Trim Size: 8.5in x 11in Cicchetti c04.tex V2 - Volume III - 08/26/2015 9:18am Page 116 CHAPTER 4 Joint Attention and the Social Phenotype of Autism Spectrum Disorder: A Perspective From Developmental Psychopathology AMY VAUGHAN VAN HECKE, TASHA OSWALD, and PETER MUNDY OVERVIEW 116 JOINT ATTENTION AND DEFINING THE SOCIAL A HISTORICAL PERSPECTIVE ON AUTISM SPECTRUM DEFICITS OF ASD 133 DISORDER 117 The Social-Motivation Model and Joint Attention in ASD 134 DIAGNOSTIC DESCRIPTION OF ASD 118 Joint Attention and the Social-Cognitive Model of ASD 134 JOINT ATTENTION IN TYPICAL DEVELOPMENT 119 The Disassociation of IJA and RJA in ASD 134 Measurement of Subtypes of Joint Attention 120 Specific Effects on Initiating Joint Attention inASD 136 Learning and the Importance of Joint Attention 121 APPLYING THE JOINT ATTENTION Joint Attention and the Social-Cognitive Hypothesis 122 PDPM TO ASD 137 THE NEURAL SYSTEMS OF JOINT ATTENTION 123 Neural Connectivity and Activity-Dependent Genes in ASD 137 Social Cognition and the PDPM of Joint Attention 128 Visual Attention Control and Joint Attention in ASD 138 Inside-Out Processing and the Joint Attention PDPM 130 Joint Attention, Learning, and Interventions for ASD 138 Active Vision and the Joint Attention PDPM 130 SUMMARY 143 DYNAMIC SYSTEMS AND THE JOINT ATTENTION FUTURE DIRECTIONS 144 PDPM 131 REFERENCES 144 OVERVIEW social-cognition. In particular, human social-cognition may be viewed as the outgrowth of a special form of This chapter describes one way translational research human information processing that we call joint attention has changed how we think about, diagnose, and treat the (Mundy & Newell, 2007). This chapter will describe how social impairments of autism spectrum disorder (ASD). It joint attention is more than a milestone in the development also relates the story of how the application of develop- of social cognition in infancy. Rather, it is an executive mental science to the study of ASD has encouraged new form of information processing that contributes to social ways of thinking about the typical development of human learning, stimulus encoding, and the facilitation of human social communication and connectedness across the life Work on this chapter was supported by the National Cen- span. This executive joint attention function integrates ter for Advancing Translational Sciences, NIH grant number information about oneself, other people, and shared 8KL2TR000056 to the first author. The research and theory attention to objects, events, or ideas. It does so through development reported in this paper were supported by NIH the integrated activation and functions of a distributed Grants HD 38052, MH 071273, IES Grant IES 324C2012–1, the system of frontal and posterior cortical networks in the support of Marc Friedman and Marjorie Solomon for the Lisa brain. Recognizing and understanding the parallel and Capps Endowment to the UC Davis Department of Psychiatry distributed nature of executive joint attention functions and MIND Institute. The data and ideas have been fostered by collaborations at UCLA, the University of Miami, Marquette contributes to new perspectives about the nature and devel- University, and UC Davis. opment of social cognition and about the nature of the 1Color versions of Figures 4.3, 4.7 and 4.11 are available at social brain in all people, including those affected by ASD http://onlinelibrary.wiley.com/book/10.1002/9781118963418 (Mundy, 2003). This new framework has emerged from the 116 Trim Size: 8.5in x 11in Cicchetti c04.tex V2 - Volume III - 08/26/2015 9:18am Page 117 A Historical Perspective on Autism Spectrum Disorder 117 interplay between cognitive neuroscience, developmental symptoms of ASD in many affected children are observ- science, and the science of autism. It integrates the idea able by 24 months of age or earlier (Stone, Coonrod, & that a “developmental analysis” (Cicchetti & Toth, 2009, Ousley, 1997; Zwaigenbaum et al., 2005), with children p. 16), which underscores the importance of developmental expressing different courses of symptom onset. Some timing, multiple determinants of behavior, and multiple children may display clear symptoms by the end of the first pathways to positive or negative outcomes, is necessary to year or early part of the second year of life. Other children fully understand the impact of joint attention disturbance may display more typical development through the first on development. As such, it provides a seminal illustration year but then not display the typical rate of advances in of a school of translational research that began three social communication behaviors in the second year, while decades ago when a farsighted group outlined the new others may display a second year course more indicative discipline