More on reflex integration in autism

As a result of my two last blogposts, there has been some interesting discussion about how impaired reflex integration may contribute to the child with autism not being able to give the parent the feedback that is necessary for the parent to know where to pitch the tiny interpersonal engagement-related challenges that are so key to development of thinking in the very early stages of baby-hood.

It is the breakdown in this crucial feedback loop that prevents the guided participation relationship from acting (via interpersonal relatedness) as the 'cradle of thought'.

I’m including here some further observations by Kimberly and Claire on how reflex integration may contribute to the breakdown in the guided participation relationship.

First, over to Kimberly:

Our discussion has made me think differently about remediation. It makes sense to me to start with the reflexes first, make sure that they are firmly in place and work up the brain stem just how it happens in normal development. In normal infant development it is movement that integrates the reflexes.

Take a look at just one movement - the belly crawl. Just some of the things it can do for the infant: stimulates horizontal eye tracking, early head movement helps the skull to round out, stimulates the nerves that go to the muscles that pull the eyes into correct alignment (in the case of crossed eyes or over convergence), helps with heel to coccyx alignment, strengthens the arches in the feet, promotes cervical and lumbar spine stability, and neck strength, so helps the development of the mature s curve from the infant c curve, makes the child aware of the genital area through ventral stimulation, and helps with on time toilet training, stabilises the hip sockets, helps with the supination and pronation of the lower arm, helps the hands to open out from the grasp reflex to eventual cortical control, creates a feeling of vertical throughness which helps the child to feel grounded, is the first self determined movement, seems to be connected with brain stem development, and functions that ensure survival: accurate perception of pain, heat, cold and hunger, builds a sense of self, and is the basis for development of empathy and compassion. You can deduce the implications of missing out on building these foundations (source Bette Lamont Developmental Movement Center, Seattle).

I'm trying to put together a website with all this information and my thoughts on remediation after doing everything wrong & backwards, but here are a few of my favourites. There's a chart on Goodchild's (Neurological Reorganization) website gives you a basic idea of the brain stages and how it affects sensory and motor development:

http://www.activehealing.org/HTML/howitworks_ontogeny.htm.

I love Sally Goddard's book (INPP) "Reflexes, Learning and Behavior" for a more thorough explaination. A quick overview can be found at Sonia Story's (Rythmic Movement Therapy & Brain Gym?) website http://moveplaythrive.com/images/pdf/integrating_reflexes.pdf and Svetlana Musgatova (MNRI) has some ways to learn more at http://masgutovamethod.com/learn-more.

There's a lot of information out there even though it comes from different camps and there are even more out there. It really makes sense to me. It's just hard finding people who really know thoroughly about all this near me. We have been doing NR for a little over a year. It is so slow. It is not uncommon for kids to take 3 years in the program with the average being 18 months. I have seen minor improvements but I stick with it because I often hear from NR graduates that sometimes it just clicks one day. I might have chosen the slowest method, but for right now it is the cheapest. So RDI is technically on hold until NR is finished but as always we continue the RDI lifestyle and higher level skills.

For my son to be fully remediated we will need to get the vision piece down and I thought if I am going to work on one area I should make sure all are solid. I was surprised to find that out of 9 basic reflexes, 8 were not fully integrated/developed. I think it is amazing how far he has come having to work extra hard to compensate. Our kids are amazing! -Kimberly

Kimberly, I’m really looking forward to your web site, and thanks so much for your insightful contributions to this discussion.

Now, over to Claire:

Hi Kimberley

I think Dr Gutstein used to refer to “obstacles” that impeded the progress of RDI programmes.  Issues such as you describe clearly fall into that category. 

I agree with you that RDI works principally at the cortical level of the brain and that neuronal connections in the cortex are made at a developmentally later stage. As you suggest, reflex development is involved in the development of the “lower” parts of the brain – including the brainstem and cerebellum and limbic system.  These systems are involved in getting on with what should be “automatic” functions like balance, co-ordination, sensory modulation, emotional regulation.

