Journal of Autism and Developmental Disorders, Vol. 27, No.

4, 1997
An Investigation of Attention and Affect in
Children with Autism and Down Syndrome
Robert M. Joseph and Helen Tager-Flusberg1
University of Massachusetts at Boston
Longitudinal videotape recordings of six young children with autism and six age-
and language-matched children with Down syndrome in structured play with their
mothers at home were coded for the focus of the child's visual attention for four
bimonthly visits and for facial affect for two of the four visits. The main finding
was that the children with autism showed reduced expression of positive affect in
a familiar social context. The autistic group attended to the mother's face and
the researchers only about half as much as the Down syndrome group, but these
differences did not reach statistical significance. Compared to the Down syndrome
group, the autistic group displayed a smaller proportion of their total positive affect
toward the mother's face and toward the researcher, but only the latter group
difference reached statistical significance. Although limited by the small sample
size, these findings suggest that autistic children's known deficits in attention and
affective responsiveness to others persist even in structured interactions with a
familiar partner in the home.
Children with autism are fundamentally impaired in their ability to initiate
and maintain interactions with other people. Their abnormalities in visual
attention and specifically in eye-to-face gaze have long been cited as a key
facet of their social impairment (Mirenda, Donnellan, & Yoder, 1983; Rut-
ter, 1978; Wing, 1976). Early experimental evidence has suggested that chil-
dren with autism avoid eye contact with others (Hutt & Ounsted, 1966;
Richer & Coss, 1976) and specifically lack the ability to use shifts of gaze
from a person's face to an object for the purpose of establishing shared
attention (Mundy, Sigman, Ungerer, & Sherman, 1986). Nevertheless,
1Address all correspondence to Helen Tager-Flusberg, University of MassachusettsBoston,
Department of Psychology, 100 Morrissey Boulevard, Boston, Massachusetts 02125-3393.
385
0162-3257/97/0800-0385$12.50/0 1997 Plenum Publishing Corporation
many recent studies observing children with autism in a variety of social
situations with familiar and unfamiliar adults have shown that they attend
to the faces of their social patterns no less than comparison groups
(Dawson, Hill, Spencer, Galpert, & Watson, 1990; Kasari, Sigman, Mundy,
& Yirmiya, 1990; Sigman, Mundy, Sherman, & Ungerer, 1986). There is
also substantial evidence that structured interactions enhance autistic children's
attention to the face of their social partner relative to the amount they attend
to the face of another person in an unstructured social situation (Dawson &
Galpert, 1990; Kasari, Sigman, & Yirmiya, 1993; Volkmar, Hoder, & Cohen,
1985; Vokmar & Mayes, 1990). As Kasari et al. (1993) have argued, the or-
ganization and guidance provided by adults interacting with autistic children
appears to serve a supportive or scaffolding function (Vygotsky, 1978) that
enhances the autistic child's otherwise deficient social skills.
The marked lack of affective responsivity to other people among chil-
dren with autism is another major facet of their social impairment that has
been noted since the syndrome was first identified by Kammer (1943). Re-
search has confirmed that children with autism display significantly lower
amounts of positive affect expressed while looking at others (Dawson et
el., 1990; Snow, Hertzig, & Shapiro, 1987; Bernstein, Shapiro, & Hertzig,
1993) and in the context of joint attention situations (Kasari, Sigman, et
al., 1990), suggesting that they are fundamentally impaired in the normal
ability to use positive affective displays to establish and regulate interper-
sonal interaction (e.g., Adamson & Bakeman, 1985; Tronick, 1989). How-
ever, these findings are based on play interactions that were not specifically
structured or that were conducted with an unfamiliar adult in a laboratory
setting. Consequently, it remains a question whether autistic children's defi-
cits in affective sharing would persist in the highly supportive social context
of a structured interaction with a familiar social partner.
