Behaviours that Challenge

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Behaviours that Challenge

• Keith Howie
• Director
• Professional Clinical Services

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40th year struggling with psychology

• I commenced my studies in psychology at
  Nottingham University in the late sixties, as a
  naive and very young 18 year old.
• Almost forty years later, I remain naïve but
  unfortunately no longer so young.
• From the very start, for me psychology was about
  being a person with a mind body that are
  inextricably bound together and existing within a
  social context.
• This remains my position and this position has
  influenced my understanding of what is and what
  matters in the study of psychology and my
  practice as an applied psychologist

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Assumptions - Development

• The life course is a developmental process,
  typically implying a move from helpless organism
  to being a more or less autonomous person that
• takes place in a changing cultural social and
  historical setting
• increasingly involves individual choices about
  actions to be taken
• entails both continuities and discontinuities
• a context for understanding interactions between
  a 'minded self' and the environment
• Grant, 2007

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Assumptions - Autism

• Awareness of the nature of autism that it
• Covers a spectrum of conditions
• Relies on behavioural and developmental analysis
• Is based around a triad of differences in the
  areas of
• Communication
• Interaction
• Flexibility and social imagination
• Is often associated with differences in the
  experience of sensory information

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Applied, practical psychologist

• I am a pragmatic, practitioner working with real
  people facing real problems and dilemmas in a
  real, messy and complex world.
• I have never been an academic psychologist
• I therefore cannot pretend that my practice is
  informed by a comprehensive and coherent
  understanding of the psychological world in which
  we all live
• .nor of course can anyone else.

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Content of todays presentation

• The cornerstones of my perspective as a
  psychologist
• My current interests
• The nature and impact of autism
• What challenges and who is challenged
• A functional approach to support where challenges
  occur

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The cornerstones of my perspective as a
psychologist

• We are thinking, reflecting, acting people who
  exist within a social context
• Even when alone we bring with us our social
  contexts these permeate our perception of the
  here and now, our thinking in the here and now
  and our actions.
• For me psychology is about using a scientific
  methodology to study and make propositions about
  these elements and related aspects of our daily
  lives.
• The relationship between biology, neurology and
  psychology

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The concept of the self in society George Mead

• Meads perspective is that humans are unique in
  taking the perspective of other actors towards
  objects, this is what enables complex human
  society and subtle social coordination. Mead
  writes in Mind, Self and Society that human
  beings begin their understanding of the social
  world through "play" and "game". "Play" comes
  first in the child's development. The child takes
  different roles he/she observes in "adult"
  society, and plays them out to gain an
  understanding of the different social roles.

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The use of roles performanceErving Goffman

• In the The Presentation of Self in Everyday Life,
  Goffman writes A set of features will be
  described which together form a framework that
  can be applied to any concrete social
  establishment, be it domestic, industrial, or
  commercial..The perspective employed in this
  report is that of the theatrical performance the
  principles derived are dramaturgical ones. I
  shall consider the way in which the individual in
  ordinary work situations presents himself and his
  activity to others, the ways in which he guides
  and controls the impression they form of him, and
  the kinds of things he may and may not do while
  sustaining his performance before them.

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Conversational dialogues John Shotter

• The Social Construction of Our 'Inner'
  Lives(1997) From within social constructionism,
  everything that is taken to be an already
  existing, real psychology object in the cognitive
  (realist) account - such as our intentions,
  memories, motives, perceptions, emotions, etc. -
  can be talked of in a different way as not
  consisting in already finished and finalized
  objective entities at all, but as still being in
  the process of construction, that is, as being
  both partially constructed and open to further
  construction, or even, re-construction - in
  different ways in different discursive or
  conversational circumstances, according to one's
  sense of how one is placed in relation, both to
  one's own project, and to the others around one.

