Faculty of Social and Behavioral Sciences
Graduate School of Child Development and Education
Pointing Fingers: The Predictive Features of
Emotional Communication and Joint Attention
During the First Year of Life
Research Master Child Development and Education Research Thesis
Linnéa Elsammak
Supervisors: Eliala A. Salvadori & Cristina Colonnesi January 10th, 2020
Abstract
Preverbal infants engage in social interactions via emotional communication (EC). By the fourth month of life, infants learn to synchronize their EC with others in dyadic interactions, as well as triadic interactions with the intention of sharing attention with a partner with regards to a third object (i.e., joint attention (JA)), which peak around the eighth month. The declarative pointing (DP) gesture, defined as the extension of the hand and/or the index finger, emerges around the twelth month. What remains unclear is whether these abilities share a developmental mechanism. The present study aimed to investigate the presence of an underlying developmental trajectory among the milestones of EC, JA, and DP in infants during the first year of life. Sixty children (45% girls) participated in the present longitudinal study. EC and JA were observed during dyadic and triadic interactions at the families’ homes when infants’ were four and eight months old. Infants’ DP abilities were assessed with an experimental paradigm in the Lab at 12 months and with parental reports of infants’ behaviors in natural settings. Structural equation modelling assessed the predictive effects of EC and JA on DP at 12 months. EC at four months was significantly predictive of DP at 12 months, but not of JA at eight months. The findings provide a first glance into the presence of the hypothesized developmental trajectory for EC and DP and highlight the role these abilities may play in social maladaptation (e.g. ASD). Limitations and suggestions for future research are discussed.
Keywords: Emotional Communication, Joint Attention, Pointing Gesture, Infancy, Autism Spectrum Disorder
Pointing Fingers: The Predictive Feature of Emotional Communication and Joint Attention During the First Year of Life
From birth, infants actively seek to learn about the social world around them. Prior to fully developing the use of verbal language, infants use nonverbal communication in order to engage in social interactions with familiar and unfamiliar interaction partners. For example, the communication by temporally coordinating the modalities of Emotional Communication (EC): 1. attentional gaze, which is directed toward (the face or body of) the interaction partner/third stimulus/somewhere else; 2. facial expressions, which range on a continuum from positive to negative; and 3. vocalizations, which are communicative attempts to verbally engage (Colonnesi, Zijlstra, van der Zande, & Bögels, 2012; Yale, Messinger, Cabo-Lewis, & Delgado, 2003). By the time infants are four months of age, they are able to efficiently and reliably coordinate these modalities with those of their interaction partner, in order to communicate their needs efficiently during daily social interactions (Bigelow, 1998; Colonnesi et al., 2012; Hsu & Fogel, 2001). Research suggests that these modalities are related to the development of individual traits/disposition and infants’ learning of emotion regulation in ways that are adaptive, considered to be socially appropriate, and contribute to social competence later on (Denham et al., 2003). For example, more emotionally expressive infants are more likely to engage in more frequent opportunities of social learning from the dyad, and thus tend to experience more advanced socio-emotional development in toddlerhood (Moreno & Robinson, 2005). The present study conceptualized EC as three combinations of two modalities (e.g. infant gazing to adult while smiling); (Colonnesi et al., 2012).
As infants mature, their interest in third objects, events, and people outside of the face-to-face dyadic interaction gradually increases (De Barbaro, Johnson, & Deák, 2013). Infants begin to share their experiences using EC in the form of joint attention (JA), which is conceptualized as the sharing of attention and interest in a third entity, whether it be an object, person, or event, with another individual (Bakeman & Adamson, 1984). This ability implies the development of a “sense of the self”, meaning that infants are learning to represent themselves as a separate individual (Colonnesi, Rieffe, Koops, & Perucchini, 2008). Because of this, JA is also considered to be an important indicator of later linguistic and socio-cognitive development (Carpenter, Nagell, Tomasello, Butterworth, & Moore, 1998). For example, Tomasello and Farrar (1986) proposed that interactions containing episodes of JA continually scaffold children’s language (e.g., vocabulary size/use), and that these interactions become more and more complex over the first two years of life (Tomasello & Farrar, 1986). So far, JA has been conceptualized in multiple different ways among researchers. The present study employed two forms of JA; the temporal co-occurrence of gaze among partners (Yu & Smith, 2013; Yu & Smith, 2016; Yu, Suanda, & Smith, 2019) and infant initiated joint attention (IJA) (Mundy, 2017; Mundy & Newell, 2007; Mundy et al., 2013).
Temporal co-occurrence of gaze
Temporal co-occurrence of gaze, intended as the duration of time that both partners are attending to the same toy, signifies a mutual interest. Moments of shared attention with a responsive and sensitive partner fosters the development of a framework for infants’ to build up their social repertoire (Tomasello, 1988). For example, during the first year, infants lack the social skills to participate in collaborative social activities and require the social scaffolding of an adult to help them further develop their ability to attend (Tamis-LeMonda, Kuchirko, & Tafuro, 2013).
