Joint Attention: What, Why, How

What is joint attention?

Joint attention is the ability to focus on the same thing (object, person, event) with another person. This means that three parties are involved in joint attention, the child, the object of focus and another person.

Therefore in order for joint attention to happen, the child needs to be able to gain, maintain, and shift his attention. In typical development, joint attention emerges around 9 months of age and is deeply entrenched by 18 months.

The importance of joint attention

Joint attention is crucial for language development. In order for a child to learn a word, he has to hear it and associate the label with an object. To illustrate, a typically developing child will look at the dog that his parents are pointing to, and hear them say “Dog”. He looks back at his parents to make sure that they are talking about the dog, and then looks back at the dog again. As he hears the word, “dog” over and over again, he starts to link the word “dog” with that furry four-legged creature wagging its tail.

In another scenario, the child may hold up a teddy bear and look at his parents. His parents may then respond with “Oh! Teddy!” The child then start to associate the label to the soft toy in his hands.

Now imagine a child lacking joint attention. Even if he had heard “dog”, he may not know what they are referring to if he is not responding to his parents’ point. In this scenario, language learning becomes difficult, if not darn near impossible.

Not only does joint attention has an impact on language, it is also necessary for social development. When children play, they are focused on and sharing toys. At a higher level, they share a make believe theme and contribute ideas to it.

Also in conversations, two people talk about an object, event or person. However, this interaction does not only linger on one topic but rather jumps from topic to topic.

So if a child is failing at such a basic level of social interaction, how can he be expected to succeed at higher levels of social engagements?

What Does a Lack of Joint Attention Looks Like?

• Not responding to the speech of others: The child does not respond when you call his name.
• Not looking back and forth from object to another person: When you hold out a favourite toy, the child becomes hyper-focused on the object and never looks back at you to see your reaction.
• Not directing the attention of others to an object or event of interest: The child does not ask for his parent’s help even though they are standing close by. He tries to reach for a toy that’s beyond his reach and cries when he fails to do so.
• Not following the point of others: A parent says “Look! Balloon” as he points to a balloon. The child does not respond and continues spinning the wheel of his toy car.

Different Types of Joint Attention

Joint attention can be divided into two parts:

Child is responding to another person’s invitation for joint attention

A dad is walking in the park with his toddler. He points to a beautiful butterfly and say “Look! A butterfly”. The child turns and follows the point of her dad, and reaches out to try and catch the butterfly.

Child is initiating joint attention with another person

Initiating joint attention with another person usually requires social motivation. This looking back and forth between the object and another person is called social referencing. The child might look at the adult as if to say “Look at me…I’m doing something great!” or to check to see if what they are doing is OK or safe.

Here are 2 examples:

• A child points to an aeroplane in the sky and says “Airplane”. When mum comments, “Wow! A big airplane”, the child looks at her and smiles.
• A child looks at parents with a big grin, topples the stack of blocks in front of him then turns back again to see his parents’ reaction.

Strategies to Build Joint Attention

Since different processes are at play for the two types of joint attention, they need to be treated differently as well. In this article, we are only covering the part of responding to another person’s bid for joint attention. The part on initiation will be covered in a later article. Do keep in mind the following for treatment:

• Children benefits most from naturalistic interventions and from interacting with another person;
• Children respond better when the activity is based around their interests; and
• Children are more likely to participate if it is fun and exciting 

Responding to Another Person’s Invitation for Joint Attention

Change yourself

• Make your face look fun and interesting
• Heighten your affect with your voice by injecting energy and emotion into it
• Use simple language to avoid over-stimulating your child
• Position yourself to make it easier for him to look at you

Check out this post on eye contact.

Teaching the child to look at you

To start off, we first need to help him to look at us:

• Hold out the child’s favourite item and go right in front of him. Make sure you are down on his level and is holding the toy in front of your face.
• Say “Look!” excitedly and activate the toy or make some noise with the toy.
• Wait for your child to look you in the eye before handing it to him. If he does not look into your eye, move your face towards where he is looking until he catches your eye. Immediately hand the item to him and say “Good looking!”.
• Keep practising until he is reliably looking you in the eye without much need for you to shift around to catch his eye.

Teaching the Child to Turn and Look at You

Now that he is reliably looking, work on getting him to turn and then look at you:

1. Hold out the child’s favourite item and go right in front of him. Make sure you are down on his level and is holding the toy in front of your face. Stay just slightly to the side of the direction where he is facing.
2. Then say “Look!” animatedly as you activate the toy.
3. If the child turns to you, say “Good looking!” and hand the toy to the child.
4. If he doesn’t, move the toy into his line of sight. Once he notices it, slowly shift it closer to you such that your child is following the toy and turning around. Then once he is facing you, make sure he is looking in your eyes before handing the item to him and saying “Good looking!”.
5. If he is still not responding to the visual cue, gently turn his face such that he faces you. Then once he is facing you, make sure he is looking in your eyes before handing the item to him and saying “Good looking!”.
6. As your child gets better, move more and more to the side such that he has to turn more and more when you say “Look!”.
7. When he can turn a full 180 degrees, move a little further away so that he has to come to you.
8. Continue to up the ante until he can come to you from afar when he hears you say “Look!”

Teaching the Child to Respond to a Person’s Point

1. Identify activities that your child likes. Then analyse to see if there are parts that are necessary to completing it. For example, if your child likes to do puzzles, use the puzzle pieces. Or if he likes to line up toy cars, use the cars. Hide the pieces around the room.
2. When your child starts looking for the puzzle pieces, you can say “Look!” and point to one of the pieces. Make sure that you move your arm slowly and intentionally such that it crosses your child’s visual field and catches his attention. When your child turns to look, run over, pick up the puzzle piece and hold it out to him. Wait for him to give you eye contact before handing it to him.
3. Continue doing this until your child is reliably following your point.
4. If your child does not respond, say “Look!” again (remember to use your voice and expression), then very gently turn his cheek so that he is looking at where you are pointing. Once he has done so, run over, pick up the puzzle piece and hand it to him.

Stretching out Your Child’s Joint Attention

1. Now that your child is reliably looking, try stretching out the interaction.
2. After your child is giving eye contact and before handing over the item, try lengthening this time by doing something novel. For example, you might place the puzzle piece on your head and sneeze it off before handing it to your child.
3. As your child can attend longer and longer, try adding in more steps before he can get the “prize”.

Conclusion

A child needs to learn language from interacting with another person. But in order for this interaction to happen, joint attention has to be in place. By first helping a child attend to us, we are setting the stage for them to want to be with us, and to learn from us. 

Though it is an uphill ride, the good news is that, like any skill, it can be improved by working on it.

Are there other ways that you have found to help with joint attention? Share it in the comments section below!