What does typical development look like in toddlers and what is joint attention? How do children learn to play with others and engage in pretend play?

Typically developing children frequently gather information from the people and objects in their environment and then use it in an organized manner. They sort and remember this information so they can comprehend it and use it for later during both solitary play and in interactions with others.  They compare this information with things they have previously learned and store any necessary information that may be useful to them later. Once this is completed, children then behave in ways that tell us that they have learned as a result of this information. The development of young children follows an often predictable and known course and the acquisition of certain milestones is often used to assess their development. Not all children reach these milestones at the same time however there is a time frame in which we expect children to master these skills. Joint attention skills are described as the skills children use when they pay attention to something with another person, at the same time. Children engage in joint attention skills when they play with a toy together with a parent or sit and listen to a story.  They will often point to an object of interest, then attempt to gain their parent’s attention to see if they are watching, and then point to the object again as if to say, “do you see that? Do you see what I am looking at?”  This is called a 3-point gaze shift and naturally occurs in the development of young children. Adults engage in joint attention when they work in pairs or cooperatively on a group project. Children with Autism Spectrum Disorder often have impairments in their joint attention skills and have a reduced interest in sitting to share their attention with another individual. Difficulty sitting for stories or letting caregivers read a book or turn the pages is common. Children with difficulties with joint attention may not be interested in trying to point to pictures that others name for them and do not often bring toys over to others to have them join their play. They may  push an adult’s hand away from toys that they are playing with or show distress when others attempt to show them a different way to play with a particular toy.

There is a significant clinical difference between a child who presents with a developmental delay vs. a child who is presenting with unusual patterns of development. Great care and close attention should be taken to distinguish the difference between skills that are just slow to emerge, and those that may be different in function or quality. These unusual patterns of development are often described as atypical and are not often seen in children with developmental delays, who are just behind in the acquisition of skills. Young children with autism often become “stuck” in very early types of solitary play and may engage in activities with no clear meaning or purpose. A child who is typically developing will carefully observe how others play with toys and will try to copy them. Children with autism may play with a toy in only one way and may show distress when others attempt to intervene or join them. By three years of age, most children have developed sequenced make-believe play skills that involve at least two to three steps. The steps of these tasks are usually related and they are creative in nature. Children may feed a doll, pat it, and then lay it down to sleep, or perhaps place pretend food onto a plate and pretend to serve it to a caregiver. In order for children to be successful with their make-believe or symbolic play development, typically developing children will seek out interactions and communication with others and will rapidly learn how to interpret others’ actions. They will then model these actions and attempt to do what they see others doing, whether it be sweeping with a toy broom or pretending to drink from a cup.

Assessing very early on whether a child is developmentally delayed or whether there are atypical patterns of development present is a critical step for health care professionals. Any impairment in a child’s language, social interactions, or play skills should be evaluated by a qualified professional as early as possible so that intervention that is appropriate to the reason for the difficulties can be initiated. This assessment can often be performed as early as 12 months of age. Intervening early to address any atypical patterns of development, where the brain is processing information along different routes, can maximize the child’s developmental potential and bring about changes that can positively impact their future. By the age of 7 or 8, atypical patterns within the brain are often ‘hard-wired’ and may be less responsive to treatment. Early identification of patterns of development within a young toddler’s brain, and whether or not these patterns are following natural developmental trajectories, is critical when a child is not meeting their milestones as expected.