Research in Developmental Disabilities 33 (2012) 2141–2152

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Research in Developmental Disabilities

Using virtual reality environment to improve joint attention associated

with pervasive developmental disorder
Yufang Cheng *, Ruowen Huang
Graduate Institute of E-learning, National Changhua University of Education, No. 1 Jin-De Road, 500, Changhua, Taiwan, ROC

A R T I C L E I N F O A B S T R A C T

Article history: The focus of this study is using data glove to practice Joint attention skill in virtual reality
Received 24 May 2012 environment for people with pervasive developmental disorder (PDD). The virtual reality
Accepted 24 May 2012 environment provides a safe environment for PDD people. Especially, when they made
Available online 7 July 2012 errors during practice in virtual reality environment, there is no suffering or dangerous
consequences to deal with. Joint attention is a critical skill in the disorder characteristics of
Keywords: children with PDD. The absence of joint attention is a deficit frequently affects their social
Pervasive developmental disorder relationship in daily life. Therefore, this study designed the Joint Attention Skills Learning
Virtual reality environment
(JASL) systems with data glove tool to help children with PDD to practice joint attention
Joint attention
behavior skills. The JASL specifically focus the skills of pointing, showing, sharing things
Single subject multiple-probe design
and behavior interaction with other children with PDD. The system is designed in
playroom-scene and presented in the first-person perspectives for users. The functions
contain pointing and showing, moving virtual objects, 3D animation, text, speaking
sounds, and feedback. The method was employed single subject multiple-probe design
across subjects’ designs, and analysis of visual inspection in this study. It took 3 months to
finish the experimental section. Surprisingly, the experiment results reveal that the
participants have further extension in improving the joint attention skills in their daily life
after using the JASL system. The significant potential in this particular treatment of joint
attention for each participant will be discussed in details in this paper.
ß 2012 Elsevier Ltd. All rights reserved.

1. Introduction

Joint attention is a core skill and an important social skill that can promote the learning in social contexts (Warreyn,
Roeyers, Van-Wetswinkel, & De Groote, 2007). Individuals with pervasive development disorder (PDD) are known to suffer
from deficient joint attention skills. Lack of joint attention skills leaves PDD unable to interact socially with others
(Presmanes, Walden, Stone, & Yoder, 2007). Kasari, Freeman, and Paparella (2006) also mentioned that individuals with PDD
have limited joint attention skills negatively impacting their ability to interact with others. However, joint attention skills
describe the coordination of attention in relation to objects and events (Mundy, 2003), and mean that describe the situation
where two or more people simultaneously focus on or share an interesting thing or experience in social situations (Adamson
& McArthur, 1995; Baldwin, 1995; Mundy, 2003). Additionally, joint attention skills also describe as a triadic relation among
the self, others and objects (Leekam, Lopez, & Moore, 2000).
Joint attention is widely divided into two classes: responding and initiating joint attention skills (Charman et al., 1997,
1998; Mundy & Gomes, 1998), and mainly involves using eye contact, pointing, showing or verbal orders to attract attention
to an object (Bruinsma, Koegel, & Koegel, 2004; Jones, Carr, & Feeley, 2006; Meindl & Cannella-Malone, 2011). Responding

* Corresponding author. Tel.: +886 4 7232105; fax: +886 4 7211290.

E-mail addresses: yfcheng@cc.ncue.edu.tw, yfcheng33@hotmail.com (Y. Cheng).

0891-4222/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ridd.2012.05.023
2142 Y. Cheng, R. Huang / Research in Developmental Disabilities 33 (2012) 2141–2152

