Thursday, 16 February 2012

Inhibition

Inhibition, in psychology, means the conscious or unconscious constraint or curtailment of a process or behaviour, especially of impulses or desires. Inhibition serves necessary social functions, abating or preventing certain impulses from being acted on (e.g., the desire to hit someone in the heat of anger) and enabling the delay of gratification from pleasurable activities. Conscious inhibition is a common occurrence in daily life and is present whenever two conflicting desires are experienced (e.g., the desire to eat a rich dessert versus the desire to lose weight).

In typical people, inhibition is a key executive control process that helps govern complex cognition and in turn complex adaptive behaviour. When response inhibition is functioning properly its contributions are not visible, because a successfully inhibited response simply does not emerge, at least not behaviourally. In autism, several types of behaviour are commonly observed that are suggestive of malfunctioning of response inhibition processes.

This study http://bit.ly/xwho9Y (Kana et al, 2007) looked at the functional connectivity between cognitive control in the prefrontal cortex and other brain regions using functional magnetic resonance imagery (fMRI).  The fMRI allowed researchers to see which brain regions were connecting to which other regions whilst typically developing people and people with autism were presented with conditions that required an inhibitory response.

The results showed a reliably lower degree of synchronization and coordination between key cortical networks in autism compared with the control group.

The research conclusion is that ‘the findings of this study suggest that in individuals with autism, inhibitory processes do not function as part of a coordinated and synchronized cortical network. Future neuro-imaging studies of autism may further modify this account, explaining the breadth and the specificity of the atypical inhibitory function in autism.’

This means that in the brains of people with autism, the neural connections required to manage inhibition were not as integrated as the brains of typical people.  So people with autism have to work much harder to inhibit a behaviour.

That is a pretty difficult challenge to be saddled with.  I’m just thinking about how many times a day I use my own inhibitory response – if I’m at work, for example, I’m using the response quite a lot to manage various frustrations – both major and minor – that occur throughout the day.  I can also imagine what would happen…….to my personal reputation, to my credibility as a professional, and to my ability to work productively with others, if those inhibitory responses weren’t working properly.

You can imagine then, the sorts of trouble and misunderstandings that people with autism, many of whom have an impaired inhibitory response, could get into.

So, what can we do?  Well in RDI, we are already working with our kids to increase the dynamic neural connections in their brains, so that’s a good start.  We do this by constantly engaging with our kids in a way that allows them to function as a cognitive apprentice to the adult’s guide, in the guided participation relationship (GPR).  I have written in detail here http://bit.ly/rSxB4E about how the interpersonal engagement that is crucial to the development of flexible thinking is supported via the vehicle of the GPR.

Philip and I have been working on low level inhibition for a long time.  My main tool (as his guide) has been my use of limit-setting and non-verbal communication in a relationship that has been nurtured so that he is emotionally invested in co-regulating with me.

That emotional investment is key, I think, as it gives him part of the motivation he needs to inhibit his distracting behaviours when we are spending time together.

Below is some footage of how I regularly use limit-setting and non-verbal communication to help Philip inhibit behaviours that are a distraction to our joint engagement.

In this activity, Philip is stimming on a particularly irritating song from the Spongebob cartoon.  I won’t give you a link to it as you’ll never forgive me – its clearly been specially designed to be irritating and is one of those songs that goes round and round your head all day that you can't get rid of.  He and Louis found a clip on youtube where the song is sung in German, which they found hilarious (they have been having fun listening to allsorts in all kinds of different languages).  Here he is singing his pidgin-Deutsch version.

This is quite a long clip, as Philip’s desire to stim with the song keeps recurring and I have to switch between different tools to manage it.

Usually stims don’t bother me and I just let him get on with them (many of them are a function of our kids’ bodies seeking the sensory input they are unable to obtain otherwise) – but with one as irritating as this that is clearly getting in the way of our joint engagement, I wouldn’t have been doing my job as a guide properly if I didn’t try to manage it.

video

At 0.34 – 1.25 we have the full rendition ('German' version) of the song.  I let that one play out, as I don’t know at this stage what the frequency of repetition is likely to be.

At 2.00 I give Philip a warning that I am going to ‘count’ him if the singing persists (counting is a limit-setting strategy taken from the book 1-2-3 Magic)

At 2.26 he leaves the room which is a reasonable enough strategy as he is being mindful of my dislike of the song

At 2.49 I do count him, as he has had plenty of warnings now

3.22 Another song is introduced.  Here he is being jokey and playful with the song singing, and I do share the joke to some extent, although my priority is to stop the singing altogether if possible.

4.20    I say I will stop doing the soup if he continues

I then do actually have to carry this through and ‘stop the action’, which enables him to re-engage.

I then introduce a conversation which distracts Philip from song singing.  The conversation goes on for about 2 mins.

So you can see, I have used different tactics several times in order to help Philip inhibit the song singing, which was getting in the way of our joint engagement.

Then out of the blue, he plays a joke on me.  This made me laugh out loud when I played the footage back so just for fun. I’m sharing it here.

video

He is a crafty little blighter!  I can’t help but admire his creativity and his sense of fun, even though he is pushing the boundaries J

Our current RDI objective is all about helping Philip to develop inhibition in more challenging circumstances.  We are using role play to go back over a recent situation where there was a challenge and a breakdown in communication as well as a breakdown in emotional regulation.  In the role play, we put the ‘thinking time’ in and generate options for different solutions before choosing a solution that doesn’t involve the forbidden or unhelpful action, and which avoids the consequence of the unhelpful action.

I’m not sure we can bring ourselves to have footage of this on the blog.  We are both feeling pretty self-conscious about it at the moment (no Oscars for us!!) but I guess we may change our minds once we are more used to it.

Would love to hear from other people who have used different strategies to help support inhibition and emotional regulation.


 
 

2 comments:

  1. Zoe, with my own daughter I looked at this a little differently. With setting limits I used this around anything that I felt she needed to know wasn't allowed whether she was or wasn't with me (or anyone for that matter) - a behaviour that needed to stop altogether at all times.

    She used to get very easily distracted by seeing her own reflection in a mirror or in a window & initially I managed that distraction for her by making sure she would have her back to those, but eventually she needed to be the one that 1) recognised that she was becoming distracted & 2)managed the distraction herself.

    My viewpoint, & maybe others see this differently, of what is happening with Philip in the first clip is that he is distracted by his own thoughts & that he also needs to have 1 & 2 in place to realise that it may be okay to do the singing when his concentration doesn't need to be elsewhere, a case of appropriate vs inappropriate.

    With Lissi we approached this in a couple of ways - by modelling our own distraction 'oops I'm starting to sing & dance when I should be cooking' said in a jokey self reprimanding way. By helping her realise she was distracted 'I know you can see yourself but we are doing ..... now' & then pausing to allow her to re-join.

    Just sharing what worked for us :-)

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  2. Thank you Sharon - yes, I had missed that.....I went into 'limit-setting' mode!! I think you are right - I need to work on supporting him to take responsibility for managing his own distractions. I'll try helping him by using declarative language to label what he's doing and pausing as you did with your daughter.

    Thanks for the tip :)

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