Caregiver object labels within supported and coordinated joint engagement during interaction with toddlers at elevated and typical likelihood of autism.

BACKGROUND: Early in development, caregivers' object labelling contributes to children's word learning. Language development is a bi-directional process, and differences in joint engagement (JE) and language among children with developmental disabilities such as autism spectrum disorder (ASD) may provide caregivers varying contexts and opportunities to provide object labels. However, potential variation in caregivers' production of object labels and its relation to language development remain relatively unexplored among toddlers with ASD. AIMS: This study characterized the structural and functional features of object labels produced by parents of children with typical (TL) or elevated likelihood (EL) of ASD during naturalistic toy play. We examined features of object labels within two JE contexts, supported and coordinated JE, which are differentiated by a child's use of eye contact, as well as their relations with concurrent and future child language skills. METHODS & PROCEDURES: The present study included 55 (TL = 12, EL = 43) children who completed a naturalistic parent-child interaction in the home at 18 months of age. Children's expressive and receptive language was assessed at 18, 24 and 36 months. At 36 months, EL children were assessed for ASD and classified as either EL-No Diagnosis, EL-Language Delay or EL-ASD. Videos of interactions were divided into discrete engagement states, including supported and coordinated JE. All parent speech was transcribed and coded to capture structural (types, tokens, mean length of utterance (MLU), sentence position) and functional (follow-in comments, directives, lead-in labels) features of object labels as well as parent prompts for the child to produce a label. OUTCOMES & RESULTS: Parents of toddlers across outcome groups labelled objects at similar rates within each engagement state. However, parents of EL-ASD children provided the lowest rates of prompts for labels in supported JE and the highest rate of labels as the final word of an utterance (sentence-final position) in coordinated JE. Additionally, parent prompts in supported JE were related to concurrent child expressive language. Labels in sentence-final position were positively related to later language outcome when delivered in supported JE but were associated with poorer language outcomes when delivered in coordinated JE. CONCLUSIONS & IMPLICATIONS: Subtle differences in parent object labels across outcome groups demonstrate the role that child language and social engagement can play in influencing parent input and the cascading impact of this input on language development. WHAT THIS PAPER ADDS: What is already known on this subject Variations in caregiver object labelling can impact child language development. However, child characteristics such as language ability also actively shape the input caregivers provide, demonstrating the bi-directionality of language development. What this paper adds to existing knowledge The present study demonstrates that characteristics of the engagement context in which a label is delivered may be important for understanding how object labelling relates to child language acquisition and whether this relation varies for children who face challenges in language learning. What are the potential or actual clinical implications of this work? As child differences in social engagement emerge, parents may be more attuned to moments their children are engaging with eye contact. Caregiver-mediated interventions might consider strategies that guide caregivers in recognizing engagement without eye contact as a similarly meaningful opportunity for learning and encourage the use of rich input within these moments.

Infants' object interactions are long and complex during everyday joint engagement.

As infants interact with the object world, they generate rich information about object properties and functions. Much of infant learning unfolds in the presence of caregivers, who talk about and act on the objects of infant play. Does mother joint engagement correspond to real-time changes in the complexity and duration of infant object interactions? We observed 38 mothers and their first-born infants (cross-sectional, 13, 18, and 23 months) during 2 h of everyday activity as infants freely navigated their home environments. Behavioral coding explored thousands of infant object interactions within and outside mother joint engagement. Object interactions involving exclusively simple play were shorter than complex play bouts. Critically, mothers' multimodal input (i.e., touching/gesturing toward and talking about the focal object) corresponded with more complex and longer play bouts than when mothers provided no input. Bouts involving complex play and multimodal input lasted 7.5 times longer than simple play bouts absent mother input. Moreover, "action-orienting talk" (e.g., "Twist it", "Feed dolly"), rather than talk per se, corresponded with longer bout duration and complexity. Notably, the association between joint engagement and play duration was not a function of mothers having more time to join. Analyses that eliminated short infant bouts and considered the timing of mothers' behaviors confirmed that mother input "extended" the duration of play bouts. As infants actively explore their environments, their object interactions change moment to moment in the presence of mothers' multimodal engagement.