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Scientifically sound framework Rom Harre,
Philosopher

• Harre proposes a new view of psychology based on
  the convergence of ideas that reject the
  traditional view that a scientific' psychology
  must rely on an experimental methodology.
  Underpinning this movement is the principle that
  the main characteristics of human life are best
  understood as produced through discourse. This
  discursive' psychology has found adherents
  across the range of psychological disciplines and
  has ushered in a completely revised understanding
  of the subject.
• He describes the philosophical restructuring of
  psychology in this proposed new paradigm, affect
  is raised to new prominence and the Cartesian
  distinction between mind and body yields to
  discourse as the origin of the self.
• Harre Gillet, 1994

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Solomon Aschs Analysis of social interaction

• The paramount fact about social interaction is
  that the participants stand on common ground,
  that they turn towards one another, that their
  acts interpenetrate and therefore regulate each
  other
• The process is not one in which individuals
  .lose their identity.Rather it requires that
  each participant retains his perspective and
  asserts his individuality.
• Asch, 1952 pp.162-3

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Development as a process of construction

• Consistent with Piagets propositions that
  development is due not to a unilateral cause
  (family, the adult community, school) but is a
  process of construction through multiple social
  interactions, and sometimes with opposed effects.
  The opposed effects .include, on the one hand,
  sociability, cooperation, sharing and empathy
  and, on the other hand, opposing others,
  violating rules, and asserting personal
  interests.
• Turiel, 2002 p. 288

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Jean Piaget Lev Vygotsky

• In 1962 Jean Piaget commented on Vygotskys work
  of 1934
• Let us turn to what most troubles Vygotsky in my
  conception of egocentrism its relationship to
  Bleulers concept of autism. Vygotsky does not
  deny that a certain amount of autism is normal
  for all people. He finds only that I have
  overemphasized the resemblances between
  egocentrism and autism without bringing out the
  differences sufficiently and in this he is
  certainly right. I emphasized the resemblances,
  whose existence Vygotsky does not deny, because
  they seemed to me to throw light on the genesis
  of symbolic games in children. In them one can
  often see the non-directed and autistic thought
  which Bleuler speaks of and which I have tried to
  explain in terms of a predominance of
  assimilation over accommodation in the childs
  early play.

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Jerome BrunerScaffolding

• The game consists of an initial contact, the
  establishment of joint attention, disappearance,
  reappearance, and acknowledgement of renewed
  contact. These obligatory features or the
  syntax of the game occur together with optional
  features, such as vocalizations to sustain the
  infants interest, responses to the infants
  attempts to uncover the mothers face, etc. These
  non-rule bound parts of the game are an
  instance of the mother providing a scaffold for
  the child
• Bruner Sherwood, 1975, p. 280

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The structure underlying cognitive processes

• Perception Groundbreaking research on Frogs
  visual system
• Lettvin, Maturana, McCulloch Pitts found that
  the very first network of cells within a frogs
  retina have much more the flavor of perception
  than of sensation, if that distinction has any
  meaning now. That is to say that the language in
  which they are best described is the language of
  complex abstractions from the visual image. We
  have been tempted, for example, to call the
  convexity detectors "bug perceivers." Such a
  fiber responds best when a dark object, smaller
  than a receptive field, enters that field, stops,
  and moves about intermittently thereafter. The
  response is not affected if the lighting changes
  or if the background (say a picture of grass and
  flowers) is moving, and is not there if only the
  background, moving or still, is in the field.
  Could one better describe a system for detecting
  an accessible bug?
• Lettvin et al, 1959

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Growth Cycles of Brain Mind Kurt Fisher
colleagues

• A child develops skills and knowledge along
  multiple independent strands for separate tasks
  and situations. A child develops skills for
  several strands in the spatial and musical
  domains, which are mostly separate. Development
  of a new skill level in both domains produces a
  cluster of forks, intersections, and changes in
  direction across most strands.

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• Skills relating the spatial and music domains
  intersect at one point (marked by a small circle)
  when the child begins to learn musical notation,
  which requires an integration of spatial and
  musical skills.

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• Development involves a long series of new levels,
  each constructed independently, in parallel, for
  each strand. These spurts in capacity seem to be
  grounded in recurring growth cycles. The
  longer-term cycle, moving through four different
  forms of action and thought called tiers
  (reflexes, actions, concrete representations, and
  abstractions). These cycles seem to be based in
  the growth of neural networks, involving a
  combination of changes in connections among
  regions of the cortex and changes in brain
  activity in particular regions.

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• A metaphor that illustrates the nature of the
  long-term cycle of tiers is the construction of a
  cube or other solid figure in four levels, as
  shown. To build a cube, we first combine single
  points to form lines. We combine lines to form
  squares, then squares to form cubes. The cube in
  turn is a new building block that begins the
  process again, as we combine cubes to form lines,
  and so forth. The shorter-term cycle occurs
  within each level.

