Supporting Joint Engagement Through Responsive Interactions

By Lauren Lowry Hanen SLP and Clinical Staff Writer



From the time they are born, children learn how to communicate during the everyday interactions they have with their caregivers. During the first couple of months, babies pay attention to people and share emotions with them during face-to-face interactions. Then, between five to six months their attention shifts to objects in their environment (Hahn, Brady, Fleming, & Warren, 2016). This is known as object engagement. Caregivers start to join in while babies interact with objects, and by about 6 months, early joint engagement emerges


Joint engagement involves: “…sustained coordination of an interaction between objects and people” (Patterson, Elder, Gulsrud & Kasari, 2014, p. 511).

The term “engagement” describes an episode during which the child actively attends to objects and/or people (Hahn et al., 2016). Engagement does not refer to a specific behaviour (e.g. eye gaze or pointing).

A note about joint engagement and joint attention The terms “joint engagement” and “joint attention” are often used interchangeably, but they are two different things:

• joint engagement refers to a sustained period of interaction when parent and child are attending to the same object or event • joint attention is a discrete skill which describes a moment when the child directs someone’s attention with eye contact and gestures and/or language for the purpose of sharing (as if to say “Hey, look at that”).

Joint engagement may or may not involve moments of joint attention. (Carpenter & Liebal, 2011; Patterson, personal communication, March 15, 2018)

When joint engagement first develops, caregiver and child are engaged with the same object, but the child doesn’t actively respond to the caregiver’s involvement (Hahn et al., 2016). This is referred to as supported joint engagement.Over time, the interaction becomes more reciprocal and the child actively acknowledges the caregiver’s participation through eye contact and gestures. This is known as coordinated joint engagement. The child may or may not use language during episodes of supported or coordinated joint engagement. The defining feature of joint engagement is that both the child.


Joint engagement and communication

Research has shown that:

• the amount of time infants spend in joint engagement with their mothers predicts infants' early gestures and linguistic communication (Carpenter, Nagell, & Tomasello, 1998)

• joint engagement that is reciprocal and collaborative (coordinated joint engagement) is very important for the development of social communication and expressive language (Hahn et al., 2016; Bottema-Beutel, Yoder, Hochman & Watson, 2014).


Joint engagement is such a powerful context for language learning because it provides the child with a context for matching symbols with their referents as the caregiver infuses language into these interactions with objects (Bottema-Beutel et al., 2014). While typically developing toddlers spend an average of 76% of their time jointly engaged during interactions, children with ASD spend far less time jointly engaged and sometimes reject others’ bids for joint engagement (Patterson et al., 2014). Without these frequent periods of engagement, critical language learning moments are lost. Therefore, finding ways to encourage and extend periods of joint engagement is essential for children with ASD.

Study: Links between parents’ interaction style and joint engagement.


In order to encourage periods of joint engagement in children with ASD, we need to better understand the factors which promote these interactions. Researcher Stephanie Patterson and her colleagues (2014) examined one of these factors – parents’ interaction style – and how this was associated with both childinitiated and parent-initiated joint engagement. Their study also looked at the relationship between joint engagement and some of the children’s social behaviours (defined below). The researchers studied 85 toddlers diagnosed with ASD and their caregivers (the majority were mothers). As the toddlers demonstrated a range of expressive and receptive language abilities, their language level needed be controlled for in some of the authors’ analyses.

They collected information about the following variables during 10 minutes of parent-child play with toys:


• Parents’ interaction style Patterson et al. evaluated whether the parents interacted in a responsive or directive manner: o Responsive style – this style is characterized by the parent’s ability to recognize and respond to their child’s cues and provide emotional-affective support. Responsive parents allow the child to choose the activity, communicate with positive affect, and provide contingent responses. o Directive style – this style seeks to influence the child’s attention and might interrupt or redirect the natural flow of the interaction. Parents with a directive style may select activities for the child and may direct the child’s attention via prompts and test questions. (Patterson et al., 2014)

• Child engagement Children’s engagement during interactions with their parents was described according to the following states: o Unengaged (the child was not engaged with objects or people) o Object engagement o Supported joint engagement o Coordinated joint engagement

The researchers also noted whether joint engagement episodes were parent-initiated or child initiated.


• Child social behaviours Patterson et al. (2014) explain that certain social behaviours demonstrated by the children during social interactions may help to describe their level of engagement, such as their: o Affect – the child’s emotional state during the interaction o Attention – how active, attentive, and engaged the child is during the activity o Cooperation – degree to which the child complies with adult requests and suggestions o Interest – the child’s motivation and satisfaction in the activities o Joint attention – how often the child directs the parent’s attention with eye contact and gestures and/or language for the purpose of sharing o Persistence – whether the child repeats or practices a behaviour when he has difficulty .

Findings

Patterson and her colleagues noted the following during the 10 minutes of parentchild play:

Type of joint engagement observed

• Episodes of child-initiated joint engagement lasted longer (average of 100.64 seconds) than parent-initiated joint engagement (average of 78.09 seconds)

Children’s social behaviors • Children’s affect, attention, joint attention, imitation and interest were significantly correlated with child-initiated joint engagement- the fact that these social behaviours were observed most during child-initiated joint.xclusively on objects (about 50% of the interaction).

