Establishing and Improving Joint Attention in Children

Johnny doesn’t pay attention to other people.  He doesn’t notice the other children that play around him and when an adult tries to get his attention, he doesn’t seem to hear.  The doctor said his hearing is fine but he just doesn’t seem to notice or care when someone is talking to him or trying to show him something.  He just seems to be tuned out.  No matter how hard you try, you can’t get him to pay attention to anything.  You can’t get any “joint attention”.

How can you do speech therapy with a child like Johnny?  How can you teach him anything?  You can’t even get him to respond to his name!

Well, the first thing you must do is establish joint attention.  Without joint attention, no learning can occur.

How do we Establish Joint Attention?

Ok, so we know we need joint attention, but how do we get it?  Follow these steps to establish joint attention for speech therapy, school, or at home:

1. Copy what the Child Does:

The first thing you can do to try to get joint attention is to copy exactly what the child is doing.  If the child is playing with toys, get down on the floor and play with those toys in the exact same manner.  If the child is stacking blocks, you stack blocks.  If the child is lining up cars, you line up cars.  If the child is spinning in circles, you spin in circles (just don’t get sick!).

Start quietly at first, just to see if the child will notice.  Just play along beside him or imitate his actions.  If he looks at you or notices what you’re doing, just smile and act like you’re enjoying yourself.

Gradually, draw more and more attention to yourself and what you’re doing.  See if you can get the child to start paying attention to you and reinforce him if he does (praise him and offer hugs or high fives if he’s into that sort of thing).

Then, start to comment on what he is doing.  Point out the cars he’s lining up.  Or talk about what actions he’s doing.  Talk about what he may be thinking, feeling, or experiencing.

2. Find Something Motivating to the Child:

For the next part, you’ll need something that the child loves.  Perhaps you already know what that is.  Does he love grapes?  Or toys that light up?  If you know what he loves, fill a tub with those things.

If you don’t already know what the child loves, you’ll want to do a reinforcer probe.  Find a bunch of toys/items that you think may be motivating to the child and present them to the child two at a time.  For example, hold up a flashing toy and a shakey toy.  Show him what each one does and then hold them both up in front of him.  Let him reach toward one.  Give him the one he reaches toward.  Put the other one aside.

Let him play with the toy for a moment and then take it back.  Introduce a new toy and then hold that toy up alongside the one he chose before.  Let him pick again.  Continue to do this until you have a pretty good idea of the types of items the child typically picks.  These will be the items you will put in the reinforcement tub.

If you’d like some ideas of different types of reinforcers that can be used in therapy, please click the button below:

3. Reinforce Proximity:

Ok, now that you have a selection of things you know the child likes, put those things away (out of sight) for a few days.  You want them to be new and exciting when you pull them out to work with the child.

Stand away from the child (not right next to him) and pull out one thing from the bin and hold it so the child can see that you have it.  If it is a toy that does something (lights up or makes sound), activate it once so the child gets interested.

If the child moves close to you (and the object), say “you see my ___” and then give it to him.  At this point, you want to reinforce the child for just coming close to you.  This is the first step of joint attention.

Let him play with it for a few moments and then say “my turn” and take it away and walk a few feet away.  Once the child comes close to you again, say “you see my ___” and give it to him again.  Keep doing this until he will consistently come close to you to share in what you have.  If he loses interest, switch to a different reinforcer.  With some children, you’ll need to switch each time.

**ALTERNATIVE**  If the reinforcement is an activity, like getting tickled, you can start by doing the activity and then walking a few feet away.  For example, tickle the child until he is smiling, and then walk a few feet away and wait.  If the child comes toward you, tickle him again.

4. Gradually Increase the Level of Engagement You Expect

Once the child is consistently moving toward you to share in what you have, you’ll want to increase your expectations.  Start requiring to the child to do something slightly more difficult before you give him the reinforcer.

Here is a suggested order of “next steps” when trying to gradually increase a child’s engagement or join

[if !supportLists]–>·       Look in your general direction/face you

• Looking directly at you or the object (hold the object near your face to reinforce faces)
• Reaching for the object
• Pointing at the object
• Pointing at the object and looking at you

You should tell the child what you want him to do and then provide assistance if you can.  For example, you can say “look at me” or “look over here” to encourage the child to look in your direction.

5. Gradually Increase the Amount of Time the Child is Engaged

Once the child is sharing joint attention with you, you’ll want to try to stretch out the amount of time it lasts.  Up until now, you have given the child the object as soon as he establishes joint attention.

Now, you’ll want to try to get the child to keep looking at the object with you before you give it to him.  The next time the child establishes the joint attention (by looking at the object with you), say “look at this” and point to something on the object.  Then, give the child the object.  By doing this, you’ve added a few seconds on to the amount of time that the child looks at it with you.

Once you can do that without the child having a meltdown or getting upset, try adding a few more seconds.  Say “look at this!  Wow, that’s cool” and then give it to him.  Continue gradually adding seconds by pointing out more features, talking about it, or anything else that will keep the child’s attention momentarily.  There’s no magic number here, just keep trying to stretch it out until you feel like the child is sharing attention with you on an object.

** ALTERNATIVE **  If the reinforcement is an activity, like getting tickled, you will want to try to stretch out the amount of time that the child is looking at you and happy about the activity.  Try talking to the child while you’re doing the activity and provide more of the activity if the child keeps looking at you or maintaining the interaction in some way.  Take little pauses and say something silly (like “here comes the tickle monster”) and then provide more tickles if the child continues to watch you or stay engaged while you said it.

6. Gradually Increase the Variety of Activities that the Child will Share Attention During:

Now that the child is able to share attention with you on a highly preferred activity (such as a preferred toy or snack), see if you can get him to share attention with you on something of your choosing.

My personal favorite for doing this is with book-reading activities.  Reading books with children is one of the best ways to increase language so if you can only get the child do to one non-preferred activity with you, it should be book-reading.    Start with books that contain real photographs of your child’s favorite things (for example, my son loves trucks).

Start by bringing out something from the child’s reinforcer tub (like a fun toy) but also have the other thing you want the child to attend to with you as well (the book in this example).  When the child tries to get the reinforcer, say “look at this” and point to the other thing (the book).  If the child looks at the other item that you have, reinforce by saying “good looking” and then give him the original reinforcer (the toy).  If the child doesn’t look at the other item, hold it up in front of him so he has no choice but to look at it, and then say “good looking” and reinforce with the toy.  Keep doing this until you no longer have to hold it up in his face.

Once the child gets better at this, try to elongate the amount of time the child is paying attention to the other item (the book) by saying “look at this.  Cool!”  or “Look at this!  Oh, look at this one, too!”.  Just keep stretching it out just like we did in the last step until the child will look at more and more of the book before getting his reinforcement.

Joint Attention Established!  Let the Teaching Begin!

If you keep working on this, you should get to the point where the child will easily sit down with you and pay attention to something that you pick out.  This will allow you to start teaching the child new skills and new concepts.

Don’t forget to download the free cheat sheet full of ideas for great reinforcers!