What Are We Thinking?

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

A call to reflect on what “social behavior” means in Autism Spectrum Disorder (ASD)

“My daughter is really struggling with attaining social skills. Sometimes I notice that she looks interested, but she does not want to venture forward. If I prompt her, she would go towards the person or group and she knows to greet, but it stops right there and her facial expression is almost “blank”. We have spent many years to get as far as we have come and she has worked hard, but we seem to be stuck now and it is going to impact on her ability to function in a social group at school. I do not know how she is feeling much of the time, not sure if she is happy or unhappy. Her preferred state still seems to be in her own world.”

I can feel the frustration of this parent, as she has dedicated many years to attain the level of skill required to attain what has been achieved. This plea is not from a parent who wishes her child to be “fixed”, simply happier, better understood and anxious over her future – to be the best version of herself she can be. I try to find ways of broaching my different responses over the years, though really it boils down to 3 aspects to consider.

Firstly, in order to consider social skill, we need to consider communication first. It starts with having the intent to communicate and understand the reciprocity of this turn taking process. In fact, this starts in utero already and continues to develop very strongly in the early bonding process. We are hard wired in our brain to connect with others, to act contingently to others’ overtures toward us. The typically developing baby responds to the overtures of their caregiver and the warm, secure bond of safety drives the intrinsic motivation within the baby to want communication and risk asking for more. This communicative intent with intrinsic motivation for initiation frequently occur as a key difficulty in autistic children and adults. They do not seem to be intrinsically motivated; they appear more motivated to avoid or use fight and flight. Connection with others can be overwhelming as so much needs to be considered. Instead of their sense of self driving toward communication, they frequently feel compelled to self-protect by retreating into their own world, where they feel so much more in control.

The second aspect to consider is that social communication depends on verbal and non-verbal skill. It is not just that we have the capability to use speech and language, but also that we can pair our verbal and non-verbal communication in order to assess a conversational turn-take and follow up on someone else’s contribution. The baby learns to use gestures and sounds before speech and it is really only when we start understanding full sentences with verbs that we can use speech in a social situation with continuous verbal flow. Yet, the baby learns from birth to about 2 to 3 years to first:

1. Enact on the environment
2. Form relationships in their lives
3. Get a grip on the emotional self
4. Get needs met with certain cries and pleas to the parent

The developing child learns emotions (dealing with self), praxis (pairing verbal with non-verbal gestures), as well as developing a physical sense of self (being separate from others). In order to consider others socially, they first learn to deal with themselves physically and emotionally. Verbal speech is built upon this sense of self as a way to express our thoughts, needs and wants and later becomes the principal player in having a debate, or a discourse, becoming a fluid stream of two-way communication from one person to another in a social situation.

As I am writing I can think of so much more to say, but will focus on only one more consideration. Erik Erikson discusses a sense of autonomy that comes with a sense of purposefulness. This is driven by the first two considerations already noted, which acts as building blocks for using working memory while simultaneously building Theory of Mind (ToM). This ability involves being able to use cognitive flexibility to assess how someone else is responding to my social overture, and within split second timing adjusting my next thought to suit the situation in an acceptable manner. This is quite complex and involves much integration of the different senses including our executive and emotional pathways.

Yet, in the light of all this complexity, we have spent the earlier parts of the child’s life focusing on speech, learning skills, “catching up on development”, in a behavioral context, using task analysis and drills to attain access to functionality in learning and language. All of the families coming my way are loving, caring and want the best for their child. Because behavioral therapy is the only therapy provided for through insurance, because all the doctors recommends it and everyone else seems to be doing it, families chose to do this therapy in these crucial early developmental years. Yet behavioral therapy has minimal to no research on contingent conversational turn taking, Theory of Mind, social perspective taking, to name only a few of the aforementioned considerations. In order to be a social partaker in our communities, these are skills honed in from birth and throughout all the drills of behavior therapy, albeit playful, the essence of social skill and the naturalness of co-reciprocity, does not feature. Social communication requires spontaneity, initiation and is not delivered through prompting. Now the families come to my office at ages 5, 6, 9, 13….. and we have to start from the very beginning. This also means we have to un-learn the habit of waiting to be prompted, which has now become a pattern of being.

What are we thinking? Are autistic children seen as walking bodies within which we must enforce what is “acceptable”? Acceptable to whom? They are babies, kids, adolescents, adults with thoughts, ideas, minds, emotions and if we do not harness their social being from the very beginning, we lose precious time that is going to be very hard to make up later.

Please think about this, too many kids are getting lost. And the excuse then? They are not developing social-emotional skill because they have a diagnosis.

Maude Le Roux, OTR/L

(484) 840-1561 for a free phone consultation