The present study was an observational investigation of attention and
affect in children with autism and Down syndrome in a home setting with
familiar caretakers, over time. The main aim of the study was to see if autistic
children's attention and affective responsiveness to others would benefit from
the optimally supportive context of a structured interaction with a familiar
person in a familiar environment. Given that prior research has consistently
shown deficits in autistic children's affective relatedness to other people, we
were particularly interested in whether the scaffolding effect that a structured
context has been shown to have on autistic children's attention to others
might extend to their affective responsiveness to people as well. To explore
this, we focused on an episode during which the child was presented with a
gift by the researchers. Mothers were asked to help the child open the gift
and play with it with their child for several minutes. Observations of the tapes
across subjects and visits confirmed that this episode represented a highly
Joseph and Tager-FIusberg 386
structured and familiar interaction between the mother and child. Mothers
helped the child to open the gift, thank the researchers, and supervised initial
play in a consistent pattern of controlled interactions.
A second aim of this study was to explore developmental trends in at-
tention and affect over time. Given that we were examining children's atten-
tion and affective responsivity to the faces of their social partners as a marker
of their social competence, we were particularly interested in whether either
of these behaviors would show increases over time, particularly as the pro-
cedures and the events became more familiar to the children.
METHOD
Subjects
The data examined in this study were collected previously for a lon-
gitudinal study on language acquisition in children with autism (Tager-Flus-
berg et al., 1990). Subjects included six children diagnosed as autistic
according to DSM-III-R (American Psychiatric Association, 1987) criteria.
These subjects had all received this diagnosis from either a psychiatrist or
neurologist. Furthermore, at the time they entered the study a behavior
checklist was completed, that included items from the DSM-III-R, to con-
firm that the children met the criteria. The autistic subjects were all males,
living at home with their biological families, and either participating in
home-based intervention programs or special day-school programs. Their
socioeconomic status ranged from lower to upper middle class. Because
the data were originally collected for a study on language acquisition, the
autistic subjects were selected for having already acquired some language.
The IQs of the autistic subjects were assessed using the Leiter (1974) In-
ternational Performance Scale. Although the autistic sample was not spe-
cifically selected for higher levels of cognitive functioning, four of the six
children scored in the normal or low-normal range of nonverbal IQ.
The comparison group included six children with Down syndrome
(DS). The DS group included four boys and two girls who were located
through hospital records and who shared similar family, educational, and
socioeconomic backgrounds with the autistic children. The children with
DS were specifically selected to match the autistic children on chronological
age and language level, as measured by mean length of utterance (MLU)
at the start of the original longitudinal study. The children with DS, how-
ever, were not matched to the autistic children on nonverbal IQ. Charac-
teristics of the autistic and DS group are detailed in Table I.
T tests confirmed that the autistic and DS groups were well-matched
on age, t(10) = 0.30, and MLU, t(10) = 0.21, at the beginning of the study,
Attention and Affect 387
Table I. Subject Characteristics
Age (months)
M
SD
IQh
M
SD
MLU
M
SD
Autistic
63.7
20.8
89.0a
16.5
2.27
0.96
Down syndrome
60.5
14.7
54.0a
7.5
2.17
0.76
aSignificant difference between group means; p <
.001.
bAs measured on the Leiter International Perform-
ance Scale.
and that the autistic subjects had significantly higher nonverbal IQs, t(10)
= 4.32, p < .001.
Procedures
Two researchers visited the children's homes every other month over the
course of 12 to 24 months. After videotaping equipment was set up, the
mother and child were invited to start playing together.2 The researchers re-
mained uninvolved in the ongoing interaction and only responded briefly
when spoken to. During each 60-minute session, one of the researchers gave
the child a wrapped gift Mothers were asked to help the child to explore
and play with the new toy. Gifts included crayons, sticker books, play dough,
and puzzles. The opening of the toy gift and the play between mother and
child that ensued served to establish a comparable, semistructured period of
social interaction across subjects and visits. The 6-minute period of
videotaped interaction following the child's receipt of the gift was the focus
of this study. The two groups of children were compared on their attention
to objects, their mothers, and the researchers over the course of four visits
to their homes and, for two of the four visits, on their facial affect and its
relationship to the focus of their attention.
Coding and Measures
All data were coded by one researcher directly from a VCR to a com-
puter (Arcus, Snidman, Campbell, Brandzel, & Zambrano, 1991). The com-
puter board linking the VCR and computer permitted keyboard control of
2In one visit a child was observed interacting with his father rather than his mother.
