음악적 단서 및 후속 자극에 따른 자폐스펙트럼장애 아동의 공동주의 반응 행동 비교

Analysis of Joint Attention Behaviors in Children With Autism Spectrum Disorder Depending on the Type of Attentional Cue and Reinforcing Stimulus

  • 투고 : 2024.03.15
  • 심사 : 2024.04.16
  • 발행 : 2024.04.30


본 연구는 자폐스펙트럼장애(Autism Spectrum Disorder, 이하 ASD) 아동을 대상으로 음악적 단서 및 후속 자극에 따른 공동주의 반응 행동이 달라지는지 알아보고, 비장애(neurotypically developing, 이하 NT) 아동 그룹과 비교하는 실험연구이다. 본 연구의 대상자는 만 3세에서 5세 사이의 ASD 아동 13명과 NT 아동 14명이다. 본 연구에서는 공동주의 반응을 유도하는 단서(음악적 단서 대 언어적 단서)와 아동의 공동주의 반응 행동에 대한 후속 자극(언어 자극 대소리 자극 대 음악 자극)을 구성하고 총 6가지 과제 조건을 2회씩 총 12회 제시하였다. 먼저, 주의 유도 단서를 제공하고 3초 이내 대상자의 주의 전환을 평가하였고 대상자의 공동주의 반응 행동이 나타난 경우, 후속 자극을 제공하였으며 후속 자극을 제공하는 동안 대상자의 사회적 참조 행동의 발생 빈도를 측정하여 비교 분석하였다. 연구 결과, 주의 유도 단계에서는 음악적 단서를 제공했을 때 ASD 아동의 공동주의 반응 행동 수준을 높게 유도하는 것으로 나타나 선행연구와 일치한 결과를 보였다. 이어 후속 자극 제공 단계에서는 음악 후속 자극이 ASD 아동의 사회적 참조 행동의 빈도를 증가시킨 것으로 확인되었다. 이는 음악 후속 자극이 단서로서의 감각자극에서 나아가 대상자로 하여금 타인의 사회적, 정서적 정보를 이해하고 반응하도록 유도하는데 그 적용 범위가 확장된 것에 의의가 있다. 또한, ASD 아동의 공동주의 행동 이후 제공하는 후속 음악 자극이 효과적인 사회적 강화 요인이 될 수 있음을 시사한다.

This study investigated whether joint attention response behaviors in children with autism spectrum disorder (ASD) change in response to musical cues and reinforcing stimulus, and compared them with neurotypically developing (NT) children. The participants included 13 children with ASD and 14 NT children aged between 3 to 5 years. The study established six task conditions, involving cues (verbal vs. musical) for responding to joint attention (RJA) behaviors and reinforcing stimulus (verbal vs. sound vs. musical) for social referencing behaviors. These tasks were presented 12 times with two repetitions each. The results of the study showed that providing musical cues during the RJA phase increased levels of RJA in children with ASD, consistent with prior studies. Subsequently, musical reinforcing stimuli increased the frequency of social referencing behaviors in these children. This indicates that musical stimuli can extend beyond mere sensory cues, helping individuals to understand and respond to social and emotional cues from others. Moreover, these musical stimuli could serve as effective social reinforcement factors for this population.