Just to give a couple of examples to illustrate – though please bear in mind that it is always somewhat artificial when you extract elements from a complex, interdependent system!   Firstly you mentioned your son’s problems with vision.  Reflex development is directly associated with the development of all the visual skills I wrote about previously – fixating, tracking, shifting from near to far vision etc.  For instance if the Moro reflex is not inhibited at the typical age of 2 to 4 months the infant will continue to be drawn to movement and light in his/her peripheral vision.  If the ATNR reflex is not inhibited by about 6 months tracking across the midline will be very difficult.  IF the STNR reflex is not inhibited to allow the infant to crawl properly accommodation (switching from near to far vision) will not be learned as it should.

As a second example – returning to the Moro reflex – if this is not inhibited at the appropriate stage then light and movement in peripheral vision (amongst other stimuli) will continue to cause a startle reaction.  The infant may develop all sorts of coping strategies.  You may see “body armouring” – ie being rigid and tense to prevent responding physically to constant stimuli that startles.  In your son it may be that – and this is just one suggestion – that he has learned to narrow his field of vision because he is so distracted and disturbed by his peripheral vision.  In other words he is trying to reduce his exposure to the anxiety caused by specific visual stimuli that triggers the startle reaction.  The startle reaction involved in the moro reflex is very different to the adult startle reflex.  In the adult something causes them to startle but then they pause, orientate to assess the significance of the stimuli (ie is it dangerous, unpleasant, important) then either ignore it or take appropriate action.  In young infants or people where the moro is still active the reaction is an emotional one.  The cortex does not immediately  kick in and say I don’t’ need to worry about that its not important.  Clearly, in autistic children, the cortex often/always kicks in later but it is too late as the intense emotional response (and sometimes “impulsive” or automatic response) has already taken place and the memory laid down that that stimuli creates a very unpleasant response that is to be avoided at all costs. 

If you look up Joseph le Doux who writes about the “emotional brain” he essentially summarises mental wellbeing (like “emotional regulation” in autism) as being about the connection between the cortex (thinking brain) and the lower parts of the brain (like the amygdala).  In a healthy well regulated system sensory stimuli is sent to the cortex for analysis so that the emotional response and the course of action taken is in proportion to the significance of the sensory stimuli.  In our children the connection from lower to higher brain is too weak and/or too slow – so you get an unregulated emotional response and an impulsive course of action.  Hence you can see how important it is that reflex development enables the lower brain to function automatically, thus putting in place the foundations for the development of the cortical brain and the effective interaction between the two.

Thank you Claire and Kimberly.  I have learned so much from this exchange via my blog. 

Reflex integration is definitely something I now want to explore more through school www.brightfuturesschool.co.uk and school will be commissioning Claire to come over and do assessments on those of our pupils who will find it easiest to engage in the assessment and subsequent exercises.  I think also that between us, me and Claire might think about blogging here about what the findings are, what treatment/exercises are recommended and what our progress is.

Watch this space!

Reflex integration and autism

In my last blogpost, I looked at the implications of autism being viewed primarily as a disorder of interpersonal relatedness.  I noted that taking this view gives us an explanation as to why the triad of impairments occur together - because good social interaction, communication and flexibility of thought and imagination all develop as a result of the interpersonal experiences and communication shared by child and caregiver in the early years.

One of my readers asked an excellent question in response to the blogpost:

'How does all this fit in with reflex integration that so successfully helped my autistic son?'

I responded by saying that I don't feel I have sufficient expertise to answer that question, but I know a woman who does.  I'm handing you over now to my good friend and colleague Claire, who very kindly gave a detailed response that I have decided to feature as a blogpost, rather than hiding it away in the 'comments' section.

Claire's response

Hi Motivatedmum

I’ve just qualified as a neurodevelopmental therapist (INPP) so am delighted to hear that a reflex integration programme made a real difference for your child.  It would be interesting to hear more about which programme you followed and what differences it has made for him.

I’ll attempt to answer your question about how this might fit in with Zoe’s post about autism potentially being reversible if you work on what Peter Hobson describes as a disorder of interpersonal relatedness.  But please bear in mind I’m hypothesizing based on what we know about autism and neurological development.

I think Peter Hobson accurately describes what happens developmentally in all those on the autistic spectrum.  In simple terms the guided participation relationship between the child and the caregiver breaks down resulting in the range of symptoms/behaviours we broadly recognise as “autism”.    This clearly occurs in every case of autism.  Outside the scope of Hobson’s work though is the question of why this relationship breaks down.  And the answer to that is that there are doubtless a number of 'reasons' – 'reasons' that we may later come to recognise as the different 'causes' of the various phenotypes of autism. 

