Below is a general skill sequence for helping learners follow gestures with consistency.
Joint attention is a social-communication skill that occurs when two people, typically an adult and a child, use gestures and gaze to direct their focus towards a shared object or event. This skill is critical for the development of language and social interaction. Impaired development of joint attention is a hallmark of autism, so it is crucial to implement early interventions to promote this skill. Teaching learners to follow gestures is a component to working on joint attention as a whole!
How this skill area relates to your assessments!
This skill area aligns with various assessments and their respective domains, with milestone and domain codes provided for reference. Additionally, DSM-5 diagnostic criteria for Autism are included to help clinicians identify how this skill area potentially supports medical necessity in relation to the diagnosis.
VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program)
Listener Responding, LR 1-M, Attends to a speaker’s voice by making eye contact with the speaker 5 times.
Visual Perception/Match to Sample, VP-MTS 1-M, Visually tracks moving stimuli for 2 seconds, 5 times
AFLS (Assessment of Functional Living Skills)
Basic Communication, BC1, Follows instructions
Phone, PH1, Retrieves phone on request
DSM-V Diagnostic Criteria for Autism
A2, Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
CDC’s Developmental Milestones
9 months, Social/Emotional Milestones, Looks when you call their name
15 months, Language/Communication Milestones, Follows directions given with both a gesture and words. For example, they give you a toy when you hold out your hand and say, “Give me the toy.”
Treatment Plan Goal Ideas
This is a list of treatment plan goals. These are different from the goals you will find in the skill sequence below. Your treatment plan goals encompass any number of goals from the skill sequence. Sometime they will include multiple goals from the sequence (”Learner will label 5 toys”) and sometimes the treatment plan goal will be simply consist of a really important goal from the skill sequence (”Will label caregiver”). An analogy I like to use goes as follows: Each skill sequence goal (commonly known as a “target”) represent each stair in a flight of stairs. The treatment plan goal is the flight itself.
Treatment plan goal ideas for this particular skill area are as follows:
Learner will follow an adult’s gesture/point to a high value item before engaging with it.
Learner will follow and adult’s gesture/point to any neutral value item.
Learner will orient their body left, right, or 180 degrees to follow an adult’s gesture to a neutral item.
Learner will follow a gesture to an instructional item from across a room.
Component Skills
Your learner may need to be fluent in these component skills first before introducing this goal/skill area. Component skills for this skill sequence may include skill areas that are fundamental to other areas. Fluency in the skill areas listed below may increase the likelihood that your learner will succeed in this skill sequence and those afterward.
One of the most valuable skills you’ll work on with your learner revolves around teaching them to follow gestures. Learners who can follow gestures are more likely to engage in joint attention with adults and peers. Gestures allow us to guide our learners attention to the stimuli that will ultimately help them experience reinforcement. Before we teach this skill area, it is important to at have started working on skills regarding reinforcer and preference expansion. Your learner doesn’t need all of the skills in this component sequence, but it might be a good idea to have at least gotten through a few.
Below is a possible skill sequence for working on increasing your learner’s ability to follow gestures. Note that every learner is different and that you likely will need to tweak and vary some programming to their needs. Click the triangle icon to view the full description for each skill in the sequence/area.
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#1 Therapist Points/Touches High Value Item During Engagement
How to Run
Allow the learner to browse and engage with the highest value item that is available.
As learner is engaged with it, point to it and/or touch it with your index finger.
There is no correct response, however, note if the learner seems to find your touching the item or pointing to it aversive.
Additional Notes
The purpose of this program is to actively pair your pointing with high value reinforcement.
All trials will be “correct” as this functions more of an exercise for pairing. Do this at a high trial rate throughout the session (50-100 trials depending on the learner).
Materials
Research/Resources
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#2 Follows Point to High Value Item BEFORE Engagement
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Immediately point to the highly preferred item or activity and say “Look”.
Once the learner looks at the item, immediately return the item to them.
Correct: Learner looks at the preferred item. Incorrect: Learner requires additional prompts to do so.
