Joint attention and symbolic play in young children with autism: A randomized controlled intervention study
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47, 611-620.
Reviewed by Casi Healey, MA, BCBA
A defining feature of autism in young children is the absence of joint attention and symbolic play. Joint attention involves the act of sharing experiences with another. Examples include looking back and forth between a toy and the person who presented the toy, pointing to or showing objects of interest, or following someone else’s line of gaze. Symbolic play involves imaginative activities such as pretending to drink from a cup or feed a doll. Because joint attention and symbolic play are a foundation for later language abilities and social relationships, it may be important to teach these skills to children with autism. Few studies, however, have examined whether it is possible to teach such skills and , if so, how much children benefit.
Kasari, Freeman, and Paparella (2006) compared interventions intended to teach joint attention and symbolic play. Fifty-eight children with autism between the ages of 3 and 4 were randomly assigned to a joint attention intervention, a symbolic play intervention, or a control group that did not receive either intervention. All children were enrolled in ABA classrooms.
In the joint attention and symbolic play interventions, each child received 30-minute sessions 5 days a week for 5-6 weeks. Sessions consisted of discrete-trial teaching followed by a more child-directed interaction. Children in the joint attention group increased their joint attention skills while children in the play group increased their symbolic play skills. Also, children generalized these gains to interactions with their caregivers even though they were not directly taught to do. In contrast, children in the control group did not improve in either joint attention or play despite being in ABA classes.
This study demonstrates that it may be important to provide direct instruction in joint attention and symbolic play to young children. This would be a substantial revision to most existing ABA curricula. One direction for future research is to examine which aspect of the treatment, (discrete-trial teaching or child-directed teaching alone, or a combination of the two) was responsible for children’s gains. Another direction is to examine whether gains in joint attention and play skills lead to other improvements in communication and social development.