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Nested Developmental Cycles

• Ages indicate approximate time at which that
  level emerges under optimal conditions. Tiers are
  listed on the left, and levels within each tier
  are listed on the right.

Kurt Fisher et al, 1998
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Emotions, thinking and acting

• I am currently interested in considering how
  these elements of our daily being interact
  impact on our development and our being in
  particular this interplay
• My emotions influence my thinking
• My thinking influences my actions
• My actions influence my emotions
• My emotions influence my actions
• My actions influence my thinking
• My thinking influences my emotions

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Emotions, thinking actionKurt Fisher
colleagues

• The following vignettes depict typical emotional
  reactions to accomplishment in American and
  Chinese children and adults. In so doing, they
  not only show the very different ways in which
  those socializing react to childrens
  accomplishments in the USA and China, but they
  also illustrate typical developmental outcomes
  spawned by these practices.

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Examples of cultural aspects of socialization on
pride and humility

• Three-year-old Danny and his mother are putting
  together the pieces of a puzzle. Danny places a
  piece in its correct location. Immediately, he
  looks up to his mother, smiles, and says Oh! I
  did it! Looking up from her work, his mother
  smiles and says You did it! Danny claps his
  hands, after which his mother applauds and says
  Thats great! (Pride exhibited by U.S. child
  and mother)
• Mother asks three-year-old Lin to sing a song for
  guests. After she finishes, with smiles and
  exaggerated expressions, the guests say
  "Wonderful! You sing nicer than my child!" Mother
  replies, "Hai-hao, she is O.K. Her voice is kind
  of off the tune, though. But she likes to sing.
  To Lin, You did all right, but now you need more
  practice. Play down your success!" (Chinese
  mother and guests reacting to child's song)
• Reactions of college students to compliments
  about their class presentations in science
  Thanks. I feel good about it. Im so glad you
  enjoyed it. (American students)
• No. Its not that great. I didnt do it well. I
  know I bored you. Im embarrassed. (Chinese
  students)

Mascolo et al, 2003
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Judgements, morality and action

• The questions I am currently exploring and
  struggling with are these
• How did I, do I continue to, learn about,
  develop the skills, to make judgements?
• What are the domains within which I make
  judgements?
• How do these judgements relate to my actions?

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The work of Elliot Turiel colleagues at Berkeley

• Peoples judgements are not disconnected from
  their actions. In considering actions, as well
  as a seeming lack of action, it is important to
  examine the connections among thoughts, emotions,
  and actions, which are inter-related in three
  ways.
• Social judgements and actions substantively
  influence the development of judgements.
• Judgements once formed, structure how people
  interpret events and influence their actions
  actions that, in turn, influence the further
  development of judgements.
• The different types or domains of moral, social
  and personal judgements interact in complex ways
  to influence peoples actions and interactions.
• Turiel, 2002

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The essential aspects of autism

• Fundamentally a profound breakdown in
  interpersonal connectedness
• These people have been key to my emerging and
  hesitant understanding of autism
• John Elizabeth Newson
• Colwyn Trevarthan
• Peter Hobson

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Close up personal the Newsons longitudinal
study

• Between 1963 and 1978 John Elizabeth published
  their work with the parents of infants, who then
  grew to be four year olds and finally became
  seven year olds.
• Liz Newson used this understanding of childrens
  development in her work with children with
  developmental disorders at the Child Development
  Centre at Nottingham University, developing a
  scholarly and humane understanding of autism.
• As an assessment process, she developed a
  flexible but clinically powerful combination of
  adult mediated and responsive play-based
  activities for children, allowing shared
  observation with parents that proceeded alongside
  semi-structured developmental interviewing.
• See Newson Newson 1963, 1967 1976 and Newson,
  undated

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Intersubjectivity

• Unlike the Newsons and others who have been
  doubtful of the intersubjectivity within
  adult-infant interactions, I share with Bruner,
  Trevarthen and Hobson a commitment to a strong
  form of early intersubjectivity.
• Jerome Bruner talks about this My first brush
  with it was in studying the development of
  exchange games in infancy, when I was struck with
  how quickly and easily a child, once having
  mastered the manipulation of objects, could enter
  into handing back and forth, handing objects
  around a circle, exchanging objects for each
  other. The competence seemed there, as if ab
  ovum the performance was what needed some
  smoothing out. Very young children had something
  clearly in mind about what others had in mind,
  and organized their actions accordingly. I
  thought of it as the child achieving mastery of
  one of the precursors of language use a sense of
  mutuality of action.
• Bruner, 1986 p. 59

