Saturday, 31 March 2018

Communicative gesture emerges (whoop!)

It’s so exciting when there is a new breakthrough with one of our pupils. In the clip below with Jo, Lucy starts to use communicative gesture for the first time. Gesture is just one of the channels of non-verbal communication (NVC) and NVC makes up 80% of the communication package. It is well known that autistic folks struggle to pick up NVC and so is easy to see how difficult it can be for them to understand others when they are missing 80% of the communicative intent that someone else is sharing with them.

Since Lucy started with us in September 2015, we have seen progress towards and then mastery of the developmental milestones of social referencing, experience-sharing, joint attention (responding and initiating), episodic memory and joint engagement. The upshot of this is that the quality of Lucy’s emotional connection to and understanding of her communication partner has increased exponentially. As a result, when the guiding framework/guided participation relationship is round her, her social reciprocity and enjoyment of her own feelings of competence and togetherness with her partner is a joy to watch.

Let’s just remind ourselves how far Lucy has come. Here is a clip of her presentation shortly after she joined us at Bright FuturesSchool and before she had taken part in any guiding (derived from RDI).

Here we can see that Lucy is resisting my attempts to co-regulate (do things together in a communicatively synchronised way) and is seeking to be on her own agenda….running up and down making noises rather than co-regulating by joining hands for the actions of a nursery rhyme or walking across the room in parallel. 

RDI/guiding is based on research that shows that the autistic preference for one’s own agenda is driven by the difficulties autistic peeps have in managing uncertainty and unpredictability. For Lucy at this time, I am far too unpredictable and uncertain and so she avoids engaging with me. A perfectly natural human response – it’s what we all tend to do initially when we are faced with an unpredictable challenge or a novel situation, except that non-autistic folk have mastered the developmental milestones and encoded the episodic memories of successfully overcoming challenges within the guiding relationship.  This enables them to manage and enjoy uncertainty, unpredictability and challenge.

In the clip below with Jo from the beginning of March 2018, Lucy’s progress with social communication and interaction (and her newly emerging use of gesture) is plain to see.

The text to this clip is narrated by Learning Mentor Jo, who is working with Lucy. The comments in blue are feedback from school’s external RDI Consultant, Sharon, whose job it is to make sure we are keeping the guiding framework around Lucy so that she can step into her co-regulatory role and take advantage of the opportunities to master the milestones she has missed.

Jo’s footage commentary

0.07 I remove distractions and use facial expression to express “No eating”

0.10 We have been taking turns at stirring so I use non-verbal communication to wonder whose turn it is. Lucy social references me (looks to Jo to check Jo's understanding of her communicative intent, Ed)  

0.13 Lucy social references and uses gesture herself by pointing to herself to answer my question. This is the first time we have seen Lucy use gesture - so exciting! I nod and Lucy takes the green spoon for herself

0.17 Lucy chooses to also add the purple spoon for me (how lovely! - thinking about her communication partner’s needs)

0.19 I use non-verbal communication to ask what the spoon is for. Lucy social references me to check her understanding of my communicative intent. Agree - I also think there is a little bit of study response from Lucy as she sort of looks down before pointing to you as if thinking about what to do here. Study response = pausing to think about something before acting (Ed)

0.21 Lucy uses gesture to point to me for me to use the spoon, stirring together Great to see

0.24 Lucy says (really quietly) “Jo have the purple spoon” - clarifying that she wants to stir together. Here she social refs to see if you understood her or if she needs to do more – she is really taking on board her communicative responsibility here

0.28 I spotlight her thoughtfulness verbally

0.30 I use gesture. Lucy looks at my thumbs up but then becomes distracted by her thoughts.  I think maybe she doesn't know what to make of the thumbs up in the situation, I could be wrong?!?!?

0.34 I answer Lucy’s query

0.36 I spotlight and add an emotion and label how I am feeling (following recent feedback) Jo I think this acts as a nice spotlight for Lucy, she looks happy

0.47 I start a chant just as Lucy starts to say “need….” – showing she is thinking about what we need next. Here too she appears to be using study response.

0.52 Lucy verbalises “Jo get the baking tray”

0.54 I use non-verbal communication to spotlight her great planning

1.00 Lucy says “Jo get a case” This is lovely! The whole interaction is at a lovely pace that enables Lucy to really think about what is going on & have more agency (influence over what is happening between you in thought & action)

1.02 I use non-verbal communication to give Lucy the opportunity to communicate

1.03 Lucy uses gesture to answer my question Love it!

1.04 I leave to get the baking tray, I set limits

1.13 Lucy chooses to ignore the limits and scoffs a spoonful of the mixture! She appeared to think about this beforehand!

