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

Teaching Individuals with Autism
Flexible Thinking and Autonomous Behaviour

Stuart Powell & Rita Jordan

INTRODUCTION

Lack of flexibility of thought and behaviour, the third aspect of the triad of impairments in autism underlies many of the features of the thinking and subsequent behaviour of individuals with autism. in this paper we consider its impact on the lives of individuals with autism, ways of ameliorating these effects and the notion of a cognitive approach to overcoming this fundamental difficulty.

ORIGINS OF RIGIDITY OF THOUGHT IN AUTISM

A failure to understand how others think and feel (Frith, 1989) would lead to a difficulty in predicting behaviour. This difficulty would result in individuals seeking out the predictable in terms of other people's behaviour and tending to impose their own regularity on what is an irregular and often unpredictable world. So, they might develop their own rituals that impose order on what would otherwise be an unpredictable situation.

Further, to be able to think flexibly people have to, at some level, know that they are thinking about a particular kind of problem and that it is resolvable with particular kinds of strategies which they possess. This, then, implies the development of an understanding of oneself as a person who is capable of solving problems. And here is the root of the problem in autism in that individuals with autism seem to have a particular difficulty in developing an awareness of self and this extends to any role as 'reflective problem solver' in which they have to think in a flexible way (Jordan and Powell, 1990a).

Lack of ability to reflect on their own thinking means that the memory processing of those with autism is qualitatively different from those without autism. Individuals with autism often have difficulty in relating personal events and remembering the gist of narratives and yet are sometimes able to exhibit exceptional feats of rote memory. Particular cues can trigger whole chunks of memory recalled as complete episodes but when asked to search memory for particular incidents that person may have extreme difficulty. Individuals with autism may be able to remember particular aspects of 'general knowledge' and have good procedural knowledge for skills but at the same time they may be unable to remember themselves performing actions, participating in events or possessing knowledge and strategies.

In short, the memory difficulty in autism is in what we may call the development of a personal memory for episodes. This kind of memory depends on the existence of an 'experiencing self', a sense of self that enables the encoding of events as part of a personal dimension. Clearly then, a deficit in developing an 'experiencing self would lead to a subsequent difficulty in developing personal memories of episodes. In the normal pattern of development, it is the experiencing-self' that enables the individual to search memory in a way that frees recall from dependence on specific cueing. We can search our minds for specific things because we remember those things happening to us. In autism, the 'experiencing-self ' appears to be impaired in some sense (Powell and Jordan, 1993a) and this means that individuals will not be able to search their memories spontaneously - they will be dependent on specific cueing. In a sense, they will need to be prompted to recall and the prompts will need to be specific and may seem to be idiosyncratic. It is the lack of an experiencing-self in autism which means that the kind of memory searching needed for flexible thinking is impossible or very difficult, and that leads to the characteristic rigidity in thinking.

THE PROBLEMS

DIFFICULTIES WITH CHANGE

Typically individuals with autism experience difficulties in coping with changes within their environment. These are not merely a matter of social preference but rather reflect a pattern of cognition which depends on the regular. We suggest that it is helpful to think of 'resistance to change' as a necessary part of the autistic style of thinking (see Sinclair 1992). If we are to be effective in helping those with autism come to accept changes in their environment, we have in the first instance to reach some understanding of what those changes mean to them and why there is a dependency on routines and familiarity.

The difficulties in understanding others and sharing their on the world through a sense of intersubjectivity is fundamental to autism (Hobson, 1993) and leads to meanings that are not 'negotiated' in the normal social interactive way. Where the non-autistic child learns to interpret the world through the eyes of his/her caregiver the child with autism does not. Autistic learning then remains at the level of the specific; what is learnt in one context will not necessarily transfer to another related context. Nor will the overall 'purpose' of events or activities be grasped and teaching approaches that focus on one step at a time will add to this of piecemeal learning. This style of learning, then, is typified as rigid and stereotypical.

LACK OF SPONTANEITY AND INITIATIVE

An apparent feature of the behaviour of many individuals with autism is lack of spontaneity within the social environment. They may follow directions from others well enough and they may follow their own pattern of behaviour, however intricate that may be, without needing to be directed. Yet they are often unable to choose activities to engage in outside of their own particular interests or habitual learned patterns. Even when put in familiar situations to perform a familiar task, they may behave in an apparently unmotivated way or as if they have 'forgotten' what to do until they are prompted or cued to start the task. Once the task or activity is underway, there appears to be no problem in carrying it out -but they find it difficult to get started without that initial support either from a member of staff or from the Particular structure provided in the environment.