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Intersubjectivity Colwyn Trevarthen

• Primary intersubjectivity this originates in the
  face-to-face communication between infant and
  caregiver in the first months of life. It
  primarily consists of eye-gaze, vocalization, and
  rhythmic turn-taking patterns.
• Secondary intersubjectivity at about nine
  months, the infant learns to pay shared attention
  with an adult to a jointly observed object. At
  that point, dyadic interaction (face-to-face) is
  transformed into triadic interaction
  (side-by-side, with both interlocutors focusing
  on the same object).
• Tertiary intersubjectivity at around age three,
  children begin to participate in linguistic
  practices that address distal temporal and
  spatial distinctions (including not-here and
  not-now phenomena), as well as their own and
  others' mental and emotional states and agency.

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Autism identifying with other people

• Peter Hobson and colleagues have been concluding
  a set of studies on the communicative impairments
  of children with autism.  Their approach is
  primarily experimental, but with a naturalistic
  bias. These studies point to an abnormality in
  autism that might have far-reaching developmental
  consequences a weakness in the propensity to
  identify with other people.  Across a range of
  settings, children with autism appear to have a
  relative lack of the natural inclination to be
  moved by and attune with another persons
  communicative gestures, and to link in with
  others mental orientations.  For example, they
  rarely nod or shake their heads when another
  person is speaking, they seldom take the role of
  the other in communication, and they infrequently
  adopt a self-orientation when copying other
  people.  This lack of perspective-taking may be
  important for a broader range of the childrens
  difficulties in moving flexibly among alternative
  viewpoints on the world.

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Experimental psychology in practice in the field
of autism

• Hobson devised an experiment that could have been
  inspired by a remark of Wittgenstein
  Wittgenstein noticed that it is very hard to
  detect the expression of a face drawn upside
  down. Expression, in other words, is not simply a
  summation of physical details it is a total
  "Gestalt". Hobson asked two groups of children,
  one autistic and one non-autistic, to sort
  upside-down faces according to their expression.
  The autistic group performed much better. This is
  because, Hobson concludes, "the 'emotions' were
  no longer recognisable as emotions when the faces
  were presented upside down. Effectively, the task
  was reduced to one of pattern or feature
  recognition.
• Hobson, 2002

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The Impact of Autism

• Those with autism live in a social connected,
  socially defined world with a core sense of being
  disconnected
• Growing up living with autism is a developing
  and on going process
• For a person with autism, this experience of and
  difficulty with connectedness is ongoing,
  cumulative and has continuing impact on the
  capacity to make sense of and gain mastery of the
  world the person lives in
• It is not just the obviously social aspects of
  the world that are affected the sounds and
  sights of blowing leaves, the smell, taste and
  texture of food how we understand and respond
  to all such things are given meaning and
  significance through social cultural
  interactions and are, as John Shotter says
  partially constructed and constantly open to
  further construction.

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Unpacking the Impact of Autism

• The severity of the range of differences and
  difficulties that those with autism experience
  has been poorly studied
• Frequently severe autism is used to mean someone
  who has both autism and severe learning
  disability whilst mild autism means the person
  has no overall learning disability.
• This is an inadequate approach and Pat Smith,
  Emma Howie I started working on this a few
  years ago.
• Using John Clements Ewe Zarkowska work, we
  have developed a questionnaire to elicit ratings
  across a number of domains

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Pointers to the experience of autism

• What does it mean to grow-up live socially
  disconnected in a world that has to be socially
  constructed to become manageable and safe?

• How does someone understand, respond to and
  regulate emotional experience without social
  connection?
• What is it like, developing cognitive skills
  outside a socially connected and shared
  framework?
• How do you learn to make social, moral personal
  judgements and regulate your behaviour without
  being able to connect with others?
• What is personhood without social solidarity,
  what is individuation without socialization?