Joint engagement in the home environment is frequent, multimodal, timely, and structured.

Infants develop in a social context, surrounded by knowledgeable caregivers who scaffold learning through shared engagement with objects. However, researchers have typically examined joint engagement in structured tasks, where caregivers sit near infants and display frequent, prompt, and multimodal behaviors around the objects of infant action. Which features of joint engagement generalize to the real-world? Despite the importance of joint engagement for infant learning, critical assumptions around joint engagement in everyday interaction remain unexamined. We investigated behavioral and temporal features of joint engagement in the home environment, where objects for play abound and dyad proximity fluctuates. Infant manual actions, mother manual and verbal behaviors, and dyad proximity were coded frame-by-frame from 2-h naturalistic recordings of 13- to 23-month-old infants and their mothers (N = 38). Infants experienced rich, highly structured, multimodal mother input around the objects of their actions. Specifically, joint engagement occurred within seconds of infant action and was amplified in the context of interpersonal proximity. Findings validate laboratory-based research on characteristics of joint engagement while highlighting unique properties around the role of mother-infant proximity and temporal structuring of caregiver input over extended time frames. Implications for the social contexts that support infant learning and development are discussed.

The Quality of Mother-Toddler Communication Predicts Language and Early Literacy in Mexican-American Children from Low-Income Households.

This longitudinal study documents the key role of early joint engagement in the language and early literacy development of Mexican-American children from low-income households. This rapidly growing population often faces challenges as sequential Spanish-English language learners. Videos of 121 mothers and their 2.5-year-old children interacting in Spanish for 15 min were recorded in 2009-2011 in the Dallas-Fort Worth metropolitan area. Researchers reliably rated general dyadic features of joint engagement-symbol-infused joint engagement, shared routines and rituals, and fluency and connectedness-that have been found to facilitate language development in young English-speaking children. The construct respeto, a valued aspect of traditional Latino parenting, was also rated using two culturally specific items-the parent's calm authority and the child's affiliative obedience. In addition, three individual contributions-maternal sensitivity, quality of maternal language input, and quality of child language production-were assessed. General features of joint engagement at 2.5 years predicted expressive and receptive language at 3.6 years and receptive language and early literacy at 7.3 years, accounting for unique variance over and above individual contributions at 2.5 years, with some effects being stronger in girls than boys. The level of culturally specific joint engagement did not alter predictions made by general features of joint engagement. These findings highlight the importance of the quality of early communication for language and literacy success of Mexican-American children from low-income households and demonstrate that culturally specific aspects of early interactions can align well with general features of joint engagement.

Triadic interactions support infants' emerging understanding of intentional actions.

Infants' understanding of the intentional nature of human action develops gradually across the first year of life. A key question is what mechanisms drive changes in this foundational social-cognitive ability. The current studies explored the hypothesis that triadic interactions in which infants coordinate attention between a social partner and an object of mutual interest promote infants' developing understanding of others as intentional agents. Infants' spontaneous tendency to participate in triadic engagement was assessed in a semi-structured play session with a researcher. Intentional action understanding was assessed by evaluating infants' ability to visually predict the goal of an intentional reaching action. Study 1 (N = 88) revealed that 8- to 9-month-olds who displayed more bouts of triadic engagement showed better concurrent reasoning about the goal of an intentional reaching action. Study 2 (N = 114) confirmed these findings using a longitudinal design and demonstrated that infants who displayed more bouts of triadic engagement at 6-7 months were better at prospectively reasoning about the goal of an intentional reaching action 3 months later. Cross-lagged path analyses revealed that intentional action understanding at 6-7 months did not predict later triadic engagement, suggesting that early triadic engagement supports later intentional action processing and not the other way around. Finally, evidence from both studies revealed the unique contribution of triadic over dyadic forms of engagement. These results highlight the importance of social interaction as a developmental mechanism and suggest that infants enrich their understanding of intentionality through triadic interactions with social partners.

Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement.

BACKGROUND: More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state. METHOD: Video recordings of 10 min of free-play between 58 children (2-4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter. RESULTS: Mothers(m) and children(c) showed similar rate of positive affect (Mm  = 0.6/Mc  = 0.5) and toy expansion (Mm  = 0.7/Mc  = 0.7) per minute, whereas mothers talked almost three times more than their children (Mm  = 10.2/Mc  = 3.8). In contrast, mothers introduced fewer toys compared to the children (Mm  = 0.7/Mc  = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = -70.7 to -48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement. CONCLUSION: Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.

The role of joint engagement in the development of language in a community-derived sample of slow-to-talk children.

We explored whether supported (SJE) or coordinated joint engagement (CJE) between mothers recruited from the community and their 24-month-old children who were slow-to-talk at 18 months old were associated with child language scores at ages 24, 36, and 48 months (n = 197). We further explored whether SJE or CJE modified the concurrent positive associations between maternal responsive behaviours and language scores. Previous research has shown that SJE, maternal expansions, imitations, and responsive questions were associated with better language scores. Our main finding was that SJE but not CJE was consistently positively associated with 24- and 36-month-old expressive and receptive language scores, but not with 48-month-old language scores. SJE modified how expansions and imitations, but not responsive questions, were associated with language scores; the associations were evident in all but the highest levels of SJE. Further research is necessary to test these findings in other samples before clinical recommendations can be made.

Hybrid implementation model of community-partnered early intervention for toddlers with autism: a randomized trial.

BACKGROUND: Interventions found to be effective in research settings are often not as effective when implemented in community settings. Considering children with autism, studies have rarely examined the efficacy of laboratory-tested interventions on child outcomes in community settings using randomized controlled designs. METHODS: One hundred and thirteen children with autism enrolled in public early intervention classrooms in low resource neighborhoods were randomized to Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) intervention or treatment as usual waitlist for 10 weeks with 1-month follow-up. RESULTS: Teaching assistants delivered JASPER at adequate fidelity. Children randomized to JASPER demonstrated significant gains over treatment as usual in core developmental outcomes of joint engagement, joint attention, and play skills that were maintained at follow-up. CONCLUSIONS: Supervised teaching assistants delivered JASPER intervention with a range of toddlers with autism leading to significant gains in developmental outcomes.

Joint Engagement in Mother-Child Dyads of Autistic and Non-Autistic Children Among Asian Indian Tamil Speaking Families.

This study profiled various levels of engagement and related communication behaviours among 50 Asian Indian Tamil autistic children (AUT) and their mothers. The interaction was compared with two groups of mother-child dyads of non-autistic (NA) children, 50 in each group, matched for chronological age (CA), and for language level (LL). Results indicated that despite mother's efforts to engage with their children, autistic children were often 'engaged with objects' or remained 'unengaged' due to children's preference for solitary play, while NA children were often engaged in 'co-ordinated' and 'people engagement'. Across the three groups, mothers predominantly took the lead and dominated the interaction, irrespective of children's language levels. These initiations by the mothers were often to provide instructions and to ask 'What' questions. Autistic children initiated communication predominantly to ask for an object and responded often in the form of negations and protests with limited verbal output or non-verbally. Most of the communication behaviours of both children and mothers in AUT group was quantitatively and qualitatively different when compared to those in both the NA groups, indicating unique nature of interactions despite matching for CA or LL. The observations from the study highlights the need for considering adult's contingent behaviours also, while assessing communication skills of autistic children in order to provide effective intervention.

Educators apply new teaching strategies despite initial attributions of autistic students' controllability of their behaviors.

