Saturday 26 November 2011

Unconditional love: Gentle Teaching

I'm in blue type here, as there's going to be two of us in this blogpost.

I am lucky to be part of an international community of RDI Consultants and trainees, many of whom are qualified not only in RDI but also in other complementary approaches, methodologies and professions.  We have Educational and Child Psychologists, Speech and Language Therapists, HANDLE Consultants and autism parents, to name but a few, in our midst.  Our community is a fantastic resource to be able to dip into – we all share a website (the RDI Platform) where we can communicate with each other and draw on each others’ experience and knowledge, sharing views as well as video clips, updates on new research and webinars.  And we often do draw upon each others experience – because the families we are supporting have children and adults who have a diverse range of needs.

Brendan is a fellow RDI Consultant based in Gloucestershire, UK, who has found Gentle Teaching to be an excellent resource for supporting people whose behaviour can be challenging.  Here, Brendan (in black type) introduces us to Gentle Teaching:

My aim here is to simply give you the flavour of Gentle Teaching, not to explain it in any great detail. I have tried to keep my writing to a minimum here as Gentle Teaching is best understood by watching it in action. All in all, this post will take up about twenty minutes of your time, so grab your favourite tipple and relax.
Originally conceived in the late 1970’s, Gentle Teaching is a relationship and development-based model for helping those in need. Relationships are the main foundational elements of all goals. Skill acquisition and behaviour are seen as by-products of a much broader process: that of teaching the person to experience and reciprocate feelings of emotional and spiritual connectedness with others. As you read on and view the video clips, those of you familiar with RDI® will no doubt see the obvious parallels between the two approaches.
Gentle Teaching is part philosophy - part intervention. Care-giving is seen as a subjective act with each person bringing his or her own unique set of values and beliefs to any interaction. Through a mentoring process, caregivers are empowered to use their personal gifts and abilities to help guide the vulnerable individual towards feeling a sense of belonging, companionship and community. Gentle Teaching is not a scientific endeavour in any respect and, because of the number of variables involved; it does not lend itself easily to scientific research.
The main strategy of Gentle Teaching, as silly as it may seem, is unconditional love. The focus is on four essential domains that need to be intentionally taught to the vulnerable person. These domains are:
1.    To feel safe
2.    To feel loved,
3.    To be ‘loving’ (i.e. to be able to reciprocate these feelings)
4.    To be engaged (i.e. to be an active participant in one’s own life project)

As part the mentoring process, caregivers learn to teach the above developmental domains using their ‘tools’:

1.      Hands
2.      Words
3.      Eyes and
4.      Presence

Have a look at this clip to see the process in action between typical parents and their infant children.

Central to all dialogues is the simple message that “You are good and I am good”. Many children and adults requiring support get stuck in the ‘terrible twos’. Over time, as the individual begins to feel very safe and very loved, caregivers gently ‘stretch’ him through those terrible twos. Gentle Teaching does not follow a step-by-step development model. Rather, the domain of safe and loved is at the core of the human condition and the other domains radiate outwards from it. At any time during our lives and through no fault of our own, this central domain may become broken or very fragile. For example, when a mother loses her baby, those close to her will provide her with the extra love and attention she needs to feel safe and loved again.
I have picked the following clip as the young man featured presents some particular challenges that make it very difficult for his caregivers to value and honour him unconditionally. The clip also features Dr John J McGee, the founder of Gentle Teaching and a little Eminem!

If you are still awake and with me (!) this third clip features David. David runs around and around. He is like a bird that continuously flits from one branch to the next. When caregivers place demands on him he can become self-injurious and aggressive. In this clip you will see John working to establish co-regulation with David.

That’s about it! However, before I go I must express my thanks to Zoe for this opportunity to share Gentle Teaching with you all. I am happy to answer any questions and/or provide more information as required. Please feel free to contact me at any time:
Brendan’s web site is
Thanks Brendan J

Tuesday 22 November 2011

IEP? Time to get your underpants on over your trousers.....

As discussed in my previous blogpost, the Individual Education Plan (IEP) is the main mechanism for monitoring and reviewing progress against agreed targets.  What seems to me to be crucial about the IEP is that meaningful, realistic targets are agreed with parents at the outset and that a timescale clearly details the period during which interventions will be monitored as well as a date at which progress in meeting targets will be reviewed.

This is the IEP that was drawn up for the elder of the two daughters whose Mum we are supporting.

Success criterion
He will understand and respond to facial expression and body language
Appropriate response seen on 10 occasions
Modelling expressions
Using emotion cards
He will use appropriate language in conversation
Appropriate use of language seen on 10 occasions
Role play appropriate use of formal and informal language
He will work well as part of a team
Seen to work co-operatively with others on 10 occasions
Set group tasks and place child in group

*Nothing was recorded in the ‘outcome’ column

What strikes me about this is the extent to which parents are at the mercy of the school.  If parents aren’t used to report writing or developing and reviewing planning documents, how can they be expected to critically analyse an IEP to make sure it makes sense?  If you are a parent in that situation, you trust the school and the SENCO to be doing their jobs…..clearly though, this school wasn’t up to the job.

