5th Congress Autism-Europe
Articulos / Proceeding
Autism-Spain

EDUCATING THOSE WITH AUTISM: FROM THEORY INTO PRACTICE

Presenter: Rita Jordan, School of Education, University of Birmingham, Edgbaston, B15 2TT. UK

Introduction

The complexities of the autistic condition have resulted in numerous explanatory theories and, in particular, psychological ones. Although autism is defined through behaviour, there are no behaviours that are of themselves 'autistic' and the diagnostic criteria relate to areas of functioning rather than particular behaviours. We argue for a conceptualisation of 'autism' as a kind of theory about the existence of a fundamental difference at the psychological level of functioning that leads to the characteristic diagnostic triad. This paper, then, considers cognitive accounts of the psychological origins of autism, concentrating on those that have arisen from the 'theory of mind' theory. For each theoretical account, and for the alternative explanations given to account for the related research, we attempt to suggest some educational implications that would follow.

'Theory of Mind' Theory

Leslie's model is an information processing one and he suggests that this includes an innately endowed 'Theory of Mind Module' (TOMM). He suggests (Leslie, 1991) that understanding propositional actitudes (believing that p, pretending that p) underlies a 'theory of mind' and that the key to this development is the capacity for pretence and 'metarepresentation' (sic). Leslie contends that what is represented in the pretend act is opaque in its meaning in the sense that it does not refer to reality but to someone's (oneselfs or someone else's) attitude to that reality; in Leslie's jargon the representation has to be 'decoupled' from reality. It is this metarepresentational function that is claimed to be dysfunctional in autism.

Leslie's view (1994) is that appreciation of ostensive communication (which is what is necessary to take part in shared acts of pretence) is innate, but, if it is a cognitive process, it should be accessible to direct teaching. An educational approach to such a difficulty, then, would be to make propositional actitudes as explicit and concrete as possible. Pretend play, for example would draw the child's attention in a very direct way to the exaggeration that is part of the ostensive communication involved (for example, exaggerated drinking gestures from an empty cup compared to 'normal' drinking from a full one, the difference being made explicit and further exaggerated, if necessary) and help the child discriminate situations where the play is functional from situations where the function is communicative. There are speech and language therapists in the UK who have adopted this way of working, but have not, as yet, evaluated their work.

The original formulation of the 'theory of mind' theory has been found to be flawed (Jordan and Powell, 1991; Leekam and Perner, 1991; Leslie and Thaiss, 1992; Parkin and Perner, 1994; Perner, 1993) and the findings to be, at least in part, dependent on language functioning (Bowler, 1992; Draper and Bowler, 1995; Eisenmajer and Prior, 1991; Happe, 1995; Lewis and Osborne, 1990; Ozonoff et al, 1991; Sparrevohn and Howie, 1995; Tager-Flusberg and Sullivan, 1994; Wagstaff, 1995), although Leslie has taken account of at least some of these factors in his latest formulation of his theory (Leslie, 1994). The relationship between the ability to pass theory of mind tasks and linguistic ability and social experience may be a problem for Leslie's theory, but it does suggest a promising focus of educational intervention. This research suggests that not only may language ability itself be a critical factor in determining success on 'theory of mind' tasks, but that the social difficulty experienced by children with autism may exclude such children from the opportunities of learning about mental states and hearing the vocabulary used in a context that would give it meaning; in other words, 'theory of mind' difficulties may be a secondary rather than a primary disability in autism. Explicit compensation for the excluded experiences (=.e. explicit teaching of mental states in contexts where their meaning is clear, as suggested by Jordan and Powell, 1995) could prevent such a secondary 'handicap' from developing.

One difficulty with this approach, however, is that, as researchers such as Bowler (1992) and Sparrevohn and Howie (1995) have pointed out, those individuals who do pass even second-order false belief tasks (demonstrating a relatively sophisticated understanding of mental states) do not perform any differently in 'real-life' situations than others with autism who fail these tests. One explanation is that those with autism do not arrive at an understanding of minds through normal developmental processes but have to use general cognitive processes to work it out. The 'puzzling out' of mental states is describes very well in a personal account of her own cognitive and social difficulties by a high functioning adult with autism (Grandin, 1995; Sacks, 1994). Frith et al (1991) and Happe and Frith (1995) also suggest that children who pass false belief tasks may do so by another route.