Joseph and Tager-FIusberg 388
the VCR and direct entry of behavioral codes and their associated frame
numbers into the computer. When entered, the codes were stored in the
order of their frame numbers and written to an ASCII file which could be
reviewed and edited in subsequent viewings. Each child's behavior during
the 6-minute period following the receipt of the gift was coded continuously
for focus of attention and facial affect.
Attention. Attention was coded for four consecutive bimonthly visits.
In 8 of the 48 visits coded for attention, a 4-month rather than a 2-month
period elapsed from the time of the previous coded visit. The lighting, fo-
cus, and/or camera position in the videotaped recordings of the interviewing
visits was judged to make the tapes too difficult to code reliably. The ex-
tended intervals between visits were evenly distributed between the autistic
and DS groups. Attentional focus was coded in terms of five mutually ex-
clusive categories: (a) mother's face; (b) researchers; (c) mother-supported
objects (an object or set of objects that was being held, touched, or ma-
nipulated by the mother); (d) nonsupported objects; and (e) unfocused (no
apparent focus of visual attention). Coding of attention to mother's face
revealed that on several occasions mothers gained their child's attention
toward their faces by physically redirecting the child's gaze (e.g., by lifting
the child's chin). Subsequently, attention to the mother's face was recoded,
resulting in an adjusted measure of attention to the mother's face which
excluded those occasions on which mothers physically directed the child's
attention to their faces.
Affect. Facial affect was coded for two of the four visits coded for at-
tention. The two visits were selected on the basis of independent judgments
of videotaping conditions (lighting, focus, camera position) that would
maximize reliability in the coding of the affect variable. The time interven-
ing between visits coded for emotion ranged from 4 to 10 months with a
mean of 5.7 months for autistic group, and ranged from 4 to 8 months
with a mean of 5.7 months for the DS group. The coding scheme for facial
affect was adapted from Bloom, Beckwith, Capatides, and Hafitz (1988).
It consisted of four categories: (a) neutral/interested; (b) negative; (c) posi-
tive; and (d) mixed (positive and negative) or ambiguous. Positive affective
displays were simultaneously coded for the focus of visual attention: (a)
mother's face; (b) researchers; (c) mother-supported objects; (d) nonsup-
ported objects; and (e) unfocused. For both the attention and affect vari-
ables, there were two additional categories used when the child's behavior
could not be coded: (a) camera off (the position of camera makes the at-
tentional focus or affective expression unclear); and (b) leaves interaction
(the child temporarily leaves the interaction).
Interrater Reliability. Reliability was determined by having an independent
observer code a randomly selected portion of one visit for each subject equal
Attention and Affect 389
to 10% of the total time coded across the four visits. Kappa values for interrater
agreement ranged between .85 and 1.0 with a mean value of .94.
RESULTS
Attention
A mean total of 6.41 and 6.44 minutes of videotape were coded per
visit for the autistic and DS groups, respectively. T tests of group means
revealed no significant difference in the amount of time children spent away
from their mothers. After these two sums were subtracted from the total
time coded, there remained a mean of 5.82 and 6.02 minute of interaction
for the autistic and DS subjects, respectively.
To correct for the small differences in the absolute amount of time
coded for attention for each visit, the amount of time spent in each category
of attention was calculated as a proportion of the total amount of time
coded for attention. These proportional figures were then subjected to
arcsine transformation (Winer, 1971) in order to meet the variance assump-
tions of an analysis of variance.
A mixed two-factor ANOVA with group as the between-subjects vari-
able and time as the within-subjects variable was run on each attention
variable. These analyses revealed no significant main effect of group for
any of the attention categories.
