In this seventh show in this podcast series, we’re examining joint attention as a skill toddlers must use before words emerge. Joint attention emerges from the previous skills we’ve discussed during the last few weeks in this series. We’ve talked about helping a child learn to respond to events or things in the environment, respond to people, and develop an attention span – all skills that are necessary for joint attention.

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Joint attention means that a child can share or shift his attention between objects or events and people. Examples of joint attention include:

• A child notices a bus and looks at his dad and then back at the bus as if to say, “Hey Dad! Check out that big bus?”
• A parent is with her little girl shopping in the grocery store. She points to a bin of oranges, her daughter’s favorite fruit and says, “There’s what you want!” The little girl looks to see where her mother is pointing, looks back at her mother and gives her a wide smile, and then begins to reach toward the oranges.
• When a toddler breaks a favorite toy, he purposefully walks around his home to find someone to help him. He see his mom standing in the kitchen as she’s talking on the phone. He tugs on her pants to get her attention and holds the toy up for her to see. Even without any words he’s telling her, “Mom! Look – it’s broken! Fix it!”

As you can see in the examples, we want children to respond to other’s bids for attention by looking at the person who is talking or gesturing to them. We also want children to learn to initiate interaction with other people by using joint attention.

Joint attention is essential for language development. Let’s look at another example to explain how this works. A little boy may be captivated by his Thomas the train, but unless he notices that mom is looking at and talking about the train too, he’s unlikely to learn the words associated with Thomas. Actually, true joint attention goes a step further. Not only do we want him to include mom in his play by looking up at her as she talks, we want him to seek out mom to show her the train to initiate this shared event. He should use a gesture such as pointing to direct mom’s focus to the toy as if to say, “Hey! Look at my cool train!” He looks back and forth between Thomas and mom as she supplies the language he doesn’t yet have. As she’s saying, “Wow! I see Thomas. I like him too!” he moves his gaze from looking at his train to watching his mom and back again. This “triad” is what makes up true joint attention.

In babies with typical developmental patterns, joint attention emerges around 9 months and is firmly established between 12 and 18 months. (Read more about my experience with assessing joint attention in typically developing babies.)

When we don’t see a child who consistently displays joint attention, we become concerned about the social aspects of language development. Children with various developmental delays can certainly show decreased joint attention, but when a child’s joint attention is very limited, we do become concerned about autism and should also look for other red flags or deficits of ASD (autism spectrum disorder) not as a way to confirm the suspicion, but as a way to address a child’s core issues.

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 may begin by working on eye contact and looking at your face.

Eye contact is very difficult for some toddlers – especially those with red flags for autism – but it’s a very important skill because so much of what we communicate is conveyed through a person’s face in addition to the words they speak. The tips we covered in Show #278 are a good place to start:

1. 1. Get down on his or her level.
   2. Place yourself where the child is most likely to look.
   3. Give a child a reason to include you. Make yourself FUN to look at and sound FUN to listen to!
   4. Do what he likes.
   5. Emphasize interaction (eye contact, closeness, a sense that the child wants to be with you) over every other goal, no matter what you’re doing with a child.
   6. Play, play, play! And when you’re sick of all that, play some more!
   7. Reward attention to you.

Other tips we discussed in today’s show for helping a child make eye contact and build joint attention include –

• Use toys or objects that are interesting and will entice a child to look at you. Hold that object right in front of your face in front of your eyes, almost sitting on your nose. Or try wearing funny glasses to attract attention to your eyes. One of my favorite tricks is to put on glasses from a Potato Headset. Those tiny glasses will barely fit on an adult-sized face, but I shove them on anyway to entice a child to look at my eyes. One talented therapist I know puts stickers on her face and lets a child pull them off her skin. Bubbles are another fun activity for this goal. Blow one bubble and catch the bubble on the wand and hold it right in front of your eyes. (Here’s a Therapy Tip of the Week about using bubbles and this strategy.)