In essence, there is a ‘snowball effect’ of social learning opportunities that stem from longer bouts of shared attention. According to the sustained-attention hypothesis, caregivers provide dynamically rich social input via the manual manipulation of toys while simultaneously providing verbal descriptions and labels of the toys, which effectively increases infants’ abilities to engage in JA (Suarez-Rivera, Smith, & Yu, 2018; Yu & Smith, 2016; Yu, Suanda, & Smith, 2019). This form of shared JA is predictive of later emerging self-regulation, language development, and school achievement, and is suggested to be a pre-requisite skill for a shared socio-cognitive developmental trajectory that infants are able to continuously practice and build upon (Suarez-Rivera, Smith, & Yu, 2019).
Infant initiated joint attention
Infant initiated joint attention (IJA) are instances in which the infant bids to socially share an object or experience with their social partner (Mundy & Newell, 2007). IJA is considered to be a cognitively complex skill, one of the earliest forms of perspective taking, and the realization of the intentionality of the self and others (Mundy 2016; Mundy et al., 2007). In preverbal infants, IJA is operationalized as shifting eye gaze behavior between an interaction partner and an object of interest (Mundy et al., 2003).
IJA is predictive of multiple aspects of later social-cognitive development, such as Theory of Mind (ToM) (Korkmaz, 2011), imitation (Pickard & Ingersoll, 2015), and language development(Farrant & Zubrick, 2012). Research findings have provided additional evidence for the claim that IJA and intention-based imitation skills in infancy are related to a more developed ToM in toddlerhood (Brooks & Meltzoff, 2015; Colonnesi, et al., 2008; Kristen, Sodian, Thoermer, & Perst, 2011), and plays a vital role in executive functioning (Miller & Marcovitch, 2015).
Although yet to be empirically investigated, findings suggest that infants with efficiently developed early EC skills may be more inclined to actively engage in and initiate triadic interactions throughout the first year (Beuker et al., 2013; Mundy, 1995). Coming back to the idea of the ‘snowball effect’, it is likely that socially advanced infants tend to monopolize social learning opportunities in a way that then places them at the front of the pack with regard to their continuous social learning. These hypotheses therefore suggest that sophisticated EC is an essential pre-requisite for IJA development, although substantial evidence explicitly investigating this link is severely lacking in the literature.
The Declarative Pointing Gesture
JA episodes often happen in combination with referential communication, which is defined as the unique human ability to direct, refer, or share one’s attention with another individual to an outside object or event. More specifically, declarative pointing production (DP), is pointing produced with the intention of directing an interaction partner’s attention to a third object or event in order to share a social experience (Tomasello, Carpenter, & Liszkowski, 2007). These episodes become more frequent and complex around the end of the first year, when infants start developing the abilities to comprehend and produce pointing gestures in order to refer to third entities (Butterworth & Morissette, 1996). Research indicates that the age of onset of pointing and its frequency at 12 months predicts infants’ speech production at 15 months (Butterworth & Morissette, 1996) as well as cognitive outcomes such as ToM (Camaioni et al., 2004). The pointing gesture is recognized as the extension of the hand (i.e., hand pointing) and/or the index finger (i.e., pointing gesture as intended in the present study) towards a specific object or event.
Recent research suggests that DP production actually belongs to the same developmental trajectory as EC, and is an extension of, JA (Salo, Rowe, & Reeb‐Sutherland, 2018), although this
link is yet to be empirically investigated. For example, findings indicate that in typically developing infants, DP occurred in combination with the EC modalities of visual gazing, positive affect, and vocalizations (Franco & Butterworth, 1996), suggesting that EC plays a vital role in emphasizing and clarifying the communicative purpose of the DP (Mundy et al., 2003). It has also been found that children with higher levels of intention understanding produce higher levels of DP than children with low intention understanding (Camaioni et al, 2004). Crucially, infants’ frequency of DP tends to be prolonged when adults share their attention and interest while incorporating gaze alteration and facial expressions in the interaction (Liszkowski, Carpenter, Henning, Striano, & Tomasello, 2004). Taken together, we know that these three milestones are combined in their expression. What is still unclear is whether they share the same developmental relation or develop simultaneously along three different trajectories.
The Present Study
Although EC, JA, and DP have been extensively studied as separate milestones, and the important role they play in later development has been established, the developmental link between these three milestone has never been empirically investigated. The present study aimed to contribute to the present literature by investigatigating the presence of an underlying developmental trajectory among the milestones of Emotional Communication, Joint Attention, and Declarative Pointing in infants during the first year of life. Specifically, it was hypothesized that EC would have a direct effect on JA and DP, and that JA would have a direct effect on DP.
Figure 1. Proposed model of EC, JA, and DP
Method Participants
The sample consisted of 60 infants (45% girls), living within or around Amsterdam, North Holland. Infants were required to be four months or younger prior to beginning data collection. Due to late recruitment approximately seven participants began with the eight-month home-visit. A complete overview of parental social demographics is provided in Table 1. Families were recruited via brochures distributed in various cafes, maternity shops, nurseries, and schools around Amsterdam. The researchers also collaborated with coordinators of pregnancy courses, pre-natal yoga teachers, as well as the Sarphati Institute. This project has been approved by the Ethical Committee of the University of Amsterdam, ID number 2016-CDE-7403.
