Do You See What I See?

Date: 
January 12, 2011
Trial demonstrates that caregivers can effectively teach joint engagement skills


The ability of very young children to engage others and communicate socially using non-verbal cues such as pointing, smiling, or making eye contact is critical to social and language development. Children learn to relate and communicate nonverbally long before they learn to communicate using words. Numerous studies show that children who engage their parent or caregiver in sharing communications such as pointing to things of interest or directing another's attention to objects, learn language faster. These skills, referred to as joint attention skills, are significantly impaired in very young children with autism and therefore have been the targets of early intervention programs.

A lack of reciprocity or joint engagement is often a red flag for parents. Given that children are being diagnosed with autism at much younger ages, there is a need to develop early interventions that target these skills. In this study, researchers asked parents/caregivers rather than clinicians to deliver an intervention aimed at increasing social communication outcomes of young children with autism. Thirty-eight caregivers and their toddlers with autism who were 21-36 months of age were randomly assigned to either the treatment group or a waitlist control group. The study focused on toddlers who had the least amount of language based on previous findings that these children benefit most from the joint engagement intervention.

The 8-week intervention focused on the development of play routines during which the parent/caregiver would actively participate, maintain, and expand upon the child's play activities. The goal was to keep the child engaged on the shared play activity for longer periods of time during which the child's social communication and language behaviors could be facilitated.

The results showed that children in the treatment group developed strong joint attention skills. These gains in joint engagement, joint attention and play were either maintained or improved one year following termination of the intervention. Children in the treatment group spent less time focused solely on objects and significantly more time engaged with parents during play compared to children in the control group.

This is one of the first randomized controlled trials to demonstrate that a relatively brief caregiver-mediated intervention can improve social interaction, joint attention and play skills in toddlers with autism. While the benefits of parent-mediated versus therapist-mediated interventions have not been studied directly, parent-mediated models may prove to be a cost effective way to widely disseminate effective interventions to young children with autism spectrum disorder.


1. Kasari C, Gulsrud AC, Wong C, Kwon S, Locke J. (2010) Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. J Autism Dev Disord. Sep;40(9):1045-56.

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