Children’s social behaviors • Children’s affect, attention, joint attention, imitation and interest were significantly correlated with child-initiated joint engagement- the fact that these social behaviors were observed most during child-initiated joint.

Relationship between parents’ interaction style and joint engagement

• Overall, parents obtained higher scores for directiveness than responsiveness

• Child-initiated joint engagement was related to parents’ responsivity - Patterson et al. explain that responsiveness creates an environment that allows children to initiate and drive the interaction.

• Parent-initiated joint engagement was related to parents’ directiveness - the authors weren’t surprised by this result as directivenss involves leading the interaction via prompts and commands, which would place the child in the role of responder.

What do these results mean?

These findings tell us that:

• Children with ASD spend almost two thirds of their time unengaged

• Episodes of child-initiated joint engagement last longer and are associated with more positive social behaviors than parent-initiated joint engagement

• Parent responsiveness is related to child-initiated joint engagement

These results highlight some of the advantages of child-initiated joint engagement and of parent responsiveness. The authors explain that, due to the established links between joint engagement and later language development, it is essential to find ways to extend periods of child-initiated joint engagement:

“Increasing the frequency and length of child-initiated joint engagement is critical for children with ASDs who are spending at least two-thirds of valuable learning time unengaged or in lower states of engagement” (Patterson et al., 2014, p. 516)

Joint engagement in More Than Words®

At the end of their article, the authors suggest that

“Explicitly focusing first on strategies to facilitate JE (joint engagement) and parental responsivity within intervention may help provide the necessary foundation for parents to effectively implement a broader array of strategies to support children’s social development” (Patterson et al., 2014, p. 516).

This sentiment fits very well with the approach and format of the More than Words® Program. In fact, the goals for parents from the first session of the program include:

• Becoming keen observers of their child’s interests

• Abandoning a directive style of interaction

• Joining in by playing the way their child plays

• Responding to the messages their child is sending (Sussman, Drake, Lowry, & Honeyman, 2016) Before parents learn strategies such as how to add structure and predictability to their routines, or how to fine tune their language models, they first learn how to achieve joint engagement with their child by Following their Child’s Lead. This is accomplished during the first session by helping parents learn how to:

• Observe, Wait, and Listen™

• Include their child’s interests

• Interpret their child’s messages Then, in the second session, parents continue to learn responsive strategies to help them achieve joint engagement with their child by learning how to Imitate what their child is doing

• Intrude by playfully insisting on joining in While the word “Intrude” may sound like a directive strategy, it is actually quite responsive as it always starts with the child’s interest and the child initiates the activity. When Intruding, the parent first observes an activity that the child engages in alone, and then playfully finds a way to engage with the child during that activity. The key to successfully Intruding is to make it fun, so that the child wants to stay in the interaction and the period of joint engagement is extended.


terson et al. found that overall, parents obtained higher scores for directiveness than responsiveness in their study. This is why it is important, as Patterson and her colleagues point out, to begin intervention with responsive strategies, as they provide the necessary foundation that parents need to later implement other strategies. Summarizing, Patterson et al. emphasize the “importance of focusing on how parents foster joint engagement with their children” and that this has “important implications for parent-mediated interventions” (p. 515). If joint engagement is one of the primary contexts within which children learn to communicate, we need to optimize how parents encourage their child to initiate joint engagement and spend longer amounts of time in these types of interactions. This can be best accomplished by helping parents learn ways to engage responsively with their child.


© Hanen Early Language Program, 2018. This article may not be further copied or reproduced without written permission from The Hanen Centre®.

References

Bottema-Beutel, K., Yoder, P. J., Hochman, J. M., & Watson, L. R. (2014). The Role of Supported Joint Engagement and Parent Utterances in Language and Social Communication Development in Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 44(9), 2162–2174. Carpenter, M. & Liebal, K. (2011). Joint Attention, Communication, and Knowing Together. In Seemann, A. (Ed.), Joint Attention: New Developments in Psychology, Philosophy of Mind, and Social Neuroscience (p. 159-181). Cambridge, Massachusetts: The MIT Press. Carpenter, M., Nagell, K., & Tomasello, M. (1998). Social Cognition, Joint Attention, and Communicative Competence from 9 to 15 Months of Age. Monographs of the Society for Research in Child Development, 63(4), pp. i-174. Hahn, L. J., Brady, N. C., Fleming, K. K., & Warren, S. F. (2016). Joint Engagement and Early Language in Young Children with Fragile X Syndrome. Journal of Speech, Language, and Hearing Research, 59, 1087–1098. Mahoney, G. & Perales, F. (2003). Maternal Behaviour Rating Scale. Using relationship-focussed intervention to enhance the social-emotional functioning of young children with autism spectrum disorders. Topics in Early Childhood Special Education, 23: 74-86. Patterson, S. Y., Elder, L., Gulsrud, A., & Kasari, C. (2014). The association between parental interaction style and children’s joint engagement in families with toddlers with autism. Autism, 18(5), 511-518. Sussman, F., Drake, L., Lowry, L. & Honeyman, S. (2016). Making Hanen Happen Leaders Guide for More Than Words® — The Hanen Program® for Parents of Children with Autism Spectrum Disorder or Social Communication Difficulties, Fourth Edition. Toronto, Ontario: Hanen Early Language Program.

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