Summary of Step 6
If you have followed along and carried out the preceding activities, you likely have learned how to use your everyday interactions to support your child’s more desirable social and communicative skills. You also know much more about why your child does all those things you wish she wouldn’t do, and you know what consequences, or rewards, are supporting your child’s use of those unwanted behaviors. You have developed some ideas about how to replace them with more socially desirable behaviors, and you have some ideas about how to avoid rewarding those unwanted behaviors. You have tried to prompt your child to use a replacement behavior before the unwanted behavior even occurs, and you have been able (we hope) to reinforce the replacement behavior. See if you agree with most of the statements in the following checklist. If so, you are now armed with (1) knowledge and skills for providing more learning opportunities within your everyday activities with your child; and (2) strategies for replacing your child’s unwanted behavior with more socially acceptable, communicative behavior. If not, review this last section of the chapter, and discuss these concepts and your observations with a supportive other—ideally, someone who also understands the basics of behavior, like one of your child’s professional team members. Mastering these concepts will help you help your child for many years to come (and your other children as well!)
Activity Checklist: Am I Understanding and Dealing More
Effectively with Undesirable Behaviors?
____ I have spent some time observing my own behavior and my interactions with my child when I am providing my child’s preferred objects and routines.
____ I am much more aware of what behaviors my child is using to request these preferred objects and routines.
____ I am developing more skills in using each of these situations as a learning opportunity, by either rewarding or cuing my child’s use of more mature communicative behaviors.
____ I have had some successful experiences in replacing one or more of my child’s unwanted behaviors with a more desirable communication or behavior.
____ I am much more aware of my tendency to provide positive consequences when my child uses an unwanted behavior, and I am doing it less.
____ I am seeing positive effects of my new knowledge in my child’s progress in learning to communicate to reach his or her goals.
____ I am seeing positive effects of my new knowledge in my child’s decreasing use of unwanted behaviors that I have focused on.
____ I am creating more learning opportunities during daily play and caregiving activities by using the ABC’s of learning.
____ I am creating more learning opportunities in most of the six types of target activities.
Chapter Summary
Behavior can be understood in terms of what takes place before the event (antecedents), as well as what follows it (consequences). This relationship or understanding of antecedents, the behavior itself, and consequences can be thought of as a set of linked actions, events, and circumstances that occur together in an environment. Understanding antecedents and consequences and their combined influence on behavior allows us to understand how a behavior functions for a child, and thus helps us know how to teach new behaviors and reduce unwanted behaviors in a systematic and effective way.
• Pay attention to times when you find yourself delivering positive consequences for behaviors that you would rather not reinforce: screaming, throwing, crying, grabbing, fussing, whining, not using words/gestures.
• Pay attention to times when your child ignores your instructions or requests and continues to do what he was doing. In these situations, your child is being rewarded for ignoring you (by getting to do what he wants to do).
• Pay attention to all the times you see your child wanting something and, through your skillful teaching, communicating nicely and receiving what he wants. You are providing great reinforcement for good behavior and an important learning opportunity.
• Pay attention to all the times your child communicates in an unwanted way, through immature behavior or unwanted behaviors, and you hold back on providing what he wants (and thus help extinguish the unwanted behavior). Instead, you prompt your child to request or behave in a desired way and then deliver the reward, supporting your child’s learning.
Every time you reinforce a desired behavior, you provide a learning opportunity for your child. Every time you prompt your child to use a more mature or appropriate skill and reinforce that new skill, you provide a learning opportunity. Every time you model a desired behavior and your child imitates you, you provide a learning opportunity. And every time you make sure an unwanted behavior is not reinforced but rather replaced by a more desirable behavior or skill, which gets your child what he wants, a learning opportunity has occurred.
Children with autism need to learn and are very capable of doing so. Teaching them is about creating learning opportunities. Understanding the ABC’s of learning helps you think about how to create learning opportunities to stimulate development and build more mature behavior.
________________________
1Keep in mind that sometimes unwanted behaviors, such as crying, screaming, and tantrums, are signs that your child doesn’t feel well. Remember that in Chapter 1 we have discussed the fact that children with autism sometimes experience gastrointestinal problems, food sensitivities, lack of sleep, and other health-related problems. Recall also that sometimes it is difficult for children with autism to tell us that they are in pain or where the pain is occurring. If your child shows a sudden change in behavior, such as suddenly becoming more fussy or aggressive, and it doesn’t appear to be linked to a specific antecedent or consequence, consider having your child’s health status evaluated by a pediatrician. Similarly, if your child is not sleeping well or is eating poorly, it will be much more difficult for her to refrain from being irritable and fussy. By making sure that your child is healthy, you set the stage for your child to be more cooperative, show fewer problem behaviors, learn more easily, and generally be a happier and more engaged child.
