Autism - Joint Attention (Social Skills) Video

Barbara L. Trommer MD Pediatric Neurology . Associate Director, Maimonides Developmental Center . Medical School: Columbia University . Fellowship: Children's Memorial Hospital Northwestern University Medical School Pediatric Neurology
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Let's focus for a bit on what we mean by the social skills as one of the core deficits that's missing in Autism Spectrum Disorders. A word that you will hear over and over again is Joint Attention, and you should have a good grasp of what Joint Attention means. It's normal spontaneous behavior whereby an infant shows enjoyment in sharing an object or an event with another; usually a parent, by looking back and forth between the two, and it's the looking back and forth that's very key. Child looking at what he has got in his hands, looking at you to see if you are looking at him, that kind of awareness. Mastery of Joint Attention is a reliable predictor of language development, and language development in turn is a reliable predictor of prognosis. Like other milestones, Joint Attention has a developmental course where receptive skills are present before expressive skills are present. So the 2-3 month old, you expect to smile when he sees his parent smile or hears his parent's voice. By 8 months old he should be able to follow his parent's gaze. You look at the clock, he should follow your eyes. By a year, by 10-12 months, he should follow a point, meaning you say, look at that, he should look at that and then again look back at you, so that this jointness of sharing an experience is established. By 12-14 months, the toddler should be initiating pointing to get something out of reach. He may not be able to ask for it, but he is pointing, and he is looking at you so that he is telling you by his finger pointing, that's what I want. By 15-16 months, the child should be able to draw a parent's attention to an object of interest by making sounds and pointing and looking back and forth. I need to very clearly distinguish this kind of normal pointing from two aberrant forms of pointing that are characteristic of Autism. One is hand leading, and that's not a communicative form of pointing, its an instrumental form of pointing. That's when a child takes your hand and brings it to the object that he wants. You are his instrument, you are his agent, but he is not communicating with you or sharing attention with you. The other is pointing to label, just pointing and naming things. Those are not the kind of pointing that signify the presence of joint attention.

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