of developmental psychopathology (Cicchetti, of the interruption or loss of elements of social commu- 1984; Sroufe & Rutter, 1984). nication development (Ozonoff, Heung, Byrd, Hansen, & The chapter begins with a brief historical review of the Hertz-Picciotto, 2008). conceptualization of ASD. One key message is that a lack Leo Kanner (1943) displayed impressive clinical acumen of precise understanding of the typical developmental tra- when he was able to discern three common characteristics jectory of social behavior impeded the accurate diagnosis that distinguished children with ASD from those in a larger of ASD until the early 1990s, which was 50 years after it was clinical sample of children with varied exceptionalities. He initially described by Asperger (1944) and Kanner (1943). noted that children with ASD appeared to have (1) a Then we provide a review of the typical development of common impairment of affective relatedness to others, joint attention, the underlying neural systems supporting which (2) resulted in a disorder that primarily involved its development, and the utility of adopting a dynamic impairments of the capacity for typical social interactions systems approach in understanding the neurocognitive and (3) was most likely caused by biologically based pro- development of joint attention. Following that review, we cesses. The recognition of the biological, affective, and discuss the relation between social impairment and joint social-behavioral syndrome triumvirate of autism was a attention in ASD. This review also illustrates how social remarkable achievement and is as valid today as it was developmental research continues to be a vital source of in 1944. Unfortunately, Kanner’s initial perspective did information about the nature of ASD, and how research not fit well with the psychodynamic zeitgeist of the time. on ASD has led to insights about the precise nature of the The psychodynamic perspective of the time emphasized typical development of joint attention in infants that have the primacy of environmental over biological factors in the contributed to the framework for a new model of human etiology of all psychopathology. Sufficient challenges were social-cognition development. As previously noted, this brought to bear in this regard that Kanner (1949) recanted chapter adopts a parallel and distributed information pro- in his initial biological view of ASD. cessing perspective on joint attention and social-cognition. In the ensuing thirty years, the science of autism drifted An advantage of this model is that it explicitly attempts to from one perspective to another. ASD was described as link developmental behavioral research on social pathol- a disorder caused by an aloof parenting style that caused ogy to a range of recent observations, from research on children to grow up to be severely emotional disengaged neural connectivity and genetics, ocular motor control, from all people (Bettleheim, 1959). By the early 1960s, and intervention in autism, discussed in the final section of compelling indirect evidence for the biological nature of the chapter. ASD had been presented to counter this parenting style hypothesis (e.g., Rimland, 1964). However, the singular prototype of people with ASD as emotionless and aloof A HISTORICAL PERSPECTIVE ON AUTISM remained for a long time. Few data were available to criti- SPECTRUM DISORDER cally appraise prototype because the social and emotional development of children with ASD was rarely a focus of ASD is a biologically based condition that is character- empirical inquiry through the 1970s. For example, Pat ized by impaired social development, impaired language, Howlin (1978) required only seven pages and 39 citations or pragmatic communication skill acquisition, and the to review the literature on the social behavior of children presence of repetitive behaviors and thoughts (Asperger, affected by ASD at the time. Moreover, only a handful of 1944; Bailey, Philips, & Rutter, 1996; Dawson, Osterling, the citations referred to peer-reviewed empirical research Rinaldi, Carver, & McPartland, 2001; Kanner, 1943). The publications on the social behavior of ASD. Alternatively, Trim Size: 8.5in x 11in Cicchetti c04.tex V2 - Volume III - 08/26/2015 9:18am Page 118 118 Joint Attention and the Social Phenotype of Autism Spectrum Disorder: A Perspective From Developmental Psychopathology research and theory at that time was taken with the notion tools to examine and define the social deficits ofASD that sensory, perceptual, or language impairments must be (e.g., Baron-Cohen, Leslie, & Frith, 1986; Cicchetti, 1984; primary to the phenotype and etiology of ASD (Mundy Dawson & McKissick, 1984; Rogers & Pennington, 1990; & Sigman, 1989a). Although this was a scientifically