Have you ever wondered if a child is “just a late talker” or if there’s a larger problem?
Research reveals that there are several risk factors that let us know that a child’s late talking is likely a part of a child’s developmental delay, rather than the only issue. I’ve started a series of articles to address these concerns. In this post, we’re addressing the second red flag which is:
DIFFICULTY WITH JOINT ATTENTION
What is joint attention?
Joint attention can also be called “shared attention” and it occurs when two people focus on the same thing. Usually an episode of joint attention begins when one person does something to alert someone else to an object or event using:
- Words such as “Hey mom!” or “Look!”
- Gestures like pointing or showing an item
- Nonverbal methods of gaining attention such as eye gaze. For example, the child looks at something and then looks back at you as if to say, “That’s what I want you to notice!”
The examples above cover a child’s ability to initiate joint attention, but responding to others is an important aspect of joint attention too. This means that a child may be happily playing with a toy, but if you call his name, he looks up at you. Another example is that she attends to what you’re trying to show her. When you point to something across the room, the child follows your point with his eyes. A child recognizes and welcomes your attempts to engage her, to talk with her, and play with her.
When I explain joint attention to parents, I talk about a child’s ability to shift his attention between an object or event and another person. Three participants are involved in this “triad” of attention – the child, you, and the item/occurrence. There’s mutual focus. Beyond both people actively participating, both also understand that they are paying attention to the same thing and it’s purposeful for both parties. That’s what constitutes the “sharing” principle in joint attention.
Why is joint attention important for language development?
Joint attention is a social skill, meaning the way a child interacts with other people. That’s what communicating is – a way of interacting with another person. Communication begins with this shared attention and engagement piece. When a child doesn’t notice that you’re trying to get him to include you or share an experience, there’s not much real interaction going on between the two of you.
Babies and toddlers must regularly interact with other people before they begin to listen to your words. Over time with consistent listening and attending to what you’re saying, they learn to understand what you’re saying by linking meaning to your words.
This is how I “draw it out” for parents who have difficulty seeing the correlation between their child’s lack of consistent interaction and delayed language skills. When I’m using this illustration, I draw an arrow when I’m saying “leads to,” as you can see here:
Interaction leads to listening.
Listening leads to understanding language.
Understanding language leads to using language…
Using language (such as gestures, facial expressions, eye gaze) leads to talking.
Of course, there are exceptions, (which point to different reasons a child isn’t learning to talk), but generally, this is how speech-language skills emerge.
Another important consideration is the frequency of a child’s ability to shift his focus and share experiences with others. A child’s skills don’t have to completely absent in this area before it’s a problem. If a child’s joint attention skills are best described as “hit or miss,” there’s still usually a language delay.
Here’s why…opportunities for learning language are limited for this kid because he’s not tuned in to what he can learn from others during exchanges virtually all day long. On closer inspection, much of this child’s day may be spent “doing his own thing” rather than seeking out someone else to play and interact with or responding when someone tries to engage her. When a child doesn’t demonstrate strong joint attention in hundreds of interactions with others every day, he is at a serious disadvantage for learning to talk. He’s missing all of those potential opportunities for learning language.
Signs of Difficulty with Joint Attention
Toddlers who have difficulty with joint attention inconsistently respond to your words, your gestures (such as pointing at something for them to look at), and your actions. They may appear to avoid others or ignore what’s said to them. They seem to tune out their own names and other verbal directions. Things need to be their own idea or they’re not really interested. Adults may have to work pretty hard to get and keep this child’s attention.
Kids with joint attention issues don’t use increasingly mature ways to gain attention from others. For example, a toddler over 12 months may fuss or cry when something is wrong, but she doesn’t make attempts to tell or show you what’s happened.
Contrast this with a child who has mastered joint attention. A typically developing toddler is quite adept at interjecting their will. They frequently interrupt and try to direct a parent’s activities in order to get what they want, even before they begin to talk. They look toward, point, or lead parents, and then they continue to use any way they can to make sure that mom or dad complies with their request.