Zoe highlighted a couple of potential 'causes' in her post – the absence of vision which is key in developing  the infant/caregiver relationship and the absence of a “caregiver” in cases like the Romanian orphans.    The latter is somewhat different to autism as the breakdown in the relationship occurs on the caregiver side of the equation.  In autism and a subset of (not all) visually impaired infants the breakdown occurs because of disordered functioning on the part of the infant. 

Of course there are many other reasons for this relationship breakdown.  Based on what we know now we are likely to identify other causes in atypical immune responses, environmental “toxins”, atypical sensory functioning etc.   Theoretically once we are able to identify and address the specific cause of someone’s autism we can “cure” it – if I can use that term without being pilloried.  So, for instance, if visual impairment lies at the heart of an individual’s autism restoring sight would “cure” the autism – but only, of course, if the “cure” is applied at developmentally the right time.    In the case of vision the right time developmentally would be no later than the time of birth as vision plays a critical role in the development of the interpersonal relationship from that moment. 

If vision is restored later in life or at the point when the visually impaired infant learns to use other sensory systems (auditory/tactile etc) to develop the interpersonal relationship his/her development will already be seriously delayed and/or disordered.    One of Zoe’s points is that approaches like RDI that work on establishing the interpersonal relationship can be used effectively in either case (ie either if the cause of autism is addressed later in development or even if the cause is never addressed). 

As for reflexes specifically  and how this fits in I think that the issues an effective reflex integration programme addresses are potentially involved in one or more “causes” of autism.    There is a “blueprint” for the development of our reflexes.    Deviation from that blueprint can result in a whole range of cognitive, physical, communication, social, emotional, sensory dysfunctions.  In simple terms the stages of reflex development that we go through – before birth and in those very early months – entrain the many functions of the brain that need to happen “automatically” if we are to function effectively and efficiently.   So for instance typical reflex development leads to a fully functioning visual system (ability to fixate, to track across a page, to follow a moving object visually, to switch from near to far vision, to switch attention from one object to another, to block out peripheral visual input and focus until such time as you need to take in peripheral input etc etc).   These are all skills that should happen automatically.  In cases where the typical reflex development has not occurred much of the brain’s energy will go towards performing what should be automatic, thus reducing the capacity and the ability to perform higherfunctioning “thinking” skills like academic skills, executive functions, problem solving etc.   This creates a very stressed neurological system and a very stressed individual.  A person with such visual problems will not be able to recognise “patterns” and make sense of visual input, they will be drawn to non significant objects/ people in their environment, they will not be able to deal with new situations .  If you want to examine one specific aspect (why aren’t autistic infants addicted to facial gazing) it is likely they may not be able to fixate (so how could they be addicted to faces as is necessary), they are likely to be drawn to visual movement (hence look at mouths that move more than eyes etc). 

The problems associated with  vision are similar to all the other senses (auditory/tactile/proprioceptive /vestibular ) but I don’t have space to expand here.   

So clearly if such problems lie at the heart of an individual's autism, addressing reflex development is key.  But, in addition, using  an approach like RDI to help to re-establish a more typical developmental trajectory as underpinned by interpersonal relationships is also important. 

I’m not sure if that helps at all.  Let me know!

End of Claire's response

If anyone would like to know more about reflex integration and development and how movement feeds the brain's development, Claire has kindly offered to write a follow-up blogpost to explore this in more detail.

Click this link for more information on INPP and how to find a Practitioner.

And a big thanks to Claire for her guest post :)

Is autism primarily a disorder of interpersonal relatedness?

A short post today in response to a new piece of research that adds weight to a major theoretical plank that underpins Relationship Development Intervention (RDI) as an intervention for autism.  

'The Cradle of Thought' by Peter Hobson develops the proposition that autism is a disorder of interpersonal relatedness: something interferes with brain development early in life which derails the typical developmental process.  In typical development, we know that flexible, adaptive thinking (and therefore flexible, adaptive behaviour) develops through the social interaction (interpersonal relatedness) between the child and his/her caregiver.