1.21 Lucy looking sheepish, knowing she had tasted the mixture

1.24 Lucy verbalises and uses gesture (pointing from the mixture to the tray) Brilliant - this is allowing Lucy to do even more problem solving!

1.27 Lucy acknowledges the next step: showing her independence and initiative, she social references whilst pointing to the cupboard where they are kept

1.29 I use non-verbal communication to spotlight Lucy’s competence

1.32 Lucy verbally communicates for me to get it

1.34-1.43 I am trying to use non-verbal communication to express to Lucy that I don’t know where the cases are in order to give Lucy the opportunity to help and be independent. Lucy verbalises “Jo get the case” 3 more times

1.42 I scaffold and verbally communicate as my attempts at NVC aren’t working Agree she needed this

1.49 I scaffold with “maybe we could look together….” and Lucy finishes my sentence “….for the case”

1.54 I use gesture (holding my hand out) to invite her find the cases together, Lucy joins me

1.59-2.06 I give Lucy the opportunity to find the cases and feel competent Good to see

2.08 I spotlight using non-verbal communication. I use thumbs up - Lucy doesn’t know how to respond so high fives my thumb

2.10 Lucy shows acknowledgement in that I had my thumbs up and walks back to the table mimicking my gesture (the first time I have known her to do thumbs up herself) YES!!!!

2.13 Lucy starts to put the cases into the tray on her own

2.16 I take control of the equipment (cases) and set up the roles so that I can enable us to co-regulate our actions

2.19 Lucy glances at the cases I am holding, maybe in response to them making a noise. I scaffold for the cases so that we can step into a co-regulatory role

2.23 I use gesture

2.26 Lucy passes me the cases in response to my low scaffold and non-verbal communication

2.30 I start our co-reg role set. Lucy accepts it and steps into it without a scaffold

2.34 I use a slow pace, Lucy uses gesture and social references for me to pass the case Looks good

2.37 Lucy says “flapjack” and I verbally answer her query

2.49 Lucy social references in response to my slow pace and prosody maybe?

2.55 Lucy uses gesture (thumbs up) on her own initiative to show she is ready. Wow!

2.57 I respond and return the gesture

2.58 Lucy social references and we are still in our co-reg role

3.03 I use a slow pace and Lucy social references

3.09 Lucy social references, I pass

3.20 I pause, Lucy verbalises and social references (even though we don’t have any white choc) I'm wondering if this was her way of asking for it, or querying whether it would go in?

3.26 I use gesture, thumbs down to show no white choc Good use of the opportunity

3.33 We step back into co reg pattern

3.36 Is this memory recall? I'm not sure that this isn't a little resistance to the pace or the doing together???

3.39 I encourage experience-sharing by using non-verbal communication to acknowledge I have heard her

3.41 Lucy looks to me to share experience

3.56 Lucy places the case down and then recalls one of her memories again about Saoirse

4.01 Another memory recall, with Lucy concentrating on her verbal communication and expanding her vocabulary.  She then social references - maybe after a response around her telling me her story?  Interesting, I'm again not sure if this is a form of resistance or if it could be that as the pace is slow it's enabling her to think about other things.  If this continues it might be a good idea to say 'let's place the cases & then talk'.  Then once you've talked take it back to the co-reg & so on.

4.10 I use non-verbal communication

4.11 Lucy responds by using her own non-verbal communication Jo this is great!

4.18 I use the thumbs up gesture. Lucy uses gesture to point to the bowl of mixture

4.24 Lucy verbalises “green spoon”. I invite Lucy to celebrate her competence with the co-reg role

Where to: This is definitely the way to move forward with Lucy, to open up a whole world of communication that may actually start to reduce her need for self-stimulatory actions, so more of the same on/off across the day. 

You may have to scaffold parts, as you have above around tying the verbal meaning to the non- verbal communication you are using.

Think about whether there's a need to set boundaries around off-topic talking (as it can become a distraction to your guiding goal) & then think about how you can slot short intervals in for Lucy to talk about off-topic things.

End of footage text.

It was lovely to share this at staff meeting last week and was a good opportunity for staff to see exactly how Jo facilitated Lucy’s NVC so that we can make sure as many staff as possible are able to have a go at this across the school day.

I’ll end by highlighting one of Sharon’s comments: ‘The whole interaction is at a lovely pace that enables Lucy to really think about what is going on & have more agency (influence over what is happening between you in thought & action)’

Increasing personal agency for the autistic person. That is at the nub of what RDI is all about.

Saturday, 21 January 2017

'Hanging out' and using non-verbal communication to facilitate emotional connection

I wrote my first blogpost about working with Saoirse at Bright Futures School here.

In this current blogpost, I'm sharing some footage of a session that Alex did with Saoirse.  On the day this was filmed, Saoirse came into school already dysregulated, and was quite difficult to engage in her earlier sessions.