There may be similar problems in planning activities or switching from one activity to another. If they do turn spontaneously from one activity to another then the reason often seems to be at the level of the immediate rather than the considered. Thus, it is as if their actions are prompted by external stimulation or events rather than from an internal source of motivation and intent. This relates to our contention that the difficulty is one of establishing a sense of themselves as actors in the world and consequently a difficulty in intending and planning actions, in monitoring their own performance and in consciously switching attention (Powell and Jordan, 1993a).

DIFFICULTIES WITH CREATIVITY AND IMAGINATION

Lack of spontaneity underpins the lack of creativity that pervades the behaviour and the work of individuals with autism. Where, for example, a non-autistic individual with learning difficulties may be able to create 'new' patterns within an overall design or make up new events within the framework of a story, the individual with autism will typically find these kinds of activities difficult. Such individuals may reach high levels of skill in terms of, for example, reproducing with paint and paper what they can see in the world. But even here the progression in 'skill'' is likely to he defined in terms of exactness of copy rather than kind of interpretation.

'Creativity' clearly involves extending the known or the seen in such a way as to produce a new interpretation or a new view. It involves bringing together different elements to produce a new understanding. The difficulties faced by most individuals with autism in this connection are not to do with being unable to, for example, paint expressively; they are to do with modes of thinking locked into what has been taught and being unable to think up solutions or ideas beyond a set learnt response.

Even at the level of everyday activities, successfully coping requires creative thought. And creative thinking requires the use of imagination. To successfully create a new meaning out of known elements requires that the thinker can imagine what the new meaning will be like. To be able to cope when, for example, the bus fails to turn up means remembering the skills of telephoning for help which almost certainly will not have been taught in this context and may have only been taught in a 'role play' way, since actual circumstances of needing to telephone for help are difficult to contrive. At the time of the initial teaching, therefore, the individual with autism needs to be aware of this activity as a strategy that can be applied in situations he or she has not yet experienced. This awareness must include a knowledge of all the skills involved and the capacity to bring them together in an act of imagination to create a new understanding, of how to behave in an imagined scenario.

In short, in autism the prerequisites for creativity are not present. The individual with autism cannot extend the known or bring together understandings to create new ones because the known remains -confined to the specific- context in which it was learned and the autistic understandings by their very nature are disparate and remain disparate. Autistic thinking is of a non-imaginative kind.

STEREOTYPICAL THOUGHT AND BERAVIOUR

All of the above results in a particular l kind of thinking. Stereotyped thinking may be characterised as thinking that follows a narrow set route. Autistic thinking, as a style which does not readily transfer knowledge from one context to the next and which does not have available a facilitatory social learning environment, will necessarily remain in the specific and the [socially] meaningless. This is not to say that stereotypies are purposeless; they may serve a useful function for the individual in reducing the stress of a world that continually threatens with new demands. But their meaning is confined to the individual and to a very specific aspect of his/her current situation.

PRACTICAL IMPLICATIONS

CREATING ANXIETY-FREE SITUATIONS

It is a feature of all behaviour that anxiety reduces flexibility and it is clear therefore that one way of increasing flexibility is to reduce anxiety levels in individuals with autism so that they are free to adopt a less rigid approach. This will not be a sufficient condition to ensure flexibility in individuals with autism, but it is a necessary one. The causes of anxiety in autism will be to some degree at least idiosyncratic and it will require individual knowledge of the individual concerned before all sources of anxiety can be eliminated or at least reduced. However, there are some generalisations that can be made about the kind of events that are likely to lead to anxiety in autism and which therefore need to be modified.

High on the list of potential causes of anxiety in individuals with autism is the social dimension. Almost all other groups will have their anxiety reduced by the presence of peers or by the supportive help of the 'teacher', but individuals with autism may find that the presence of others adds to the confusion and the level of anxiety associated with the task. Indeed, it may well be that it is the attempts at the social mediation of a task that are the main source of anxiety. New tasks, or tasks where a flexible approach is required, will be best tackled in as asocial a way as possible. This may be done in some cases through the use of computer-assisted learning or the task requirements may be presented in a structured visual way that enables the task to he tackled independently.

At the same time, staff should not accept the anxiety-producing effect of others as an immutable result of autism. It is true that social signals are always likely to be difficult to interpret for those with autism but staff at least can learn to behave in ways that make their social signals easier to interpret and so make them less a source of anxiety and more a potential help and support. They can do this initially by reducing the number of simultaneous social signals (not gesturing or making overt facial expressions while giving verbal instructions, for example) bid then using each of those signals, the words, the facial expressions, the body posture, the gestures, separately and with a clear and explicit meaning. In such ways, the signals (of that individual at least) become familiar and understandable and so anxiety may be reduced. In short, it is important when working with individuals with autism to make oneself more predictable. It is also important to remember to slow down the messages given and to wait for a response; too often, the individual with autism is just marshalling a response when the teacher has given up on getting that response and proceeds to re-phrase the command or to use gesture or guidance on the assumption that this will help.

