What is Joint Attention in Childhood?
Joint attention in childhood is the skill of focusing on objects or activities that are of interest to others.
For example, if a parent says, “Wow, that’s a beautiful bird!” while looking up in the sky, the child will look up to enjoy seeing the bird too.
When clinicians are attempting to see if a child can demonstrate this skill, they will point at an object such as a toy or an animal and see what the child does. In response, a child may point, laugh, make a facial expression, or make eye contact with the adult who initiated the attention. In clinical terms, we call this practice ‘establishing joint attention.’
“Joint attention is the most basic and perhaps the most important social skill of all. Essentially, all social learning skills build on one another. Joint attention is the cornerstone. In our clinical work, we have always told interventionists, ‘If you don’t have joint attention, you don’t have squat.’ The child must be able to pay attention to the learning experience for it to be meaningful.”
In order to make friends, children must be able to pay attention to what is of interest to other people to learn from them. Joint attention plays an important role in typical child development.
‘He’s in his own world’ is something you will notice when a child struggles with joint attention. Some children seem to be comfortable on their own and do not invite others to join to enjoy items of interest. They don’t respond when others act like something interesting is happening.
‘Wait! Did she see this?” is another phrase you may hear when a child has an issue with joint attention. Pretend for a moment that a fire truck goes by the window at the preschool. Almost all the kids come over to see the truck. Two kids do not go to the window, and instead, are busily playing with a toy as if nothing is happening. When this occurs in the classroom or on the playground, teachers and parents need to take notice.
If your child does not share attention with others, this issue might indicate concerns about their social development.
Symptoms of Joint Attention Issues in Children
- In their own world: child is focused internally and not externally
- Does not pay attention to others: child is unaware of other’s actions and interests
- Looks away: child is not interested when someone points or shows something
- Seems to ignore people: child is doing their own thing and is not interested in others
- Is a loner: child prefers playing alone or has trouble playing with or talking to other kids
- Excited about objects vs. people: child focuses more on objects rather than people in the room
- Doesn’t share enjoyment: child gets excited about a toy or object and does not bring others to enjoy it too
- Misreading cues: child does not understand cues in the social environment
- Can’t play games: child does not pay much attention to others and has trouble joining into games with other kids
Causes of Joint Attention Issues in Children
- Social skills deficits or delays: when children have a delay in social skills, it may be hard for them to notice that others are trying to get their attention
- Attention problems: when children struggle to pay attention in general, they may find it difficult to focus on the interests of others
- Developmental delays: when children have developmental delays, they may not hit social milestones at the same pace as other children. Joint attention typically develops 18 and 30 months but children with developmental delays can be behind in this skill
- Neurological differences: when children have autism spectrum disorder there are differences in the white matter connections in the brain. Issues with joint attention can be an early warning sign of autism. Other neurological differences like ADHD can also underlie challenges with joint attention
- Cognitive development: when children have delays or deficits in their cognitive abilities, they may be slower to make social skills progress. Thus, you may see skills like joint attention develop more slowly
What to Do About Joint Attention Issues in Children
In order to help your child with joint attention, it is important to know what it is at a foundational level. Parents can significantly impact a child’s joint attention through direct teaching, practice, and reinforcement of these important social skills.
Joint attention has two parts
Joint attention has two parts, which are initiating and responding.
Imagine a child who is at the park and notices an ice cream truck. If the child looks at mom, smiles and jumps enthusiastically, we call this initiating joint attention.
Now imagine a child is quietly playing on the swings at the park when the ice cream truck comes. The child doesn’t see the truck, but notices other kids are all excited about it. When this child goes over to see what the other kids are looking at, we call this responding to joint attention.
Initiating joint attention
Initiating joint attention has three parts that work together to build social connection, as follows:
- Noticing an object of interest
- Changing attention to another person
- Changing attention back to the object
For example, a child sees a bunny in a field, looks at mom, and then looks back at the bunny while pointing. This is an example of good initiation of joint attention. Essentially, the child saw something and brought it to their mom’s attention.
In a counterexample, a child watches a window washer who dropped in front of a window. The child stares at the window washer but does not point it out to mom. This child is not initiating joint attention. Essentially, the child saw something and did not bring it to anyone’s attention.
Responding to joint attention
Responding to joint attention has the following two parts:
- Noticing another person’s interest by following the gaze or point of another person
- Following their gaze or point to an object of interest
For example, imagine that the kids are all on a field trip at the museum. If the teacher points to the dinosaur and the students all look at it, they are responding to joint attention.