Alex nails it here by taking all demands off Saoirse and just 'hanging out' with her in a guiding-friendly way.  She lets Saoirse choose her activity and finds a way to introduce co-regulation into the activity.

In the footage analysis below, Alex is in black and Sharon (our external RDI Consultant, who moderates and guides our practice) is in blue.

0.02 – prosody used to try to gain attention 

0.09 – “says flap” – something that S and I have done in the past when I tickle her (the tickly bird is coming)

0.11 – very brief glance as S takes the toy off me 

0.18 – looks to me and makes a “eee” sound – I don’t know whether S has remembered our tickle game or if she is just making noises

0.22 – emotion sharing with me? or simply inviting interaction from you because you are so quiet??

0.27 – S makes a verbal rhythm

0.29 – I repeat

0.30 – another glance in my direction

0.31 – S puts the toy down and it is quite loud and she references me

0.32 – I respond with facial expression

0.33 – S (I think) acknowledges this and says “ooo” which I repeat this looks really good, inviting the co-reg of 'you & me'

0.34 – S repeats pattern and looks to me again as it makes a noise

0.35 – as it’s the dragonfly again I say “flap”

0.37 – S moves the cat and I say “meow” – still trying to see if I’m allowed to join in

S then moves each toy again and I make the noise of each animal that is moved – S smiles at this but no referencing or emotion-sharing with me 

0.46 – S places a penguin – I have no idea what noise penguins make?

0.49 – S moves the penguin again

0.50 – more animal moves again so I repeat the noises this is a co-reg pattern with each of you having a role to play

0.56 – the penguin again – so I say “penguin”

0.57 – I get a reference – which makes me laugh as it’s as if S is saying – “come on”

1.01 – it did look for a moment that this amused? agree.

Alex what is great here is you are comfortable doing what seems like nothing with Saoirse, when in actual fact you are both interacting loads!  Just being happy in one another's company without a specific goal of getting something completed/done by the child is very hard for a lot of people to do.

About 5 minutes later, Saoirse copied what Alex started above, clearly seeking to initiate further experience- and emotion-sharing:

0.04 – S makes the noise “flap” as she puts the dragonfly into the house – I didn’t know if she was inviting me to do what I did previously? maybe

0.05 – I repeat and add gesture

0.08 – attempting engagement through prosody again

0.12 – my new ‘penguin’ noise

0.15 – “meow” – I am going somewhere with this – in my head – I was wondering if S would reference me if she later moved the animals and I didn’t say anything – to see if she was listening and enjoying the ‘involvement’ 

As S starts to remove the animals I again make the noises

0.22 – S emotion shares with me around the “flap” – again I think this is due to the tickly game we play 

0.23 – I add the tickle game gesture 

0.24 – really smiling – I think it is again about the tickle 

0.27 – this time as S places her animal she does look to me   Isn't that lovely... a real connection of 'if I do this, then you will do that'

0.29 – S doesn’t place an animal but references me and touches another one – I did not realise this initially - it's a JND!! (small variation) to the pattern.

0.31 – I catch on… “flap”

0.35 – S touches another animal and I make the noise – I do this for each animal in turn – no emotion sharing or referencing it all speeds up here & becomes a little more task focused from Saoirse which probably explains the lack of emotion-sharing and referencing.  

0.40 – I stop the noise as S touches to see if I do get the reference… no! that's exactly what I would do.... interesting, I wonder if that would still be the case on a good day??

0.45 – S slumps back in her chair – I do not know if this is because I didn’t ‘play’??? S then leaves the game herself, sits for a while before moving away  

Okay so this sounds like Saoirse simply doesn't know how to fix the co-reg breakdown so retreats.  If doing this again it might be worth playing with it a little more.... so instead of not giving a sound for any of the animals maybe add the silence for some & noise for others, so there is still a level of unpredictability re how you will respond, but not total withdrawal on your part because you aren't getting the social referencing

And Sharon's final comments:

I believe this is exactly the type of interaction that Saoirse needs, tiny baby steps - literally - to encourage her to be motivated to interact with another.  She needs to learn to trust in herself & in others before she will be able to develop her emotional interaction further. 
Keep on doing what you are doing would be my advice.  And do show these clips to others.  I did a similar thing with animals & sounds when I was at BF & started to get a reaction, nothing like what you got here.  But it was a way in, a way of making me be there not just the toys.
At the moment, Saoirse hasn't got the 'why bother' of interaction.  It hasn't clicked for her that other people can be fun and exciting, or that the things we can do together can make us feel good about ourselves.  It's early days and we are still building up trust with her.

Given that, I think you'll agree that the above engagement that Alex facilitated is excellent work :)