joint attention (RJA) skills refer to response by pointing or showing to enhance social interaction with others (Brooks &
Meltzoff, 2005; Leekam, Hunnisett, & Moore, 1998; Sigman & Ruskin, 1999). Initiating joint attention (IJA) skills is defined as
the use of eye contact, gaze shifting, and pointing to initiate coordinated attention with another individual (Franco &
Butterworth, 1996; Mundy & Crowson, 1997; Seibert et al., 1982). More specifically, some studies indicated that children
typically develop the ability to participate in joint attention at between 6- and 12-months of age (Butterworth & Jarrett,
1991; Leekam et al., 1998; Mundy & Gomes, 1998; Povinelli & Eddy, 1997). Initiating and responding joint attention skills are
related to expressive and receptive language acquisition, and even associated with general cognition (Morales et al., 2000).
Furthermore, initiating and responding joint attention skills reflect behavior and mental processes and promote human
learning and development of social cognition, interaction and communication (Mundy & Newell, 2007). Additionally, the RJA
and IJA are also characterized by affective development of symbolic play and imitative behavior for children with PDD, which
are essential in social language development. Therefore, initiating and responding joint attention skills is closely correlated
in the development of social skills for PDD.
However, the children with PDD always distract difficulty in understanding the intentions and inferring the mental states
of others (Tomasello, Carpenter, Call, Behne, & Moll, 2005), and consequently preventing them from using RJA and IJA skills
for social interaction, such as pointing and showing (Carpenter, Call, & Tomasello, 2002; Mundy, Sigman, Ungerer, &
Sherman, 1986). Kasari et al. (2006) suggested that significant joint attention deficits exist for children with PDD, rendering
them unable to establish joint attention skills to interact with others. Thus, such children were unable to participate in or
respond to joint attention associated with others (Corkum & Moore, 1998; Presmanes et al., 2007). Furthermore, Whalen,
Schreibman, and Ingersoll (2006) tried to develop a treatment for responding and initiating joint attention skills, and taught
children with PDD appropriately implement responding and initiating joint attention skills their results indicating that
children with PDD were exhibited a positive change in joint attention skills. MacDuff, Ledo, McClannahan and Krantz (2007)
used the verbal bids including the script prompts, the no script prompts, and pointing to teach three children with PDD joint
attention skills. Their study of indicated that three participants could use promote bids of joint attention skills to interact
with others. But, some uncontrollable situations were happened (e.g. unstable emotions) for children with PDD.
Recently, some studies have found that children with PDD were attracted to computer-based tasks (Chen & Bernard-
Optiz, 1993), and that computer technology provides an opportunity to practice skills with repetitive function. The virtual
reality environment also has navigation features based on user of perspective view, and can enable children with PDD to
experience situations similar to real life (Parsons et al., 2000). Further, the virtual reality environment provided an virtual
character (avatar) to represent user participation in social activities (Cheng & Ye, 2010), and social cognitions and skills
learning (Cheng, Moore, McGrath, & Fan, 2005; Parsons & Mitchell, 2002).
Studies have shown that individuals with PDD can use virtual reality to learn simple social interaction skills, and computers
can provide them with more opportunities for involvement in learning activities (Parsons, Mitchell, & Leonard, 2004). Mengue-
Topio, Courbois, Farran and Sockeel (2010) built a virtual route map environment and requested that people with PDD identify
the shortest path from a specific station to a store for subjects with PDD and furthermore compared with 18 members of a
control group. The results indicated that participants with PDD memorize the landmarks and then find the shortest path
through learning the virtual map environment. Cheng, Chiang, Ye and Cheng (2010) proposed using the collaborative virtual
learning environment intervention-system to improve social empathy for three children with PDD, and showed that three
participants improved their empathic skills and understanding of social empathy. Furthermore, Cheng and Chen (2010)
investigated using the 3D virtual character expression system to help three children with PDD understand the expression of
others, and the results demonstrated that three participants exhibited significantly improved understanding of social emotions.
Therefore, the virtual reality environment provided an interesting and stimulated motivation for learning social skills (Brown,
Neale, Cobb, & Reynolds, 1999), and provided users potential benefits by allowing them to simulate their real life human social
interaction (Churchill, Snowdon, & Munro, 2001; Parsons, Mitchell, & Leonard, 2005; Passerino & Santarosa, 2008).
Additionally, data gloves motivate children with PDD to interact in virtual environment. Bruno and Muzzupappa (2010)
designed 3D virtual microwave applied data glove to assess effects of virtual microwave for PDD with children, their study
demonstrated that the usefulness of the virtual reality was helpful for children with PDD. Pabon et al. (2007) proposed
designing a virtual kitchen scene using data gloves and vibration tactile stimulus to help with social interaction and physical
rehabilitation, and the results demonstrated that the data glove stimulates capture of hand motion in rehabilitation and also
help their social skills. Thus, the results indicated that using computer technology in education for children with PDD is a
trend, and such children have the potential ability to learn social skills through individualized learning (Bell & Potter, 2001).
Therefore, this study developed the Joint Attention Skills Learning system (JASL system) and applied data glove to practice
joint attention skills, and learned the fundamental concepts of the joint attention skills of pointing, showing, sharing, and
interaction for children with PDD.