  

One of the many things that I like about the Hobson hypothesis is that it gives us a unifying theory for the triad of impariments: good social interaction, communication and flexibility of thought and behaviour all develop as a result of the interpersonal engagement that takes place between child and caregiver in the early years.  Studies in the fields of child psychology and child development have shown us that social referencing, joint attention, joint engagement, theory of mind, executive functioning, perspective-taking, the 5 stages of intersubjectivity and many more key thinking competencies all develop as a result of this interpersonal engagement in the early years.  

Without mastery of these developmental milestones, there will inevitably be impairments in social interaction and communication plus rigid and repetative behaviours.  These milestones are what enable us to take different perspectives, understand others, contrast our thinking to theirs, think flexibly and to cope with (and enjoy) change and uncertainty.

Earlier today I was introduced to a study (thank you fellow blogger Paul Whiteley) 'Reversible autism and intellectual disability in children' which appears to provide further support for the theory of autism as a disorder of interpersonal engagement.

I was particularly struck by the evidence in the study for early institutionalisation and blindness as 'causes of autism in a minority of cases' and the 'reversibility of autism' in these cases.  The 'Cradle of Thought' also studies children from these sub groups.  In 'Cradle', in the majority of cases of children in these sub-groups, children no longer met the diagnostic criteria for autism when the institutionalised children (who suffered social deprivation in the orphanages of Romania) were re-habilitated (via interpersonal engagement) and when the blind children found ways to link with other people on a personal level (lack of sight was found to be a major impairment to interpersonal engagement.)

I think what this tells us is that the triggers for brain disrpution that lead to autism may be many and varied, but these triggers seem to result in a similar outcome - the derailment of the typical pathway of development......a chain reaction of missed developmental milestones  that eventually leads to a diagnosis of autism.  If a child doesn't master social referencing (looking to see what a guide or communication partner thinks about something and then using the partner's thinking to direct their own action), s/he definitely won't go on to master the initiation of joint attention (directing a social partner's attention towards an object with the purpose of sharing thinking/feelings about the object).  Without joint attention, there can be no joint engagement (active and sustained involvement in a joint activity with the intention of sharing experience/emotion).  

Here is a clip of me and Philip from 2008 tidying the train track that shows both joint attention and joint engagement.  I can't get the video to embed in the blog, so am having to provide a link instead :(

http://www.youtube.com/watch?v=XVRbgraHiOc

There is some good joint attention e.g. at 0.34 when we both look at the track tub as we throw our pieces in, then look at each other to share our emotion about our success in 'getting a turkey' (three pieces in a row).  Joint engagement happens throughout the interaction - notice how much Philip is enjoying our pattern of throwing pieces in at the same time and enjoying the variations we do around this.  Both if us are varying the pattern and we can see that he is emotionally invested in this (enjoyment, smiling, feelings of competence) and therefore motivated to keep going with the activity.

When children fail to master all these fancy-named higher level thinking competencies, we are left with children and adults who often get 'stuck' in their thinking and who crave routine and sameness.  It is a developmental domino effect.

I think the research also tells us that with the right intervention (as above, social interaction that fosters interpersonal relatedness) some children who initially meet the criteria for autism will no longer meet these criteria.

The finding that autism is reversible in these cases screams out (in my view) that it is social communication interventions which support the development of interpersonal relatedness that should be the priority for autism research.

Dynamic intelligence

I’ve started providing RDI consultancy to a new family recently.  I find that every time I work with a new family, I either re-discover something about RDI or something is positively reinforced for me.  This time, it’s the difference in outcomes that can be achieved with static and dynamic intelligence. 

What’s dynamic intelligence I hear you ask – well it’s the opposite of what’s measured by IQ, which measures what we know…..how many facts we’ve accumulated and whether we can work out formulas and patterns.  Basically, academic learning.  Most schools have a primary focus on teaching academic learning, which is static by nature i.e. the facts and formulas don’t change.  Dynamic intelligence is about what we can do with what we know…..how we can use the information in our noggins to adapt in the moment to the ever-changing demands of the world. 

In typical development, kids are quickly motivated to take part in social interaction because of the emotional feedback they get from their parents.  Here is an example of two toddlers: a typically developing toddler receiving and responding to positive emotional feedback from her parents; and a toddler with autism whose development has been derailed by the autism. 

Some of you have seen this clip before in a different blogpost.  It’s a great clip in that it reveals so much about social interaction from different perspectives – let’s look at it now through the ‘dynamic intelligence’ lens.  The time codes we want to look at for this video are 2 mins to 6 mins.