Autistic children are less likely to be jointly engaged with a play partner than nonautistic children, negatively impacting social communication development. Promoting joint engagement during play can be an important target for educators of autistic students, but educator perceptions of autistic students may affect their interactions with students. This secondary data analysis investigated educator perceptions of the behaviors of their autistic students, their relationship on educator behavior, and their relationship on the implementation of an intervention promoting joint engagement. Participants included 66 autistic preschool students, and twelve educators from six preschools. Schools were randomized to educator training or a waitlist. Before training, educators rated their students' controllability over autism related behaviors. To observe educator behavior, they were filmed playing for ten minutes with students, before and after receiving training. Ratings of controllability were positively correlated with cognitive scores, and negatively correlated with ADOS (Autism Diagnostic Observation Schedule) comparison scores. Furthermore, educator ratings of controllability predicted joint engagement strategies used by educators during play. Educators tended to use strategies promoting joint engagement for students perceived as more able to control their autism spectrum disorder behavior. Among educators that received JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) training, ratings of controllability did not predict changes in strategy scores after training. Educators were able to learn and implement new joint engagement strategies despite their initial perceptions.

Joint engagement and early language abilities in young children with Down syndrome.

Introduction: Early social strengths likely serve as a foundation for language acquisition for young children with Down syndrome (DS). One way to characterize early social skills is to examine a child's engagement with a caregiver around an object of interest. The current study examines joint engagement in young children with DS and its relation to language abilities at two-time points in early development. Methods: Participants were 16 young children with DS and their mothers. At two time points, mother-child free plays were completed and coded for joint engagement. Language abilities were measured at both time points using the Vineland Adaptive Behavior Scales 3rd edition and the number of words understood and produced on the MacArthur-Bates Communication Development Inventory. Results: Young children with DS spent more time in supported joint engagement than coordinated joint engagement at both time points. Using a weighted joint engagement variable, children with DS who had higher weighted joint engagement had lower expressive language raw scores on the Vineland when controlling for age at Time 1. At Time 2, children with DS who had higher weighted joint engagement had higher expressive and receptive language raw scores on the Vineland when controlling for age. Predictively, children with DS who had a higher weighted joint engagement at Time 1 had a lower number of words produced at Time 2 when controlling for age at Time 1. Discussion: Our results suggest that young children with DS may compensate for their difficulties with language by using joint engagement. These results highlight the importance of teaching parents to be responsive during interactions with their child to move them into both supported and coordinated engagement, which in turn may foster language development.

Early language outcomes in Argentinean toddlers: Associations with home literacy, screen exposure and joint media engagement.

This study aimed to analyse the contribution of mothers' home literacy beliefs and practices and the quantity and quality of screen media exposure on Argentinean toddler's language. In addition, we considered parent-child joint engagement, as well as adult scaffolding behaviours during the use of electronic devices. A total of 465 mothers of 18-36 months old children completed an online survey including: the MacArthur Bates CDI, home literacy, screen exposure, joint engagement and scaffolding questionnaires. We observed positive effects of literacy beliefs, PC times and verbal scaffolding on language outcomes. TV exposure contributed negatively to vocabulary and, along with educational content, to sentence use. Shared reading and screen media experiences can be an opportunity for language stimulation, provided there is dialogue and joint engagement. Passive screen exposure and inadequate content may be detrimental for toddlers' language outcomes, probably by displacement of socially significant interactions.

Joint Engagement, Parent Labels, and Language Development: Examining Everyday Interactions in Infant Siblings of Children with Autism.

This study examined joint engagement, parent labels, and language development in infants with an elevated (EL) and typical likelihood (TL) for ASD. Parent-child interactions were coded for joint engagement and parent labels at 12 and 18 months, and language skills were assessed later in toddlerhood for 12 EL infants diagnosed with ASD (EL-ASD), 17 EL infants with language delay (EL-LD), 14 EL infants with no diagnosis (EL-ND), and 12 TL infants. Infants spent substantial time in supported joint engagement and received similar rates of input from parents across outcome groups. However, parents of EL-ASD infants increased the rate of labels provided in coordinated joint engagement. While labels positively predicted language for TL infants, the opposite pattern emerged for EL-ASD infants.

Exploring coaching and follow-up supports in community-implemented caregiver-mediated JASPER intervention.