2. The development of JASL system

2.1. JASL system

This study creates a simulated environment to promote joint attention skills for children with PDD, and the JASL system
was developed using 3Ds Max and Virtools. Virtools Scripting Language (VSL) was selected as the programming language
(VSL) owing to its functions.
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Fig. 1. The scenario of virtual playroom.

The system was presented to participants on a Desktop workstation computer with Dual-Core AND, opteron(tm),
Processor2212, 2 GHz, 3.5 GB ARH and running HP xw9400 Workstation Base Unit.

2.2. System design

The creation of the3D virtual environment with animated scenarios involved social-learning situations and presented
first-person perspectives for users.
The system contains six true or false questions, as well as multiple-choice questions in the system. User can use the
keyboard to select their response, and if they select the correct answer; the system will present a 3D animation with
applause, and encourage them to continue to the next question. If the users select the incorrect answer, they will be shown
an immediate prompt. More importantly, users can control virtual car or aircraft using the arrow keys, enabling them to
interact by moving forwards, backwards, left and right. Furthermore, the system also enables participants an opportunity to
practice their joint attention skills using the data glove.

2.3. System content

A playroom was selected where children with PDD can play with other children. Twenty-four questions were designed
based on social events in the system, which included learning joint attention conception and used data glove to practice joint
attention skills (pointing, showing, sharing and interaction) (Figs. 1–3). The JASL system employs 3D animated social events,
text content, prompt instructions, voice and feedback, and uses data glove to practice joint attention skills (Figs. 4–6). The
joint attention skills of each target behavior are described as follows.

Fig. 2. The question of true or false choice.

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Fig. 3. The question of multiple-choices.

Fig. 4. The interface of hint used in JASL system.

The ‘‘pointing’’ skill teaches participants by following the gestures of a virtual character that points out then looks at a
virtual toy, and initiatively pointing out the object and sharing it with others, for example, ‘‘when Tommy and I go to the
playroom and see the pretty bell on the door in the morning, Tommy happily points out the bell and says to me ‘‘WOW! You
see the pretty bell!’’ The question is ‘‘can I look at the bell? The ‘‘showing’’ skill teaches children how to show and share with
virtual characters, and how to respond to virtual characters when showing something to someone, for example, ‘‘When I am
playing with an aircraft, and I want to show and share with my classmate, what should I do?’’ The ‘‘sharing’’ skill teaches
participants to share virtual objects with a virtual character, or to pay attention to the object simultaneously when sharing a
virtual object, for example, ‘‘I see birds flying, but I do not want to share with others. Is this right or wrong?’’ The ‘‘interaction’’
skill teaches participant how to interact with virtual characters, for example, ‘‘I saw Tommy throwing a ball into a basket, and
I want to play with him, and What should I do?’’ Another question is ‘‘I want to show the picture of SpongeBob to the teacher.
What should I do?’’ The system can give a cue to use data glove to practice joint attention skills.
All scenarios and questions were designed following numerous consultations with professionals in PDD, who suggested
that the scenarios frequently occurred around this special group of PDD. All situation-questions were based on daily life for
children with PDD.

3. Method

3.1. Participants

Three participants with PDD were recruited from a special school in Taiwan. The three subjects were selected because
they met relatively good prerequisites in terms of verbal IQ (VIQ), performance IQ (PIQ), and full-scale IQ (FSIQ), as assessed
 Y. Cheng, R. Huang / Research in Developmental Disabilities 33 (2012) 2141–2152 2145

Fig. 5. The interface of hint used data glove in JASL system.

Fig. 6. The participant used data glove in JASL system.

by the clinical psychologist by the Wechsler Abbreviated Scale of Intelligence III > 50 (WASI; Wechsler, 1999). Participants
were diagnosed with pervasive development disorder based on parental records as demonstrating their deficits in joint
attention skills. Parental permission was obtained before the experimental study. All participants were boys aged 9–12 years
old, all of whom had disabilities with joint attention skills, with no skin allergies and able to use data gloves (Table 1).

3.2. Setting and design

A multiple-probe design involving multiple participants was designed to measure the effectiveness of using the JASL
system. All experiments were conducted in the virtual reality laboratory. The laboratory was equipped with a standard
desktop workstation computer, two projectors, a projection screen and data glove. Each experimental session comprised two
researches, involving one instructor and one participant. To ensure the data integrity for the significant improvement of joint
attention skills for each participant, one researcher and two observers (one teacher and researcher) were involved. To
explore the effects of using the JASL system with data glove for each participant, the questionnaire was administered to the
parent to survey their observations of the improvement of joint attention skills.