The inability to read the intentions of others means that the individual with autism is faced with real difficulties whenever social situations are constructed upon what others want or intend. Clearly, these kind of constructions permeate most, if not all, social scenario. So, whenever the client is in a situation where his/her 'next move' is reliant on a reading of the intentions of another then that client is likely to experience confusion and subsequently anxiety. There is a need therefore for explicitness on the part of those working with such clients and for the extensive use of clear, regular and dependable markers which enable the client to interpret the meaning of situations more effectively.

Anxiety and frustration are also associated with inability to see the purpose of certain activities. In such cases, the teacher may need to introduce other more tangible 'goals' to an activity to give it meaning for the individual with autism. Teachers may hope that the individual will gain from the experience of climbing a mountain, feel the exhilaration as he or she reaches the top and enjoys the view, but it may be impossible to offer these as goals to the individual who cannot imagine what has not yet been experienced.

TEACHNG UNDERSTANDING AND AWARENESS

Attending to relevant meanings. Behaviourism is a useful tool in the education of those with autism in teaching everyday skills and habits where the performance of those sidus in an automatic way is beneficial. Thus, there is nothing wrong with learning to wash oneīs hands after a visit to the toilet as a matter of routine, without needing to understand about the nature of germs or the final details of hygiene. And it can be argued that the benefits of establishing a functional routine that is followed as a matter of course rather than requiring continual monitoring and prompting, outweighs the occasional problems encountered in unusual situations.

Nevertheless, if the only teaching approach used with individuals with autism is that of Behaviourism, then this is likely to make for less rather than more flexibility in thinking and behaviour. Teaching one step at a time, does nothing to help the individual see the overall purpose of his or her actions and the concentration on rewarding performance does nothing to educate the cognitive strategies that are needed for such flexibility. So, while the use of behaviourist techniques may have their place in the overall approach to working with those with autism there is a need to recognise the underlying learning style in autism and work towards remediating that as well as accommodating it with particular structures.

A cognitive approach to everyday problems means that the teacher will help the individual develop cognitive strategies rather than just behavioural ones, and, most importantly, become aware of those strategies and be better able to access them on future occasions. In this approach individualss with autism will be encouraged to develop their own structure rather than to rely on a staff-generated one. At the first step, this mean involving individuals with autism in planning for activities. They need to be taught to males choices about what to do and when, in appropriate circumstances, and they need to decide on what they will need to complete the task. Of course, this cannot be managed all at once and each of these processes will need to be broken down into steps. For example, when being asked to wipe the tables in preparation for lunch, the individual might be offered a cloth, a bucket, cleaning fluid (all necessary for the task) and then an irrelevant item such as a broom for the floor. Even without language, in such ways, the individual can come to develop ways of attending to task relevance, by discarding the broom in this case.

Note that the task is simplified but the steps are not meaningless odes, with each one needing to be chained to the next in an automatic way, as is the case in a Behavioural programme. Rather, the individual's attention is drawn to the overall meaning of the task at each step. In the example above, the nature of the task of cleaning the table needs to he considers in order to discard the broom as irrelevant. Increasing the difficulty of the task by adding other irrelevant items, still keeps the focus on this meaning.

Developing memory strategies. To aid the development of useful memory (as opposed to rote memory of skills or knowledge that depends on prompting or cueing to become available), individuals with autism need to become aware of their own strategies for learning and they need to be consciously aware of the tasks they are understanding and the experiences they are undergoing and, where possible, to be emotionally engaged with those tasks and experiences. Those who are able to understand and use spoken language can be encouraged to talk about w-hat they are doing as they are doing it and to notice when they are enjoying something and when they are finding it difficult and frustrating. These same prompts that are used to direct attention to these experiential aspects of their learning, can be used later as cues for recall of the task and the individual's role in it.