Procedures and Settings
Four- and eight-month home visits. Both the four and eight-month observations took place in the families’ homes. For a visual representation of the observation settings refer to Figure 2. The present study only included infant-experimenter interactions and all experimenters involved
in the study were female. The infant and the experimenter sat across from one another at approximately an arms distance. At four months infants were seated an infant car seat, while at eight months they were in a high chair due to the children’s improved motor control. Whereas the four month was a face-to-face setting, at eight months the set up was intended to create a triadic setting in order to enhance triadic interactions which included engaging with the toy while seated at the table. A Samsung 360° camera placed in between the infant and experimenter was used to capture the interaction. In order to minimize distractions, parents and older siblings were invited out of the testing room in another room during the interactions (parents could watch the interaction live on a Samsung phone, from the other room).
The four-month observation consisted of a minute dyadic interaction, and a two-minute triadic interaction with a proximal toy (i.e., a small light-up ball). The eight-month observation contained the same procedure but used a larger novel toy compared to the four-month observation (i.e., a rattle). The experimenter was instructed to interact with the infant as she normally would in order to capture the most naturalistic observation.
12-month lab visits. The 12-month observations took place in the Family Lab at the University of Amsterdam where the infant interacted with an experimenter and engaged in a task aimed at capturing infants’ pointing gesture abilities (Camaioni et al., 2004). For a visual reference of the experimental setting refer to Figure 3. Infants were first placed into a high chair at a small table and sat directly across from the experimenter. Behind the experimenter were long, dark blue curtains. The accompanying parent sat behind the infant and was asked to remain as affectively neutral as possible if the infant attempted to engage with them during the observation. In the event of excessively fussy behavior from the infant, they were shifted from the highchair to the parent’s lap for the rest of the experimental task.
The DP production task consisted of three experimental conditions: positive, neutral, and negative. For a visual reference of the experimental stimuli refer to Figure 4. Each stimulus was exposed one at a time from behind the curtain, outside the experimenter’s field of vision, and directly in line with the infant’s field of vision. Only if the infant pointed at a stimuli during the trial could the experimenter turn around and provide a reaction of acknowledgement. Two trials were repeated for each stimuli to the right and left of the experimenter for approximately 15 seconds each.
12-month QPOINT questionnaire. Both parents were asked to fill in the QPOINT questionnaire concerning their infant’s pointing abilities in a natural setting within a two week window prior to or following their child’s first birthday (Camaioni et al., 2004). The present study only used the section concerning infants’ DP which consisted of 8 questions regarding infants’ DP production in a natural setting (e.g. points to an animal in the house or outside) answered on a scale of one to three, one being ‘never occurred’ and three being ‘occurs often’. The questionnaire contained adequate internal consistency (Cronbach’s = .60). An overview of the questionnaire can be found in the Appendix.
Coding system and inter-rater reliability. All observations were systematically coded at the micro-level using the Observer XT 13.0 (Noldus, Trienes, Hendriksen, Jansen, & Jansen, 2000), which allows for the coding of state events (i.e. duration) and point events (i.e. frequencies) at a speed of one second, and less, up to an accuracy of 1/25th of a second (i.e. a frame). EC and
JA at four and eight months were coded according to Colonnesi et al. (2012)’ coding scheme. DP was coded according to the coding scheme of Camaioni et al. (2004).
Emotional communication and joint attention. Attentional gaze and facial expressions
a) Attentional Gaze: indicates the attentional state of the infant, what he/she is currently attending to or is socially interested in, whether that be with an interaction partner or an additional stimulus (Lavelli & Fogel, 2005; Weinberg & Tronick, 1994).
b) Facial Expressions: provide visual insight into their emotional state, which ranges on a continuum from positive to negative emotions. For example, infant smiles indicate rising pleasure and a positive experience, while cry faces indicate a state of anger, distress, or overwhelming discomfort (Camras, 1992; Messinger, 2002).
c) Vocalization: represent pre-linguistic communicative attempts to interact with, or gain attention from, the interaction partner (Jaffe, Beebe, Feldstein, Crown, & Jasnow, 2001).
Declarative production. DP behaviors at 12 months were coded as infant initiated
interactions in an effort to share attention with the experimenter by pointing to a stimulus out of the experimenter’s range of vision. DP and was operationalized as the production of a pointing gesture with the intent to share the experience (Colonnesi et al., 2008).
1. ‘Declarative production pointing’: coded as the production of either hand or index finger points measured in both duration and frequency
2. ‘Correct pointing’: coded as instances of DP when the stimulus was visually available to the child. Instances of DP where no visual stimulus was available were coded as incorrect.
Parental reported pointing behaviour. Both mothers and fathers were asked to fill out the
QPOINT questionnaire within a two week window before or following their infant’s first birthday.
Inter-rater Reliability.