Table 1
Participant’s information.

Gender Mark M John M James M

Age 12 10 9
FSIQ 65 63 57
PIQ 67 61 51
VIQ 80 75 50
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Table 2
The JASS item.
Initiating joint attention skills  initiatively paying attention to something and turning the head to others
 initiatively pointing at an object to share it with others
 initiatively showing something to others to share it

Responding joint attention skills  the child turns in response when called by name or nickname
 the child pays attention when it is spoken to
 whether the child follows the gestures of others, such as pointing
 whether the child following the gestures of others showing an object
 whether the child responds to others when they point to or display an object

3.3. Measurement

The measurement of using ten picture cards of joint attention (PCJA) and joint attention skills scale (JASS) (Table 2), and it
referred to the early social communication scales (Mundy, 2003) with the questions adapted to assess the joint attention
development for each participant during the baseline, intervention and maintenance phases. All measures were discussed in
detail with professionals and PDD experts to ensure their validity and suitability for application to people with PDD. Each
participant selected PCJA randomly, and their joint attention skills were then assessed using JASS. The JASS comprises two
major items, including initiating and responding joint attention skills, which it divided into eight subdivision topics for
scoring. Responses to participant performance in joint attention skills were assessed on a 4-point scale ranging from 0 to 5.
Clear responses were scored 5, hesitant but complete responses were scored 3, partial responses were scored 1, and no
response situations were scored 0. The total score is 40. One researcher and one trained observer coded the appropriate
response of the joint attention competence of each participant. Both coders understood the study purpose.

3.4. Procedure

Three participants participated in the experiment 1 day per week for 30–40 min sessions over a 3-month period,
comprising baseline, intervention, and maintenance. All participants received baseline ranging from 2 to 10 days, followed
by intervention for 6 days, and maintenance was conducted once weekly for 12 days following the intervention. This
experimental study comprised three sessions, which are described as follows.

3.4.1. Baseline
The baseline for Mark was 3 days, while that for John was 6 days, and that for James was 7 days. The data collection
comprised participants being asked questions randomly selected from PCJA and JASS measurement was recorded according
to the participant’ performance of joint attention skills observed by the researcher and one observer.

3.4.2. Intervention
The intervention was designed to increase appropriate joint attention skills. The JASL system with data glove involved 12
true or false and multiple choice situational questions to learn concepts and practicing joint attention skills such as pointing,
showing, sharing and interaction.
At the beginning of the experimental study, participants were given instruction in using the system and provided a
practice opportunity focused on joint attention skills. The participants were brought by their patents to the experimental
laboratory and seated in front of computer installed with the JASL system. Participants began to work through the playroom
scene in the system. The social events utilizing joint attention skills were presented on the computer screen. The system
provides speaking question, 3D animated social events, text content, prompt instructions, voice and feedback to help
participants to learn fundamental concepts related to joint attention skills. More importantly, the system allows participants
to use data glove to practice joint attention skills, for example: ‘‘I want to show a picture of SpongeBob to the teacher. How
should I do this?’’ The system then gives a cue to use the data glove for to grab the picture of Sponge Bob (see Fig. 7). To ensure
the participants’ emotional stability of participants, reinforcement was also used, in the form of cookies or drinks.
The intervention lasted approximately 30–40 min. All questions were presented contiguously to each participant. The
system included the phases of a problem-based situation, rewarding appropriate responses, correcting error answers, and
providing a hint. A 5 min break was allowed when participants exhibited emotional instability. After completing the JASL
system, participants could break for 10 min, after which they were asked five questions randomly selected from PCJA.
Additionally, the measurement using JASS was recorded by the researcher and one observer according to the participant is
performance of joint attention skills.

3.4.3. Maintenance
Each participant received 3 weeks of treatment to assess their learning effect. The data collection comprised participants
being asked five questions randomly selected from PCJA, and the measurement using JASS was recorded based on the
participant performance of joint attention skills as assessed by the researcher and one observer.
 Y. Cheng, R. Huang / Research in Developmental Disabilities 33 (2012) 2141–2152 2147

Fig. 7. The participant used the data glove to practice joint attention skill.