Table II displays the mean percentage of time each group spent in
each attention category, based on the total of four visits. Whereas four of
the mothers of the autistic children used physical means to gain attention
to their faces on 23 occasions, on only one occasion did one of the mothers
of the DS children physically redirect her child's gaze toward her face. As
can be seen in Table II, after the times during which mothers physically
manipulated the child's attention toward their faces were subtracted, the
resulting adjusted measure of attention to the mother's face showed a
Table II. Mean Percentage of Time in Each Category of Attention
Autistic
Category
Mother's face
Mother's face (adjusted)
Mother-supported objects
Nonsupported objects
Researchers
Unfocused
M
3.8
3.3
48.0
41.6
2.6
4.0
SD
2.8
2.7
13.6
17.8
1.3
4.0
Down syndrome
M
6.0
6.0
45.7
40.7
5.7
1.7
SD
3.7
3.7
7.9
14.7
4.6
1.4
Joseph and Tager-Flusberg 390
larger group difference, but this difference still did not reach statistical sig-
nificance. The occasions on which mothers physically directed attention to
their faces were excluded from the remaining analyses of the attention data.
Additional mixed-model ANOVAs on the mean duration (in seconds)
and frequency (per minute) of each category of attention also showed no
main effect of group for any of the attention variables. However, a group
difference in the frequency of attention to the mother's face per minute
approached significance, F(1, 10) = 3.62, p < .10, with means of 1.32 and
2.46 for the autistic and DS groups, respectively. In contrast, there was
virtually no group difference in mean duration of attention to the mother's
face, with means of 1.37 and 1.36 seconds for the autistic and DS groups,
respectively.
None of the analyses showed a significant effect of time for the
amount, frequency, or mean duration of any of the attention variables.
However, there was a nearly significant, F(3, 30) = 2.78, p < .06, increase
in the amount both the autistic and DS groups attended to their mother's
faces over the course of the four visits.
Affect
A mean of 6.97 and 5.97 minutes of interaction time per visit were
coded for facial affect in the autistic and DS groups, respectively. For 24%
of the total time coded for each group, either the child leaving the inter-
action or the position of the camera prevented coding of facial affect.
Elimination of these data left a mean of 5.30 and 4.51 minutes of coded
interaction time per visit for the autistic and DS groups, respectively. As
with the analysis of the attention data, differences in the absolute amount
of time coded for affect were corrected by calculating the amount of time
spent in each category of affect as a proportion of the total amount of
time coded for affect, and the proportional figures were subjected to
arcsine transformation. Mixed two-way ANOVAs with group as the be-
tween-subjects variable and time as the within-subjects variable were con-
ducted for the amount, frequency, and mean duration of each category of
affect as well as each subcategory of positive affect.
As can be seen in Table III, children with autism spent a significantly
smaller proportion of interaction time in positive affect than did the DS
children, F(l, 10) = 5.66, p < .05. Conversely, the autistic group was ob-
served to appear neutral or interested for a significantly greater proportion
of the time than the DS group, F(1, 10), p < .05. Both autistic and DS
children displayed relatively small amounts of negative and mixed/ambigu-
ous affect, with no significant differences between groups. Analyses of the
frequency and mean duration of children's displays of positive, neutral, and
Attention and Affect 391
negative affect showed that autistic children displayed positive affect sig-
nificantly less often than the DS children, F(1, 10) = 7.98, p < .02, with
group means of 2.88 (SD = .84) and 7.56 (SD = 3.96) positive affect dis-
plays per minute.
As displayed in Table IV. analyses of the amount of positive affect chil-
dren exhibited in relation to each attentional referent showed that the
autistic group displayed significantly less positive affect than the DS group
toward the mother's face, F(1, 10) = 5.01, p = .05, the researchers, F(l,
10) = 9.76, p < .02, and nonsupported objects, F(l, 10) = 5.44, p < .05.
Because the autistic group showed less overall positive affect than the
DS group, the amount of positive affect toward each attentional referent
was also analyzed as a proportion of the total time in positive affect, which,
as shown in Table V, resulted in only one significant difference between
groups. Autistic children spent a significantly smaller proportion of their
total time in positive affect displaying positive affect toward the researchers,
F(l, 10) = 8.03, p < .02.