Four- and eight- months observations.
Nine percent (seven videos) of the four-month observations and eight month observations were double coded for reliability by trained graduate students. Reliability for all coded behaviors
met Cohen’s Kappa (1968) cut-off scores of .70 or higher. For the four month observations, kappa for attentional gaze was .77 (94.46% agreement), for facial expressions .90 (95.0% agreement), and for vocalizations .84 (94.95% agreement). For the eight month observations, kappa for attentional gaze was .92 (98.37% agreement), for facial expressions .75 (81.93% agreement), and for vocalizations .80 (93.79% agreement).
Twelve month observations.
Fifteen percent (nine videos) of the 12 month observations were coded for reliability. The kappa for declarative production in the lab was .95 (95.76% agreement).
Data Preparation
Outcome variables. For the four- and eight- month observations, data were exported separately for EC in the dyadic observations, while JA was exported for the triadic observations. For the 12 month observations, data were exported with regards to DP. Outcome variables were created and exported by imputing algorithms in the software program The Observer XT 13.0 (Noldus et al., 2000). All outcome variables were corrected based on the total time for the observations. Corrected proportions of duration were calculated based on the expected observation duration (i.e. for the four and eight months observation, 120 seconds; for the 12 month observation, 90 seconds). Corrected frequencies were calculated by multiplying the expected observation duration by the actual observation duration.
Emotional communication. Three outcome variables were exported for EC at four and
eight months as the intra-personal co-occurrence of two EC behaviors (Colonnesi et al., 2012): 1. ‘Infant Gaze to Adult Face/Body while Smiling’: measured in duration
2. ‘Infant Gaze to Adult Face/Body while Vocalizing’: measured in frequency 3. ‘Infant Smiling while Vocalizing’: measured in frequency
Joint attention. The present study investigated two forms of JA; the temporal
co-occurrence of gaze, and infant IJA:
1. ‘Temporal co-occurrence of gaze’: operationalized as moments of simultaneous gaze to the same object of interest by both interaction partners (i.e., duration of shared attention; Yu, Suanda, & Smith, 2019).
2. ‘Infant IJA’: operationalized as infant alternating gaze between object of interest and adult’s face or body was implicitly suggested through the coding of frequency in ‘gaze shifts’ according to the coding manual ‘Early Social Communication Scales’ coding manual of Mundy et al. (2003) (Mundy, Delgado, Block, Venezia, Hogan, & Seibert, 2003). IJA was operationalized as gaze switches from the infant from the adult to the toy that occurred while the adult was gazing to the infant. Findings suggest that infants younger than 12 months have a visual preference for their own as well as interaction partners’ hands which may be a significant contributing factor to the development of JA skills during the first year (Ray & Hayes, 2011; Yu & Smith, 2013).
Figure 5. Data visualization of Temporal co-occurrence of JA
Figure 6. Data visualization of child IJA
Declarative pointing. Two outcome variables were exported for DP at 12 months.
1. ‘Declarative pointing lab’: exported as correct instances of DP during all three experimental conditions. For the current study ‘DP’ was measured in frequency.
2. ‘QPOINT M & F’: due to the significantly positive correlation of mothers’ and fathers’ questionnaire responses (r = .43, p = .009), QPOINT scores were merged into one average score for both parents.
Analytic preparation. Preliminary analyses were conducted to check for missing data, outliers, and normality. Missingness of the data was determined to be at random according to Little’s Test, 2 = 171.201, df = 186, p = .775. For each individual variable, missingness was
between 15 and 30% and it was therefore deemed appropriate and necessary to perform multiple imputation in order to have a complete dataset. Imputation was performed in R (Team, 2013) using the MICE package (van Buuren & Groothuis-Oudshoorn, 2011).
Following data imputation, data were screened for the presence of outliers using box and whisker plots. Observations flagged as extreme were first reassessed for coding errors using the original video and coding scheme, however no adjustments to the originally coded videos were made. Winsorization was applied to the data where necessary in order to minimize the influence of outliers, meaning that Z-score values larger than 3.5 were fixed to be the value of the second highest score, plus one (Fidell & Tabachnick, 2003). A check of normality indicated that for three variables: ‘Infant Gaze to Adult Face/Body while Smiling’ at four months, ‘Infant Gaze to Adult Face/Body while Vocalizing’ at eight months, and ‘Declarative Pointing’ at 12 months, skew and kurtosis values were all larger than 2, indicating that these variables were positively skewed. All three variables were therefore transformed using a log10 transformation (Pituch & Stevens, 2015). Reassessment of skew and kurtosis indicated that a violation to the assumption of normality was no longer present.