In a counterexample, all the kids in the class notice a clown outside the doorway and start pointing and commenting excitedly. A child who does not turn to look at the doorway is not responding to joint attention.
Joint attention is the most basic and generally considered the most important social skill. We simply cannot learn how to socialize if we aren’t paying attention.
“To help your child initiate joint attention, notice what your child is noticing.”
Say something like, “what are you looking at, buddy?” If your child says, “the boat” you might say, “oh, that’s a really big boat, isn’t it?” If your child responds by agreeing or commenting, immediately respond. You can say, “thanks for showing me” or “it is so fun to look at the boats together.” What is happening in this interaction is that you are showing your child that you like to be brought into their world and you are interested in hearing their perspectives.
Get your child’s attention in a gentle way
If you want to help your child respond to joint attention, try to get your child’s attention in the gentlest way. For example, if your child is playing with a toy and you really want to show them the boats out the window, you can say, “Hey, look at those boats” or simply point to the boats and see if your child looks. If your child does look at the boats, immediately praise this behavior. You can say, “Oh, I am so excited you like boats too” or “I am so glad you are here with me, and we can enjoy these boats together.” Again, you are showing your child that it is important to join other people in their experiences.
If you are doing these activities and your child is truly not responding, treatment may be needed. Early intervention, meaning getting help while your child is still young, has the best outcomes for improvement in this area.
When to Seek Help for Joint Attention Challenges in Children
Joint attention skills need to be taught for many children, particularly if there are neurodevelopmental disabilities present. An ABA therapist can work with your child to model and teach both initiating and responding to joint attention. A therapist can provide direct support, at the child’s current level, to teach these skills step-by-step. Through direct teaching, a therapist can increase a desired behavior like socially responding or initiating joint attention.
“Simply stated, a therapist can help your child learn how to get people’s attention and how to pay attention to you.”
For example, let’s say your child wants a cookie off of the top shelf. An ABA therapist would require that your child get their attention in an appropriate way before they would respond. The therapist may give the child the language to get attention and make requests.
As parents, it is often easy to skip over this step. We want to meet our child’s needs so if they ask for something, we might just naturally give it to them. In therapy, they would not give the child the cookie until they try to request it appropriately. For example, making eye contact and saying, “Can you help me get that cookie down?”
This same type of modeling can be done by parents at home. The need for a therapist depends on the intensity of the behavior and how receptive the child is to learning new techniques.
Further Resources on Joint Attention Challenges in Children
- Psychologist or neuropsychologist: to conduct an evaluation to understand your child’s needs. A diagnosis of a developmental disability can often open the door to therapies that your child may need to improve their social development. These therapies are often covered by insurance and may also be available at the school in the form of special education services
- Developmental pediatrician: to do an evaluation or guide medical and behavioral intervention. A developmental pediatrician specializes in children with developmental concerns. They can help guide behavioral and medical treatment.
- Psychotherapist: to provide intervention for social skills and related emotional issues. Cognitive Behavioral Therapy (CBT) and play therapy interventions have been shown to help children make gains in recognizing and understanding emotions, improving perspective taking, and social skills
- ABA therapist: to directly teach skills like initiating and responding to joint attention. Applied Behavior Analysis uses principles of reinforcement to increase desired behaviors like communication, social interaction and engagement with peers and adults
Similar Conditions to Joint Attention Issues
- Attention problems: difficulty with joint attention may be associated with other types of attention problems such shifting attention or sustained attention
- Executive functions: difficulties related to planning, sequencing, and organizing information may go hand in hand with attention challenges
- Processing speed: difficulties with fluency in cognitive processing can cause issues with joint attention. A child may not learn from others, or join them in conversation, if they have trouble processing what they are hearing
- Social skills problems: difficulty engaging in flexible back and forth communication and building social connections can be associated with joint attention issues
Resources for Joint Attention
 Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.
 Autism Speaks: https://www.autismspeaks.org/science/science-news/do-you-see-what-i-see
 Linder Ed.D., Toni & Petersen-Smith Ph.D., Ann (2008) Administration Guide for TPBA2 & TPBI2 (Play-Based Tpba, Tpbi, Tpbc). Paul H. Brookes, Inc.
 Barkley, Russell A. (2013). Taking charge of ADHD, 3rd edition: The complete, authoritative guide for parents.
 Giler, Janet Z. (2011). Socially ADDept: Teaching social skills to children with ADHD, LD, and Asperger’s.