The second toddler is unable to be soothed by the parent when something goes wrong – he starts to get mad and cry when the tower tumbles.  If we contrast this with the typically developing toddler, we see that she is able to take her mishap in her stride, re-placing the brick and echoing her Dad’s ‘uh oh!’

The first toddler is getting positive feedback from her parents and she is able to use it to help her stay on task and to keep regulated.  A crucial bit of feedback here is the Dad’s off-camera ‘uh oh!’…….a shorthand vocalisation of the thoughts ‘oh no – what a shame….never mind, it’ll be ok, you can try again!’  The emotional feedback loop between this child and her parents is working.  The child borrows Dad's thinking (conveyed in the vocalisation of 'uh oh!') to help keep herself from getting upset and frustrated when things go wrong.

The emotional feedback/thinking-sharing loop is not working between the second toddler and his parents.  It has been disrupted by the onset of autism.  Why do we need that emotional feedback loop?  Because it is right at the heart of child development.  It is Peter Hobson’s ‘Cradle of Thought’ – emotional feedback/thinking-sharing between child and caregiver enables the child to develop ‘dynamic intelligence’ (DI). 

With my new family, I asked parents to think about the differences between what can be achieved with static intelligence and what can be achieved with dynamic intelligence.  Here (with kind permission….for which, thanks) are their answers:

Skills and abilities that can be achieved through behavioural and academic programmes (developing static intelligence)

Improved IQ, speech and language and task focused / instrumental behaviours that can be taught through rehearsal, repetition and modelling. (As opposed to spontaneous, flexible and emotionally driven behaviour that is informed by the person’s dynamic intelligence).

Skills and abilities that can be achieved through RDI (developing dynamic intelligence)

Flexible thinking, problem solving, critical analysis, grey area thinking, good enough thinking, simultaneous processing and integration and assimilation, relational thinking, emotional regulation, self-evaluation / awareness, reflection, emotional resilience, empathy, seeing it from another's point of view, ... and so on.

Without the skills and abilities that can be achieved through RDI, you are very limited in what you can do with those skills that have been acquired through behavioural and academic programmes.

We also had a discussion about how dynamic intelligence helps to achieve good mental health and wellbeing.  Here are parents’ thoughts:

DI enables you to have meaningful interpersonal engagement with others. Having reciprocal relationships with family and friends, people to confide in as part of your network of support, is a protective factor against mental illness.

DI enables you to develop adaptive coping skills and strategies (manage uncertainty and change) and this is a protective factor against mental illness.

DI can enable you to engage and sustain purposeful activity and/or employment. This can foster a sense of independence, self-worth/improved self-esteem and this is another protective factor against mental illness.

Great responses, helping us to see very clearly that whilst we need both static and dynamic intelligence, dynamic intelligence ‘provides the tools to successfully solve complicated problems, prioritize multiple demands, carry on meaningful relationships and achieve long-term goals. Jobs, friendships, marriages and most aspects of daily life are primarily dynamic in nature.’

I think this feedback from my parents sums it up: ‘Without the skills and abilities that can be achieved through RDI, you are very limited in what you can do with those skills that have been acquired through behavioural and academic programmes.’

RDI gives our kids another chance at developing dynamic intelligence – all those key competencies that are crucial for jobs, relationships and independence. 

To read more about dynamic intelligence, please follow this link:

http://www.rdiconnect.com/pages/Dynamic-Education-Program.aspx

Looking through a different lens

I have a new friend called Emily who I met on facebook a couple of weeks ago.  A week later we were on the phone and a week after that, making plans to meet in person.  You know when you just ‘click’ with someone?  Emily’s business provides consultancy to schools where there are vulnerable children who are struggling to learn and/or thrive in their educational setting.  The children she consults on may not have a diagnosis of any particular difficulty but they are clearly having problems fitting in and/or learning.  Her approach is based on Ross Greene’s work.  I have discussed Ross’ Collaborative Problem Solving in previous posts and we continue to use it very effectively both at home and at Bright Futures School.

Over to Emily for more about her business……..

My bio through my eyes

I am called Emily and I am a mother of two boys, one is 12 the other is 7. I am a qualified teacher and have worked within Mainstream and all styles of Special Needs provision in Early Years and Primary schools for the last 11 years.

