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The ESDM and Joint Attention

Autism is a complex neurodevelopment condition. Early intervention is key to helping children with autism. The Early Start Denver Model, or ESDM, is an intervention for young children with autism. It is delivered by our certified ESDM therapists. At our Sydney clinic, OnOnOne Children’s Therapy is proud to offer this early intervention to all our families.

This series of posts will help parents understand how the ESDM improves the features of autism so children can grow and learn.

What is joint attention?

Joint attention is a social communicative skill that begins very early in life. Joint attention is the development of specific skills that allow adults and babies to share their attention with each other.

Children and adults share attention in lots of different ways. Some people will refer to joint attention as eye contact. However, joint attention is more complex than just looking at some one else. Joint attention is when children point at objects and people to show they they are interested in them. It is when children bring objects to people to show them. It is when they look at their friends as they give and take toys to and from each other. More complex development of joint attention occurs when children look at objects or person, then they look back to their parents or friend to make sure they are also looking at the same thing.

Children learn to do this for sustained periods of time so that they can look at books with their parents, play toys with their friends and play chasings with a group of children. For children to be successful in these activities, they all require joint attention.

Joint attention skills start to develop soon after birth and by the age of three children are usually competent at gaining and maintaining joint attention from adults and peers.

Why is joint attention important?

Joint attention is a social skill. It is a way of interacting with another person. It starts with a baby and adult looking at each other. However, as the child begins to develop, joint attention leads to so many more skills. It leads to:

  • Interacting with others
  • Listening to others
  • Understanding what others say
  • Using facial expression and gestures to communicate with others
  • Talking and the development of complex language
  • Play skills
  • Fine and gross motor skills

When children look at others and share their attention they are more likely to imitate. Imitation is a key factor for all children’s development. The frequency of joint attention matters. Children use joint attention at a very high frequency. When they are engaged in the appropriate activity, joint attention can be as high as ever 5-10 seconds. Many of the children on our clinic in Sydney’s Bondi Junction have joint attention. However, they don’t have it often enough. Sometimes it is too brief. In both of these situations, the lack of joint attention can negatively impact learning and development.

How do children develop joint attention skills?

After babies develop the initial ability to look at their parents and share smiles, joint attention develops in the following sequence:

  • Children respond when other people tell them to ‘look’
  • They respond when someone gets their attention and points to something in the distance
  • They show things to others
  • Children point to things of interest to them and look for others to follow what they are pointing to
  • They look at people and share smiles a number of times during an activity

What is autism?

Autism is a condition which means that it affects the brain’s growth and development. It is a lifelong condition, with symptoms that are noticed very early in the child’s life:

Autism interferes with development because it causes:

  • Difficulties communication and interacting
  • Repetitive and unusual behaviours such as moving their bodies in different ways
  • Strong interest in one toy, or topic, or area of interest
  • Unusual sensory reactions to what they see, hear, smell, touch or taste
  • Strong preference for things to be the same and difficulty with change on many levels
  • Autism always affects the way individuals interact with others and how they experience the world around them.

What is the ESDM?

The ESDM is an early intervention model for young children with autism. It targets the key features of autism, and has as strong evidence base for very young children.

The ESDM involves intensive teaching in play-based sessions. It uses a curriculum that has strong focus on building interactions and relationship in everyday routines. The ESDM uses the teaching principles of Applied Behaviour Analysis. These principles have been researched and are the best way to teach children with autism.

It draws upon several different but approaches, including the original Denver model (Rogers et al 1986). Over 30 years of research has gone in to this ground breaking intervention program.  you can find out more about the principles of the ESDM here.

How does autism impact joint attention skills?

Social skills and developing friendships are particularly hard for children with autism. They are more interested in what they are doing. They are preoccupied with  what they are thinking. Because of this, they do not develop joint attention skills or they do not develop them at the right frequency. This lack of joint attention means they have more difficulty with social skills, cognitive skills, language and play.

How does the ESDM improve joint attention?

Any intervention program for children with autism should have joint attention as a core component. The Early Start Denver Model (ESDM) has four levels that follow general development for children. However, it focuses on the areas that challenge young children with autism.

The ESDM uses the following principles to improve joint attention:

  • Setting up the environment to encourage joint attention
  • The child initiates each activity for better joint attention
  • Playing in familiar routines
  • Modulating attention and arousal states to keep. child’s joint attention
  • Scaffolding and elaborating the play token the child engaged
  • Facilitating joint engagement through ABC principles
  • Waiting and allowing the child to initiate communication
  • Recognising and responding to every attempt by the child for joint attention
  • Generalising skills to other people and environments

The ESDM attempts to use joint attention every 10-20 seconds in every activity during the session!

How do I find out more about the ESDM?

You can read more about the ESDM and how it improves all areas of development:

OneOnOne Children’s Therapy offers the ESDM. We were one of the first small private intervention clinics in New South Wales to offer this evidence based practice. In our Sydney clinic our certified ESDM therapists constantly strive to deliver the Early Start Denver Model at the highest levels of fidelity so we can improve children’s lives. Our Speech Pathologists, Occupational Therapists and Psychologists are certified ESDM therapists so that each child can have the highest quality, individualised program.

If you are interested in learning more about how the Early Start Denver Model can support your child’s learning and development, please call us on (02) 80657837 or email us. OneOnOne Children’s Therapy is located in Bondi Junction in the Eastern Suburbs of Sydney. ESDM is also available via Skype for remote and regional families.

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