  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
  2. Charman, T. (2003). Why is joint attention a pivotal skill in autism? Philosophical Transactions of the Royal Society of London, 358, 315-324.
  3. Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: Social orienting, joint attention, and attention to distress. Developmental Psychology, 40(2), 271-283.
  4. Dube, W. V., MacDonald, R. P. F., Mansfield, R. C., Holcomb, W. L., & Ahearn, W. H. (2004). Toward a behavioral analysis of joint attention. The Behavior Analyst, 27, 197-207.
  5. Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with autism: A comparison of music and non-music interventions. Autism, 14(4), 321-348.
  6. Fredericks, B. M., Sng, S. S. Y., Parry-Cruwys, D., & MacDonald, R. P. F. (2023). Teaching joint attention: Assessing generalization and maintenance of effects using multiple exemplar training. Journal of Autism and Developmental Disorders, 53, 1117-1129.
  7. Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Review, 2, 1-22.
  8. Hardy, M. W., & LaGasse, A. B. (2013). Rhythm, movement, and autism: Using rhythmic rehabilitation research as a model for autism. Frontiers in Integrative Neuroscience, 7, 19.
  9. Ingersoll, B., Scheribman, L., & Tran, Q, H. (2003). Effect of sensory feedback on immediate object imitation in children with autism. Journal of Autism and Developmental Disorders, 33(6), 673-683.
  10. Jeong, P. E. (2017). A comparison between music and non-music conditions in reciprocal attention intervention for improving joint attention behaviors of children with autism spectrum disorder. Journal of Music and Human Behavior, 14(2), 19-43.
  11. Kalas, A. (2012). Joint attention responses of children with autism spectrum disorder to simple versus complex music. Journal of Music Therapy, 49(4), 430-452.
  12. Kelly, M. A., Roscoe, E. M., Hanley, G. P., & Schlichenmeyer, K. (2014). Evaluation of assessment methods for identifying social reinforcers. Journal of Applied Behavior Analysis, 47(1), 113-135.
  13. Kim, M. J., & Chung, K. M. (2016). A review of behavior interventions for joint attention in children with autism spectrum disorder. Korean Journal of Clinical Psychology, 35(2), 557-583.
  14. LaGasse, A. B. (2017). Social outcomes in children with autism spectrum disorders: A review of music therapy outcomes. Patient Related Outcome Measures, 8, 23-32.
  15. Landry, R., & Bryson, S. E. (2004). Impaired disengagement of attention in young children with autism. Journal of Child Psychology and Psychiatry, 45(6), 1115-1122.
  16. Martins, M. P., & Harris, S. L. (2006). Teaching children with autism to respond to joint attention initiations. Child & Family Behavior Therapy, 28(1), 51-68.
  17. Meyer, L. B. (1956). Emotion and meaning in music. Chicago: University of Chicago Press.
  18. Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A., & Seibert, J. (2003). Early Social Communication Scales (ESCS). Coral Gables, FL: University of Miami.
  19. Mundy, P., & Neal, R. (2000). Neural plasticity, joint attention and a transactional social-orienting model of autism. International Review of Research in Mental Retardation, 23, 139-168.
  20. Mundy, P., & Newell, L. (2007). Attention, joint attention, and social cognition. Current Directions in Psychological Science, 16(5), 269-274.
  21. Mundy, P., Sigman, M., & Kasari, C. (1994). Joint attention, developmental level and symptom presentation in autism. Development and Psychopathology, 6(3), 389-401.
  22. Murza, K. A., Schwartz, J. B., Hahs-Vaughn, D. L., & Nye, C. (2016). Joint attention interventions for children with autism spectrum disorder: A systematic review and meta-analysis. International Journal of Language & Communication Disorders, 51(3), 236-251.
  23. Naoi, N., Tsuchiya, R., Yamamoto, J., & Nakamura, K. (2008). Functional training for initiating joint attention in children with autism. Research in Developmental Disabilities, 29(6), 595-609.
  24. Presmanes, A. G., Walden, T. A., Stone, W. L., & Yoder, P. J. (2007). Effects of different attentional cues on responding to joint attention in younger siblings of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 133-144.
  25. Taylor, B. A., & Hoch, H. (2008). Teaching children with autism to respond to and initiate bids for joint attention. Journal of Applied Behavior Analysis, 41(3), 377-391.
  26. Whalen, C., & Schreibman L. (2003). Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry, 44(3), 456-468.
  27. Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of autistic spectrum disorder: Clinical application and research evidence. Child: Care, Health and Development, 32(5), 535-542.
  28. Yoo, G. E. (2014). Differential response to joint attention in children with autism spectrum disorder depending on the level of attentional cues. Journal of Music and Human Behavior, 11(1), 21-37.