10
The Joint Attention Triangle
Sharing Interests with Others
Chapter goal: To help you teach your child how to share interest in objects with you.
WHY SHARING INTERESTS AND ATTENTION (JOINT ATTENTION) IS SO IMPORTANT
So far we’ve been emphasizing how to increase your child’s interest in paying attention to you. You’ve now learned (and, we hope, are using) methods for encouraging your child to pay attention to your face, voice, and actions. By teaching and promoting turn taking, imitation, and nonverbal communication, you’ve been showing your child the power of two people communicating directly with one another. Your child has learned that looking at you, coming to you to express his needs and desires, following your lead (and seeing you follow his), and enjoying activities with another person all have rewards that your child may not have grasped as easily as other children do. The importance of this is huge for your child’s learning potential, both in structured educational settings and in the all-important social world, where children gain so much new information and understanding by interacting with others.
But these dyadic (back-and-forth) interactions aren’t enough. Now it’s time to teach your child how to share his attention to objects and other interesting events in the world with others. This capacity to share attention with others is called joint attention, or triadic attention. Triadic means “three-way” and refers to the three points of the attention triangle—your child, you, and your child’s focus of interest. Joint attention allows people to share information, emotion, or meaning about an interesting event.
Think about a time when you were at lunch with a friend and you noticed something unusual or interesting. You likely looked at the interesting spectacle and then were naturally motivated to share what you were seeing with your friend. After first looking at the interesting spectacle, you looked back to your friend, then commented on or pointed at the spectacle, and then
looked back again at your friend to see if she was looking at it too and to notice her expression. You were sharing your attention with your friend. This triangle of attention—the three-way interaction involving two people and an object or event—is joint attention. And it is a fundamental building block for young children’s communication and language learning. Studies we authors and our coworkers have carried out, as well as other studies, have shown that children’s joint attention skills are strongly related to their later language abilities.1
Parents and their young children often share moments of eye contact, smiles or other expressions of interest, gestures (pointing, showing, and giving), and sounds or words to communicate about something one or the other has noticed. They might communicate about things like these:
• The names of objects: Mom holds up a round blue object in her hands and, as her daughter reaches for it, says, “It’s a balloon.”
• Actions happening in play: Dad points to the open spot in the puzzle and tells his son, “The tiger goes here.”
• Instructions: A toddler finishes her drink and then hands her empty cup to Grandma while she looks at her and vocalizes, clearly communicating “I want more.”
• Experiences to share: A child points to a dog across the street, and Mom looks and answers, “It’s a doggie.”
A fundamental skill required for joint attention is the child’s ability to shift her gaze back and forth between you and the object. Before joint attention develops, children focus their attention mainly on either an object or a person during play, but they aren’t yet able to shift their attention back and forth, to focus on both the object and the person. At about 6 months of age, children learn to shift their gaze back and forth between an object and a parent’s face. This skill contributes greatly to the joint attention skills and the related social, communication, and language learning that comes from it.
What’s Happening in Autism?
Two difficulties seem to interfere with joint attention development in ASD. First, as we have said earlier, children with ASD are a little less socially oriented to begin with. They seem to be less motivated to share and engage socially than other children are. Second, children with autism have difficulty learning to shift their gaze from people to objects easily and frequently. They tend to focus on objects more than people, and they may sustain their attention to objects for a long time. They may struggle to attend to multiple people or things in an environment, even when no demands are imposed. Sometimes their attention gets “stuck” on the first thing they are noticing, and they have difficulty flexibly disengaging their attention from the first object and moving on to the next. Most early intervention approaches focus one way or another on teaching young children with ASD to shift their gaze from objects to people and back. Our goal in helping you teach your child joint attention is to help him communicate with others about his shared experiences in the world. Without intervention, developing spontaneous joint attention skills is one of the harder skills for young children with ASD to learn.
Why Is It a Problem?
Without joint attention, children with autism tend not to share their thoughts and emotions about objects and events with important others, and so they lose out on these learning opportunities that contribute greatly to enhancing language, social, and cognitive development. Joint attention also involves reading another person’s cues and understanding the partner’s desires or feelings about the object—in other words, reading the partner’s mind. When joint attention is limited, so is the ability to understand the meaning behind any situation (what something is called, how an object works, or what should happen during an activity) by looking at and following people’s eye gaze and gestures.