One of the first things you will notice is that the document – the IEP of a girl – uses the pronoun ‘he’ throughout.  This probably tells you all you need to know about the level of care and attention used in developing the document and the commitment of the school to addressing this child’s needs L
There are other causes for concern, for example, the targets themselves are so general as to be completely unachievable. I would suggest that they need to be broken down developmentally to focus on the component parts that make up the whole, one at a time.  So, for example, ‘working well as part of a team’ depends upon mastery of competencies such as social referencing, co-regulation and joint attention (see previous blogposts).
In typical children, these developmental steps take years to master and the ultimate goal (teamwork) will not be achieved unless the foundational steps that underpin it are sufficiently mastered.  I call this ‘Vygotsky’s Law’ after the father of developmental psychology who introduced this concept.
We know that social referencing, co-regulation and joint attention are all impaired in autism, so we can see that ‘working well as part of a team’ makes no sense as a target for a child who does not have the lower level competencies in place.  The same could be said for the other two targets, as both of these require underpinning competencies to be in place.
In terms of the interventions suggested, I am not aware of any research (peer reviewed or otherwise) which demonstrates that any of them would successfully address the difficulties outlined.  For example, I know of no studies showing that using emotion cards helps a child with autism either to respond better to facial expressions or to improve their social communication (which is the ultimate purpose of being able to read facial expressions – it is not an end in itself).  Recognising facial expressions from a card or from the face of an animated train is one thing, but using the information transmitted in a facial expression to inform thinking and action is quite another.  I’ll quote from one of my favourite people with autism, Janine Collins, Research Associate, University of Maine, who reinforces this point when she writes, ‘Methods of teaching proceed as if being able to state, identify a statement describing, or select a picture depicting when and where to use a skill is the same as being able to actually initiate the skill when needed. This allows for no real way to build one's capacity to deal with social nuance and novelty.’
Then there is the issue of measuring progress.  The success criteria given in the IEP above are pretty meaningless.  Increases in frequency of a behaviour tell us nothing about whether the child exhibits the behaviour consistently across various settings and contexts (i.e. in different environments with different levels of challenge and with different communication partners). 
David Sponder, an RDI Consultant, Educational Psychologist, and Board Certified Behaviour Analyst (BCBA) gave an excellent webinar about measurable outcomes (archived on the RDI Platform for those of you with access to it).  Here is an abridged example he shared comparing measuring progress in developing joint attention by increases in frequency of a behaviour vs. measuring progress by using ‘foundation and elaboration’. 
Measuring by frequency
·        Benchmark 1
‘Student will demonstrate evidence of receptive joint attention 2/5 opportunities during periods of unplanned, unstructured social interactions with age mates each day for a period of 3 weeks.
·        Benchmark 2
‘Student will demonstrate evidence of receptive joint attention 3/5 opportunities during periods of unplanned, unstructured social interactions with age mates each day for a period of 3 weeks.
·        Benchmark 3
‘Student will demonstrate evidence of receptive joint attention 4/5 opportunities during periods of unplanned, unstructured social interactions with age mates each day for a period of 3 weeks.
Measuring by ‘foundation and elaboration’
·        Benchmark 1
Student will respond to joint attention by focusing on the shared referent when the communication partner engages the pupil directly.
·        Benchmark 2
Student will respond to joint attention by focusing on the shared referent when the joint attention bid is expressed to a group and not directly to the pupil.
·        Benchmark 3
Student will respond to joint attention by focusing on the shared referent when the joint attention bid is expressed to a group and the pupil overhears it or oversees it.
We can see that the ‘foundation and elaboration’ measures give us far more information about the level and quality of mastery of the developmental milestone of responding to joint attention. 
If we look at autism from a child development perspective, we can see that the IEP targets do not take account of the underpinning competencies that need to be mastered in order to facilitate the emergence of the desired skill.
We also know that there is a lack of evidence to support the efficacy of any of the proposed interventions.
This IEP hasn’t really got anything going for it at all……..yet it has been submitted to a panel of experts and the panel has used it to help them conclude (with nothing recorded in the ‘outcomes’ column) that this child’s needs are being met at school.
It really is a system that is heavily loaded against parents………where a school is not cooperating with a request for statutory assessment and/or in developing, implementing and monitoring IEPs, think how much knowledge, perseverance, assertiveness and organisation it takes for parents to be able to make sure that the school is doing its job properly, not to mention the emotional resilience needed to keep on fighting your child’s corner in the face of professionals and so-called ‘experts’ who are not on your side (and are often being defensive about their role).

You really have to have your underpants on over your trousers to be on top of all that…………..