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Two accounts from people with autism

• Firstly from Ms AJ Mahari who reminds us she is
  differently abled, not disabled
• I experience this social disconnectedness, as an
  adult with Aspergers Syndrome (AS), in ways that
  I imagine are more difficult for me than they may
  be for those with more classic autism. It is the
  awareness that one has with AS that often brings
  with it a more painful lack of connection. Many
  have strong desires to try to be as social as we
  can. This is, however, coalesced with what is an
  equally strong aversion to being social.
• This paradox of simultaneously desiring and
  feeling aversion is born out of a lifetime of
  difficult and painful experiences in the social
  realm coupled with a lack of understanding and
  difficulty in truly being able to feel a sense of
  joining in what others are experiencing as a
  shared experience.
• Mahari, 2005

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Gregory Yates Theory of Autism

• Social disconnectedness is the central, eponymous
  feature of autism. A sample case of mild autism
  illustrates typical secondary features a boy
  routinely rocks and bangs his head against
  furniture he speaks like a little professor.
  People remark at his poor eye contact he has a
  focused, persevering interest in mechanisms like
  flying machines, electronic devices and brains.
  However, it is social disconnectedness that most
  defines autism - social disconnectedness is the
  horse of autism.

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Facing unwanted challenges

• Anxiety
• Fear
• Uncertainty
• Loosing control of our emotional regulation
• Loss of our own sense of being in control

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Having autism means being challenged

• Without autism
• The world we live in is socially constructed,
  enabling us to experience safety continuity and
  security we know this is not a spider
• The routines and patterns of life are predictable
  and comfortable pressing this button is OK

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Facing unwanted challenges means becoming someone
who is challenging

• Unwanted challenges bring
• Emotional reactions anxiety, distress, anger,
  fear and more
• Impaired cognition, with inflexible patterns of
  thought
• Identification of others as the source of the
  challenge
• Thus actions are driven by negative emotional
  arousal, thinking that lacks reflection, based on
  recursive patterns and directed at the perceived
  source of the challenge.
• These process are even more powerfully driven
  when the person being challenged has autism.

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What works when facing challenges from another
persons behaviour?

• Regulation and management of emotion
• Adoption of a problem solving, empirical
  approach.
• Recognition that the other persons behaviour is
  explicable and has a meaning that can be
  constructed.
• Understanding that the sharing of meaning will
  ameliorate the challenge

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Functional analysis

• An empirical, evidence based approach originating
  from behavioural and social learning theory
  perspectives.
• It recognises that if someone repeats a pattern
  of behaviour then this must serve some function
  for them.
• Understanding the function immediately
  illuminates ways of avoiding the behaviour
  occurring and provides a rich seam for
  denitrifying productive ways of responding

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The behaviours of concern

• Behaving in a way that is likely to lead to
• Harm to themselves or other people
• or
• Damage to property
• or
• Harm or damage to that persons esteem or to
  their social presence

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Functional not intentional

• A key vulnerability when responding to a person
  with autism is that the everyday ways of judging
  another persons intentions are valid.
• We are so well versed and effective in using our
  skills in understanding intentions that we often
  ascribe intentionality to inanimate objects.
• We are also familiar with adjusting these
  judgements to account for age differing with a
  2 year old than for an adult.
• However with those with autism our everyday
  fluency will not be of value. We need a
  different perspective, a different set of tools -
  functional analysis.
• Once we have a working, useful function for a
  pattern of behaviours then we can say that this
  pattern communicates.

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The functions of behaviour

• Pat Smith, Emma Howie and I carried out an
  investigation into the functions of behaviour.
  Emma analysed functions from Behaviour Support
  Profiles using Grounded Theory, whilst Pat I
  looked at functions from a logical, first
  principles base. We identified the following
  functions for behaviour
• Attempting to communicate a need or want to
  another person
• Expressing an emotion or feeling
• Responding to another person
• Responding to something in the environment
• Trying to make another person behave in a
  predictable way
• Responding to a bodily function or sensation

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Data Collection

• At the core of effective functional analysis has
  to be the collection of valid and reliable data.
  This data will consists of
• Information from those who know the person well.
• Records of previous incidents with clear
  information about context and outcomes as well as
  behaviours.
• Analysis of this data, with particular reference
  to before and after any changes.