Equally important, joint attention appears to strengthen children’s desire to appreciate, value, and seek out social attention and praise from others when something fun and enjoyable happens. Remember how excited you were to share something you did with Mom and Dad when you were a child? It might have been a drawing you completed that day at school, or a great move you made during a board game, or when you tackled a new feat that you thought was impossible to do. Chances are that you looked right into your parents’ eyes, gave a huge smile, and beamed with delight as they congratulated you on your success. This experience does not have to be different for children with autism. We want them to enjoy the excitement, praise, and pride that can result from social interactions. But to make this happen, they need to understand and use joint attention.
What You Can Do to Increase Your Child’s Joint
Attention Skills
In its most basic form, joint attention involves the ability to shift eye contact or gaze between a social partner and an object or event. Once gaze shifts occur easily, children start to use three main gestures to share attention—giving, showing, or pointing at the object or event—while making eye contact. Joint attention also involves sharing feelings about an object or event through gaze and facial expressions. The child looks at the object and then looks at the adult with a smile or frown, communicating her feelings about the object or event. How can you work with your child to develop joint attention? You are already doing some of the work, by doing things you have learned in earlier chapters:
1. Drawing your child’s attention to your face and eyes (Chapter 4)
2. Positioning yourself in front of your child for all activities to assist with eye contact (Chapter 4)
3. Pausing and teaching your child to use her body (talking bodies) to communicate her needs to you (Chapter 7)
4. Developing a number of sensory social and object routines that you do together (Chapters 5 and 6)
Once you have increased your child’s eye contact and your child’s gesture communications, you and your child are ready for the three specific steps toward joint attention skills:
Step 1. Teach your child to give you objects.
Step 2. Teach your child to show you objects.
Step 3. Teach your child how to point to objects to share experiences.
In the following pages, we describe how to carry out each of these steps, give you some ideas for activities to try, and suggest what you can do to solve problems that may come up.
Step 1. Teach Your Child
to Give You Objects
Rationale. Joint attention is a kind of turn taking, and it cannot occur unless your child is willing to hand over an object on request and then get it back. Because your child may not have the built-in motivation to interact in this way, you’ll have to teach it “from the ground up,” starting with the fact that an outstretched hand is a request for the child to give you an object he is holding. Your earlier work with turn taking (Chapter 6) has provided your child with a foundation for this skill. Continue working on this skill to lay the foundation for joint attention skills.
Activity: Teach Your Child to Give Objects to Get Help from You
Teaching your child to give an object to you when she needs help with the object is an important initial step. It motivates your child to learn the gesture, because the action that follows (your help) works in your child’s favor! That gesture becomes much more powerful, however, when your child learns to use eye contact as well as giving to communicate a need for help. When your child makes eye contact and gives an object to you for help, your child has made a powerful communication about her goals.
Here are ideas for teaching your child to give you objects to receive help:
Begin by showing your child a clear container (plastic zipper bag, lidded plastic container) that your child cannot open by himself, and that holds a highly motivating object. This could be a favorite snack during snack time, a favorite bath toy during bath time, or part of a favorite toy during toy play (e.g., the pieces to a puzzle). Your child will see the objects inside the bag and should reach for it when you offer it. Give the container to your child. Your child will likely struggle to open it.
Then reach your open hand to your child while saying, “Need help?” Prompt your child
to give you the container, take it and open it quickly, and give it right back, saying, “Here’s the [object name].”
Repeat this in various activity types across the day—bath toys in containers, food at meals in closed bottles or containers, fun toys in containers during toy play. Always use the same cues: your outstretched hand and the words “Need help?”, “I’ll help you,” and “Here’s the [object name].”
As this becomes a familiar routine over a few days or so, see whether your child will initiate the request. Give the container as usual, but do not offer your hand or ask about help. Wait, looking expectantly at your child. Your child is likely to hand you the bag. Say, “You need help. I’ll help,” and then “Here is your [object name]” as you hand back the open container. Celebrate! Your child now knows a way to ask for help.
Once your child spontaneously and routinely hands things to you for help, start to work on encouraging eye contact when he asks for help. To do this, start as described above and wait for your child to initiate the request for help. Wait a little after your child has given you the object. If your child is making eye contact after he hands it to you, open it immediately, with your script. If your child is not making eye contact with you, then do not open the container. Instead, just continue to hold it in your hand and look at your child expectantly. Chances are that your child will briefly make eye contact. When he does this, quickly catch his gaze and immediately open the container. If your child doesn’t spontaneously look at you when you wait to open the container, ask, “Need help?” without moving the object. If your child makes eye contact, immediately open it. If your child still doesn’t look, move the container near your face while looking at your child and ask again or shake the container. Wait for the gaze and then open it. Notice what is happening here. You have shifted the reinforcer (opening the container) so it now follows eye contact, rather than giving. Over time, this should increase your child’s use of eye contact and giving to request help.
An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn Page 26