Antony Cox

Testing joint attention, imitation, and play as infancy precursors to language and theory of mind

Abstract Various theoretical accounts propose that an important developmental relation exists between joint attention, play, and imitation abilities, and later theory of mind ability. However, very little direct empirical evidence supports these claims for putative “precursor” theory of mind status. A small sample ( N =13) of infants, for whom measures of play, joint attention, and imitation had been collected at 20 months of age, was followed-up longitudinally at 44 months and a battery of theory of mind measures was conducted. Language and IQ were measured at both timepoints. Imitation ability at 20 months was longitudinally associated with expressive, but not receptive, language ability at 44 months. In contrast, only the joint attention behaviours of gaze switches between an adult and an active toy and looking to an adult during an ambiguous goal detection task at 20 months were longitudinally associated with theory of mind ability at 44 months. It is argued that joint attention, play, and imitation, and language and theory of mind, might form part of a shared social–communicative representational system in infancy that becomes increasingly specialised and differentiated as development progresses.

Predicting language outcome in infants with autism and pervasive developmental disorder

BACKGROUNDnTo examine longitudinal associations between diagnosis, joint attention, play and imitation abilities and language outcome in infants with autism and pervasive developmental disorder.nnnMETHODS AND PROCEDURESnExperimental measures of joint attention, play and imitation were conducted with a sample of infants with autism spectrum disorder at age 20 months. Language outcome was assessed at age 42 months. A within-group longitudinal correlational design was adopted.nnnOUTCOMES AND RESULTSnLanguage at 42 months was higher for children with a diagnosis of pervasive developmental disorder than for children with a diagnosis of autism. Language at follow-up was also positively associated with performance on experimental measures of joint attention and imitation, but not with performance on experimental measures of play and goal detection at 20 months, nor with a non-verbal intelligence quotient, although these associations were not examined independent of diagnosis. However, floor effects on the measure of play at 20 months and the small sample size limit the conclusions that can be drawn.nnnCONCLUSIONSnIndividual differences in infant social-communication abilities as well as diagnosis may predict language outcome in preschoolers with autism spectrum disorders. Attention should be directed at assessing these skills in 2- and 3-year-old children referred for a diagnosis of autism spectrum disorder. Imitation and joint attention abilities may be important targets for early intervention.

Screening and surveillance for autism and pervasive developmental disorders

Screening and surveillance are different but related activities involving the detection of impairments with a view to prevention or amelioration of consequent disability and handicap. Screening is the prospective identification of unrecognised disorder by the application of specific tests or examinations. Surveillance refers to the ongoing and systematic collection of data relevant to the identification of a disorder over time by an integrated health system.nnThe review by Hall1 in Health for all children concluded that most screening tests that set out to identify neurodevelopmental disorders do not meet the stringent criteria outlined by Cochrane and Holland2 and Wilson and Jungner.3 In some conditions, for example language disorders, this is because there is uncertainty about “caseness” and tests tend to have low sensitivity and specificity.4 5 This is particularly the case for screening tests that attempt to identify a specific condition rather than general developmental delay, and for the identification of relatively rare disorders. In the latter case, even when the sensitivity and specificity of a screen remain constant, the positive predictive value (the proportion of children with a positive screen result and who have the disorder) is lower the rarer a disorder is within the population.6 nnThe concept of developmental surveillance is a parent–professional partnership that takes a broader look at developmental and behavioural skills and progress over time. It combines the observations of parents with the developmental knowledge of the professional and the deployment of specific tests. There is evidence that the use of screening instruments in combination with asking parents about their concerns improves the efficiency of an instrument.7 8 nnHowever, the number and type of concerns that parents have about their childs behaviour and development determine whether using a screening instrument within the clinic setting is effective. For example, Glascoe, …

Psychological Disturbance and Child Sexual Abuse: A Follow-Up Study.

OBJECTIVEnThe aim of this prospective study was to identify risk factors for the development of psychological disturbance in sexually abused children, enabling recognition of the need for appropriate psychological intervention and provision.nnnMETHODnA city-wide study of children aged 16 or under was carried out, with all cases of CSA requiring investigation within 12 months included. Data were collected on 144 children from police, social services, and pediatricians. Follow-up was by questionnaire and interview with involved professionals at 4 weeks, 9 months, and 2 years post investigation.nnnRESULTSnInitially, two-thirds of children showed emotional or behavioral indicators of disturbance, commonly sleep disturbance, temper tantrums, and depression. Over time, there was a substantial increase, with anxiety and depression, suicide attempts, substance abuse, lack of interaction with peers and sexualized behavior showing increases over the studys duration. Age, gender, abuse, and perpetrator characteristics did not show strong effects initially. Children involved in criminal proceedings were at particular risk. No improvement was evident over time.nnnCONCLUSIONSnIn the absence of clear risk factors other than initial disturbance, process models involving cognitive factors may be helpful in explaining disturbance, and the need for early identification of disturbance and intervention is highlighted.