There were no significant group differences in the mean duration of
positive affective displays toward the various attentional referents, but there
were significant group differences in the frequency (per minute) of two of
the categories of positive affect. The autistic children displayed positive af-
Table IV. Each Category of Positive Affect as a Percentage of Total
Timea
Autistic Down syndrome
Category
Mother's face
Mother-supported objects
Nonsupported objects
Researchers
Unfocused
M SD
0.8b 0.8
7.8 7.0
4.3* 3.6
0.4* 0.8
0.5 0.5
M SD
2.3* 1.7
7.3 4.7
9.1* 4.6
3.8* 3.7
1.6 2.1
"Statistics are based on arcsine transformations of proportional data.
bSignificant difference between group means; p < .05.
Joseph and Tager-Flusberg 392
Table III. Mean Percentage of Time in Each Category of Affecta
Category
Neutral/interested
Positive
Negative
Mixed/ambiguous
Autistic
M SD
85.0b 5.9
13.8* 7.0
1.2 1.5
0.3 0.4
Down syndrome
M
75.4*
24.3*
0.3
0.0
SD
9.7
9.6
0.4
0.0
"Statistics are based on arcsine transformations of proportional data.
bSignificant difference between group means; p < .05.
Attention and Affect
fect toward the researchers and nonsupported objects significantly less
often than did the DS children, F(1, 10) = 6.25, p < .05 and F(l, 10) =
7.89, p < .02, respectively. Autistic children's less frequent display of posi-
tive affect toward their mothers' faces approached significance, F(l, 10) =
3.77, p < .10. None of the analyses showed a significant effect of time on
children's affective behavior across the two visits.
DISCUSSION
In the context of a semistructured social interaction in the home in
which children were assisted by their mothers in playing with a new toy,
children with autism showed an overall pattern of attention similar to that
of a comparison group of children with Down syndrome. However, the lack
of significant differences in attention between groups needs to be inter-
preted cautiously given the small sample, the large amount of variability
among subjects, and the subsequent possibility of a Type II error. In fact,
the autistic group spent only about half as much time as the DS group
attending to their mothers' faces and to the researchers. In addition, moth-
ers of children with autism on many occasions physically directed their chil-
dren to look at them, a behavior that was virtually absent in the DS group.
These observations suggest that the children with autism were impaired in
their ability to use eye contact to facilitate social interactions and, further,
that their deficits in social attention were not offset by the supportive social
context provided by their mothers. These findings are inconsistent with
prior research showing that children with autism attend to the faces of their
social partners no less than control subjects (Dawson et al., 1990; Kasari,
Sigman, et al., 1990; Sigman et al., 1986), especially when the interaction
is structured and guided by an adult (Kasari et al., 1993). One possible
explanation for this inconsistency is that the interactions examined in the
present study, organized around the receipt and exploration of a new toy,
393
Table V. Each Category of Positive Affect as a Percentage of Total
Time in Positive Affecta
Category
Mother's face
Mother-supported objects
Nonsupported objects
Researchers
Unfocused
Autistic
M SD
8.6 11.3
42.3 27.8
40.1 28.7
4.1b 5.6
4.8 4.6
Down syndrome
M SD
14.9 16.1
27.8 14.7
36.9 18.0
16.2* 12.8
4.2 5.1
aStatistics are based on arcsine transformations of proportional data.
bSignificant difference between group means; p < .05.
may have been specifically pulling for joint attention behaviors, including
shifting of gaze between object of shared attention and social partner, in
which children with autism have been found to be particularly lacking
(Mundy et al., 1986). Eye-to-face gaze has been observed to serve several
important regularly functions in human interactions, such as initiating or
terminating an interaction sequence (Knapp, 1980), indicating an interest
in an object of shared attention (Bakeman & Adamson, 1984), and refer-
encing a person's reaction (Feinman, 1982). Both the autistic and Down
syndrome children in this study showed an increasing amount of attention
to their mothers' faces across the four visits to their homes, suggesting that
attention to the mother's face is indeed an important marker of social and
communicative development in these groups.
The children with autism exhibited significantly less overall positive
affect than did the children with Down syndrome, particularly toward the
researchers. This finding is interesting in that the researchers, in contrast
to the mothers, never attempted to engage any of the children in social
interaction. Thus, it appears that in a situation in which the autistic children
would have been required to initiate a social interaction, they were par-
ticularly lacking in affective responsivity toward others.
