The 'why bother?' and autism

Last week I attended the Advanced Seminar training for RDI ® Consultant trainees, which took place over 4 days in London.  It was a thoroughly invaluable and enjoyable experience on many levels.  Several things stood out for me but the biggest take home message came from watching an RDI  ®assessment unfold over the course of 2 days.  The goal is to assess the current state of the 'guiding' relationship between each parent and the child - to what extent are the parents good guides, how can they improve; to what extent is the child able to take on the role of 'apprentice' within the guiding relationship, how can any obstacles to apprenticeship be addressed.  This special guiding relationship has been shown to be universal to every culture throughout the world - it is the process through which typically developing children develop flexible, adaptive thinking.  If this guiding relationship gets derailed (as it does in autism) then the child becomes a rigid thinker who has difficulty adapting in the face of uncertainty and change.

In the assessment, each parent takes part in different activities with the child.  The activities involve interacting together with either balls or drums, doing a puzzle of some kind or building a house of cards together, and looking at either personal photos or interesting pictures together.  The activities are filmed and from them, the Consultant is able to rate to what extent the dyad (pair) is socially co-ordinated (co-regulation), how they are collaborating (working together as a team) and whether the child is either initiating and/or responding to joint attention.  Lots of other observations are made but those 3 are the broad headings for parent/child interaction that help to assess the state of the guiding relationship.

The Consultant then develops a hypothesis about what the possible obstacles to co-regulation, collaboration and joint attention could be and tests this out in a further assessment that takes place with the Consultant interacting with the child.  Watching our Consultant trainer (Jessica Hobson) interact with our child was poetry in motion as she playfully segued between one activity and another keeping the child within her framework whilst allowing him to contribute variations and elaborations to the different games they were making up with the objects she had provided.  At the same time Jessica was skilfully and quietly testing out our hypothesis....no mean feat when you are working with a child who is primarily motivated to be 'on his own agenda'.

As a trainee group we had decided, after considering the current progress of the child in question within his own RDI ® home programme and what we had seen in the first part of the assessment, to look at his ability to respond to or initiate joint attention.

To recap – joint attention is when one person borrows the perspective of another’s mind in order to enhance their own ability to obtain meaning (I’m not clever enough to have created that explanation, I nicked it from The Master - Dr Gutstein J).  So it involves a child looking at something interesting (the referent), pointing to it and looking towards the adult to make sure that the adult is looking at the referent…but its not just the pointing and looking back that’s important, it’s the fact that the child is interested in the adult’s reaction to the referent and will then use that reaction to inform their own decision about (and response to) the referent.

Researchers have concluded that joint attention is a pivotal skill in child development http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1693124/pdf/12639329.pdf

and that individual differences in joint attention are related to the intensity of social symptoms, responsiveness to interventions, and long-term social outcomes in children with autism.  So, joint attention is pretty important.

Here is an example of joint attention in a typical child, a child with Down’s and a child with autism:

At 1 min 43 we see the typically developing child begin to respond to joint attention – the object/focus of the attention (referent) is the strange toy.  The child borrows the perspective of the adults to decide what her reaction to the toy should be.  The adults react with fear, and so the child processes their emotional response and has a fearful response of her own – at 1.59 she cuddles close to the adult and looks as if she wants to be picked up out of the way of the toy.  The response of the child with Down’s Syndrome is lovely – he boots it out of the way (my hero!) and then reassuringly says ‘all gone’ (what a sweetie!).  The child with autism ignores (or is not interested in) the reactions of the adults and plays with the toy….he doesn’t respond to the joint attention that the adults initiate.

In our live training assessment, we saw our child respond to occasional joint attention bids by his Mum during the different activities….but nowhere near the level of joint attention response you would see in a typically developing child.  He didn’t initiate joint attention either until the very last activity when he was looking at interesting pictures with his Mum.

So we knew he could both initiate and respond to joint attention….we just needed to figure out why he wasn’t doing more of it.  The hypothesis we developed was that our child didn’t have what we call the ‘why bother’ during most of the activities – he wasn’t motivated to seek the perspective of his Mum in relation to the referent.

This then fell into place for me with something that Peter Hobson had said in last year’s RDI Beginners Seminar training – that as humans we are biologically predisposed to engage with other people. 

Recent research on twins in utero entitled 'Wired to Be Social: The Ontogeny of Human Interaction' confirms this idea: the performance of movements towards the co-twin was shown to be deliberate - already starting from the 14th week of gestation twin foetuses execute movements specifically aimed at the co-twin (Castiello et al 2010).

From an evolutionary perspective, being hard wired for social engagement makes sense – interpersonal engagement confers huge advantages on the human race.  A simple example of this is that in working as a team (which requires cooperation, collaboration, and co-regulation in order to be successful), people can achieve much more together than they can alone.

I remember Peter talking about ‘the grip’ that one mind has on another’s and that in autism, the ‘grip’ isn’t absent, but that it is fragile.  This was exactly what we were seeing during our live assessment – fleeting, fragile joint attention –  with more occurring when the child was intrinsically motivated to share and use the Mum’s perspective regarding the pictures.

What was it about the pictures that motivated him to share his experience and seek Mum’s perspective so much more than when they were doing a puzzle, playing ball or building a house?  And how could we facilitate his ‘why bother’ and ‘the grip’ of his Mum's response to the pictures so that this was embedded within other activities?

To be continued…….as always when I write my blogposts, I am embracing my inner vampire.  It's 2am and I must go to bed....