Analysis strategy. All analyses were conducted in R version 3.4.3 (Team, 2013). Structural Equation Modeling (SEM) was determined to be the most appropriate analytic strategy
as it allows for the investigation of the directional relations among unobserved common factors via a set of observed ‘indicators’ selected to best represent the constructs of interest (Keith, 2014). For the present study, five common factors were created for analysis: EC at four months and EC at eight months, both containing the indicators ‘Infant Gaze to Adult Face/Body while Smiling’, ‘Infant Gaze to Adult Face/Body while Vocalizing’, and ‘Infant Smiling while Vocalizing’; JA at four months and JA at eight months containing the indicators ‘Temporal co-occurrence of gaze’ and ‘Infant IJA’, and DP at 12 months containing ‘Declarative pointing lab’ and ‘QPOINT M & F’. Prior to analysis, a covariance matrix was created from the correlations and standard deviations of all indicators using the lavaan package (Rosseel, 2012). (see Table 2). A sample size of 60 families is considered to be on the small side for conducting SEM but is still considered to be acceptable (Iacobucci, 2010).
In order to assess the appropriateness of the indicators for their designated factors, a Confirmatory Factor Analysis (CFA) was conducted as a first step. Model fit was assessed using the 2 goodness of fit test, the Root Mean Square Error of Approximation (RMSEA) and its 90%
confidence interval, as well as the Comparative Fit Index (CFI). RMSEA is a useful tool as it provides an estimate of misfit in the population along with a confidence interval versus an estimate simply for the sample. For the 2 goodness of fit test using an alpha level of .05, model fit is
considered acceptable when the fit was not significant, therefore implying that the model-implied covariance matrix did not significantly deviate from the sample-implied covariance matrix. Models containing RMSEA values of <.05 are considered to have a close fit, <.08 to have acceptable fit, and >.10 are considered to have poor model fit due to unmodeled dependency of the variables (Browne & Cudeck, 1992). CFI values of .95 or higher are considered to indicate
good model fit. Due to the nesting of models, a 2 test with an alpha level of .05 was used for
model comparison.
In order to investigate the hypothesized directional relations among the common factors, an Exploratory Factor Analysis (EFA) was conducted as a next step. Assessment of model fit for the CFA remained the same for the EFA.
Results Preliminary Correlations
For an overview of the correlations for all indicator outcome variables refer to Table 3. A preliminary assessment of the correlations showed that all three indicators within EC at four months and within EC at eight months were moderately to highly significantly correlated. Unexpectedly, for JA at four months and eight months, both indicators were negatively significantly correlated. Surprisingly, IJA at eight months and declarative pointing in the lab were negatively significantly correlated. For DP at 12 months, both indicators displayed a small significant correlation. Intriguingly, the averaged QPOINT questionnaire indicator was slightly but significantly correlated with two of the EC indicators at four months.
Confirmatory Factor Analysis.
The initial CFA model containing the originally hypothesized five factors assessed the appropriateness of the hypothesized indicators (see Figure 7). Three of the five factors contained indicators deemed acceptable for further analysis. More specifically, the factors EC at four months, JA at eight months, and DP at 12 months were retained. For JA at 8 months only the indicator, ‘Infant IJA’ was used. For ‘Declarative Pointing’ only the indicator ‘QPOINT M & F’ was used (see Figure 8).
The first CFA model containing the factors EC at four months, JA at eight months, and DP at 12 months exhibited poor model fit 2 (4) = 19.63, p = .001; CFI = .941; RMSEA = .148 [.087
- .216], which rejected the hypotheses of good and moderate fit. Due to the assumption that the three modalities of infant EC are highly dependent on one another and not mutually exclusive in their expression, it was hypothesized that the indicators’ residual errors would likely be related as well. The second CFA model containing the modelled residual covariance of the indicators ‘Infant Gaze to Adult Face/Body while Smiling’ and ‘Infant Gaze to Adult Face/Body while Vocalizing’ exhibited poor model fit 2 (3) = 15.05, p = .002; CFI = .955; RMSEA = .150 [.080 - .229], p =
.012. The covariance of the indicators ‘Infant Gaze to Adult Face/Body while Vocalizing’ and ‘Infant Smiling while Vocalizing’ was added to the model which then exhibited good model fit 2
(2) = 5.74, p = .057; CFI = .986; RMSEA = .102 [.000 - .205], p = .136, and was determined to be the final measurement model (see Figure 9).
Exploratory Factor Analysis
With regards to the structural part of the model, the hypothesized full mediation model of a shared developmental trajectory of infant EC at four months on DP at 12 months through JA at eight months was assessed, however model fit was poor 2 (3) = 29.68, p = .000; CFI = .900;
RMSEA = .223 [.154 - .299], p = .000 (see Figure 10).
The direct path of EC at four months on DP at 12 months was added to the model and determined to be significant (b = .437, p = .000) (see Figure 11). The model displayed acceptable model fit and was determined to be the final model 2 (2) = 5.74, p = .057; CFI = .986; RMSEA =
.102 [.000 - .205], p = .136.
The present study aimed to investigate the presence of an underlying developmental trajectory among the milestones of Emotional Communication, Joint Attention, and Declarative Pointing in infants during the first year of life. Specifically, it was hypothesized that EC would have a direct effect on JA and DP, and that JA would have a direct effect on DP. Overall, the results of this study provide partial support for the hypothesis of a shared developmental trajectory among EC, JA, and DP. Specifically, EC at four months, but not JA at eight months, is predictive of DP at 12 months.