The lack of other significant group differences in affective behavior
again raises concern about the small sample and inadequate statistical
power. In fact, even when their overall deficit in positive affect was taken
into account, the children with autism were found to express positive affect
specifically toward their mothers' faces only a little more than half as much
as the children with Down syndrome. Although not confirmed by statistical
analysis, this finding is consistent with prior research (Dawson & Galpert,
1990; Snow et al., 1987; Trad et al., 1993).
Relative to the children with Down syndrome, the children with autism
expressed the same amount of positive affect in relation to objects that
were physically supported or manipulated by their mothers, but significantly
less positive affect toward objects that were not physically supported by
their mothers. These findings suggest that affective engagement of the
autistic children was more successful when their mothers actually handled
and manipulated the object of shared attention, and that the autistic
group's affective responsiveness may have been enhanced by a concretely
defined joint attention situation. This issue seems worthy of further inquiry,
especially in regard to what types of interventions maximize autistic chil-
dren's deficient social skills. In contrast to the findings on children's atten-
tion, neither the autistic nor the Down syndrome children showed changes
in the levels of positive affect they expressed in relation to the various at-
tentional referents across the two visits. It is possible, however, that the
Joseph and Tager-FIusberg 394
small number of visits precluded detection of developmental trends in af-
fective behavior.
In summary, in a highly supportive social context conducive to optimal
social performance, a group of high-functioning children with autism
showed deficits in both their attention and affective responsiveness to other
people. These findings are limited by the very small sample and the fact
that several group differences, although substantial, were not confirmed by
statistical analysis. The present findings are, however, consistent with prior
evidence that children with autism attend less to their partners' faces in
the context of joint attention situations (Mundy et al., 1986) and are less
likely to use positive affective displays to communicate about objects of
mutual attention (Kasari, Sigman, et al., 1990). Further, these findings sug-
gest that autistic children's deficits in eye-to-eye gaze and affective respon-
sivity persist even when joint attention situations are structured and guided
by the mother in the familiar environment of the home.
An important issue to consider in evaluating the results of the present
study is the suitability of the Down syndrome children as a comparison
group. There is evidence that Down syndrome children look at the faces
of their social partners for longer average durations in the first (Berger &
Cunningham, 1981; Landry & Chapieski, 1990) and second (Kasari, Mundy,
Yirmiya, & Sigman, 1990) years of life. In addition, research on Down syn-
drome children in the toddler and preschool years (Kasari, Mundy, et al.,
1990; Kasari, Sigman, et al., 1990) has produced some evidence that they
exhibit higher levels of positive affect in the context of social interaction
than do normally developing children. Consequently, future research ad-
dressing the core social deficits of autistic children will benefit from the
inclusion of children with nonspecific mental retardation as well as normally
developing children.
REFERENCES
Adamson, L., & Bakeman, R. (1985). Affect and attention: Infants observed with mothers
and peers. Child Development, 56, 582-593.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders
(3rd ed., rev.). Washington, DC: Author.
Arcus, D., Snidman, N., Campbell, P., Brandzel, S., & Zambrano, I. (1991, March). A program
for coding behavior directly from VCR to computer. Biennial Conference of the Society for
Research in Child Development, Seattle, WA.
Bakeman, R., & Adamson, I. (1984). Coordinating attention to people and objects in mother-
infant and peer-infant interaction. Child Development, 55, 1278-1289.
Berger, J., & Cunningham, C. (1981). The development of eye contact between mothers and
normal versus Down's syndrome infants. Developmental Psychology, 17, 678-689.
Bloom, L., Beckwith, R., Capatides, J., & Hafitz, J. (1988). Expression through affect and
words in the transition from infancy to language. In P. Baltes, D. Featherman, & R.
Lerner (Eds.), Life-span development and behavior. Hillsdale, NJ: Erlbaum.
Attention and Affect 395
Dawson, G., & Galpert, L. (1990). Mothers' use of imitative play for facilitating social re-
sponsiveness and toy play in young autistic children. Development and Psychopathology,
2, 151-162.
Dawson, G., Hill, D., Spencer, A., Galpert, L., & Watson, L. (1990). Affective exchanges
between young autistic children and their mothers. Journal of Abnormal Child Psychology,
18, 335-345.