An issue with decreased joint attention is even more serious when a child also has difficulty with other social skills such as making eye contact with other people and sharing frequent warm, joyful expressions with others during close interactions.
Diagnostic Implications for Decreased Joint Attention
When a child doesn’t consistently display joint attention, we become concerned about the social aspects of language development. Toddlers with various developmental delays can certainly show lapses of decreased joint attention, but when a child’s joint attention is consistently limited or absent, we do become concerned about autism. We should look for other red flags or deficits of ASD (autism spectrum disorder) not to confirm the suspicion, but as a way to address a child’s core issues.
Ways to Improve Joint Attention
There are plenty of things you can do to establish solid joint attention skills during everyday activities at home. Strategies to improve joint attention with young children begin by working on eye contact and his ability to look at your face when you’re talking to him. I encourage parents to give a child something worth paying attention to – be fun to look at and listen to as you’re playing or talking together! Use interesting objects to capture a distracted toddler’s attention. Frequently model gestures, such as pointing and showing items, so that a child will first begin to understand these important nonverbal ways of communicating and eventually use them to initiate interaction with you. Position yourself to make eye contact and sustained interaction easier for the child. Get on their same level. For example, if he’s up on the couch, sit on the floor so that your eyes are across from his. For additional ideas, read more about joint attention. If you’re more of an auditory learner, listen to my podcast about joint attention.
Recommendations for Parents
The most important recommendation I can make for parents of a child who is struggling with joint attention is to get professional assistance. Begin by discussing the concerns with your pediatrician or other healthcare professional. Ask for a referral for a developmental assessment. If your doctor dismisses your concerns, get another opinion! You know your child better than anyone else ever will and if you’re feeling uneasy about your child’s development, trust your instincts!
Early intervention is especially critical for a child with joint attention and other social skill problems since maturity alone does not resolve these kinds of issues.
By this I mean that a child won’t “grow out of it.”
Intervention is absolutely necessary and may look different over the course of a childhood for a kid with social interaction differences. In early toddlerhood and throughout the preschool years, I believe that specialized developmental services are critical. This period is when we can make the MOST difference in a child’s outcome. It’s when developing brains are most “ready” for growth.
Parents of a child with any kind of social-communication problem will benefit dramatically from having a professional or team of professionals teach them ways to successfully address their own child’s needs at home. When this happens, intervention isn’t a once or twice a week thing limited to therapy or preschool. By working with therapists and teachers who have had experience treating other children with similar backgrounds, you’ll be able to trust that you’re doing everything you can to help.
Special note for/about professionals…
Sometimes a speech-language pathologist may be reluctant to discuss the importance of joint attention and other red flags for autism with parents opting for more general terms such as “language delay” or “late talker.” This can occur when a therapist is unsure if a child would meet the diagnostic threshold for receiving an official diagnosis of autism. A therapist may be afraid of being “wrong” or overstepping their bounds. In some states, therapists are discouraged from offering a diagnosis and must refer a child for further testing from a developmental pediatrician, neurologist, or another medical specialist.
While I understand these issues, it’s not an excuse not to talk honestly with families. As I’ve stated in previous posts in this series, when we don’t share the full extent of a child’s issues with parents, I believe that we’re essentially withholding important information. I don’t want to be that kind of professional (or that kind of person) so I have “the talk” with parents, even when it’s uncomfortable for everyone.
If you’re a parent and working with a professional who you sense may be holding back, be direct. Bring up the subject yourself. Take a deep breath and ask, “Do you think this is more than late talking?”
In summary, a toddler with limited joint attention may have difficulty acquiring a broad range of developmental skills including learning how to interact with others and make friends, how to talk, how to understand words, and how to process and use incoming information. These challenges may overlap into additional areas of development, but early intervention (when the child is young – before 5) can be highly successful for significantly improving, and in some cases, even eliminating these problems.