This study is explorative in nature in that it is the first to explicitly investigate the presence of a developmental continuity among three milestones. The finding of EC at four months’ predictive effect on DP at 12 months provides empirical evidence for the concluding suggestions of Matthew and colleagues (2012) that infants’ prior social cognitive ability appears to be a strong determinant of infants’ development of DP around the end of the first year (Matthew, Behne, Lieven, & Tomasello, 2012). Identifying temporal windows where social development could show a decline is central for furthering our understanding of when atypical development occurs and the way in which atypicality in development can result in major deficits later on. The presence of this trajectory provides strong evidence for developmental stability over the first year and challenges the previously conceived notion that these social milestones developed along three separate trajectories.
Currently, diagnosis for ASD is provided following a child’s second birthday, meaning that although deficits may be present in their social development as early as four months, these children do not receive any form of intervention until much later. In fact, already at four months, infant siblings of children with Autism Spectrum Disorder (ASD) tend to display less affect variability and engage in lower levels of interactive synchrony compared to infants not at risk for ASD
(Yirmiya et al., 2006). While some findings suggest that observable differences in multiple cognitive social-emotional domains are only detectable at the end of the first year (Ozonoff et al., 2014), other research proposes that irregularities in more specific behaviors, such as visual attention and positive engagement during the first semester of life, and even as early as the two months of age, should be considered markers for early identification of children at-risk for later ASD (Jones & Klin, 2013, Lambert-Brown et al., 2015; Sacrey, Bryson, & Zwaigenbaum, 2013). As a next step, replication using diverse samples is necessary to confirm these findings. Additionally, continued investigation into the longitudinal EC development of high and low-risk infants at four months is of the upmost importance.
The current study observed JA skills at eight months and although infants’ ability to organize and use this skill is actively increasing at this age, it is possible that infants’ handle on this social skill is not complex enough at eight months and therefore, the developmental window chosen for the current study did not appropriately capture JA as intended. Earlier research has indicated that while the emergence of JA skills does occur between the fourth and tenth month with the majority of infants showing stable JA skills by the eighth month (Aureli et al., 2018; Striano & Bertin, 2005), the development of this skill is gradual (Striano & Bertin, 2005). Therefore, it is likely that the methodological approach of this study did not provide an adequate assessment of JA skills in order to capture a true measure of infants’ JA abilities. Future research implementing more rigorous longitudinal investigations including additional measurements of JA throughout this window of development could help in capturing a clearer picture of this gradual development.
Studies investigating JA before the diagnosis of an ASD disorder are few. Given the knowledge we have that JA deficits are strongly linked to later ASD diagnosis, demonstrating the
presence of developmental stability across EC and JA behaviors in future research could solidify the suggestions from past findings that disturbances to the quality of these milestones prior to the 12th month could be indicative of atypical social development. While infants typically develop the
ability to engage in shared attention for longer periods of time, the inability to disengage one’s attention from an object when an interaction partner is no longer interested or is engaging with a new object, is indicative of potentially maladaptive social development (Sacrey et al., 2013). In fact, children with ASD tend to display this form of ‘sticky attention’ throughout development (Sacrey, Karl, & Whishaw, 2012). As a result, these children miss opportunities for actual social engagement with a social partner, consequently leading to a decrease in their social learning.
Deficits in IJA have been identified as of the earliest indicators of a child at risk for later ASD development (Barbaro & Dissanayake, 2012a). Limited IJA hinders opportunities for furthering socio-cognitive development, and increases the risk for future impairments in language development later on (Murray et al., 2008). A recent finding by Franchini and colleagues (2019) found that IJA behaviors were observably impaired in children later diagnosed with ASD from 12 months onward, while these differences were not distinguishable in their sample at six months (Franchini et al., 2019). However, their sample was relatively small, containing 17 ASD infants and 19 typically developing infants.
Although it was expected that infant production of DP in the lab setting would be a useful indicator, this was not the case for our study. Parental reports of infant DP in a natural setting indicate that production was higher than what was observed in the lab. One possible explanation for this contradiction may be the effect of the novel situation of both the lab and interaction partner on infants’ willingness or interest in pointing. Also, a wider variety of stimuli may be necessary. The stimuli used in the current study may have been too arbitrary or ordinary in that they did not
elicit the expected interest as intended. Future research should aim to extend the length of the DP task as well as use multiple stimuli. In order to investigate the effect of novelty, comparing whether infants’ production of DP is significantly higher when interacting with parents versus an unfamiliar partner in a lab setting may be of great value to investigate significantly differing interaction styles among infants socially interacting with a novel partner.
Deficits in the production of declarative gestures are found in children with ASD and is considered an important indicator for warranting diagnosis in toddlers (Baron-Cohen et al., 2000; Charman et al., 1997; Charman & Baird, 2002). In their literature review of home-video use for retrospective confirmation of ASD symptomology, Saint-Georges and colleagues (2010) concluded that DP production was significantly lower in children at the beginning of their second year of life who later received an ASD diagnosis (Saint-Georges et al., 2010), meaning that deficits were identifiable almost a year and a half prior to an official diagnosis. Identifying connections among EC, JA, and DP has important social implications through earlier identification of atypical development with the potential ability to buffer the negative effects of compromised social development. The findings of the current study could provide practitioners with insight into the stability among the social development of EC at four months and DP at the end of the first year.