3.5. Data collection

The experiment session was videotaped using a video camera located near to the participant in the baseline, intervention,
and maintenance phases. Three participants were measured using JASS and PCJA and one observer was recorded to analyze
their joint attention skills. The observers reviewed the videotape and coded the responding appropriate joint attention skills
after measuring each session. The data were gathered and averaged across four baseline sessions, four intervention sessions
and three maintenance sessions for three participants. Furthermore, the parents observed their children to examine the
effect of using the JASL system with data glove intervention and completing the questionnaires.
Inter-observer agreement (IOA) was obtained by the one teacher and one graduate student who served as the reliability
observer independently recorded use of JASS on the joint attention skills. Inter-observer reliability was calculated using the
number of agreements divided by the number of agreements plus disagreements multiplied by 100 (Tekin-Iftar et al., 2001)
Inter-observer agreement data were recorded for probe sessions in the baseline, intervention, and maintenance periods with
a criterion level of 80% inter-observer agreement. Furthermore, Mark’s probe with reliability in the IOA averaging 97.5%,
John’s and James’s probe with reliability averaging 98.86%.

4. Results

All scores were measured using JASS at the baseline, intervention, and maintenance phases, analyzed, and compared to
assess the effectiveness of JASL system with data glove in teaching three participants joint attention skills of pointing,
showing, sharing and interaction. All session data were examined visually inspected for evidence of improved joint attention
skills through using the JASL system. Fig. 8 shows that each participant exhibited different improvements of the baseline,
intervention, and maintenance sessions in the joint attention skills of pointing, showing, sharing, and interaction.
2148 Y. Cheng, R. Huang / Research in Developmental Disabilities 33 (2012) 2141–2152

Fig. 8. The scores measured using JASS during baseline, intervention, and maintenance.

4.1. Mark

Table 3 shows that the mean score of Mark in JASS measurement was 17.5 (range = 18–17) during the baseline. He
demonstrated his improvement of joint attention skills. Mark’s mean score was 33.25, and the scores increased significantly
during intervention. The appropriate behavior of Mark increased from 32 to 34 (range = +2) during the intervention phase.
Fig. 8 shows that the non-overlapping data point was 100%, which suggesting a highly effective intervention with the JASL
system. Mark maintained stable performance and during maintenance following the intervention phase. The scores indicate
using the JASL system with data glove, Mark maintained a mean score of 37.5 in maintenance period compared with 33.25 in
intervention demonstrating standard joint attention skills.

Table 3
The appropriate response in using measurement of each phase by three participants.

Stage Mark John James

A1 B2 A0 3 A4 B5 A0 6 A7 B8 A0 9

Stable (%) 100 100 100 100 100 100 100 100 100
Range 18–17 32–34 38–38 17–15 22–31 34–38 5–5 24–31 34–36
Change 0.5 +2 0 2 +9 +4 0 +7 +2
Mean 17.5 33.25 37.3 15.25 29 36 4.75 29.5 34.7
 Y. Cheng, R. Huang / Research in Developmental Disabilities 33 (2012) 2141–2152 2149

Table 4
The scores of pointing, showing, sharing, and interacting performance.

Experimental session Mark John James

0 0
A B A A B A A B A0

Pointing (full score is 10) 4.7 8 10 5.5 8 10 1.25 10 10

Showing (full score is 10) 3.8 8.3 10 4.5 7.3 8.3 1.5 8 10.7
Sharing (full score is 10) 6 9.3 19 5 8 10 2.5 10 12
Interaction (full score is 15) 6 13.7 12.3 2.5 10.3 14.7 1.25 12.7 15

Note. A, baseline; B, intervention; C, maintain.

4.2. John

Table 3 shows that the mean score of John in JASS measurement was 15.25 (range 17–15) at the baseline. Although John’s
scores have dropped slightly, with the first score reaching 17 points and last reaching 15 points, average score has stabilized.
During the intervention phase, John’s score moved upward, indicating that the JASL system helped his response in joint
attention skills. John’s score increased from 22 to 31 (range = +9) during the intervention phase. John’s mean score was 29
during intervention, compared with the baseline, indicating an effective intervention that improved joint attention skills.
During the maintenance phase, the mean score of appropriate response remained 36, showing that John maintained his joint
attention skills after using the JASL system when practicing these skills using the data glove.