• For a child who seems to avoid looking directly at you, try introducing eye contact play with a mirror. Parents can do this even in small doses throughout the day by holding a child up to see herself in the mirror while they’re in the bathroom taking a bath or brushing teeth at the sink. One mom, I worked with placed one of those full-length door mirrors on its side on the floor and she worked on eye contact several times a day with her little girl in small 10 minute spurts by getting down on the floor, most of the time lying flat on her belly, and making silly faces in the mirror. Initially, she had to hold her daughter there to teach her to stay there in front of the mirror with her, even for a minute or two. Eventually, that little girl loved this game so much that she led her mom to the mirror several times a day as if to say, “Momma! Come play this fun game with me!”

• Try different positions with your child that might make eye contact more likely. Many children first begin to sustain eye contact with me while lying on their backs on the floor while I sit at their feet. Introduce games that make staying in this position more fun. Play any kind of toe game such as counting a child’s toes, playing the game“This Little Piggy,” or make a child “clap” and kick their feet. If you’re playful enough, you can keep a kid in this position looking at you for quite a while! Other things to try are getting under a blanket, in a child-sized tent, or under a table with a child. Those novel experiences and small, tight spaces make it more likely he’ll look at you.

• Sometimes eye contact is hard because a child is having difficulty processing information with multiple senses at the same time. This is frequently noted in children with autism or other sensory processing issues. For example, you’re trying to get a child’s attention by talking a million miles a minute, using an animated voice and exaggerated facial expressions, all while holding him or touching him. Don’t be surprised in this situation if that child does everything he can to get away from you because you’re overstimulating him! In other words, some children can’t look and listen at the same time. It becomes overwhelming for them! With this kind of child, you may have to isolate eye contact first in situations when you’re not talking too much, if at all. You can play with a child by just looking at him and changing your facial expressions to keep his interest. If a child seems overly sensitive to noise, try toning it down by speaking or singing or chanting softly as he watches you. For children with these hyper-responsive systems, bigger isn’t always better. Go with what works! Once you figure out when a child makes his best eye contact, practice extending the time he or she can look at you.

• Make looking at you part of the game or the next part that’s required before you continue the game. It’s the PERFECT way to teach a toddler to include you! Play social games where a child is more likely to look at you – Row Your Boat, Ride a Little Horsie, Peek a Boo, Chase, etc… as we talked about in show #279. One idea we didn’t discuss in the show (but I meant to include this!) is to play with toys that involve simple back and forth actions such as rolling or kicking a ball, car, or truck to each other. I help the child do his part during this play and let mom be the other partner because she’ll be there after I’m gone and I want the child accustomed to playing with her, not me!

• Make it easier for a toddler to look at you all day long.  When a child wants to clean up a toy or needs help with something, I practice “give me” commands with my hand right in front of my eyes. A mom I’m working with now does this with the remote control to give her little boy a chance to look at her routinely as he’s “asking” her to turn on the TV. They also use PECS and this skilled mom places her hand right in front of her face when she’s receiving her child’s pictures to teach him to look at her in order to interact communicate.

• Pay attention to pointing! Model pointing and (gently) help redirect your child’s attention to follow your point. Do what you can with your voice and body language to get him to look where you’ve pointed. Following someone else’s point generally comes before a child will begin to point himself. If your child isn’t pointing yet, we’ll have to teach him! We’ll be talking about specific ideas for teaching a child to use gestures coming up in two weeks with skill #6.

• Other fun ways to strengthen joint attention once the ideas above have been moderately successful –
  • flashlight games
  • hiding games where the child finds a part of a toy and then brings it to you for the other part of the game
  • placing objects out of reach or up high where he needs to get you to help him retrieve what he wants

In case you’ve missed the other shows in this series, catch up here:

#275 Introduction Show – Why These Skills are Important

#276 Overview of Skills 1 – 5

#277 Overview of Skills 6 – 11

#278 Responds to Things in the Environment

#279 Responds to People

#280 Building an Attention Span

I hope you’re enjoying this series! Go to the next show

Leave me a comment if you have a question. I’d love to hear from you!

Laura