Although the current study’s sample size could be considered acceptable compared to similar studies investigating the micro-analysis of infant social development (Beebe et al., 2011; Beebe et al., 2016; Colonnesi et al., 2012; Messinger, Ekas, Ruvolo, & Fogel, 2012), the sample was not optimal for the originally hypothesized SEM model. Due to the high amount of effort and time required to both recruit and collect data of this nature, social sciences face a predicament as the research questions we wish to investigate require such complex analyses, however the feasibility of acquiring a large enough sample is currently very challenging. Therefore, it is
imperative that researchers continue to come up with innovative strategies for recruitment and data collection that makes it as easy as possible for families to participate. A considerable strength of the current study is that two of the three observations took place in the families’ homes. This allowed for more flexible scheduling and less participant fatigue since families were only asked to travel to the lab once instead of three times. Additionally, observations were collected in a natural setting in an effort to observe the most typical behaviors from the infants. Future research using larger samples is needed to help design reliable screening tools that could aid in anticipating potential diagnosis.
Conclusion
The current study provides a first glance into the developmental trajectory of EC and DP during the first year. Although previous studies have speculated of their developmental continuity, this study was the first to empirically investigate this link. A better understanding of the relations among these milestones will provide a clearer picture of infants’ social development and its relation to psychopathology. Earlier identification of children at risk for ASD development can allow for the implementation of earlier interventions in an effort to reduce the development of social deficits during the first formidable years of life.
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Table 1
Mothers and Fathers Social Demographic Characteristics
Mothers Fathers
Characteristic (n = 60) (n = 60)
Average Age in years 34.2 (5.46) 37.7 (3.85)
Land of Origin Netherlands 85.0 83.3 European Origin 10.1 11.9 North America 3.4 3.3 Other 1.7 1.7 Completed Education Primary Education - -
Primary Prof Edu (LBO) - 1.8
Secondary Edu (MAVO) 1.7 7.3
Higher Secondary Edu (HAVO) - 1.8
Secondary Scientific Edu (VWO) - -
Secondary Prof Edu (MBO) 1.7 9.1
Higher Prof Edu (HBO) 22.0 34.5
Higher Scientific Edu (University) 62.7 38.2
Other 11.9 7.3 Employment Status Housewife/husband 6.8 - Student/scholar 1.7 - Working, full-time 20.3 69.1 Working, part-time 54.2 30.9 Sick leave 3.4 -
Occupational Dis. Ins. Act - -
Unemployed 5.1 -
Other 8.5 -
Table 2
Covariance matrix of all variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12 1. Gaze + smile 4 0.04 2. Gaze + vocal 4 0.29 22.75 3. Smile + vocal 4 0.42 13.88 14.82 4. Gaze + smile 8 0.00 0.16 0.13 0.05 5. Gaze + vocal 8 -0.09 -1.61 0.99 0.47 31.48 6. Smile + vocal 8 -0.18 -0.60 0.08 0.38 12.00 9.18
7. Temp co-oc gaze 4 -0.22 -0.07 -2.58 0.18 -9.83 -9.75 202.78
8. IJA 4 0.10 1.29 1.94 0.03 1.55 -0.15 -16.41 10.30
9. Temp co-oc gaze 8 0.48 -10.62 -3.77 -0.20 5.14 -0.55 3.64 -3.56 113.42
10. IJA 8 0.06 3.23 2.08 0.21 -3.31 0.00 8.35 0.86 -12.53 12.18
11. DP Lab 12 -0.02 0.63 0.63 -0.04 3.66 0.52 -0.57 0.11 0.30 -2.38 5.51
Table 3
Correlations and Standard Deviations of all Variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13. Gaze + smile 4 1 14. Gaze + vocal 4 .34** 1 15. Smile + vocal 4 .60** .76** 1 16. Gaze + smile 8 .05 .15 .16 1 17. Gaze + vocal 8 -.09 -.02 .06 .48** 1 18. Smile + vocal 8 -.19 -.04 .01 .57** .76** 1
19. Temp co-oc gaze 4 -.08 0 -.05 .06 -.14 -.23 1
20. IJA 4 .16 .08 .16 .04 .08 -.02 -.36** 1
21. Temp co-oc gaze 8 .23 -.21 -.09 -.09 .04 -.02 .02 -.10 1
22. IJA 8 .07 .19 .16 .27* -.11 0 .17 .08 -.36** 1
23. DP Lab 12 -.02 .09 .09 -.09 .12 .04 .02 .08 .11 -.33* 1
24. QPOINT M+F 12 .37** .13 .30* -.03 -.15 -.20 .16 -.10 .08 .08 .26* 1
SD .06 4.77 3.85 .22 .45 3.03 14.24 3.21 10.65 3.49 .31 3.85
Figures
Figure 2. Setting for four month (left) and eight month (right) observations
Figure 7. CFA model containing all five originally hypothesized factors
EC
4
JA
4
EC
8
JA
8
DP
12
Gaze + Smile Gaze + Smile Gaze + Vocal Gaze + Vocal Smile + Vocal Smile + Vocal Temp Co-oc Gaze Temp Co-oc Gaze IJA IJA DP Lab QPOINT M+F Figure 8. CFA containing three final factors
EC
4
DP
12
JA
8
Gaze + Smile Gaze + Vocal Smile + Vocal IJA QPOINT M+F Figure 9. CFA with covarying residuals among the indicators for EC at four months
EC
4
DP
12
JA
8
