD who were followed from 15 to 34 months of age. Results revealed that initial level of responding to joint attention and growth rate of weighted triadic communication predicted the degree of social impairment at the final measurement period. Additionally, both predictors were associated with later ASD diagnosis. In contrast, unweighted triadic communication, age of entry into the study, and initial language level did not predict later social impairment. The importance of considering social outcome as a continuous variable in prospective studies of Sibs-ASD is discussed.

A parallel and distributed-processing model of joint attention, social cognition and autism

The impaired development of joint attention is a cardinal feature of autism. Therefore, understanding the nature of joint attention is central to research on this disorder. Joint attention may be best defined in terms of an information-processing system that begins to develop by 4-6 months of age. This system integrates the parallel processing of internal information about one's own visual attention with external information about the visual attention of other people. This type of joint encoding of information about self and other attention requires the activation of a distributed anterior and posterior cortical attention network. Genetic regulation, in conjunction with self-organizing behavioral activity, guides the development of functional connectivity in this network. With practice in infancy the joint processing of self-other attention becomes automatically engaged as an executive function. It can be argued that this executive joint attention is fundamental to human learning as well as the development of symbolic thought, social cognition and social competence throughout the life span. One advantage of this parallel and distributed-processing model of joint attention is that it directly connects theory on social pathology to a range of phenomena in autism associated with neural connectivity, constructivist and connectionist models of cognitive development, early intervention, activity-dependent gene expression and atypical ocular motor control.

Anticipatory smiling: linking early affective communication and social outcome

In anticipatory smiles, infants appear to communicate pre-existing positive affect by smiling at an object and then turning the smile toward an adult. We report two studies in which the precursors, development, and consequences of anticipatory smiling were investigated. Study 1 revealed a positive correlation between infant smiling at 6 months and the level of anticipatory smiling at 8 and 10 months during joint attention episodes, as well as a positive correlation between anticipatory smiling and parent-rated social expressivity scores at 30 months. Study 2 confirmed a developmental increase in the number of infants using anticipatory smiles between 9 and 12 months that had been initially documented in the Study 1 sample [Venezia, M., Messinger, D. S., Thorp, D., & Mundy, P. (2004). The development of anticipatory smiling. Infancy, 6(3), 397-406]. Additionally, anticipatory smiling at 9 months positively predicted parent-rated social competence scores at 30 months. Findings are discussed with regard to the importance of anticipatory smiling in early socioemotional development.

Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months

BACKGROUND

Parental distress following the birth of a premature infant diminishes the parent's ability to be sensitive to the infant's cues, and this may affect infant developmental outcomes.

AIMS

The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood.

SUBJECTS

A sample of 56 mothers and their VLBW infants were recruited in the NICU.

STUDY DESIGN

During the infant's NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales.

RESULTS

Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age.

CONCLUSIONS

Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother-infant relationship.

Why Does Joint Attention Look Atypical in Autism?

This essay answers the question of why autistic children are less likely to initiate joint attention (e.g., use their index finger to point to indicate interest in something) and why they are less likely to respond to bids for their joint attention (e.g., turn their heads to look at something to which another person points). It reviews empirical evidence that autistic toddlers, children, adolescents, and adults can attend covertly, even to social stimuli, such as the direction in which another person's eyes are gazing. It also reviews empirical evidence that autistics of various ages understand the intentionality of other persons' actions. The essay suggests that autistics' atypical resistance to distraction, atypical skill at parallel perception, and atypical execution of volitional actions underlie their atypical manifestations of joint attention.

Joint attention development in toddlers with autism

Deficits in Joint Attention (JA) may be one of the earliest signs of Autism Spectrum Disorders (ASD). In this longitudinal study we investigated several types of JA behaviors at the age of 24 and 42 months, and their development over time. Eleven children with ASD, 10 children with other developmental disorders, and eight children without a developmental disorder participated. It was found that children with ASD showed significantly less JA at the age of 24 months. At this age, the various types of JA (Basic Joint Attention, Associated Joint Attention, Joint Visual Attention) were correlated with developmental level and number of autistic characteristics. However, at the age of 42 months, these associations were absent. Although children with ASD may show less JA at the age of 24 months compared to other groups of children, by the age of 42 months they reach about the same level of JA, except for joint visual attention. In fact, at both ages, children with ASD differed consistently only on JVA from the other groups. JVA may be a core component of an early screening device for ASD.

Respiratory sinus arrhythmia and tympanic membrane compliance predict spontaneous eye gaze behaviors in young children: a pilot study

The Polyvagal theory proposes the Social Engagement System as a theoretical model linking social behavior with the neural regulation of the heart (via the vagus) and the striated muscles of the face and head (via special visceral efferent pathways). The current pilot study tested the feasibility of this model with typically developing 3-5-year-old children by evaluating the relation between spontaneous social engagement behavior measured by eye gaze behaviors and the visceromotor (e.g., respiratory sinus arrhythmia) and somatomotor (e.g., right tympanic membrane compliance) components of the Social Engagement System. Regression analyses supported the hypothesis that the visceromotor and somatomotor components of the Social Engagement System significantly predict social behavior (indexed by spontaneous eye gazes). Future studies assessing indices of visceral regulation and middle ear muscle function may provide insights into neural mechanisms mediating features of developmental disorders, such as autism, that have deficits in spontaneous eye gaze, auditory processing, and social behavior.