Mapping the landscape of joint attention assessment in autism spectrum disorder: a systematic review of tools, techniques, and gaps

Challenges in joint attention are well documented as hallmarks of autism spectrum disorder (ASD). Many different measures have been used to study autistic individuals within a wide range of age groups, meaning that there is currently no clear picture of how joint attention has been assessed across studies. In this systematic review, we aim to provide a clearer picture of joint attention assessment methods used with autistic individuals, identify gaps in measurement, and make recommendations for future research. We searched PubMed, EBSCO (APA PsycINFO, APA PsycARTICLES), Scopus, Ovid, Google Scholar, and Web of Science. A total of 129 studies involving 5536 autistic individuals were retrieved for the period 1989–2024. Out of 129 studies reviewed, 57 compared the joint attention of autistic (N = 1727) and non-autistic (N = 2094) individuals. In 51 of these studies, autistic individuals scored significantly lower on joint attention assessments, indicating substantial challenges in maintaining joint attention. Measures of joint attention included eye-tracking (18 studies), standardized scales and questionnaires (57 studies), and play- or activity-based measures (63 studies). Eye-tracking has been used mainly in comparison studies with autistic children over five years old, whereas intervention studies have primarily assessed younger autistic children under five years old using standardized tools and play- or activity-based measures. These studies also differed considerably in the tasks used, the operational definitions of joint attention, and the ways in which joint attention skills were measured. The wide variation in methods makes it difficult to compare outcomes across studies. Our review therefore recommends the development of comprehensive standardized measures that are sensitive to developmental variations in joint attention, enabling more reliable cross-study comparisons and ultimately supporting more accurate diagnosis and tailored interventions for autistic individuals. Moreover, we recommend the establishment of clear guidelines for designing eye-tracking tasks and play- or activity-based procedures for assessing the joint attention of autistic individuals, as well as the development of specific joint attention scales for consistent use in both research and clinical contexts.