LAY ABSTRACT: The next step for communication interventions for young children with autism include coaching/teaching for caregivers that have been tested in university clinics and testing these interventions in real world systems with early intervention providers who serve children and families in their communities. However, there are few projects that have tested how well the intervention can be transferred to community providers and what types of progress children and caregivers make in these services. This project took place in partnership with a community early intervention agency in the province of Ontario, Canada. The agency provided government-funded public health services. The agency was funded to take part in a pilot program to try out one of four early intervention models that included coaching for caregivers and was designed to support children's social engagement, play, and communication skills. The team decided to test two ways to start the intervention: (a) begin with observation of the practitioner for 4 weeks and then start coached practice with the child and (b) start coaching immediately. The team also tested two ways to support families for 3 months after intervention: (a) group booster sessions and (b) individual visits. The practitioners delivered the intervention well (M = 83%), and overall, caregivers and children made significant gains by the end of intervention in both observation + coaching and coaching. Attendance for follow-up boosters was variable with fewer families attending groups. More research is needed to test different strategies and roles to individualize interventions for caregivers with a range of goals and learning styles.

Brief Report: Collateral Joint Engagement During a Playdate Intervention for Children with and at Risk for Autism.

Joint engagement involves a child coordinating their attention between a person and a shared event. Children with autism present with impaired joint engagement. Playdates are a common way that children socially engage yet have been largely overlooked in the social skills literature. Requesting skills have been conceptualized as pivotal, producing collateral effects. In the current study, we conducted a secondary analysis of a single-case design that evaluated a parent-implemented playdate intervention focused on supporting children and peers to request and respond to one another during games. We examined the collateral effects of the playdate intervention on joint engagement. Two children demonstrated gains in joint engagement with a peer, and the third exhibited variable changes. Implications for future research are discussed.

Generalized Effects of Naturalistic Social Communication Intervention for Minimally Verbal Children with Autism.

JASP-EMT, the combined Enhanced Milieu Teaching (EMT) and Joint Attention, Structured Play, and Emotion Regulation (JASPER) interventions, has been found to be effective for promoting social communication in young children with autism (Kasari et al. in J Am Acad Child Adolesc Psychiatry 53(6):635-646, https://doi.org/10.1016/j.jaac.2014.01.019 , 2014). The current study examined the effects of this naturalistic intervention on social language use in three children with autism who were in the early stages of language acquisition. Generalization to communication partners who did not utilize the intervention strategies was systematically examined using a multiple-baseline design. The results from this study indicate that this blended intervention is effective in increasing target social language for young children with autism, however, generalization to communication partners does not readily occur. Implications for practice and future research are discussed.

Identifying when children with visual impairment share attention: A novel protocol and the impact of visual acuity.

BACKGROUND: In Coordinated Joint Engagement (CJE), children acknowledge that they and their social partners are paying attention to the same object. The achievement of CJE, critical for healthy development, is at risk in infants with visual impairment (VI). Research on CJE in these children is limited because investigators use a child's gaze switch between social partner and object to index CJE. Research is needed that identifies CJE in children with VI using behaviors that do not require normal vision and that explores the relationship between CJE and visual function. This study aimed to (a) develop a protocol for identifying CJE in children with VI, and (b) explore the relationship between CJE and infants' visual acuity (VA) and contrast sensitivity (CS), measured with Preferential Looking (PL) techniques and Visual Evoked Potential (VEP). METHODS: A protocol that included 9 indices of CJE that did not require normal vision was developed to code videos of 20 infants with VI (mean age =1 year, 6 months, 27 days) and their caregivers. The percentage of CJE episodes in which each index was observed was calculated. Inter-coder reliability was measured using Cohen's Kappa. Linear regression analysis was used to examine the relationship between the infants' visual function and CJE. RESULTS: Inter-rater reliability between a first coder and each of two second coders were 0.98 and 0.90 for determining whether the child participated in CJE. The following indices were observed the most (in 43-62 % of CJE): child's body orientation to caregiver, gaze switch between caregiver and object, and vocalization to caregiver. The only significant model included VA (measured with PL) as a single predictor and explained 26.8 % of the variance in CJE. CONCLUSIONS: The novel protocol can be used to identify CJE in children with VI with good inter-coder reliability. The data suggest that children with lower VA exhibited less CJE.

