Aspects of Joint Attention in Autism Spectrum Disorder: Links to Sensory Processing, Social Competence, Maternal Attention, and Contextual Factors Andrew J. Dakopolos Submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2019 © 2019 Andrew J. Dakopolos All rights reserved ABSTRACT Aspects of Joint Attention in Autism Spectrum Disorder: Links to Sensory Processing, Social Competence, Maternal Attention, and Contextual Factors Andrew J. Dakopolos Background. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction, communication, and restricted and repetitive behaviors (American Psychiatric Association, 2013). Given the heterogeneity of ASD it is important to understand individual differences within the disorder that are related to cognitive and language development, and how such differences may be related to differences in caregiver behavior or aspects of the social environment. Joint attention is an important component of early social communication and is considered to be a “core deficit” of ASD (Kasari, Freeman, Paparella, Wong, Kwon, & Gulsrud, 2005). Individual differences in joint attention during infancy have been shown to relate to language and cognitive development (Mundy, Block, Delgado, Pomares, Van Hecke, & Parlade, 2007; Nichols, Martin, & Fox, 2005). Therefore, joint attention serves an essential role in the study of child behavior within ASD across development. The present study consists of two manuscripts that explored how joint attention in children with ASD related to sensory responsiveness and social competence (Study 1), and how child joint attention related to mother attention and contextual factors (Study 2). Specifically, Study 1 investigated relations among children's sensory responses, dyadic orienting, joint attention, and their subsequent social competence with peers. Participants were 38 children (18 children with autism spectrum disorder (ASD) and 20 developmentally matched children with typical development) between the ages of 2.75 and 6.5 years. Observational coding was conducted to assess children's joint attention and dyadic orienting in a structured social communication task. Children's sensory responses and social competence were measured with parent report. Group differences were observed in children's joint attention, sensory responses, multisensory dyadic orienting, and social competence, with the ASD group showing significantly greater social impairment and sensory responses compared with their typical peers. Atypical sensory responses were negatively associated with individual differences on social competence subscales. Interaction effects were observed between diagnostic group and sensory responses with diagnostic group moderating the relation between sensory responses and both joint attention and social competence abilities. Study 2 investigated relations between child joint attention and mother attention during three social contexts (competing demands, teaching, and free play) among 44 children with ASD between the ages of 2.5 and 5.6 years, and their mothers. Observational coding was conducted to assess children’s joint attention and mother’s dyadic orienting. Children’s expressive and receptive language was measured by teacher report. The rate of children’s joint attention, and mothers’ dyadic orienting differed depending on the context of their interaction. Children’s joint attention, expressive and receptive language, age, and ASD severity, and mother dyadic orienting were related, and these relations differed by context. Child initiating joint attention (IJA) was also related to mother attention, and this relation was moderated by the child’s expressive and receptive language. A temporal contingency was revealed for the association between child IJA and mother attention with a bi-directional association such that child IJA predicted subsequent mother attention, and mother attention predicted subsequent child IJA. When the sample was split by children’s language ability (i.e., minimally-verbal and verbal groups) there was a group by receptive language, and a group by expressive language interaction on the contingency between child IJA and subsequent mother attention. Conclusion. The results from study 1 and study 2 suggest that individual differences in children with ASD, including their sensory responses and social competence, as well as mother attention and contextual factors are related to children’s joint attention. When addressing theory and interventions for children with ASD, it is important to consider children’s language and sensory sensitivities, the demands of the interactive context, and factors related to mother attention and approach to her child. TABLE OF CONTENTS List of Tables ................................................................................................................................... v List of Figures ................................................................................................................................. vi Acknowledgements ...................................................................................................................... vii Introduction ..................................................................................................................................... 1 Joint Attention .............................................................................................................................. 2 Joint Attention and Sensory Experiences .................................................................................... 4 Purpose of Study 1 ................................................................................................................... 5 The Role of Parent-Child Contextual Factors .............................................................................. 6 Purpose of Study 2 ................................................................................................................... 7 Review of Literature ........................................................................................................................ 9 Joint Attention in Typical Development ...................................................................................... 9 Theoretical Perspectives of Joint Attention ........................................................................... 10 Child-specific aspects of joint attention development. ....................................................... 11 External aspects of joint attention development. ................................................................ 13 Behavior analytic approach to joint attention. .................................................................... 15 Joint Attention in Autism Spectrum Disorder ........................................................................... 17 Relation Between Initiating and Responding Joint Attention ................................................ 18 Joint Attention and Language Development in ASD ............................................................. 18 Joint Attention and Social Competence ................................................................................. 20 Child-Specific Aspects of Joint Attention in Autism Spectrum Disorder ................................. 21 Sensory Responsiveness in ASD ........................................................................................... 22 Sensory responsiveness and joint attention. ....................................................................... 25 i Sensory responsiveness and social competence. ................................................................ 27 External Aspects of Joint Attention in Autism Spectrum Disorder ........................................... 29 Parent Behaviors and Joint Attention ..................................................................................... 30 Contextual Factors and Joint Attention .................................................................................. 34 Study 1 Manuscript ........................................................................................................................ 40 Wiley Copyright ..................................................................................................................... 65 Study 2 Method ............................................................................................................................. 66 Participants ............................................................................................................................. 66 Procedures .............................................................................................................................. 66 Parent-Child Interaction ......................................................................................................... 67 Competing demands task .................................................................................................... 67 Teaching task. ..................................................................................................................... 68 Free play task. ..................................................................................................................... 68 Measures ................................................................................................................................ 68 Autism diagnosis. ..............................................................................................................