Saturday 1 February 2014

The 'goal beneath the goal'

I am excited to be able to share with you some footage of Ben, one of our pupils at school, with kind permission from Ben himself and from his parents. 
Here is a 2 min clip of Ben before he started his placement at Bright Futures School.  This clip is from February 2012, with the white table in shot. 


Ben is hardly looking to me at all (social referencing) for the information in my facial expression that will help him to understand my thoughts and intentions. He is competent at doing the task but he is not emotionally connected to me.  I am having to talk a lot to ensure that he understands.  It doesn’t feel like there is much reciprocity in this clip and neither of us seems very comfortable.
In the second clip, I am working towards Ben being able to take more emotional responsibility for the interaction, including re-engaging me if I withdraw (e.g. if I was tired, lacking in enthusiasm etc).  In order to do this, I first want to make sure Ben is competent and comfortable with reading all my non-verbal communication so in this clip, I am continuing to isolate communication channels and work on each of them separately.  Here I am using prosody (communicative noises) as the main communication channel in order to continue to expand Ben’s ability to read the whole communication package when interacting.  This includes facial expression, gesture, body proximity as well as prosody, and of course, speech.  Most children with autism rely on the spoken word.  80% of communication is non-verbal, therefore they miss a lot of meaning!!
The non-verbal communication is what holds the ‘intention’ of the communication partner.  It holds the whole range of emotions that tell us what our communication partner is really thinking.  If we can’t ‘read’ non-verbal communication (NVC), we are going to have a lot of difficulty understanding other people.
Not only does Ben read my NVC, he actually uses it himself quite naturally and spontaneously….and his use of it is spot on J Compare this to the first clip and you’ll see how far he has come.
As you know, social referencing is also key to communication.  Here I wait for Ben to reference me before taking many of my actions and Ben reciprocates at different points by referencing me to ‘check in’ to see whether his own actions are on the right track.
In this clip (from last week), Ben is increasingly looking for my emotional reaction to things.  This means he is interested in my perspective and my views about what should or shouldn’t happen.  Taking on board other people’s perspectives and being able to adapt to them is what helps us become flexible in our thinking and therefore adaptive in our behaviour.
I am quite animated in my interactions with Ben because he is the sort of young person who responds well to this.  I wouldn't necessarily be the same with other all depends on what is appropriate for them individually.
The clips:
Clip 1 I set up that I am going to use prosody.  There is no expectation for Ben to mirror this.
Clip 2 I start off using prosody
Clip 3 Cutting the butter - I give Ben the butter and wait.  He references (refs) around what to do with the butter and I use prosody to clarify.  He refs again around what to do when it’s on the scale, I use prosody again and B mirrors the sound I make to emphasise.  He figures out it’s too much and goes to get a knife
Clip 4 Checking the weight of the butter....I hesitate, Ben uses prosody, I re-test the scales, Ben uses prosody again with gesture and refs, I confirm.
Clip 5 Ben gets the bowls, refs and uses gesture to check if it’s what’s wanted – lovely use of referencing and gesture by Ben.  I use prosody to turn him down and then hold up the butter.  I look at the cooker as a clue which shows he also uses facial ‘eye pointing’ as a means of understanding another's communication (we need to melt the butter) and then Ben gets up to problem solve by getting a pan.  This is a great example of reciprocal non-verbal communication between the two of us that Ben would never have been able to do when he first started with us at Bright Futures.
Clip 6 Chocolate!  We scoff a naughty piece and there is some great reciprocal facial communication here.  Ben also starts to initiate looking for my emotional reaction/ perspective at 3:37 when he picks up the packet & makes a noise. 
I use prosody to set up a throwing rhythm.  I vary the rhythm and then let Ben lead.  He goes out of turn and I spotlight this, he laughs at his own mischief.  You can see him self-regulating around his cheekiness too, wiggling fingers, a little disconnected.
I let him know its ok for him to go and he goes. I vary the rhythm again and we share emotion about the piece getting stuck on the butter.  Just before this at 4:43 he is struggling to break the chocolate & he is expressing this non-verbally.  He doesn't look for my emotional reaction here, although he does while placing pieces back on the wrapper & I give a smile.
He is adding some great variations in this clip, showing his increase in flexibility and in initiating and accepting new ideas.  Variation (including looking at different options for how to do something) is key when using RDI.  Lots of other approaches recommend routine and structure.  Here we have a structure (I have set up or 'framed' this activity to work on key developmental goals, with specific complementary roles for each of us)....but within the framework there are plenty of opportunities for variation.  We're not rigidly following a set routine - we're improvising, elaborating on each other's ideas, adapting in the moment to our joint appraisal of what we can do together.  Because of this, Ben's ability to be flexible in other situations and other settings is improving. 
Clip 7 Ben has an idea (variation) re the eggs - I go with it.  We work together to separate the eggs. Ben gives me a nice gaze shift when doing this.  We have an accident on the second one as it doesn’t separate.  The third egg is also tricky but we manage it and share emotion around our success with 'egg juggling.'  This is a real 'we/together' moment!
Clip 8 Ben pours too much xylitol and I spotlight this.  He resolves it using gesture and facial expression.  His use of non-verbal communication here is excellent and again something he wouldn’t have done when he first started with us.
Compare the feeling of connectedness in this second compilation of clips to the first clip.  In the compilation, we are really having fun, working together as a team, able to accommodate each other's variations (and turn-downs) and there is just a significantly greater feeling of togetherness.  Our activity goal is to make buns, but the more important goal (the 'goal beneath the goal') is for me to use the secure emotional connection I have established with Ben and use it to work on key developmental milestones. 
Thank you RDI.
P.S. Anyone who has been following the story about unfounded allegations of Fabricated/Induced Illness being used against families of children with autism, look out for an article in the Mail on Sunday tomorrow.