This view would be supported by the work on training and theory of mind in individuals with autism (Ozonoff and Miller, 1995; Starr, 1993; Swettenham, in press) where success in 'Laboratory' conditions is not reflected in real life situations. It is an empirical question as to whether early and consistent long term intervention, in real life contexts, would enable a more 'habitual' response to mental states that would be capable of being generalised and spontaneously applied.

Other explanations for 'theory of mind' difficulties in autism also suggest fruitful avenues for education. Clements and Perner (1994) found that more normally developing young children could show they understood false belief (by looking) than could answer the question explicitly. This time lag in development between implicit and explicit knowledge and understanding might be even more crucial in autism where there are difficulties in self awareness and an inability to reflect on their own thought processes. This suggests, in turn, that children with autism might benefit from being taught ways of reflecting on their own understandings and making these explicit both for themselves and others. We have advocated such training in thinking skills in autism (Jordan and Powell, 1990, 1995; Powell and Jordan, 1991) and attempts to evaluate this approach are underway.

Sodian and Frith's (1992) study finding children with autism competent at sabotage but not at deception was shown by Hughes and Russell (1993) to depend on difficulties in inhibiting actions. This finding has very strong pedagogical implications in training or transferring new skills or in changing disturbing behaviour. The knowledge that the behaviour of people with autism is not internally triggered but dependent on external cueing, means that attempts to change behaviour (either in the direction of learning new skills or removing unwanted behaviours) can only follow one of two routes: the external cues (the environmental triggers) can be changed or the 'old' behaviour (even if it is passivity) must be physically prevented whilst a new competing behaviour is trained in that environment. This provides another rationale for what is already established 'good practice' in behaviour management in autism (Zarkowska and Ciements, 1989; Jordan and Powell, 1995).

The research showing that intelligence is positively correlated with empathy in autism alone (Yirmiya et al, 1992), and the work mentioned above suggesting that those with autism come to an understanding of mental states through a problemsolving route, suggests an alternative view of the findings related to 'theory of mind' in autism. It might be that, far from suffering from a lack of a theory of mind, as Leslie would suggest, those with autism might more usefully be characterised as the only ones who need a theory of mind. Others develop understanding of mental states through spontaneous intuitive routes operating through social and emotional awareness and experience, as Hobson (1993) and others (e.g. Dunn, 1988, 1991) suggest and it is a deficit in these natural intuitive routes that leads to the cognitive route having to be adopted. However, just as language impaired children cannot benefit from normal exposure to a language rich environment, so the pedagogical implications of this are not necessarily the teaching of early interactions but rather the exploitation of the compensatory route available to the individual with autism: the cognitive one.

Evolutionary Theory

i) ID (Intentionality Detector).

This mechanism enables the interpretation of approach and avoidance behaviour, leading to the attribution of agent status to the source of non random stimulation. The ID represents dyadic relations between an agent and an object or between an agent and seif. It is not clear from Baron-Cohen's exposition whether it would also represent self as agent (using proprioceptive or kinaesthetic stimulation, perhaps). This is important because of Russell's (1994) use of 'efference copying' as an explanation of the development of a sense of agency and Powell and Jordan's (1993a) argument that such a sense may be missing in autism. Baron-Cohen suggests that the ID mechanism is intact in autism, although the evidence is based on experimental manipulations rather than 'real life' functioning.

ii) EDD (Eye-Direction Detector)