Gaze + Smile Gaze + Vocal Smile + Vocal IJA QPOINT M+F Figure 10. Full mediation model .077 .138*
EC
4
DP
12
JA
8
Gaze + Smile Gaze + Vocal Smile + Vocal IJA QPOINT M+F Figure 11. Final model .437*** .099 .034 Gaze + Smile Gaze + Vocal Smile + Vocal IJA QPOINT M+F
EC
4
JA
8
DP
12
Appendix
QPOINT Questionnaire filled out by both mothers and fathers at 12 months (declarative pointing only)
Pointing
The following contains a list of questions about behavior children around the age of 12 can show. Children at this age are not yet capable to make something clear through speech, but they can show or ask something to others by making a pointing gesture. They make this gesture with a closed hand while pointing their index finger in a certain direction. While doing this, the child sometimes looks at the parent or at the pointed situation or object. Nonetheless, it is also possible that children at the age of 12 months are not yet capable of making this pointing gesture. The pointing develops during the second year of life. This questionnaire is about the possible pointing of your child. The first part is about pointing to ask something, and the second part is about pointing to show something. For each question, please indicate how often your child has shown this behavior? Please mind to register only the real pointing gesture, thus with a pointing index finger, not with the whole hand.
0 Never occured 1 Occured once or twice 2 Occured more than two times
Pointing to ask for something:
1. Points at toys he/she can not reach 0 1 2
2. Points at the bottle or the food he/she desires 0 1 2
3. Points at the person (other then the parents) by who he/she wants to be lifted 0 1 2
4. Points at the spot he/she wants to go to 0 1 2
5. Points at a mechanical toy he/she wants to turn on or off 0 1 2 6. Points at the door when he/she wants to go outside 0 1 2 7. Points at something in the store he/she wants to have 0 1 2 8. Points at something if someone asks: ‘What do you want?’ 0 1 2
Pointing to show something:
9. Points to an airplane or a bird in the sky 0 1 2
10. Points to an image, picture or illustration 0 1 2
11. Points to another child he/she comes across on the street or sees through the window 0 1 2
12. Points to an animal in the house or outside 0 1 2
13. Points to a sudden or unexpected noise. 0 1 2
14. Points at a person or object on the television 0 1 2
15. Points to images in a book/magazine without touching them 0 1 2 16. Points to the right image (in a book, magazine etc.) when (you or) someone (else)
asks: ‘Where’s X (name of the image)?’ 0 1 2
The following contains a list of questions about behavior children around the age of 12 can show. Children at this age are not yet capable to make something clear through speech, but they can show or ask something to others by making a pointing gesture. They make this gesture with a closed hand while pointing their index finger in a certain direction. While doing this, the child sometimes looks at the parent or at the pointed situation or object. Nonetheless, it is also possible that children at the age of 12 months are not yet capable of making this pointing gesture. The pointing develops during the second year of life. This questionnaire is about the possible pointing of your child. The first part is about pointing to ask something, and the second part is about pointing to show something. For each question, please indicate how often your child has shown this behavior? Please mind to register only the real pointing gesture, thus with a pointing index finger, not with the whole hand.
0 Never occured 1 Occured once or twice 2 Occured more than two times
Pointing to ask for something:
1. Points at toys he/she can not reach 0 1 2
2. Points at the bottle or the food he/she desires 0 1 2
3. Points at the person (other then the parents) by who he/she wants to be lifted 0 1 2
4. Points at the spot he/she wants to go to 0 1 2
5. Points at a mechanical toy he/she wants to turn on or off 0 1 2 6. Points at the door when he/she wants to go outside 0 1 2 7. Points at something in the store he/she wants to have 0 1 2 8. Points at something if someone asks: ‘What do you want?’ 0 1 2
Pointing to show something:
9. Points to an airplane or a bird in the sky 0 1 2
10. Points to an image, picture or illustration 0 1 2
11. Points to another child he/she comes across on the street or sees through the window 0 1 2
12. Points to an animal in the house or outside 0 1 2
13. Points to a sudden or unexpected noise. 0 1 2
14. Points at a person or object on the television 0 1 2
15. Points to images in a book/magazine without touching them 0 1 2 16. Points to the right image (in a book, magazine etc.) when (you or) someone (else)
