Need time: Joint attention in interactions with people with profound intellectual and multiple disabilities

Heleen Neerinckx, NEED TIME: Joint attention in interactions with people with profound intellectual and multiple disabilities

Doctoral Dissertation submitted to obtain the degree of Doctor in Educational Sciences, 2015

Supervisor: Prof. Dr. Bea Maes

Because of their complex support needs, people with profound intellectual and multiple disabilities (PIMD) need others to explore the world and to show their abilities. Therefore, high quality interactions are indispensable for a good quality of life of people with PIMD. Joint attention is described as a constituting factor of high quality interactions, indicating the sharing of a focus of attention between two partners, while both partners are aware of each other’s attention towards the element of mutual attention. The development of the ability to share attention requires specific skills: responding to joint attention behaviours, and initiating joint attention behaviours, respectively.

To date, we do not know to which extent the low rate of joint attention behaviours of people with PIMD is related to individual or to context characteristics. Therefore, the aim of this doctoral dissertation was to gain insight in the amount and the nature of joint attention behaviours of people with PIMD and to investigate which factors can promote or hinder these behaviours. To examine this goal this doctoral dissertation includes three parts.

First, we investigated which individual (manuscript 1) and context (manuscript 2) characteristics are associated with the nature and the amount of joint attention behaviours of people with PIMD. People with PIMD generally appeared to show joint attention behaviours at low rates. The developmental age, visual disabilities, motor impairments and perseverance were associated with the amount and the nature of their joint attention behaviours. A structured interaction was the most motivating situation for people with PIMD to show initiatives towards their partner, while a spontaneous interaction was the most motivating situation for responding to an initiative. The familiarity of the objects used in the interaction, and the familiarity of the interaction partner were not associated with their performances in joint attention behaviours. The responsivity of the interaction partner, however, was positively associated with the amount of their joint attention behaviours.

Second, we analysed the sequential relationships between the joint attention behaviours of both partners (manuscript 3) and between the initiating joint attention behaviours of the partners and the attention episodes in the interaction (manuscript 4). Direct support workers already use successful strategies to  direct the attention of the persons with PIMD, however, being directed by a person with PIMD, was still challenging for them. Direct support workers are very directive in the interactions, which became clear by the fact that they frequently use several initiatives within one single interval. No causal relationship was found between the specific initiatives of the interaction partners and the attention episodes in the interaction.

Third, using the knowledge that we had obtained from the previous studies, we developed and evaluated an intervention to promote joint attention behaviours of people with PIMD (manuscript 5). An increase in the joint attention behaviours was observed when the interaction partner uses adaptive communication strategies, is responsive and follows the lead of the person with PIMD, and gives him/her time to respond to or initiate a focus of attention.

The empirical findings as well as the methodological and theoretical reflections derived from this doctoral study provide essential knowledge to guide future research on joint attention in interactions between people with PIMD and their social partners. With regard to practice, the obtained understandings and the observation tools can be considered a vehicle for practitioners to gain insights in their attitude and behaviours directed to persons with PIMD, to be confirmed in the available qualities in their interactions and to discover new perspectives on moments of ‘sharing attention’ about a topic of mutual interest.