Joint engagement and movement: Active ingredients of a music-based intervention with school-age children with autism.

BACKGROUND: The effectiveness of music-based interventions (MI) in autism has been attested for decades. Yet, there has been little empirical investigation of the active ingredients, or processes involved in music-based interventions that differentiate them from other approaches. OBJECTIVES: Here, we examined whether two processes, joint engagement and movement, which have previously been studied in isolation, contribute as important active ingredients for the efficacy of music-based interventions. METHODS: In two separate analyses, we investigated whether (1) joint engagement with the therapist, measured using a coding scheme verified for reliability, and (2) movement elicited by music-making, measured using a computer-vision technique for quantifying motion, may drive the benefits previously observed in response to MI (but not a controlled non-MI) in children with autism. RESULTS: Compared to a non-music control intervention, children and the therapist in MI spent more time in triadic engagement (between child, therapist, and activity) and produced greater movement, with amplitude of motion closely linked to the type of musical instrument. CONCLUSIONS: Taken together, these findings provide initial evidence of the active ingredients of music-based interventions in autism.

Developmental associations between joint engagement and autistic children's vocabulary: A cross-lagged panel analysis.

LAY ABSTRACT: In this study, we used a cross-lagged panel analysis to examine correlations over time between two types of engagement between children and their parents and children's later expressive and receptive vocabularies. This kind of design can help researchers understand which early developmental achievements "drive" later developmental achievements. It is important for intervention researchers to know which developmental achievements happen first, so that they can set intervention goals appropriately. The two joint engagement variables we examined were (a) higher order supported joint engagement, which occurs when caregivers influence their child's play with toys and the child reciprocally responds to the caregiver, but does not manage the interaction by shifting gaze between the toys and the caregiver, and (b) higher order supported joint engagement that co-occurs with caregiver's follow-in talk (higher order supported joint engagement + follow-in). Follow-in talk occurs when the caregiver talks about objects and events that the child is focused on. Ninety-one autistic children (n = 91) with language delay (mean chronological age = 39 months) participated, along with their primary caregivers. Each of the four variables was measured twice, 8 months apart. Our statistical procedures showed that early higher order supported joint engagement and early higher order supported joint engagement + follow-in were significantly associated with later expressive and receptive vocabulary. In contrast, associations between early vocabulary variables and later joint engagement variables were not significant. Our results suggest that higher order supported joint engagement and higher order supported joint engagement + follow-in may be useful initial intervention targets, for developmental interventions aimed at promoting language development in autistic children who are initially language delayed.

The stability of joint engagement states in infant siblings of children with and without ASD: Implications for measurement practices.

Obtaining stable estimates of caregiver-child joint engagement states is of interest for researchers who study development and early intervention in young children with autism spectrum disorder (ASD). However, studies to date have offered little guidance on the numbers of sessions and coders necessary to obtain sufficiently stable estimates of these constructs. We used procedures derived from G theory to carry out a generalizability study, in which we partitioned error variance between two facets of our system for measuring joint engagement states: session and coder. A decision study was then conducted to determine the number of sessions and coders required to obtain g coefficients of 0.80, an a priori threshold set for acceptable stability. This process was conducted separately for 10 infant siblings of children with ASD (Sibs-ASD) and 10 infants whose older sibling did not have ASD (Sibs-TD), and for two different joint engagement states; lower- and higher-order supported joint engagement (LSJE and HSJE, respectively). Results indicated that, in the Sibs-ASD group, four sessions and one coder was required to obtain acceptably stable estimates for HSJE; only one session and one coder were required for LSJE. In the Sibs-TD group, two sessions and one coder were required for HSJE; seven sessions and two coders were required for LSJE. Implications for measurement in future research are discussed. Autism Res 2019, 12: 495-504 © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study offers guidance for researchers who measure joint engagement between caregivers and infants who have an older sibling with ASD, and who have older siblings who are TD.