This mechanism works only through vision. It has three functions: to detect the presence of eyes or eye-like stimuli, compute whether the eyes are directed towards self or not and to infer from own case that eye direction equals seeing what they are directed at. Baron-Cohen (=bid.) suggests that knowledge of seeing and not-seeing, related to eye direction, is generalised to an agent by analogy with the self. This assumes that the notion of the self is primitive and Baron-Cohen offers no mechanism for its derivation. Baron-Cohen maintains that during the early stages, when EDD is working alone, it is intact in autism, but once more the evidence derives from experimental results in structured situations. It fails to take account of the evidence (Leekam et al, 1993; Loveland, 1991) that gaze monitoring is not spontaneous in autism, but has to be cued or prompted. A failure to spontaneously activate a crucial innate mechanism, would seem to us to be of significant developmental import.

iii) SAM (Shared Attention Mechanism)

This third mechanism is responsible for building the triadic representations that specify the relations between an agent, the self and a third object. It includes embedded knowledge that an agent and the self are attending to the same object, this accounting for the triadic nature of the representations. SAM receives information from the EDD as a privileged relationship but it can use information about perceptual states from other modalities. SAM also makes ID's output available to EDD so that eye direction is then read in terms of goals and desires. This also allows joint referencing so that eye gaze is interpreted as an intention to refer. Baron-Cohen suggests that this mechanism is specifically impaired in autism so that it does not function through any modality (vision, touch or audition). Thus, in autism, there is no output from SAM to trigger TOMM. The evidence of its failure to work in autism comes from joint attention studies (Baron-Cohen et al, in press, a; Dawson and Fernald, 1987; Landry and Loveland, 1988; Leekam et al, 1993; Loveland, 1991; Mundy et al, 1986).

The key role of SAM in this theory is an important addition to Leslie's theory from the point of view of the educationalist. So much of teaching assumes that this early social and communicative understanding is present that the teacher does not think to check that the child is aware, for example, that the object held up in the teacher's hand is meant as the focus of attention when the child is asked questions such as "What is this?" or "Who can tell me about this?" etc. Nor does the teacher think to expand the instruction to "Look!" to include "Look where I am looking!" (perhaps a function of EDD?) or "Look where I am pointing!". Even more subtly, unless the teacher understands that this shared attention difficulty applies across all modalities, the child will not be taught explicitly to attend to sounds alongside others nor will a failure to spontaneously 'Iisten' or 'hear' in groups be appreciated.

iv) TOMM (Theory-of-Mind Mechanism)

This part of Baron-Cohen's theory is derived directly from Leslie (1994). An overall 'test' of, the theory has come from its application. Baron-Cohen et al (1992, in press, b) have developed a screening device for autism based on this theory and piloted it among 'at risk' 18m. olds with a diagnostic follow-up at 2;6 years. The three predictors of autism at eighteen months were absence of protodeclarative pointing, pretend play, and shared attention. The latter two predictors, at least, can be seen to derive from this theory. Baron-Cohen specifically excludes the role of emotion from his theorising on the grounds that insufficient is known of normal emotional development to make this worthwhile.

The danger in deriving educational approaches based on this theory, is that a deficit model will be followed. Thus, if the absence of certain early occurring behaviours are seen to lead to autism, there would be a temptation to assume that the pedagogical imperative would be the direct teaching of those behaviours with the aim of preventing the autism. The problem with this is not just that such behaviours are almost impossible to teach in a way that is more meaningful than the mere copying of actions (although that is certainly true) but that the teaching of missing 'skills' in this way is to miss the point of why they are missing. The meaningless teaching of children with autism to comment or to look at items or events pointed out by others has little value if the child does not understand the purpose behind the comment or the reason for looking. A true sharing of attention must involve an emotional as well as a physical sharing and it is this that is missing from the theory.

Interactive approaches (Christie, et al, 1992 ; Wimpory, in press) seek to elicit these same attention sharing behaviours in the context of emotion and meaning-rich interactions and have had some success, that is beginning to be documented. These approaches have used musie as a support, although it remains to be seen whether that is an important part of the meaning attribution for the child with autism. Approaches such as Option (Jordan, 1990; Jordan and Powell, 1993; Kaufman, 1994) and interaction based on early dyadic interactions (Nind and Hewett, 1994) use scaled intrusion into the individual with autism's emotional involvement with an activity, to develop this sense of shared experience; the results of intensive treatment are reported as promising, although there is little in the way of scientific evaluation. Conceptually, these approaches appear to us to have a greater chance of success than an approach that is purely skills focused.