The effect of a child's disability on mother's mental health.

The prevalence of maternal depression was investigated in the mothers of 96 children: 30 premature infants at risk for the development of cerebral palsy; 35 premature infants considered not to be at risk for the development of cerebral palsy; and 31 healthy fullterm infants. There were equally high levels of depression in all three groups of mothers, regardless of birth status, prediction of disability, or presence of actual disability, throughout the first year of the childrens lives. Depressed mothers were, however, found to have significantly more psychosocial stress. An early physiotherapy intervention had no effect on the prevalence of depression in mothers whose children were at risk for the development of cerebral palsy.

A Description and Evaluation of a Community Child Mental Health Service

A community-based child mental health service was established for families of preschool children with emotional and behavioural problems in the children, psychosocial problems in the family or parenting difficulties. The intervention was home-based and conducted by health visitors and paediatric community medical officers trained in parent counselling, parenting issues and child behavioural management. The approach was based upon frameworks derived from counselling theory, with the intervention dependent upon the development of a trusting and respectful partnership with the parents. The aims were to promote and support the parents own exploration of the identified problems, and to help them establish clear aims and effective problem management strategies. Ongoing supervision was provided by a clinical psychologist. The evidence indicated that the training course was acceptable to non-mental health professionals and effective in preparing them to work with psychosocial problems. The service was a feasible option for work at the community level; it was acceptable to both referrers and parents and beneficial for families living in a very deprived inner-city community.

Assessment and therapy with children : Can computers help?

The use of computers in assessment and therapy with children is a relatively new field and one in which there is little research. This article reports on the development of a computer-assisted interview for children and the potential applications of this type of approach to helping children describe their experiences. The computer medium offers a number of important advantages in work with children: (i) its novelty and appeal for the child; (ii) the opportunity that it provides to take the focus of interaction off the one-to-one relationship of child and interviewer, introducing a shared external focus for attention and reducing stress on the child; and (iii) the controllability and structuring of the setting, both for the child and interviewer. The development of a computer-based interview format is described, as are pilot studies of the properties of the program. The use of the program in forensic, child care and therapeutic settings is discussed, together with its applicability to a range of forms of disability.

Preventing child abuse: a review of community-based projects II: Issues arising from reviews and future directions

Detailed examination of evaluated community programmes for the prevention of physical child abuse and neglect shows that success depends on matching the skills of the staA to the needs of the families. The relative ineAciency of risk screening and attrition from prevention programmes argues for comprehensive as well as focused aspects of programmes and variation in which is available. Sexual abuse prevention programmes have usually been implemented in schools but are more successful when the focus includes bullying and when children and parents are also actively involved. This is also true of bullying programmes. In establishing risk for abuse, more eAective methods are required to assess aspects of family life that are not readily observable, including involved but non-resident adult males. It is important not only to approach abuse prevention by intervening in diAerent ways and at diAerent points in the network of processes within and around the family, but also to find cost-eAective ways of sustaining preventative eAorts. * c 1998 John Wiley & Sons, Ltd.

Preventing child abuse; a review of community-based projects 1. Intervening on processes and outcome of reviews

Recent theories advocating ecological and developmental perspectives on child abuse and neglect are summarized. Reviews of community prevention programmes underline the importance of focusing on processes and viewing the developing child and their family in a broad context. The conclusions of the reviews are reported. Although the reviews suggest that some programmes to prevent physical and sexual abuse and bullying are at least to some degree effective, their impact has been reduced by a failure to encompass adequately the various influences that operate across difference domains of the childs life at different stages of their development.

Taking Control: A Single Case Study of Mellow Parenting

A single case study is presented illustrating the theoretic approach and practical implementation of Mellow Parenting, a group intervention for families of young children where there are parenting problems. The parents in this case had a long history of marital violence, and, following the breakdown of their relationship, the father continued to terrorize the family, with adverse effects on the mothers and childrens mental health. The mother felt unable to relate to her son, aged 2, because of her own profound depression and the similarity between him and her former partner. He had marked eating problems and her daughter had been referred to child psychiatry with severe separation and sleeping problems. In the course of the group, the mother grew in confidence and began to separate her feelings about her partner from the needs of her young son. A one year follow-up showed that she had been able to move away from the area, make a secure and affectionate base for her children and begin a course of adult education to further her career. The combination of support for herself and practical parenting workshops was effective both in her own emotional containment and in mobilizing her ability to contain her childrens distress.