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. 2022 Mar;61(3):413-422.
doi: 10.1016/j.jaac.2021.03.023. Epub 2021 Jun 2.

Variability in Responding to Joint Attention Cues in the First Year is Associated With Autism Outcome

Isabella C Stallworthy  1 , Carolyn Lasch  1 , Daniel Berry  1 , Jason J Wolff  1 , John R Pruett Jr  2 , Natasha Marrus  2 , Meghan R Swanson  3 , Kelly N Botteron  2 , Stephen R Dager  4 , Annette M Estes  4 , Heather C Hazlett  5 , Robert T Schultz  6 , Lonnie Zwaigenbaum  7 , Joseph Piven  5 , Jed T Elison  8 ; IBIS Network
Affiliations

Variability in Responding to Joint Attention Cues in the First Year is Associated With Autism Outcome

Isabella C Stallworthy et al. J Am Acad Child Adolesc Psychiatry. 2022 Mar.

Abstract

Objective: With development, infants become increasingly responsive to the many attention-sharing cues of adults; however, little work has examined how this ability emerges in typical development or in the context of early autism spectrum disorder (ASD). This study characterized variation in the type of cue needed to elicit a response to joint attention (RJA) using the Dimensional Joint Attention Assessment (DJAA) during naturalistic play.

Method: We measured the average redundancy of cue type required for infants to follow RJA bids from an experimenter, as well as their response consistency, in 268 infants at high (HR, n = 68) and low (LR, N = 200) familial risk for ASD. Infants were assessed between 8 and 18 months of age and followed up with developmental and clinical assessments at 24 or 36 months. Our sample consisted of LR infants, as well as HR infants who did (HR-ASD) and did not (HR-neg) develop ASD at 24 months.

Results: We found that HR and LR infants developed abilities to respond to less redundant (more sophisticated) RJA cues at different rates, and that HR-ASD infants displayed delayed abilities, identifiable as early as 9 months, compared to both HR-neg and LR infants. Interestingly, results suggest that HR-neg infants may exhibit a propensity to respond to less redundant (more sophisticated) RJA cues relative to both HR-ASD and LR infants.

Conclusion: Using an approach to characterize variable performance of RJA cue-reading abilities, findings from this study enhance our understanding of both typical and ASD-related proficiencies and deficits in RJA development.

Keywords: autism spectrum disorder; infant siblings; joint attention; non-verbal communication; response to joint attention.

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Figures

Figure 1:
Figure 1:. Example Sequence of the 4-Dimensional Joint Attention Assessment (DJAA) Bids in Each of the 4 Trials
Note: Reprinted with permission from Infancy, John Wiley And Sons. Reilly et al. Infants’ abilities to respond to cues for joint attention vary by family socioeconomic status. https://doi.org/10.1111/infa.12380. Each trial begins with an RJA bid using the least redundant cue type (1). If the infant does not respond (ie, shift gaze in the direction of the target), the experimenter delivers up to 3 more bids (2–4) in attempt to elicit a response, each with increasing in cue redundancy, separated by a couple minutes of play. This sequence is repeated for each of the 4 trials.
Figure 2:
Figure 2:. Age-Related Increase in Mean Dimensional Joint Attention Assessment (DJAA) Scores by Autism Spectrum Disorder (ASD) Risk and Outcome
Note: Standard error confidence intervals are shown. HR-ASD = high risk for ASD and did develop ASD; HR-neg= high risk for ASD but did not develop disorder; LR= low risk for ASD).
Figure 3:
Figure 3:. Linear Age-Related Decrease in Coefficients of Variation of Mean Dimensional Joint Attention Assessment (DJAA) DJAA Scores for Low Risk Infants and High-Risk Infants With and Without a Diagnosis of Autism Spectrum Disorder
Note: HR-ASD = high risk for ASD and did develop ASD; HR-neg= high risk for ASD but did not develop disorder; LR= low risk for ASD.
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