Additional Notes
Materials
Research/Resources
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#3 Follows Point to Neutral Value Item
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Immediately present a neutral value item, point to it, and say “Look”.
Once the learner looks at the neutral item, immediately return the high value item to them.
Correct: Learner looks at the neutral item or at least orients in a way that indicates they have looked at it. Incorrect: Learner requires additional prompts to do so.
Additional Notes
As a prompt, you may need to wiggle your index finger when you point. Gradually fade this as your learner becomes more fluent.
Materials
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#4 Turns Head to Left/Right to Follow Point
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Point to a neutral value stimuli that requires the learner to turn their head to the left or right.
Once the learner turns their head and looks at the neutral item, immediately return the high value item to them.
Correct: Learner turns their head to look at the neutral item (or at least orients in a way that indicates they have looked at it). Incorrect: Learner requires additional prompts to do so.
Additional Notes
As a prompt, you may need to wiggle your index finger when you point. Gradually fade this as your learner becomes more fluent.
Materials
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#5 Looks Up to Follow Point
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Point to a neutral value stimuli that requires the learner to look up (it can be the ceiling).
Once the learner looks up, immediately return the high value item to them.
Correct: Learner looks up (or at least orients in a way that indicates they have looked up). Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Materials
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#6 Follows Gesture to Page In Book
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Present a book and point to any page in the book.
Learner should look at the page in the book.
Once learner looks at the page, immediately return high value items.
Correct: Learner looks at the book. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too while holding the book. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the book (and not your gesture).
Materials
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#7 Follows Gesture to Screen
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Present another item with a screen (tablet, phone, etc.), point to it, and say “Look!”
Learner should look at the screen.
Once learner looks at the screen, immediately return high value item.
Correct: Learner looks at the screen. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too while holding the device. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the screen (and not your gesture).
Materials
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#8 Follows Gesture to Another Person
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Point to a peer or adult in the immediate environment and say “Look!”.
Learner should look at the peer/adult.
Once learner looks at the peer/adult, immediately return high value item.
Correct: Learner looks at the peer/adult. Note: Does not need to make eye contact. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too while in the presence of the other person. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of simply being around other people (and not your gesture).
Materials
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#9 Follows Gesture to Mirror
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Point to a mirror (can be a hand mirror) and say “Look!”.
Learner should look at the mirror.
Once learner looks at the mirror, immediately return high value item.
Correct: Learner looks at the mirror. Note: Does not need to make eye contact. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too while in the presence of the mirror. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the mirror (and not your gesture).
Materials
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#10 Follows Gesture to Look Through Binoculars (or similar)
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Present a pair of binoculars to the learner.
Point to the lens of the binoculars (where your eyes go) and say “Look!”
Learner should look through the binoculars.
Once learner looks through, immediately return high value item.
Correct: Learner looks through the binoculars (or at least puts eyes up to them). Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too while holding the binoculars. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the binoculars (and not your gesture).
Materials
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#11 Follows gesture to look in trashcan/box
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Ensure that the learner is near a box or a trashcan (or similar).
Gently remove the highly preferred item.
Point inside the box/trashcan and say “Look!”
Learner should look into the item.
Once learner looks into it, immediately return high value item.
Correct: Learner into box/trashcan. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too while near the trashcan/box. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the box/trashcan (and not your gesture).
Materials
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#12 Orients Body 180 Degrees to Follow Point
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Ensure that you are directly in front of the learner.
Gently remove the highly preferred item.
Point to a neutral value stimuli that is behind the learner and say “Look”.
Once the learner orients their body to the neutral item behind them, immediately return the high value item to them.
Correct: Learner orients their body to look at the neutral item behind them. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Therapist should be in front of them so that they can see that they are pointing behind them.
Materials
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#13 Follows Gesture to Look Out Window
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Gently remove the highly preferred item.
Go to a nearby window (stand around 1-5 feet away).
Point to the window and say “Look!”
Learner should look out the window.
Once learner looks out the window, immediately return high value item.
Correct: Learner looks out the window. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner look at other things too. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the window (and not your gesture).
