Background: Prior studies have shown that joint attention (JA) behaviors and episodes, which involve person-person-object awareness, serve an important role in toddlers cognitive and social development. There are two forms of JA behaviors in which a toddler can engage: responding joint attention (RJA) behavior in which the toddler shifts attention to an object to which the mother is attending, and initiating joint attention (IJA) behavior in which a toddler bids for the mother's attention around an object. If a JA behavior is responded to, it becomes a JA episode. Prior research suggests that these different JA behaviors (RJA and IJA) rely on different underlying cognitive processes (Mundy, Card, & Fox, 2000; Vaughan Van Hecke et al., 2007). Furthermore, prior research has made a distinction between earlier (gaze following) and later developing (pointing and showing) forms of RJA and IJA behaviors because these behaviors occur at different points of development (Tomasello, 1995; Vaughn van Hecke et al. , 2007). Specifically, gaze following occurs earlier in development than showing and pointing (Van Hecke et al., 2005). The few studies that have examined RJA and IJA behaviors in toddlers born very low birth weight (VLBW) have been mixed, with some studies suggesting toddlers born VLBW show deficits in RJA but not in IJA behaviors (Landry, Schmidt, & Richardson, 1989) and other studies suggesting toddlers born VLBW show deficits in both RJA and IJA behaviors (De Schuymer et al., 2011). To our knowledge, only one study has explored joint attention episodes in a VLBW sample, and no study has examined RJA and IJA behaviors examining gaze and point behaviors separately within this population. The current study hypothesized birth weight group (VLBW, normal birth weight (NBW)) differences in RJA-gaze, RJA-point, IJA-gaze, and IJA-point behaviors such that toddlers born VLBW would engage in fewer of these behaviors than toddlers born NBW. It was further hypothesized that toddlers born VLBW would engage in fewer RJA-point, RJA-gaze, IJA-gaze, and IJA-point episodes with their mothers compared with toddlers born NBW. It was also hypothesized that there would be no group differences in 'missed episodes. Methods: Participants included 52 toddler-mother dyads (50% VLBW) between the ages of 18 and 22 months (M = 19.0). The VLBW cohort was born under 1,250g and at fewer than 32 weeks (N = 26, 46% female); and the NBW cohort was born at or after 37 weeks gestation (N = 26, 42% female). Mothers completed a set of sociodemographic questionnaires, and mother-toddler dyads were videotaped for 10 minutes of free play with a set of toys. Joint attention behaviors and episodes were coded using Tasker's (2012) Coding Manual for Mother-Child Joint Attention. RJA-gaze behaviors included the toddler's attention shift to a mother's gaze, and RJA-point behaviors included the toddler shifting attention to the mother's point to a toy. IJA-gaze behaviors were defined by a toddler trying to get their mother's attention by glancing at an object, and IJA-point behaviors were defined by a toddler trying to get their mother's attention by pointing and showing an object (Tasker & Schmdit, 2008; Tasker, 2012; Mundy et al. 2007). If the JA behavior was responded to within 5 seconds, then this was considered a successful episode (Tasker, 2012). If no response occurred to the JA behavior, it was considered a 'miss. These JA episodes were divided into four types of JA, which can be distinguished by the 'successful' JA behavior that began the episode: RJA-gaze, RJA-point, IJA-gaze, and IJA-point. Inter-rater reliability was considered almost perfect with all Fleiss Kappas > .94. Results: RJA-gaze behaviors did not differ significantly by birth weight group. However, toddlers born VLBW displayed significantly less RJA-point behaviors than toddlers born NBW. Contrary to hypotheses, toddlers born VLBW displayed more IJA-gaze behaviors than their NBW counterparts. IJA-point behaviors did not significantly differ by birth weight group. JA episode findings paralleled JA behavior findings. RJA-gaze episodes did not significantly differ by birth weight group. Toddlers born VLBW and their mothers displayed significantly fewer RJA-point episodes than toddlers born NBW. Interestingly, toddlers born VLBW displayed more IJA-gaze episodes than toddlers born NBW. IJA-point episodes did not differ significantly by birth weight group. As expected, toddlers born VLBW and born NBW did not differ in the number of JA misses. Conclusions: These findings partially support the hypothesis that JA behaviors and episodes differ by birth weight group. As expected, toddlers born VLBW engaged in fewer RJA-point behaviors and episodes than toddlers born NBW. Differences in RJA-point behaviors and episodes show that, in this sample, mothers of toddlers born VLBW bid less frequently for their toddlers' attention by pointing and showing than did mothers of toddlers born NBW. This study found no differences between groups for RJA-gaze behaviors and episodes, and this may be due to the low frequency of occurrence of these behaviors and episodes for toddlers born VLBW as well as NBW. The finding that toddlers born VLBW displayed more IJA-gaze behaviors and episodes than toddlers born NBW was not anticipated. One possible explanation for this finding is a methodological artifact in the coding system: an IJA episode may not have entailed an intention from the toddler to engage in an episode but rather included a mother being more sensitive to her toddler's behavior. Mothers of toddlers born VLBW may notice exactly when their toddler shifts his/her attention to another object and may begin play around the object without the toddler having intended to engage with the mother. This maternal sensitivity to the shift in their toddler's attention may be propelling the toddler's gaze behavior into joint attention gaze episodes. In addition, if increased maternal sensitivity by mothers of VLBW toddlers explains the increased IJA-gaze behavior and episodes found among this group, it may also explain the lower frequency of RJA-point behavior and episodes in this group: mothers of toddlers born VLBW may be highly responsive to their toddler's cues and, simultaneously, not initiating many point and show behaviors to gain their toddler's attention. If this hypothesis about the coding system is correct, these data would suggest that mothers of toddlers born VLBW show greater sensitivity to their toddlers' behavior rather than the alternative interpretation that toddlers born VLBW exhibit more gaze initiation behaviors. This unique finding is congruent with the literature to the extent that mothers of toddlers born VLBW have been found to be more responsive to their toddler's behavior (Salerni, Suttora, & D'Odorico, 2007). Whether this explains the greater number of IJA-gaze behavior episodes among the VLBW dyads remains to be investigated. No differences were found between birth weight groups on IJA-point behaviors or episodes. Interestingly, almost all JA behaviors for both groups became JA episodes, as there were very few JA misses. Overall, the current study's results suggest similarities as well as differences in JA behaviors and episodes for toddlers born VLBW compared to toddlers born NBW. If further corroborated, these findings may suggest early intervention targets for mothers of toddlers born VLBW that include supporting more initiation of RJA with their toddlers.
Level of Degree
First Committee Member (Chair)
Second Committee Member
mother toddler interactions, joint attention, premature, preverbal language, very low birth weight
Rowell, Lauren. "INVESTIGATING JOINT ATTENTION BEHAVIORS AND EPISODES IN 18-MONTH TODDLERS BORN VERY LOW BIRTH WEIGHT COMPARED TO TODDLERS BORN NORMAL BIRTH WEIGHT." (2015). https://digitalrepository.unm.edu/psy_etds/123