Abstract | Summary | Original Article

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study.

Kasari C, Freeman S, Paparella T.

Journal of Child Psychology and Psychiatry. 2006; 47:611-620.

Question: Did teaching joint attention or symbolic play improve the language skills of children with autism?

Background: To develop language skills, children need to be able to pay attention to other people’s spoken language and body language. Children with autism have problems with joint attention, a set of skills needed to follow or pay attention to the verbal or nonverbal communication of other people. Typically developing children generally develop joint attention skills through their daily interactions with adults and other children. Play is another way that social and language skills are acquired by typically developing children. Many children with autism also do not play as much or with the same degree of complexity as typically developing children.  They usually need deliberate teaching of both joint attention and play skills.

Design: A randomized controlled trial (RCT).

Setting: A school in the United States.

Participants: Fifty-six 3- to 4-year-old children with autism enrolled in an early intervention program took part in the study. The children were divided up into three groups: 20 children in the joint attention group, 21 children in the play group, and 17 children in the control group in which they participated in just ABA.  All of the children had a formal diagnosis of autism, none  had a seizure disorder or a genetic condition.  

Intervention: The intervention consisted of 30 minutes of extra teaching during a 6-hour school day focused on ABA, over a 5 to 6 week period. The children were shown either how to engage in pretend play or to follow an instructor’s gaze or pointing towards an object. Each child also received ABA-based programming that included the techniques of following the child’s lead in play, talking about what they were doing, repeating what the child said, and making eye contact to encourage joint attention and play.   

Main Outcome Measures: Both standardized and experimental tests were used to assess the children’s overall functioning, learning ability, use of pointing and whoing, and their use of language.

Main Results: Children in both of the intervention groups showed improved expressive language skills compared to the control group, no matter their initial level of functioning, although higher functioning children made greater gains. The improvement, however, was greater for the joint attention group, especially the children with lower expressive skills. The children in both treatments groups did not improve on measures of receptive language. Children in the play group showed greater improvement in the complexity of their play and the types of play they engaged in.

Conclusion: Both of the interventions produced improvements in language skills, particularly for expressive language.  Both the joint attention and plays skills should be taught together to get the best results for the most children.