Materials
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#14 Follows Point To Item 6 ft Away
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Ensure that you are directly in front of the learner.
Gently remove the highly preferred item.
Point to a neutral value stimuli that is at least 6 feet away and say “Look.”
Once the learner orients their body to the neutral item, immediately return the high value item to them.
Correct: Learner orients their body toward the item that is 6 feet away. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Therapist should ensure that their gesture is visible to them.
Materials
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#15 Follows Gesture to Look at Dry Erase Board/Similar
How to Run
Allow the learner to browse and engage with and reach for highest value items.
Ensure that you are in a room with a dry erase board, calendar time visual, chalk board, or similar.
Gently remove the preferred item/activity.
Point to the dry erase board and say “Look!”
Learner should orient toward the dry erase board and look at it.
Once learner looks at the dry erase board, immediately return high value item.
Correct: Learner looks at board. Incorrect: Learner does not do so or requires additional prompts to do so.
Additional Notes
Make sure that the learner can see your gesture.
Ensure that you are gesturing the learner to look at other things too. If other gestural programs are not targeted, the learner’s response may be under the stimulus control of the room with the dry erase board (and not your gesture).
Materials
Concurrent Skills
Working on these skills at the same time could help with goal mastery. Maybe your learner has mastered these skills already. Perhaps they are already listed as component skills above. That’s okay! Targeting other learning channels might help your learner.
These are the possible next steps for learners who have mastered, or are mastering, the skills listed above. Note that new skill areas may require fluency in other component skills not listed above. Also, you can introduce composite skill sequences prematurely to keep your learner progressing, as generativity may occur earlier than expected.
Bruinsma, Y., Koegel, R.L. and Koegel, L.K. (2004), Joint attention and children with autism: A review of the literature. Ment. Retard. Dev. Disabil. Res. Rev., 10: 169-175. https://doi.org/10.1002/mrdd.20036
Charman, T. (2003) Why is joint attention a pivotal skill in autism? Phil. Trans. R. Soc. Lond. B 358 315–324 http://doi.org/10.1098/rstb.2002.1199
Deák, G. O., Flom, R. A., & Pick, A. D. (2000). Effects of gesture and target on 12- and 18-month-olds' joint visual attention to objects in front of or behind them. Developmental Psychology, 36
(4), 511–523. https://doi.org/10.1037/0012-1649.36.4.511
Elizabeth R. Lorah, Shawn P. Gilroy, Philip N. Hineline,
Acquisition of peer manding and listener responding in young children with autism,
Research in Autism Spectrum Disorders, Volume 8, Issue 2, 2014, Pages 61-67,
ISSN 1750-9467,
https://doi.org/10.1016/j.rasd.2013.10.009.
Jones, E. A., & Carr, E. G. (2004). Joint Attention in Children With Autism: Theory and Intervention. Focus on Autism and Other Developmental Disabilities, 19
(1), 13–26. https://doi.org/10.1177/10883576040190010301
Kaitlin G. Causin, Kristin M. Albert, Vincent J. Carbone, Emily J. Sweeney-Kerwin,
The role of joint control in teaching listener responding to children with autism and other developmental disabilities, Research in Autism Spectrum Disorders, Volume 7, Issue 9, 2013, Pages 997-1011, ISSN 1750-9467,
https://doi.org/10.1016/j.rasd.2013.04.011.
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Disclaimer
Consistent with ethical obligations outlined by the Behavior Analysis Certification Board (BACB), users acknowledge that goal selection/direction is the responsibility of the BCBA. Users understand that goals should be tailored to the learner while ultimately involving the input of clients/stakeholders. Users understand their ethical obligations to the client/stakeholder concerning the selection, implementation, design, and minimization of risk regarding behavior change interventions as outlined in BACB Code. As such, this skill sequence serves as a general framework for generating ideas around this particular skill area and not as an assessment or curriculum.
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Intro to Reinforcer/Preference Expansion
Intro to Scanning 
Intro to Manding
Single Actions with Common Toys
Intro to Eye Contact