If you’re a parent, I hope that this information will help you understand what may be going on with your own child. If you’re a therapist, this is the kind of information that doctors and other professionals may not be sharing with parents of a child with a language delay due to limited social skills. It’s up to us to help families understand the depth of a child’s issues and provide hope that therapy, along with consistent parental commitment, can make a huge difference!
Product Recommendations from teachmetotalk.com for Helping Toddlers with Language Delays due to Limited Joint Attention
Kids with decreased joint attention will have difficulty learning to understand and use language. My best resources for parents include:
Teach Me To Play WITH You is my first book written for both parents and professionals. In this therapy manual, you’ll learn my best tips for helping a toddler learn how to consistently interact with you during fun games and social routines. It’s the starting point for therapy for any child with limited joint attention. Each activity is written in a “homework format” with step-by-step instructions and goals that are clearly delineated. I get emails everyday from parents who rave about how quickly they noticed changes in their toddler once they implemented these techniques.
Teach Me To Listen and Obey (2 DVD Set) focuses on receptive language or what a child understands. Many children with significant differences in their joint attention skills also have severe receptive language delays. Here’s why…if a kid doesn’t regularly attend to other people, he’s not going to understand what they say to him. When a child doesn’t understand words, he’s not going to use words (aka…talk). If a toddler is over 18 months and doesn’t follow simple directions, receptive language delays are highly likely. In this DVD for adults, you’ll learn important comprehension milestones and receive recommendations for working on these skills at home and during therapy sessions. You’ll SEE video clips of me working with children with language delays during speech therapy sessions so that you can duplicate the activities.
Teach Me To Talk the DVD focuses on expressive language or what a child says. In this DVD, you’ll see the 6 beginning strategies I teach parents of late talkers. The DVD is filled with video clips of children with a wide range of abilities from 12 months to 3 years. It’s a great starting place for most parents (and therapists!) who want to learn real life ways to work with a toddler with language delays.
If you’re more of a reader or if you want detailed goal lists for both receptive and expressive language matched with activities to use with toddlers and preschoolers, take a look at my book at Teach Me To Talk: The Therapy Manual. There’s a chapter on social skills that’s a fantastic guide for targeting joint attention and social interaction. This book was written for speech-language pathologists, but many parents use it as their basis for “at home” therapy.
For therapists (and ULTRA committed parents who are working with their children intensely or parents who don’t have access to services and need professional-level information), my CE courses that best address social skills are:
Is It Autism? Recognizing and Treating Toddlers and Preschoolers with Red Flags for ASD. This course on DVD has two parts. Part One entails a comprehensive look at the diagnostic criteria for autism so it takes some of the guesswork out of this process. If you’re a professional and find yourself wondering if a child would or wouldn’t get an ASD diagnosis, this course is for you! Part Two is all about intervention. You’ll learn the most effective treatment strategies and approaches to jump start progress in a toddler with red flags for autism, including limited joint attention.
Early Speech-Language Development: Taking Theory to the Floor is a comprehensive 12-hour course on DVD. All areas of language development (social, receptive, expressive, and intelligibility) are addressed. There’s a long section with lengthy, meaty discussion about social issues since this information is limited in grad school programs for SLPs.
Both courses are approved for ASHA credit for speech-language pathologists (and if you’re in IL, it’s preapproved for EI credit!) with a certificate of completion for other therapists to use toward licensure or certification requirements.
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Links to Milestones
Follow these informative links to the Center for Disease Control website with lists of skills and pictures to show you what’s normal for a child’s age range. Remember that most babies will have easily achieved the skills listed there – meaning that the standards listed are set at a minimal level to account for a wide range of “normal.” (In other words, the bar is pretty low.) If a child hasn’t met all the skills on these lists or especially exhibits the concerns in the bottom “Act Early” boxes, there is a definite reason to speak to your child’s doctor or healthcare professional.
**Photo from mom-psych.com**