I have a dream ........that one day I will be an educationalist and change the way we communicate with children in educational settings.  I also dream that I will conquer the world (well maybe a small town!) and provide the best education possible for children with any sort of challenging behaviour.  My passion and reason for being is to ensure my goal is achieved. I feel very strongly that my philosophy has no flaws if followed correctly.  I am ox-strong with it and I am now on my journey.   I have left teaching to start my pledge and have a new company called EncompassNow

www.encompassnow.co.uk

Labels to me are pretty irrelevant (obviously we need them to get support, or at least that’s the myth).  If a child has any sort of difficulty they need that extra help and support to work through it and this needs to fit to the child not the expectation of how children should react dependent on a label.

 Children and people respond like us all to compassion, love and understanding. I will expand: if children feel love they offer it back, if children feel trust they give back trust, if they feel comfortable they feel free to try out new things and if they are not constantly being instructed they will eventually work things out for themselves and regulate their own environment.  Some children - about 10-15% find it difficult, well impossible, to regulate themselves and this is where the problems lie.  These children need help and support, they need to be taught how to regulate themselves and how to work things through that don’t go the way they ‘perceived’ they should.

I kind of don’t want to mention this as it is pretty obvious where my feelings lie but I guess I have to ...... aggression, punishment and bribery puts anyone’s backs up makes people suspicious and is never going to work. I will expand, shouting, putting down, sticker charts, detentions, being kept away from friends ..... it goes on and on.  These exacerbate already poor situations and encourage children to lose faith in a system that is rapidly letting them down.

I have read and read up on the subject, almost to exhaustion and eventually after reading a lot of nonsense and non-starters I came across a man called Ross Greene.  He is amazing.  He put my words into his mouth, mixed them up a bit made them sound ever so grand and popped them onto paper.  He says it all.  He has a philosophy that is above and beyond anything else I have ever come across.  “He gets it”, he understands, he realises how people really respond to each other and how the world should be communicating and I think he is the bees knees.

Ross Greene's web site is www.livesinthebalance.org

I have worked with children for years, many of them with additional needs and I know that my methods can help the children who find life that little bit more tricky than most.  The children I have taught have excelled, shown me immense respect and parents have flooded my doors with happy words and sounds of relief that at long last a teacher really understands their child.  I have been through four gruelling Ofsteds and been given ‘outstanding’ for every single observation.  When I was training to be a teacher many moons ago I remember being told that you must never  ask children if they would like to ..... you should always tell them.  My certainty started way back then as I knew at that moment deep within me, my empathic understanding was on a different playing field.

Teachers are in a tricky position, they are stressed and expected to meet targets which don’t really reflect anything but academic achievement.  More important to a person for their life- long achievement is to be happy and relaxed, confident and able and have an ability to work things through,  when under stress or alive with immense jubilation.  Once a person can do these things they will learn and they will excel, if they cannot do these things they get switched off and problems creep in.

Do parents really care whether their child is level 6 or can read all the high frequency words by the end of nursery? Maybe they do but not if their child is struggling.  They really don’t give a hoot, they want strategies built up, they want their child to be able to ask for help, express themselves in order to become independent and think for themselves, but also be able to function in a society where they have to conform.

As professionals it is always important to remember that it is ever so much more difficult for children to misbehave than conform.  Allowing children to work through emotions and building strategies with them enables them to work through ways in which to conform when needed.  We need to listen and listen hard to all the ways children communicate.  This can range from shouting something abusive to attempting to hit out at someone or even hiding under a table.  The way people behave demonstrate their discomforts or comforts and children are no different.  Children with heightened sensory awareness or an ability to feel emotions but not express them, may present in this way and these are the children that are crying out for help.

I have often had staff trouble shoot with me and ask my advice when having difficulties.  I have been told time and time again how good I am with the ‘difficult’ children (labelled by schools) and how on earth could I manage to get them to do certain things when other staff couldn’t.  The answer lies in the fact I never ever told them to do it.  I talk to children about what is difficult for them and we work out a solution together which is comfortable for both of us.  Here as an example of working within a mainstream classroom.  This below sounds so straightforward and obvious but many people would not even consider carrying it out.

Anxiety about whole school gatherings

Background

Whilst working in a year one class teaching a child that found whole school gatherings difficult.  He would become disruptive and loud, causing other children’s behaviour to escalate and make lining up very challenging. Over a short period of time I soon worked out that he wasn’t misbehaving to be difficult, he was doing it as he did not know what to expect and found transitions very tricky.

