JOINT ATTENTION AND CHILDREN WITH AUTISM:AREVIEW OF THE LITERATURE Yvonne Bruinsma, * Robert L. Koegel, and Lynn Kern Koegel Special Education, Developmental Disabilities, and Risk Studies, Graduate School of Education, University of California, at Santa Barbara, Santa Barbara, California Preverbal communication and joint attention have long been of interest to researchers and practitioners. Both attending to social partners and sharing attentional focus between objects or events and others precede the onset of a child’s first lexicon. In addition, these prelinguistic acts also appear to have important implications with regard to learning to socialize. The construct of joint attention has been noted as an early developing area prior to the transition to symbolic communication. Thus, the importance of joint attention in typically developing children, and the lack thereof in children with autism, has interested researchers for use in diagnosis and intervention for autism. That is, joint attention has been gaining momen- tum as an area that not only helps characterize children with autism, but also as a prognostic indicator and a potential intervention goal. In this paper, the status of the literature about initiation of joint attention by young typically developing children and young children with autism was exam- ined. Empirical studies regarding joint attention behaviors, including eye gaze alternation, the use of protodeclaratives and protoimperatives, and studies that investigated joint attention as a predictor of language acquisi- tion were reviewed. Possible areas for future research for children with autism are discussed. © 2004 Wiley-Liss, Inc. MRDD Research Reviews 2004;10:169 –175. Key Words: autism; joint attention; intentional communication I nterest in joint attention in children with autism has greatly increased in the recent literature. However, the term “joint attention” can be a confusing construct, because it often refers to not one, but a cluster of behaviors that share the common goal of communicating with another person about a third entity in a nonverbal way, including eye gaze alternation and gesturing. Although the literature contains a number of different definitions of joint attention, these can be divided into one of two classes: 1) response to joint attention (RJA), which can be defined as a child’s response to the parent’s point or shift in eye gaze, or 2) initiation of joint attention (IJA), which can be defined as a child’s seeking another’s attention. Due to space limitations, this paper will exclusively focus on the different forms (eye gaze alternation, pointing, and showing) and func- tions (i.e., protoimperatives and protodeclaratives) of IJA by young typical children and by young children with autism. Specifically, this paper will begin by examining the importance of intentional communication and how it relates to the devel- opment of IJA. Subsequently, an overview of the development of the initiation of joint attention bids will be provided. Finally, this paper will examine the value of IJA as a prognostic indicator of outcome. INTENTIONAL COMMUNICATION In typical children the emergence of joint attention skills is closely intertwined with the development of intentional com- munication. Intentional communication is most likely the result of the infant beginning to understand that another person can be a means for the achievement of the infant’s goal and that the infant can send signals that effect that person’s actions [Bates et al., 1975; Prizant and Wetherby, 1987]. This developmental continuum has been charted in considerable detail by Sugarman [1984], who described the transition from the newborn baby’s showing little awareness of a goal and instead reacting diffusely with primary emotions to nonspecific situations, to the evolu- tion of understanding of the world; ultimately coordinating behaviors, modifying communicative signals as needed, and directing communication to more than one person if unsuccess- ful with the first. As the child progresses along this continuum, behaviors become more and more goal directed, conventional, and purposeful. In other words, there is no distinct moment in development where child communication becomes “intentful.” Rather, the child slowly learns between 6 and 9 months of age, that behaviors have “consistent and predictable effects” [Wilcox et al., 1996, pp. 373] as a result of parents or other communi- cative partners attributing meaning to actions. For example, an infant may reach for a desired toy on the table. The nearby parent interprets this behavior as a request for the toy, even though the child never communicated directly in any way to the parent, and hands the toy to the child [Wilcox et al., 1996]. However, some authors [i.e., Trevarthen, 1979] argue that the infant plays a more active role in this process and that the emergence of intentionality is consequently also the result of child behaviors that can be observed as early as 2 to 3 months of age. As Trevarthen puts it, it is not merely the mother who attributes meaning to the infant’s actions, the child “is speaking to her” [Trevarthen, 1979, pp. 346]. No standard operational definition exists in the literature for the construct of intentional communication [Prizant and Wetherby, 1987; Calandrella and Wilcox, 2000]. The ground- *Correspondence to: Yvonne Bruinsma, Componistenlaan 195, 2215 SR Voorhout, Netherlands. E-mail: bruinsma@education.ucsb.edu Received 19 October 2004; Accepted 20 October 2004 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/mrdd.20036 MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 10: 169 –175 (2004) © 2004 Wiley-Liss, Inc.