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Key issues

• When with people with autism it is critical to
  remember that there is very little likelihood of
  a shared, coordinated and mutually regulated
  construction of the here and now.
• Even worse is the strong likelihood that we will
  try to impose our construction without any
  sharing or mutual agreement.
• Such an approach is not only doomed to failure,
  it will also continue with the process of
  marginalising the other person.

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Behaviour Support Profiles
This is an example of a fuzzy function
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My challengeYour challenge?

• Each individual is first foremast a person -
  endeavouring to make sense of, think about and
  act within a socially constructed world
• It is the same for those with autism except
  by definition, each will have a
  personal struggle with social interaction, with
  the core of communication with flexibility
  imagination
• It is my argument that the sensory world will
  also be a place that they will struggle to make
  sense of, think about and act within because of
  their struggle with the socially constructed
  world.

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The challenge for professionals

• In 1967, addressing the American Psychological
  Association, Martin Luther King chided
  psychologists for framing psychological health
  well-being as adjustment to social conditions and
  social arrangements Turiel 2002.
• I believe we face the same challenge when dealing
  with autism and more generally with those with
  developmental or neurological disabilities. We
  need to challenge the social conditions and the
  social arrangements that exist within society.
  Acceptance of difference and willingness to
  accommodate individuality in all its diversity
  must be our aim. An assumption that what people
  do, however different they may seem, has some
  function for them would be a productive start.

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Capabilities What is necessary for a good life

• Life Free to live to the end of a human life of
  normal length not dying prematurely.
• Bodily health and integrity Having good health,
  including reproductive health having adequate
  nourishment having adequate shelter.
• Bodily integrity Free to move freely from place
  to place, secure against violent assault,
  including sexual assault having opportunities
  for sexual satisfaction and for choice in matters
  of reproduction.

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Capabilities

• Senses, imagination, thought Free to use ones
  senses to imagine, to think and to reason in a
  way informed and cultivated by an adequate
  education able to use imagination and thought in
  connection with experiencing and producing
  expressive works and events of one's own choice
  using one's mind in ways protected by guarantees
  of freedom of expression with respect to both
  political and artistic speech and freedom of
  religious exercise able to have pleasurable
  experiences and to avoid non-beneficial pain.
• Emotions Free to have attachments to things and
  persons outside ourselves allowed to love those
  who love and care for us able to grieve at their
  absence, to experience longing, gratitude, and
  justified anger not having one's emotional
  developing blighted by fear or anxiety.

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Capabilities

• Practical reason Allowed to form a conception of
  the good and to engage in critical reflection
  about the planning of one's own life.
• Affiliation Free to live for and in relation to
  others, to recognize and show concern for other
  human beings, to engage in various forms of
  social interaction allowed to imagine the
  situation of another and to have compassion for
  that situation having the opportunity for both
  justice and friendship. Being treated as a
  dignified being whose worth is equal to that of
  others.

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Capabilities

• Other species Free to live with concern for and
  in relation to animals, plants, and the world of
  nature.
• Play Free to laugh, to play and to enjoy
  recreational activities.
• Having control over one's environment
• Political free to participate effectively in
  political choices that govern one's life having
  the rights of political participation, free
  speech and freedom of association.
• Material allowed to own and to hold property
  (both land and movable goods) having the right
  to seek employment on an equal basis with others.
• Martha Nussbaum, 2000

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References

• Asch, SE 1952Social Psychology, Englewood
  Cliffs, NJ Prentice-Hall
• Bruner, JS 1966 Toward a Theory of Instruction,
  Cambridge, Mass. Belkapp Press
• Bruner, JS 1986 Actual Minds, Possible Worlds
  Harvard University Press
• Bruner, JS Sherwood, V 1975 Peekaboo and the
  learning of rule structures. In J.S. Bruner, J,
  Jolly, A Sylva, K (Eds.), Play Its role in
  development and evolution (pp. 277-85).
  Harmondsworth Penguin Books
• Clements, J and Zarkowska, E 2000 Behavioural
  Concerns and Autistic Spectrum Disorders London
  Jessica Kingsley Publishers
• Fischer, KW and Rose, SP 1998 Growth Cycles of
  Brain and Mind Educational Leadership Volume 56
  Number 3
• Goffman, E 1959 The Presentation of Self in
  Everyday Life, University of Edinburgh Social
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