Solution

I was able to help him very easily by having a quiet word prior to us leaving the classroom about where we were going and what was going to happen.

Outcome

He was happy with this and we soon built up a strong trusting relationship.  .  This was a simple effective and manageable solution.  I always tried to ensure that plans remained the same as transition times were such a hurdle for him, if for any reason they changed at the last minute the trust was there and he began to calmly ask me what was happening.

My company offers a unique training package for educational settings.  I am offering to go into a setting and train staff for a day on empathic collaborative working and then spend several sessions with a class or individual child and their teacher modelling exactly how my practice should be carried out.  It is essential the staff at school are competent in this way of working in order to build up trust with their own pupils.

I hope that schools that have children who are struggling have the confidence to ask for help as it takes a much braver person to express your difficulties to others rather than struggling along helplessly.  Our spirited and special children surely prove this to us by their actions.

You can follow Emily Neal on twitter at @encompassnow

You can find encompassnow at www.encompassnow.co.uk

Great stuff – thanks Emily!  A much needed service for schools.  I like Emily's emphasis on the fact that often the first thing we need to do when considering how to support a child who is struggling is look through a different lens at what is happening for that child.  Too often, the child is labelled as ‘naughty’ or ‘oppositional’ when actually the behaviours we are seeing are either an expression of anxiety and inability to cope or a manifestation of the child’s needs not being met appropriately.

I'm looking forward to meeting up with Emily - first step, blog collaboration, next step....who knows?  The world is our lobster..........

The cutest clay baby helps with a simple explanation of RDI

I just got into a friendly discussion on my Food for Thought facebook page about RDI (https://www.facebook.com/pages/Food-for-Thought/215175045234350 - shameless self- promotion, please head over and ‘like’ my page).  The person asking me about it wanted an easy read introduction to what RDI is and how it works and I thought I would just reproduce it here in case it’s useful as a point of reference in the future – for me or for anyone else.  This is how I explained it:

We know that autism is a developmental disorder.  That means kids have missed out on key communication and thinking milestones in the early stages of their development.  We know what some of these milestones are (they have fancy names like ‘referencing’, ‘joint attention’, and ‘theory of mind’) and we know that if children don’t master these milestones, they become rigid thinkers who find it difficult to cope with uncertainty and change. 

This is why children with autism have high levels of anxiety and are prone to what some parents describe as ‘meltdowns’ – they are constantly coming up against uncertainty and change and are unable to cope with it.

Everyday uncertainties include (for some children) simple things like a change in the route of their journey to school, new clothes or shoes, a new teacher at school…….things most typically developing kids wouldn’t bat an eyelid at.  If a child with autism is unable to cope with any type of uncertainty, they react in one of 3 ways – flight, fight or freeze.  What we see as ‘autistic behaviours’ (avoidance, withdrawal and meltdown) are actually an expression of this anxiety and inability to cope.

Fear and feelings of incompetence make us all anxious – but typically developing people have had thousands of experiences that have led to memories of competence and success.  They have had these experiences during their early years in the special relationship they have with their parents.  It is the interpersonal engagement (interaction) that takes place within this special relationship that enables each child to develop flexibility (via those fancy-named milestones that they master).

I've included this pic because I love it - it reminds me of Louis (my typically developing son) as a baby and is the kind of activity that he would have loved.  Actually he would probably love it as a 9 year old, but perhaps not naked ;-)  The other reason I love it is that it's a great illustration of a guided activity where the parent is gently introducing a new, novel experience to the baby (exposing the baby to uncertainty) in a way that promotes the baby's feelings of competence and success.  You can tell the baby is loving this new experience from the rapt expression of concentration on his/her face.

So what RDI does is it takes parents back to the beginning of development with their child so that they can help their child master those important developmental milestones that they missed.  RDI enables children with autism to overcome their rigidity and to improve their ability to regulate themselves emotionally.

Here is a link to some recent emerging research that demonstrates this:

http://imfar.confex.com/imfar/2011/webprogram/Paper8196.html

Here is a link to a young man with autism who blogs about his own experience of RDI:

http://myautismrecovery.com/

To learn more about RDI, go to www.rdiconnect.com 

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.

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.

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.