Eclecticism, Pragmatism and a Principled Approach to Practice

The danger with this attitude is not only that valuable time is wasted when a more productive method of education might have been followed, but that the time lag between research and theory being produced and its recognition by practitioners can be considerable. Thus, educational practice may just begin to adapt to a particular theory or body of research findings when new research has shown that the theory has serious flaws or a 'better' explanation is offered to account for the research findings. This may mean that nothing is done and teaching stagnates. To some extent this is what has happened to the 'theory of mind' theory and subsequent research.

The original theory and research was disseminated in an accessible form (Frith, 1989) and many teachers began to consider its implications for teaching. However, this had only reached the level of being aware of alternative explanations for behaviour and a confirmation of the different learning and thinking style of individuals with autism (Powell and Jordan, 1993b) when alternative conceptions to the 'theory of mind' theory became apparent (Hobson, 1993). This was not so accessible to educationalists and, so they were not able to see that a difficulty in understanding mental states in autism was not the issue being debated, but rather how such a difficulty was to be interpreted. The effect on those beginning to develop more cognitive approaches was to make them less certain of the validity of what they were doing.

Much of this is a confusion between what is proposed as a difficulty or a defect in autism and what can be used as a teaching approach. Remembering the strictures about deficit models of teaching voiced above, identification of a problem in early interaction and the sharing of emotion does not mean that these have to be the focus of teaching any more than Leslie's position suggests that teaching about propositions and how to make triarchic representations will be the best approach. In fact, it might suggest the opposite, since it is likely to be more productiva to teach to strengths. The suggestions made above about cognitive teaching about mental states and attitudinal stances might just as easily follow from Hobson's viewpoint as it might from Leslie's. Both theories suggest that interpersonal development will not oecur spontaneously in autism and will need to be taught and each would suggest that a cognitive route would be the most accessible to the child with autism. The difference would be that Leslie's approach would attach a ceiling beyond which the child could not follow, whereas Hobson's theory would suggest earlier intervention using emotional involvement as part of the cognitive process and allowing for the possibility that, if emotional engagement could be taught at a sufficiently early stage, the prognosis would be significantly better. Neither theory would suggest an approach that could lead to a cure, but the straight cognitive approach leads more naturally to compensatory approaches and the building of prosthetic learning environments, whereas Hobson's approach is more open to the possibility of remediation and tackling the autism itself.

Conclusion

Our own view of a principled approach to the education of individuals with autism would be one that recognised that normal intuitive routes to learning and understanding are absent or disturbed and that compensatory routes, using intact general cognitive abilities (more problematic, of course, in those with additional learning difficulties), must be developed. In addition, we are convinced from a number of theoretical accounts, including our own, that a remediar approach in which there are attempts to build a sense of self (and consequently of social agency (Russell, 1994) is also importante We find it both interesting, and encouraging, that the practical ways of achieving this would lead to kinds of teac ' hing (in terms of content and approach) that also arise from other theoretical understandings. Thus, facilitating interactive routines can be seen as deriving from intersubjective accounts of autism (Hobson, 1993) but also from an appreciation of the role of SAM (Baron-Cohen, 1995) or from the need to establish a sense of social agency (Russell, 1994) or narrativo structure (Bruner and Feldman, 1993). Equally, periods of reflection after activities (Jordan and Powell, 1995) might be derives from this same notion of a failure to appreciate narrativo structure as well as from the motivation to facilitase the developrient of an 'experiencing self'.

What may seem chaos, in terms of educational prescription for autism, can only be made sense of, if we begin to develop a culture of research related to practice. Only in this way can current thinking from theory and research reach practitioners, and evaluations of theoretically derived practice inform theory making. In autism in particular, there is often disparity between what is shown in structured research situations and the everyday experience of living and working with individuals with autism. We need to bring these understandings together if we are to advance to a full understanding of the condition.

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