For those without spoken language, the task is harder to overcome. We have achieved some success through the use of instant photographs of the individual at key stages of the task, which direct attention at the time and can be used as later cues for memory (Powell and Jordan, 1991). Access to a still video would be even more advantageous in that it would be more flexible. For those with very severe learning and language difficulties, it may still be possible to increase understanding, and aid later recall of a task, through the use of strategies that help the focus on that individual's experience at the time. This can be done by performing tasks alongside the individual with autism, emphasising the key points in an exaggerated and explicit way, and drawing the individual's attention to their own expression of emotion (intense interest, enjoyment, frustration or even anger), by modelling and by using a minrror to capture the expression at the time (as well as the photograph for later recall). Even just being able to use an object of reference (a shopping bag to 'stand for' a shopping trip, for example) to recall a past event and to plan a forthcoming event not only adds to communication but enables the individual to excercise some choice and to remember some key aspect of the event (its nature as a shopping activity, in this case) rather than just be tied to particular meaningless chunks of memory (as in only remembering one of the items purchased) or some isolated salient (perhaps idiosyncratically so) aspect of the event.

Developing Choice. The most basic levels of exercising choice would involve teaching the individual to refuse items or activities not wanted and to accept those that are. The barriers to doing this effectively are that it can so be difficult to be sure of what the individual does or does not want or like (even when they have speech, since they may simply say what they have been taught to say in answer to a question or invitation) and, from the individual with autism's perspective, it can be difficult to know what is wanted and what choice means.

There is then a difficulty in teaching concepts relating to choice and also ensuring understanding. Individuals with autism, if they do not understand what choice is, may simply assume that what they are being given is one more conforming behaviour that they must adopt without understanding. To overcome this problem, it is necessary to concentrate on and teach the meaning of choice right from the start. It may be necessary to introduce a separate stage of choice involving pictures (or words, if they are) before the point of selection of 'items' themselves. Thus, a child might simply learn to associate pictures with menu items and then select her own menu for her meal before going to 'ask' for it.

Similar choices could be introduced into all (or nearly all) aspects of the day until the idea of making decisions and evaluating alternatives is understood. Many individuals with autism may never be able to do this mentally (even Temple Grandin, 1992, finds this impossible) but can be helped to make effective choices by using lists, pictures, symbols or even objects of reference. It is important in the latter case to establish first that objects of reference are understood and the making of the choice is not confused with the point of choice.

Teaching More Flexible and Creative Behaviour

The most obvious manifestation of the poverty of imagination and the lack of flexibility in individuals with autism lies in their repetitive and often stereotyped behaviour. We need to try to work out the 'meaning' of that particular behaviour for the individual concerned, before we can do anything effective to alter that behaviour. It is not just a question of effectiveness, either, but also of ethics. As Sinclair (1992) notes, people with autism do not necessarily want to change their behaviour, they may just want to understand ours.

So, a programme to develop more flexible and creative behaviour in individuals with autism would need to have several parallel fronts. There would need to be careful and insightful observation, trying to determine the meaning and function of the existing behaviour for the individual with autism. Then there would need to be further observation and more hypotheses testing to determine which aspects of the more flexible and creative behaviour we would like to develop are an enigma to that person with autism, and furthermore, what functions could he served by the new behaviours that would have meaning for the individual with autism and that would add to that individual's quality of life. The next step is to try to teach the understanding that would overcome the difficulties in seeing the meaning and purpose of the 'more desirable' behaviour. Only after this, would it be productive to try to teach the behavioural forms.

The above statements form the general principles on which to operate. However, there are some exceptions, where there may be a value in teaching behavioural form as a way through to teaching understanding. If it is difficult for us to emphasise the of events in a way that makes them meaningful to the person with autism, as in the sphere of social behaviours for example, then it may be better to use his or her own meanings and attach them to the behaviour that is to be encouraged. If this can be done in such a way that it does not just reinforce particular behaviour patterns, but also makes key aspects of the events salient, then this will also further that individual's understanding and make their behaviour more adaptable in turn.

CONCLUSION

Individuals with autism do not behave in inflexible, repetitive ways because such behaviours as such are part of the biology of autism It is true that some forms of perseverative behaviour do follow from particular aspects of brain damage, but the real difficulty is in being aware of ones own thinking and behaviour and thus having the ability to plan actions, monitor them, adapt them according to their effectiveness in pursuing a particular goal and remember and apply them in new situations.

We are not dealing with wilful, stubborn behaviour but with a core difficulty in having access to and reflecting on one's own thinking. It is seldom a matter of 'motivation' but more that individuals with autism cannot do what we want them to do, and they often cannot even do (or at least plan to do) what they want to do themselves, because they do not understand what is wanted or how to evaluate the situation, including their own behaviour, to see what is required. We need to respect the fact that, as Option (Jordan, 1990) says, they are doing the best they can within their own understanding and the resources available to them.

Some of the ideas in this paper are expounded more fully in JORDAN, R.R. & POWELL, S.D. (1996) Encouraging Flexibility in Adults with Autism, in: H. Morgan (Ed) Adults with Autism Cambridge, Cambridge University Press.

Stuart Powell & Rita Jordan

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