Feinman, S. (1982). Social referencing in infancy. Merrill-Palmer Quarterly, 28, 445-470.
Hutt, C., & Ounsted, C. (1966). The biological significance of gaze aversion with particular
reference to the syndrome of infantile autism. Behavioral Science, 11, 346-356.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250.
Kasari, C., Mundy, P., Yirmiya, N., & Sigman, M. (1990). Affect and attention in children
with Down syndrome. American Journal on Mental Retardation, 95, 55-67.
Kasari, C, Sigman, M., Mundy, P., & Yirmiya, N. (1990). Affective sharing in the context of
joint attention interactions of normal, autistic, and mentally retarded children. Journal of
Autism and Developmental Disorders, 20, 87-100.
Kasari, C, Sigman, M., & Yirmiya, N. (1993). Focused and social attention of autistic children
in interactions with familiar and unfamiliar adults: A comparison of autistic, mentally
retarded, and normal children. Development and Psychopathology, 5, 403-414.
Knapp, M. L. (1980). Essentials of nonverbal communication. New York: Holt, Rinehart and
Winston.
Landry, S., & Chapieski, M. (1990). Joint attention of six-month-old Down syndrome and
preterm infants: I, Attention to toys and mother. American Journal on Mental Retardation,
94, 488-498.
Leiter, R. (1974). International Performance Scale. In O. Buros (Ed.). Tests in print II: Index
to tests, test reviews and the literature on specific tests. Highland Park, NJ: Gryphone.
Mirenda, P. L., Donnellan, A. M., & Yoder, D. E. (1983). Gaze behavior: A new look at an
old problem. Journal of Autism and Developmental Disorders, 13, 397-409.
Mundy, M., Sigman, P., Ungerer, J., & Sherman, T. (1986). Defining the social deficits of
autism: The contribution of non-verbal communication measures. Journal of Child Psy-
chology and Psychiatry, 27, 657-669.
Richer, J., & Coss, R. (1976). Gaze aversion in autistic and normal children. Acta Psychiatrica
Scandinavica, 53, 193-210.
Rutter, M. (1978). Diagnosis and definition. In M. Rutter & E. Schopler (Eds.), Autism: A
reappraisal of concepts and treatment. New York: Plenum Press.
Sigman, M., Mundy, P., Sherman, T., & Ungerer, J. (1986). Social interactions of autistic,
mentally retarded and normal children and their caregivers. Journal of Child Psychology
and Psychiatry, 27, 647-655.
Snow, M., Hertzig, M., & Shapiro, T. (1987). Expression of emotion in young autistic children.
Journal of the American Academy of Child and Adolescent Psychiatry, 26, 836-838.
Tager-Flusberg, H., Calkins, S., Nolin, T., Baumberger, T., Anderson, M., & Chadwick-Dias,
A. (1990). A longitudinal study of language acquisition in autistic and Down syndrome
children. Journal of Autism and Developmental Disorders, 20, 1-21.
Trad, P. V., Bernstein, D., Shapiro, T., & Hertzig, M. (1993). Assessing the relationship between
affective responsivity and social interaction in children with pervasive developmental dis-
order. Journal of Autism and Developmental Disorders, 23, 361-377.
Tronick, E. (1989). Emotional communication in infants. American Psychologist, 44, 112-119.
Volkmar, F., Hoder, E., & Cohen, D. (1985). Compliance, negativism, and the effects of treat-
ment structure in autism: A naturalistic, behavioral study. Journal of' Child Psychology and
Psychiatry, 26, 865-877.
Volkmar, F., & Mayes, L. (1990). Gaze behavior in autism. Development and Psychopathology,
2, 61-69.
Vygotsky, L. (1978). Mind in society: The development of higher psychological processes. Cam-
bridge, MA: Harvard University Press.
Winer, B. (1978). Statistical principles in experimental design. New York: McGraw-Hill.
Wing, L. (1976). Diagnosis, clinical description, and prognosis. In L. Wing (Ed.), Early child-
hood autism. Oxford: Pergamon.
Joseph and Tager-Flusberg 396