Joint Engagement Skills of Children at Risk for Autism Spectrum Disorder

Joint engagement is the child's ability to share an experience involving an object with social partners. This skill is critical to the social and communication development of young children. Previous semi-structured investigations in clinical settings revealed that children with Autism Spectrum Disorder (ASD) present with deficits in joint engagement. Additionally, findings from retrospective studies of home videotapes of children later diagnosed with ASD indicate that ASD symptoms can be observed within naturally occurring activities prior to a diagnosis. Therefore a systematic method of examining the joint engagement skills of children at risk for ASD within everyday activities is warranted. Children between 17 and 34 months (N = 42) were recruited from the FIRST WORDS® Project prospective study based on risk for ASD. Participants were videotaped during everyday activities and interactions with maternal caregivers. Consistent with the results of retrospective home video studies of children diagnosed with ASD and previous joint engagement investigations, the participants in the current study spent more time playing with toys than in other everyday activities, such as book reading and playing with people. Results indicated that the participants spent the majority of their time in object engagement without symbols and rarely participated in supported or coordinated joint engagement. Children who spent more time in coordinated joint engagement received lower autism severity ratings in the social affect domain of the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLvore, & Risi, 2002). Additionally, object engagement with and without symbols was associated with autism severity. The understanding and use of symbols during various engagement states was associated with fewer autism symptoms and higher verbal ability. Overall, these findings indicated that systematic home observations of children's joint engagement skills could contribute to the early identification of ASD symptoms in infants and toddlers. These observations also provide detailed information on children's use and understanding of symbols within everyday activities. Examining the joint engagement skills of children at risk for ASD in natural environments could validate caregivers' oncerns of ASD symptoms and help build consensus with a diagnostic evaluation in a clinical setting. The current findings also have important implications for promoting the education of caregivers and professionals on the importance of this pivotal skill.