4.3. James

James’s JASS measurement score was 4.75 during the baseline phase. Moreover, his score for joint attention skills
increased from 24 to 31 during the intervention (see Table 3). James demonstrated significant progress from the baseline to
the intervention phase. The mean score of appropriate response was 29.5 during intervention, compared with the baseline,
and visual analysis revealed that the score increased, which suggesting a highly effective intervention using JASL system and
data glove. During the maintenance phase, James’s mean score was 34.7, and he performed stably following intervention
phase, which suggesting maintenance of his joint attention skills.

4.4. The target behaviors of joint attention skills

The four target behaviors in the performance of joint attention skills, namely ‘‘pointing’’, ‘‘showing’’, ‘‘sharing’’, and
‘‘interaction’’ were explored. The data information was evaluated via visual inspection by observers to record the data, and
the scale ranging from 0 to 5, the highest score is 5 and the lower score is 0. Table 4 lists the baseline, intervention, and
maintenance scores means.
Mark had low scores for ‘‘pointing’’ (4.7) and ‘‘showing’’ (3.8) at the baseline stage. He did not know how to use ‘‘pointing’’ and
‘‘showing’’ skills to interact with the researcher. After using the JASL system and data glove to practice, these skills Mark learned to
use ‘‘pointing’’, and ‘‘showing’’ skills to interact with the virtual characters in the system. Subsequently, his scores increased from
4.7 to 8, and reached 10 during the maintenance phase. Mark’s score for the ‘‘showing’’ skill increased from the baseline to reach
3.8, then reached 8.3 during intervention and 10 during the maintenance phase. This shows that Mark exhibited stronger joint
attention skills to interact with others following intervention learning of the JASL system with data glove.
John exhibited standard levels of ‘‘pointing’’ (5.5) and ‘‘sharing’’ (5) at the baseline stage and also continued to improve
following the intervention phase. John was also able to follow the researcher in showing an object (e.g., cookies), although he
was unable to interact with the researcher at the baseline phase. Following the intervention period, the score for ‘‘showing’’
increased from 4.5 in the baseline phase to 7.3 in the intervention phase and 8.3 in the maintenance phase; moreover, the
score of ‘‘interaction’’ rose from 2.5 in the baseline phase to 10.3 in the intervention phase and 14.7 in the maintenance phase
after the experiment conducting a few times. John extended his learned joint attention skills to his mother and he was
starting to take a ‘‘clock’’ to interact with his mother after using the JASL system with data glove.
James did not perform well in every skill at the baseline, achieving a score of 1.25 for ‘‘pointing’’, 1.5 for ‘‘showing’’, 2.5 for
‘‘sharing’’, and 1.25 for ‘‘interaction’’. James ignored the pencil when the researcher showed it to him or shared it with him,
and was unable to interact with the researcher during the baseline phase. During the intervention period, James displayed a
strong interest in the JASL system and data glove, and used the gestures of ‘‘pointing’’ and ‘‘showing’’ a toy car to the
researcher. During the maintenance stage, James also exhibited appropriate behavior, and was not interested when the
researcher shared an object with him. Table 4 shows that John improved his scores for each item after using the JASL system
with data glove.

4.5. The questionnaire by the parents

Three parents strongly supported for this intervention-system. The parents indicated that the JASL system provides visual
stimuli and assistance to help their children developing joint attention skills. All parents mentioned that their children were
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very interested in operating the system and using data gloves to practice join attention skills; moreover, their children
enjoyed the process of practicing joint attention skills using 3D animated scenarios. For example, James expressed that it was
fun to use the data gloves to grab the virtual toys and interact with the virtual characters in the system. Regarding the JASL
system with data glove, John’s mother stated that the system can be extended to more social scenarios and used to teach
more social skills, thus providing additional benefits in practicing social interaction for children with PDD. Mark’s parents
mentioned that the data glove can help other children with different levels of deficit in joint attention skills to learn
concentrative difficulties.
Therefore, all three parents confirmed that using the JASL system with data glove that provided effectively practicing joint
attention skills for their children. The parents also noted that the JASL system with data glove provided real-world simulated
situations, and could provide children with PDD with more opportunities to practice joint attention skills and interact with
others.

5. Discussion

This study has investigated IJA and RJA behaviors using the JASL system, and used the data glove equipment for individual
with PDD. The result indicated that three participants exhibited improvement and showed appropriate joint attention skills.
The consistent with ideas that provide virtual environment with data glove assistant can help children with PDD learning
practical skills (Carrozzino, Tecchia, Bacinelli, Cappelletti, & Bergamasco, 2005; Pabon et al., 2007). The JASL system thus
provides an opportunity to help children with PDD practicing joint attention skills. Similar experimental results have been
demonstrated by Mengue-Topio, Courbois, Farran and Sockeel (2011), Lotan, Yalon-Chamovit, and Tamar Weiss (2010),
LaCava, Golan, Baron-Cohen, and Myles (2007) and indicated that virtual environment significantly affects learning in people
with PDD and stimulates learning motivation.
Each participant demonstrated individual improvements in this experimental study. Mark was unable to proactively use
gestures of pointing, showing, and sharing an object or interacting with others in the baseline session. However, during the
intervention session, Mark showed more interest in learning these skills from the system. Mark was very interested in using
the data glove to practice joint attention skills, and also explained that the data glove could be used to grab a virtual toy,
which he found very entertaining. Mark showed his improving IJA skills and shared his happiness with the researcher after
using the JASL system with data glove; for example, he enthusiastically pointed out a Christmas decoration to the researcher
and said ‘‘You see the Santa!’’ and he also sharing his cookies with the researcher and saying ‘‘This packet of cookies is for
you!’’ During the maintenance phase, Mark displayed IJA behaviors to the researcher, he shared his story book to the
researcher and said ‘‘Look! I have a story book’’. Additionally, Mark also took spontaneous and alternate looks at a target
object when the researcher gestured by showing a pencil. Mark’s mother mentioned that Mark showed greater ability to use
pointing, showing, or sharing to interact with others after using the JASL system with a data glove.
During the baseline session, John ignored the researcher pointing out an object to him. During the intervention phase,
John was interested in using the JASL system with a data glove to practice joint attention skills, and was also able to share the
virtual toy with the virtual character in the system. For example, John simultaneously used gaze shifting and shared his IJA
behavior of grabbing the basketball in the system with his mother; he excitedly told his mother, ‘‘I can use the data glove to
grab the basketball and put it on the shelf.’’ John also performed RJA skills after the intervention session, and pointed out the
alarm clock to the researcher after spotting it. During the maintenance phase, John also proactively interacted with the
researcher; for example, he intended to use the gesture of showing to share his pencil with the researcher. John’s mother
reported that using the JASL system with data glove intervention-system positively affected the development of joint
attention skills in her child.
Concerning James, when the one of the researcher pointed out the puppet, James ignored it because he was not interested
during the baseline session. At the beginning of the intervention James rejected wearing the data glove, but still made some
brief attempts to use it. When he found that data gloves can grab virtual toys (such as aircraft, car), he became very excited.
Jams showed his IJA skills to his mother, for example, he shared immediately shared this discovery with his mother and said
‘‘it was very fun!!’’ during the intervention phase. Further, James became able to pay attention to uninteresting objects when
the researcher showed them to him. During the maintenance phase, James performed spontaneous sharing experience with
the researcher in IJA skills, for example, he played a small ball, showed it to the researcher, and used gaze shifting and said
‘‘Look! This small ball is very cute.’’ James’s mother noted that James was interacting more actively with others using joint
attention skills. She also confirmed that the system achieved the effect of learning for her child who enjoyed the system and
used data glove to learn joint attention skills.
However, the results also showed that the content of 3D animated social situations is related to the school events for
children with PDD, which motivates their learning. Three participants showed great enthusiasm and interests in interacting
with virtual characters and toys in the system. This demonstrates that the system provides effective learning progress for
participants.

6. Conclusions

This study investigated the performance of joint attention skills for PDD after using the JASL system with data glove. The
findings suggested children with PDD can operate the JASL system and use data glove in the intervention-program. More,
 Y. Cheng, R. Huang / Research in Developmental Disabilities 33 (2012) 2141–2152 2151

importantly, participants showed significantly improvement in joint attention skills, and able to extend learned joint
attention skills into their daily life. But time limitations prevented the collection of generalizable data for each participant.
Future studies could collect generalized data on joint attention skills and design more social events to practice different joint
attention skills for different types of people with disabilities.

Acknowledgements

The authors would like to thank the National Science Council of the Republic of China, Taiwan for financially supporting
this research under Contract No. NSC_99-2221-E-018-002. Thanks to the children with PDD and their parents who
participated in this research by generously volunteering their time. And Mr. Ted Knoy is appreciated for his editorial
assistance.

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